Preparing for Surgery

Surgery is on your (or loved one) horizon.  How to prepare?

Because we are complex, whole people, this is a layered question.  There is the practical outer aspects of preparing and there is the internal aspect (in my mind, also practical).  Whereas every surgery is unique and every person approaching it is unique, there are some universal commonalities.

Anxiety.  Everyone has some degree of anxiety.  Anxiety is promoted by tension, which usually turns to fear which unfolds into streams of negativity.  Finding ways to manage one's anxiety and negativity/fear is key.  Manage is the operating word, because it is only human to have intrepidation moving into the unknown of what will be.  Practically, information gather with gusto.  Find out everything you can about your condition, the nuts and bolts of your surgery including expected anesthesia, the rehabilitation anticipated and the process.  Because of the ACA (Affordable Care Act), it is mandatory for doctors, hospitals and their staff to fully educate their patients on their medical conditions.  There are negative consequences for MDs that don't do this, that don't follow up, or monitor their patient's aftermath from hospitalization (they won't get paid for re-admissions and are accountable to some extent for hospital acquired infections).  Be pro-active, be interested, curious and knowledgeable.  Knowledge is power.  A knowledgeable patient is empowered and that puts you in a strong place entering a vulnerable situation.  With your best inquiring self in place, ask a lot of questions. Keep asking them until you are fully satisfied.  Ignore the huffy healthcare person that is rebuffed or contemptuous of these questions.  Questions help build relationship with healthcare people.  It does not empower or become you to be passive.  If this is difficult for you not to do, good.  It's a challenge to your personal status quo, one you should have challenged a long time ago.  Still, it would be helpful to have an advocate (loved one, family, friend, wellness coach) to saddle up to you through this fact finding mission.  Keep a journal or log of doctor visits, information gathered, thoughts, feelings, experiences with healthcare people.  Practitioners that are deleterious, note and figure how to remedy.  A certain nurse you sense is disinterested, cuts you off, is impatient?  Get another one.  You can ask for this and you can say why.  You want to situate yourself in the best possible position mentally and physically as you can.  So write everything down, chronicle your journey (the good and the bad) and make sure you feel strongly you are in the best  possible place in yourself and in the best of hands walking into your surgery.  Trusting you are optimally positioned before this event means a much better outcome for you.  Having a lack of trust or relationship with your healthcare providers undermines you deeply and this effects your outcomes and healing.

In this anticipatory process the anxiety will get in the way.  You will keep grasping at providers for handholding, your fears will trip you up.  Whereas, its great to gather information, it will not totally alleviate your anxiety.  You must start taking some steps to support your well being.  If  you don't meditate, figuring out what this is for yourself, giving yourself some alone, quiet time every day where there is stillness and breath.  Read up on affirmations.  There are tons of books out there that lead us into a more positive frame of mind through affirmations.  Some are "hokeyer" than others.  You can only skim through potential titles and content to get a feel of what is right for you.  With practice, you start making your own, framing them in your own lingo that feels best for you.  Start some rituals you do everyday.  Five minutes of creative time every day:  write a poem, keep a small book of sketches or quick water colors. A night time ritual of putting yourself to bed; bathing, lotioning, use essential oils, brush your hair, set the "stage" of your bed:  fresh flowers, a candle, meditation tapes.  These are ways we love ourselves, care for ourselves.  Self touch with intention is healing.  You want to kick in the parasympathetic nervous system, the relaxation response, regularly and potently.  The body's cellular memory remembers this and when given the chance goes there more and more easily with these ritual reminders.  Breathe.  Smell the roses.  Smell the coffee.  Take a lot of time to be with yourself and your pleasures. If you don't want to depend on loved ones and you have the resources, hire a wellness coach.  They can give you specific, useful exercises to ground you in quiet and wellness.  After they get to know you, they tailor everything to you, so you will receive optimal, useful information on the pragmatic details as well as the non.  They are your hand holders, the go-to people when a melt down is imminent.  Hired for a specific time period before through after surgery, it is money well spent.

If you are not a pragmatic person, you probably love someone who is.  Enlist this person as an advocate.  Weeks before, have them sit down with you and figure out a strategy and plan for the practical details leading up to the surgery, rehabilitation and beyond.  If you are pragmatic, you probably love someone who is as well (there are a lot of us around!).  Two heads are better than one.  Figure it out together.  How are you getting to (and returning from) the hospital, is your set up at home adequate for your return (do you need a hospital bed, bed-side commode, grab bars for shower, etc)? Schedule helpful visitors for the first two weeks, people who make meals and don't mind doing a little light housework, errands, grocery shop, etc.  Schedule upbeat, easy-going, happy-go-lucky folks; people who have a good comedy DVD collection, who aren't going to do your spirit ill.  Schedule people who know when to stay and when to leave and whom you don't have to entertain (or necessarily entertain you).  Not feeling well is a good excuse to start saying "No" to everything that doesn't feel right.  People who love you won't take offense and will probably learn to be a little more sensitive in their approach.  The best of these folk will help you find the humor in all the "no-s" and be able to bring some lightness to the cranky periods.

These are practical preparations.  The mental and emotional preparation are often the most challenging and also the most important.  When this is well done, the practical becomes a piece of cake, as you are thinking and feeling with more clarity.  Fear isn't the modus operandi.  Also, in being more clear, a plan B often naturally surfaces, always a good thing.  We plan for the worst, hope for the best....  The better your frame of mind and spirit are, the quicker you will rebound, recover.  This is science.  Find your joie de vivre, your life force, your wish to live and prosper and bring them to the event.  Those who are rarin' to go do their physical therapy first thing in the morning post surgery, are positive.  This positivity saturates their being and wellness is theirs.  Their recovery times will be faster, their pain will be less, their outcomes optimal.  They have their endocrine system working for them and their good energy only supports the healing process (unlike the negative which absolutely undermines it).

An upbeat attitude, a good relationship  to and use of your breath and certain essential oils go far in dealing with pain.  Laying a strategy for yourself in dealing with it is important.  In the first few days, take the pain meds allowed.  Trying to be a hero by not taking them can set you back.  In pain, the relaxation response is impossible.  You want those feel good hormones cascading to support your healing process.  You will have good days and you will have bad ones.  Just keep moving through them as best you can, ask for the help you deserve.  All will be well.

Memory: Portals and Thresholds

The brain is a mysterious organ.  Medical people are the first to admit although they know an iota of its workings, for the most part, it's a mystery.  Why, for example does a historically belligerent psychopath become docile and non-manipulative after sustaining a brain injury?  Reasoning brings us to our anatomy and physiology texts to understand better why damage to one aspect of the brain jump-starts another part, changing personality sometimes in the process. 

There are lots of reasons and speculations behind what happens in the world of Alzheimer or dementia patients.  Those of us with experience working with people with memory challenges do a lot of watching and surmising.  But we really don't know what a person with this type of brain change is going through.  We can speculate, but we don't really know. Understanding that there is an atrophying in the synapses of the brain which impact neuro-transmission is information, but that knowledge does little to support the relationship at hand. Occasionally, there will be a moment when the portal door of their world opens up to the outside and one  sees the terror of their situation (only for a moment).  Something else is required.  In our trying to understand their reality, we can often end up becoming extremely limited in our observations, possibly because it's impossible to have a fixed knowing for ourselves in regards to their reality (and any one's reality if the truth be told).

The fact is, we are breathing the same air, eating the same food, but living extremely different realities (or are we?). As a dear mentor of old used to tell me, "What can you trust?  Most aspects of oneself are wholly unreliable.  But there is usually something which can be relied upon, something one can trust in oneself." Whereas brain function in the memory-challenged is mostly fully unreliable (and getting more so all the time), the experience and understanding the world through the experience of energy can almost always be trusted.  Much like a sense that has been lost, other senses pick up the sensitivity and awareness.  Hearing becomes more acute for the blind, touch and sight becomes acute for the deaf.  Possibly, energy awareness becomes larger when any part of the body loses function, especially mental capacity. Again, it is possible the body circumnavigates its loss into a win of sorts.

Most Chinese temples and ancient abodes  have elevated (about 18 inch) thresholds.  Legend says these raised thresholds were meant to trip up bad spirits from entering the temple. In this day and age this myth might serve to remind us to remember (the best parts of) ourselves as we high-step into the new territory of space.  And like the many maladies that will strike us over a lifetime, loss of  memory is that new space, whether it be our own or somebody else.

Having information or knowledge about the disease process or the function of the brain system is just that, its information.  Unfortunately its not all that helpful in having a relationship with memory challenged people.  Being with someone with memory changes requires another aspect of ourselves other then the part of us that is trying to figure him/her/the expression out, a part that isn't so entrenched in one's own reality.  It's an opportunity to high step it over that threshold and straddle both realities;  my own which I (delusionally) believe to be infallible and an other, seemingly anchored in a suspension of time and place.  Humble meets humanity and there is a breath.

Ego-comfort often demands of us to assume much.  For the ego, it's comforting to imagine what we think another is going through, thinking or feeling.  That is our sentimentality showing through, a type of romanticizing of the condition, probably due to the paradoxically perceived realities-- theirs and ones own.  It's also ego's self-soothing mechanism to believe my reality is somewhat more "real" than a memory-changing other.  The truth is their reality is just as real for them as mine is for me.  I need to find in myself that which can accept this.  Otherwise, energetically I will always read as patronizing to the mentally challenged and that would be an insurmountable obstacle to making a trust relationship with them. When approached energetically, other's manifestation is taken in differently because one's own approach has become different.  One becomes less concerned about cognitively understanding the sometimes startling behavior or pattern of thought ("lack of reason" as ego knows it) and more concerned with meeting the energy field of oneself and the other. 

This idea of seeing another through the momentary portals that materialize, stepping over those high thresholds to meet another requires a willingness to suspend one's entrenched belief in what reality is.
This approach calls for us to be more open, cultivate an intrigue and wonder of what is there, an energetic being who Is and the shared time.  Memory lapses are real, but they become less "the thing" to notice and more the terrain that is tread.  Attention is in the life present, not necessarily the organic manifestation.

Threshold  

By R. S. Thomas
 

I emerge from the mind’s

cave into the worse darkness

outside, where things pass and

the Lord is in none of them.

I have heard the still, small voice

and it was that of the bacteria

demolishing my cosmos. I

have lingered too long on

this threshold, but where can I go?

To look back is to lose the soul

I was leading upwards towards

the light. To look forward? Ah,

what balance is needed at

the edges of such an abyss.

I am alone on the surface

of a turning planet. What

to do but, like Michelangelo’s

Adam, put my hand

out into unknown space,

hoping for the reciprocating touch?

Sleep Tight

Frederic Leighton

My recent post, The Fine Art of Self Soothing, was written primarily with children in mind.  Adults too, struggle through their continuum with rest and especially sleep issues.  This one is for you.

What causes insomnia, wakefulness long past lights-out, broken/interrupted sleep?  Even for those who claim they are great sleepers, there is usually a period of time in life when sleep patterns are not solid.  It could be when raising children and all those middle of the night feedings. It could be middle-age, the changing hormones wreak havoc on your circadian cycle, and we become sensitive to substances and habits that never kept us awake before.  It could be old age when hormones, a sedentary life style, frequent day napping, bladder control problems lead to a brief and unsatisfying night rest.  It could be the general tensions and anxiety of living in the 21^st century. How can we get better rest, some reliable peace at night?

The concept of ritual which I discussed in the Self-Soothing post applies as much to adults as it does to children.  Most of us were raised on some type of night ritual to help us sleep.  As we age and go through different developmental cycles, many of the tried and true ways we took for granted growing up fall to the wayside and are not replaced.  Repetitive patterning (rituals essentially) cue the body to prepare for whatever the patterning was initially instituted for.  Creating new patterns for the life I find myself in now will help the repose I long for.

Creating bedtime rituals is committing to spending time before bed preparing for sleep.  Many sleep problems are born because an hour is spent watching the news or stimulating talk shows on our electromagnetic charged devices before we expect to sleep.  Or, we fall into bed after a long day expecting sleep to take us over without any preparation.  We have to set the stage, create the conditions for sleep. This takes some thought and intention.

Look at your surroundings:  your bed, what you face from your bed.  Is it serene, pleasing to your senses?  If not, make it so.  Your bed is your haven, it should be extremely comforting and comfortable; the linens and bedding especially restful to your senses.  Get rid of unnecessary clutter, open up your dream space.  Clutter is more stimulation; you want simple (austere?), clean, restful impressions. Make your bed everyday if you don’t already.  Be slow and deliberate about how you spread and smooth the linens.  When you see it next (at bedtime) you want it to sing lullabies (figuratively speaking) and be consummately inviting.  Your bed clothes should reflect this as well and be treated special and put in a special place.  Before turning in at night, consider spritzing the linens, bed clothes circumference around your bed with sleep essential oils (Lavandin, Bergamot, Sweet Marjoram, rose Otto—whatever is pleasing).  The repetitive use of these oils will become familiar and cue the body it is time to sleep. Try a diffuser of your favorite essential oils at night.

Pre-bed rituals like night hygiene, bathing, rubbing oils into your feet and neck are other repetitive patterns to help the body to sleep. Be deliberate in your bathing.  Feel the skin you touch, be slow and loving drying yourself off (that's your leg you are toweling, it brings you everywhere you want to go without fail).  Once on a retreat, the woman sleeping in the bunk next to me spent 20 minutes a night with lotion massaging her feet, touching and just putting them to bed. (I asked her after seeing her do this for 3 nights if her feet hurt and she said no, this is what she did nightly to prepare for bed).  Laying in bed and running your hands down your limbs and body, pausing when necessary at the achy parts, sending some loving energy that way is a great way to say good night to yourself.  There is something very affirming about your own loving, caring self touch that calms and establishes acceptance and peace to your own energy field.

Reading some poetry, listening to Mozart or Bach for a time before sleep is helpful.  Try this over a specific time period and then put it away; try not to fall asleep reading or listening to music (it can be a reason one wakes up in the night; cycling tracks of music or a burning light from reading).  Sensitizing oneself to one’s breathing patterns and paying attention to it repetitively can sometimes stop a busy mind.  Guided Imagery, allowing the bones and flesh of the body to sink into the safe-haven of the bed is restful.  I teach a “10:10” exercise that involves breathing in to the count of 4 and exhaling to the count of 6.  Establish this breathing rhythm and after you have done it 5 or 6 times breathe in one impression you are grateful for in the day that has just ended.  Breathe with that 5 times in the breathing rhythm established.  This is one cycle or pattern. Repeat the pattern 9 more times, a new day’s gratitude for each cycle.  You will be lucky to get to the fifth cycle, it is very relaxing.  Not only is the breathing rhythm soliciting the relaxation response, but the series of gratitudes also support the parasympathetic nervous system in its quest for repose.

The main point about any of these practices is establishing a repetitive ritual.  Do a few of them for several nights; try a few others.  You will have your favorites.  Taking the time to establish soothing patterning will reap many rewards.  Your waking will be a peaceful waking because you’ve instilled this in your thinking, feeling and physiology pre-sleep.  This sends well being messages to your central nervous system and saturates your nerves.  You will benefit from this in the morning.

Birds Appearing in a Dream  One had feathers like a blood-streaked koi, another a tail of color-coded wires. One was a blackbird stretching orchid wings, another a flicker with a wounded head. All flew like leaves fluttering to escape, bright, circulating in burning air, and all returned when the air cleared. One was a kingfisher trapped in its bower, deep in the ground, miles from water. Everything is real and everything isn’t. Some had names and some didn’t. Named and nameless shapes of birds, at night my hand can touch your feathers and then I wipe the vernix from your wings, you who have made bright things from shadows, you who have crossed the distances to roost in me.

-- by Michael Collier
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