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[kradeelav]

What a Surgery Is Really Like (in the Patient's POV)

Long time readers will know I've had quite a few surgeries.
(Part of why it's on the to-do list to get a tattoo that lists them - I'm genuinely losing count now. Think it's somewhere north of 16? 17?) 

Given I just had one a week ago and another three months ago, and am able to handle talking about medical stuff in depth after going through therapy,  it actually may not be a bad time to write this up. I figure a frank description would be good to satisfy idle curiosity of others, act as part resources if this will help other people's fanfiction or anxiety (or both lol), and ... part just the act of remembering for me.  Feel free to copypaste if you think it will help others, I don't care about credit on this one.

Arrival

If it's a scheduled procedure you're likely going to be arriving at the hospital the early morning somewhere.

You will likely be cranky between understandable nerves/stress and not eating (they will ask you to not eat or drink that previous night/morning. You can kinda cheat with like, one teeny tiny sip of water to rinse the teeth, but know you're playing russian roulette re: post-op nausea if you go further. If it's a major one and you're expecting to be intubated -tube down the throat- for a long time, I would not even do this.)

You can arrive with just yourself, or with an advocate buddy. I would strongly recommend having at least one advocate buddy in the waiting room at minimum; you can have more (i had a whole herd of a family at one point), but they are very useful for moral support, non-brain-worm infected people in case if you blank on stuff, and driving you back home if it's a same-day-back-home thing.

Depending on the hospital you'll find yourself / be directed to the main waiting room that's larger than your standard doctor's office waiting room. You'll likely have to stand in a short line right before this and let them know your name, date of birth, what you're here for, who your surgeon is, yadda yadda.

After confirming this information, they will print out at least one of those plastic bracelets with bar codes you'll be keeping on for the whole time (they make great mementos or stuff to burn afterwards in a "fuck yes i'm alive" ritual.)  One is your general identification bracelet, one usually gets slapped on if you're a fall hazard, and I know there's others. They will be scanning these somewhat often like you're a piece of fruit (it's all very industrial these days).

You'll be asked to sit down in the waiting room anywhere from 30 minutes to an hour. It's a good time to have a mindless game on the phone or have a buddy to talk to.

Eventually you'll be called to a set of double doors, and asked to follow a tech through a maze of hallways to your pre-op room. You can take a small backpack of your stuff into this room, and I'd even bring stuff like your phone, a book, a blankie/stuffed animal/comfort item, and something tactile if medical anxiety's a thing.

There's three phases to this whole thing: pre-op, operating (theatre), and post op; this is the first one.

Pre Op

Something I noticed about the recent surgeries: if you're lucky, you won't smell the classic hospital antiseptic smell. This can be a bad flashback trigger for some (me), and maybe it's a widespread thing because I'm noticing they're using odorless chemicals more. If that doesn't hit, the first thing you'll notice is a lot of beige-y hallways with a lot of activity and wheely-carts of equipment dotted between the doors.

Regardless, Pre-Op is where they get you prepped up for the anesthesiologist, surgeon, and interns to go to town on you. :P

Less, uh, glibly, this is where the paperwork is handled, IV is inserted, monitoring vitals gets started and all that jazz. Your tech will give you instructions: to strip everything (yes, everything) after they leave, put on the gown provided, hat, socks, and show you a button somewhere that you can press if you need help or have questions. You're on a timer now after they leave, so it makes no sense to waste time. Strip -underwear and anything removeable-, get re-dressed and wait on the next tech.

They're going to repeat a lot of the same questions at you in this part through the Operating Theatre; most notably "in your words, describe what you're here for today."  this is by design; a small number of surgeons have been disgraced because they've removed the wrong eyeball or leg or whatever by accident. Promptness with checklists should make you feel better, not worse. Sloppy is yellow-orange flag bad. Do not be afraid to correct them politely on shit that doesn't sound right (or at least ask clarifying questions at minimum) - you are your own best expert. Seemingly random details like your weight matter - anesthesiologist needs that to calibrate the right level of chemicals. Even better if you've got your advocate buddy* with notes to double check.

*usually they don't allow your advocate buddy in the pre-op room, but if you're disabled, have SEVERE debilitating anxiety, or have some kind of weirdass complication, they'll allow one person. Try to bring somebody that's chill with hospitals, knows doctor's personalities, good with details, and not squeamish. Ex-nurses are the best. Even better if they've got a notebook of details that you've been writing down in the previous appointments (you have been writing down things, right? Dates, meds prescribed, things docs have said? )

There's going to be some paperwork read with scary sounding stuff of "there can be risks of infection, paralysis, death, (insert scary sounding complication for your area being operated on), etc" that you'll have to sign. These are your consent forms, and there's a good chance you've already signed one round of copies - this is normal. For natal women, they'll ask you to either do a pee test or sign some more papers with a witness to ensure you're not pregnant. Which uh, make sure you're not.  They don't really care which version you do, they just don't want you suing their pants off. :P 

By now you've got your clothes in a bag, you're in their clothes on the bed, things are beeping, and techs are hooking up tubes to you. One of these tubes taped to you is a pulse-ox, usually a passive sensor attached to a finger or toe on whatever side of the body you're being operated on. This measures your oxygen levels, and never hurts. (You can buy those things at the local drugstore). Another one of these tubes is the IV line. They'll prod the veins in your arms, sometimes ask you for your opinion for where to be poked (if they sense you've been through this before), and disinfect it before the needle comes out.

It may be wiggy if you have a specific fear of needles, but after the initial set of jabs, the first successful flush, and them taping it up, you don't "really" feel it after until they remove it. It's a really damn good sign when they remove the IV line - they're confident you won't face plant and code blue on the floor. Anyway, they'll do a "flush" (of clean saline water) to ensure the liquid flow is goin'. If you pay attention to your body, you'll feel it - it's like a little neat internal cool wave along the arm. Some IV medicines can burn going in, but water doesn't.

For extremely local and out-patient procedures (think minor to medium eye surgeries), they'll even let you take a small blanket or similar discrete soft comfort item into the operating room itself.  I personally would not do this as there's a risk the item could get lost or accumulate exotic bacteria (and you're gonna be unconscious for the vast majority of this part), but it's there if you wish. Either way, you can hang onto something during all of this prep.

Typically other than the techs, you'll see the anesthesiologist and the surgeon himself in the 30 minutes before.  The surgeon will drop by to check in, see how alert/cooperative you are, do any operation-specific procedures on their end (eg, eyedrops for eyes), and be there for last minute questions or concerns. If you've got anxiety about a specific part of the process, now's the time to (quickly, respect their time) ask about that and what they plan to do.

The anesthesiologist will stop by for much the same; a hello, checking again to see how cooperative you are (if you're not, they'll stick you with an IV sedative to slowly ramp down; this happens a lot with kids). If you are cooperative, this is a great time to address any potential complications/anxieties with them or ask them to walk you through the process. Don't be afraid of being frank, but be specific - I specifically mentioned my trigger of a full oxygen mask and we ended up not having to use it for one procedure (opting for a cannula, basically a tube taped right outside your nose. there be too many tubes, yes) which massively helped.

The OR nurse will then be one of the last ones to appear and double check everyone else's work before it's show time. They're to be respected. Typically they or another tech will be the ones to roll you (on your bed) to the OR.  When they say it's go-time, this is as far as your advocate can go, if they were in pre-op; they'll be led back to the waiting room.

Operating (Theatre)

aka the ol' long roll to the room itself.

There'll be a fair few double doors, and the hallway decor will change slightly. Lot more scrubs, lot more "this is business" big ass heavy duty equipment and boxes in various rooms. A lot more tile and liquid-resistant surfaces; some of these rooms look like they can be pressure-washed safely. Try not to look too hard unless if your brain is genuinely wired to be curious and is unafraid.

This is where people can get a little wiggy - I've been there.

It's a little grim, but imagine Fate with a set of dice out in front, rolling the dice for you on this one. You want to get a good roll.

The important thing to remember about surgeries is they're a last resort (compared to medicine): but they're a thing for a reason.  They're not to be taken lightly or cosmetically or frivolously; you need to be at peace betting your life on this. But you also need to not keep yourself in misery with pain (mental or physical) if there's a solid chance surgery can fix something with minimum risk. It's all about stacking the risk/reward ratio. Weighing the dice in your favor.

Fate's not trying to kill you; you've got a lot of existing cards stacked in your favor (modern medicine and tech is a miracle). Odds are, you'll get a pretty benign dice number in the middle. Maybe you'll get a little post-op nausea. Maybe you won't get anything. Maybe you'll get a mild infection that goes away with some antibiotics. Just keep the cards stacked in your favor by somebody (you or your advocate) paying attention and knowing thy body. Catching shit early is the best way to prevent a landslide to hell.

Back to the actions.

You'll get rolled in a room; the room's probably busy with at least 6+ people scurrying around getting Stuff ready, a lot of chatter. This is Tuesday for them. If you're lucky you'll get some people with a good bedside manner who can talk calmly to you / talk you down. 

You'll get yet more shit taped on you around your torso - something like 5 circular white dots with wires on the back; these measure your heartbeat, and don't hurt. You'll also get wrapped up in a tight blanket or two (sometimes they're even warm!) to keep your body from flopping around, and possibly adjusted around on the table (or hauled over to a metal table if there's expected to be a lot of liquids). Depending on the surgery, you may be awake for these parts and coherent.

If they haven't asked you before, they'll ask you if you've got any metal in your body or implants. This is because some of the heavy-duty equipment can interfere with both on an electrical or magnetic standpoint.

Sometimes, if you've got a history of anxiety, they'll start IV-feeding you sedatives at this point. There's actually several (endless, really) levels of anesthesia, ranging from local areas that can numb a patch, to sedatives that simply make you sleepy/loopy, to stronger sedatives that are a mix of 'i'm dreaming and/or tripping balls on the insides of my closed eyelids and can't feel shit but not fully unconscious' chemicals, to finally, stone cold knock-out shit where you blink and you wake up elsewhere.

This is going to sound counter-intuitive: typically you want the least anesthesia as possible. 

These chemicals are no toys, and there's no anesthesia that has no side effects. It's really half a science, half an art, since there's so many variables to not knowing if somebody's allergic to it, might have a reaction (immediate or delayed), or something else. Even after you "wake up" that day, you'll feel the effects tapering off for at least a week or two, even if it's a quickie 30 minute stint being under. Anesthesia fatigue isn't like normal fatigue; close your eyes and you'll get trippy vivid patterns that first day, and there can be memory issues and delirium for a while after. I think it says a lot while I have a lot of wariness/fear-respect for this whole process, it goes mostly for anesthesia itself.

One of the last things you'll remember is them sticking oxygen on you, either with a cannula or a whole mask. This in itself doesn't hurt, but can be tightly bound with a lot of triggers if it's a big one. Be kind to yourself here. There's no going back at that point.

Godspeed.

Post-Op

Good news: you're past the worst where shit can really go sideways. You're alive. Advocate buddy is sometimes allowed in the post-op room, but you/they have to ask nicely ahead of time. Again, better if you've got an ex-nurse advocate buddy who knows the system; i swear they can sense each other.

Bad news: recovery is rough, man. I've always said recovery (both immediately at the hospital, and in the months after) is never pretty or glamorous. You just want to crawl out with your carcass intact. Focus on the survival instinct.

This next part can really be variable in a big way if you're out-patient (sent home same-day), or in-patient (require a day or several in the hospital's general areas), or if you're really unlucky, on the fast track to in-patient ICU.

I'll start with the worst: in-patient ICU, you won't remember this part. Generally if you're headed to ICU (intensive care unit), you've had major, likely traumatic surgery, and their mission is to get you as stable as they can. heartbeat, breathing, no infections, awake, drinking, peeing/shitting, eating, roughly in that order. You'll be tripping balls on heavy duty anesthesia and won't remember anything until you start waking up in ICU proper, often still intubated. And that is a totally different post I don't think I'll be able to write ever; you'll likely have to go to reddit for those details.

I'll also be candid and say I actually don't know what it's like from post op > general hospital room; all of mine has been both extremes, more often in ICU. :D;; My guess is it's probably similar to the "sent home same day" part, except, well, just transferred to a different area of the hospital to keep an eye on you.

Now, good news - most people have minor surgery which is same-day out-patient stuff. You get to (almost) walk out of here on your own two feet.

When you wake up from out-patient post-op, you'll be in a pretty large open area room divided with a lot of curtains, and a lot of beds lined up against the walls. The curtains are there to give some people privacy, but also let the nurses and techs in/out if somebody starts going sideways. This is a delicate part of the process where eyeballs are (or should be) on you to monitor you clawing your way back to consciousness.  Your body doesn't like being forcefully put unconscious.

They will be watching for your vitals, and potential signs of reactions or infection; infections are probably the n1 cause for complications. Red ugly swollen tender puss-filled wounds. Rash-like reactions are another major red flag that they'll throw some medications at to squish immediately.

Either way, you'll be waking up.

I suggest to just focus on breathing, mentally cataloguing all systems and figuring out if something feels off. Let the techs know anything; sometimes they'll offer you a sip of water. By this point somebody will have let your advocate-buddy know in the waiting room that you're back online and what your status is. You can text, read, whatever at this point in the post-op room; they're gonna make you stay there for an hour or so to make sure you're stable even in the best case scenario. (You will most likely want to just lightly rest with your eyes closed.) 

Once when you've gotten the thumbs up from the techs about your stable-ness, and you've got your driver home lined up, they'll start removing all the tubes and wires. Pulse-ox, IV line, electrode stickers, anything of that nature. Hospital bracelets stay on until you get home, to which after that, you can cut off as needed. Any tape they leave on you, I would leave for at least 12 hours and then work off unless if they say otherwise.

Then they'll walk you over to a wheelchair, and connect you with your person to go home and continue recovery there.

[nge voice] Congratulations!