Emotional Issues surrounding Surgery

There are a number of emotional situations that can arise before, during and after surgery. We will talk about ways of coping with these situations in Preparing Emotionally for Surgery.

Before the Operation

Making the Decision: Should I choose the surgical option or try more conservative methods? Should I go for a second opinion? Perhaps I should have preventative surgery or maybe I should wait until the next pain attack? Should I listen to this doctor or that one? These, and many other questions are likely to arise before you make a decision whether or not to operate. The decision and the responsibility are often in the patient’s hands (when the surgery is elective of course. Emergency surgery is a different story.) It is not easy to choose to undergo an operation with all the fears and risks involved.

Choosing the “Right” Surgeon and Hospital: This kind of ‘logistical’ decision allows the patient to regain some element of control. Gathering information about the various surgeons available allows you to learn more about the issues and to arrive with a lot more confidence for your operation. “To feel you’re in safe hands” takes on greater significance when you give the operating surgeon full control over your body.

Lack of Control: A very common feeling among patients who feel their body is betraying them because they need surgical intervention. In particular, those who “take good care of their health” (diet, work out, healthy lifestyle, etc.) feel strongly out of control of their physical situation.

Anxiety: Fear of surgery is an emotional situation in which the patient is so scared that he or she begins displaying symptoms such as faster heartbeats, sweating, nausea or chest pressure. It can manifest itself as over-worrying or strong panic attacks. Anxiety could arise from the results of the operation (what will Pathology reveal?), the ramifications (amputation, damage to one’s self-image, chemotherapy, etc.), the pain afterwards, lack of control during anesthesia, horror stories about similar cases and more. Anxiety leads to annoying cognitive processes that can affect sleep and consequently create a vicious circle – fatigue, more pain, greater stress, and greater anxiety.

Pain: Some diseases cause pain that affects every aspect of the patient’s life. A person in pain will feel anger, sadness and helplessness. They won’t be able to think clearly, make decisions or explain themselves. A person in pain does not function properly, or at all. They will get into bed, seclude themselves, but they won’t be able to sleep.

Guilt: We will discuss this issue at greater length in the context of adolescents, but adults too are liable to feel guilty around surgery – about things they did that damaged their health (smoking, drinking, drunken driving, etc.), or things they didn’t do that could have prevented deterioration (drugs, diet, working out, etc.)

Loneliness: Illness or pain can cause a person to feel isolated, misunderstood, abnormal. Before surgery, our need for a supportive ‘safety net’ grows. Preparing for hospitalization also demands enlistment. Sometimes patients have a wonderful support network which they feel is insufficient and sometimes they don’t. In both situations the patient could still feel alone.

Support: With many patients, the time before the operation and hospitalization is somewhat euphoric, when they feel enveloped by love and help. Family and friends come together to fight the ‘crisis’ and this kind of support is generally considered a secondary benefit of the surgery.

Fears: As the unknown approaches, our imagination becomes more active and allows room for fears to develop. The most common pre-operation fears are connected to sedation, waking up in pain, scars, complications and even death. Despite an extremely low mortality rate during operations, thoughts of death do cross the patient’s mind and they are worth paying attention to, because they do not help at all. The proper response can help prevent these and other unfounded fears from becoming stronger.

Dreams: Dreams allow a person to express fears that cannot find conscious expression, and so the pre-op period could be full of dreams and sudden awaking at night. A dream is another way in which our souls express distress and fear.

Comparing Previous Operations: An ‘experienced’ patient may sometimes compare the current surgery to his or her previous operations. If the earlier surgery was successful and left the patient with a positive experience, the comparison is likely to be beneficial. But if the memory is negative, perhaps even traumatic, any comparison is likely to increase anxiety in advance of the impending operation. Therefore comparisons are problematic and not reliable and the patient should remember that what was has passed and will not necessarily happen again.

Hope: The most important word before an operation! As we have seen from the definition of the word surgery, the aim is to improve the patient’s medical state. Patients come for an operation so they can improve an existing situation, whether painful or not. So the word hope carries great significance, because from here on the situation is only going to improve (despite the fact there may be difficulties along the way, hope shows progress is being made!)

Curiosity: Certain patients manage to arouse their curiosity, which allows them to enter into the surgical process with a critical, confident approach, often accompanied by humor (mostly black but still humor), which together help them cope effectively with worries and fears.

Hospitalization and Surgery

Anxiety: A strong emotion accompanied by physical signs such as faster pulse, breathing difficulties, pressure in the chest and more, expressing fear of the procedure. Most patients will experience some level of fear before surgery. Various studies, as well as our own clinical experience, show the effectiveness of reducing anxiety levels before surgery, both in coping with the operation and recovery afterwards.

The Unknown: A new place, another neighbor and family in the bed next to yours… all the questions you had before the operation now become immediate (what are the nurses like here? Are the rooms clean?)

Exposure and Privacy: The hospital gown you tie with a thread, communal showers and bathrooms, conversations on sensitive and intimate matters with only a curtain separating you from the next bed… for some patients these issues are very trying and distressing. However, in most cases, patients manage to ‘disconnect’ from their surroundings and create their own private space within the curtains.

De-Personalization: When patients arrive in the department, a CEO, cleaner, taxi driver or bank clerk all receive the same gown, all wear the same white band and all wait to be told what to do. This can be a difficult and sometimes humiliating feeling for some people.

Sedation: An issue that troubles many patients, both from an emotional perspective (lack of control, “They’re going to do what they like with me,” helplessness), and a practical one (“Will it really not hurt at all?”)

Relief: Some patients already begin to feel more at ease as soon as they walk into the hospital. They say things are now out of their hands, despite the fears. And that releases them from responsibility which helps them feel a certain relief.

Incidental Benefits: Receiving visitors, help at home when the patient is in hospital, calls from friends and colleagues checking if you need anything and wishing you well… so as well as the isolation of pain and anxiety, most patients feel a comforting sense of warmth, love and attention that helps them find the strength to cope.

After Surgery

Pain: Pain after the operation could be perceived as the “pain of redemption” or the “pain of despair.” For the first type, the operation is considered a sort of challenge after which there will be an improvement. The pain is therefore something temporary and transient, rather like the final tough climb before reaching the summit. But for the second type, pain represents suffering and despair, and recovery is generally accompanied by depression. This will happen in cases of chronic illness or an operation that is only part of a longer recovery process, and the pain is often perceived as unbearable. In both cases, it is recommended to take painkillers soon after the operation.

Low-energy Mood: Many people feel down, or even depressed, during the recovery period. There are those who attribute this to a drop in tension once the surgery is over. Others see it as proof the patient has returned to his or her former self and so does not need to enlist extra strength as they did for the operation. Still others report this emotion accompanied them throughout the entire operation and beyond, At any rate, if it is not diagnosed as clinical depression, these feelings should disappear within a relatively short time.

Matching Expectations: Understanding and knowing about the recovery process beforehand will help and allow the patient return to normal functioning at the appropriate pace.

Loneliness: Returning home after prolonged hospitalization can often be experienced as a crisis, despite the expectation of going home. Suddenly all the incidental benefits we had in the hospital – frequent visits, immediate care, painkillers on request, the sense of security, etc. – have disappeared and we are on our own.

Dependency: Many patients talk of the difficulties in feeling dependent on a parent/partner/child/friend in the first days after the operation. After certain surgery it might be difficult to bend down or to get up by yourself and you find yourself dependent on others even more than you were in hospital.

Complications: Complications can happen during an operation or a few days after (like leakage for example). In these cases, the patient has to dig deep to find the strength again to cope with the unexpected, the uncertainty and the lack of control.