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|Newsletters: Making Friends with Fear|
Making Friends with Fear
Sheila Messina, RN, MA, Education and Training Specialist, HomePN Consumer
Most patients on specialized nutrition have had their share of traumatic medical and/or surgical procedures. One would think that repeated exposure to this experience would result in a sense of familiarity and fearlessness, but often the opposite appears to be true: while repeated exposure may bring a sense of the known, it usually brings a greater level of fear.
What happens to you when you are told that you will need another surgery or complicated procedure? If you are like me, your whole body tenses up and you want to run. What’s happening? For me, I fear a loss of control. I am afraid my independence will be compromised. I believe I will experience unmanageable pain, and if general anesthesia is involved, I am afraid I will not wake up.
I share this from my own experience, but in talking with others, I find this happens to them as well. Over the past 30+ years I have had more than 12 major surgeries. I remember very vividly in 1974 being on the gurney in the hallway outside the OR, trembling and telling the nurse how afraid I was. At that time I did not know why I was afraid. I did not have any skills to deal with this fear and it was apparent that the nurse didn’t either as she was unable to comfort me. I went through that surgery extremely tense with a sense of “impending doom” and I believe this contributed to a very difficult recovery.
Since that time, with many more ensuing surgeries and procedures, I came to recognize just how fearful I became as I approached these encounters and realized that I must develop some skills for modifying the fear. I have found that I cannot erase it entirely — that would take a major case of denial — but I can certainly make it more manageable and not become paralyzed by it.
Recognize the Fear
When a procedure or surgery is scheduled, I acknowledge that I am frightened and need to talk to someone about it. I do this with friends, since talking about it with my family tends to make them as frightened as I am. In fact, many times they look to me to make them feel better. (Maybe that’s because I am a nurse and they expect me to know and understand everything.) When I talk about the fear with friends, I find that it gets outside of me and becomes diluted. I am not necessarily looking for answers; I just want others to know what is going on with me.
If you are a family member or caregiver, you also need to recognize your own fear. Find someone to talk to — other than the patient. This can be a health care provider, a good friend, or other family members, as long as they are supportive and trustworthy.
Recognizing that emotions and attitudes can affect a patient’s outcome, clinicians too have a role in reducing their patient’s fear. Questions like “Do you have any fear about the surgery and/or procedure?” and “Do you have any questions for me?” can invite the patient to express their concerns and give you an opportunity to lessen them. Knowing what to expect, and being aware of the patient’s concerns can alleviate the patient’s stress, help avoid complications and contribute to a speedier, smoother recovery.
Visit the Recovery Unit
Ever since I had a less than optimal experience in the surgical ICU in 1992, I make certain that whenever possible, I go and visit the hospital unit where I will be recovering — before the surgery. I introduce myself to the staff and try to get acquainted with the personnel and surroundings. A key here is to dress your best when you make the visit. Remember, the hospital gown can hide who you truly are. You want the staff to see you as a whole person with a life, not just as a patient. I want to be known as Sheila Messina: someone with an identity other than “the patient in Room 322.”
Speak with the Anesthesiologist
Here, I am trying to achieve three things. First, I want to let the anesthesiologist know about my fear as it can affect my response to the medications being administered. Among other things we tend to become hypertensive when we are fearful which can make recovery more complicated.
Second, I want to know what his/her plans are for anesthesia. Will I be receiving conscious sedation? Is an epidural block being considered? I’m trying to gain more information so I can be mentally and physically prepared for the procedure/surgery.
Third, I want to convey my special concerns. I have major vertebral fractures. The anesthesiologist (and surgeon) needs to know that I cannot lie flat; trying to do so creates major post-op pain problems. Additionally, since I have had so many surgeries the amount of medication I require will most likely exceed usual expectations. To avoid wasting valuable time and creating confusion with a verbal explanation, I provide the anesthesiologist with an updated list of my relevant medical history.
Practice Your Advocacy Skills
You may believe these skills are too difficult for you to learn — that my training as a nurse gives me an advantage in this area — but it’s not true. I had to learn these skills by trial and error. My voice used to tremble when I started “standing up for me” by asking questions. Now I am able to “speak my piece” in a strong, stable voice, most of the time. Like any skill, the more you use it, the stronger it becomes.
You also may believe that your health care providers know all there is to know about you and that you don’t need to be an active participant in your care. Again, it’s not true. The last time I checked, “mind reading” was not a requirement for the health care professional. And as tighter budgets result in less time for patient care, busy clinicians need to be reminded of your unique situation.
What happens if, despite your best efforts, you find yourself in a situation where everything does not work out as you had anticipated, and that fear you do not like begins to surface? I had that happen to me recently. I had arrived for elective surgery and found that the anesthesiologist I had requested was not available and the one I would be having was someone who did not “listen to me.” I handled it by making certain that everyone in the surgical unit knew my concerns and how I was feeling. It did not change the circumstances of the situation, but it did allow me to “stand up for myself” and let my needs be known.
Facing your fears using skills like those I have described, can only have a positive influence on your recovery, regardless of the pending surgery or procedure. Hopefully they will generate some new ideas that allow you to express yourself in ways that reduce your fear and permit you to have a more positive health care experience.
Reprinted from Nutrition, “Making Friends with the Fear,” by Sheila Messina, RN, MA, Volume 18, Page 360, Copyright 2002, with permission from Elsevier Science.
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