Practical preparation for life after surgery

When someone has a date for surgery, particularly if they are in pain or worried, it can be difficult to think beyond this. Yet this is about a new beginning and temporary adaptations can be really useful to prepare for the days and weeks following an operation. Although each person is an individual, many things go in patterns, and we can learn from past patients and health professionals who have experience.

For elective patients, the time waiting is currently too long and should be viewed as a “preparation list” rather than a “waiting list”. Patients admitted for emergency surgery comprise 16.8% of the total operations (but a greater proportion of hospital bed use). There is still time for practical preparation to go on, such as on family or neighbour WhatsApp groups. For some patients there is sadly too much time in hospital post-operatively since there is a national shortage of funded therapy posts that limit input at weekends. 

As humans, we sometimes find it hard to picture our future self, or to take the advice that we would give a friend. It can be empowering for patients to feel they can make decisions and have choice. I am a great fan of patient information leaflets and standardising messages so that every staff member feels confident giving clear information. I have coordinated dozens of patient information leaflets at my own Trust. I recommend our Trust’s “hip fracture leaflet” with information about how to get home as a car passenger and how to get up and down stairs. In my own clinics, I give people a leaflet about their condition to read in advance because that is part of Shared Decision Making of whether to operate or not, but I give a different sort of leaflet once we have signed a consent form, about “preparation for surgery” – that is just to spark ideas for the patient.

There are many practicalities to manage the “Activities of Daily Living”, or “ADLs”. Many health professionals and other staff have great experience in the tips, tricks and ideas to get through the first days and weeks. We can learn from other initiatives, such as falls prevention. Some specialties have traditionally had more involvement in post-operative preparation than others. As an orthopaedic surgeon, I am used to Occupational Therapists advising patients about how to manage at home and Physiotherapists advising about moving. Some patients hear ideas in advance – such as in surgery schools. Over my career, the care for emergency hip fracture patients has improved by adding aspects from the elective hip replacement pathway. Ideally, everyone would have surgery schools.

I have had some time as a patient. At a critical stage, I found it comforting when a friend told me I was being a chrysalis – doing time while my body changed. Life is a balance of being in control and having the serenity to accept what we cannot control. So please don’t see this as a list of things to achieve, but a few pointers that might help for those weeks.

Below is a scattergun of my top tips, followed by a more structured list of topics that might be more useful to consider.

My top tips are:

• Be a slob. It feels strange if you are used to being well-groomed and in control but try to feel liberated. Who needs a bra? Track suits and baggy t-shirts work.
• Drop your standards.
• Have food ready that is easy to open, easy to prepare and eat, but nutritious.
• Get flannels. Humans never used to wash every day. Make a mess.
• Trust your amazing body. You will get through this. Just existing is good enough. You are healing. You cannot speed up this phase.
• Remember there are only 168 hours in a week.
• Pace yourself. It takes two weeks (roughly) for wounds to settle and any stitches to be removed and six weeks for muscles and bones to settle, but a year to get the best out of it.
• Accept help. Other people get a buzz of serotonin from doing good and oxytocin from being together. So you are doing them a favour. But tell your helpers what to do. Eg – doing some cleaning, moving your favourite chair, putting a chair in your kitchen, rearranging your cupboards, giving lifts to appointments, helping shopping, etc.
• Also, be clear with friends or family about what you don’t need from them. You can say no. You may need to be firm.
• Put commitments or appointments into a diary or planner.
• Set a time to get your tedious life admin under control. One friend of mine booked a friend to work through it with her for a morning.
• Check out the bus services in your area. Most timetables are on-line. Many buses are great and they are used by people with disabilities. You have time to plan. Use this time when you cannot drive or cycle to explore.
• On-line shopping is great – the delivery driver will bring it in to your kitchen. Family members can order things to your address.
• Consider buying an extra-long charging cables for your phone or perhaps get a spare.
• Try a shoulder bag to move things between different rooms.
• Get a thermos flask for moving hot drinks between rooms.
• Do sit-to-stand exercises or lots of stair-climbing in advance so you don’t need your arms to get up out of a chair.
• Try to get fresh air, sunlight and human connection every day.
• Have things ready (shoes, coat, keys) to go for a walk every day.
• How will you keep warm – do you need a portable heater, or extra blankets or fleecy warmers?
• Get supplies in of any craft work or books you want to read.
• Don’t promise anything. You won’t be as productive for a few weeks.
• Get supplies of fruit and vegetables – this is for vitamin C and to reduce constipation from taking painkillers and not moving as much.

It may be helpful to plan aspects in topics. What might you do to make things easy, for various tasks?

Basic Activities of Daily Living (ADLs):

1. Washing
2. Using the toilet
3. Dressing
4. Eating
5. Moving around
6. Getting in and out of bed or a chair

Instrumental ADLs 

These are more complex tasks that require more thinking and organisational skills, and might include: 

• Preparing meals
• Shopping
• Doing housework
• Using a telephone
• Housekeeping
• Laundry
• Transportation (driving, using buses)
• Taking medication
• Handling finances
• Using a computer

Other important things to plan in

• Keeping entertained
• Keeping connected with friends and family
• How to use offers of help

Equipment can help with tasks – see www.livingmadeeasy.org.uk:

• Cutting food
• Pouring kettles
• Turning taps
• Getting out of the bath
• Getting up stairs
• Going to the toilet
• Remembering what pills to take and when to take them

There should be a continuum between preparing for surgery, having active hospitals with #EndPJparalysis and good practical preparation for life at home. 

Good luck!