i greatly benefited from a session focused on surgery prep at UCSF, led by a nurse named teresa corrigan. i want to share these insights with you, because if past predicts future, some of you will have surgeries of your own to successfully move through. maybe nuggets in here can inform your own healing. surgery is admittedly scary as shit–there are risks, there is pain, there is the unknown. will someone leave a sponge in me when i’m getting sewed up, only for it to become a pus-filled infected mess that requires a second surgery? will i become addicted to painkillers? will it be successful? will it solve the problem? will i wake up? and on and on.  but, as with anything in life, there are things you can control, can do to wrap your head around the process of surgery and what comes afterwards. some of these things are applicable to relaxation and anxiety more broadly too. 

i’ll be doing a few of these ‘as an aside’ posts in the future, to try and share all of the knowledge i’ve accumulated and tucked away this past year. that my are teachers is part of my DNA, permanently lodged in me, like a itch that needs to be scratched (although they probably hate that run-on sentence). i also see what you have taught me this past year. and i hope i can teach you something too. 

so let’s begin. 

emotionally and mentally.

• one of the few things you have ultimate control over is your breath. think about it: only you can take it, expel it, develop a rhythm, use it to sustain your life. abdominal breathing is a trick to help you relax, calm down your nervous system and fight or flight response. try placing your hand on your stomach. breathe in slowly so that your stomach and diaphragm expand. relax your shoulders, relax your jaw. breathe out slowly.  keep doing this, even for 5 breaths, 15 breaths, or however long you’re up for it.
• if you find breathing hard, there is an app called “my calm beat.” it shows a pair of lungs expanding and deflating. you can switch the pace of breaths so that it matches your pace. it can even ding for when to breathe in and when to breathe out. especially good if you have a hard time focusing.
• if you’re feeling ready to advance to more than breathing, couple breathing with thoughts. breathe in gratitude, breathe out illness. breathe in strength, breathe out love. breathe in love, breathe out anxiety. whatever works for you and whatever you need, breathe it in. breathe it in from the world around you and your support network, whatever that might include. (btw, this is also called meditation. but that might be too new agey for you, so call it whatever you want–breathing, sucking in air, staying alive, keeping busy.) 
• some natural oils like lavender are proven to help ease anxiety. get some, put them under your nose or on your wrists and neck, breathe them in. envision anxiety melting away. other natural oils like citrus or eucalyptus or mint can help revive you. think about what you need most.
• think about what you do to relax otherwise, especially when sitting still. do you like crossword puzzles? stand-up comedy? celebrity-gossip-filled mags? listening to music? start relaxing as soon as you can and as far advance of surgery as you can. carve out a few minutes each day to sit with whatever it is that makes you relaxed and happy. and when packing your bag for surgery day, pack it full of these things. ask friends to bring you these things, because they want to help.
• laughter breaks the cycle of worry. something to remember when gearing up for surgery, hanging out in waiting rooms, being with pre-op nurses, and eventually being on the table. there are a lot of things to laugh about. the absurdities of life, the silliness of all the clunky hospital equipment and operating room attendees head gear, the funny memories you have in your head. spontaneous laughter is a real possibility that again, you can control.
• a company called healthjourneys.com makes a cd on “successful surgery” (it makes cds for just about everything related to health too). it’s full of guided imagery and positive affirmations for surgery. i loved it. the woman’s voice soothed me. it’s not over the top. it acknowledges the scariness of it all. and i could put it on my ipod and listen to it while getting prepped. my surgeon was even open to me listening to the ipod when going under for surgery, and this cd was on my playlist.
• speaking of, if music, podcasts of comedians, books on tape, or guided imagery and meditation make you happy, consider asking your surgeon if s/he is amenable to having this with you as you go under anesthesia. if not, you can at least keep it on with you in the first waiting room and pre-op room.
• you don’t need a cd to have a positive surgery experience. you can create those images on your own. imagine yourself going into the hospital, calm and peaceful. see yourself easing into surgery, your body fully cooperating with the surgery. see yourself in the recovery room, calm and with minimal discomfort. see yourself coming to your hospital room and what you want to be surrounded with. see yourself months later, fully recovered and doing what you love most. there is great evidence of the mind body connection, shown in this cure magazine article (click here) to reduce anxiety and help healing.
• you probably wouldn’t be reading this unless you were a bit anxious about the surgery, right? so acknowledge that surgery and hospitals are scary places. it’s ok to not push those thoughts and feelings away, and not try and sugar coat it all. but try and couple them with other truths. like, “i’m afraid, but i really trust my doctor.” “my body has prepared for the worst, but i hope for the best.”
• surgery can be surprisingly emotional. for me, i was sad (sad, not in a trivial overused kind of sad, but a mournful, grieving sad). i was losing a body part, my breast. something that had been with me yet betrayed me, that had provided pleasure but could end my life. i worked on first saying goodbye to my breast and forgiving it. i know i know, but it really helped me move to accepting the truth. i knew i’d forever miss it but i accepted that i could let it go. and i thought about what it would say as well…perhaps it would have said: “i’m sorry. i got mixed up. please forgive me. i’m ready to say goodbye and leave you to live a long, healthful life.”
• hospitals are frenetic places. there are loud noises. a lot of movement. people coming in and out at all hours to ask you important questions (are you having any pain?), annoying questions (have you had a bowel movement today?), and often the same questions over and over again (what is your name? what are you allergic to?). once you get to the hospital, recognize and be open to unpredictability. your doctor might be running late or be stuck in another surgery. one of your records might be missing. the hospital’s computer system could be getting updated. lots of things could contribute to the hectic-ness. be prepared for this with your bag full of relaxing distractions. 

physically and practically, some things to consider.

• do a dry run the day before surgery.  for example, go to the hospital, see where you’ll park, time how long it takes to get there, make sure you have enough gas in the car. this can help visually but also helps dissolve any anxiety or uncertainty about the practical process of getting to surgery.
• pack what you want to have at the hospital with you the day before. these creature comforts can be positive and warming distractions–talisman, a special pillow or blanket, flowers, postcards of places you want to visit after surgery or pictures of your family and friends.
• pick out your clothes for after surgery to put in your surgery bag. think about what you want to leave the hospital in, perhaps loose clothes with easy access on and off, like zippers rather than buttons, or slip on shoes without shoelaces. 
• eat a plant-based diet a few days before surgery. often times, the anti-nausea drugs given with anesthesia cause constipation (believe me, they do).  a plant-based diet helps ease this discomfort. talk with your doctor though; my surgeon wanted me to eat a lot of red meat before surgery to increase my iron intake given that i was anemic going into surgery. it was admittedly hard on the ol’ digestive tract after surgery, but oh-so-delicious going in.
• drink a lot of water the few days before. when you’re hydrated, the IV can be easier to start. and given that you likely won’t be able to eat or drink before surgery, having a lot of reserves will carry you though.
• bring a copy of your medication list and any health issues, including allergies and past experience with anesthesia.
• bring a copy of your advanced health care directive. yes, it’s scary, but it’s also important.
• plan ahead for when you get home. if you’ll be unable to lift your arms, set your dishes on the counter, or your toiletries on the sink to avoid reaching for them. think about what other physical limitations you might have and try and work around them.
• what else will you need when you get home? meals? rides? help moving around inside your home? work on mapping that out and asking for help, often times the hardest but most important thing we can do.
• when you’re getting discharged from the hospital, you’ll get a whole whack of discharge instructions. it’s a hectic time and can often be confusing, mostly because you’re so ready to get home but also because the discharge instructions can be long and complex.  you might print out a discharge planning checklist before surgery (examples here and here).  it can help prompt questions like:  what can i do to help myself get better? what problems should i watch for and what should i do about them? who do i call? what are my prescription drugs and how do i take them? when will i be ready to bathe, dress myself, drive, etc? when do i come in for follow-up appointments? you might also record the discharge instructions on your phone to listen to later, when you really need them.

of course i hope you never have to refer to this surgery prep post, but if you do, just some things to consider. much love and talk with you soon.

xom