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Tenoretic (Atenolol, Chlorthalidone)

Trying to explain a subjective experience is a difficult thing— particularly when the event that triggers it may be very dramatic. There is so much variation that we can only highlight some common characteristics. Perhaps the clearest way to present this is through a series of figures. Simple! However, we must keep in mind that the way each of us processes events—that is, the way each of us experiences the happenings of the world—is unique. Not only are the details of the response subtly or greatly different between people, but the intensity of response varies from ultracool to very dramatic, with most of us in the middle, as well as the timing of response, from immediate to delayed.
The arrow (or event) has now penetrated the circle. It has crossed the boundary, gone into our consciousness; this is what we call the impact of the event. Now, although there is a wide variation in people’s emotional responses, there are common features. Generally, our response is one of alarm, but on the surface, it is dulled or muted even though, below the surface, an emotional upheaval may be taking place. The term coined by the crisis theorists for this phenomenon—shock—has a dramatic connotation.
The outward calmness shown by most patients can be surprising both to them and to their loved ones. Although this self-protective mechanism belies the suppressed emotions under the surface, it helps deal with the surprise and fear of the event itself. A potential problem can be that loved ones fail to understand that “things may not be okay even though everything looks okay.”
The shock response diverts attention from what is actually going on—a potentially serious cardiac event. While the body is being worked on, so to speak, the mind shuts down. This is similar to being given a local anesthetic; say, for example when we are receiving stitches for a deep cut. We are protected from feeling what is being done to us. On a psychological level, a type of numbing is occurring.
The shock response corresponds to the time surrounding the event; this means the onset, the lead-up and the admission to a hospital and, often, the early discharge period. One of the reasons for shock to persist on arrival home may have something to do with the current practice of releasing patients with relatively uncomplicated cardiac events after only a few days of hospitalization.
So, the duration for the shock response is relatively short, depending on what has happened and how we process this event. It may last only hours, and it is usually over in a matter of days. For some, though, it can go on for weeks. In such cases, the patient has not only been distressed by the event, but has experienced something more. This “something more” is what we call a post-traumatic response. In these cases, there is often an extra component to the story, as the case history on the next page illustrates. However, for most patients, the shock response is a brief one, very brief compared to the rest of the journey of recovery.
It is not uncommon for repeated cardiac events to affect the shock response. In group sessions at the rehabilitation program, there may be a person who volunteers that he cannot relate to the various experiences in the journey to recovery. At the same time, there will be someone else who identifies easily with these phases. This second person will have coped famously with a first episode, but a second episode will intensify his or her identification with the experiences we discuss. There is not necessarily anything abnormal about the response of the first individual. Nobody prescribes how you must feel.
Another possibility is that the shock is pronounced the first time, especially when the event comes out of the blue, as it so often does, but is diminished in a repeat episode. Predicting how the human mind will respond is a hazardous activity.
Sometimes the shock can be unusually prolonged. Dr Baker once saw a woman who, a few weeks back, had had a heart attack, but her recovery had been unusually slow and the cardiologist wanted an opinion. Initially, not much information could be obtained that would unlock the problem. After probing the question of her fatigue for signs of possible depression, suddenly there was an outpouring of anger! The story emerged that this woman was very unhappy with her husband, to whom she had been married for twenty-five years. While he was apparently committed to staying in the marriage, he was unable to show love and express caring for her. She had complained to him about this, which had made the situation worse. (Harriet Lerner elegantly describes this common “pursuer-distancer” interaction in her book The Dance of Anger.)
When this woman’s chest pain started, she had asked her husband to take her to the hospital, but he had refused, implying that there was no basis to her complaints. Her adult children were finally contacted and took her to the emergency room, and it was discovered that the delay had worsened her condition. This left her in an extended shock phase, which was finally resolved with the emergence of anger toward her spouse. This experience amounted to a traumatic one for this woman, and she therefore had features of a post-traumatic response. Most patients do not have such a pronounced response to a cardiac event, the shock usually lasting, as mentioned, hours or days

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