Recovery from Major Surgery Requires Gumption

John J. Hohn, Writer

#by-passsurgery  #heartattack  #convalesces #cardiac

Recovery from major surgery is a drawn out process. Depending on the patient’s age and physical condition, it can take months. The body has absorbed a tremendous shock, especially with highly invasive procedures like coronary bypass surgery, joint replacement, or organ transplant. The patient’s strength is depleted. Muscles that worked just fine prior to surgery are sluggish and weak. Fatigue haunts every waking moment. It can feel like a draining away of the soul.

While philosophers for centuries have labored a definition of the human soul, one this is certain. The soul in all living things is the intangible force that holds the body in a state-of-being called life. The weakness and fatigue that overtakes one during recovery from major surgery depletes the spirit. The lack of vitality is in itself painful. It affects a person emotionally and spiritually.

Of course the implications are a bit ponderous. Vigor inevitably declines with age. Older people are not less soulful for it. The opposite is more often true. Our elders have usually have a more detached perspective on life and are wiser for it. Yet given what is optimal at any age against what is actual can still be a measure of soulfulness. Older folks are often described as sprightly and alert. More soulful, in other words. Against what could be the standard for their age, they weigh in at top form. It’s a relative scale, but the message is clear. Maintaining vitality at optimal levels is caring for the soul just as slothfulness and gluttony disgrace it. The ancients included both in the listing of capital sins for a reason.

Not to strike too moralistic a note, the message is care for yourself. You’re the only you you’ve got. There’s no new you coming down the line as some kind of scintillating persona that will slide into place like a perfect fitting overcoat. There’s no old you that you will return to at some time in the future. The very idea is an oxymoron. This ain’t no rehearsal, this life. Being oneself implies caring for oneself. Caring implies liking who you are. If don’t like who you are, seek professional help. Good things rarely happen to people who do not like themselves.

Good Physical Condition . . .

The Grim Reaper

But back to anesthesia and recovery from major surgery. Current practice is to get the patient sitting up and walking as soon as possible to prevent blood clots or an embolism. Being in good physical condition going into surgery helps immensely. For one thing, patients are advised not to use their arms rising from a sitting position as it puts a strain on the sutures. Consequently, good leg strength makes rising much easier. The patient who routinely completes a set of deep knee bends or squats will do much better than those who do not. The patient who has does sit-ups or ab crunches will do better also. Good muscle tone speeds healing. The hangover effects of anesthesia and the side effects of pain pills diminish one’s capacity. Thus the degree of overall fitness is a major factor in performing the required tasks in the first 72 hours or more after an operation.

With diminished physical strength and stamina comes the attendant inability to focus sharply on what is happening. As bodily functions come back onto line – urination, bowel movements, and sputum expectoration – the mind slowly comes around. Heart patients, for example, are cautioned against depression. Studies now show that the many nerve channels connecting the heart to the mind have an impact on memory, sensory perception and thought patterns. The patient’s heart is physically manipulated during heart surgery. The impact of this manual intrusion has yet to be measured and understood. But its impact on the patient has been observed and documented. Depression is seen too often to be dismissed.

I, for one, did not experience depression, an old acquaintance of mine. I endured several painful episodes as a young man. I know firsthand how it can distort perception and foul up the thinking process. I resolved long ago to make the opposite choice if presented with a depressing thought or mood swing. All that happened to me, like a flash on a screen, was the image of me holding a gun to my head. It came a went in a nano second. I did not want to  dwell on it or ask myself what it meant. Nothing I recall prompted the image. Nothing in my thoughts triggered it. Over the years, I have grown to respect, and sometimes fear, my imagination. Images pop into mind as if by magic. I don’t need to be in deep sleep to dream. That facility has helped me a writer. It has also made recovery from depression or other self-defeating mindsets all the more difficult. Over the years, I have learned  to intervene aggressively when my imagination wanders off into unhealthy territory.

On the Prowl at All Times . . .

Depression is on the prowl at all times. One of the better ways to fight it is to become physically active. Go for a long, fast walk. Run a couple of miles. Get on the bike or treadmill. But do something! The problem, of course, is the convalescent can’t do any of these things. Instead it takes mental strength and alacrity to defeat it.

Pain is subjective. Nurses use this scale of help patients be more clear.

Recovery brings on two kinds of pain. The first is the spike of pain that feels like dagger stuck into a vital area and it can hurt like the devil. This kind of pain can be managed quite effectively with pain pills. The other kind of pain is a heavy dullness that invades the body and weighs down every limb. It is the pain of Sisyphus, the Greek mythological figure who is doomed to roll a monstrous boulder up the steep incline only to have it roll back on him as soon as he nears the peak. The pain of Sisyphus is in a patient’s first attempt to sit. In the first short walk in the corridor and many similar walks to be repeated day after day until strength is reestablished in the body. The pain of Sisyphus cannot be wished away. Like the boulder it rolls back over one every night and waits to burden the subject the next day almost as severely as the first.

A morning shower is exhausting the first few days in recovery from major surgery. For a couple of weeks my day began with breakfast, a shower, and then a nap because those two mundane activities exhausted me. The fatigued patient is the host depression seeks. With no reserve, let alone the mental discipline, to fight it off, depression gains easy access. Further, the mind is awakening to the thought that the grim reaper is at hand. Death feels more realistic. Denial just doesn’t work as it may have in the past. Fear, or at least an anxiousness, takes over serving as advance scouts for depression. Anxiety predisposes the patient to an onset of futility and a sense that life is not going to work out to be much after all. Time is running out on the some days when this or that would be achieved. Unfinished business and unresolved conflicts with loved ones stack up as indictments. They will stand as they are forever. It’s useless to plead understanding and forgiveness. No reprieve.

A Spirit Less Willing . . .

So it is that recovery from major surgery requires gumption and commitment when the spirit is less willing. The worst thing a patient can do is surrender to the fatigue, the weight of Sisyphus, and not try. ”Do everything they tell you,” a friend of mine who had gone through bypass surgery wrote. “There’s no easy way.” I took his advice. I may have fudged a little bit this day or that, but I set goals for myself. At first, I wanted to walk to my neighbor’s house and back, a distance of about 150 yards. Once I achieved that, I set a new destination and continued until in a short while I could walk for 25 to 30 minutes without getting so tired that I needed to stop. I plan to keep challenging myself.

Hospitals want to send patients home as soon as possible. I was discharged three days after my surgery. I welcomed being back at home but found breathing was too difficult if I took to my bed. My recliner allowed me to sit somewhat upright, as I had in the hospital, and comfortable enough to drift off. After a couple of weeks, I found that I could spend half the night in bed and half the night in the recliner. Again, challenging myself to get back to normal as soon as possible helped me move along. I came off pain pills as quickly as I could, within a day or two or returning home.

August 4 marked the third month anniversary for my triple bypass. My recovery from major surgery is nearly complete. I spend the entire night in my bed. I walk at least twenty minutes every day, sometimes twice, and have begun my workouts at the gym using lighter weights – all with the mind of trying to get back to as healthy as I can be at age 76. Knowing others have survived for fifteen, twenty or even more years after bypass surgery spurs me on. I want my body to be strong. I want my spirit to be strong. I want to be a wise, loving, productive, thoughtful senior and I am happiest when I am doing things that serve those goals.

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