Navigating adversity: A personal and professional journey through unexpected challenges

The personal experience I am relating below touches upon matters I deal with in my clinical practice as a consultant clinical health psychologist: how to become stronger in the face of adversity and how to promote a sense of self-confidence and wellness despite ongoing limitations in role and function caused by health problems. 

In the same way as I encourage people I see at clinical settings to gain as much information as possible in order to make informed decisions based upon outcomes of clinically relevant research, I searched for potential risks and complications of laser-based refractive eye surgery.  During the process of balancing out pros and cons, I wondered whether I was tempting fate by going through this process, given that aided by contact lenses and glasses I had optimal eyesight.  Other than the inconvenience of relying on these aids, I was perfectly able to lead a normal life with no discomfort and my eyesight was not a major concern in my life.  There was certainly some anxiety associated with the decision-making process. 

My professional experience had contributed to biasing my thinking towards feeling very cautious and slightly reluctant to go through medical interventions or surgical procedures.  I am unsure whether I am fortunate or not, however, for most people I see at medical settings within the context of pain clinics, medical procedures have been unsuccessful in the long-term to cure or even minimise pain and suffering.  I understand that the portion of the population dealing with persistent pain and seeking the specialised services in my field is relatively small compared to those managing pain on their own.

As I was preparing to go into the operating room, I drew on relaxation skills I have acquired over the years and surrounded myself with positive energy.  I put myself into the hands of the surgeon.  What was meant to be a very precise, pain-free, highly technical and rigorously standardised procedure turned out to be inaccurate, painful and irreparable.  I experienced the pain, the feeling of intrusiveness into my being when a very delicate part of me was being interfered with by mechanical means.  I felt vulnerable, insecure, alone, isolated and out of control.  I had no idea what had gone wrong, all I heard was “irregular cut”.  A short while later I had to put my already shattered trust once again back onto the surgeon who had once represented the powerful knowledge and competence but was no longer in such a position. 

I found myself sitting on the other side of the fence.  This time I was not the one from whom others would seek advice or consult.  I was no longer in the position of the professional who is seen as the expert.  I had no other choice but to go along with the surgeon’s decision to perform a second intervention.  Reflecting back, had I had full knowledge of my situation I would have chosen to postpone the intervention until the initial stages of healing had taken place.  I was absolutely devastated.  The whole world around me seemed to start collapsing.  Notions by Winnicott (1974) about the fear of breakdown and disintegration came to my mind.  Uncertainty about prognosis and potential for recovery set in. 

My worst fear had become a reality.  The medical intervention had failed in its accuracy.  The realisation of my shattered expectations was shocking.  I started to become worried about how I would cope with this unexpected and unwanted outcome.  Despite the strong and unconditional support and love around me, I felt isolated and lonely in this new world.  I was very fearful of potential repercussions.  Questions started to invade my mind: Are these long-term consequences? Is this outcome amenable to improvement? Will there be change over time? 

Vision is certainly one of the most powerful senses, which puts us in touch with the outside world.  We make sense of the world and ourselves by having the privilege to make sense of, see and contemplate what is in front of our eyes.  Visual perception invariably influences learning and memory and it helps us attach meaning to people and other forms of being, as well as construe the world around us.  Perception also requires peripheral sensations as well as understanding, “we don’t directly experience what happens on our retinas.  What we actually experience is a product of many processes of interpretation” (Dennet, 1991). 

I was no longer able to recognise people’s movements, familiar objects and dearly loved places.  The outside world was becoming blurred, confusing, distorted and foreign.  Opening my eyes was a continuous reminder, an intrusive disruption, a distressing re-experiencing of what had happened as a result of eye surgery. 

By this time, I really started doubting myself, wondering whether I was unconsciously creating a new reality.  Uncertainty, lack of knowledge and understanding, lack of ability to verbalise my inner experience were my real limitations.  There was no meaningful explanation or answer, which could explain what I was experiencing.  I found myself disbelieving what had happened, perhaps unwillingly trying to deny it.  Self-doubt, self-blame and a distorted sense of responsibility set in, in an attempt to find answers to questions, which had no answers.  How many times have I talked to my patients about misfortunes and unfairness in life?  Trauma involves a piercing of the skin whether physical or emotional.  This time it was my own skin; it was me going through the same questions patients always voice: why me?  It was like being in a dreamlike state, finding it very difficult to accept my new reality in which the external world had changed. 

Not only did I need to manage changes within my universe’s reality, but also within people’s reactions.  It was as if those close to me were feeling anger, frustration and disappointment on my behalf. 

I considered whether it was a case of negligence and what legal implications might be in a culture of compensation.  Suggestions were strongly put forward about seeking legal action.  However, my hands were absolutely tied.  Not having signed the consent form would have meant the intervention would have not been performed.  However, by giving my formal consent, I was in principle allowing for error and mechanical failure to cause potential complications.  There was a definite dilemma between my urgent need to receive ongoing treatment and the medical profession taking responsibility for what was a treatment failure. 

In the social process of the interaction between the surgeon and myself as the patient, I became extremely disillusioned about my expectation of the doctor as the person able to fix the problem.  Was I then becoming the “bad patient” in that I was angry, suspicious and highly critical?  Equally, my experience may have contributed to the surgeon having to face his own fallibility and limitations as I showed little change in my presentation over time.  This was an example of a potential dissonance in the doctor’s mind in his inability to cure and therefore being unable to fulfil a basic role expectation.  Despite having used all available pharmacological and surgical procedures, I was still unsatisfied and left with the only option of acknowledging and accepting that a fix and a cure were not potential solutions.  Cure was no longer the significant aim of this biomedical intervention.  “Symptom burden and functional capacity” (Sullivan, 2001) became the focus of trying to improve my quality of life. 

I then started wondering whether my intense and at the same time quiet emotions (low mood, frustration, disappointment) could potentially affect my recovery adversely.  This experience of ‘medical-limbo’ was in itself a source of stress (Turk & Rudy 1992).  I knew the only way forward was to get in touch with my sense of loss and grief before I could accept my new reality.  I had to accept a number of surgical failures not leading to a full recovery.  Perhaps my need for a diagnosis and external confirmation of the validity of my confused and changeable personal experience was a way of overcoming my shattered self-confidence and loss of independence. 

My inner strength, determination and wish to overcome adversity helped me to continue in my professional role, fulfilling my responsibilities, with no significant impact on my clinical work and personal function regardless of this unsuccessful eye surgery bringing on unexpected change into my life.  Although there was unconditional support from my family, friends and caring work colleagues, I also had to listen to unsympathetic and very unfair remarks from a minority of colleagues who resented the time I had to take off work.  Again, there were clear links with patients’ stories about the invisibility of pain and scars, which cannot be seen but felt. 

There are implications from personal experiences like the above which need to be seriously taken on board by medical teams who are not only responsible for direct clinical care but also for informing best clinical practice through knowledge sharing, education, training and research.  The potentially adverse outcomes of this intervention (e.g. corneal reshapes through inaccurate cuts, optical aberrations, hypermetropic astigmatism) were not openly discussed with me at the assessment process, making out that success is such a common occurrence in most cases that the potential for risk or complications was not really on the cards. 

Being on the edge of pioneering treatments is a two-fold sword.  On one hand, it offers the possibility of heading towards clinical improvement, on the other, it leaves the door open to a series of untested, unproven and under-researched outcomes. 

I thought many times what it would be like if I could turn back the clock.  I realised I needed to be prepared to take the responsibility of my initial decision.  By allowing my internal eye observe my inner eye and by looking at the little person in the pupil of my own eyes, I started seriously re-evaluating where I was in my life in terms of personal relations, professional directions and future plans and, I initiated a process of actually seeing experiences in a much clearer fashion.  I pursued projects, which had been placed in the background, giving day-to-day experiences a new refreshed vision, a more mature appraisal, achieving personal and spiritual growth.  I was closing the door of a stressful life event and entering a new place by regaining my true being and seeing this experience as a stepping stone towards development (Adwin & Sutton, 1998; Parkes, 1971).  I was also aware that writing about traumatic experiences can help assimilate those into new more accepting schema (Pennebaker, 1993). 

May 2004

Dr Cristina López-Chertudi

Chartered Clinical Psychologist

References

Aldwin, C.M., Sutton, K.J. (1998).  A developmental perspective on posttraumatic growth.  In Tedeschi, R.G., Park, C.L., Calhoun, L.G. (Eds), Posttraumatic Growth: Positive Changes in the Aftermath of Crisis.  Mahwah, NJ: Lawrence Erlbaum. 

Dennet, D.C. (1991).  Consciousness Explained.  Boston: Little Brown & Co. 

Parkes, C.M. (1971).  Psycho-social transitions: a field for study.  Social Science Medicine, 5, 101-115. 

Pennebaker, J.W. (1993).  Putting stress into words: health linguistic and therapeutic implications.  Behavioural Research Therapy, 31, 539-548. 

Sullivan, M.D. (2001).  Finding pain between minds and bodies.  Clinical Journal of Pain, 17, 2, 146-156. 

Turk, D.C. & Rudy, T.E. (1992).  Cognitive factors and persistent pain: a glimpse into Pandora’s box.  Cognitive Therapy Research, 16, 99-122. 

Winnicott, D.W. (1974).  Fear of breakdown.  Internal Review Psychoanalysis, 1, 103-107.