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Craig Morgan (center left) with some members of his care team: (left to right) Chelsea Apland, a Friendship Ark Homes coordinator; Gina Smith, RN; Carrie Adams, BSN, RN, clinical supervisor for cardiac rehab, and Andy Nichols, a Friendship Ark Homes supervisor.

Something was clearly wrong with Craig Morgan. Those closest to him could sense it. He wasn’t himself. He seemed tired and confused.

Craig, unfortunately, couldn’t really explain what he was going through. A resident of Friendship Ark Homes (FAH) in Ames, Craig is an adult with intellectual disabilities. While his communication skills are limited, he’s an endearing guy, agreeable almost to a fault. His response to any question is often, “Yeah,” accompanied by a big smile.

His well-being depends on those who know him best being able to read his moods and actions, and, by doing so, help others provide Craig what he needs.

“Craig is eager to please. He’ll always say ‘yes’ and can feign understanding whether he has it or not,” says Andy Nichols, a supervisor at FAH who has known Craig for years. “That’s a big part of working with Craig in the community – helping him understand and helping others understand him.” This was vitally important when Craig was brought to McFarland Clinic and then to Mary Greeley in early August.

“His spirits were fine,” says Nichols. “He was a little more confused than normal and over the weekend had become very weak and tired. We thought he might have pneumonia.”

From McFarland, Craig was sent to Mary Greeley’s emergency department for immediate tests. It wasn’t pneumonia. Craig had experienced a heart attack.

Diagnosis and Big Decisions

Craig was admitted to Mary Greeley’s intensive cardiac care unit (ICCU). The next day, he underwent an angiogram performed at Mary Greeley’s cardiac catheterization lab by Iowa Heart
cardiologist Dr. Ravinder Kumar.

Kumar discovered that all three of Craig’s major heart vessels were seriously blocked. He had suffered what’s called a NSTEMI (Non-ST elevation myocardial infarction). It is sometimes called a silent heart attack. Conversely, a STEMI (ST-elevation myocardial infarction) is an immediate emergency type of heart attack.

Heart bypass surgery was considered the best option, but Craig’s family and FAH caregivers felt that he wouldn’t be able to understand the recovery and rehabilitation requirements of such invasive surgery. Doing the surgery was as potentially dangerous for Craig as putting him through it.

A decision was made to monitor Craig’s condition, to treat it medically and not surgically. That decision was promptly reconsidered after Kumar visited Craig the next day in the ICCU.

“He was miserable,” says Kumar. “Just sitting up on the side of the bed would make him exhausted. There’s no way we wanted him going home feeling like this.”

Kumar spoke to a colleague, and Craig was transferred to Des Moines for a high-risk stenting procedure to open his blocked arteries, with the help of an Impella heart pump during the procedure. (Mary Greeley’s cardiac cath lab can perform stent procedures but does not have the Impella device.)

Rehab Challenge

Carrie Adams, BSN, RN, clinical supervisor of Mary Greeley’s cardiac rehabilitation center, was surprised when she ran into her old high school friend Andy Nichols in the halls of the hospital that day in August.

“One of my guys had a heart attack,” Nichols told Adams.

A few weeks later, Adams met that guy. It was Craig, who had been referred to Cardiac Rehab after his surgery. In these cases, a patient is generally referred to the rehab service closest to their home.

When Adams received the referral details and realized who the patient was, she knew to call Andy. That local connection was important because Adams and Nichols had an instant trust. Their conversation was the beginning of a coordinated effort to help Craig.

It is not unusual for the cardiac rehab staff to make accommodations for patients, but because of his cognitive abilities, Craig posed a new kind of challenge.

“It’s pretty individual for everyone,” says Adams of the Cardiac Rehab program. “We’ve had competitive athletes and people who have never stepped on exercise equipment in their lives. You’ve got to make it work for all of them.”

Making it work for Craig was personally important to Adams, who has a close relationship with a nephew who has special needs.

Cardiac Rehab at Mary Greeley usually involves small classes of people going through a prescribed set of exercises while wearing heart monitors. Rehab can last several weeks. Could Craig handle this? Should he receive treatment on a one-on-one basis, or be part of a regular group? Would being in a group be too busy for him, too much stimulation?
Nichols assured Adams that Craig could handle it all.

“The goal is to progress the exercise without making it too difficult,” says Adams. “Craig does a lot of active outings and we wanted to make sure he could get back to doing those things without Friendship Ark staff having to constantly worry that they were pushing him too hard.”

Recovery Plan

It was decided that Craig would benefit from being part of a regular rehab class. A slightly shortened 12-session course of treatment was planned. Because he had had falls at home, it was also decided to limit Craig to seated equipment. FAH coordinators Cassie Shivers and Chelsea Apland attended classes with Craig. They provided encouragement and helped cardiac rehab staff work with Craig.

“We would ask him ‘Are you OK?’ ‘Is this too hard?’ ‘Is this really easy?’ ‘Does your chest hurt?’ ‘Is it hard to breathe?’ Yes or no questions for the most part,” Adams says. “We couldn’t have done it without his helpers.This really was a team effort, with our staff working closely with staff from Friendship Ark to make sure Craig got what he needed.”

Friendship Ark staff echoed those sentiments.

“In the 10 years I’ve been with Friendship Ark and working with Craig, this was the most exemplary health care experience he’s had,” says Nichols. “The cardiac rehab staff
paid very close attention to him and got more out of him than any medical professional ever has since I’ve known him.”

In October, Craig finished his therapy. “We wanted him to feel like part of the group, and he did,” says Adams. “Other patients would ask him how he was doing and they cheered when he graduated. I loved seeing that. It was really sweet.”

Craig is back home at Friendship Ark, keeping busy with regular outings, or crocheting and jigsaw puzzles. Did he enjoy his cardiac rehab experience? You already know that answer. It’s a big smile and, “Yeah.”

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