THE TRAUMA FROM SLASHED DIGNITY IN THE OPERATING THEATRE

Anybody who has ever had to undergo any kind of operation or procedure knows that an operating theatre is a cold, clinical, and sterile place.  The absence of both warmth and a feeling of safety is more than enough to unsettle even the most confident patient.  But what happens when the blood in the veins of the warm-blooded people (theatre staff) runs as icy cold as the stainless steel around them?  They now have the ability not only to make precision incisions into outer body parts with scalpels, but also to slash gashes into inner dignity with indifferent disrespect.  Before anesthesia, all patients are vulnerable and exposed, and depending on the invasive/intrusive nature of the operation or procedure, they could well be powerlessly subjected to the possible violation of their deepest hidden fear of having their nudity shamelessly exposed.  This can cause indescribable trauma and unlock complex emotions, especially for fragile, previously-traumatized individuals.  Past trauma unconsciously merges with new fears to form compound trauma.  The past and the present become inseparable, and the patient's ability to discern between old and new becomes unreliable.  This inability to rely on discernment challenges, in turn, the ability to trust and the patient finds him-/herself in a place where they can, ultimately, trust nobody, not even themselves.  Based on my own personal experience (during the course of several decades) with doctors who have treated either myself and/or members of my family, it is with a profound sense of sad disappointment that I can declare that the truly dedicated doctors who are entirely committed to the wellbeing of their patients, constituted but a small minority of the total group.  These are the remarkable, selfless doctors who strive to address their patients’ anxieties and fears to, thereby, earn their trust.  Unfortunately, the vast majority of our treating doctors seemed to have rather exacerbated the anxieties and fears of their patients.  It appeared as if they were intentional catalysts to the generation of compound trauma by side-stepping the responsibility of addressing their patients’ anxieties and fears.  By the time these patients reach the point of failure to trust, they are silenced into confusion and their silence significantly raises their risk of being exploited.  I believe that it is time to break this silence.

I recently had to undergo a cystoscopy for the second time in two years.  During this procedure a urologist uses a probe-like device with a camera on the tip to examine the urinary tract of a patient.  With the patient under anaesthesia, the urologist forcefully gains access to the urinary tract through an opening in the patient’s genitals.  Two years ago, I consented to this procedure on the condition that my urologist at the time, would identify the cause of my recurring bladder infections as well as find the source of blood in my urine.  He, subsequently, dishonoured this agreement when, after performing the procedure, he declared that he did not find cancer and that nothing was wrong with me.  With arrogant indifference and a derisive shrug of his shoulders, he simply dismissed, without merit, the very conditions under which I consented to this invasive/intrusive procedure.  Since I had informed him, in writing, of my extensive anxieties and fears, he intentionally deceived me and his betrayal of my confidence caused me an unspeakable amount of trauma.  In addition to the trauma, my symptoms not only continued relentlessly, but it became progressively worse.  Although I continued to suffer, the continuation of these symptoms, at least, represented sufficient evidentiary proof that this urologist was incompetent and that, through his professional negligence, he added himself to my experiential majority group.  When this same procedure was performed a second time by a different urologist, it was a distinctly different experience.  However, this time a highly experienced man listened with compassion, in person, to all of my now-compound-trauma-induced anxieties and fears.  At the end of the consultation he, then, affirmed everything.  Once again, I consented to the same procedure under the same condition as before, but this time I felt comfortable to trust someone who took the time to hear me out.  It turned out that my trust in him was rewarded with not only a diagnosis, but also a commitment to engage in a treatment plan.  I would like to address a message to all doctors and health care professionals who might fall into my aforementioned experiential majority group, those who are involved in surgeries and procedures where the nudity of patients are exposed under anaesthesia:

Dear Doctor and/or Health Care Professional, allow me to remind you today that, regardless of many genitals of naked patients you have seen in your career, that everytime you have to expose someone’s nudity or are present when it happens, you are on sacred ground.  Back in the Garden of Eden, God bestowed an intimate protective sense of modest shyness about nudity on every human being.  For a brief moment in time, you are awarded the authority to violate this measure in order to use your God-given talent and gifts to help your distressed patient while you uphold his/her dignity in the process.

This narrative tells of my own personal experience.  It is raw, genuine, and transparent, but I believe that by my attempt to break the silence with it, it will hopefully bring liberation to other people who are also burdened by unaddressed theatre- and/or hospital induced trauma.

On a hospital-bed-on-wheels I lie, covered only by a sheet and a single duvet cover.  The faithful prayers of my beloved travel companions on this particular part of my life journey serve as the proverbial glue holding me together now.  Their love and wisdom envelop me in a safe cocoon from where I was able to flick my internal violation override switch.  Their faith and their strength could now carry me through what lay ahead.  My own prayers were soaked in anxiety and deep within me I wished that I could just experience a Jesus-Veronica moment (referring to a scene from The Chosen where Jesus healed the woman with the blood disorder) during anaesthesia.  I am wearing only a hospital gown and a giant blue, transparent teabag-with-three-reinforced-elasticated-holes in strategic places.  The teabag is supposed to be a panty, but to me it feels like a deceptive, pseudo-smart attempt at giving a vulnerable patient a false sense of security.  My hospital bed is not in the ward where I was first admitted to, it was stationary in front of two elevator doors in an unobstructed passage/thoroughfare with unrestricted access to all other hospital staff as well as public visitors.  Along with a ward nurse and a porter, we wait for an elevator to take me to the theatre on one of the upper levels of the hospital.  The very theatre where the hospital gown will be pulled out from under me and placed in way which will expose the fullness of my nudity to all staff present in that theatre.  The very theatre where the teabag will be ripped along the seam rendering it a useless piece of cloth, completely void of the properties of a transparent panty.  The same useless piece of cloth which will hitch a ride back with me on the bed and serve as a mocking reminder of what transpired in that theatre.  My attention is drawn to a man walking by, but as he approaches me, it sends icy shivers down my spine.  He looks directly at me, and when our eyes meet, I know exactly who he is.  I spot a look of arrogant condescension on his face and for a fleeting moment, there appeared to be a message in his subtle contemptuous smirk.  It feels like it is saying something like Oh, it’s just you.  I remember you, I remember EVERYTHING about you!  This is the dingbat charlatan of 2022 whose incompetence caused me to be here again today and whose insolence still gives me night terrors to this day.  The choice-grade-messed-up-super-quack (in my best attempt at not swearing) who looked at EVERYTHING and saw NOTHING!  Suddenly this nightmare-turned-reality encounter declares an open season to all the fear gremlins in my head. 

By the time we reach the waiting room of the theatre, I am filled with vulnerable insecurity and my anxiety levels rapidly increase as I observe the staff simply going about their jobs.  Forms are filled out and my medical information is confirmed before I am wheeled into the theatre.  Upon arrival, my out-of-bounds anxiety reaches the point of no return.  I am instructed to slide myself from my bed over onto the hard, pathetically tiny operating table.  In my most desperate attempt at keeping my dignity covered while moving my obese petite 76kg-body, I realised that my priority completely mismatched that of the nursing staff around me.  I wanted to maintain my dignity and they were in a hurry to get me on the operating table so that they could move the bed away and continue with their conveyor-belt-day-task.  I cannot help but wonder how difficult it must be for larger, heavier people to secure themselves onto this centre stage balance beam.  Madam, please slide back.  I feel like a numbered piece of meat waiting to be processed.  Madam, please slide back further.  Nobody checks in on me, nobody asks if I am okay and I realise that nobody cares about that part of my wellbeing.  I see my new, kind urologist on the opposite side of the room.  He is the only familiar person in the room, but he is engaged in a serious telephone call.  He earned my trust the day before and I wish he could just come over and reassure me before commencement of the procedure.  But the conveyor-belt-people are in a hurry and I do not get to speak to my doctor.  The anaesthesiologist takes a firm hold of my left arm and when he becomes aware of my tightly-wound rigid muscle stiffness as a result of intense anxiety, he simply increases his force on my arm.  With the increased force, he manages to stretch my arm out and securely tie it down to allow him to find a vein into which he will inject the anaesthestic.  You must calm down now, Madam, otherwise it will be impossible for me to get this thing into your arm!  Despite his palpable impatience, he finds a small vein and successfully pricks it.  I find myself feeling like prey, just taken down by a hungry lion and I decide that any resistance from me, at this point, would be foolishly futile.  Nobody notices the tears in my eyes.  Nobody knows what I had to endure to be here again today.  Nobody knows about my soul-wrenching decision to flick the violation override switch.  Nobody knows that I had to betray myself to do so.  The anaesthesiologist injects the anaesthetic, and I made a conscious decision to succumb to the blissful oblivion of nothingness.  Just before I do, I noticed the time on the wall clock.  It is just before 12:00.  I wake up in the corridor just outside of the recovery room.  I am in my own bed and the wall clock shows the time at 12:30.  There is a porter next to my bed awaiting someone else to assist him in wheeling me back to my ward.  I feel how all of the pent up fear and anxiety in me reaches the critical breaking point and when the walls of containment start to crumble, I cannot hold back my tears.  I cry without shame, without control, without stop.    The poor porter is out of his depth.  Madam, we will return to the ward really soon.  I am in so much pain that I cannot find a comfortable position.  This is so excrutiatingly painful and I feel so unspeakably abandoned.  Where is the anaesthesiologist?  I need more anaesthesia.  Lots more.  But I don’t get more anaesthesia.  I didn’t see Jesus while asleep.  I’m not Veronica from The Chosen.  Again I feel like prey and then I remember that even Mufasa from The Lion King gets trampled to death.  It is the circle of life.

I am finally wheeled back to the ward, and my beloved Assie, my amazing IronMan, is there, waiting, happy to see me again.  The sense of abandonment begins to fade, but the pain increases with vengeful ferocity.  The nursing staff administer the first pain meds through the anaesthesiologist’s feeble little vein, but it proved to have about the same pain killing ability as a vial full of water.  The pain rages on powerfully.  The second dose of meds needs to be administered through a new IV, and I request, in advance, to have the most skilled vein-poker and NOT a tissue miner perform the insertion.  The champion vein-poker in the department takes his seat next to me and pulls the new IV equipment trolley closer.  First, the tourniquet has to be clipped securely around my upper arm before it is pulled tight in an attempt to drow the veins out on my forearm.  I hear the click of the secured tourniquet, but then the sudden youthful force with which the tourniquet is pulled tight, feels like my arm is being ripped from my body.  This immediately awakens the pitbull inside me.  What the hell is wrong with you, you cannot yank it that violently, you’ll rip my arm clean off!  The young vein-poker is suddenly shocked into a wide-eyed stare at the pain-blinded middle-aged-woman-turned-bloodthirsty-fight-crazed-pitbull in front of him.  I have fibromyalgia, and what you just did caused excruciating pain, arguably equal to that of actually ripping a limb off!  Also, where the hell is your compassion performing this task?  I have "notoriously bad" veins, but I don’t see you heating up a bean bag to place on my arm so that the heat could draw out veins.  They do that in the chemo room at the private hospital in the southern suburbs, and they have profound success with it.  It is simple technology, an act of kindness, and it works!  Are you just ignorant towards those of us with "bad" veins who do not suffer from cancer, or do we not deserve simple kindness?  Thankfully, the young vein-poker lives up to his reputation, finds a suitable vein and pricks it successfully.  Another round of pain meds is administered, this time stronger and mixed with something (not on my allergy list) to counter possible nausea.  It only makes me groggy & cranky, but the pain continues to rage relentlessly stronger and was now also spreading across my body.  Assie watches, in utter helplessness, as I writhe in agony and he is also an unwilling witness to how every gut-churning crazed cry from my throat slices off a part of my sanity.  I need to pee, but I am not allowed to get up and use the bathroom.  The nursing staff brings a bedpan, and when I finally manage to get the right parts of my large, heavy body over the bedpan, my bladder refuses to cooperate.  The damn thing literally screamed out in urgency-pain, but when offered relief, could not perform, and then continued to pain in wilful defiance.  I notice the torn teabag next to the bedpan and the pitbull is swiftly executed.  I cry.  I cry because it hurts so much.  I cry because I don’t know what happened in the theatre earlier on.  I cry because I fear the same devastating outcome as last time, that NOTHING is wrong.  I cry because I was violated.  I cry because I consented to being violated.  Finally, a few hours later, my kind urologist shows up at my bedside.  Mrs Van Aswegen, there is most certainly NOT NOTHING wrong with your bladder.  I was able to confirm my suspicions and I can now diagnose you with Interstitial Cystitis.  I had to stretch/enlarge your severely narrowed urethra and ureters.  It was an extremely painful procedure and I had to quit once your heart rate spiked dangerously.  I also had to stretch your bladder by filling and emptying it.  The inner lining of your bladder comprises of multiple perforations and bleeding ulcerative sores, the last-mentioned being the direct cause of blood in your urine.  You suffer from an irreversible chronic inflammatory condition for which the limited treatment is not guaranteed.  Our best hope is that, given a few months of treatment, most of your pain and discomfort will be relieved and your bladder lining partially replenished.  The road to this best case scenario outcome is long and tedious, you are going to have to be patient.  My kind urologist prescribed TarginAct (S6 opioid painkillers), and about 20 minutes after I literally gulped down the first two tablets, I felt the pain starting to melt away as I slipped into a welcoming cloud of carefree, drug-induced coma-like sleep.  It was like having the superpower of being as high as a kite, but with the added ability to drift into and out of sleep as I pleased.  I skipped my Concerta the next day, in order to be a model patient and honour my kind urologist by utilizing the full benefits of the medicine he prescribed to me.  I slept so well that, if sleeping was to be considered an Olympic sport, I would have been the favourite candidate to take the gold medal.

After a four-and-a-half-decade-long battle with painful, intermittent bladder infections, I was finally presented with a diagnosis.  But this diagnosis could neither reverse the physical damage nor eradicate the accumulated trauma.  I am NOT okay and that IS okay.  But I will be okay again.