Coping with the Emotional Impact of Orthopedic Surgery
Snap, snap, crackle, pop. That was the sound of my life changing in an instant during a summer stroll. I fell on slightly uneven pavement and broke three bones in my ankle and severely dislocated it, leading to a surgery and months of recovery.
An orthopedic injury is typically a traumatic event. The recovery can elicit many emotions. As a psychotherapist, I was surprised not much has been written on coping with the psychological impact of such an injury and the following recovery.
By allowing emotions to arise without judgment, we allow them to move through us. We can also take committed action to make positive changes as a response to these reactions. The following list notes emotions and reactions that might be felt as part of an injury that requires many weeks to months of recovery. This list does not imply that every patient will experience all or even most of these, but many patients will feel at least several of the following:
Trauma can be anything we experience or witness that threatens life or well-being. Depending on how the injury occurred, studies have shown 20-50 percent of orthopedic injuries can lead to Post Traumatic Stress Disorder (PTSD). Risk increases with age. While most patients won’t develop full PTSD, the physiological trauma reactions immediately following the injury may include shaking, chills, nausea, insomnia, and lack of appetite. Such reactions may also happen once the cast is removed and one sees the limb or foot looking quite different from what it did before the injury. Trauma first produces physiological responses and then brings psychological reactions, such as flashbacks, fears and avoidance behaviors. Calm the nervous system with slow, deep breathing through the nose. Bring yourself into the present moment by noticing five separate neutral things you can see, hear and touch in this moment. Listen to good quality guided imagery or meditation. An excellent source is www.healthjourneys.com or a meditation app. Also, ask your doctor or nurse what to expect before the cast is removed so you are at least somewhat prepared for what you’ll see.
Fear and anxiety
Our fears can help keep us safe. Patients understandably fear re-injury. Our brains help us by noticing actual dangers so we can avoid them. Sometimes our brains work a little too well and create more anxiety than is helpful. Anxiety and fear can also apply to the distant future, as patients worry if they will ever again regain full or even close to full mobility. Talking with one’s doctor or physical therapist can help allay these fears.
Many patients replay the injury and blame themselves. When my doctor asked how my injury happened and I began with, “It was really stupid…”, he told me everyone says that. Ask yourself what was the original intention of whatever it is for which you are blaming yourself.
You will probably miss enjoyable events or outings while recuperating, or at least not be able to participate how you would have planned or wanted to. Of course, this will be disappointing. Remind yourself this is a temporary state.
Some people will feel ashamed of the less-than-able shape they are in as they heal. You can ask yourself, “Is this a helpful thought?”
Almost everyone might feel frustration to at least some degree. It’s not easy getting around on crutches or even the knee-roller, which to me had looked easy and fun until I actually had to use one. You may remind yourself that you are growing in ways and literally and figuratively using muscles you otherwise wouldn’t have.
Some may turn anger toward others or oneself. Perhaps there is blame of someone you perceive caused the injury. Anger at oneself is also common (see Self-blame). Anger is often either anxiety, fear or hurt in disguise. Ask yourself what’s beneath the anger and breathe into it to allow if to move through you.
Feelings of loss are real and understandable. With each loss, there are multiple losses. Some of the notable ones may include a loss of a sense of control or invulnerability; a loss of a certain body image; a loss of social connections; and a loss of financial stability, among others. Allow yourself to feel these feelings and grieve or cry if needed.
Vulnerability/lack of control/helplessness
We all need to believe in a sense or order and control in the world, otherwise we would have a hard time functioning. For example, if we didn’t trust that other cars would stop at a red light, we would be afraid to drive. Yet with a life-changing injury, those assumptions about ourselves and the world may be shaken. Remind yourself that whatever caused your injury is probably the exception to the rule and not a normal occurrence. Also, note what you do have control over now and ways you can help yourself.
Some people have resentment arise if they perceive others are not there to help or understand them in their time of need as they would have expected. Remind yourself our expectations of today are our disappointments of tomorrow. No one is obliged to help us, even if we have helped them in the past. There may be reasons we don’t know or understand for why they can’t be there for us at our time of need.
Feelings of sadness may arise for a variety of reasons. Feel them, and allow them to flow. Have a good cry if you feel that arising. Share the feelings with a supportive person. If you begin to feel hopeless, that’s an indicator of depression and you should consult a mental health professional.
Not being able to move much for many weeks can be monotonous. Appreciate that at least we live in the best time in history to have such an injury with access to all media at our fingertips. Take the time the learn something new online. Write in a journal. Call friends you have been meaning to connect with but hadn’t had the time. Meditate.
Lack of energy
Fatigue is common, as the body is taking energy and putting it toward healing bones and tissue. The body has wonderful ways of protecting us and fatigue can be a way of forcing ourselves to take it easy and cocoon as needed to protect ourselves. Ongoing low energy, however, can also be a symptom of depression and if you believe that’s what you may be experiencing, talk to your doctor or mental health professional about this.
The good news is positive change can come from moving through a life-changing injury. Post-traumatic growth is real. We can find a sense of strength and resiliency we may have never realized we had.
Through slowing down, we can take the time to figure out what’s important to us in life and what isn’t. We may set new priorities and clarify values and goals. Some may even be able to take the time to begin to live those values and work toward the goals while healing. I know one person who found a more fulfilling life path when she changed careers after she broke her ankle.
With such an injury, one has a good excuse to retreat from the everyday stressors and obligations of the world. This gift of time can be used for reflection and turning inward in a growth-inducing way.
Some relationships may be strengthened, as we realize there are people around us able to provide care in ways we may not have imagined. While others may let us down, we can ask if those relationships really add to our lives or drain us.
The recovery period also allows us to take time to choose health. We are forced to take care of ourselves in ways we may not have considered before. We can also choose to think about ways of caring for our well-being in the future.
Although we wouldn’t have chosen such an injury to learn these lessons, reframing this period as a gift and staying open to the lessons can be most helpful. Instead of telling ourselves, “This happened to me,” we can say, “This happened for me.”
Levin Belzer, K. (2018). Coping with the Emotional Impact of Orthopedic Surgery. Psych Central. Retrieved on March 28, 2020, from https://psychcentral.com/lib/coping-with-the-emotional-impact-of-orthopedic-surgery/