Series: Open Heart Surgery. During (Stress Management)

Last week I started a series on planning for and dealing with major surgery.  In my case, it was open heart surgery, but I imagine this could apply to other surgeries, as well.

The first post focused on the planning phase, so go check it out if you want some tips on what you need to do plan for such an event.

My initial intention was that the second post in the series would just be about what to pack to ensure a more comfortable hospital stay.  However, in giving it more thought, I'm switching gears to discuss stress and anxiety, on how that can impact you and what you can do to get a handle on it.
I'll include a few pictures from the hospital.  Some are gross, so look away f you're squeamish.  You have been warned.


STRESS
There are so many things out of your control during this phase, sometimes frighteningly so, that I think it wise to get a handle on self-calming techniques so that stress and anxiety do not become a runaway train for you. Allow me to provide a review of some times that could leave you feeling anxious:

On the shuttle bus from the parking garage to the hospital.  Starting to feel nervous.

PRE-OP
This is the period of time that you are being prepped for surgery.  You might want to think of this in two parts.  There is the time that a host of professionals are getting you ready in a curtained-off bay, and then there is the prep time in the actual OR before you are put under.

The prep time will include changing into a hospital gown, a review of your vital signs, sometimes peeing in a cup, getting an IV line started, and a multitude of redundant questions about your name, date of birth, why you are there, what allergies you have, what medications you are on, when you last ate and drank, history of reactions to anesthesia, and more.  You will be asked these questions again and again and again by different disciplines, including techs, nurses, nurse practitioners, physician assistants, residents, fellows, doctors.  Don't be surprised if the janitor asks you a few just for good measure. The point is, expect it, and try not to get upset that you just answered the same question for the last three people who walked through your curtain.
You may or may not have your support person with you at this time, depending on hospital policy and current climate (my surgery took place during the pandemic, so having a support person was not allowed).  *See end of post for clarification on this*
(INSERT STRESS-REDUCTION TECHNIQUES HERE)

Once all of that is done and the surgeon is ready, you will be wheeled in to the OR.  It will be cold.  There will be lots of lights and gadgets.  There will be a mass of people milling about.  All of this can be pretty overwhelming, so this is a good time to start putting into practice any calming strategies that work for you (I will review some resources later).  In addition to all the sights and sounds, there may be more procedures to go through, none of which you will be able to see very well as you will be flat on your back.  With my surgery, they still needed to install some catheters and measuring devices in my wrist and neck, as well as "way down south" (be sure to take care of any landscaping needs prior to heading to the hospital).  I didn't care so much about the wrist and neck doo-dads, but they thankfully put me under prior to inserting the Foley catheter.
(INSERT STRESS-REDUCTION TECHNIQUES HERE)

Photo from Quora

This whole period of time when you're in the OR but still pre-anesthesia can almost feel like an out-of-body experience, because you are just lying there on the OR table and there are so many people all around, but for the most part they are not talking to you, just to each other as they complete their tasks. They are all working on some piece of you as you stare up at the ceiling and listen to their murmuring. So again, some calming breaths and peaceful thoughts would be really helpful during this stage.
(INSERT STRESS-REDUCTION TECHNIQUES HERE)

Anyway, at some point they will mercifully bid you good night, and that cold OR is the last thing you will remember before waking up in the ICU.

POST-OP/ICU
For me, this was the most stressful time of the whole ordeal, soup to nuts.  Having a better handle on stress management could have helped me tremendously during this phase.  And I thought I knew all about it.  I teach it to my patients for crying out loud.  Problem was, I hadn't really practiced any of it, which I should have done.  I will share my personal experience with you, not to scare you, but so that you can figure out what techniques would work for you should you ever need to go through something similar.
And this is where the pictures get kinda gross.

Although I knew I would awaken from surgery in the ICU still hooked up to the ventilator and unable to speak or breathe on my own, there was a vast gap between the knowledge of it and the experience of it. Once I "came to" more, I became increasingly aware of the tube down my throat.  Both the physical and psychological aspects of that really ramped up my anxiety.
(INSERT STRESS-REDUCTION TECHNIQUES HERE)

Eyes not open yet, but responding to commands.

To make matters worse, they weren't real enthusiastic about whatever numbers rule their world, so my extubation time kept getting pushed back by 15 minutes, again and again.  As each 15 minutes passed, I would become more alert, but then more anxious when they would decide to delay extubation another 15.  Panic started to set in, to the point one of my caretakers had to talk to me in that calming voice that you know means you're in trouble.  "It's okay, look at me, you're okay, you're doing fine..." Which was probably true for THEM, but for ME I felt like I couldn't breathe and was going to die. There, I said it.  I've heard of people who had complications coming out of anesthesia, and I just knew I was going to be one of those people.
(INSERT STRESS-REDUCTION TECHNIQUES HERE)

But you know what?  I wasn't.  Eventually, my numbers made my nurses and doctors happy, and they pulled the tube.  That, in itself, was horrendous, but at least it was coming out, and that was all I cared about.  They tell you to cough, they pull, and out it comes.  Easy peasy.  But it felt dreadful and there was much suctioning going on and throat pain and the feeling of drowning because you've got ick in your lungs that you're not strong enough to expel.  Cue more feelings of death and despair.
(INSERT STRESS-REDUCTION TECHNIQUES HERE)

When the worst of that passed, excruciating thirst kicked in.  I asked my nurse for a mouth swab, which is a little tiny water-soaked sponge about the size of your fingernail on a lolli-stick. She was kind enough to grant that wish.  But when that wasn't enough, I begged her in the name of God and all things holy for a cup of ice chips.  She said she couldn't do that, because it always got her in trouble.  I offered her up my first-born.  She didn't really want my first-born, but she was a kind and merciful soul, so she acquiesced. I chewed on the ice and I was in nirvana.  I would never want for another thing in my life.  Until I wanted to gulp the ice water that had collected in the bottom of the cup.  What is beyond nirvana?  Whatever it is, I found it.
Until I needed to throw up.  Someone passed by my room and I yelled in my post-ventilation tube throaty rasp, "I'm going to be sick!" He ran in and said, "I'll go find a basin, but here's the suction tube for now."  He handed me the tube and ran out the door.  When the vomit came (and it did come), I shoved the tube in my mouth, clamped my lips shut, and turned on the suction.  It did the trick.
(INSERT STRESS-REDUCTION TECHNIQUES HERE)

But from that point on, things got better.  I learned some things about my body in its current state.  I learned what it feels like to have plastic sleeves on my legs that inflate every so often to squeeze the legs in order to prevent clots.  I learned what it feels like to have a Foley catheter pulled from your body (not at all pleasurable).  I learned that I now had three enormous tubes coming out of my upper abdomen, each snaking its way to its own large plastic box that measured how much stuff was draining out of the spaces around my lungs and heart.  I think they use it to give me an oil change, too?  Not sure.  I learned that I still had a myriad of other tubes and lines in my neck, wrists, and arms, as well as ekg leads and the generic nasal cannula to provide still much-needed oxygen to my under-performing lungs.
(INSERT STRESS-REDUCTION TECHNIQUES HERE)

Chest tubes.  The Three Amigos.

So many monitors, so little time.

But I also learned that I had compassionate and professional care-providers who seemed to know a thing or two about what they were doing.  And that one by one, all the tubes and wires would be removed from my body.  Some before I left the ICU, some once I was installed in my room on the regular hospital floor.  For the first time, I began to feel less anxious and more confident.  This is an excellent time to mentally review all the goals ticked off, and fully realize you are making progress.
(INSERT PRAYERS OF GRATITUDE HERE)


HOSPITAL ROOM
There continued to be more stressful moments in the ICU, such as getting the first of the chest tubes removed, but having that first bit of confidence restored really helped me to manage the anxiety better.

However, there were plenty of stress-inducing matters to come.  I won't continue with a play-by-play, but I will fashion together a list of things that may cause you to feel increased stress, as well as suggestions for what may help.

Exhaustion
What you'll feel: Prepare to feel extremely low energy levels and just pure exhaustion, both mentally and physically.  Like, you didn't think it was possible to feel this poorly.
How to cope: Don't sweat it.  It's normal after something so traumatic to your body.  Give your body a chance to work its healing magic, and try to get as much rest as you can.  And a helpful tip: in your pre-hospital preparations, ask someone to be your liaison with family and friends.  In this way, you can connect with that one person by phone or text when you're able, and he or she can provide updates to everyone else.  You will likely be too tired to scroll through a bunch of different texts from well-wishers and provide very repetitive information to each.

Nausea
What you'll feel: Anesthesia and pain meds can make you feel nauseous, which will just add to your overall feelings of exhaustion and sickness. Besides the suction tube incident in the ICU, I got sick again as they were taking me to my hospital room, and continued to feel nauseous for awhile before it finally went away.
How to cope: Let your nurse know, and he or she can usually provide you with some medication to help.  Ice chips will also help (just don't gulp the water, lol!) .

Pain
What you'll feel: Pain.  Duh.
How to cope: Communicate with your nurses.  Each person is different in terms of pain thresholds and what types of medication they can tolerate.  It may be a little trial and error, but the goal is to find what works for you.  And you may never be completely pain free.  Maybe you will, but don't get upset if you're not.  The goal is not to keep people completely free of pain, but to keep it well-managed so they are comfortable. I can also tell you that in hindsight I think I would have done better with feeling a little more pain in order to feel less groggy and just so OUT of it.  It's a trade-off and you have to figure out what you can tolerate.

Sleep
What you'll feel:  You may become sleep deprived due to lack of good, deep sleep. Between the meds you're on, need to pee, vital sign checks every four hours, an uncomfortable bed, and the noise/lights/bustle of the hospital, it's unusual to get more than a quick doze here and there.  This at a time when you need more sleep than a three-toed sloth with a hangover.
How to cope: Ask your nurse or tech to keep your door closed, which helps more than you would think.  Close the window blinds. Bring an eye mask and possibly ear plugs.  Also a comfy pillow or a travel neck pillow.  Play around with the settings on the bed.  I found I was most comfortable with both the head and knee section of the bed raised, and it kept me from sliding down in the bed.

Hopelessness
What you'll feel:  You may feel like you'll never be back to normal.  I've never been one to put a whole lot of stock in "normal", but at this time it was something I longed for.
How to cope: In my hospital room, there was a white board on the wall for each bed.  There were pre-printed things on the board like date, nurse, doctor, etc, and the nurse would update the info as needed.  One of the items was goals.  I found this very comforting and motivating.  The goals were often simple, but left me feeling like I was making progress.  Things like walk 3x/day, use the spirometer 10x/hour, manage pain, wean off oxygen.  Some of these were things I could DO, and cross off at the end of the day.  It helped me feel more in control and less anxious.

Day before discharge, I still had one chest tube to go.

Toileting
What you'll feel: You will probably need to pee a lot due to medications aimed at keeping your fluid levels down.
How to cope: This can be difficult when just the act of getting in and out of bed can be a monumental feat.  In the beginning, you will need help, and will probably need to use a bedside commode instead of making the trek to the bathroom.  As you recover, you will be able to get to the commode without help, and eventually even be able to walk to the bathroom without help. Bottom line, just ask for assistance.  Also, don't even bother with underwear, at least not in the beginning.  It's just one more thing to make your life difficult.  You sexy, sexy thing, you.

Mobility
What you'll feel: On the topic of getting back and forth to the potty, walking is a big deal when recovering.  It is important on so many levels, yet feels impossible in the beginning.  When you've got chest tubes poking out of your body and their accompanying drainage boxes and the pulse ox on your finger and the heart monitor weighing you down and your body freshly torn asunder and stitched back up, it seems impossible that someone would expect you to WALK anywhere.  But they do.  And you will.
How to cope: Know that they will not expect you to fly solo.  They may give you a walker.  They will hang your drainage boxes or carry them for you.  They will monitor your oxygen levels and heart rate, and constantly ask you how you feel, and they will be with you every step of the way. Sometimes your nurse, sometimes an aide, and occasionally PT and/or OT will accompany you.  Take it slow.  Breathe.  Be honest about communicating when you've had enough or if you're scared.  I tend to be someone to bite off more than I can chew, but there were a few times I could not meet their suggested distance.  It was okay. There were other times I was able to do more than they asked, so it all balanced out.  Soon you'll be back to running marathons.  Or at least, I don't know, walking to the freezer in your kitchen for ice cream without help.


So those are the main things that came to mind.  If you have questions about other aspects of the hospital stay, let me know and I can try to address it.

As I said at the start of the post, I will add a list of resources on stress management.  I will also add some basic pointers right here so if you don't feel like looking at other websites or apps you don't need to.

Stress Management 101
Stress is your body's reaction to perceived danger.  It's the fight or flight syndrome.
How it works in a nutshell is that your brain perceives danger, and reacts by activating the sympathetic nervous system, which prepares your body for fight or flight.  This is survival mode, so the things that are needed most for survival are hyper-awareness and muscles-at-the-ready to fight or to run.  Your heart prepares by beating faster, your digestive system prepares by closing up shop.
This is all great, and serves us well, but the problem is that on a primal level, we don't really know the difference of danger as in, a lion is about to pounce on us, or danger as in, I never paid my electric bill and I'm afraid my power will get shut off, or danger as in,  I'm scared because a surgeon is about to cut me open.  Stress is stress is stress as far as our body is concerned.
So that means regardless of the stressor, our body will react by sending adrenaline and cortisol coursing through our system, and we will be left dealing with a jackhammer heart, racing thoughts, and rapid breathing, even if there is no big hairy lion for miles.

So stress management, then - quite simply - is learning to manage our stress.  We have to let the brain overrule the body as to whether or not we are actually in immediate danger.

With me so far?

So to combat that rapid breathing?  Nice, slow, deep breaths.
To counteract the hyper-awareness? Mindfulness.
To alleviate the tension in your muscles? Muscle relaxation.

I will summarize each of these three things very briefly, and provide links in case you want to learn more.

Pursed-lip breathing is a way to get your breathing under control by filling and then emptying your lungs with nice deep breaths, to break the pattern of the rapid breathing,  To do this, just breathe in deeply through your nose like you're sniffing a flower, to the count of 2, then exhale through pursed lips like you're blowing out a candle, to the count of 4.  Repeat.  And repeat and repeat.

Mindfulness is the opposite of being hyper-aware and having racing thoughts.  It is being hyper-focused on the here and now.  Go through your senses one by one.  What do you see, smell, feel, hear?  Not just a cursory inventory, but really immerse yourself in each, one by one.  A helpful acronym here is STOP:
S is for Stop.  Stop the roller-coaster of thoughts and emotions.
T is for Take a breath.
O is for Observe.  Observe everything around you, but not in a racy-racy way.  In a thinky-thinky way.
P is for Perceive.  How do the things you're observing impact you?

If you're too geared up or just feel too unpracticed in mindfulness, there are some shortcuts you can take to counteract the physical effects of stress:
Listen to calming music
Look at pictures or artwork or videos (like a clip of ocean waves) that soothe you
Segmental relaxation: starting at your toes and working up to head/neck/face, squeeze a muscle group tight-tight-tight, hold, and then release.  Feel the heaviness of the muscle groups.
Prayer
Guided imagery: think of a place that is very relaxing to you (for me it's the ocean).  Close your eyes and picture yourself there.  Then use a modified mindfulness technique, by going through the senses to more deeply recall that place.  What do you see, hear, feel, smell?

So that's the basics, and you can do pretty much all of it with just mind and body, no apps required.  But if you want to learn more, or have some music clips to choose from or meditation guides, here are a few things you can check out.  My personal favorite is the app Calm.

General info:
Web MD
Mayo Clinic
American Heart Association

Books:
Why Zebras Don't Get Ulcers
The Relaxation and Stress Reduction Workbook

Apps:
Headspace
Calm

That's it for now, folks!  This was a lot of information.  My next post will be a brief one that will just focus on some products and tips that could make your life easier/more comfortable during your hospital stay.  See you then!


*PS: I'm now realizing I need to clarify something.  As far as having a support person, I DID have one.  My amazing baby sister Veronica.  She drove me to the hospital and we took the shuttle bus over, and found our registration area/waiting room.  I think they did not allow her back to rejoin me after the initial pre-op prep was done, but I'm hazy on that.  I know that they allowed her to visit with me for about 15 minutes once they settled me in the ICU, but I don't have any recollection of that.  She tells me I was able to nod and squeeze her hand.  I'll have to take her word for it.  And she took the ICU photos (at my earlier request).  After the 15 minutes, they sent her on her way, and from that point on I was not allowed any visitors.  She was also my "liaison" that kept all my peeps updated on how I was doing.  Her help and support were immeasurable.  Thank you, Ron!