My patient, who was built like a linebacker, was a week out from major heart surgery. He sat in a chair in his ICU room with his head drooped down. The surgery had gone well, and his heart rate, blood pressure and respirations were all normal.
When I asked him how he was doing, he refused to make eye contact and just shrugged his shoulders.
Before surgery his face was full of life and we chatted about his work as a carpenter. But now the nursing staff and doctors hesitated to go into his room, unless it was necessary. “He is so depressed,” a doctor told me.
I recalled when my father had undergone bypass surgery more than a decade ago. After the operation, he, too, had lost all interest in living.
“Your heart is better,” I insisted, trying to shake off his depression.
“I know, but not my mind,” he said.
Postoperative depression is a common syndrome, but one that is under-recognized and under-appreciated by doctors and patients’ families. One 2001 study found that 20 percent of patients experienced major depression after bypass surgery. The causes are many; feelings of mortality, of loss or of vulnerability may surface and impede recovery. “I ain’t depressed,” my patient insisted. “I’m just thinking about stuff.”
Unfortunately, those with postoperative depression have a higher complication rate. In the study, nearly 30 percent of the patients who were depressed had a major cardiac event, such as a heart attack, in the following year compared with 10 percent of patients who did not suffer from depression. In other studies, depression doubled the risk of death or heart-related illness among patients with underlying heart disease.
So on that Friday morning, standing in my patient’s room, I tried to engage him in a conversation about something other than his illness. “Do you like football?” I asked.
“Who is you favorite team?”
Another shoulder shrug.
“Well, I grew up in Boston and New England Patriots are my favorite,” he said.
Knowing that they had a winning 9-3 record, I said, “This weekend I want you to watch the game and root for the Patriots.”
Raising his head, he said, “No. I can’t do that, I can’t stand (quarterback) Tom Brady.”
“OK, then who are you going to root for?”
“Indianapolis Colts. ”
“They haven’t won a game,” I said.
“And they likely won’t win one this season,” my patient replied. He seemed determined to be glum. I let the conversation stand.
Too often, we on the medical team fail to treat post-surgical depression. But there are many good treatments that may help. Exercise can strengthen the heart and improve body image, self-esteem, mood and quality of life. Exercise also allows the body to release “feel-good” brain chemicals, such as endorphins. The physical therapist was scheduled to start walking with my patient, and we hoped this would help both his heart and his mood.
Social support can also improve mood and increase survival from heart disease. This patient was fortunate to have his wife of many years seated by his bedside.
Short-term antidepressant medicines are helpful, and we had called in a psychiatrist.
On Monday, I asked my patient about the games. The Patriots had won and the Colts had lost. “Yeah, you knew that was going to happen,” he said, this time with a smile.
Who knows? Maybe we can add watching football games to our list of remedies for post-surgical depression.