The value placed on open communication is an ideology in U.S. American discourse. It has particular urgency among couples coping with a cardiac event, who are often advised that open communication can enhance recovery, bolster individual coping, and sustain relational satisfaction. Our interpretive analysis of 41 interviews with cardiac patients and partners explored the connection between a widespread ideology of openness and varied ways of enacting it that included apparently contradictory practices. Our findings raise questions about interventions designed to change couples' communication, expand concepts and theories of open communication, and suggest developments in the ideology of openness.