Preparing for Surgery: Suggestions for Survivors
By Lynne M. Constantine and Suzanne Scott 

Impending surgery generates a certain amount
of anxiety in almost everyone. The thought of being put to sleep and
operated on, no matter how routine and safe the procedure, is unpleasant at
best. Many people fear waking up during the surgery. Others fear not waking
up at all.

For many survivors of childhood sexual
abuse, those natural fears of surgery are intensified by the fears that
their bodies will be completely given over to and invaded by another person.
However therapeutic and necessary the procedure, it calls up powerful
emotions of helplessness and can re-create old feelings of being victimized.

If physicians, surgeons, nurses, and
ancillary staff are unaware of the early abuse, they may unwittingly
revictimize such patients. One survivor who recently underwent surgery had
made sure her surgeon knew that she was a survivor, but that information did
not get passed to the recovery room staff. When she began to regain
consciousness, she was disoriented. She began to re-experience her old
feelings of abuse and therefore began to act as if she were about to be
abused. The staff, assuming they were dealing with a bizarre patient, spoke
harshly to her and refused her pleas for her partner's presence in the
recovery room.

Children who have been sexually molested are
also at risk of reexperiencing the feelings associated with their abuse when
being prepared for surgery. One 50-year old survivor recalls the terror she
felt at age seven as she was torn away from her mother to have her tonsils
removed. "I had no idea what to expect," the woman said. "So when they
wheeled me away with those expression less faces, I cried for my mother to
come with me. She couldn't, of course. So I screamed louder."

After she was in the operating room, her
hands were tied down, and a rubber mask was slapped on her face. "I
remember pushing a scream from my rigid body as I fought against the straps
and the ether until they finally won," said the woman. "And for weeks after
the surgery, I awakened in the night screaming that I smelled ether."

Perhaps that experience would have
traumatized any child, even if she had not been sexually molested prior to
her surgery. Certainly, today's medical professionals are far more
sensitive to the needs of children, but being a survivor of childhood sexual
abuse leaves patients particularly vulnerable in an already frightening
situation. Many people who have been sexually abused have especially strong
reactions in situations where they are required to give up their control
precisely because they had no control when they were being abused.

Support and Self-Care
Psychotherapy is the best place for
survivors to address the issues of reexperiencing childhood sexual trauma
when preparing for surgery. With the help of a competent therapist who
understands the dissociative process and gives credence to post-traumatic
stress, survivors can learn to face situations such as surgery and to manage
their fears.

In addition to working with a therapist,
survivors may use a number of other self-help steps to help reduce anxiety
The chance of moving into a full-fledged flashback of the original abuse
during the hours before and after surgery can also be minimized. Survivors
who have learned self-hypnosis, for example, can use that tool to help them
relax during times of surgery-related stress.

Meditation is another tool that reduces
stress and promotes an overall sense of well-being. Meditation does not
need to be associated with any particular religion, although many different
religions use meditation in their religious practices. Meditation can
consist of focusing on a secret mantra, on your own breath, or on an object
such as a seashell. It is a gentle way of freeing the mind of anxiety.

For some survivors, relaxation tapes are
helpful. If the tapes are used in conjunction with therapy and are a part
of the survivor's lifestyle, then the images from the tapes can be called up
during those anxious hours before and after surgery.

Enlisting the Help of the Surgeon and Hospital Staff
Sometimes survivors are embarrassed to tell
others about being abused. However, physicians and the surgical team need
and want the information in order to respond appropriately to the patient.

For those who simply cannot bring themselves
to speak the words, giving the physician a written statement about the abuse
is a viable alternative. In fact, a written statement that includes basic
information about the abuse along with a list of current medications, names
of other specialists, and pertinent medical information is good to have in
the medical records. The statement could include a sentence explaining the
possibility of emotional reactions to invasive medical procedures because of
childhood sexual abuse. just giving the statement to your surgeon will open
the door for a discussion.

Anesthesiologists should also have this
information. One survivor who has had several surgeries over the past few
years said that anesthesiologists and nurse anesthetists are, for the most
part, enlightened about the subject of sexual abuse and understand its
implications for survivors who receive anesthesia. During discussions with
the anesthesia team, a survivor can gain more of a sense of control by
asking what being put to sleep is like, whether an injection or mask is
used, and if there are options about the types of anesthesia that may be
used for their particular procedure.

It is probably a good idea to ask that the
post-anesthesia (recovery room) staff, who are completely different from
operating room staff, be told that the recovering patient is a survivor.
The experience of the woman who was treated as if she were bizarre could
have been turned around if the staff had known her history and been educated
about how to deal with a person experiencing post-traumatic stress /
flashbacks.

Tips for Preparing for Surgery
In addition to working with a therapist and
talking to the surgeon, survivors can take a few more important steps to
prepare for surgery. To ease tension, survivors may want to consider doing
the following:

* Clarify for themselves what they need in order to feel better.
Would having someone hold their hand as they drift off to sleep make them
feel better, or would they prefer having someone stand close and talk to
them, without touching? After survivors know what they need, they are in a
better position to ask for it.

* Compassionately acknowledge to themselves the terror that strikes
when they think of invasive procedures such as surgery The fear cannot be
managed if it is not accepted as a natural response to having been
terrorized.

* Talk about the fears with understanding friends and professionals.
Discussing the fears helps demystify them and reduce their power.

* Practice relaxation techniques while imagining going into surgery
and waking up in a totally different environment with strangers in the room.

* Build a back-up plan in case a flashback does occur. Arrange for a
spouse, partner, or therapist to be on hand to offer comfort.

Suzanne Scott and Lynne Constantine are
health and behavioral sciences writers and owners of Community Scribes, a
communications consulting firm in Arlington, VA. They are contributing
editors to Moving Forward and coauthors of the book Migraine: The Complete
Guide (Dell, 1994).