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Hey everyone,

First time posting here and I've got what feels like is an odd situation that hopefully I can get some help/feedback on. I've been working as an ortho surgery first assist for a good while now and have become proficient with the procedures and am generally happy with it. Recently, however, I've started to get intense anxiety in the OR. I've never previously been that bothered by intraoperative bleeding or minor complications during surgery, but lately I've been having a difficult time with this. All of a sudden I get anxiety/panic feeling any time there is unexpected bleeding or anything resembling a surgical complication and feel like I'm going to vasovagal. I never used to think about surgery outside of my OR days but now I obsess about this anxiety. It's gotten to the point that I'm now nervous about going into the OR at all. I've not talked with my SP about this as it seems so ridiculous. Anyone with any similar experience or insight into what might be underlying this feeling?

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The first time I went into surgery, as a student, I had a panic attack, the first of my life. I was working with a thoracic surgeon. I had been sitting and talking to the patient and then the next thing I know, I was holding his beating heart in my hand. No one noticed but I had a full-fledged panic attack. Eventually the anxiety abated.

With such panic attacks, as you may know, may be provoked by an anxious event. But then the anxiety becomes centered around the fear that you will have (or have another) panic attack. Vasovagal induced LOC is uncommon. Hyperventilation can lead to LOC, but it is very hard to hyperventilate while wearing a surgical mask.I think a good cognitive therapist can help train you to self-talk you way down. Remember, exposure helps and leaving the OR, to never come back, will make it worse (or rob your life of the experience).  I've heard that OR anxiety and panic attacks are quite common.

Edited by jmj11
because I am I wanted to.
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Hello, OR RN here. I’ve worked in surgery for 4 years now doing mostly general surgery and robotics, but also some ortho in there as well. The best advice I have for you (and what i do) is when something is not going as expected I plan everything I need mentally for that situation. Notice a new perfuse bleeder?- what does that surgeon use to stop that- clamp? Suture? What kind? I have it in my hand before they can even ask for it. We’re having a difficult intubation and the anesthesiologist is struggling Im calling for the glydescope handing them back their mask and getting a rigid stylet. We’re doing a robotic lobectomy and were close to hitting the pulmonary artery I replay what I am going to do if we emergently open. Thinking about appropriate ways to intervene when things are not going right may make you feel like you have more control and less anxious. I hope that helps.

Jess BSN, RN, CNOR

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Thanks for the helpful replies. It's an interesting physiological response I'm getting. Intense anxiety but very little sympathetic drive, predominantly dizziness/lightheadedness and occasionally nauseated. Definitely prone to the fear of future anxiety attacks. Maybe I can approach it roundabout with my SP by having a conversation about reviewing how to respond to various complications. Regardless, I feel sure the best way to handle this is like anything else; head on with understanding that it'll get better with time. Thanks again for the replies.

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Guest Elpatodog

I think you have it figured out, talk to the doc you are working with or if you have any friends that do the same type of job as you discuss with them if you feel comfortable doing so. If not talk to a counselor. Sometimes there may be somethIng else bothering you or they could have good strategies to help you deal with the issues.

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I second the above. Your anxiety could be stemming from something completely unrelated to surgery but somehow being projected onto or manifesting during surgery.

On another note, idk what "a good while" translates to, but are you working a lot? Maybe it's burnout quietly starting to creep in. Take some PTO, burn off some steam, work out, etc. 

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My heart goes out to you. I am a provider in the ER and go through similar phases of anxiety. Some days are great and other days I agonize about things I might have screwed up on, and stay up all night worrying and replaying the day in my head. I agree wirh the above poster that your anxiety could be related to burn out as mine DEFINITELY IS. When I am working too hard for too many hours that’s when these feelings start to really creep up.

Mindfulness training and meditation will really help you. Sometimes when I am starting to note the anxiety creep I start practicing mindfulness - focusing solely on the task at hand, the present moment. When you’re in surgery and feel the thoughts start to race and the anxiety come on - think about how the instruments feel in your hand, how slow and controlled your motions are, what you are seeing right in front of you. When anxious thoughts pop up, acknowledge them and bring your focus back to the present moment. This can be done in the OR or even when you’re washing dishes.

I would also recommended seeking counseling to talk through some of these feelings.

You are a talented, well trained, dedicated surgical PA bad a$$! Keep reminding yourself of that. We all have moments of self doubt and many of us deal with anxiety, sometimes crippling anxiety. You’re not alone.

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Me thinks that it's something else in your life, and this is a reaction similar to PTSD.

What else is going on?

Good luck, perhaps it will pass

Edit: PS, I too have worked in the OR, as first Assist for many years, CV&T, Ortho, General

 

* When I read your title, I thought it might have been you had anxiety about an upcoming surgery that you were the patient in, as in your surgery

Edited by MidwesternTexan
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I'd like to say it gets better, but in my experience the longer we practice the more the anxiety seems to steamroll.  It's kinda like when I was younger I "didn't know what I didn't know..." So I was never anxious.  Now, older and wiser I know what I don't know and I also know what the eventual outcome of most patient care is and that produces anxiety.  One thing I disagree with above...I would NOT recommend talking to your doc about it.  Whoever recommended that, have you ever met an Ortho surgeon?  They are your employer, not your counseler.  At the first sign of any mental instability, they will drop you.  See a counselor and try to get it fixed (or managed) without anyone at work knowing.  I know this sounds harsh, but trust me, you don't want them knowing.  Hell in Texas you could literally be reported to the medical board for "mental issues" even if it's just anxiety.  No joke, I've seen it happen.

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On 6/15/2018 at 10:42 AM, Cideous said:

I'd like to say it gets better, but in my experience the longer we practice the more the anxiety seems to steamroll.  It's kinda like when I was younger I "didn't know what I didn't know..." So I was never anxious.  Now, older and wiser I know what I don't know and I also know what the eventual outcome of most patient care is and that produces anxiety.  One thing I disagree with above...I would NOT recommend talking to your doc about it.  Whoever recommended that, have you ever met an Ortho surgeon?  They are your employer, not your counseler.  At the first sign of any mental instability, they will drop you.  See a counselor and try to get it fixed (or managed) without anyone at work knowing.  I know this sounds harsh, but trust me, you don't want them knowing.  Hell in Texas you could literally be reported to the medical board for "mental issues" even if it's just anxiety.  No joke, I've seen it happen.

Fair points, I didn't intend to discuss it directly, just more of a review of certain surgical complications and how to handle them to help put my mind at ease. It's funny how the more we know the more we agonize about it. When I didn't know anything about the procedures I didn't even understand how to worry about complications. It's good to now it's not just me, though. 

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7 hours ago, PASurg said:

Fair points, I didn't intend to discuss it directly, just more of a review of certain surgical complications and how to handle them to help put my mind at ease. It's funny how the more we know the more we agonize about it. When I didn't know anything about the procedures I didn't even understand how to worry about complications. It's good to now it's not just me, though. 

I know sometimes my posts come off harsh on these boards.  Trust me, I'm really not trying to be a jerk.  I've just seen a lot in 25 years and a lot of it bad.  Conventional wisdom, the advice that most will give you over your career is honestly mostly wrong.  Telling you not to say a word to your Ortho doc about any anxiety struggles is the perfect example.  Most would say talk to him....I say the opposite.  There is the way the world should be.....then there is the way it is.  We would all like to live in the way it should be, but we live in the *is*.  Make all your decisions without emotion and based upon how medicine is, not the way we want it to be.

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9 hours ago, Cideous said:

I know sometimes my posts come off harsh on these boards.  Trust me, I'm really not trying to be a jerk.  I've just seen a lot in 25 years and a lot of it bad.  Conventional wisdom, the advice that most will give you over your career is honestly mostly wrong.  Telling you not to say a word to your Ortho doc about any anxiety struggles is the perfect example.  Most would say talk to him....I say the opposite.  There is the way the world should be.....then there is the way it is.  We would all like to live in the way it should be, but we live in the *is*.  Make all your decisions without emotion and based upon how medicine is, not the way we want it to be.

Have to agree. My significant time in anesthesia taught me and reinforced by surgical rotations that anyone in the OR is not going to take well any sense of weakness. I’m sure there are exceptions. Overall they (from OR nurses, to anesthesia, to surgeons) are sharks who are looking to smell blood in the water. Just my experience.

to be helpful, when I’m concerned throughout the day about complications or missing something, I look at the rates of those complications to reassure myself of how unlikely it is. Seems to bring the anxiety from what feels like a 10 to a 5.

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Some great advice here and a good post by Jessica. I agree you should talk to your Doc who will settle your nerves and tell you of his or other colleagues experiences. Remember, you are not the Captain of the ship and the Doc will react if you do not in a proper manner. You might also sit down with a counselor and talk about anxiety in your prior experiences as they can surface again and when you understand them, you have become the conqueror.

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Thanks again for all the thoughtful replies. I have a PCP who has recommended a counselor, if I decide to go that route. I'm going to give myself 3 moths, and if it's not improving I'll go that direction. Currently, I've been approaching the OR with the mindset that it's all an opportunity for growth. Sort of like exercise. The repetitions closest to failure are the ones that drive adaptation. Haven't spoken to SP yet. 

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