Question:

As an adult male with hypospadias, I’m now facing having to go in for some surgery again after many years of staying away from hospitals for things related to my penis. As the surgery date gets closer, I find that I have a great deal of anxiety and emotions coming up, as well as many fearful thoughts of all the things that could go wrong. I’ve even thought about canceling the procedure. What tips can you give to help deal with the anxiety and stress leading up to a surgical procedure that has many bad memories attached to it?

Dr. Tiger Responds:

When any of us have to go back for surgery after many years of being free from surgery, we have to face the feelings that were last dealt with at the time of the previous surgery. So, if your last surgery took place when you were 13 years old and you are going back for surgery at 30 years of age, you have a bunch of feelings of a 13-year-old to go back and deal with.

The question refers to “a great deal of anxiety and emotions.” As adults, we want to feel in control of our lives, involved in our own medical decisions. As children, even as teenagers, many of us were not. Thus, the feelings that come up are those of a person not in control of the situation, developmentally much less well defended than the adult you are now. The fear can be great enough, and unmanageable enough, that we can make a poor decision and just cancel a procedure that we decided was necessary before our emotional unfinished business came knocking at our unconscious back door. This unfinished emotional business is retraumatization that is triggered by the upcoming surgery. Separating what is real right now from what isn’t happening right now and did happen back then is very important to making sense of how to contain the feeling of out-of-control emotions. This doesn’t mean that simply writing down the story of what happened to you when you were a kid is going to get you in control of your feelings and prepare you for adult surgery. To prepare you for adult surgery, there are good steps to take that will help to keep the past out of your current experience and that will give you both the tools to deal with feelings which occur and the chance to have a surgical and hospital experience that is healthy for you and doesn’t add to the trauma you have stored up from previous bad experiences.

Get someone on your team

Whether it is a spouse or partner, a best friend or family member, find someone in your life who knows your story, who knows what you went through as a kid, and who can help to keep you clear and calm as you approach and go through your procedure. If you don’t have someone like this in your life or just don’t want to go through that with him or her, then employ a therapist who is familiar with preparing for surgical procedures. Your doctor or hospital ought to have a referral for that.

Talk through your past, and learn about the present

The job of your support person, whether friend, relative, or therapist, is to be with you as you narrate what you went through in the previous hospitalization (tell the story two or three times in the weeks approaching the surgery) and to help you to relax as you recount the story and make sense of the differences in your life now versus then. If questions come up about the procedure, the hospital, or any aspect of what you think may happen to you, then instead of just making things up out of your fears, call the doctor or surgical intake nurse at the hospital to get some real information. You should be able to collect enough facts to be very clear that you are choosing this surgery because you know everything you can about it and you are sure that given your options, surgery is your best choice. Confidence in this is necessary so that nothing that comes up when you actually go to the hospital can send you back into the mind of the 13-year-old who is just responding in mortal fear. That is what all this preparation is about: to keep you aware as the adult in charge of what is happening to you, to prevent you from feeling out of control in a way that puts you in fear.

Visit the hospital in advance

If your “team member” can go to the hospital with you in advance and help to walk you through all that you will see when you go in for your procedure, then it will be familiar instead of strange and frightening. The admissions staff and your doctor can help to arrange to show you the steps you will go through in advance, starting from walking through the door, going through admissions, even what your room will look like. The sights, sounds, and smells of the hospital can trigger memories you might not have been aware of in your sessions with your team member. Making a visit in advance can help to reduce any kind of last-minute surprises you might experience when you go in for your surgery.

Have your support person with you on the day of the surgery

If at all possible, have your team member with you on the day of the surgery, at your side as you ride to the hospital and go through admissions, and even with you in surgery prep. Ask if he or she can stay with you until the last possible moment before surgery and be present as soon as possible after you awaken in recovery. Your support person will have been your reassuring guide for the last several weeks and can be that for you throughout this adult surgical experience. She or he is also your witness, so that as you reflect on this procedure after your hospitalization, your support person can help you to remember this experience as one for which you were well prepared and for which you had support that was as close to ideal as possible before, during, and after the surgery.