Psychosis after Open Heart Surgery: A Phenomenological Study

Article excerpt

This brief self-reflective phenomenological study attempts to throw light on the inner mental processes that go on immediately following open heart surgery. The combination of organic assault, medication, post-traumatic stress, and psychological injury involved produces an abnormal mental state that can better be treated if it is understood from the point of view of the patient.

Phenomenology comes to understand the truth of something not simply by reference to scientific study and terminology but by moving around it, experiencing it from different perspectives, and letting the manifestations of each perspective communicate the truth of the subject directly. In order to be successful in the psychotherapy of patients with cardiac problems it is necessary for the therapist to have an empathic grasp of what they go through. Cardiologists often do not understand this, and psychotherapists can be of great help in treating the cardiac patient and educating cardiologists, if they are open to the phenomenologic method of approaching patients. As an illustration of this method for psychotherapists, I studied myself from a phenomenologic stance less than two weeks after undergoing cardiac surgery.

An evening in October, 1993: "My heart is in turmoil, and is never still; days of affliction come to meet me" (Job 30:27). Five times now in less than two weeks I have been in and out of atrial fibrillation, on the edge between life and death, and five times I had to go back to the hospital to the emergency room. Using verapamil and digoxin they were able to convert the fibrillation into a steady rhythm that enabled my life to go on. Last night was potentially the sixth time. I had eaten dinner and I was very scared, wondering if I was going to convert yet again into atrial fibrillation. I began reading an exceptionally interesting new novel called Gospel, by Wilton Barnhardt, describing the tracing of a lost gospel written during the time of the life of Jesus all over the Mediterranean and Africa, in a variety of localities that I have visited myself in the past. He writes:

And that's all that survives of you when you die, My child, the good that you have done. So much bad theology and empty talk about faith over works. Better the dispirited cynic complaining as she dishes free food in the soup kitchen than the pieties of cloistered prelates, theologians, purveyors of empty ritual, thesiswriters, makers of religious regulations.

I thought that I was reading the book. I thought that what was taking place was in Jerusalem as they were attempting to get hold of the missing scroll and to decipher the peculiar language of the scroll which up to that time no one had been able to understand. I thought I was reading and enjoying the novel. Suddenly the telephone rang and woke me up. It was a call from a friend of my daughter Brenda, telling her that she could indeed pick up Brenda at the airport on Wednesday, the day Brenda is leaving to return with my granddaughter from my home to her home in another city. Brenda, a coronary care nursing specialist, came to be with me during the surgery and has gone with me during each of these episodes of atrial fibrillation to the emergency room. She helped me to decide that it was time to go: my blood pressure was too low, the ventricles were beating irregularly, and it was too dangerous to stay home and not get the arrhythmia converted.

In my half-awake state a sudden thought occurred to me with a shock: What if during surgery some transformation in my body has taken place that no one understood until now. What if that surgeon, who had my heart in his hand when he did the surgery while my blood was shunted to a heart-lung machine, what if that surgeon had somehow removed my soul and the essence of my life, placing my soul into my new granddaughter, Brenda's baby, and making Brenda the essence of my life? In that case, when Brenda and her daughter will leave again for their home in another city, there would be nothing left of me but an empty shell, a body with no soul and with no essential life:

Surely now God has worn me out;

he has made desolate all my company. …