Lillian: For several years, Lillian had looked forward to kidney transplant. Now eighteen, she had lived all of her life with failing kidneys. During the past four years, she spent three afternoons a week at the dialysis center. Until recently, other health problems had prevented her from transplant surgery. Lillian was excited when the team told her that they could now go ahead.
One month after kidney transplant, Lillian felt great in most ways. It thrilled her to have recovered well from the surgery. But she was restless during the day and had difficulty sleeping at night. She ate more junk food than was good for her. She was irritable when her friends asked her out. This in particular, Lillian could not understand. While on dialysis, she had always felt that she did not have enough freedom. And when she used the washroom, she was sure that there was a pain in the area of her new kidney. However, the doctors found nothing wrong.
Lillian asked her transplant coordinator if she could talk with him. She had looked forward to the transplant for so long. Now it seemed to her that she was not able to enjoy her health. The coordinator commented that Lillian appeared very worried about upcoming exams at school. When she first mentioned this, Lillian thought that the coordinator had misunderstood her. She had never been nervous about exams.
Later, Lillian found herself thinking of the coordinator's comment. She never worried about exams. But it was true. She was worrying now. And she was nervous that she wouldn't excel as she wished. This played on her mind during nights when she could not sleep. "If I do not do well, I will not have the excuse of dialysis to fall back on." It seemed that she was placing extreme pressure on herself. "I should get higher marks now. I am healthier than before," she thought.
Lillian told the school guidance counselor about her concerns. The counselor described this type of worry as performance anxiety. It occurred when someone was uncertain if they could live up to their own expectations for success. "That fits," said Lillian. "I expect more of myself now. And I don 't have dialysis to blame if I fail. I am more on my own. And it makes me nervous."
There will be many times, both before and after transplantation, when you will expect yourself to achieve some goal. Many of these goals (e.g., gaining strength with rehabilitation exercises, losing or gaining weight with a recommended diet, leaving hospital after recovery from surgery) will be important to both you and the transplant team. The occurrence of stress related symptoms might suggest that you are placing too much pressure on yourself to excel. Of course, you will want to work hard to achieve your goals. But too much pressure can impair your ability to act.
Finally, don't assume that stress can occur only after some event or change. You may experience stress in anticipation of some upcoming event. We have all had the experience when we couldn't fall asleep easily the night before an important day. This is a normal and common example of anticipatory stress.