The deep psychic effects of medical care

In his brilliant 1993 satire “Et Tu, Babe,” Mark Leyner proposed a new concept in body art, which is the specialty of “visceral tattoos.”   The narrator travels to Mexico where his chest is opened and the insignia of a “guy surfing a wave of lava, wearing polka-dotted trunks,” is tattooed directly on his heart.  The dye used shows up on CT scans and apparently women, especially x-ray technicians, love it.   Superficially, a jest at those who indelibly paint their skin, Leynor’s parody is an allegory to the brutal invasiveness of healthcare.  Going even further, we must understand that medicine often causes deep injury beyond that of the flesh.  That injury is a tattoo of the mind.

When someone is treated for disease, their body is invaded.  We open someone’s chest and replumb the vessels of the heart, remove and rebuild a breast, reconstruct a larynx, open the skull to remove a cancer, resect and reconnect inflamed bowel or simply use a scope to repair a knee.  With these procedures, a person is healed, fixed and often cured.  They are whole and pure again.  Perhaps … but what about the mind?

Any invasion of the body that scars bone, muscle, and vessel, also scars the mind.  An imprint on the spirit if you will, changing us at the deepest level.  The psychological damage may be slight, just a little irritation, to be tucked away and never again considered.  Sometimes the cut is so deep, so profound, that the person becomes forever a patient transformed, always wounded.  The emotional ghost of the invasive act is a complex visceral picture stamped on conscious and unconscious mind, like the residual image of a brilliant flash bulb to the eye.

How can we predict how deep a wound may become, and how much it may transform? Is it the person or the act?  It was just a minor procedure, a one day stay in the hospital, not really much pain, rapid recovery, she was back to work in two weeks, but somehow the wound buries deep into the core of a mind changed forever, a deep pain that never heals.  Stage 1 melanoma … take out the ovaries …  a near lethal aneurism … no big deal … really?

Such transformative wounds humiliate and confuse.  How do you tell those that you love that though you are cured you are still in pain?  How does one say, “I am different.” Should you not just be happy to be alive, and healthy?  It is time to enjoy life and get back to the day-to-day!  The world knows that you are well.  Why does it not feel that way?

I have a patient who is born again healthy.  His diverticulitis was treated with two surgeries, heart disease bypassed, prostate cancer in remission, hip replaced, cataracts removed, laryngeal polyps gone, hypertension controlled, hearing aids fitted and ulcers healed.  He is perfect and has a fine prognosis.  Nonetheless, he is a shell of the man who raised children, built a career, reveled in sunsets and deeply loved his wife.  A posttraumatic skeleton.  Empty, depressed, nervous … the surgeon’s brand burned into his mind.

The critical lesson for doctors is the deep psychic effects of even successful therapy.  Physicians must be aware that we invade not just the body, but also the psyche, leaving behind transformative images of pain, humiliation, and fear.  This means choosing therapies carefully, educating well and giving care gently.  It requires engaging with each patient after it is “over” to help him or her reconnect and heal.  It means being aware that very long after the procedure, the invasion, wisps of suffering remain deep inside.

As family and friends of patients, we must also remember that healed and Healed are not the same thing.  Just because the body is better, does not mean that the mind has followed.  We need empathetic support and understanding long after the crisis has past.  New trauma or stress can release demons, and we must all be aware and sensitive, for yesterday’s surgery is tomorrow’s pain.

Finally, as patients we must understand we have been changed.  There is something brutal about invasive medical care, which may affect us deeply. We must be gentle with ourselves and realize healing is more than tissue deep.  Healing is of the mind, and may in part take a lifetime.  A wound hard to expect, a sore slow to mend.  If we are not cautious, it can change our soul.  A tattoo on the brain.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

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  • Homeless

    I have my before and after moment…I find doctors really don’t care unless it can be labeled and treated.

  • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

    Wow. Very thought provoking indeed. Thank you for sharing this.

  • lemaman

    I’ve watched my father undergo this transition. Never went to the doctor until he was around 68. Melanoma, prostate ca, 5 vessel CABG and voila, he’s a nervous wreck. He’s gone from free spirit to fatalist, thinking every routine post op, post rx, post anything test is going to reveal the cause of his demise. It is hard to watch, especially as a physician. It has created a dissonance in me such that I just don’t care. I don’t go for any check ups, I don’t even know if I believe half the crap I have to spout off routinely anymore, and that’s just sad, but true. I exercise religiously, am fit and feel great and plan to ride this wave for all it’s worth. I know other docs will cringe at this blasphemy coming from a fellow physician, but this article hit home. I suppose I have a deep fear of what may be found or what may come to pass, but at the end of a day I’m just tired of practicing medicine, tired of demanding patients, and tired of dealing with unreasonable expectations from administrators. The last thing I want to do is walk into this quagmire called healthcare as a patient, especially on my day off.

  • Katherine

    As a hypnotherapist and former “professional patient” (23 surgeries) I can very much relate to this article. After my hip replacement I went through severe grieving over losing my own hip joint. I doubt if the doctors had a clue that it might happen. So, deep psychic effect — absolutely.

  • bruni brewin

    I would add that the same happens with emotional invasion through physical or psychological abuse – the body and mind keep score. There is release if you find the right practitioner – one with left brain knowledge and right brain intuition – someone who heals from the heart and soul with inborn wisdom. We have to be open to both orthodox medicine and spiritual medicine.

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