Preparing for Surgery – A Survivors Guide

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 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).