In late December, Ellen Wolk, a 36-year old Arlington woman, lay on a gurney amid the other patients awaiting surgery at Deaconess Hospital, getting more anxious by the minute.
Her doctors weren’t sure, but they were worried that she had cancer of the thyroid, a plum-sized gland in the neck that makes a hormone critical to normal metabolism.
Hoping they were wrong, Wolk agreed to have one lobe of her thyroid removed, leaving the other in place to make hormones so she wouldn’t need to take medication the rest of her life. If she did have cancer, she figured, she’d have another operation later to remove the other lobe.
As it turned out, Wolk did need another operation, which was done earlier this month.
Although both operations were done at the same hospital, by the same surgeon, her experiences were as different as night and day, and not simply, she says, because she was a surgical veteran the second time she went into the operating room.
The first time, she was not only scared before surgery, but had considerable pain and several complications afterwards.
The second time, Wolk took control in every way she could, managing her own pain medication patient-controlled analgesia, and reducing her anxiety to speed her recovery.
She lined up friends for emotional support, including one who stayed with her before and after surgery. She went to a cancer support group at the hospital. She listened to relaxation tapes twice daily before the operation and during it as well.
She even asked her surgeon, Dr. Charles Norris, Jr., chief of head and neck surgery at the Deaconess, to talk to her as he operated, saying things like, “After this operation, you will feel comfortable and you will heal very well.”
Surgery is a booming business in America, with more than 30 million procedures expected this year, according to SMG Marketing Group, Inc., a health care market research firm in Chicago.
But with two-thirds of these operations now done on an outpatient basis, and with insurance companies insisting on ever-shorter stays, how well you fare as a surgical patient increasingly depends on you – and your family and friends.
“Because patients are spending less and less time in the hospital, they have to take more responsibility for caring for themselves at home before and after an operation,” says Dr. George Sheldon, chairman of the surgery department the University of North Carolina and a spokesman for the American College of Surgeons.
In the old days, for instance, a person taking blood-thinning drugs to prevent strokes or heart attacks would spend a night or two in the hospital being monitored as he was weaned off the drugs to prevent excess bleeding during surgery.
Now, people are told to wean themselves off such drugs at home under a nurse’s or doctor’s supervision by telephone.
Diabetic patients, too, must work extra hard prior to an operation to keep insulin levels under control, particularly during the immediate pre-op period when they’re not eating.
This balancing act used to be done in the hospital, says Sheldon: “Now we have to educate patients to do it at home.”
At many hospitals, including Beth Israel in Boston, pre- and post-op education has become such a fine art that many patients now skip the traditional pre-op hospital visit.
Instead, a nurse calls them a week or so before surgery to answer questions and screen for any unusual problems.
Patients love it, says Mary Jane Costa, nurse-manager of ambulatory surgery at Beth Israel: “It’s a working society, and patients had a hard time getting the day off to come in.”
Patients also get detailed instructions by mail, including a list of drugs containing aspirin or ibuprofen to be avoided before surgery, and specifics on when to stop eating and drinking before operations.
Considerable evidence, including data from a decade ago when patients had longer hospital stays, also suggests that the more patients are told what to expect – especially how they will feel as they recover – the better they fare after surgery, says Harvard Medical School psychiatrist Dr. Malcolm Rogers.
Some people take self-preparation even further.
Prior to her second operation, Wolk consulted with self-healing guru Peggy Huddleston, the Cambridge-based author and publisher of “Prepare for Surgery, Heal Faster,” a book of anecdotes, common sense and some scientific reports.
Huddleston, who has a master’s degree in theological studies from Harvard Divinity School and practices psychotherapy, says “people can do a lot emotionally and spiritually to speed healing.” To wit:
“Learn to get deeply relaxed” before surgery, says Huddleston, who sells relaxation tapes with her book. You can also ask doctors to play such tapes in the operating room.
Before and after surgery, she continues, try to “actively visualize the healing process. Don’t imagine the worst.”
It also helps, she says, to organize a support group, as Wolk did, and ask someone to be with you before and after surgery.
And you might trying asking your surgeon or anesthesiologist to make “healing statements” during the procedure.
The jury is still out on all this, but studies from Scotland, Canada and Atlanta suggest that people may retain the ability to hear, even under general anesthesia, and that “therapeutic suggestions” may diminish pain and help speed healing.
If you’re worried about anesthesia, she says, ask for a face-to-face appointment with the anesthesiologist.
Dr. Susan Troyan, surgical director of the BreastCare Center at Beth Israel, endorses Huddleston’s approach, but she adds that people should not fear that “how well they do in surgery depends on doing these techniques.”
But Wolk, a Cambridge chiropractor, is utterly convinced that she did better with her second surgery because she took control in these and other ways, and her surgeon doesn’t disagree.
Norris says he had never made healing statements during a procedure before. But Wolk “was very organized and made the request,” he says, “and I freely admit she had a much smoother time the second time around.”
“With both surgeries,” says Wolk, “I was back to work in eight days. But the second time, I felt much more like myself and was more ready to take on my full workload.”
They’re not exactly rushing mindlessly into the 20th century over at the 184-year-old New England Journal of Medicine.
In fact, the top editors at the nation’s most prestigious medical journal still use different color pens to show who made which changes when they edit manuscripts.
But the Journal took a big step into the information age this week when it announced that abstracts of its major articles and the full text of editorials are now available on the World Wide Web, at http://www.nejm.org by 7 a.m. on Thursdays.