The Washington Post - 12.11.2019

tuesday, november 12 , 2019. the washington post eZ ee E5

each the size of a grain of rice.
When it’s over fresquez says
she felt “relief and joy that the
hypnosis worked, that I went
through surgery without general
anesthesia.... I felt like I had run
and won a marathon.” (As a
friend, she let me watch the pro-
cedure by video.) Although she
had worried in the beginning
about relying only on a local anes-
thetic, when roelants assured her
that she could change her mind
and be put under at any point
during the surgery, fresquez felt
reassured.
And she says, “I would abso-
lutely not hesitate to do it again.”

Some hospitals try it

Hypnotherapy — also called
clinical hypnosis or hypnosurgery
— has been used in Europe for
minimally invasive procedures,
such as hernia repair, lumpecto-
mies, biopsies and some mastec-
tomies in breast cancers for sever-
al decades. But in the United
States, hospitals and doctors have
shied away from the therapy.
Girish Joshi, an anesthesiolo-
gist at UT Southwestern medical
Center in Dallas, who has studied,
with European colleagues, using
virtual reality in hypnosis, says
that, in contrast to a quick injec-
tion, hypnosis takes time to im-
plement, the response rate can be
slower and the U.S. payment sys-
tem is not geared to alternative
medicine.
Now, h owever, some U.S. hospi-
tals are offering hypnosis to pa-
tients to lessen preoperative anxi-
ety, to manage postoperative pain
and even to substitute for general
anesthesia for partial mastecto-
mies in breast cancer. (Hypnosis
has been used for years to help
people quit smoking, lose weight,
get to sleep and control stress.)
Houston’s mD Anderson Can-
cer Center, for instance, started
using hypnotherapy about two
years ago for segmental (partial)
mastectomies and sentinel node
biopsies, in which doctors identi-
fy a nd remove a lymph node in the
underarm area as well as cancer-
ous tumors in the breast, says
staff anesthesiologist Elizabeth
rebello, who is also an associate
professor in anesthesiology at
mD Anderson Cancer Center at
the University of Te xas.
W hile there have been no pub-
lished results yet of the hospital’s
ongoing randomized control
study comparing surgical pa-
tients who get either general an-
esthesia or hypnosis with local

hypnotherapy from e1 anesthesia, the feedback and re-
sults from the 60 hypnotized pa-
tients in the ongoing study have
been positive, rebello says.
Before the surgery, patients
have a 15- to 20-minute practice
session with a hypnotherapist.
During the breast surgery itself,
the patients are awake and EEG
monitoring of brain electric im-
pulses shows many patients re-
sponding to the hypnotherapy as
if they are under sedation. When
patients were asked whether
they’d use hypnotherapy again,
she said, “the overwhelming re-
sponse is yes.”

treatment isn’t a magic trick

G uy montgomery, a clinical

psychologist at New York’s Icahn

School of medicine at mount Si-

nai, who has studied hypnosis for

cancer care, says that while the

technique is “not magic,” it can

make pain more manageable.

“I ’m not saying they would have

zero pain — although that may

happen for some people — but

let’s see if we can turn that dial

down” on pain, he says.

Let’s be clear: This is not the

parlor game where a hypnotized

person is convinced to disrobe or

prance like a chicken. The Ameri-

can Psychological Association de-

fines hypnosis as a “state of con-

sciousness involving focused at-

tention and reduced peripheral

awareness characterized by an in-

creased ability to respond to sug-

gestion.” I t’s like being so focused

on a task that a person doesn’t

notice what’s going on around

her, experts say.

Proponents note that patients

are always in control, and they are

never persuaded to do something

they’re unwilling to do. And no

medical expert is suggesting that

hypnotherapy be used for major

invasive surgeries.

m ontgomery says patients

should definitely bear in mind

some caveats before they opt for

hypnotherapy: make sure they

get a licensed health-care profes-

sional since anyone can claim to

be a hypnotherapist. for people

with certain mental health prob-

lems, such as dissociative disor-

ders, hypnosis could trigger unex-

pected reactions, such as para-

noia. “You might be thinking

about controlling pain, and some

big psychological issue starts pop-

ping out,” montgomery says. A

health-care professional will

probably be prepared for such

situations.

Daniel Cole, vice president of

the Anesthesia Patient Safety

foundation and clinical anesthe-

Some hospitals try

out hypnotherapy

siology professor at the David

Geffen School of medicine, Uni-

versity of California at Los Ange-

les, says that hypnotherapy is a

“very intriguing alternative” for

some patients.

If the definition is simply a

“focused attention that allows a

patient to enhance control over

mind and body,” i t could work for

minor surgeries, he says. It also

could be an option for older pa-

tients who are more susceptible

to delirium after general anesthe-

sia, he adds.

Patients also need to be able to

expect that their pain can be con-

trolled by a combination of local

anesthesia and hypnosis. “The

last thing you want is to compro-

mise the procedure because the

patient is suffering and in pain,”

he says.

Managing pain, limitations

Psychiatrists and some anes-

thesiologists say it is not surpris-

ing that hypnotherapy has been

shown to work with pain manage-

ment. Pain perception, because it

originates in the brain, can be

different for every person, says

David Spiegel, associate chair of

psychiatry and behavioral scienc-

es at Stanford. Hypnotherapy can

actually alter how much pain a

person feels, he says. Stanford

offers patients classes in self-hyp-

nosis to deal with a variety of

medical issues, including pain,

stress-related neurological prob-

lems, phobias, side effects from

medical treatment, such as nau-

sea and vomiting, and cancer.

Debbie Phillips, 63, an entre-

preneur based on martha’s Vine-

yard, turned to hypnosis 10 years

ago when she needed a biopsy

done on a growth on her thyroid.

She d id a few preparatory sessions

with Elvira Lang, at the time chief

of interventional radiology a t Beth

Israel Deaconness medical C enter.

Lang then accompanied Phillips

to her needle biopsy, helping Phil-

lips imagine a placid beach scene

as a long needle was inserted into

her neck with no local anesthetic.

It w asn’t c ompletely painless, Phil-

lips said, but Lang would sense

that “and take me deeper.”

Lang, who calls her method

“non-pharmaceutical patient se-

dation, or “comfort talk,” s ays she

developed her system over the

past 25 years as a radiologist

working with patients who need-

ed “minimally invasive” proce-

dures that didn’t involve cutting

but that used X-rays to guide

doctors to open up blocked arter-

ies or treat gallstones.

“The patients are awake, and

they look at you with their big,

fearful eyes,” s he says. She realized

that drugs go only so far, but if

someone is unconscious, they can’t

cooperate with the procedure.

When Phillips’s biopsy showed

she had thyroid cancer and would

need surgery, Phillips continued

to use hypnosis for anxiety. This

time, Lang did her hypnosis by

phone. Phillips says she was so

relaxed she said to her husband,

“I’m having major surgery, and

I’m totally cool about it.” Her

husband responded, “You are

technically under hypnosis.”

A lthough she needed general

anesthesia for this procedure, she

said she was so relaxed she re-

fused any presurgical anxiety

medication.

Using hypnotherapy in place of

sedating and pain medicines is

also being used at mD Anderson,

says rebello, who noted that in

some breast cancers surgeries it

has meant less reliance on opioids

for relief during and after the

procedure.

“Hypnosedation will not com-

pletely replace general anesthe-

sia,” rebello says. But in some

cases when the standard of care is

general anesthesia, hypnoseda-

tion might be a better plan. “If this

is the case, we owe it to our

patients to explore this option.”

[email protected]

Md anderson cancer center

Staff anesthesiologist elizabeth rebello, background, watches as rosalinda engle, a “mind-body intervention specialist” at Md anderson

cancer center, uses hypnotherapy on a patient. “hypnosedation will not completely replace general anesthesia,” rebello says.

“I would absolutely not

hesitate to do it again.”

Diane Fresquez, a patient who was

given hypnotherapy during an

operation in Brussels

thing except the patients right in
front of me, and my responsibili-
ty over their basic health and
survival. And when I arrived
home in the early morning and
stripped off my scrubs and clogs
in my apartment entry, I as-
sumed the armor came off with
them.
Three weeks into my time in
the Er, the son of a woman I’d
been tending to asked whether I
could give him a call when his
mother got into her transporta-
tion, as he had to leave the
hospital. It was my busiest night,
and I was managing many other
critically ill-patients, and I was
scared of making a fatal mistake.
I responded quickly: “It might
be late. Does your mother have a
cellphone? remind her to give
you a call.”
I could have quickly written
his number down, but at that
moment it felt like too much; not
a “critical” action.
I wish I could say I ran after
him as he left, or got his number
from his mother so that I could
call him as she was leaving, but I
didn’t.
my psychological armor was

new doctor from e1 doing its job. B ut it w as g etting in
the way of a much simpler piece
of advice from a different men-
tor: “Be kind.”

a bad moment

This moment kept nagging at

me. I thought about my own

family members, who had been

patients themselves, and remem-

bered stories of them asking for

help in hospitals.

Stories of doctors who had

brusquely ignored simple re-

quests, like where to find the

cafeteria or bathroom.

These doctors had been too

consumed by their duties and

their own stresses to extend a

small but critical kindness

And later that night, when I

finally got home, I cracked off the

armor and cried.

I cried because I now related

to those doctors who’d failed to

help my own family members.

When I had refused to call the

son of the woman I’d treated in

the Er, it had felt like too much

— another task I couldn’t fit into

my brain.

I wanted to think that those

doctors, l ike me, were having b ad

moments. m oments of emotional

and intellectual exhaustion —

burnout.

But that lack of simple kind-

ness wasn’t the real me.

It’s become a buzzword,

“burnout.” It’s a term that any

med student sees splashed

across slides, training modules

and news reports. A term that

can mean many different things:

depression, physician suicide, an

inability to do one’s job well, a

dissipation of meaning from

one’s work. And now I saw it in

another form: a loss of kindness.

After I took down m y defenses,

I felt all the things they were

protecting me from: t he smells o f

the Er, the screams of pain and

frustration, and even the heavi-

ness of my own swollen legs.

But I also had time to recog-

nize small acts of humanity. A

nurse who runs to get a patient a

peanut butter-and-jelly sand-

wich from across the building

because those are the patient’s

favorite; attending doctors or-

dering f ood for their t eams in the

middle of the night; family mem-

bers holding each other.

I’m now beginning to under-

stand the delicate balance that

my doctor friend’s advice re-

quires, a balance that every med-

ical student and doctor in the

country has to maintain: to pro-

tect yourself, but not to cover

yourself in armor so thick and so

heavy that you lose yourself in-

side it.

[email protected]

isobel rosenthal is a psychiatry

resident in new York.

As an ER resident, I learned to couple

my professionalism with kindness

istock

I’m now beginning to

understand the delicate

balance that my doctor

friend’s advice requires.

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