The Emotional Hysterectomy

I write this post as kind of a lay person, even if I am a professional nurse with over twenty years experience, who has had a hysterectomy without having had any children. I went through my own grieving process in regard to never having my own biological children.  Albeit a short process of grief, I still grieved somewhat, well before my surgery  — at least two years.  

From fearing surgery complications to grieving the impending loss of fertility, deciding to have a hysterectomy can trigger emotions that other kinds of surgeries probably wouldn’t.

Every Day Health: The Emotional Impact of a Hysterectomy

Before my hysterectomy, my surgeon’s office asked me if it was OK if I was on the postpartum floor after surgery — the floor with the mommies who have recently given birth (or are about to do so).  Being a nurse for so many years, and more importantly having accepted my childlessness, I said yes, of course.

I wanted the expertise of the nurses who deal with women, and specifically those who have taken care of women who’ve had hysterectomies.  

The Postpartum/Gyn floors are generally newly-remodeled with up-to-date appearances to lure prospective mothers so they can be the boon for future word-of-mouth for the hospitals’ clean and new look.  Not all of the floors in a hospital are remodeled and decorated as nicely as the postpartum floor.

All remodeling and new furniture aside, I wanted the nurse who is accustomed and experienced in caring for GYN patients.  There is less room for error and the nurse would possess a sense of ease with a woman who has had her baby house excavated — she’s taken care of these patients before.  Although I may have been a refreshing type of patient for the med-surg floor nurse … a healthy recovery is primarily about me.  My physical needs and safety became tantamount in regard to my post-op care.  I didn’t want any ol’ nurse to take care of me, but one experienced in women’s health.

Some women cannot fathom being on a floor where a baby might appear or a pregnant woman may be seen … it can drive some women into a psychosis because the grief of a past lost child’s memory is still with them and/or they have not come to terms with their inability to reproduce.  In these cases, the woman may want to hold off on surgery until the emotional aspect has been more clearly dealt with through counseling and more time.  However, holding off on the hysterectomy may be impractical for whatever reason.  In these cases, then the woman should probably go to the med-surg floor if there isn’t a wing in the hospital specializing in only GYN patients.

While it’s normal to experience some anxiety before the procedure, it’s important to calm those fears before you have a hysterectomy. Not only has stress been linked to slower healing of wounds after surgery, but how you feel about a hysterectomy before you have it may also determine your emotions afterward.

From Every Day Health: The Emotional Impact of a Hysterectomy

The show-stopper in all of this is can be a woman’s level of readiness for a hysterectomy with the realization she can’t give birth to any more children, if she had any to begin with. Sure, there’s adoption and that’s a can of a whole lotta worms of a different color.  And simply because a woman has already had children or is too old to have children doesn’t mean she can’t grieve this loss.  Being emotionally ready to have a hysterectomy doesn’t effect only the childless.

In case you’d like to explore the experience of the adoption process, here’s an excellent blog to read written by a woman with a huge heart, a tender soul and a longing to be a mother: My Perfect Breakdown: Surviving. Living. Hoping. Recurrent Pregnancy Loss & Adoption.  (This is an aside, as the above blog writer is not interested in hysterectomy, not being the intent of her blog.)

anxiety no-mommy

Women who are depressed before having a hysterectomy tend to stay depressed afterward, says Kristen H. Kjerulff, MA, PhD, a psychologist, researcher, and professor in the departments of public health sciences and obstetrics and gynecology at the College of Medicine at Penn State University in Hershey.

My surgery was scheduled well after I accepted my infertility.  I didn’t know if there would be crying babies or not, if I would see dozens of pregnant women walking the halls getting ready to give birth while seeing every door decorated with congratulatory baby stuff.

My experience on the postpartum/GYN floor was a great one.  After my surgery and during my brief overnight stay, I didn’t hear one baby cry.  The only woman I saw walking the hallway was hooked up to an IV with the smallest of discernible baby bumps, so I  know she must have been there for some prenatal problems.  I saw a few doors with the baby decor, not thinking much of it either way.  I actually walked up to the nursery for viewing and was disappointed by the lack of babies present.  Then there was a man who saw me walking the hall and asked if I’d had a boy or girl.  I replied, “Neither.  I had a hysterectomy.”  He seemed shook up and apologized for asking the question.  I wasn’t offended or hurt.  He was simply a man who saw the world as every woman there having a baby.  I simply gave birth to a uterus!  (I also adopted that uterus out just so you know I didn’t bring it home with me.)

child my husband

There are some cases where a woman cannot ready herself for a hysterectomy because there isn’t ample time to think about the decision.  Cases like emergent hysterectomy after c-section or birth, usually from a ruptured uterus and/or uncontrollable postpartum hemorrhage doesn’t give the woman any time to think about hysterectomy; the choice of hysterectomy is made for her to save her life.  Even in advanced uterine and/or ovarian cancer, sometimes bowel, there isn’t time to mull over having a hysterectomy or not; it’s a surgery that needs to be performed sooner than later to risk having metastasis or impending death if the surgery isn’t done.

Ninety percent of hysterectomies are elective, meaning there is time to think of alternative procedures, medications and therapies.  In this time a woman can, and should prepare herself for the hysterectomy.  Some women may never come to terms with the permanence of not being able to give birth — even if they have already given birth ten or more times!

Probably one of greatest determining factors of emotional readiness for hysterectomy is how much a woman wants to have children.  If a woman doesn’t want children and never has, then the decision for hysterectomy is much easier.  If a woman has ambivalence about having children, the decision to have a hysterectomy can also be one of ambivalence.

I can relate to this: 

The parallel between my life some 45 odd years ago and my life now both fascinates and surprises me.  At times, it makes me sad.  And I wonder if I was predisposed to end up with a feline family rather than a human one.  Or if the instinctual choices I made as a child, influenced my trajectory as an adult.  Or if I missed the clear warning that I needed a better plan.  … [O]n a day like this … with my glorious kitties, I think, not a bad life.

Jane Ratcliffe – My Feline Family 

cat momma

In no way am I implying that a woman should not have a hysterectomy if she hasn’t come to terms with her own childlessness or inability to bear more children. However, simply being aware of this emotional sensitivity is key in recovery.  Like I stated previously, some women may never come to terms with their inability to bear children, but having the hysterectomy will offer a more pain-free and/or higher quality of life.

Certain strategies can help counteract the negative emotions that may come before having a hysterectomy.  Here’s a list with some suggestions from Every Day Health in regard to a smoother overall recovery from hysterectomy:

  1. Remember why you are having a hysterectomy.
  2. Know the facts on hysterectomy.
  3. Have a support system.
  4. Learn relaxation techniques.
  5. Anticipate symptoms during recovery.
  6. Talk openly with your doctor about your fears.
  7. Join an online support group like HysterSisters ONLINE GROUP.
  8. Order the FREE HysterSisters BOOKLET.
  9. Talk with other real life women who have had a hysterectomy.
  10. Let the nurses who care for you know about your concerns.

As for me … I remembered EVERY month why I wanted a hysterectomy  Every painful month.  The facts about hysterectomy, yep, I read up on all that asking my doc a plethora of questions, talking openly about all my concerns and fears.  My support system was my husband, myself and my cats — it may have been a small support system, but it was a quality one!  The healing of cat purrs … see below. Relaxation techniques — well, that’s called sleeping, taking it easy and napping … oh, and taking my pain medication routinely … all of those helped to relax me.  AND being on medical leave from work for four weeks — that relaxed me quite a bit!

* By the way, I’m not affiliated with HysterSisters in any way.  I simply found their free booklet very useful in my post-op experience.

cat purr healing

I got so excited and then …

… it all went away after a few minutes in.

screaming uterus

Since my hysterectomy I get especially excited to work with patients who are going to have a hysterectomy.  I’ve been there.  I’ve done that.  And while each hysterectomy and the person having the surgery is unique, there are still commonalities about the hysterectomy.

A few weeks ago … I’m still thinking about this patient and what happened … I got excited to call a patient who was to undergo a hysterectomy just like mine.  I got all excited to talk to her and then … all she wanted to talk about were her innumerable food, medicine allergies and sensitivities along with her severe Celiac Sprue disease. 

allergies jesus

This is all good and fine, but I couldn’t serve her in the best role I was meant for and set out to be.  I’m not a nutritionist nor an allergist nor would I be serving her any of her meals, because like I tell most of my patients, “You probably won’t see me … I’m simply that mysterious phone nurse.”  And LET ME MAKE THIS VERY CLEAR, yes, yes and some more yes, I do think knowing a patient’s allergies and sensitivties are VERY IMPORTANT.  There is no confusion here.  Or Confucius either.

cat confuciousI like listening to patients and I’m pretty good at reassuring anxious ones — in fact, it’s probably my secret hidden super power.  I call patients all day long spending about eight hours talking and listening, so much so that when I get home I don’t want to talk to my dear husband, ending up listening to him instead (or at least pretending).  He has a deficit of how many people he gets to be heard by and talk to in a day, so I’m the brunt of his verbal download.

This poor patient has unheard by previous medical people because I paid the price of her dissatisfaction with the healthcare profession.  I got to hear all about how she gets severe anxiety when nurses and doctors term her Celiac Sprue disease as only an allergywhich I never did once in the conversation.  She made it very clear that this disease is simply not an allergy and is an autoimmune disorder.  No argument from me there … I would have never oversimplified this disease, or what she has had to endure.

We spent a lot of time going over the Celiac Sprue.  I listened and listened and listened some more, taking her very seriously.  I really, really, really, really wanted to tell her about the pre-op hysterectomy process, the recovery room and what her stay in the hospital would be like.  I wanted to tell her about the surgery she was about to have.

WE NEVER EVER EVER WENT THERE.

She told me how we (people who work in hospitals) in my state kill people.  I had to do a double take on this statement.  I almost fell out of my chair.  Yes, she used the word kill.  Apparently she moved from another state and somehow got misinformation that my state, which will remain unnamed because that’s not the gist of this conversation — to defend my state — unplugs people at the drop of a hat and doesn’t save people when they are about to die.  I will, however, defend my profession and my experience.  I’ve been a nurse for two decades and I’ve never, ever experienced anything close to anyone not saving someone who looked like they were dying, getting ready to die or even dead — yes, we’ve even tried to save the dead in my E.R. experience!  I’ve worked in pediatrics, the ICU, ER and recovery room to name some critical places where patients are most likely to have life-threatening situations.  We go through a lot of training on how to save people and what codes mean and how to call them and what each person’s role in a code is.  We as nurses take your sickness, your signs of dying VERY, VERY, VERY seriously.  We are here to help you.  There is a reason why nurses are called angels!  And where I work is no exception — some of the most caring nurses I’ve ever met who will give each and every patient the best care humanly possible!

So … I had to spend some time gently educating her that the mission of my hospital and my profession was to save people at all costs UNLESS they specifically had the legal document of a DNR (do not resuscitate) with them or on their chart.

In that point in time, this is what she wanted and needed — she needed to talk about serious dietary concerns and what happens in dire life circumstances.  I couldn’t share my hysterectomy knowledge or experience with her.  I am saddened because I feel like my care wasn’t complete.  She was pretty much done with the conversation when I finished getting and giving the essential information like directions to the hospital, asking her what medications she was taking and instructing her on basic pre-op instruction like no eating and drinking after midnight.

This patient still sits in my mind today while I wonder if she’ll get the information she needs through her surgeon, the internet or whatever sources she may find.  She and I couldn’t get there — into hysterectomy world.

doubt and fear

I feel horrible that she has severe Celiac Sprue disease because it must be hell to manage a daily diet, let alone even begin to eat out at any restaurant or have dinner at someone’s house without constant worry and fear.  I am sorry that she wasn’t listened to by some other healthcare professionals (or felt like she wasn’t listened to) in the past and her disease wasn’t taken seriously.  AND I feel empathy for her in that she fears for her life thinking that healthcare professionals in my state won’t act to save her life if needed.

DISCLAIMER

This must be a terrible place to be in one’s mind.

bread cat

The nurse I’m glad I never had …

I can remember when I was in nursing school in the early 90s; one of the RNs I was working with made a comment how whiney her recent hysterectomy patient was.  She proudly boasted, “When I had my hysterectomy [which would have been in the 70s] I was out diggin’ in the dirt the next day!”

Um … wow … um … ow … I cringed.  I didn’t know what to say.  She prolonged giving that poor patient pain medicine because of her own beliefs and her own past pain experience.

I actually discussed that nurse’s comment in our post-conference with the other nursing students and our instructor.  It made for a good discussion about the importance of giving compassionate care and how sometimes bad examples, like that nurse, were sometimes important in learning what not to do.

She is the nurse I’m glad I never had.

I will have to say that nursing has come a L O N G way since that time.  Thankfully.  Thankfully.  Thankfully.

thankful cat

Can you hear me NOW?

As my day nurse S. was giving change-of-shift report to my new nurse C. I was about to experience a completely different nurse.

During the report that was being given by nurse S. to nurse C. I could tell something was amiss with my nightshift nurse. I thought she was: A) uncaring, not giving a damn about what I was saying, or B) completely absorbed in her work or C) hearing-impaired.  I was leaning on choice C because I truly hoped no nurse could be that cold in their care.

Gradually as the evening shift progressed and I asked and said things that went unaddressed or were answered oddly by nurse C.  Finally I asked C. if she had a hearing deficit.  She looked at me like I was psychic and exclaimed, “How did you know?!”  I explained that when the other nurse was present how she didn’t seem to understand some important things being conveyed and how I could tell she wasn’t hearing me.  She was genuinely caught by surprise.

That night nurse seemed somewhat relieved that I had caught on to her loss.  She explained that earlier this year she had suffered such severe allergies that she had lost a significant portion of her hearing that required her to wear hearing aids.  C. explained that she had recently moved to my city from Arizona after caring for her mother who died of complications from Alzheimer’s dementia to be closer to her daughter and grandchild.  We did have a record allergy year in my city by the way.

I also relayed my own story of sensory loss in the Spring of 2013 when I lost my sense of smell for quite some time after a cold and how I couldn’t even smell the fur of my cat who had just been put to sleep.  I longed for the last scent of my furry friend of over seventeen years … and I also told her that a loss is a loss, empathizing with her recent hearing loss.

That night nurse explained how her manager had not been understanding about her sudden hearing loss belivieving that she had fabricated the whole thing primarily based on a phone conversation the nurse had with her manager. The nurse manager had told her, “Well, you sure seemed able to hear me just fine on the phone!”  I explained to that nurse that I deal with patients all day in-person, but mostly by phone and those that have hearing impairments can often hear me better when they are on the phone than when they are right next to me.  It was like a lightbulb momemt for her — someone validating her real life experience.  I felt bad for her in this moment … the fact that she had a loss but couldn’t convey the reality of the effect it had on her own life to her manager and other nurses.

This nurse is a woman who has had her sense of hearing intact all her life and now is dealing with this loss.  This is a serious loss.  She is too embarrassed and ashamed to admit that she has this deficit.  I told her that as a patient, my nursing profession aside, that she needs to tell her patients about this hearing loss because of how she can be perceived and for safety reasons. I adamantly emphasized that there was absolutely nothing to be ashamed of!  I actually saw her smile … I don’t think this woman has smiled in quite some time.  She felt understood and accepted while most importantly heard.

But I still don’t think she quite caught on how important it will be for her to reveal her hearing loss; she only mentioned that she would push her hair behind her ears hoping that her patients would see her hearing aids.  I was tired and medicated from my surgery, truly incapable of getting on a pushy persuasive bandwagon at that time to tell her that by simply putting her hair behind hers ears would not be enough to communicate to her patients that she may not hear them.

I feel bad for her because losing a sense you’ve been used to all your life is sad … it’s a grieving condition.  And most importantly her communication and rapport with others will be negatively effected … I didn’t like her in the beginning because I thought she didn’t care, but after finding the real reason for our communication problems, grace was able to make its way into our brief relationship, my hard feelings about her softened.  If she doesn’t let others know about this deficit what will they come away thinking?

I thought about writing a letter to her manager about this issue, but realize there will be no way I convey in written form the tender nature of this serious matter that should be addressed if only for safety reasons alone.  When I’m more healed I plan to talk to her manager in-person and talk about this hearing deficit that C. has, hoping that the nurse manager can become more understanding of C.’s loss and also encourage C. to openly and shamelessly share this deficit she has with her future patients.

I do have some more thoughts on C. … but somehow they seem immaterial at this point when I see her in this light.  I don’t think she was the kindest nurse I’ve ever had and I was uncomfortable when my Foley catheter kinked up and the tubes to the SCDs dug into my legs — she didn’t readily fix these items and I was reduced to that needy, whiney patient that I don’t even really like to care for.  And how much of this was due to C.’s age (mid-to-late 60s I presume), her adjustment reaction to a new hearing impairment, recovering from recent family stress, and possibly being burned out professionally with feeling that her manager didn’t appreciate her?  I give her only the benefit of the doubt.

And I kept a positive attitude … all the time doing that unfair thing of comparing one person to another — my day nurse to my night nurse.  Truthfully I longed for the next morning when I would see S.’s shiny bright face again.

communication-is-to-hear-what-isnt-being-said-quote-1

The post-op fun continues … sort of

day-night1

Can I just get this out right now … my day and night nurse were literally like day and night!  Luckily the nurse I got to spend the most time with or who spent the most time with me was the nurse I preferred.  Not all nurses are the same, just as all people aren’t the same.  There’s usually a chemistry between people or their isn’t and this was the case for me and my two nurses.

Nurse S. was my day nurse; she was attentive, kind and thorough.  She was also a great listener too … I’ll get into that a bit later.  I was a bit sad when she had to end her shift, but she did have a life and family to go home to.  She did make me feel like her only patient.  I hope I didn’t make her feel that way because I know some patients can be time-hoggers and as a nurse you end up feeling guilty by not being as attentive to your other patients.

Nurse S. used to by an L&D (labor and delivery) nurse before working on this postpartum / GYN floor.  I was kind of afraid coming to this floor that I’d be the boring, non-cutesy-baby-having-momma patient and might be ignored … but this is far from what actually happened.

Prior to being placed on this floor I was asked if the predominantly postpartum floor would be an OK place for my post-op recovery.  I was asked this by the pre-op nurses prior to my surgery.  If I was OK with being on the postpartum floor — the floor with all the brand new babies — then I would be on the general surgery floor.  I was totally OK being on the postpartum floor even though I am childless.

Apparently there was an incidence of some woman in the past who had a hysterectomy, who already had three boys, who got placed next to a room with a new infant girl.  That patient went hysterical after her hysterectomy because she had always wanted a baby girl; it was a trigger for her.  Honestly, all I ever wanted was healthy normal baby with 46 chromosomes and no major structural deformities … nothing perfect … simply an intact start for my baby’s life.

So, yeah, the postpartum floor was what I wanted; I figured they knew about women’s needs better, to include female anatomy.  The only weird baby situation I ran into was when I got up for a walk down the hall, rolling my IV pole and carrying my Foley bag along, was the man who walked by me and asked, Boy or girl?  To which I replied, Neither.  I had a hysterectomy.  He looked visibly embarrassed and apologized.  His question had no effect on me emotionally; I understand that not everyone knows the postpartum floor also has GYN patients, not merely new mothers.

One thing I will have to impress on anyone who goes to the hospital is to bring snacks.  I was starving after surgery.  It was EIGHTEEN hours before I ate something.  And, no, ice does not count as eating something.  I scarfed down all the orange jello and graham crackers they would give me until my meal tray arrived.  The hospital food true to cliché was terrible with the exception of the next morning’s bacon.  But when you’re hungry, you’ll eat just about anything.

As for my patients that I talk to when I return to work and if I’m every hospitalized again, I’m going to emphasize the importance of having available finger-food snacks.  Holy cow I was hungry!  And it sucks to beg for graham crackers and jello from your nurse when you know these are trivial items in the scheme of actual nursing care!  I joked with nurse S. that I really wasn’t needy but wanty instead; she laughed.  I also told her I might have been somewhat hangry and asked her to forgive me.  She had a puzzled look on her face.  I can’t believe she hadn’t heard the term hangry before.  I had to bring her up to speed.

HANGRY!She got it and a let out a small chuckle.  Wish I’d known this word years ago … it explains a lot with a lot of people I know (and have known)!  I don’t think I was really angry … I was only graham cracker and food obsessed … I did have a Dilaudid pump infusing into my veins by the way!

Can this post-op day really continue?  Yes, it can … I’ve got some more stuff to milk this one day into a few more posts.  Stay tuned.