When Past Trauma Shows Up During Surgery
From My Perspective of Patient AND Therapist
Happy Friday!
This week I had an ear operation - the same op that I had last year, but for my other ear. I have (had?) a condition called otosclerosis. Extra bone growth on my stapes (the smallest bone in the body) restricts the movement of the inner ear bones, which reduces their efficiency; sound waves can’t pass through so well, resulting in progressive hearing loss.
I wanted to write and tell you about it because I think my experience works as a great example of how trauma can affect us. If you want to cut to the points that you may find insightful and helpful, I’ve summarised them at the end, although they will make more sense if you read the whole thing.
Before I had the initial operation (a stapendectomy) last year I perused a Facebook group in which many people discussed having, or not having, the operation. Woeful tales of dizziness, tinnitus and hearing loss peppered the pages - and that was AFTER they had had the operation.
If I had relied on that as a basis for my decision I wouldn’t have gone through with it. Instead, I made an appointment with an eminent professional in his field and (equally important) a genuinely affable guy who was open to answering any and all of my questions.
He presented the risks, in a way that felt considered and non-dismissive. Frustratingly, he managed to evade a ‘yes-no’ answer to my question, ‘If this was your ear, would you do it?’ which was, of course, the right thing to do.
The reason I share it today is because of the two very different experiences I had with the operations.
The first passed without a hitch and was over in 20 minutes. The consultant discussed what he was going to do before hand and the anaesthetist joked that she would make me feel like I was having several nice gin and tonics.
An interesting way to describe the influence of anaesthesia, and I did wonder about how that would have landed with someone dealing with, or in early recovery from, alcoholism (never quite taking off my addiction therapist’s hat!).
And you may think, good lord! You can’t say anything nowadays without someone taking offence, but having a simple awareness of the potential vulnerabilities that a patient may have and saying something innocuous like ‘it will help you feel relaxed and whoozy’, is way to avoid potential pitfalls.
That first operation last year went extremely smoothly.
After it, I went back to my room and had something to eat - which promptly came back up - but I was reassured that this can sometimes happen with a local anaesthetic.
Sure enough, I soon felt right as rain and walked out to meet my husband shortly afterwards to go home.
A year later, the day of the second operation had not started brilliantly.
A few weeks ago I started a discovery Zoom call with a potential client, only to find that I was being indecently exposed to. I had the presence of mind to take a screenshot for evidence before I closed the call and contacted the police.
Subsequently, I had been contacted by the police several times, having to repeat the story again each time as they came at it afresh. It just so happened that on the same day as the operation, the police called to take my statement.
Although I could have asked to delay it until after my op, I was sick of these calls and wanted it to be dealt with as soon as possible so that I could hand over my statement, send over the evidence, and get it off my computer.
All was well until the police officer asked how I was doing
At which question, I disintegrated. I had the resources and resilience to deal with the incident in and of itself, illustrated by the fact that I did not go into freeze, and was able to take action to take the picture. The disintegration came from what was activated when she asked that question.
The times that I had been dismissed, ridiculed and told ‘I got the wrong end of the stick’ when I had tried to speak up in the past about sexual trauma as a child. The upset that now, at a time when I was physically safe (the incident happened online), had agency (I could get myself out of the situation by shutting down the call) and was empathically attended too, all served to highlight what I didn’t receive in my other experiences from any authority figure when I was a child, adolescent and young adult.
I have done a lot of work on what I endured, and am proud that I have managed to get to a place of post traumatic growth where I can help others have an experience of feeling safe, seen and soothed in the work we do together.
And so I went on to have my second operation with, perhaps, less resilience than I had had the previous time.
Relaying the incident, and the grief that that activated, left my nervous system a little more jangled than it may have ordinarily been.
The second operation started well. The same reassuring chat beforehand with the surgeon and anaesthetist (no mention of booze) and we even had a good laugh as she was administering the drugs; Noah and the Whale (the surgeon’s surgery soundtrack - I asked) gently on in the background.
Within a few minutes I noticed myself getting quite shivery and slightly anxious. I therefore started to ‘walk’ my feet left and right to promote bi-lateral stimulation. This helps the nervous system by activating both hemispheres of the brain, which helps to activate the calm ‘rest and digest’ parasympathetic system.
The surgery was a bit more laborious as my stapes bone was still a bit bendy (technical term) which meant that it was not as easy to snap off with the laser. I was reassured by the surgeon’s humming to the music in the background - perhaps his own way to stimulate his vagus nerve and keep him calm.
He had laid the surgery tools on my chest, I imagine for ease of access. Quite often he was reaching to pick up an implement, or plop one back down again. For many people this may have been ok, but for someone who has experienced sexual trauma, to be sedated, unable to see or move (other than some foot twiddling) and have someone using my chest as a table, it had my nervous system in a pickle.
Although I was aware of this making me uncomfortable I didn’t say anything because I was unable to say much due to the several gun and tonics effect and, to be perfectly honest, I didn’t want to distract him from fixing my ear, as he was in the depths of right-angled scalpels, curved needles and lasers.
I do not believe that the surgeon in any way meant any ill-will and am not accusing him of any nefarious intent. I do, however, want to share this to illustrate how decisions made out of urgency, habit, or whatever reason it may be, may still cause a traumatic reaction based on the resilience and resources of someone.
That resiliency and those resources can fluctuate, based on someone’s immediate and historic previous experiences. Yes, we can do much to heal our trauma, but I do believe there can still be aspects that can get triggered, and this is an opportunity for more healing.
I’m also not suggesting that we all need to be wrapped in cotton-wool or anyone needs to tread on eggshells, but a more trauma-informed approach may at least create an understanding of how these seemingly innocuous events could cause duress.
I share this to highlight Dr. Gabor Maté’s point about trauma, ‘It is not what happens to you, but what happens inside of you as a result of what happens to you.’
As the surgery ended I immediately felt nauseous and dizzy. This is to be expected when diving in around the inner ear. However, I wonder how much was also due to what my nervous system had already endured that day.
For the next two hours I was repeatedly sick (no mean feat when I had been fasting since 7am that morning). The medics commented on my departure that they had never given anyone as much anti-sickness medication.
As I was pumped with a saline drip, my legs went into involuntary shaking - something known as neurogenic tremors. I was not alarmed at this, but rather grateful for my body to know what to do to process the trauma. I did not try to stop or mask this, but surrendered to the shakes, knowing that they would pass.
Quite soon after the tremors ended I started to feel better and was able to leave within half an hour.
Imagine how that would have been had I not had the resources at my disposal to manage my nervous system. Even with those to hand, it still reacted in the way that it needed, to process everything.
Although I had enough agency and awareness to ask for much of what I needed (another sick bowl please, please remove the cold towel from my neck…) there were still moments where I did not.
I share this to hopefully clarify a few things:
We all carry the imprints of past trauma in our bodies, and these can surface unexpectedly.
I experienced this when the police officer's compassionate response triggered memories of times I wasn't believed as a child about sexual trauma.
We need to recognise that our resilience isn't a constant
It fluctuates based on recent experiences and emotional states. I felt this deeply when I went into my second surgery with my nervous system already activated from the police interview earlier that day.
We must understand that seemingly neutral actions can trigger profound trauma responses in those with specific histories.
When the surgeon used my chest as a tool table during surgery - though well-intentioned, it activated my trauma responses.
We have the capacity to understand and work with our body's natural trauma responses.
When my legs began shaking with neurogenic tremors after surgery, I knew to let my body process rather than fight against it.
As Dr. Gabor Maté teaches us, that trauma's impact lies not in the event itself, but in our internal response to it.
I lived this truth through my contrasting experiences of two identical surgeries, shaped by my different emotional states.
We can develop tools and strategies to manage our trauma responses.
Bilateral stimulation helpful during surgery, moving my feet to help regulate my nervous system, being armed with these resources helped to build my resilience.
We need to acknowledge that healing from trauma isn't linear
Even with significant growth, certain situations may still trigger us. These moments are not setbacks, but opportunities for deeper healing and understanding.
This doesn’t make us a ‘failure’. It makes us human.
I really hope that this has helped to offer reassurance if you have had your own moments of disintegrating, not speaking up, having a sudden trauma response at an innocuous event, not feeling heard of validated, or feeling like you ‘regressed’ when you were ‘doing so well’.
As Ram Dass said, we are all walking each other home and I hope that by sharing this I have helped some of you to take another step.
No poem for this this week, just honest prose. Who knew, maybe I am learning to trust myself to be honest in a way that is not masked in metaphor (although I do love doing that!)
For paid subscribers, please see below for some techniques to help balance your nervous system.
In other news
I’d love to get your input about the types of products or offers you may be interested in. I want to develop the ‘therapeutic poet’ side of things. I’m currently working on refining my first course and need your help!
Which one of the following course topics would you be most likely to purchase and how would you like them to be delivered?
Please let me know if you have another topic you’d be interested in.
Many many thanks!
That’s it for now,
‘Til next time!
Jacky ✨
Grounding techniques can by physical and mental. Here are some ideas:
Physical Grounding Techniques help to connect your back to your senses, which is the language of the nervous system:
Put your hands in cold water
Breathe deeply
Give yourself a butterfly hug
Hold a piece of ice
Smell eucalyptus oil
Massage your hands
Listen to your surroundings
Try the 5-4-3-2-1 method (5 things you can see, 4 things you can touch, 3 things you can taste, 2 things you can smell, 1 thing you can taste).
Sit with a pet and stroke them.
Mental grounding techniques
Say what day and time it is and your name out loud as many times as you need.
Count down from 100 in 2s
Recite a nursery rhyme.
Describe what is around you.
Plan an activity.
Run through the alphabet.
Describe the path to walk to your local shop.
Retell a funny story that happened.
Describe how you would perform a common task.
Describe your favourite meal.