Helping a Tuberculous Patient to Face Surgery

Throughout my contact with Mrs. M, I attempted to hold to my role of helping her work through each problem she presented, keeping the focus on its relation to her illness and her part in moving toward her goal of getting well. In doing this, I discovered that her major problem in accepting surgery was her fear of helplessness and loss of control, a more or less universal problem for the pre-operative patient. The assistance given Mrs. M in releasing, recognizing, and accepting her own negative feelings, especially in relation to the second operation, enabled her to accept the emotional side of herself and to trust this rather than to fear it, thus making it possible for her to move forward toward her cure. Mrs. M's experience in relation to surgery is unique because it is her own. This is true of any patient facing an operation; for to it he brings his individual personality and his pattern of meeting crises. The nature of his problem may be evident neither to the patient nor to his physician and it is sometimes possible for a person to make a good recovery without any change in his characteristic way of handling his problems. Many patients, however, do not have sufficient energy to keep continued control over their emotions and at the same time retain enough reserve to put into the effort required in mobilization of the self for an experience as threatening as surgery. The threat is present for everyone, whether it is in relation to fear of death or fear of life. For some patients, this fear is placed chiefly in terms of disfigurement or pain; but for most of them, like Mrs. M, the great fear is loss of control with its attendant helplessness and the danger of revealing some weakness through expression of emotions consciously and unconsciously held tightly within. For the tuberculous patient, who has already had to accept separation from family and friends and a greater degree of dependency than generally is considered legitimate for the well person, the normal fears in connection with surgery are likely to be increased. Furthermore, as in the case of Mrs. M, the previous way of meeting crises often proves inadequate and some change in old patterns of behavior is necessary if cure is to be achieved. Many of the patients experiencing the changes required of them need and can use the services the medical social worker is equipped to give. In view of this fact, and of the increasing number of physicians who recognize the importance of emotional factors in the patient's illness and cure, it seems paradoxical that many sanatoria have inadequate social service staffs and some have no social worker at all. Mrs. M is not unique in her need for assistance from the social worker but she is among the fortunate few who have such services available. Countless other patients with as great need and as much ability to use help constructively must manage alone. We do not have statistics to answer the question as to whether adequate provision of social service materially reduces the cost of cure to the patient, the family, and the community, but the case illustration is sufficiently clear on this point to indicate the need for experimentation and study in this area. Mrs. M, in contrast to most tuberculous patients, was able to return to her family and gradually assume her usual household activities within less than a year after she entered the sanatorium. Her use of social service, in finding and employing her inherent strength in meeting the myriad personal and social problems that beset her throughout hospitalization, was undoubtedly an effective agent in her remarkable recovery. Her experience is also indicative of the importance of the availability of social service to every tuberculous patient. Whether he wants or can use such a service is a decision which each patient must make for himself. He must decide, too, whether he can take advantage of the medical service available to him. The social worker's contribution, through his relationship to patient and doctor, is often a major factor in that decision and therefore an indispensable ingredient in the patient's maximum use of the facilities the community has provided for his cure.