As a practitioner and teacher of Somatic Experiencing® for the last 30 years, and as someone who has undergone a number of surgeries herself, starting with some “harmless” dental surgeries as a child, I have had occasion to work with many different surgical traumas over the years, both in my own system and with my clients.
Surgical trauma is a very special and often delicate category of trauma, because of the intersection of diverse elements, each of which can be traumatizing on its own, and when coupled together, can create stress and trauma, some of which is unavoidable and some of which is quite avoidable.
This blog, and the ones that follow will discuss some simple and effective measures to assure that no extra or unnecessary trauma is suffered in a surgery and give the reader resources to go into and emerge from surgery feeling in charge of their own destiny and body, as well as measures for a smoother, easier post-operative experience.
Let’s start by looking at what exactly it is that happens in a surgical experience that can be so challenging. Our body doesn’t know the difference between the surgeon’s knife and the fangs of a sabertoothed tiger. When it is cut, it only knows that it has been attacked, and surgery is an attack that cannot be resolved with the active responses of fight and flight. The anesthesia keeps us immobilized during the surgery, and immobility plus fear is a sure recipe for trauma and freeze. Above and beyond this, the inescapable attack of surgery happens while we are in an altered state of consciousness due to the anesthesia. Add to this the fact that most patients are frightened when they go under anesthesia and often disoriented and further frightened when they come out. Some of these factors of traumatization are inevitable with a surgery–however, there are many ways that we can act to reduce the traumatic charge.
So, what are the actions to be taken so that surgical trauma can be reduced or avoided? There are many more than may be immediately apparent. What follows is a list that touches lightly on each factor. Later blogs will go into more detail.
One of the first and most important choices is who will be your surgeon. Finding a doctor who takes the time to listen to your concerns, and to explain to you about your condition and about the surgery that they will do is an important first step. Seeing how your surgeon responds to your questions and the following requests (see below), will often give you a measure of whether you want to work with that person or not. Trusting your doctor allows you to relax and go into the surgery with confidence.
Transitions in a surgical experience are extremely important. The state that we are in as we go under the anesthesia, will color the whole experience. If we are terrified as we go under, terror will imprint throughout the entire surgery. And likewise, if, in the phase of disorientation as we come out from the anesthesia, we find ourselves, alone, in pain or with unsympathetic or overworked medical staff, this can create unnecessary fear that may taint our nervous system for a long time to come. Of course, it is natural to be nervous before a surgery, but there are steps that can be taken to diminish this nervousness to the point where it will not cause harm. This is important with adults and essential with infants and children. The child should go to sleep with a parent or caregiver present. If the child is an infant, the best way for them to go under anesthesia is in the loving arms of their parent, and when they wake up, they should find that trusted caregiver with them to reassure them and help them to reorient. This simple precaution alone can save enormous amounts of unnecessary trauma. For adults if they have a friend in the medical profession who can be with them throughout the surgery and in the recovery room this can be enormously resourcing. Further resources, especially for children will be explored in a future blog.
A hidden cause of trauma in surgeries are the conversations that happen in the surgical theater. Clinical experience, my own and that of my Somatic Experiencing® colleagues, as well as experiments in hypnosis, have shown that although the patient is unconscious during the surgery, they still register every word that is said during this time. And because of the altered state of consciousness induced by the anesthesia, as well as the heightened state that the body goes into when it is being cut open, conversations during the surgery are registered with high intensity attention and can act as hidden post-hypnotic suggestions that continue to work long after the surgery has passed. For this reason, it is very important to find a surgeon and their team who are willing to respect the request for only neutral and necessary conversation during the surgery. In a future blog, I will explore how this heightened state of suggestibility can also be used to help recovery and strengthen health.
There is a practice called preemptive analgesia, which many hospitals and institutions have already adopted as part of their normal routine, because of how it has been shown to facilitate post-surgical recovery and reduce post-surgical pain. It consists of giving a local anesthetic at the site of the incision. Although the anesthetized patient does not consciously feel the pain when the body is cut, the brain stem receives a flood of distress signals from the area that is cut, and this activates the entire system. A state of activation and distress does not support the smoothest post-operative experience or recovery. The simple practice of preemptive analgesia allows the autonomic nervous system to stay in a calmer state that is more supportive to healing while the surgery takes place and in its aftermath.
When the surgery is done with a sedative, the choice of sedative is also important. Midazolan (generic name) for example, is better avoided as a sedative. Midazolan–Versed in English– is an extremely dissociative drug which fragments the body memories, making it harder at the unconscious level for the body to make sense of what happened and leading to a below the threshold experience of disorientation and insecurity that can continue for a long time, or even become part of the body unconscious. On the other hand, Propofol (generic name) leads to a gentle, soft sleep with an easy awakening. Requesting the use of Propofol instead of Midazolan can make a significant difference in the way that the body is able to make sense of and renegotiate the surgery as time goes along.
Last but not least, in the aftermath of a surgery, it is common and helpful for the patient to shake and tremble. This is one of the body’s ways to discharge the extreme stress that it underwent during the surgery. Stress and activation that can discharge, leave the system more resilient instead of less and allow the whole body to settle. However, the intensity of the shaking and trembling can often be frightening to the patient who is unprepared for this, and uncomfortable for the medical staff. Inhibiting this natural and helpful discharge, either by giving medications to suppress it or by holding it back in an attempt to “stay calm” doesn’t allow the body to release the activation of the surgery and imprints this activation further into the system. Again, preparing both patient and medical staff for the shaking and trembling that may occur as the patient is coming out of the anesthesia and reassuring them before the surgery that it is a natural and helpful part of their recovery will give them the confidence to allow this to happen.
The above measures, if followed, will considerably decrease the likelihood of developing post-traumatic stress syndrome after a surgery. Finding the courage to talk to one’s doctor and make these requests, also helps the patient to become proactive in their own process of surgery and recovery.
For a PDF checklist of points to reduce traumatization with surgery go to laelkeen.com and sign up for the mailing list where you will receive a login to my bonus page, which will slowly fill up with the bonuses from these blogs.
© Lael Katharine Keen 2024