Tag Archives: anxiety

Prepping for Surgery and a sense of the absurd

anesthesia

I know I’ve been quiet for a while. Seems like time got away from me, and a severe case of writer’s block apparently required surgical interventions or at least the threat of them to budge.

Surgery is a funny thing. I don’t mean funny “Haha,” but funny peculiar. Think about it. In order to fix something in our body, someone with letters after their name and hopefully a lot of impressive training is going to actually injure and go poking around inside what is generally supposed to be a closed and intact system. Now, I’m not knocking medical procedures. We’ve accomplished some astounding things, and it seems like every day they are improving the methods to prevent complications. Modern surgery and the accomplishments thereof are a far cry from the near butchery of the antecedents. Still, I wait with great impatience for the days when I can take a pill and grow a new kidney (or any other organ for that matter… Points to the people who get the reference).

And yet… there are parts of the process that still cause me to ponder, ruminate, become anxious, and aye, even cause me to shake my head with humor and irony. If you haven’t yet figured it out, I’m no stranger to the surgical theater. Due to a number of genetic quirks and other accidents, I’ve been the recipient of quite a number of procedures, mostly to my skull… No, they still haven’t found that brain they have been seeking. All the operations in question were to my jaws and dental structures. In fact, after one surgical procedure, I could walk through a metal detector stark naked and set it off. I quite enjoy to this day the look on the faces of x-ray technicians when they see the odd collections of wire embedded in my jaw hinges. But, I digress… I do that a lot, which is why this blog even exists, when we come down to it. If my brain always stayed on an expected track with normal and logical thought processes and zero tangential traipses through the ether, none of this rambling nonsense would be out there.

The interesting part of all the surgical curiosity is the instructions that the patients are given before (and after) the processes to insure the best possible outcome. Honestly, even understanding the reasons behind the directives does not always alleviate my perpetual ruminative escapades. Without fail, my mind will wander about after reading or hearing specific instruction and think about various aspects including what would happen if one didn’t actually follow the directions given. This last bit is frequently not really a good idea if one is, in fact, the patient. While I have been privy to a number of surgeries and recovery wards as observer or clinician, my imagination can still become quite creative enough to depict scenarios that are not only completely unrealistic, they would put the best of the horror directors to shame. So, as I said, not the best mental occupation for the intended target… I mean subject of the surgeon’s skill.

What brought on this recent rambling through my cranium is, as you might have surmised, that I am once again going under the knife. Nothing terribly serious, but as they do say there are inherent risks with all surgical procedures. It is another oral surgery, and I’ve become, after nearly three decades of experience with this form of intervention, somewhat inured to the general angst… but not entirely immune. I will occasionally and inexplicably have bouts of anxiety that are only relieved by contrarily imagining the worst possible situations and outcomes and making a complete farce of the whole ritual of instruction. Today, for instance, I receive the call (Like ya do) from the surgeon’s office reminding me of my appointed time and confirming that I had not left the state, country, or planet accidentally. I assured them that I was Earthbound and in the near vicinity still. As the caller was about to ring off, I asked if there were any instructions. To which, the lady gave me the usual “Nothing to eat or drink 6-8 hours before. Wear short sleeves. Bring someone to drive you and all your money.” Ok, I might have exaggerated the “all your money bit.” I think they only want most of it. Honestly, health costs in America… but I digress… again. I’m just a digressing fool today.

Anyhow, the caller ended the conversation at that point, and left me to my usual mental calisthenics about all of the foregoing… and of course the impending doom. I was so caught up in all of it that my usual morning conversation with my friend was the recipient of the overflow. I expressed to him that the worst part (aside from the monetary extortion) was that part about not eating or drinking. This is normally not a problem for me. It would be unlikely that I am imbibing or participating in a repast after midnight, but now… I will be thirsty as hell at 3:00AM. It’s true, and totally psychological. I consume more than enough liquid to keep myself hydrated (water, of course… a woman cannot survive by coffee alone, but without the blessed bean everyone else might die), but because someone told me I could not have anything to wet my whistle after the appointed hour, I will develop cotton mouth that would make the Mojave look like a lush oasis. Additionally, the eating thing… I’ve been in an appetite lull for a few weeks. That is the pendulum swing from the periods of time when I can’t seem to sate the empty cavern of my gut and want to eat ALL THE THINGS. For whatever reason, I just haven’t really been neck deep in the trough. I continue to eat small meals and snacks and consume protein shakes in an attempt to keep the energy stores going, fuel the physical machine, and avoid metabolism shut down, but otherwise… meh, just not that hungry. However… now, because I have been told I am forbidden to eat after midnight, I will very probably become quite ravenous at 12:01AM and nothing will do but to eat an entire wildebeest. Maybe it isn’t surgery that is so odd. It might actually be the perversity of my own mental nature. Nah! Surely that cannot be it…

On top of all the cogitating about the instructions for all good patients, I also, due to my years of experience, know what to expect in the aftermath. Again, this is where we have advanced beautifully from days gone by when I would have been laid up for hours or days in recovery and med-surge units while the anesthesia worked its way slowly from my system, groggy, nauseous, and grievously hung over (I usually try to reserve that for New Year’s Day). Now, the modern cocktail they use wears off very quickly with very few lasting effects. There is one, however, and it is a doozy. Because this is, as I said, oral surgery, one of the things they use is atropine. For those who don’t know, atropine dehydrates. In other words, it dries up everything. This makes it more convenient for people trying to deal with any and all things inside the saliva factory that is the human mouth. The natural consequence of using this tool is that there is a rebound effect when it wears off. It rather seems like everything on your face (and sometimes the rest of your body) is trying to liquefy or melt. Combine this with the local anesthesia that they use, and voila, snotty, drooling, tearful mess… I feel like a toddler left for the first time at daycare. On top of that, I cannot actually feel from my nose to my chin and so all attempts clean up aisle 4 are rather like Gumby trying to wipe the nose of a latex Richard Nixon Halloween mask. Super sexy, right?

And just like that… sense of the ridiculous appears to be my saving grace from rising anxiety levels. It is just virtually impossible to be scared of something that turns me into Tim Conway’s dentist routine or my own one-woman sitcom. See ya in the aftermath…

Confessions of the Over-utilized, Queen of the List-makers

I have a confession. I have a touch of the obsessive-compulsive traits. Most of the people who know me are now screaming out, “A touch?!?” Yes, a touch. I know that it is just a touch because I don’t break out in hives walking in my own very messy house. I can actually reside with the man I married who never seems to notice the clutter that to me looks like an audition for an episode of Hoarders. Also, as a psychologist, I know I don’t actually meet the criteria. I don’t have rigid rituals or counting or irrational unbidden thoughts of doom if I don’t complete those rituals.
So, I don’t have the full blown disorder, and while I am a control freak of the highest honor, I am not going to melt down if someone goes through the house making every picture crooked. No, that is not a challenge! However, in the last year or so, I have developed at least one ritual that intrigues and even concerns me a bit, if I’m completely honest with myself.

I’ve started making lists. I don’t mean the shopping list, or the going-to-the-store-don’t-want-to-forget-the-one-thing-I-actually-needed list. I mean lists for tasks, lists for packing, lists for work, for after work, for vacation, lists for the day, the week, the next trip, and the next six months. Yeah, I admit it. I’m a little worried. At one point, it was genuinely just a way for me to make sure I didn’t forget to do important things, especially during the health crisis of the last year. However… it has become something more.

It may be that my life has quite literally developed way more irons in the fire than any one person can technically manage. On any given day, I have too many tasks, too many things to worry about, and way too many places I’m supposed to be at any given time. I know this. And, it most definitely calls to mind other articles I’ve read and advice from other people about simplifying my life and learning to say “No,” but that might be a bit advanced for me at this point. The overall outcome to the plate spinning and balls in the air is that I’m always afraid that they are going to all come crashing to the ground in a gloriously, unholy mess. The result is that I get anxious, very anxious… occasionally finding myself holding my breath without realizing it. I do all the normal, healthy things for this. I use my belly breathing techniques that I use with trauma victims and clients with anxiety. I use the yoga and mindfulness techniques that I have learned from Mary NurrieStearns (awesome lady, by the way). I focus on my breathing and the sensation of my feet on the floor and my ass in my chair… and it works… for approximately 10 minutes. It isn’t that the techniques aren’t good. It is that my brain is ruminating and still processing all the things that I need to do, and it is in a muddle and swirling around, and very unlike the clouds passing (Another Mary technique), they buzz around in my head like a swarm of angry yellow jackets.

So, I succumb to what has become my most reliable coping mechanism. I start making lists. Like magic, the anxiety dissipates. Now, in this world of technology, smart phones, personal planners, smart watches, electronic assistants (Siri hates me), wearable technology, and every other means of keeping us on time for our very busy lives, you would probably think that I’ve got it all on my phone ready to notify me of every upcoming meeting and missed appointment. Nope. Not this time.

Our electronic babysitters are actually contributing factors in my occasionally overwhelming angst. My phone pings, my computer pings, my alarms go off… hell, the car even yells at me for seatbelts and fuel. The point being? I fluctuate between tuning out the pings, beeps, pongs, and boits… OR I jump out of my hide for every blessed one of them. Either way, it isn’t particularly helpful to my anxiety levels, stress, or me actually not forgetting any of my obligations. There is also something just amazingly therapeutic to writing out a list of things that have to be done and crossing them off… sometimes like Zoro with a rapier! It helps to write my tasks out where I can see them. It takes them out of the buzzing cloud in my head and makes them physically present in the world in front of me. I can actually look at them and assign different priorities or deadlines. When I actually do the task, I can cross it out, or I can erase it on a dry erase. (But I have to tell you, there is something much more satisfying about crossing it out.) My typical habit is to start out the week with a list of tasks. Some of them are actually tasks that I do every single week, and technically, I shouldn’t need to write them down to remember them. They are almost habit, but I put them on the list first thing on Monday morning anyway. Throughout the week I cross accomplished ones off, and others get added as fires crop up to be addressed in my work/life balance. When I get to the end of the week and there are a few tasks still there, they move to the top of the list for the next week and so it goes.

Maybe it isn’t so bad. So far, I haven’t gotten into the quagmire of ruminating and circling the same tasks that rotate from week to week without ever being crossed off. It works for me… so far. It helps me stave off the overwhelming urge to run away and join the circus… so far. It hasn’t let me forget anything really important… so far.

So far… so good. I guess I will go ahead and accept my coronation as Queen of the List-Makers.

 

Monster Spray: For Things that Go ‘Bump’ in Your Life

www.gocomics.com/9chickweedlane/2005/11/05
9 Chickweed Lane

Many people talk about being an optimist or a pessimist. They talk about drinking vessels with various descriptions of their contents as an assessment of being one of these. I’ve tried my hand at optimism, and I have been accused of being a pessimist; but in truth, I prefer to think of myself as a realist. I try not to expect the worst. I always try for the best outcomes, but I prepare myself for negative outcomes because I just want to have a fallback plan. Does that make me the harbinger of gloom and doom? Am I a Negative Nelly? I hope not. I certainly do not want to be.

In the course of human experience, I have found that my involuntary, sometimes unconscious response to events in my life, positive or negative, is to expect the worst and take what I get. If things turn out to justify my expectations, I’m never pleased with the results, but I use the outcomes to reformulate a plan to address the situation from a different approach. If things turn out better than I expect, I am relieved or elated. I worry that this approach is more negative than I would prefer, and knowing that negativity can actually serve as self-fulfilling prophecies in a neurolinguistic way, I have spent much effort attempting to change my way of thinking. The best I’ve been able to accomplish so far is to take a neutral stance in my expectations without giving bias to my fears or my wishes. It doesn’t work 100% of the time, though. I still find myself frequently looking over my shoulder and waiting for that alternate piece of footwear.

This is where that “expect the worst and take what you get” philosophy has really been the biggest detriment to my own peace of mind and happiness. While there may be some logical premise in expecting a negative outcome so that I am not surprised or disappointed, the side effect of this attitude is that I am not always able to relax and enjoy the positives that occur.

Perhaps it is a holdover from years of childhood superstitions and folk wisdom that became so ingrained that I cannot seem to shake off their lessons. Perhaps it is a result of traumatic experiences that have indelibly written their warnings on my memory to never get too comfortable with the good times of my life. No matter what the etiology, I find myself (like many others) when things are going too well looking under the bed for the monster, around the corner for the mugger, or over my head for the anvil. I know that I am not alone in this particular human frailty. There are many of us who cannot seem to enjoy life when it seems to travel smoothly avoiding the usual potholes that liter the road. It almost seems that we are tempting or cheating fate when all the stars and planets align to make the path we tread a bit too gentle and pleasant. We expect that other shoe to fall from the sky and squash us like a bug under one colossal heel.

I think it boils down to Maslow’s Pyramid of Needs. Anxiety generally stems in some part from the lack of these needs being met. The first tier is the basic needs that each person has for living, in other words biological necessities. The second tier is safety, shelter, and access to resources. People who have threats to meeting these basic of all needs have no energy to expend on other tiers, which involve things like social interaction, belonging, and achievement. For people who have experienced these threats and overcome them, the fear of falling back to that level is sometimes so real that it is difficult to shake off the constant thought that at any time, all could be lost. For others, the fear of losing the respect and love of family or other social supports may be as overwhelming as the idea of wondering where the next breath or morsel of food might be obtained. We fear being defined by our mistakes with the tarnish of failure marking not only ourselves but anyone with whom our lives might be linked.

What it all boils down to is that regardless of what tier we manage to attain, most of us never reach the pinnacle of self-actualization (especially in the current economic and social climates) because like toddlers struggling with learning to walk presented with a staircase, we cling to our highest achieved step looking down with fear that we will plummet back to the bottom. Any rock climber will tell you, “Don’t look down!” To ascend to the top, it is important to keep eyes on your goal, not where you have been. It is easier said than done. The fear of failing, falling, and losing the tenuous ground we have worked so hard to achieve keeps us from risking whatever progress we have been able to attain, but it traps us in the lowest levels of mere existence.

For some, this can become a debilitating depression or anxiety that paralyzes action and activity, isolating us from friends and family or making us such a misery to ourselves that we even shun the company that misery always loves. I have often wondered why this trait plagues some more than others, or if there is some way to inoculate our psyches against such attacks as you might vaccinate yourself against epidemic illnesses prior to a trip to undeveloped territories. Why shouldn’t we have monster spray to ward of the evil unknown lurking in the closet of anxiety? Why can’t we arm ourselves with the Acme Anvil Umbrella (which also protects against falling foot fashions)?

So much of what happens in our lives is a matter of choice. I am not necessarily saying that we choose everything that happens within our experience, but I am saying that choice has a much bigger part in how we approach the life we live than we might realize. This isn’t a philosophy welcomed by many. If life is a choice, then we have to take responsibility for the bad that happens in our lives as well as for the good. Too many of us get caught in the trap of relegating the responsibility for the bad stuff happening to us to the realm of evil or other people who carry out the evil. That is why I have avoided even using the phrase “happens to us”; it implies an external locus of control and puts all the responsibility outside of ourselves. The contradictory part of the philosophy, for me, is that the same people who talk about things happening to them will usually be the first to claim the victory and success in their own actions. Now, before some of my readers start calling “foul,” I know that there are people who attribute all success and goodness in their lives to their higher power. That is very generous of them, and it shows an element of piety that precludes pride. However, I still think that is giving over to an external locus of control that does no honor to human spirit and dignity, and yes, even to the higher power to which you ascribe merit but deny the free will given to humanity by same. For without free will, what is piety and goodness. If it is not by choice, where lies the merit. However, I did not intend to go off on a religious or metaphysical tangent. So, I will try again…

We live by our choices. Consciously or unconsciously, it is true. By saying this, I am not (with intentional emphasis) saying that we choose the negative aspects of our life or the occurrences that impact us in less than positive ways. Our choices are limited to our own responses and actions. We cannot choose for others (with the exception of the relatively brief period of parenthood or some aspects of other types of guardianship and political decisions). We cannot choose the behaviors of others or how they will treat us, but we do have the choice in how we respond, react, and behave.

Our lives are a series of choices that we make. While there are contributions of physical and biological directives that compel some of the actions that we take, we are unlike the rest of the animal kingdom in the development of a prefrontal cortex in our brains that provide us the cognitive benefit of decision. We can decide, maybe not so much what occurs by the choices of others, but we have the power to choose our own emotional and behavioral responses. This may not seem like much of a superpower to some, but it’s is one of those “sleeper” powers that have more impact than you realize. If you believe in evil or a spirit of antagonism, the inability for those choosing to act against us to impact our spirit, will, and emotions greatly reduces their powers.

So back to those monsters and shoes and such… We do have a built-in monster bane that we just need to activate: The power of our choices. We may not be able to entirely dismiss the monster under the bed, but we have the choice of whether we allow it to prevent us from taking actions of our own. We have the choice of whether to allow the fear of loss or failure to paralyze us. I think that I will start making some active choices in my life about how I respond and what (and who) I allow in my life to impact my emotions and self-concept. Will I be free of the monsters and anvils, probably not, but I can try to reduce their perceived control.

9 Chickweed Lane is a daily comic strip by Brooke McEldowney. It can be found at http://www.gocomics.com/9chickweedlane