Association of Women Surgeons – volume 8, No.3
Preparing Patients for Surgery
by Dixie Mills, MD, FACS
We all want our cases to go well and our patients to do well. According to Prepare for Surgery, Heal Faster (Angel River Press. Cambridge, MA), a patient can play a more active role in that process. I’ve found people quite receptive and eager to learn how to prepare themselves for an operation. The experience becomes a very “teachable moment,” as surgery is a crisis point for most people. As a medical student, being confronted with the need to have an appendectomy for a pain I just wanted to sleep off, I tried to talk a surgeon into a spinal so I could watch and not be put “under.” Most of us do not like being out of control and being “put under.” Whether we are being put under gas or a knife — it is a terrifying experience.
Memories of the after-effects, before the newer antiemetic agents were available, also are not pleasant. I have been fortunate enough not to have needed general anesthesia again myself. Others are haunted by what is unknown and what the surgeons will find. However, I have seen these fears and anxieties transformed into positive attitudes beyond the recovery from the operation by patients who have read this book.
Author Peggy Huddleston, a Harvard University Divinity School graduate and psychotherapist, addresses these concerns in a stepwise fashion and asks pre-op patients to formulate a plan. Her five steps include: learning some well-established relaxation and visualization techniques, organizing a support group of family and friends, and making a list of healing statements to be read by the surgeons and anesthesiologists. I personally have found that patients and OR staff deal quite well with these suggestions. Sometimes, it is a challenge to arrange for patients to meet the anesthesiologist, given the nature of their schedules, but it can be done! And as the nurses are doing their sponge and instrument counts, those of us at the front of the table repeat the patient’s statements that they will recover quickly, urinate easily, and be hungry for a treat, usually ice cream.
Always interested in new things, but a bit of a skeptic, I am still continually amazed at patients’ outcomes — they really do wake up quicker, go home sooner, and use less pain medication. Patients who are able to obtain the tape that accompanies this book and listen to it for at least a week before their operation also have an almost uncanny glow and serenity about them during pre-op preparation. This book is a beginning in returning the human spirit to our now overly high-tech, sterile OR’s.
Appendices deal with vitamins to speed healing, preparing children for surgery, and lessening the side-effects of radiation and chemotherapy – all very practical advice. Ms. Huddleston and colleagues are about to launch a multi-institutional trial involving patients who are undergoing a range of procedures from prostatectomies to mastectomies. The trial will document benefits in terms of cost saving and answer the broader, more interesting question to me – what is the value of eliciting the patients intent in healing? Or to state it in a different way – Is the attitude of the patient entering surgery as important as the skill of the surgeon?