The Night Before an Operation

The bag is packed. You have the time you are meant to arrive and the hour after which you cannot eat or drink. And now there is a whole evening to fill, with nothing to do but think about it.

It is a strange kind of waiting. You are not ill right now, in this chair. You are simply holding the knowledge of tomorrow, and your mind keeps running the frightening version while your body gets ready for something it cannot do anything about.

Why the night before is harder than the day

On the day there are nurses, forms, a gown, people telling you where to go. There is movement, and movement uses up the fear.

The night before has none of that. There is nothing to do, which leaves your attention free to run ahead. Add hunger from the fasting rules, a disrupted routine, and a very early alarm set for the morning, and a bad night is close to guaranteed. That is the situation, not a failure of nerve on your part.

Deal with the practical list first

A surprising amount of the churning is admin your mind has not been able to put down. Write it out and it stops circling.

The address and the time, written where you will see it. Who is taking you and who is collecting you. Your medication list and whether you have been told to stop any of them. Bag packed: phone charger with a long cable, loose clothes, slippers, something to read, lip balm, earplugs, a list of questions. Who is feeding the cat, collecting the children, telling your work. Where your glasses, hearing aids or dentures will be while you are under.

Once the list is written, you are allowed to tell yourself the arrangements are handled, because they are.

Ask the questions you have been afraid to ask

People often go into surgery carrying a specific fear they never said out loud: that they will wake up during it, that they will be sick afterward, that the pain will not be controlled, that they will say something embarrassing, that they will not wake up at all.

Ask. The anesthesiologist usually sees you beforehand and these are the most ordinary questions they hear. Getting a plain answer about how they manage pain, or sickness, or what they monitor while you are asleep, settles more than any amount of reassurance from the internet, and it hands you a fact instead of a fantasy.

Stop looking it up

By the night before, searching has no upside left. You are not going to learn anything that changes the plan, and search results are full of the rare bad outcome, because that is what people write about. If your hand keeps reaching for the phone, put it in another room and tell the person with you why.

Let the evening be dull and occupied

The aim is not calm. The aim is occupied. Something absorbing and undemanding: an episode of something you have seen before, a jigsaw, a hot shower, a walk around the block, folding laundry, a call with someone who will talk about their own life rather than yours.

Keep the night before free of big conversations, difficult relatives and anything you have to decide. Tomorrow will take what you have.

Expect a poor night and plan for it

Lying there not sleeping is miserable mostly because of what you tell yourself about it: that you will be exhausted, that you cannot face it tired. One bad night before a procedure is normal and the team is used to it. Your body will do what it needs to do under anesthetic whether or not you slept.

Make the night itself easier where you can. Get into bed late rather than early, so you are not lying awake for hours. Keep the room cool and dark. If you are still awake after a long stretch, get up, sit somewhere dim, do something quiet, go back when you are heavy. If your mind reaches for the surgery, give it something duller and more physical: the weight of the blanket, your breath going out slowly, counting backward from three hundred in sevens.

The waiting on the day

The morning often involves hours of waiting in a gown, and that stretch catches people out. Bring something for it. Ask the nurses roughly when you are on the list, and ask again if the time passes, because being told you are third is easier than wondering.

If the fear peaks while you wait, the quickest help is cold and breath: a cold cloth on your wrists or neck, and letting each breath out slower than you take it in. Tell a nurse you are frightened. They have something for that, and saying it out loud takes the edge off.

When to get help

Tell the team beforehand if you have had a bad reaction to anesthesia, if needles or enclosed spaces frighten you badly, or if you have had panic attacks, because there are things they can do differently when they know. Please talk to your doctor if dread of a procedure is strong enough that you are considering canceling, or if it has you unable to sleep or eat for days, and ask about speaking to a therapist. Being frightened before an operation is ordinary. Being frightened alone is not necessary.