How can I turn my mind off from these pervasive thoughts?

July 24, 2015 11:55 AM

I recently suffered a near catastrophic medical experience and am having emotional difficulties dealing with the aftermath. I had been ignoring symptoms for days and only went to hospital because my spouse and kids were leaving town for a few days and figured what the heck, go to the ER, it would be a pain for them to come back abruptly. At the hospital, I had emergency surgery that was unnecessarily risky (I'm an experienced medical professional, so please, assume I know what I'm talking about) in that it could have led to an intraoperative complication that would have left my 5-year survival at less than 25%. I also would have been in the same boat if I chose to ignore my symptoms. In the end, surgery was successful and what was thought malignant turned out to be benign. I have some lifelong medical follow-up to pursue, but for all intents and purposes I'm OK know. So what's my question?

I cannot stop perseverating about all of this. "What if I ignored my symptoms even one more day?" "Why did the surgeon do the operation 'that way' and put my life unnecessarily at risk?" " OMG, what if it were cancer and not benign?" I CAN'T CLEAR THESE THOUGHTS FROM MY HEAD. I'm taking some benzodiazepines to take the edge off right now, but it's not doing as much as I'd like.

I plan to see a therapist for some help, but I wanted to get any recommendations of books, techniques, theories, whatever to help get me back in control of my mind. I have a very supportive spouse but it's getting to the point that they don't know what to do with someone who should be elated and not super-anxious. I also feel tremendous guilt and shame because there are millions of people out there who get terrible medical news and react bravely and strongly, and here's little ol' me who's 'gonna make it' and I'm falling to pieces.

posted by anonymous to Human Relations (26 answers total)

No past, no future. Only now. Past is over and nothing but a dream. What ifs are pointless. It did work out. You are alive. Your mind is grabbing onto a thought and turning it into a catastrophe when it isn't a catastrophe. They are only thoughts your mind is creating and are not true. They are not what is.

If you want to "control" your mind, notice this moment and the next moment. You are safe in this moment. Do not think of your "lifelong medical follow-up" as some terrible thing. It is only a practical matter to be addressed when you have your next doctor's appointment, you will be in that moment. But at this moment, you are safe. You are not in danger. You do not have to believe your thoughts. Recognize the thought, acknowledge it, "oh, I'm having an anxious thought over my health, that's interesting" and let it go.
posted by Fairchild at 12:03 PM on July 24, 2015 [9 favorites]

Since you're saying book recommendations, Feeling Good is the one my therapist recommended to me. It will have techniques for managing cognitive distortions you can work through. (For instance, all your guilt and shame your brain is making by constructing millions of people acting in the way you think you should act, when everybody is going to react to terrible medical news in their own way, and you don't actually know their innermost feelings about it compare to public faces that you see, and you haven't even encountered those millions of people doing just that. It's more likely that you are reacting to finely honed media stories about medical disasters and are using them as a stick to beat yourself up with.)
posted by foxfirefey at 12:04 PM on July 24, 2015 [2 favorites]

Man, I feel you. This is totally normal. I have just finished the hard parts of treatment for Stage IA breast cancer and occasionally feel an almost physical thrill of fear thinking about what might have happened if I hadn't noticed that tumor when I did. And I feel guilty being so afraid when every single person I met at my hospital during chemo and radiation had more serious cancer than mine.

Therapy, yes, but for me the big thing that's helping is time. Letting life get back to a new normal, letting your brain adjust to and recover from the trauma. I know that's an unhelpful answer, really, because it's not an actionable thing you can do. But if you need reassurance, I've got it: It gets easier. It really does.
posted by something something at 12:09 PM on July 24, 2015 [3 favorites]

You came face to face with your own mortality. In a real sense, you looked down the barrel of a gun. There are few things more traumatic. If reading helps you, I'd try looking for books by survivors, but best of all is your plan to take this discussion to a qualified therapist. Give yourself a break, too. What would be odd if this weren't a life altering experience for you.

Also, so glad you are still here.
posted by bearwife at 12:11 PM on July 24, 2015 [1 favorite]

Intimations of mortality. In my experience, we fear less for ourselves than for the unhappiness of our loved ones. Is your family back yet? I think time with family would be the best therapy.
posted by SemiSalt at 12:12 PM on July 24, 2015 [1 favorite]

It takes time. I had a similar experience and went from feeling kinda sore to the ICU over the space of a few days. Once I was back home I could not shake the shock and the fear the problem would return.

It's now a decade later, and yes it was a scary episode. It took a long while for my daily worries to subside... But they did. And they will for you. Meantime, remind yourself you are a tough survivor and will be in the future.
posted by ecorrocio at 12:13 PM on July 24, 2015

Guy with clinical OCD, "pure o," here. I would say some CBT therapy, probably for a short-term, as it seems it's incident-specific, may be in order here. There are a ton of techniques for dealing with intrusive or obsessive thoughts, and if you take the time to work with them, they can be a lifesaver.
posted by xingcat at 12:15 PM on July 24, 2015 [3 favorites]

I assume you were under anesthesia? When I had surgery the anesthesia did CRAZY things to my head. I was an anxious wreck.
posted by easter queen at 12:15 PM on July 24, 2015 [4 favorites]

This is totally normal for what you are narratively and emotionally characterising as a near-death experience. Utterly normal. It will de-escalate with time but you should seek support in the interim.
posted by DarlingBri at 12:18 PM on July 24, 2015 [1 favorite]

There's a great Jewish prayer that one recites after a disaster of any kind has been averted (illness, natural disaster, etc.).

"Blessed are You, LORD our God, King of the Universe, Who bestows good things upon the unworthy, and has bestowed upon me every goodness."

Congregational Response: "Amen. He Who has bestowed upon you every goodness, may He [continue to] bestow upon you every goodness. Selah."

I'm not particularly religious, but after my car accident last fall I found myself repeating the prayer over and over to myself, and it helped calm me down.
posted by Melismata at 12:27 PM on July 24, 2015 [3 favorites]

Someone here gave me a very helpful idea when I was having rampant anxiety once. She said to see each worry I was having as a car of a passing train and just visualize the train going by.

It sounds like you're feeling "survivors' guilt." Maybe searching that specifically will help.

Good luck. Glad you will be okay.
posted by mermaidcafe at 12:29 PM on July 24, 2015 [1 favorite]

I'm really sorry this happened to you, and I'm glad you are physically OK now.

This sounds like a very normal reaction to a sudden and unexpected traumatic surgery. Of course that doesn't mean you shouldn't try to get help in feeling better, just that you're not alone in having these feelings after a situation like this.

One thing that has helped me process traumatic events is to recount the narrative of what happened, either verbally or in writing. My guess is that these kinds of experiences feel very terrifying partly because of our loss of bodily autonomy, so gaining control over our own narrative, being able to tell our own story, helps us regain that sense of self-control. It can take me dozens of times of writing and re-writing, or talking about what happened, before I start to feel better, but it does work for me.

I'm wondering if the fact that you're a medical professional is also making things more difficult--sometimes ignorance is bliss, but you didn't have that option of not knowing exactly how things could go wrong. From my conversations with friends who are medical professionals, I know it can be an uncomfortable change to be on the other side of treatment. If you feel like you're the one who is supposed to be doing operations, not getting operated on, it can be disturbing to suddenly be the patient.

Good luck--I hope you are able to find a helpful therapist and that you feel better in time.
posted by hurdy gurdy girl at 12:32 PM on July 24, 2015

I have a serious medical condition and, very often, I fall apart in a heap of anxiety and suicidal thoughts and what not because of the chemical fallout of my medical condition. Please consider the possibility that this is a somatopsychic condition -- a mental health side effect of the physical trauma you have endured. If it is, there may be practical things you can do about it.

Some things that can cause sudden mental health weirdness for me include:

Sudden vitamin deficiencies due to medical drama. If I can pinpoint what I am deficient in, a supplement or eating the right food can help.

Stress on various hormone emitting organs, like my thyroid or pituitary. If I can symptomatically pinpoint which one, I can get this under control as well. In my case, I usually pursue nutritional support for it. It is possible though to get medication for such issues.

Inflammation, that can be a side effect of my condition. This can be treatable in the short term with anti-inflammatory drugs.

Fever and lack of sleep can make me really OCD and unable to clear certain thoughts from my head, almost always something negative. Getting the fever down and somehow getting me to get more sleep can really help.

The other thing that helps is just keeping me occupied. I sometimes play marathon games of SimCity or whatever when I am a total mess. It needs to be something you find mentally absorbing. Passively watching TV, unless it is something really gripping, may not do it.

For me, this kind of thing is very consistently a medical side effect of my serious medical problems and dealing with it like I am merely neurotic is wholly unhelpful. Dealing with it as a symptom of a medical issue has a far better track record of success. This is something I have been working on since I was in my teens when I did a research paper on functional hypoglycemia and learned that my frequent nightmares were likely due in part to my low blood sugar. I then made dietary changes to get that under control and my nightmares stopped. I rarely have nightmares anymore.

I am so sorry you are going through this.
posted by Michele in California at 12:44 PM on July 24, 2015 [1 favorite]

Do you have a throwaway email account? I would like to message you privately.
posted by Naamah at 12:55 PM on July 24, 2015

With regards to guilt and shame: you've gone through some major and sudden trauma - it would be completely unfair to expect that someone who has experience trauma will just move on and be happy that it's over, and it's certainly unfair to expect that of yourself. I had a traumatic medical event about five years ago, although it was not nearly as intense as yours. I was placed on benzodiazepines, and I kept thinking there was something wrong with me for needing them. It wasn't until therapy that I realized it's completely normal to be having a hard time after a traumatic experience.

CBT and other methods (mentioned here already) helped me, and you'll find something that works for you. In the meantime, along with the suggestions other folks have made, I would just add that you have nothing to be ashamed of, and nothing to feel guilty about.
posted by teponaztli at 12:58 PM on July 24, 2015 [1 favorite]

Look up 'radical acceptance,' it's a piece of DBT. tldr: accept what cannot be changed. And everything that happened before now cannot be changed.
posted by feckless fecal fear mongering at 1:30 PM on July 24, 2015 [1 favorite]

surprised no-one has mentioned mindful meditation. i thought that was a pretty standard recommendation these days from doctors, though, so perhaps you already know of it. good luck.

(i also suspect - with no medical basis at all - that you just need to give it time. it may even be that you're recovering already. when i had some bad medical news, it was only when i started to recover from the shock / depression that i even realised i was stressed out. that was also when my partner started pushing back - she'd supported me through the worst and then, apparently instinctively, started telling me i needed to sort things out once i was recovering and could handle it).

ps also, i think your reaction is completely normal.
posted by andrewcooke at 1:31 PM on July 24, 2015

It's probably not the healthiest coping mechanism but personally I've found that drinking while playing immersive video games is a pretty effective way to shut down unwanted obsessive thoughts whenever I get myself all wound up and anxious over something.
posted by Jacqueline at 1:48 PM on July 24, 2015 [1 favorite]

I am not your therapist, but I did notice this:

"I had emergency surgery that was unnecessarily risky (I'm an experienced medical professional, so please, assume I know what I'm talking about) in that it could have led to an intraoperative complication that would have left my 5-year survival at less than 25%."

Maybe you're really ANGRY (as well as having other feelings) and you don't know what to do with that anger, so you're hanging onto it in the form of obsessional ideation. Maybe you want to bring up this possibility with the therapist you're going to see.

It's hard to let go of UNFAIRNESS in any form, particularly when it may be somebody else's actual FAULT.

I'm glad you're okay.
posted by DMelanogaster at 1:59 PM on July 24, 2015 [3 favorites]

There are therapy protocols to head off PTSD, including medical/diagnosis PTSD, before the six months it takes to meet the criteria for full-blown post-trauma diagnosis. Time will help - usually - but you don't have to suffer unaided while you wait for time to kick in.

I don't know if there are any books out there that are considered especially good for emergent trauma. This one's hard to deal with from the inside, it really requires external guidance.
posted by Lyn Never at 2:06 PM on July 24, 2015

Oh man, I can so easily imagine that kind of intrusive thinking happening to me. You have my sympathy. A few ideas:

1) Do what you can. E.g., if your intrusive fear was about earthquakes, then as step one, put together an earthquake kit. Otherwise, the fear is serving a real purpose, to remind you of something you do need to know or do. In your case, one fear seems to be, what if I'd ignored it?, so maybe it would help to address whatever tendency caused you to not act sooner in the symptoms. Set up six-month physicals or whatever would be appropriate. Have a "come to Jesus" meeting with yourself where you get to the root of why you put that off and mental changes or commitments you can make to yourself so that in the future, you act promptly. You want to get to the point where you can honestly tell the panic "I've done everything I can, and now the best thing I can do for my health is to relax."

2) Someone above mentioned CBT. I've had success with using mantras for intrusive worries liked this. It takes some trial and error to get the mantras right. You have to find ones that you really believe, and ones that your worry can't find holes in. Then whenever the worry arises, you defuse it with the thought.

3) Take care of yourself physically. Sleep deprivation, hunger, etc. can really exacerbate anxiety. On days when I'm really sleep deprived, I put myself in "safe mode," no self criticism or panic allowed.

Good luck. It's really understandable that you'd have a LOT of feelings in the aftermath of that event. I hope you're getting a lot of support and space to process your emotions.
posted by salvia at 2:12 PM on July 24, 2015

This sounds really hard, and I agree with others that you should give yourself some time to... just process it all. I really liked and once used Full Catastrophe Living, both for its mindful meditation tips (h/t to previous poster, andrewcooke) and also for its ability to lend some perspective viz a viz individuals who survive and thrive in incredibly difficult circumstances. Its chops when it comes to science and medicine are also particularly good and may appeal to you as a medical professional.
posted by pinkacademic at 4:01 PM on July 24, 2015 [1 favorite]

This has helped me with obsessive thinking in the past:

When you notice your thoughts are turning towards the object of your obsession, immediately shift your attention to the room around you. Mentally describe what you see (or out loud if it helps): There is the purple vase. Next to the vase is a pencil. Next to the pencil is a cookbook. Etc. Just keep naming objects until you feel yourself relaxing.

After I first learned to do this I found out that it's similar to grounding techniques. Here are some more suggestions.

I'm sorry you are dealing with this. Good luck to you.
posted by bunderful at 4:25 PM on July 24, 2015 [2 favorites]

I think the advice given so far is good. It's normal to have anxiety and/or intrusive thoughts after a traumatic experience, and it is absolutely true that simply having general anesthesia -- for any reason -- can cause some psychic distress for weeks or months afterward.

That said, I notice that one of the questions you're perseverating on is not necessarily rhetorical. You wrote that you wonder "Why did the surgeon do the operation 'that way' and put my life unnecessarily at risk?" There's no reason that you can't seek to find this out. If you have a follow up appointment in the clinic with your surgeon (as you should), this is absolutely something you can ask. It would probably be best to phrase it in a more non-confrontational manner, but explaining clinical judgment and decision making, particularly when decisions were made about your treatment without your input or knowledge, is part of the job of a clinician. I would also note that operative notes are often accessible in EMR patient portals or via an 'old fashioned' paper HIPAA request.

Best case scenario you might learn that there was a factor, until now unknown to you, that made that the best course of treatment. Worst case you might have your fears confirmed that it was simply luck of the draw or even ignorance of the risk. Then you'll be back where you started, but at least you'll have taken control of the knowledge (or lack thereof).
posted by telegraph at 6:39 PM on July 24, 2015

To some extent, this sounds like PTSD, which is a thing that can happen from scary medical situations, especially ones that require emergency surgery. I'm with DMelanogaster that there might be a lot of anger that's popping up, and that might be specifically what you're having a hard time letting go of. I did EMDR therapy and talk therapy to help me with the PTSD I experienced during a traumatic birth and my daughter's extensive NICU experience, and as wacky and woo as it sounds, it really did help me let go of the intrusiveness of the thoughts.

I don't think it's something you can do on your own with a workbook or whatever, so I just encourage you to pursue therapy sooner than later and don't discount the possibility of something like that helping.
posted by peanut_mcgillicuty at 8:14 PM on July 24, 2015 [2 favorites]

I don't have any life-threatening medical stuff. I do, however, have a whole heap of medical stuff. At last count, I've got 23 diagnoses between physical and mental health conditions. After my last visit to my primary care provider, with ensuing referrals to specialists, I joked to my best friend that the only specialists I don't have now are a podiatrist, an oncologist, and a proctologist, and that I fervently hoped I never had need of any of them.

I have a lot of obsessive thoughts around medical issues. The technique my therapist taught me to use is thus:

Challenge the thought. Does it have any factual basis? Does it serve a useful purpose? Is there benefit to me focusing on it? Is it a true thought, or is it a worry/panic/anxiety fueled thought?

Then, replace the thought. Consciously decide to think a different thought. I sometimes have to do this out loud.

Examples: I have a condition that causes excruciating pain in my face. I am currently on my 6th dosage increase of the 7th drug cocktail my neurologist has prescribed to manage this condition. The thoughts frequently occur that Condition will never be well-managed, I'll be in pain for the rest of my life, that there's nothing anybody can do to fix it. When those thoughts crop up, I stop what I'm doing and say "No. That's not true." out loud. Then I remind myself that just because Condition is not currently well-managed does not mean it won't ever be. That there's absolutely no evidence that I'll be in pain for the rest of my life. That successful surgeries of multiple types are done every day to treat this condition, and people go on to lead pain-free lives after those surgeries.

I wish you all the best.
posted by The Almighty Mommy Goddess at 12:49 PM on July 25, 2015