The Surgical Patient

Patients faced with a surgical procedure may be frightened despite a calm appearance. They may feel helpless and out of control. The fear of anesthesia, disfigurement, disability, or death is always present. The fear of not awakening from the anesthesia can be devastating. When they awaken, will they find that their body is no longer ''whole''? Did the surgeon find something that was not expected? These patients fear the unknown. A question about the surgeon's ability is an expression of the patient's anxiety. Often, patients have tests and are told the results are normal ''except'' for a small area: they will need surgery to ''check it out.'' This lack of communication by the surgeon adds to the patient's anxiety. A surgeon's schedule is frequently erratic. Surgery may be delayed or postponed, which adds to the surgical patient's anxiety and anger. Many possible communication difficulties exist. The best way to avoid the unnecessary anxiety-provoking situations is to maintain open communication among the patient, the physician, and the patient's family. In the postoperative period, the patient's relief over having lived through surgery may be displayed in a variety of ways. The patient may be apathetic and show a general lack of interest or may be moody, irritable, aggressive, angry, or tearful. Subconsciously, patients may wish to harm the surgeon for ''cutting'' into their bodies, whereas consciously they want to thank the surgeon. This dichotomy may be the root of the anger so commonly seen in postoperative patients. In other patients, depression may be seen as a result of the loss of part of the body. The best example of this is the ''phantom limb.'' Patients who have undergone an amputation of a leg frequently claim sensation in their lost limb. Some of this may be physiologic, but certainly some of the phantom leg pain is related to depression. The caring interviewer should allow the patient time to release these tensions and feelings of loss.

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