by Carol Sipes, M.Ed.

When Michael Crayton, RN, CCRN, first started working as a cardiac rehabilitation specialist at Methodist Charlton Medical Center in Dallas, he was deeply affected by the impact of coronary artery disease on the patients he saw every day.

So much so that he asked a cardiologist to perform a catheterization to determine if he had heart disease. The doctor asked what he would do differently if he knew he had blockages in his arteries. Crayton replied that he would change his eating habits and start running every day. “Exactly,” said the cardiologist. “Everybody should treat themselves as if they have heart disease.”

Good advice to be sure, but like most of us who are only motivated to make lifestyle changes when they become critical, Crayton did not dramatically alter his personal habits at that time. It wasn’t until several years later that he received the catalyst he needed. In 2007 while attending a meeting at the hospital, he suddenly experienced severe chest pain.

“I got this pain that was like a Ford F-150 truck bumper on my chest, just unbearable,” says Crayton. He tried to relieve the discomfort with nitroglycerin but it didn’t help. Even though as a cardiac rehab nurse he was acutely aware of heart attack symptoms, he found himself behaving like a typical patient.

“I was in such denial,” he says. “You just don't want to believe that you're having a heart attack.” But eventually he had to admit to his coworkers that he was in trouble. Twenty-five minutes later he was wheeled into the cardiac catheterization lab, where he underwent angioplasty and had three stents implanted.

Going through rehab

Like most of the patients he’d seen over the years, Crayton never expected to have a heart attack. He was in his mid-fifties at the time without any particularly strong risk factors. Now he found himself in the unique position of being a cardiac rehab professional who is asked to attend his own program as a patient.

“There were no shortcuts for me,” he says.

As a result of going through the program, he developed a newfound empathy with his patients. For example, previously he’d noticed that they often resisted coming to rehab until they’d gotten the okay from their doctor. “I’m not going to do anything until I see my heart doctor,” they would tell him.

“I got this pain that was like a Ford F-150 truck bumper on my chest, just unbearable…I was in such denial. You just don't want to believe that you're having a heart attack.”

“I never did really understand it until I was a patient and my colleagues wanted me to come to rehab,” recalls Crayton. “I got teary-eyed and I said, ‘I'm not going to do anything until I see my heart doctor.’”

Only then did he fully grasp why patients need reassurance that participating in rehab is safe. As he experienced it first hand, he also came to appreciate the quality of his hospital’s rehabilitation program.

The program consists of 36 sessions over 12 weeks and combines exercise with education. After each exercise period, the participants watch informative videos on topics such as cholesterol, high blood pressure, stress, weight loss, or the emotional aspects of heart disease.

“As they cool down, they go to the education room and watch the video. It’s really great,” he says. “We have all the highlights of the video on a piece of paper and we run that by them again and answer any questions they have.”

The rehab program also provides an excellent opportunity to reinforce diabetes education, since at times as many as 50% of the participants have the condition. Blood glucose is monitored both before and after each exercise session, giving patients immediate feedback about the effects of diet and exercise on their glucose control. As a result, many patients who begin the program with elevated blood glucose values are gradually able to improve them.

“When they come in, their blood glucose reading might be something like 275 and they get embarrassed about it,” Crayton says. “The next time they come in, they’ve eaten a more simplified breakfast, something we’ve shown them in a video.” Eventually, their blood glucose readings begin to drop.

“They see that it really does work if you monitor your diet,” he says.

Making changes

After the heart attack, Crayton’s life changed both personally and professionally. In his personal life, he finally started following the advice he’d been giving to his patients for years.

“Since that time, I've been great,” he says. “I've lost 35 pounds; I've tried to do everything right. I've cut back on my saturated fats and chocolate and everything. I exercise.”

Crayton has three dogs that help him stick with his exercise program. “They meet me at the door with their leashes and then I have to take them for a walk, no matter rain, sleet, or snow. We go for 45 minutes every day and I've only missed three days since my heart attack.”

Reaping the benefits of role reversal

His professional life has also changed for the better. When he first went back to work after the heart attack, he didn’t have any anxiety about returning. “I had missed not being here. A lot of the weight had been lifted and I see everything from a better perspective now.”

His patients have benefited from that new perspective as well. Crayton now has a tremendous amount of credibility with his patients. When they’re resistant to the idea of rehab and insist that Crayton doesn’t understand their pain, he tells them “Yes I do. I had a heart attack and I was in the same room as you about a year and a half ago.”

“After the heart attack, Crayton’s life changed both personally and professionally. In his personal life, he finally started following the advice he’d been giving to his patients for years…Crayton now has a tremendous amount of credibility with his patients.”

He marvels at how that admission transforms their attitude. “They immediately change their whole demeanor and they'll say, 'Really? What do you do now to not have a heart attack?’  Instead of being obstinate about the whole thing, they turn completely and say ‘Tell me about what I can do.’”

Of course, not all cardiac rehab professionals can gain credibility by having a heart attack – nor would they want to. But they can motivate patients in other ways. Crayton suggests that educators tell stories about relatives or friends who have been through similar experiences, so the patient knows that the educator can relate to their situation in a personal way.

For example, Crayton often teaches smoking cessation. When he admits that he’s never smoked, a patient sometimes tells him that he doesn’t know a thing about quitting smoking. He’ll then say, “Well, both my parents died of smoking cigarettes. My dad died before he was 50 and my mother died of lung cancer before she got her first Social Security check.”

The patient will then understand that even though Crayton isn’t a smoker, he has firsthand experience of the devastating effects of cigarettes and that increases their willingness to listen.

Becoming a role model

He’s also become a role model to his patients. When he talks about dietary changes and they ask whether he eats that way, he invites them to take a look at his lunch tray in the cafeteria.

“I’m never ashamed to show them my tray. It’s two vegetables and a salad usually,” he says. “I’m trying to live the way I tell people to live. It validates what I’m trying to teach people.”

“I’m never ashamed to show them my tray. It’s two vegetables and a salad usually. I’m trying to live the way I tell people to live. It validates what I’m trying to teach people.”

He recognizes that most people don’t worry about the consequences of their habits until it’s too late. “They slip into a false sense of security because their health has always been good,” he says. “’I'll start exercising tomorrow. Or, I'll eat this chocolate cake, or 3 dozen eggs, or sausage and biscuits and gravy, and Monday I'll start.’ But Monday never comes until you have a heart attack.”

When Crayton talks to a patient who’s had a cardiac event, he tells them their “get out of jail free card” is gone and they need to get serious about exercising and improving their diet. Then he tells his story and it helps them accept the changes they need to implement.

“I’m walking the walk and talking the talk,” he says.

Facing the future

In recent years, Crayton has noticed a larger percentage of younger patients entering the cardiac rehab program. On the bright side, he finds that many of the younger patients are more accepting of change. They also tend to be more computer literate, which means that the internet may start to play a greater role in the rehab process.

Speculating about the possibility of hospitals making patient education videos available on the web for patients and their families, he says, “We live in an information society and people want more information. If they have the ability to watch at home, you’re going to get a high response.”

Meanwhile, he is simply happy to be helping patients with the benefit of his unique perspective. “I take every day as a blessing,” he says. “I don’t take anything for granted. My outlook on life has totally changed.”

Words that we would all do well to keep in mind, whatever our health happens to be.