Help me get my dad back

April 17, 2009 7:33 PM

My normally confident/upbeat dad recently went through a major surgery and has come out with his morale/confidence destroyed. Help me talk to him.

My dad is one of the most amazing people I know. He has always been kind and considerate to everyone, a great husband to my mother, a wonderful dad to me and my sister.

He endured exceptional hardship early in his life (lost his father as a teenager), but still managed to support his disabled mom and put himself through college/graduate school. He had stood by me and my sister through every crisis we've had (and continue to have) and we couldn't really have asked for more. We are in our 30s and he is in his mid 60s.

Dad was also very disciplined in almost all areas of his life, but particularly with his diet and exercise. Last month, what started as a routine check up with his cardiologist, led to more tests, resulting last week in a bypass surgery. This was all very unexpected. The operation seems to have worked and (physically) he is on the road to recovery. But mentally he is not.

He is no longer the same confident person he used to be. He seems defeated and has lost interest in everything. I have never seen him more vulnerable in my entire life. First, he did not anticipate how difficult the surgery would be. When he went under, he was pretty sure that he wouldn't make it. When the nurse in post-op tried to wake him, he thought he was already in a coma and was just hearing voices inside his head. I don't know what to make of this. I keep telling my family these kinds of feeling are normal for someone who has never had surgery (dad particularly since I can't ever recall him being sick) and he will be able to process these emotions better after he regains his strength (it has been 12 days since the surgery).

Second, he feels like he's been cheated. To him all that diet/exercise made absolutely no difference at all. He has now decided that he is not going to care about his finances, investments, properties or anything else in his life. "What's the point, it's all a crap shoot anyway". This coming from him is a shock to me. I can understand that surgery this big (especially for him since he has never been under full anesthesia ever), can be hard to get over.

What can I do to reassure him that this is not the time to throw everything out the window? Are these feelings normal for someone just out of surgery? I want to be the person he was to us, and help him but I don't know how.

I appreciate any thoughts you have. thanks.

posted by anonymous to human relations (15 comments total)

There have been some studies (sorry, no cite) that indicate that heart surgery in particular can lead to clinical depression. Can you and he speak to his primary doctor about this?
posted by thebrokedown at 7:43 PM on April 17

Ok, here's an interesting link: Cognitive Behavioral Therapy for Post Heart Surgery Depression. I just Googled "heart surgery depression" and came up with oodles of stuff. Good luck, your dad sounds like a great guy.
posted by thebrokedown at 7:45 PM on April 17

Definitely talk to your father's physicians about this. It has been known for some time that cardiopulmonary bypass can lead to a number of changes in mental function and behavior. Here is a 2001 New England Journal of Medicine article on the subject. If you want a lot more information, here is a previous AskMe. This is in addition to the fact that serious illness in and of itself can cause depression and personality changes, and of course there may be something else entirely going on. I have known a number of people who have undergone bypass surgery, and almost all of them (including two heart surgeons) returned to their normal routines and jobs afterward, so I hope the changes in your father are only temporary as well.
posted by TedW at 7:51 PM on April 17

You might try this (although he's probably heard it several times already): the diet and exercise did make a difference. He's not dead!
posted by amtho at 7:57 PM on April 17

Say something like this to him:

"Dad, I know it's hard now, maybe harder than you ever had it before, but you're still here and we still need you. You may feel weak, but you're not, because we here for you and you've made us strong, stronger than I ever thought possible, enough to help the strongest man I know and that's you. It may not be easy, it'll take discipline and work, but you've spent your whole life learning how to do those things, so you'll be able to do this."

Sounds like your dad lived his life a certain way and by certain rules and life has smashed all that to hell. He personal roadmap on how to live has been torn up and thrown aside and yeah, it probably all looks pointless right now. That sounds like a completely understandable reaction. Be there for him and remember what he taught you about being kind and considerate as you help him.
posted by Brandon Blatcher at 8:04 PM on April 17 [2 favorites]

My family went through something very similar involving an emotional reaction to a difficult surgery with a person at a similar age. I think the psychological effects of the major physical trauma of serious surgery is underestimated. For a person who not much previously basically felt healthy to suddenly be considerably debilitated is a shocking transition.

But I also think the 60s are prime time to have a life-altering collision with the real apprehension of mortality. Something, more or less serious but serious enough, will happen that reminds you you aren't the exception to any rule, that the next stop is seventy and seventy is old and the only destination of old is dead. It is ugly and it is not without basis. We're all headed in the same direction and most 60 year olds are a whole lot closer to it than most 30 year olds.

It was in a sense easier for us because the person in question had some history of anxiety and depression so it wasn't a complete shock. My first reaction was "12 days? Give it twelve months" but I can see how the radical change in perspective could be very unsettling. I still think you're very early to be worried that this is substantially more than just an immediate emotional reaction to the roughest patch in the recovery. I think you need to be present, loving, positive but let your dad talk out his negative feelings. My loved one really bottled them up I think to their substantial detriment.

Give him more time to recover but if the change in attitude doesn't seem to start catching up with his physical recovery it might get to trying to get professional help engaged. I don't want to be alarming but I think it is fair to offer the context of a worse extent of this sort of reaction: my loved one was having suicidal thoughts and not telling anyone about them, and eventually needed to get help and medication. Nevertheless they did get past that low point. But right now I really think the best you can do is to keep reminding your dad that you're really glad he is still with you and be optimistic that he will eventually come to the same conclusion.

At some point you may want to directly engage some of the irrationality in his thinking (his lifetime of diet and exercise weren't wasted, there's a good chance they saved his life, for example - or the fact that while life might be a gamble, there are always stupider and smarter ways to approach any gamble) but right now I think you need to accept and help your family accept that a couple weeks is nothing in terms of recovery from really major surgery. You need to think in terms of several months and be patient. Given his lifelong personality my bet is that he will snap back eventually.
posted by nanojath at 8:09 PM on April 17

I have not had heart surgery, but I have had two horrible, sudden lung surgeries. So, I feel like I have some first hand knowledge of what your father is going through. I am much younger than your father though (still under 30).

My advice is to just listen, listen, listen to what he has to say for a while. Don't try to guide his recovery just yet. There is something unspeakably invasive and sinister about thoracic and brain surgeries. Whether we like it or not, your father is privy to some real heavy information. Life is a crap shoot. Does it mean we shouldn't try? No, of course not, but when your illusion of power and safety have been destroyed, and your only body has malfunctioned and your vital organs have been fucked with, it's not so easy to see the point in it all. It's a natural reaction to the whole experience.

This happened to your father last month. It took me, an otherwise healthy young man, 6 whole months to feel anywhere near normal. He is in another phase of life than me, as well. So, I expect he is likely to grapple with The Looming End a bit more than me.

Your father is in information overload. Give it time. Just listen to him. Be there as he cries it out. After another month or two, ask what you should do based on how things have progressed.

Your father will recover. He will forget the pain and shock he is now convinced he will never, ever forget. With that being said, it's very possible that he will never be the same. If that's the case, get to know your father again. He's likely a bit wiser than he was in February. He just can't process it yet.
posted by milarepa at 8:20 PM on April 17 [1 favorite]

Depression following cardiac surgery is no uncommon.

It's only been 12 days. You father will make it.

You can help him by making a lot of positive statements about his life like the ones you mentioned in the post. Plus, you can help him develop the cognitive tools he needs to recover by saying things like: "It must be tough now, but you've done incredible things. You will get through this because you are going to try hard."
posted by KokuRyu at 8:25 PM on April 17

No solutions, but just to support the experience: I had an angiogram just a few weeks ago. I'm in my early 40's and this was all a huge surprise. It turns out that I'm fine and no bypass or any other kinds of procedures are needed, but just being in the hospital and being prepped for the angiogram was very emotionally difficult. When I got home I found myself feeling depressed for a few days, not even sure why since I got good news at the end of it all. But there was something about the whole process that reinforced my mortality and my aging. It drove something home to me that I had been able to deny up until then. With your dad, it's all the more real and terrifying.

More than likely the best medicine will be time - but many other answers in this thread are good too.
posted by crapples at 8:25 PM on April 17

Your dad's surgery circumstances sound very similar to my own father's. He was late 50s. 30-year vegetarian. Runner. Fit....went in for routine tests and left a week later with exciting new scars and a quadruple bypass. And it just came down to genetics for him. The doctors all agreed, it wasn't his diet or lifestyle. But here's where he was really really lucky (and it sounds like your dad is as well)..he did NOT have a heart attack. And today, six years post-op, he's on no medication (with doctor approval) and just really healthy and happy.

Depending on his experience in the hospital, and the drugs, and his own sense of mortality, your dad is fully justified in feeling funky. He just had MAJOR surgery and the medication he's on to control the pain of having his chest literally sawed open may be interacting with his own brain chemicals weirdly. Other people have posted good links showing a strong correlation between heart surgery and depression. What I can say is that while the recovery for my own father was hard while he was in pain, once that part was over and he started being able to get back to his old routines, he quickly got back to his old self.

If you haven't already, now may be the time to have a heart-to-heart (ugh), and TELL him how amazing he is and how much you love him and just remind him how LUCKY it is that the doctors caught the blockages in his heart before it did him any permanent damage.

Good luck!
posted by ilikecookies at 8:38 PM on April 17

I answered a related question a while ago here. The exercise routine definitely helped. I felt quite a lot like your Dad after my surgery, particularly the 'feeling cheated' angle. All I can offer is that it does improve, for me as I was getting back into my old routines and realising that my whole world hadn't, in fact, ended the day I had the surgery. The operation is extremely physically traumatic, I think it's inevitable to have some mental repercussions too. Still being medicated for the depression, but it gets better, honest. All the best.
posted by punilux at 3:59 AM on April 18

It sounds like your father has been a pillar of strength for you and your family his whole life. Now it's you guys' turn.

Even though your father should, with time and healing and medical and psychological help, bounce back from this nadir of helpless hopelessness, in the long run the second law of thermodynamics gets us all. You cannot step in the same river twice. It is very likely that your father, who has so much of his identity tied up in doing the right thing and taking care of everyone, will continue to struggle with the implications of his body's ongoing betrayal.

Instead of trying to get your dad back, try to help him get better. Let him know how grateful you and your sister are for everything he did to make you the strong, wise, capable people you are today, and how glad you are to be able to return the favor now that he needs you.
posted by mayhap at 8:15 AM on April 18

As others have said, depression is a very common sequela to heart surgery. I'm surprised the cardiologist didn't mention it.

It's also possible that your father is experiencing depression as a side effect from his medication. He needs to talk to the doctor about that, and set up some appointments with a counselor. (Again, I'm surprised the cardiologist didn't mention this and that his or her staff didn't offer to facilitate this--maybe my dad's cardiologists are more awesome than I thought!)

When the nurse in post-op tried to wake him, he thought he was already in a coma and was just hearing voices inside his head. I don't know what to make of this.

This kind of delusion is not uncommon after general anesthesia. It's just neurological static.
posted by Sidhedevil at 9:01 AM on April 18

I doubt your father's morale and confidence are destroyed; just wounded. Heart surgery is incredibly violating and as others have noted - depression, even despair, are not uncommon responses. Also as others have noted if he hadn't exercised and eaten well he'd be dead rather than in recovery.

I would suggest that what he is experiencing is grief and that he'll move through it an be fine (maybe even better than before) on the other side. His response at this point is normal: he didn't have time to prepare and he hasn't yet had time to recover - he's traumatized.

Often other people's response to someone's grief is to get very anxious and want the person to be back to who they were and attempt to get them back to where they were through logical arguments. This response is almost always unhelpful to the person who is suffering. In my opinion, your father (and your family) is not going to go back to normal but rather will find a new normal.

How you frame the situation will impact both you and him. I would frame it as a temporary situation that will pass rather than a true change in his core self. I wrote this a while ago about grief, I don't know if it will help...

Never presume a time-table for the process. Grief does not follow a calendar. It does not move in a straight line. It takes as long as it takes. Be patient. Commit to the journey, no matter how far or how long. Slowly, maybe, the good days start to outnumber the bad, but sometimes it's when things start to get better that they suddenly get worse.

Take a breath, center your heart and go deep. Don't try to pull the person you love to the surface; instead go down with them into the dark. Maybe you can't go all the way, but you can sit quietly waiting at the entrance to the cave. And while you wait, remember that grief in them may bring up grief in you. This may make you fear them or their feelings. If that happens, it's fine to say that you're scared or overwhelmed. They are probably scared and overwhelmed too. But if they're going to get better they have to go all the way down. They have to feel the grip of the loss in order to be released. Please let them go. Please don't ask them to come back before they are ready. Wait quietly nearby; your presence will be a comfort when they emerge from the darkness.
posted by orsonet at 10:18 AM on April 18 [1 favorite]

nthing talking to the doctor. there is strong evidence that ICU stays can cause neurological issues and depression. heart surgery is a biggie.
posted by thinkingwoman at 1:20 PM on April 18