According to the multiverse theory, there is an infinite number of other universes that coexist with the one before us. Meaning there’s a version of you who never left Kansas. One who dropped everything for the adventure, or didn’t. A version who held onto your dream of becoming an oil painter and is now in overalls on a porch in Taos. A version who arrived at the bar ten minutes later and never met that person who altered your life in some profound way.
The multiverse theory is also at play when we’re patients. Though we like to think medicine is an exact science, it’s subjective, and second opinions are an incredible testament to this fact. It’s estimated that upward of 60 percent of second opinions result in a different diagnosis or course of treatment—yet many patients don’t pursue them. This makes medicine look more like a serendipitous chain reaction than an exact science—the decisions tenuous, the outcomes dependent on instinct, time, and place.
Upwards of one fifth of all surgeries performed in the United States are unnecessary, as are one third of elective surgeries (those that are scheduled in advance, instead of done during an emergency).1 It’s easy to glaze over the numbers, but consider that if you and three of your family members have surgery in the coming years, one of those surgeries will likely have been unnecessary. There’s also a one-in-three chance that a colleague of the surgeon who operates would have taken another course of action. That’s how often medical professionals disagree on complex matters.
Even with second opinions, there will be risks to calculate, and decisions that come down to gut and instinct. Still, I recommend getting the additional opinions. Take the chance to glimpse the multiverse and see a few possible outcomes before embarking.
Don’t Worry about Offending Your Provider
Second opinions are a standard of practice, a matter of routine for all medical professionals. Many patients think that asking for another opinion will directly challenge the person they’ve already placed trust in, and many worry it will result in a compromised relationship and subpar treatment should they decide to stick with the original plan. Shed this complex! Medical professionals certainly seek out other opinions for themselves and their loved ones, so this concern for their ego is unfounded. Your health and safety come first, and humility should be a trait in any medical professional you’re trusting with your body.
Some patients avoid getting a second opinion out of anxiety about time. When you find out something is wrong, you may want it out, eradicated, addressed as soon as possible. It makes sense. Still, stop and get another set of eyes on your situation. Don’t let time dissuade you from taking this route.
A general rule of thumb when looking for another opinion is to avoid bias. This means not taking a recommendation from your first provider (though some might disagree here). Many hospitals now offer second opinions online, but whether they’re a formality designed to make money or adequately thorough depends on the quality of the program and institution.
I advise taking the matter into your own hands. Do some research and find another specialist, ideally one in another hospital network. You can ask friends in the industry or employees at other hospitals (see here for how to find the right surgeon), and use the online tools referenced in this book.
Many insurance plans cover second opinions. If you are, in fact, one of those 34 percent of people who do not need a procedure, it’s much less expensive for the insurance company to cover the cost of a second opinion than that of the procedure. It’s in everyone’s best interest. If the second opinion is deemed medically necessary, most insurance plans will pay at least part of the cost. Medicare will pay 80 percent of the cost and, if the second opinion doesn’t agree with the first, 80 percent of the cost of a third opinion.2
Some plans have more comprehensive coverage than others, and for some you will need a referral from your PCP, so call and get the details of what your plan offers before you commence the search.
Bring your medical records, with the most recent notes from your first assessment at the top of the pile. Do not assume the second provider has read up on the case; ensure the information is readily accessible to them so they can review it in front of you.
You certainly don’t need to sit in silence, but you also don’t need to go into great detail about the first opinion, or attempt to dissuade the provider from going in a certain direction. Answer questions and communicate your priorities toward the end of the discussion, but give the provider space to view the case through the most objective lens possible.
If the second opinion corroborates the diagnosis of your initial evaluation, you can proceed with a newfound sense of confidence. If the opinions conflict significantly, it’s advisable to go for a third. It varies case by case, and you’ll have to tap into your own intuition and the specifics of your situation here. At a certain point, continuing to get opinions will stall things too long and start to introduce noise that could dissuade you from taking the best course of action. Use your best judgment.
Second Opinions Are Not Just for Procedures
This one tends to surprise patients, but surgeries and invasive treatment plans are not the only medical interventions for which you can get second opinions. Radiology interpretations (of CT scans, MRIs, and X-rays) are also vulnerable to errors and subjectivity—radiologists even frequently disagree with their own interpretation of slides when they assess them a second time. Any time you are given a major diagnosis based on one of these scans or tests and your team isn’t 100 percent sure, you can ask that the slides are sent for another opinion, such as to a nationally recognized lab for a second or third evaluation. Contacting a professor of radiology at an academic institution near you might also help guide you in where to send the slides.
When you want to be convinced, beyond a reasonable doubt, that the procedure is the best option for you, you’ll need to do some reconnaissance. Here’s a mnemonic I came up with to remember questions you should always ask in conversations about surgeries and procedures:
R (risks and benefits): What are the risks and benefits?
E (experience): What is your experience/success rate with this procedure?
C (cost): What will it cost and why?
O (other options): What other options do I have?
N (nothing): What are the risks of doing nothing, compared to the risks of the procedure?
We all value different things during a medical encounter, including a hospital stay. One person might hate the thought of being referred to in the third person while a herd of students crowds their room, while another person might love the attention and the opportunity to be part of the educational process. While a hospital’s proximity to home or a support network might matter greatly for an elderly couple because one will be going home each night during the hospital stay, others might send this to the bottom of their list.
There’s a good bit of nuance that comes with choosing where to have your procedure. First, know that you have the ultimate say in where you go. Use the tips below to help you make a sound decision on the best setting for your care.*
QUALITY
When it comes to the quality of care you’ll receive at a given hospital, the issue is twofold: how successful the surgery will be, and how you will be cared for before, during, and after.
A simple rule of thumb is that the more times a procedure has occurred at that hospital, the more successful the procedure will be. You can look up these rates across all zip codes using CareChex (http://www.carechex.com), which factors in not only the hospital’s quality for performing your particular procedure but also how it ranks overall in safety and quality.
Certain types of hospitals are also better for certain types of procedures. Say, for instance, you’re having a tonsillectomy and want to go to the big, sparkling academic hospital on the hill because you want the best. It’s possible your boring (to them) little procedure might get lost in the shuffle. Remember all the moaning on ER when the residents got assigned to the appendectomy instead of the Whipple? There’s a reason! There’s a lot of glamour to the cutting edge, the novel, at hospitals like those, and they might not be the best choice for something common if you want the most attentive team. This isn’t a reason not to have a procedure there, but one that should prompt you to consider other options as well. Don’t choose a hospital because of the research wings being erected across campus. Rather, look up the statistics about the procedure you’re getting using an independent source like the one previously listed.
The second issue, how you will be treated after the procedure, is equally important. It’s easy to think you’re willing to compromise bedside service for a world-renowned surgeon or state-of-the-art technology, but these things do not always translate to better care if the hospital misses the mark on postoperative follow-up. (See “The Importance of Follow-Up Care” for a story.)
TYPE OF FACILITY
Outpatient, ambulatory surgical clinics can be a good option if you want to avoid hospitals altogether and your procedure can take place outside of one. But it’s important to discuss a backup plan with the doctors there in case there’s a complication during the procedure, as most clinics don’t have emergency facilities. Where is the closest emergency center or full-scale hospital? What is their step-by-step plan of getting you treatment if you have a stroke or heart attack while in their care, or if something else happens that’s beyond their expertise? These are questions to ask.
POLITICAL
This country has both for-profit and not-for-profit hospitals, and while they handle tax write-offs differently, both are rolling in the dough. I recently visited a hospital whose lobby had glass floors with crystalline streams and tiny fish running underneath, and collections of paintings adorning the walls that might as well have been on loan from the Louvre. The hospital also boasted an established chef running the “dietary program” (which means a chef designed some foolproof recipes that could be produced on a mass scale and styled for photos). And, like other hospitals of its kind, it was erected recently in an affluent, suburban setting—meaning because of the cruel reality of residential segregation in our country, it’s inaccessible to people of lower socioeconomic status. It means those fountains and paintings were bought with a huge sum of tax dollars that could have gone to helping people in the community who couldn’t afford an emergency visit or a checkup.
Politics alone shouldn’t determine your decisions, nor would I judge anyone for receiving a procedure from a great surgeon at this hospital. But in the current social climate, many of us are reconsidering the ways small, seemingly benign decisions reinforce societal systems of oppression. It’s fair to consider these issues, or at least be aware of them.
PRICE
Price is the determining factor for most of us. This book includes a simple five-step process you can use to determine what your procedure would cost at each location you’re considering—and they could vary exponentially. Head to “Healthcare Bluebook,” here, for more information.
One last thing: You don’t have to make your final decision sight unseen. You can ask to tour a unit or outpatient clinic where the procedure will take place. Call and set it up beforehand, and you can get a feel for the facilities and staff before committing to a procedure there. Simply remember this is another aspect of your healthcare about which you have a say. Don’t just let someone tell you where and when to show up!
We can thank Sweden for IKEA, ABBA, H&M, and gravlax—and better surgical outcomes.
In 2010, the Enhanced Recovery After Surgery (ERAS) Society was established in Stockholm. Its goal was to improve care and avoid complications during commonly performed surgeries by reviewing research and designing more refined care pathways. Its first program was implemented at Örebro University Hospital to great success, and the initiative was brought overseas in early 2016.
These programs are already starting to show promise for their ability to shorten hospital stays and recovery times and reduce the incidence of complications in US hospitals. Today, an ERAS care pathway signifies that a hospital has redesigned their standard of care for a procedure based on a national, comprehensive review of the literature on outcomes in pain management, patient stress, length of stay, and common complications.
The protocol uses multidisciplinary input from surgeons, hospitalists, nurses, physical therapists, and social workers to develop a plan around a surgery. Think of it as a redistribution of weight along the care continuum of a procedure: The crescendo of attention is typically on the table, in the operating room, but this model gives equal consideration to preoperative, postoperative, and recovery periods. The bar is set as high for pain control, infection prevention, and return to quality of life as it is for successful surgery.
Let’s take the example of a knee-replacement surgery. The day after such surgeries, patients typically experience intense and only moderately controlled pain. The hospital stay usually lasts three to four days. In contrast, the ERAS program uses a novel eleven-point pain scale designed specifically to manage postoperative knee pain. The new care pathway, composed of this knee pain scale and other customized interventions, has been shown to reduce pain drastically, with one in three patients reporting no pain throughout the entire hospital stay. The ERAS program also reduces the stay to fifteen hours. I don’t think it’s a stretch to say that these programs can have as much impact as the expertise of the surgeon.
Care pathways are gradually being adopted in American hospitals across various specialties, but it will take time before they’re widely accessible. As you consider different locations for your procedure, you can call around and see what institutions in your area offer care pathway programs. The list is evolving rapidly.
If you’re seeking a second opinion or moving forward with an elective procedure, you may have a sea of potential surgeon candidates. Here are some tools to help you find the best match.
First and foremost, check the Federation of State Medical Boards (http://www.fsmb.org) to ensure that any surgeon you’re considering is licensed, without sanction.
Review the surgeon’s complication and success rates. The sites http://www.surgeonratings.org and http://projects.propublica.org/surgeons allow you to access detailed information about surgeons in your zip code based on their success rate with various common procedures.
Ask the staff at the hospital where they practice for recommendations. Do you have a friend or relative who works for the institution and can ask for you or connect you with someone on the floor? Do you know any nurses who would be willing to do some reconnaissance? If not, you can cold-call the unit yourself, explain your situation, and ask if they recommend any particular surgeons.
Ask the surgeon if you can talk to their former patients. While HIPAA (a confidentiality-protection law) prevents surgeons from giving out contact information, they might have a past patient or two who would be amenable to speaking with you, and they could connect you after confirming. This is a courtesy on the provider’s part, as it takes additional work, but it’s a standard request and any good surgeon is likely to grant it.
Before any major surgery, schedule meetings to tour the unit where you will be cared for before and after the surgery, and to meet the surgeon in person. Enlist your primary care provider’s help to request this appointment, or call the office yourself. State that you’d like fifteen minutes with the surgeon to go over things sometime in the week or days leading up to the surgery. Also try to meet with the anesthesiologist assigned to your care.
Questions for your surgeon
Briefly go over your medical history. Then ask:
Which complications are they most concerned about?
What is the plan to address postoperative pain or nausea?
Who will oversee your care in the hospital after surgery? Will they be accessible after surgery, and how will they be reachable? (For example, if your surgery is on a Thursday, are they working over the weekend? If they aren’t available, who will be covering?
(If it’s a teaching hospital) Will they be performing the surgery themselves, or standing by while a resident performs it?
Questions for your anesthesiologist
Ask for fifteen minutes with your anesthesiologist to:
Do a thorough review of your medical history.
Get assurance that they will be in the room with you for the duration of the procedure.
Ask how any special circumstances (e.g., if you’re frail or have allergies to standard anesthesia formulas) will be addressed.
The Days Leading Up to a Procedure
The week leading up to a major procedure is one of strange weather. If you’ve been there, I imagine you can recall the time with particular clarity.
I tell my patients that this is a time to be gentle with yourself. It’s a highly personal task—it can’t be prescriptive—but it should involve things that help you feel settled and place a few coins of resilience in your back pocket for when they’re needed.
If the surgery is scheduled (nonemergency), let your primary care provider know that you’re having it. Doing so will create a channel for better communication between you and your primary care provider, as well as between your primary care provider and the surgeon. For example, since your PCP knows your history more thoroughly, they might advocate for taking you off of a medication prior to surgery. Two heads are better than one, and if your PCP has knowledge of the surgery they can add additional insight and support to the case. This communication will also pave the way for more coordinated follow-up care once you’re released from the hospital.
It’s also a time to connect with your advocate, and/or the other friends and family who will be around. On one of the days leading up to checking in (perhaps not the evening prior to your procedure, since that’s typically colored by anxiety or Xanax), schedule a game-plan discussion with your person or people. (If you do not know who to turn to in this situation, see here for tips and resources on identifying and appointing an advocate.)
Compile the following information about your procedure. Make copies available for each person who will be around, or send it via email.
DETAILS
Place (including the unit you will be admitted to and returned to after surgery), date, time, and expected duration of the procedure
The procedure itself and the specific condition it is treating (e.g., lumpectomy for tubular carcinoma of the breast, Stage II)
PEOPLE
The names of the surgeon, anesthesiologist, and any other specialists directly involved in the procedure
The name of the charge nurse who will be working on the unit to which you will be admitted after the procedure (you can call the unit to get this information a few days ahead of time)
MEDICATIONS
A comprehensive list of the medications you take daily and that you should be taking while in the hospital
A list of medications commonly prescribed for use before and after your procedure, and what they’re for (you can find this information online, or ask your provider’s office for a list—you can also enter the condition on http://www .drugs.com/condition to see which drugs are commonly used to treat it)
Any serious to life-threatening side effects to be aware of for each medication (you can look them up at http://www.drugs.com/sfx)
COMPLICATIONS
This section rests on a discussion with your provider (which can be done as soon as the procedure is scheduled), plus some brief, supplemental Internet research. In this section, list out any complications associated with the procedure, and how to recognize their signs.
This sounds daunting, but all the information is there—you just need to compile and distill it. Then you can use it to have a conversation with your advocate, friends, and family. Here’s an example that should illuminate the task and show you it’s more simple than it sounds.
DETAILS
I am having a coronary artery bypass surgery at Cedar Sinai Hospital, unit 5A, this coming Thursday. The surgery is scheduled for 7 a.m. and expected to last four hours.
The bypass surgery is an intervention for a plaque in my coronary artery that needs to be circumvented. The surgeon will go in and graft a vein around the blockage so blood can flow more easily.
PEOPLE
Cardiothoracic surgeon: Martha Rush
Anesthesiologist: Kasra Shokat
Vascular surgeon: Tess Tumarkin
Charge nurse: Gabriel Zinn (unit direct line: 503-555-0142)
PCP: Jillian Porten (office number: 503-555-0101)
MEDICATIONS
Daily, I take:
Vitamin D, 200 units
Lexapro, 50 mg
Lotensin, 40 mg
Inderal, 25 mg
Baby aspirin, 81 mg
New medications that might be used during this stay, and potential adverse side effects to keep an eye out for:
IV morphine (for pain): dizziness, slowed breathing, constipation
Phenergan (for nausea): dizziness, ringing in ears
Coumadin (to control bleeding): severe bleeding, blood in urine
Pepcid (to protect stomach lining): dizziness, weakness, constipation, or diarrhea
COMPLICATIONS
Clot forms after surgery, causing heart attack, stroke, or pulmonary embolism
Watch for: Irregular activity on heart monitor, chest pain, face drooping, arm weakness, speech slurring, sudden confusion, shortness of breath, chest pain
Internal bleeding
Watch for: Sharp stomach pain, shortness of breath, decreased blood pressure (so, watch my vitals)
Infection of chest wound
Watch for: Any signs of infection in the wound, fever, rapid pulse, unusually low body temperature, vomiting, diarrhea
If any of these happens: Alert my assigned nurse.
Alert Gabriel Zinn, the charge nurse, and ask him to page surgeon Martha Stevenson, who is overseeing the case. If there is no response within thirty minutes, call the rapid response line and request an evaluation: 503-555-0001.
Once you’ve made the list, go over it with your advocate and see if they have any questions. This will prime them for any common complications they should be on the lookout for, and empower them to ask questions. It’s not to make them (or you) nervous or anticipate disaster, but to instill a deeper sense of confidence, preventing a situation where everyone goes in blind and has to address problems reactively.
Us: Blah blah blah.
You, as the patient, nod, and look like you’re paying close attention.
Us: Did you understand everything we said?
You: Yes.
Us: Any questions?
You: No.
There’s a sort of collusion that takes place, and we’re all complicit.
—MIKKAEL A. SEKERES AND TIMOTHY D. GILLIGAN, NEW YORK TIMES
Informed consent is meant to inform patients of the risks and benefits of medical interventions. It serves this function, sometimes successfully and sometimes not so successfully, but it also protects surgeons, doctors, practitioners, and hospitals against malpractice.
Providers want you to understand the risks and benefits of a procedure—its potential alternatives, the likelihood it will have the intended outcome, the result of not going forth with the intervention, and the worst-case scenarios. To skip this step would be to rip the medical code of ethics asunder. Whether or not they communicate these in a way you can understand is another matter.
Signing an informed consent form indicates that you understand all aspects of the medical intervention, and you’re making a voluntary choice to proceed with it. If the provider is rushed, if you are anxious, and if communication is tenuous, you may assume that—like with most medical forms—you’re being told to sign this rather than asked. Informed consent cannot take place under these circumstances, however, regardless of whether or not you signed.
Informed consent is black-and-white: Do you have free will? Given the outlined information, do you give consent to proceed? You, as a patient, are responsible for covering the gray area in between. Under proper informed consent, you navigate that territory with the help of your provider.
If you are up for a big procedure, surgery, or medical intervention (such as chemotherapy), schedule the informed-consent discussion, when you will sign the sheet, a few days to a week before the procedure itself. This limits the effects of urgency and anxiety on your ability to make decisions. It also gives you time to look into alternative options, get a second opinion if you want to, or talk to another patient who has gone through the intervention. This is also a good time to look into the hospital’s record and the surgeon’s record around the procedure (see here and here).
Your safety is more important than the provider’s time. Do not feel rushed to sign, even if your questions are met with a look of impatience or skepticism—or even if you’re scheduled to be in surgery within the hour.*
Only providers can discuss informed consent. Fight the urge to ask a nurse or therapist their opinion, as they are legally and ethically prohibited from providing it.
You never have to sign away your rights. You do have to sign the form in order to be admitted, but you can modify it as you like. Writing “I am forced to sign in order to get treatment for condition X, but I do not relinquish my rights willfully” can protect you later if malpractice occurs.
Ask any questions you have. Even if they seem outlandish, even if you’ve already discussed them last week in your doctor’s office but want to go over them again. If you can’t think of questions, explain back to the provider what you understand will happen. This is the same as the teach-back method and can be as simple as this:
“I understand that I have and am moving forward with because it’s going to . I also understand that could happen if I proceed, and could happen if I don’t.”
Only once the above items have been covered should you move forward.
There’s no such thing as an off-limits question when it comes to ethical informed consent. The medical community set up this system to empower patients, protect their dignity, and respect the decision-making process. It can only function if you’re an active party in the process.
If you’ve had major surgery, it’s likely you’ve been hit over the head with the rules. No food after midnight. Do not shave with a razor beforehand. (Anywhere! It leaves you prone to infection.) Stop those medications. Start these. Get an incredible, restorative night’s sleep beforehand, and, oh yes, arrive at 5 a.m. for prep.
To balance it out, here are a few things you are going to ask from your care team to ensure not only that things go well on the operating table, but also that you’re as comfortable as possible post-op.
The priority of any surgery—be it to remove an appendix or fix a leaking aortic valve—is a successful operation. After that, the most pressing concern on every patient’s mind before entering an operating room is pain—what to anticipate, how to avoid it, how to control it. But pain tends to take up so much of the conversation that it’s easy to sideline something that can be just as miserable—postoperative nausea and vomiting (PONV). Planning is key, as treating PONV preemptively is more effective than treating it at its onset. Approximately one in three of us might experience PONV after surgery, thanks to a combination of our physiological makeup, the anesthesia cocktail that’s been coursing through us, and the painkillers that disturb the GI tract. Females, nonsmokers, those who get motion sickness, and those taking opioids are at increased risk for PONV.
If these apply to you, let your surgeon or anesthesiologist know. Also keep in mind that gynecological, abdominal, and inner-ear surgery are associated with some of the highest rates of PONV. To prevent PONV, your provider will apply a patch before the surgery and give you a regimen of antiemetics post-op.
If you’re having major surgery and anticipate substantial pain, ask your provider if you’re eligible for a PCA pump. This is a patient-controlled opioid pump (it stands for “patient-controlled analgesia”) that allows you to control when and how much pain medication is dispensed. It’s hooked up to the IV and a small control button rests in the bed. In cases of major surgery, it’s important to stay on top of pain to the best extent possible, but often a patient’s ability to communicate pain and a nurse’s ability to manage it at every turn are compromised. While the option isn’t suitable for everyone—such as patients with a history of opioid addiction, or complex cases with too many medications on board to allow flexibility with pain intervention—it’s worth discussing with your surgeon.
The Importance of Follow-Up Care
He was the best. He’d operated on Pavarotti! It was like being in the presence of a demigod. Sure, there were moments we questioned his judgment . . . but we never questioned him. When I look back . . . I should have made something happen.
—AN INTERVIEW WITH PHYLLIS MOSSBERG, MY MEEMA, NEW YORK, 2018
Ten years ago, Phyllis lost her husband, Sandy, to postoperative complications. A few months before the surgery, he was diagnosed with a rare type of cancer in the islet cells of his pancreas. While the prognosis for pancreatic cancer is typically grim, islet-cell tumors tend to be less aggressive, and patients often go into remission once the tumor is removed. A gastroenterologist himself, Sandy was optimistic, and so was his family.
He knew the success of the operation hung on finding an excellent surgeon, so he and his family searched until they found the best. Dr. A had a reputation that preceded him on the East Coast. As the family describes it, receiving him—with a swarm of residents on his tail—at NewYork-Presbyterian/Columbia University Medical Center (one of New York’s best teaching hospitals) was nothing short of ceremonious.
“He’s in recovery. It was a huge success. The tumor virtually popped out,” he told the family while Sandy recovered in post-op.
Soon after, Sandy was moved to a rehabilitation unit on the basement floor of the hospital. Around this time things began to unravel as staff stopped communicating with one another.
The first incident happened a few mornings into his stay in the basement, when Phyllis was en route to the hospital and got a call from her husband. He told her he was having chest pain.
“It was hard to get people to come down to that floor,” she recalls, especially the team who oversaw his surgery and knew his case. She finally got the attention of a fourth-year resident.
“He poked his head in,” she recalls, “not his whole body but just his little head. And he said it was probably just a pulled muscle.”
“I was pushy,” she says. “I was not worried about being loved by anyone.”
“Young man,” she said, “this is a person in his seventies with chest pain and you’re chalking it up to a pulled muscle? Let’s come back in here. All the way.”
Sandy did not have a pulled muscle—he had a collapsed lung and needed immediate intervention.
That same week, Meema stopped a nurse from mistakenly giving Sandy Coumadin, a blood thinner that would have caused him to bleed out in his condition. At another point, when Sandy was in physical therapy in a separate wing of the hospital, his vitals started to deteriorate and staff called a code blue—but no one came. It wasn’t until twenty-four hours later that Sandy’s surgical team arrived and finally intervened to bring his vitals back up. They defended their absence by explaining that the physical therapy unit was technically not part of the hospital, so they were unavailable to respond to the code in the same way.
Sandy and Phyllis’ daughters, Amy and Julie, recall that the anticipated postoperative weakness went on for longer than anyone expected. It took great effort for Sandy to swallow, and he didn’t have the strength to eat much of anything. This didn’t seem to concern anyone—until Sandy’s friend, an outside physician, told the family how important it was for Sandy to get protein and nourishment so he could heal. This is a basic tenet of postoperative healing, yet Sandy’s medical team didn’t concern themselves with it. The family expressed doubts and the team assuaged them, reassuring them that Sandy would start eating again soon. Pavarotti’s surgeon went on a weeklong vacation, and by the time he came back and realized the gravity of the malnutrition and ordered a feeding tube, Sandy had deteriorated past the point of recovery.
Here is an example of a well-executed, lifesaving surgery that failed a patient in part because of poor aftercare—a reminder that once through the surgery, the need to advocate and keep an eye on things doesn’t end.
Below are the pillars of a good surgical recovery, and things to consider as you advocate for yourself or someone else post-op.
NUTRITION
As with Sandy, nutrition after surgery is highly important, its power underestimated! Protein helps with wound healing, vitamin C has antioxidant properties to protect cells from inflammatory damage, and B12 and iron are essential precursors to regenerating blood cells. Fiber and probiotics help the gut get back in gear. More on food to come soon.
MODERATE EXERCISE
Physical therapy may commence as soon as the day after surgery. You won’t be doing lunges across the room, but even slight muscle and joint activity is important to get blood moving around, stimulate the GI tract, and reorient you.
BLOOD CLOT PREVENTION
Getting moving is also key in preventing deep vein thrombosis (DVT). After surgery, the blood goes through a series of changes, with a higher potential to form clots (which makes sense, as your body doesn’t want you to bleed out). These conditions, however, can last up to twelve weeks after surgery. When you’re relatively immobile, shored up in bed, your blood moves around less, increasing the chance a clot will form. If it breaks off and travels to the lungs, a serious or life-threatening problem called a pulmonary embolism could occur. For this reason, get moving as soon as you can, wear those terribly annoying compression stocking contraptions when you’re asked to, and always alert someone if you notice a sudden change in breathing.
PAIN
Severe, prolonged, improperly addressed pain will negatively impact the healing process. Stay on top of your pain, using the several tools and recommendations throughout this book to communicate with your care team about keeping it at a tolerable level.