“I was very,
very depressed after this fall,” R. said in her deep, soft voice – a soothing
voice that must have been considered alluring during her youth, when she lived
in Big Sur and worked as a server at the famous Nepenthe’s Inn. Now she is 76. She fell one day around
Christmastime last year, when walking her dog. A neighbor saw her on the street
near her home in Santa Fe, unable to get up, and took her to the hospital. The
hip was broken.
“I wasn’t sure I wanted to live any longer,” Sylvia added.
“But little by little it’s getting better.”
I suggested that it might have something to do with the
drugs. Painkillers are basically downers. Of course it’s also a shock to find
that one has become so vulnerable. A tug of the leash, and the walk is over,
for six months or more.
In fact, a hundred years ago, as my Buddhist friend Jay did
not hesitate to point to me after my own fall, such a break would likely have
been fatal.
You go to bed, and you lie in pain, waited on by unwilling
relatives; and maybe the bone heals, maybe not; and maybe you “give up the
ghost” (a wonderful old phrase that you don’t hear much anymore), and die.
Now you have surgery, the leg is set, you are up on your
wobbly feet in two days, and then you start doing physical therapy. A few
months later, you are on your feet again.
Given this illuminating historical perspective, it’s
somewhat surprising that we don’t wake up after surgery stunned, but grateful.
Instead of shouting, “I’m alive!” we may wish we had already died. Perhaps the
nervous system, recognizing that the experience was life-threatening, does not
know how to update itself.
Or this depression may be due to the ambivalence we feel,
especially as we age, about the value of our lives, the death wish (thanatos, according to Mr. Freud) struggling against the life
wish (libido) until, needless to
say, death wins out.
But as I considered my own experience after a recent
surgery, I learned that it is the anesthesia administered during surgery, more
than the painkillers that follow it, which may have a very disorienting effect
on many people.
There is even a name for this condition, and, naturally, an
acronym: Post
Operative Cognitive Decline (POCD). This decline was first identified in
elders after cardiac surgery, but it turns out that orthopedic surgery can have
the same result, even when it’s elective. (When surgery is mandatory, after an
accident, one might expect POCD to be more common, as trauma is known to be
associated with loss of control; and
trauma can lead to depression.)
In any case, POCD is caused not by the drugs per se or by
the trauma, but by the effect of the anesthesia on the flow of oxygen to the
brain. This reduction of oxygen supply, however brief, is likely to have
negative effects on cognitive ability. Now scientists are researching ways to
minimize this loss, particularly in the elderly. In one study, research showed
the value of “intra-operative monitoring of
anesthetic depth and cerebral oxygenation as a pragmatic intervention to reduce post-operative cognitive
impairment.”
That’s the scientific angle, the
one likely to produce helpful surgical interventions. Now that we are living
longer, it will be helpful if the various orthopedic surgeries some of us must
endure do not accelerate cognitive decline! I have not had the opportunity to
ask my surgeon, but I assume the cocktail used in my case was adapted for this
very purpose. The nerve block I was given before going into the OR is intended
to reduce the need for anaesthesia. I do know that I had no trouble breathing
when I woke up, a good sign!
Even then, I definitely
experienced a journey into the twilight zone that became more evident a week
after the surgery and continued for about a month. Part of that experience was
a curtailment of my ability to think clearly. But another part of it was more
like Sylvia’s depression. I, too, wondered whether I wanted to go on living;
the very question seemed to bring on a wave of hopelessness. My physical
condition, though a temporary one, seemed chronic, timeless, a new state of
being that I resented, that capped my ability to make up for whatever I had
failed to do in this life thus far.
I had a lot of very colorful
dreams, most of them bizarre and alarming.
Looking back, it feels to me as
if I had entered a dark tunnel, not of cognitive decline per se, but of life
review that seemed preparatory for death, even though I knew I was not dying.
It was a descents into a
subconscious region, where it seemed the body itself, stirred and jumbled by
the surgical intervention, released buried complexes regarding self-worth and
purpose.
One morning, after a long
meditation, I bumped into an old belief – that I needed to somehow be Great in
order to deserve my life. That belief had been with me since childhood, an
ambition passed on to me by my mother, who wanted to be a great writer herself!
Exploring this lifelong negative
fantasy, I discovered that I did not have to have a justification for living –
I did not have to reach for some vaunted, special goal in order to prove my
worth.
I just had to set my sights on
realistic, attainable goals, and try to be a good person while I carried them
out.
This was quite a profound
realization. Ultimately it offered great relief…but first I had to process the
realization of how unattainable my goals had been all these years. I couldn’t
get out of the tunnel until I had conducted this painful review.
Meanwhile, as time passed, my
body continued healing. What a miracle that is! And as I regained the use of my
legs and made my way into the light of day I knew the journey had fixed
something more than the hip.
I had revisited an ancient
complex held in the bone since childhood, when it was first discovered that my
hips were out of place; and it had been released.
It had been, after all, despite
the modern technology, a shamanic journey, and I had come back to life having
retrieved a lost piece of my soul.
