Waking Up Swinging

Approaching a vaginal surgery as a survivor of sexual abuse.

Approaching a medical procedure can be worrisome enough without shadows of past trauma interfering with what may or may not go right or wrong. It is also no secret that survivors of sexual abuse face many complex emotions and experiences as a result of what was done to them. Many go through endless cycles of shame, worry, fear, and embarrassment. One common side effect of traumatic experiences like that is panic attacks and/or night terrors. While it is uncommon to dream under anesthesia, we are more aware and in a dreamlike state whenever we are waking up from anesthesia.

For those of us with past sexual abuse trauma, it is important to consider how a medical procedure that requires vaginal entry, such as a hysterectomy, may be impacted by our past trauma. I, for one, was incredibly worried about how my body would respond when waking up from anesthesia if I was coherent enough to recognize the pain in such an intimate area but wasn't coherent enough to understand that I was perfectly safe in the hospital. Before my operation began, I was asked if I had any questions about the operation by my surgeon's nurse. I told her, "I understand the operation, but ummm, I do have one worry about waking up..." My heart was pounding as I explained my past and told her about my still occurring panic attacks and night terrors. The anxious part of my mind expected to be brushed off or told that I was just being dramatic or worrying over nothing, but that cold response never came. My nurse met my concern with empathy and actually told me that she was glad that I informed her of my past because it was a very valid concern and one that she wished more patients with similar experiences knew to make their care team aware of.

My nurse then explained to me why it is important that the anesthesiologist team and nurses are aware of any trauma-related reactions upon hysterectomy awakening.

• It is difficult for them to differentiate a patient's physical pain from emotional pain/panic, but the two ailments are treated with different classes of medications.

• When your team is aware that you may wake up in a traumatic flashback headspace under sedation, they can be ready to have someone on standby to help ground you and remind you where you are and that you are safe while the anesthesiologist works on getting your panic attack chemicals under control.

• Your care team cannot be expected to fix problems that they are not aware of; they will be more understanding and empathetic if they know what's going on.

• There is a big difference in the treatment of post-op confusion and a PTSD flare. You don't want the team mistaking your panic and emotional pain for physical pain and having pain meds increased when that won't help the problem at hand.

• Waking up from a major procedure in a fight or flight state is dangerous for your fresh incisions, so if it's a possibility that you may wake up swinging, alerting your care team ahead of time allows for them to be on standby upon your waking and ready to keep you safe.

I never really thought about how much goes into keeping us safe, as well as considering the nurses' perspective in regard to being able to understand the patients' distress signals. In the end, I was very glad that I made my team aware of my past because, unfortunately, I did wake up swinging and in a fearful panic. I was convinced that my abuser was present somewhere and that I was unsafe. I kept trying my best to get out of the bed and just remember repeating the words "I'm scared" on repeat. However, because my care team was aware of what was happening in my mind, they were very quick to act. My nurse kept me in the hospital bed and held my hand firmly while her hand on my shoulder kept me in bed as she had me look at her and was firmly reminding me where I was and promised that I was safe and that the man that I thought was trying to get me was not here and most importantly I was safe. Meanwhile, the anesthesiologists were hard at work with Valium to level out my emotions and put my mind to rest until more of the anesthesia was out of my system so I could wake up more calm and aware. I am beyond grateful for my care team that I had for my hysterectomy. I cannot imagine how scary it would have been waking up like that and not having them aware of what was happening in my mind while I was not in a position to communicate for myself much. It is scary to open up about past trauma even to care teams, but I cannot stress the importance of having them in the loop of anything that may need to be communicated when you may not be able to speak for yourself.