V. Narayanan, 28, was just back from a business trip to Hong Kong in 2001 when he experienced excruciating back pain. Days later, he discovered a lump on his back. Doctors found that his vertebral column was being ravaged by a life-threatening infection. Narayanan spent about 60 days in hospital, 40 of them in the ICU, and doctors performed 10 procedures on his back.
Archana Kumar had just delivered a baby a month ago when doctors told her they would have to operate on her painful anal fissure. “I was plagued by anxiety. I was responsible for a little one who was totally dependent on me. I was in agony till I went in for surgery two months later. Then, just before I was given anaesthesia, I panicked. I had morbid thoughts.”
Most people experience fear and panic attacks before going in for surgery, usually fuelled by half-truths from acquaintances and from the Internet. Surgeons say one of the ways to tackle this is to spend time with patients and explain the surgical procedure to them.
Develop a rapport
Laparoscopic surgeon C. Palanivelu of GEM Hospital, Coimbatore, says it is vital to develop a rapport with the patient. “When that happens, they develop the confidence to go ahead with surgery.” In critical cases, he informs the patient about possible complications. “But, I also let them know I am there to take care of them.”
V.P. Shanmuga Sundaram, chief general surgeon, KG Hospital, Coimbatore, says patients today are vastly different from what they were 30 years ago. “They had blind faith then. Now, they come prepared with a list of possible complications, most of them sourced from the Internet!” He says that initially, he speaks to the patients about everything other than their disease. “I ask if it rained in their hometown. Any talk about food relaxes them a lot. Once they realise doctors are interested in them as people and not just as a patient number, they instantly feel better.”
Surgeons also say it is better to tell patients upfront about their problems and possible solutions. That’s what Narayanan’s doctor did. “My surgeon told me that I was in a bad shape and we had no time to lose. He could either operate and try and save me, or wait for the culture reports, by which time, I would be dead. I was worried about my new job, medical insurance, mobility. But, he assured me he would give it his best shot.”
Some patients get unduly worried about the duration of surgery. In such situations, consultant laparoscopic surgeon Damodar R. Rao of Rao Hospital, Coimbatore, gives them an approximation, with the rider that it might take longer depending on what they find once they start the surgery. “That way, the family is not terribly anxious too.”
He also says that if the patient can be treated non-surgically, that option must be given. “If it is serious, the doctor will decide for you. When offered a choice, patients must make an informed decision, based on information provided by the doctor.” So, doctors have to explain things in simple language to the patient, discussing the pros and cons, he adds.
People mainly fear anaesthesia and post-operative pain. This, says V. Ravichandran, consultant anaesthesiologist, is uncalled for in this day and age; superior drugs ensure almost zero pain following surgery. “Even during the pre-operative assessment, we reassure patients about their fears. Many think spinal or epidural anaesthesia will leave them with back pain, which is not true. You have to educate and convince them.”
As for pain, Dr. Damodar says that nowadays, doctors take precautions to ensure the pain never starts. “It’s easier to prevent pain than tackle it once the cycle begins.”
Sometimes, patients cheer up seeing others like them. Dr. Ravichandran says that before major procedures such as open heart surgery, patients are taken to the post-operative ward, to show them people who are recovering after a similar surgery. It also familiarises them with the equipment in the room, he says.
Dr. Shanmuga Sundaram says attention must also be paid to the attendants accompanying patients. “I keep them in the loop as to what is happening; they, in turn, reassure the patient.”
Financial implications
Fear about the financial implications of surgery is a worry too. Dr. Palanivelu says that hospitals must categorise patients depending on their affordability. “That way, they end up paying much lesser for a surgery than someone who can afford to.”
Dr. Damodar says patients must be informed about the expected cost, and how much it could go up by. “That way, they are better prepared.”
But, finally, acceptance is the key. Narayanan says that when it was time for his third surgery, he was more at peace. “I realised that surgery was essential and that I had to accept it.” And, though he had a high pain threshold, he could not handle the acidity brought on by pain killers. “There were times when I was in severe pain. I had little choice — I could either bear it stoically or scream. Either way, the pain was there to stay. I chose to bear it.”
TALK THINGS OVER
- Speak to the surgeon to clarify all doubts; don’t rely on the Internet
- Discuss the monetary implications of the surgery
- Meet the anaesthesiologist to discuss pain relief
(Patient names changed on request)
