I wish my doctors had warned me that some patients have trouble recovering emotionally from major abdominal surgery and its painful complications. Surgeons and gastroenterologists read through lists of physical warnings that include serious infections that can lead to death, but nowhere on that list is the warning that what happens when you walk through the hospital doors may change who you are and how you function forever.
Postoperative post-traumatic stress disorder is more common in trauma patients, but it can also occur in patients whose recovery is prolonged and complicated, including those who have to undergo a second surgery after their first surgery site leaks, causing infection. According to MentallyHealthy.co.uk, the criteria for post-traumatic stress disorder (PTSD) as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-4) is:
- A traumatic event that involves actual or threatened death, or the threat of physical integrity to self or others and the person’s response to that event was intense fear, helplessness or horror
- At least one symptom of re-experiencing of the event, such as intrusive memories, nightmares, a sense of reliving the event, and/or psychological distress when reminded of the event
- Three or more symptoms of avoidance, such as avoidance of thoughts, feelings or reminders of the event, inability to recall aspects of the event, withdrawal from others, emotional numbing, sense of foreshortened future – and
- Two or more symptoms of increased arousal, such as insomnia, irritability, concentration difficulties, hypervigilance and exaggerated startle response.
I’m not comparing abdominal surgery with the intense and debilitating PTSD suffered by veterans or victims of violence, but I can’t help but find a shade of my response in each and every bullet point. The helplessness that one feels in a hospital bed while trying desperately to communicate to doctors and nurses that something is most definitely wrong, only to be brushed off as overly emotional, is traumatic. That feeling–the need to avoid reminders of hospitalizations or withdrawing into oneself, avoiding phone calls from friends and family because you can’t concentrate on anything but your pounding heart–is one that shouldn’t be ignored.
Postoperative PTSD is why I can’t tolerate the sights and smells of spring. It’s why the pleasant kiss of warm sunlight on my shoulders takes me back to darkness even when I haven’t thought of surgery for months. My response is visceral and instant–I will be lost in the joy of playing with my children and dogs and have to stop the minute a neighbor revs up their lawnmower. And it’s why I haven’t set foot in my backyard in two years without wanting to cringe.
All of us fight through the pain of successful surgeries and many of us come out on the other side completely whole–physically and mentally. Not everyone will develop a life-threatening abscess and know what it’s like to be forced back into the hospital after fighting so hard to leave the first time. We may even achieve remission and go on to lead lives where “Crohn’s disease” or “ulcerative colitis” are randomly paired, powerless words that have limited meaning in our new lives.
I hope that one day the psychological effects of complicated surgeries are addressed immediately. Surgeons must take the initiative to ask patients how they are feeling and put their own discomfort in the back seat when their patient reaches out to them and expresses signs of anxiety and depression.
More than anything, doctors must have safety-nets in place for patients and their families and not wave goodbye the minute the staples or stitches are removed. We must have resources in place to treat all scars.