Surgical patients learn to relax to ease their fears

NorthJersey.com ^ | Sunday, March 16, 2008 | LINDY WASHBURN

[Coleus]

I'd already lost consciousness when the nurse started reading from the paper I'd given her when I climbed on the operating table.  "After this operation, you will feel comfortable and you will heal very well," she read.  At least, I'm pretty certain she said that, because later in the recovery room, she asked if I'd heard her.  "I did it just like you asked," she reported. "Five times."

Asking for those healing statements was part of my preparation for breast cancer surgery last summer. I'd been reading a book about the mind-body connection in healing and the importance of deep relaxation before surgery. Hearing such statements while in a suggestible, semiconscious state — almost like hypnosis — would help me recover faster and with less pain, it said.

It felt a little strange to ask medical professionals to do this, I admit. But when I tracked down the anesthesiologist by phone and asked if this would be possible, she didn't dismiss me as a nut. "I believe in that," she said, offering to play calming music.  Few experiences rival the anxiety of the lead-up to cancer surgery. The countdown is a strange thing. On the one hand, I was strengthening myself to battle a potentially life-threatening disease. I worked out, I ate well, I tried to boost my immune system.  But when the big day arrived, I wasn't going to fight anything. I was going to slip into the dreamless nothingness of general anesthesia.  In fact, it was a countdown to oblivion.

How to get ready for that?

I veered between a desire to pretend nothing was wrong and an urge to scream at everyone about the stress I was under. Some days, the drill at home and at work was a welcome distraction from frightening thoughts; other days, it seemed pointless.  What mattered most to me during these weeks was not so much medical, it was emotional, spiritual and social. It was time to gather myself and the tools I needed to heal.

"The patient is the one who has to heal," says Dr. Elissa Santoro, a pioneering surgeon and founder of the Breast Care and Treatment Center at Saint Barnabas Medical Center in Livingston. "I tell my patients, 'I will be your mountain guide, but you will climb the mountain.' " A friend gave me some materials by Peggy Huddleston, a Massachusetts psychotherapist who has treated many patients facing surgery. Her program, "Prepare for Surgery, Heal Faster," focuses on what a person can do emotionally and spiritually to speed healing.  Patients are often overwhelmed by anxiety. They can't sleep. They anticipate the pain and worry about complications.

Huddleston's program includes recordings to help patients relax deeply to feel calm and peaceful. She encourages patients to visualize themselves healed and to gather a support group to send thoughts of love on the day of the operation. Before the operation, she says, patients should speak to the anesthesiologist to get any questions answered and ask a member of the medical team to read "healing statements." As a result of these steps — and much to my surprise — my experience of the operation and its aftermath was profoundly positive. There were moments of real pain and strangeness, to be sure. But thanks to the work I did ahead of time, I wasn't afraid. I was as relaxed as possible, and confident in the surgeon and my health.

The sense of being able to promote my own healing and accept help from others has been a powerful gift.  "What I found most moving," Huddleston says, "were the patients who said, 'Using this has changed my life — I've connected with an inner peace I've never known before.' "

Changing mind-sets

Huddleston's materials are passed hand to hand among patients. I've passed out three. They are in use at a handful of hospitals across the country, including Saint Barnabas, Morristown Memorial Hospital and New York University Medical Center. Before Lucy Phelan, 43, had a mastectomy in late January, Santoro, her surgeon, introduced her to Huddleston's program, as she does all her patients. "I have to cancel a lot of funerals that first visit," Santoro says. "They all feel they're going to die. In patients' minds, cancer is death, or if not that, mutilation. We have to reprogram them. This is one of the tools. ... We see them change in front of our eyes. They start to heal before the surgery."

After listening to the guided relaxation and imagery on the CD for the first time, Phelan says: "I don't know when I had felt that relaxed before." She told her friends to send positive thoughts her way on the day of her surgery. "Send me a healing white light," she told them. "Visualize me wrapped in a pink blanket." The day of her surgery, she taped a piece of paper to her hospital gown with the healing statements she wanted read. She listened to the CD on earphones. As she went under anesthesia, the doctor read: "Following this operation, you will feel comfortable and you will heal very well." "It might sound weird for something that was the worst thing that could happen to you," Phelan says now. "But if you could say that surgery could be positive, this was it."

Pre-surgery party

I used Huddleston's CD daily for about three weeks before my surgery. The day before the operation, I threw a party and invited friends. It was a strange idea, but what better way to get through those difficult hours than surrounded by people I loved? Pre-party preparations were a welcome distraction, and the lift from their company carried me all the way to the hospital the next morning. The day of the operation, I was helped by little gifts from my friends — a joke, a prayer, a story, a beautiful picture, a puzzle.  I listened to the CD in the pre-operative holding area, a noisy place where patients returning after surgery cross paths with those awaiting surgery. After four 9-inch needles were positioned to mark my tumor, it was hard to relax, but I tried.

At one point, as Huddleston's calming voice in my earphones told me to feel the heaviness "in my eyelids," the Jersey accent of the patient across the way broke through. He'd just come out of hernia surgery. "Yup,'' he said loudly on his cellphone. "I still got both my nuts, so I'm doing all right."

So much for concentration.

I fixed an image in my mind: a healing blanket of saffron-colored silk. When the orderly wheeled me through the doors and down the long, wide hallway to the operating room, I imagined a bolt of this beautiful fabric rippling and unfurling and connecting me to my waiting husband.  The wheelchair stopped at the operating room door, and the nurse took my hand. "I'll be with you every minute," she said kindly. Her name was Dottie, which, as it happens, is my mother's name.  I walked through the door and climbed up on the table.

"When people are under tremendous anxiety, fight-or-flight hormones kick in," says Susan Weinstein, director of women's health education at Saint Barnabas. "Your body is flooded with adrenaline, cortisol and other hormones. It increases your heart rate, and that causes your blood pressure to elevate. It causes your body to tense. It causes your respirations to go faster." But the mind also can create a calming response. Images of peaceful pleasure — holding a sleeping child or basking in Hawaiian sunshine — can flood the body with hormones that resist the fight-or-flight reaction. The feeling of love or protection can defuse anxiety. Muscles unclench. Blood pressure lowers and immunity improves, Weinstein says. "There is faster, better healing and recovery, just by flooding the brain with positive feeling," Weinstein says.

Quicker recovery

Huddleston has conducted a few small, controlled studies that show a reduction in hospital stays and prescription pain medication for those who prepare for surgery with her method. For example, 44 knee-replacement patients at New England Baptist Hospital in Boston were discharged 1 1/3 days earlier, on average, than a control group that didn't use the program. Fifty-six colorectal surgery patients at the Lahey Clinic in Burlington, Mass., left the hospital 1.6 days earlier than a control group, according to another study.

Although such reductions translate into cost savings, few institutions have embraced this approach. Medicine, as practiced in most hospitals, does not integrate the physical and the psychological.  "Medicine is more a business than pure hand-holding patient care," says Dr. Mehrdad Rafizadeh, associate chairman of the department of anesthesia at Saint Barnabas Health Care System. "Doctors have to meet schedules, and see so many patients a day."

Most anesthesiologists have little contact with their patients other than a few minutes just before surgery, Rafizadeh says. Their approach to patient anxiety is to medicate them so they neither feel nor remember the pain, he says. But even under anesthesia, doctors can tell which patients are more anxious than others.  "Mental preparation will, 100 percent, make a difference," he says.  As I lay on the operating table, the anesthesiologist slid the intravenous needle in the back of my right hand, and the nurse held my left. I told her about my sons. Then it was as if a curtain dropped.

The next thing I remembered, I was in the recovery room.  How do you feel? the nurse asked.  "I feel OK," I said. Without thinking, I echoed the words of the operating room nurse. "I think I'm going to do just fine."  And I did.

Postscript: It is now nearly a year since my diagnosis and nine months since my operation. I've completed my treatment and am, thankfully, fully recovered.

[Slings and Arrows]

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