Through The Surgical Tunnel

  “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.