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Coping with Cancer Surgery: The "Psychology" of Surgery
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About 50 million surgeries are performed each year in the United States. Surgery places us in a completely helpless position, with having to rely on the doctor, while being in an unconscious state. Although all surgical patients experience fear to some extent, psychiatrist Dr. Jimmie C. Holland says, "…there is a significantly greater stress involved when cancer is the suspected diagnosis or the condition for which the surgery is being performed." Why is that?
Well, in one study that interviewed 51 cancer surgeons, it was found that the information they frequently withheld from their patients included: the cause of their disease, the effects of the surgery on their sexual functioning, the psychological effects of the surgery, the impact the surgery may have on the family, the amount of support that they would need at home following surgery, and how soon they could expect to eat solid food again following surgery.
Therapists following the tradition of Analytical Psychologist Carl Jung say that surgery soulfully stirs up our primordial fears of death partly due to its resemblance to "indigenous initiation" rites of the past. In preparing for surgery, we are taken from our familiar surroundings and are "prepared" for an elaborately "ritualized" ordeal. Being required to fast before surgery parallels religious ceremonial rites as is being wheeled into the operating room, placed on the operating table and draped with a special robe akin to ancient sacrifices. As surgery patients, we in effect, "re-enact" the ritual of death and rebirth. No wonder it's scary.
Sociologist Arthur W. Frank, in discussing his own cancer surgery, says, "…when you say goodbye to your body, as I was doing that night (before surgery), you say goodbye to how you have lived."
Strategies to Overcome Pre-Operative Anxieties
Here's some soul-enhancing preparation "tips" that helped me get through my own surgery that may help you as well. First, be assertive with your surgeon and the hospital staff. Ask for it. A simple request often brings big results. Ask your surgeon the following questions—BEFORE you undergo surgery: Why do you think I need surgery? Will you explain exactly what type of surgery you're suggesting? Are there other, less invasive options I could consider? What will happen if I postpone the surgery for a while? What will happen if I don't have the surgery at all? What benefits will I gain from having this operation? What side effects or complications might I expect from this surgery? How long will I have to stay in the hospital? Where will the incision be made? How large will the incision be? What types of incision closure should I expect (stitches, staples and so on)? Will there be bandages and drains after the surgery? Will I need blood replacement? Will I need a tube in my windpipe to breathe? Will you, or a resident in training, be doing the actual surgical procedure? (Especially important to ask at a teaching hospital.) And, what can I expect during the recovery period?
During your pre-surgery meeting with your anesthesiologist (the person who knocks you out, keeps you under sedation and sees to it that you don't feel any pain during the surgery), ask the following questions: Are you board certified? How many years have you been in practice? How familiar are you with my surgeon and my type of surgery? And, if there will be an anesthesia resident trainee involved in my surgery, how will they be supervised?
Also, know what pre-medication, anesthesia technique, and postoperative pain procedures will be used, and discuss your options with your surgeon ahead of time. One of the most important features regarding surgery and its aftermath is, taking charge of your pain control by obtaining information on postoperative pain management and making arrangements with your surgeon on what types of pain medication you want.
One system of pain control is called "patient-controlled analgesia" (PCA), in which a pump provides a small dose of medication, usually morphine, into your body, when you push a button. Many large cancer centers have specialized "pain units" that will come to your room, evaluate the intensity, duration and frequency of your pain, and prescribe a unique combination of drugs to help relieve your pain. It is now written in patient care law that hospital staff must, on a regular basis, assess and "measure" your pain, as they traditionally have done with regard to your blood pressure, bowel movements and eating.
In my surgery experience, the first full day after surgery was the toughest. I was in a lot of pain. The debilitating nature of my pain compounded the emotional trauma associated with my surgery and recovery. I had to demand that the nurse call my surgeon and get an order for more Morphine or Toradol—in order for me to obtain some relief. Having your own button delivery system can avoid this problem.
Ask for your surgery to be scheduled for the first thing in the morning. Surgeries customarily begin at 7:15 AM in the morning, requiring patients to check in at 6:00 AM. There is an advantage to having your surgery scheduled as the first one of the day: you don't have a lot of "down time" to get nervous. You will be kept busy from the time you arrive at the hospital to the time you are wheeled into the operating room.
Have your mental strategy ready and in place. Know where you would like to go in your imagination as you begin drifting into anesthesia (imagine a comforting, favorite soothing place), and practice going "there" several times before the actual surgery commences (mental fire drills if you will). If you want to use music and headphones as part of this strategy, preset the volume, and coordinate your plans with your anesthesia provider.
Instruct your body beforehand. You can simply give yourself instructions mentally to relax, telling yourself that everything will be okay, much as an athlete does when "psyching up" for a big event. For example, try some muscular relaxation exercises. This involves doing deep breathing while tensing and relaxing major muscle groups in the following manner:
- Mentally sweep through your body, tensing and relaxing each major muscle group
- First focus on alternating tensing and relaxing your hands and fists
- Then focus on your arms
- The focus on your shoulders and neck
- Then focus on your chest and abdomen
- Then focus on your hips and buttocks
- Then focus on your toes, legs and knees
- Feel the tension and hold, hold. Now let go, let relax, let open and breathe deeply.
Protect yourself against un-necessary emotional trauma during surgery. Some of us overhear conversations or events that occur in the operating room during surgery that are disturbing (such as conversations of concern or noises of cutting or smells of burning). To avoid this, you can use earplugs to block out noise or an auto-reverse battery-operated cassette player with earphones playing familiar and soothing music.
For example, I remember undergoing a previous minor surgery for a suspicious "mole" in 1994. I closed his eyes thinking that it would help me remain calm and not get upset. However, I was still able to hear the cutting and plucking sounds during the procedure, in addition to smelling the scent of burning skin when they cauterized my wound. I found himself getting upset and feeling ill over these sounds and smells. Following the advice above, and putting on a Walkman with my favorite music, and placing some Vick's under my nostrils, would have helped me tremendously.
Respect your style of coping. You will cope with surgery best if you are aware of your preferred way of handling stress. There are two major ways of coping with surgery; both are considered to be "active" styles of coping. They are: Avoidant Copers—Those of us who don't want to be overwhelmed with information that we don't need or be asked to make too many decisions. The way an avoidant coper reduces stress is by saying, "Just knock me out and get it over with doc. Spare me the gory details."
And then there are the Vigilant copers—Those of us who want a sense of control over your situation by seeking out a great deal of information before surgery. "I want to know who, when, what, and where doc. Take me through it step by step. Don't skip any details." Both approaches to coping are valid ways of confronting the life crisis of surgery. Both approaches are examples of how you can be an active participant in your own treatment.
Also, this is a perfect time to use your SANITYMatrix™ and its Transformational Grid with the 14 Pods of Healing. This will go a long way in helping you bring down your anticipatory anxiety while at the same time, pumping yourself up, in a focused and centered manner, to withstand the multiple assault on your being that all major surgeries tend to bring about. I include another blank SANITYMatrix™ for you to use at the end of this chapter.
And finally, I recommend that you attend several support group or group therapy sessions before surgery. It has been found that people who undergo multiple educational sessions prior to surgery returned to work faster.
Surgery can be frightening to anyone—especially to the person with cancer. It is my hope that by following these recommended strategies, you will have less anxiety and discomfort, and will recover quickly from your surgery experience, with little or no lasting effects.
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