Tears fell down their cheeks. There was a long pause. “My heart broke and I’m just having trouble processing that,” the patient said. They’d been hospitalized for a heart attack several months earlier. I was seeing them at a primary care visit long after discharge. On paper they were recovering well, but they didn’t feel that way. They felt broken.

This interaction resurfaces in my mind periodically because it shows a side of illness that isn’t often seen in the hospital (where I’ve spent most of my time training). This patient had experienced an acute illness (heart injury). They had recovered their functionality. By medical definitions, they were a success story. Yet, they were miserable. How could that be?

In medicine we organize diseases into buckets with specific treatments and endpoints related to the organs affected by each disease. For example, this patient had a disease of the heart which might include endpoints like their ability to tolerate exercise or their heart rhythm. These endpoints are a simplicity required to synthesize something as complex as the human organism. However, as this story shows, looking at only specific endpoints can lead to missing things related to the illness that aren’t listed as clear endpoints to track. In the case of this patient, the heart is connected to the brain which is an organ of personality, mood, and feelings (among other things). While the functionality of this patient’s heart met all medical endpoints, their mood/feelings were severely affected by the experience of surviving a heart injury.

This patient’s experience reminds me that the diagnoses we make and interventions we do have lasting impacts on patients. Remembering this motivates me to provide information and support that I think will empower patients in their processing of what happened to them while they were hospitalized. I often wonder what conversations this heartbroken patient had with their care team while they were in the hospital recovering from their heart attack. Was there anything that their care team could have done differently to lessen the patient’s distress after discharge or was the patient’s feeling of heartbrokenness inevitable? I’ll never know the answer.

With this patient’s experience in mind, I try to ask myself if there is anything missing or left unclear before I discharge a patient. Healthcare is far from perfect (it’s quite broken actually) yet, even in a broken system, we can choose to communicate and help as best we can.