After Heart Surgery

Because open-heart surgery has a massive impact on the system, surgeons routinely keep close watch on the patient's bodily functions during the postoperative period. Now, to hasten recovery, doctors are being urged to study their patients' psyches as well, and for good reason. A Yale University School of Medicine researcher, Dr. Chase Patterson Kimball, has found that open-heart surgery sometimes produces severe psychological reactions.

Serious operations may leave psychological scars. Feelings of rage are common in women who have undergone hysterectomies; depression is understandably frequent among those who lose a breast because of cancer. Open-heart surgery, reports Kimball, produces its own constellation of symptoms: temporary loss of memory and intellectual function, delusions and even life-threatening depression.

Painful Awakening. Kimball bases his findings on observations of more than 200 open-heart patients during the past six years. Of this number, at least 70% suffered some psychological aftereffect. A few became euphoric, assuming, sometimes incorrectly, that the successful surgery had solved all their health problems. Others became withdrawn and depressed, convinced that neither the operation nor the care they were receiving would help. In some cases, there were lapses in the ability to read or speak. One 50-year-old man found himself unable to understand a simple sentence, or count backward from 100. A 57-year-old patient became violent, shouting unintelligibly and attempting to rise from his bed and pull out his intravenous tubes.

The reasons for such reactions vary considerably. Oxygen deprivation during surgery, leading to identifiable brain disturbances, explains only a handful of cases. Many problems appear to be emotional in origin. Most patients go into such operations with anxiety, sometimes depression over both the risks and the results. Those who survive face a painful awakening when the anesthetic wears off. They come to in the hospital's intensive care unit, surrounded by machinery to help them breathe and with tubes coming out of their noses, mouths and other orifices. Some resent this depersonalizing dependence upon technology and remain depressed until they are returned to their rooms. By contrast, others fear being disconnected from the machines. "It's like being pushed out of the nest," said one patient. "You have to fly or..."

Most patients, fortunately, succeed in flying, recovering physically within a few months after their operations. Some even develop amnesia where the operation's emotional aftermath is concerned. Most, believes Kimball, could recover faster if they could be spared psychological upsets. His studies have shown that advance screening can identify those patients most likely to react badly to open-heart surgery. A complete description of what the patient can expect when he emerges from anesthesia, something few doctors now bother to give, could ease emotional anguish and make his recovery more rapid.

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