One hundred years ago, a child's appendectomy was a dangerous event. It involved the entire family: most likely, someone so close would never have had surgery. All the family members sensed that anything could happen and there was not much that any of them could do to alleviate the pain of the child or the parents. Maybe everything would end up being an anecdote. At that time, surgery was already saving lives, yes. But saving them often meant altering them forever.
It was never easy to operate and nor completely accurate. In previous centuries, surgery was socially linked to war. Thanks to her, many soldiers saved their lives, for example, but not their legs. In a fight against death, it is enough to survive and the hope of the individual always faced harsh reality. The most grounded expectation was often a success with flats. It was a gruesome negotiation, where staying alive went hand in hand with -perhaps- never being the same again. It is from perhaps where a certain revulsion, no less respect, for everything that is surgical is broken down (and persists). Of the lack of certainty, of the blind bet. Even today, with all the advances we have, no one would want a loved one to need to undergo surgery. Or maybe yes?
The mystique that surrounded surgical acts has been diluted. Today we see people entering and leaving the operating room every day, in our environment and also in series and movies. There are surgeries in social debate and there are also surgeries in children's books. We all have friends with metal parts or organs from the tissue bank. We no longer look for surgeons only to continue living, but also to feel, to be and to see ourselves: surgery as a bridge to a different, better future.
The number of people who have undergone a surgical procedure is increasing. In fact, in 2024 the majority of surgeries performed are elective, and not urgent. This change in usage has mainly to do with safety around operating rooms, the dissemination of scientific information and the commercialization of surgery.
What has not changed in 100 years is the transformative potential that surgery has on people's lives. Post-surgical life includes positive or negative physical changes, although I find the possibility of profound psychological, emotional and social changes more interesting. What we do with that opportunity for change and where we go from the operating room is a matter of destiny and of each individual, given the opportunity to choose. But that surgery offers us transformation is undeniable. Well, if we are on a surgical waiting list, it is worth taking a few minutes and negotiating about it.
The surgical reform seems a priori mainly organic. Whether it's because you walk straighter or breathe better than before, the first evidence of surgery is usually a positive change in how your body functions. But this is not true for everyone. People who have suffered an accident do not necessarily experience an improvement in the functioning of their body. For those who survived an unfortunate mishap, waking up from anesthesia can be like being reborn, even if they wake up in worse conditions than before the accident. These urgent and desperate surgeries can have a profound transformative effect on us and those who accompany us.
In organic terms, surgery has prevented a life from ending; But for many, in emotional terms, what follows the event seems more like a second life than an extension of the first. Seen this way, for some, waking up from an operating room is a gift like no other. And often, people who survive, especially with disabilities, acquire a renewed life philosophy that is difficult to match.
For the patient who entered the operating room on his own, the path has been less unexpected but longer. The diagnostic process has given room to conceptualize things. This happens little by little in meetings with the surgeon. During the negotiation doubts and answers appear. And the proposal is materialized through signatures and preoperative tests. The decision can be very circumstantial. It depends on what he or she wants or needs, on the moment we are living. Other times we don't have much choice, they tell us. The final decision is subject to our expectations and balancing risks and benefits that we do not always fully imagine.
To give a curious example: more people fear being paralyzed after spinal surgery than dying during it. And the consequences of dying are more difficult to imagine. Transformation begins with accepting all possible outcomes, including maybes; also in giving up control, in looking in the mirror and in deciding.
One of the most difficult aspects to encompass when thinking about the surgical experience is that at the zenith of the transformation, the operated individual will be the only one who does not participate in the moment. It is managed for us, but without our participation. One is induced into an unstoppable pharmacological sleep and upon awakening a new life begins with no turning back. Most likely it will be a better life, everything and that the maybe of yesteryear still prevails. I think it has to do with the leap of faith involved in the final step of the process. Sometimes, the experience does not allow us to return to who we were before surgery; or makes the return to our own skin require a self-exploratory walk. Check the emotional oil level, start the engine, go for a spin and let us breathe.
For some people, having surgery means suddenly growing older and feeling frail for the first time. Surgery can be a first contact with a maturity that has been discreetly knocking on the door for years. Consequently, many wake up from anesthesia and put aside the fantasy that we will always be young. This truth, as hard as life itself, can explain the vital sadness and feeling of being unprotected that accompanies the first days of post-surgical recovery for many, especially the first days back home.
Surgery can let us imagine what some aspects of life will be like in the distant, not so distant future. Having surgery teaches us to live with pain (at least for a few days) and makes us empathetic with our elders and more tolerant of those who suffer.
Often, discovering that life is not infinite ends up awakening new purposes or renewing old motivations. Many become more assertive and determined about what they want from life and what they are willing to do to get it. Surgery can give us greater awareness about the time we have left and what we want to do with it. Or (even better) what we should do with it, since without a doubt, it is also common for us to find a renewed vocation to exercise our responsibilities, the guiding thread of our search for meaning.
The post-surgical months are an oasis for the mind. And the accompanying low is the spiritual retreat that is needed to recover the wounds, to digest what has been experienced and renew, if anything, the direction.
I have known people who, once operated on, rediscovered themselves. It is as if for a few years they have lived on autopilot and it is the surgery that opens a new chapter. In this new chapter, the individual feels called to make changes, to leave vices, to start healthy habits that were previously unmanageable. One of them told me in surprise: "The day he operated on me, he took away my addiction. I no longer have interest in those things." As you can imagine, I have never seen the internal button of addiction. But I also don't believe that the cessation of addiction and the surgery simply coincided in time.
These people come to the control visit accompanied by disbelieving relatives. Beyond feeling better from his sciatic pain, "Ramiro is a different person," they tell me. And it's not that he is another person that he never was before, it's that he has the desire that he had three decades ago, with clear priorities as you only have after sixty and he doesn't want to waste any more time. And good old Ramiro lives it as intensely as Mr. Scrooge does on Christmas morning. I hope it lasts for many years.
On the contrary, other people have progressively adapted their lives. Many Ramiros stopped going running or going out to avoid pain and avoid the operating room. These people sometimes limit their activities. These forced changes in our habits are, in the long run, psychologically harmful. The anticipatory anxiety aroused by the mere idea of going for a walk and suffering pain becomes a daily occurrence and a sedentary lifestyle becomes a modus vivendi. The indiscriminate use of painkillers, opiates and neuromodulators also has a harmful effect on the psyche of those who consume them. Many of these drugs make us lethargic and slow down our thinking. And in general, confessing to being dependent on a medication to operate normally is restricting one's own agency. Therefore, for people living with pain, surgery can be tremendously liberating.
Just making the decision can be empowering. An operation can banish the anxiety or depression caused by a life of polypharmacy and inactivity. Of course: surgery rarely does the complete job. It is the person who, in the context of a recent intervention, sees things differently, sometimes from a day-to-day life with less pain, sometimes from a greater commitment to his or her health to avoid repeating the episode. Who has the best surgical result? In my opinion, the best result comes from those who make the most of the experience, moving both organically and psychologically: a back without pinching and a renewed commitment.
Experiencing surgical metamorphosis is a unique experience. For each person it will be different. For some it will be a benevolent process and for others it is painful and devastating. Surgery can reveal an unpleasant future. A surgery can take place with or without incidents, and this is impossible to predict. In that sense, surgeons are like health meteorologists. Regardless of the initial forecast, it can always rain. Seeking emotional transition means that there will always be growth and learning around surgery, regardless of the outcome. Thus, the change of perspective may be the healthy common denominator of all modern surgical interventions.
Finally, for many people, the minutes before surgery and the anesthesiologist's countdown mean those last few minutes alone, staring into the abyss. To mitigate that final vertigo, I always recommend a cognitive exercise. Here it goes: weeks before your appointment, try to summarize “why I should have surgery” in one sentence. There are no right or wrong answers, but be as intimate and honest as you can. "To live with less pain" is a valid premise, like "to be able to carry my grandchildren on my shoulders." Once you are satisfied with the chosen phrase, make it a mantra to return to when the very natural fear of the unknown attacks you.
