Like a Fish Out of Water; Surgery and the Hospital Outside the Psych Ward

Well, it’s happened. I’ve made it through my hysterectomy slash bowel-resection surgery and in hindsight it appears that having an exploratory surgery a month previous to this one gave both my doctors and myself the opportunity to work all the kinks out before tackling the more serious subject of my bowel being invaded by endometrial tissue.

The two weeks leading up to surgery were torturous and the overwhelming amount of anxiety I was feeling about the aftermath led me to skirt around the fringes of paranoia when it began to escalate.

Generally for me, paranoia tends to take the form of the belief that someone is trying to kill and/or undermine me in some way. My paranoia stemmed not from the surgery itself but from the 5-7 days I was expected to spend in the hospital recovering after surgery.

I had never spent time in a hospital –that is to say, I have never spent time in the hospital, save the psychiatric ward. Trying to fend for myself in a psychiatric ward (and by that I mean communicate properly with my doctors and nurses about my particular medication sensitivities and the odd tendencies of some of my psychiatric symptoms) has often led to both a communication breakdown and further exacerbation of whatever unfortunate mental state that landed me there in the first place. This is an issue I’ve had with many regular doctors as well, so the idea of being drugged (or asleep) in a hospital bed and at the mercy of whoever was on duty that shift frankly scared the hell out of me.

To offset my crippling fear of facing (another) abusive nurse or another medication slip up (as happened with my last surgery) I spent the week leading up to surgery generally huddled in my apartment making list after list of instructions, drugs to avoid, people to contact in the event of psychosis or mania induced by medications, etc. followed by lists about each of the lists, color coded and copied several times over to be available on my bedside table.

Though I found this slightly soothing, there was still an extraordinary amount of fear. What would happen if I had to share a hospital room with a stranger? Would my PTSD land me in a situation where I became manic or psychotic -as it has several times in the past? And what about if I did become manic or psychotic, how would the hospital staff respond to that? The hospital I was to have surgery at doesn’t have a psychiatric unit, so I was baffled at what might take place if I needed one.

A touchy subject for me, given my history of difficult hospitalizations and abuse in hospitals. Thankfully it was not one I needed to explore, because after speaking at length with my surgeons and anesthesia team on surgery day we made a quick decision that allowed me to bypass the use of narcotic pain killers almost entirely. I opted instead to receive an epidural, which numbed my body from my waist to my knees, rendering the use of the narcotics (that have proven to be big time triggers for me in the past) unnecessary.

So not only was I not triggered by the narcotics, I did not require much medication for nausea (also a trigger for me) since I was without the narcotics. I was able to be put in a private room (given my mental health history and luck regarding room availability) and since I only had to take a small fraction of the drugs I would have otherwise, I was generally alert and able to communicate with the staff more easily regarding my drug allergies and (psych) medication needs. My alertness definitely helped ease my concerns in the area of paranoia… though I did wake up once or twice in the middle of the night certain that the balloons next to my bed were up to no good.

Actually, the bigger problem (in terms of my mental health) in the hospital was the fact that my vitals were being taken every hour over night, so I was not able to get more than 45-50 minutes of sleep at a time. Sleep disruption can also be a trigger for me (both in terms of mania and depression) so I opted to get home from the hospital as soon as humanly possible.

Generally speaking, the staff in the regular part of the hospital were much more kind and eager to listen than those I have met in the psych wards in the hospitals I have been to. I feel very lucky that they treated me respectfully and did not discount my concerns merely because I have a mental illness, something that unfortunately is a serious issue in many psychiatric units today.

I definitely can’t say that I went the four days in the hospital without any mood swings at all, but they were generally depressive waves… much more easily managed laying around in a bed all day than mania. In the last week I’ve been home they have definitely been increasing in frequency and severity, but I am hopeful that being able to finally diversify my meals a little bit and spending more time without intense pain (rather than with it) will help tip the emotional scales back in my favor.

All in all, I would say that the surgery and hospital time went better than I expected. There were no incidences with bad medication reactions, or particularly volatile interactions with the staff (ok, maybe one), and it felt like a totally different experience when my doctors made everyone else adhere to my psychiatric and physical particulars.

The difference this time around surely came from one of my surgeons having had a foster daughter with bipolar disorder. He has a first hand experience seeing the sorts of episodes and behavior that can be triggered (for me at least) by many medications, among other things, and there is no doubt in my mind that this led to him directly telling the staff to take my concerns very seriously. Frankly, he seemed just as concerned about triggering me as I was, which is how I imagine (in a perfect world) healthcare professionals should act!

Anyway, I am glad to be home.

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6 responses to “Like a Fish Out of Water; Surgery and the Hospital Outside the Psych Ward

  1. Although I am enormously pleased to hear that you had a comparatively good experience this time, I’m not sure I have the words to express my feelings regarding the fact that you found a “medical” trip to hospital more conducive to your mental health than a trip to the psych ward. Surely a psychiatric ward and/or hospital should be far better-equipped to help mitigate psychiatric problems, and to support patients suffering from such, than a run-of-the-mill medical facility…. I suppose it just goes to show you, it’s about the people in any given situation. That’s what I’m taking away from this, anyway. Does that fit your experience?

    Again, and more importantly, I am glad everything went so well. Best of luck for a speedy recovery, and the cessation (or at least steady improvement!) of all the issues this surgery is meant to correct. It sounds like you’ve been having a truly rotten time of it… ain’t nobody got time for that.

    Amanda 🙂

    • I would say the biggest difference I saw between a hospital stay in a general hospital vs. a psychiatric hospital is the way the staff interacts with the patients. I can completely understand that those working in a psychiatric facility work hard to enforce certain rules and models meant to keep patients and staff safe, both from other patients and themselves. For example, most psych hospitals I have encountered will not allow a patient to close the door to his or her room… and though this makes sense in terms of allowing staff to keep an eye on all patients, being subject to constant ambient noise and feeling afraid that someone will walk in at any moment without my consent are both huge triggers for me. These details alone are capable of negating potential “positives” I might be gaining there or prolonging my psychiatric turmoil.

      Likewise, the psychiatric facilities I have experienced also contain staff that act under the notion that patients are lying or hiding something, often based solely on their mental health history and the fact that they are in the hospital in the first place. In this sense, patients are guilty until proven innocent.

      In the general hospital the need for security was much more lax, and something as simple as being able to have the door to my room shut during the day helped keep me from becoming agitated. Patients in a general hospital setting are also considered to be within the confines of the hospital for reasons out of their hands (not always true in a psych ward despite the notion that “mental illness” is an illness) and there seems to be no need for scrutinizing every small detail; patients in the general hospital setting are innocent until proven guilty.

      (Well, that’s my own theory anyway based on my experiences.)

      Having said that, I did have to go to a regular hospital ER before my last psych hospitalization and was basically put into lockdown. I was locked in a room with a nurse for over 24 hours until they could transfer me to the proper facility. In times of crisis it seems attitudes and methods defer back to a basic setting in all facilities. As often as I have told myself, “ah, well this is probably for my own good,” it hasn’t improved how rotten it feels to be treated relatively inhumanly. The system could definitely use some work, but finding absolutes that apply to every situation might mean over-security for some, and under-security for others.

      Sorry for the long reply, but it is a topic that gets my gears going a bit… I think about this a lot. Thanks for your comment!

  2. I am glad to hear that you have navigated this challenge with minimal hardship. More importantly it is great to hear that your mental health remained stable and that you had an overall positive experience.

    Continue to take care of yourself and I look forward to more posts!

  3. What irony to read this wonderful post the week before I have to be admitted to the hospital for surgery. Like you I haven’t spent much time in hospitals, and indeed my last hospitalization was on an inpatient psych unit. I’m stable now but can’t help worrying if they’ll screw up my psych meds, if the narcotics will trigger me, if the experience will throw me off kilter. Thank you for sharing this. I’m glad you were well taken care of and that your intestinal issues are at an end. 🙂

  4. glad to hear from you again. I hope improved physical health can help lead to improved mental health for you. Happy thoughts.

  5. I recently had similar surgery and a surprisingly similar experience. I’m glad you had sensitive care and were able to avoid major triggers. I know I have struggled to get back to well-being and balance as the narcotics they gave me pushed me into a small depressive window so I’m relieved you didn’t go through that. Glad you are on the mend and wishing you the best of luck!

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