07 February 2017

What To Expect At A Same Day Surgery Center

Hi again. Wanted to continue with a follow up post after same day surgery last week. This post is all about what to expect going to a Same Day Surgery Center. As I mentioned earlier, in the past three-an-a-half years I've had three surgeries all at different surgical centers. So I thought it might be comforting to readers to share what that experience is like and help you know what to expect. This is a long post, but I tried to cover all aspects of surgery day, plus illustrate with my experiences. I hope it's helpful!

First, expect that every surgery center will be a little different. So far I've had three pretty different experiences. My first experience was in Santa Monica and I now realize the facility was one of those fancy SoCal surgery centers that are tucked away, where celebrities can sneak in and out for things like plastic surgery. Ha. I just went to where my doctor sent me, so I really didn't know what to expect or that this spot was a little unusual. It was very upscale and very small. I never saw another patient. As far as staff I think I only saw maybe 5 people total from front door to departure.

We walked into a very well-appointed, small, upper floor waiting room. One staffer met us there, processed paper work and took me to a small wood-paneled pre-op room. There I met the anesthesiologist who did all his necessary pre-op work and a nurse was in and out with me. After about an hour of pre-op they took me into the most gorgeous operating room with one wall entirely of glass, overlooking the city all the way to downtown Los Angeles. It looked a bit like a beautiful sci-fi movie set.  I saw my doctor briefly along with the small surgery team. I was conscious only for a moment or so, woke up in recovery and was on my way home a couple of hours later. Slept all afternoon and was feeling a lot better the next day. Everything was very simple and things went smoothly and easily.

Second surgery was at UCLA Ronald Reagan Medical Center. You can imagine this was a vastly different experience based on the fact that this was a BIG hospital environment. There was one large waiting room, dozens of patients in surgery, whose families could track their progress by a number up on a big electronic board. The pre-op area was a large hospital ward, lots of patients and staff on the move all the time. The pre-op and post-op rooms were curtained areas. There was less staff around during my recovery time and I felt like I was alone much of the time. I think with this experience my recovery was many hours and looking back I probably should've stayed overnight in the hospital. I had the option and wanted to go home. Lessons learned.

My third experience last week was in a mid-size surgical center attached to a hospital. There were probably 10 other families in the waiting room and again each was assigned a number to track on the a much small electronic board. Again pre-op and post-op were curtained areas in a hospital ward. It was peaceful and quiet most of the time, except nurses talking in the halls. For the most part I was really impressed with the staff, energetic and very attentive. Appreciated that.

So beyond the differences in facilities, here are a few things to expect when you go to a surgical center.

1) FASTING: You'll have to fast from midnight until your surgery. For a variety of reasons they want your stomach empty. Plan on this. You may want to plan to have a meal at midnight if your surgery is later in the morning or afternoon. Since my surgery was at 11 am, I had a bowl of cereal and a big glass of water at midnight.

I was told I could drink until four hours before the surgery so I had a good drink four hours before. This conflicted with instructions from others along the way, but since I was told this by a pre-op RN who I had an appointment with, I felt okay going with it and didn't seem to have any problems.

2) LOOK SO YOU FEEL GOOD: I will tell you I got a mani-pedi the day before my surgery because I didn't feel like having crusty winter hands and feet that people might be looking at all day. I felt better when I looked better. Not a must, but wearing a gown isn't a pretty situation anyway, so anything you can do to feel a little better is a good move. You'll also want to shower, shave, buff, moisturize your skin all over or whatever else you need to do to feel clean and pretty when you get there. It's nice to take a little extra time.

3) NO JEWELRY: Don't wear any jewelry to the surgical center, just leave it all home. It becomes a security issue if you bring it with you and something that could get lost -- and they will ask you ten times if you have any jewelry you need to remove. Easier to not have to deal with it.

4) NO MAKEUP: Since I couldn't wear makeup but still wanted to look my best I washed my face well that morning and then heavily moisturized my skin a couple of times until it glowed. Then I curled my eyelashes so that my eyes would look bright and perky. I looked rosy, sunny and healthy which made me feel better about running around with no makeup on -- and I hoped it would give the medical staff confidence that I was happy and in good spirits.

5) SIMPLIFY BELONGINGS: This is a good time to go through your purse and clean out anything that isn't essential for you to have. Again this is a security issue and can cause delays later if you have a lot of belongings that have to be locked up once you get there or taken to your car where they are also at risk. I took the very least possible, just ID, wallet (take anything out you won't need and leave that home too!), my little toiletries bag that I carry in my purse and my cell phone.

6) PLAN FOR SCHEDULING CHANGES: Surgery schedules are VERY fluid, they change all the time. So keep your day very flexible when you or someone you love has a surgery scheduled. When The Man had a surgery scheduled a few years ago, it was pushed back several times in the day to the point.  They eventually ended up cancelling it and rescheduling it after multiple delays because it was getting too late and they didn't have enough staff who were fresh to start another surgery. Mind you he had been fasting since midnight the night before and things were delayed until early evening. Not fun.

For my surgery last week, the day before they moved it up by two hours. This messed us  up because The Man had a doctor's appoint two hours before my original check-in time. I was planning to go with him to that and then we were going to head to the surgical center. So instead he dropped me off an hour early so he could get to his appointment then came back when he was done. So I was at the hospital at 8:30 when our original plan was that I needed to be there at 11, then it had been bumped up to 9:30.

Once I got checked in they immediately started surgery prep and I ended up heading in to surgery early before The Man even got back to the surgical center.

7) BRING SOMETHING TO DO: If you do get delayed it's nice to have a magazine, book or something to do while you wait. It's good to have something to keep you pre-occupied and if you have to wait it's not so frustrating to feel your time is totally wasted. I took a small bag with my journal, a book and a couple of magazines. But I never had time to look at them.

8) PLAN FOR A VARIETY OF EMOTIONS: This past week I was super chill about going into surgery. Very relaxed and calm. I have had times where I got teary-eyed thinking, "what if I die and never see my family again?" I think I felt this even worse when The Man had surgery and I had those thoughts of what if something happened to him?!!  Going into surgery can be stressful. Be accepting of how you or your loved one is feeling and try to do what you can to calm the fears. Expect that you could have a variety of emotions hit you as they are wheeling you or a loved one out of Pre-op. Don't be surprised or too worried. If you are the one having surgery, in a few minutes you'll be totally unconscious and it will all be over before you know it.

9) PRE-OP IS A BUSY TIME: You will check in two hours or so early and you envision you'll be sitting around a lot. It's a pretty busy time with a lot going on. You'll check in at the front desk, then a nurse will come and get you and take you back to Pre-op. You'll change into a gown, pack up your clothing in a big plastic bag and hop on the gurney. At some point they'll bring you a nice warmed up blanket and you'll get your free prize, a pair of grippy socks to put on your feet that they always make sure you know "you can take home with you".

Because I checked in a full hour early last week I thought for sure I would have some wait time somewhere in the process. During the entire Pre-op process I probably was along maybe 10 minutes. You'll have lots of constant visitors from nurses, anesthesia team, your doctor, etc. You'll be changing, they'll be hooking you up to stuff and you'll get asked a lot of questions as they repeatedly review all the important forms, pre-op evaluations, etc. It goes by quite quickly, which is nice because at this point you just want to get things moving.

They will lock up valuables like your purse if you want them to or they give you a locker and key to do it yourself. Usually they will let your family come in once you are set up and comfortable for a few minutes before you head out for surgery.

10) IV HOOKUP: They'll hook you up with an IV pretty quickly. This week my IV insertion was really painful and it hurt and was uncomfortable most of the entire time. Looking at my hand, I did look quite dehydrated and it was in a sensitive spot. I talked to the nurses about it and we decided to just live with it that way for lack of better options. But I've never had it hurt as much going in or while it was in. They ran plain fluids for a while and then inserted the relaxation and further drugs later in the morning. I definitely started feeling the relaxation drugs around the time they wheeled me into the O.R.

11) MEDICAL TEAM VISITS: As I mentioned, you'll have different nurses and anesthesia team and your doctor will probably pop by for a pep-talk/quick review of what to expect during the Pre-op time. You'll sign paperwork and everyone who comes by will check to make sure you've signed in all the appropriate places. They will also ask you a pretty standard set of questions including:

  • What are we doing with you today?
  • Height? Weight?
  • Are okay with getting a blood transfusion if needed?
  • What is your religious affiliation?
  • Who is here with you today?
  • Do you have allergies?
  • Have had any problems with anesthesia before like nausea, etc.?
It's great that they all come and introduce themselves and/or check in to see how you are doing. I never remember any of the team's names, but it's nice to meet them or see your doctor again one more time before you go to surgery.

12) WHEELED TO SURGERY: When it's time to take you to the O.R., a few people will roll you down the hall, through the doors and you'll be getting a little wazzy at this point because they've already giving you a hit of "relaxation". I only remember a few seconds of this phase every time and then I'm out. It's always a little fuzzy what I'm seeing and it feels like there are a lot of people buzzing around you for a few seconds getting you all set up once you enter the operating room and then your unconscious.

13) WAKE UP CALL/RECOVERY: At some point, you'll wake up in another place, Post-op/Recovery. It's a little weird to wake up in a different place than you went to sleep. You'll feel groggy or maybe a little worse and they'll keep a close eye on you during this time. You'll probably come in and out of consciousness for a while and you might have a nurse there with you monitoring your vitals and asking how you are doing. They may administer some drugs through your IV and they'll be watching your pulse, blood pressure, oxygen levels, etc. Your belongings (clothing, etc) will be there waiting for you and when it's a good time they'll let your family or accompanying caretaker come sit with you.

Depending on what you have had done and how you progress this may take anywhere from an hour to several hours. I've had both experiences. My first surgery I don't remember feeling too weird, I was up and out of the center pretty quickly. My second surgery was many hours and again I should've just agreed to stay in the hospital. This time I was really sick the first hour, started feeling significantly better 90 minutes afterwards and went home.

In my surgery last week, I would wake up and there was a big red digital clock right outside my room so I remember it was 12:08 when I first opened my eyes and then I thought I was out for a long time and it was like three minutes later. I've never had a clock nearby before so I was very aware of how I had no sense of time as I watched that clock and sometimes it seemed like I'd been asleep for a long time and it had only been a couple of minutes and other times it would be half an hour later. That was weird. But it was comforting that as time passed I began feeling less groggy and sick.

My curtain was all the way open and I seriously thought I was in a hallway all that time, but it was actually a corner room which lead straight out into a long hallway. (I didn't figure this out until I got up to get dressed.) I was fine with that, it was quiet and there weren't a lot of people around and frankly I didn't care. My first hour coming in and out I was really miserable. This varies a lot. I was never really nauseated with my other surgeries.  But this time I was. I felt like I was going to throw up at one point and urgently asked the nurses to get me a bedpan quickly. They hurried to grab one and hand it to me and before I could actually throw up I was passed out again. I thought that was really weird when I woke up again and realized I'd never quite gotten to throwing up. Weird stuff!

They gave me some medications for pain and I think for nausea too and they kept pushing me to breath deeper. Apparently I wasn't getting enough oxygen and I heard the nurse tell another nurse my pulse had dropped quite low at one point when they gave me some pain meds. They made me test my oxygen by breathing as hard as I could into a plastic handheld mouth device and while I thought I'd breathed very hard they both looked at me and one said, "You're going to have to do a lot better than that" in a nice way.

So I stayed there for a while longer. They were kind enough to go and get The Man and I was really ready to see him. I thought I would feel a little better when I saw him, comforted and not alone. So he came and sat with me for about 30 minutes or so until we could go home.

14) HEADING HOME: Once you are ready to go home, they'll get you up and if you need help, they will help you get dressed. The Man helped me unpack my bag and handed me clothes and I was able to do everything else myself. It felt good to get my clothes on, rather comforting somehow - like I was human again. Then I sat down in the wheelchair the nurses had brought. They sent The Man out to get the car and a few minutes later one of the nurses wheeled me out to the front entry way where The Man met us, got me in the car and we were on our way home.

Driving home was a little weird because I was still a little wazzy. Being in traffic felt fast and confusing. Thankfully I was just in the passenger seat. I was starting to get hungry so we planned to get me a milkshake. That sounded both delicious and easy to put down. By the time we got to ordering a milkshake I was so hungry I asked for a chicken sandwich too. I sipped on the milkshake on the way home and I was a happy camper. We were soon home and after I ate my sandwich I was in bed for the afternoon.

In the past I have gone straight to bed without eating anything and just focused on being dehydrated and needing to drink as much as possible. Drink, drink, drink. But this time I was hungry and not as sleepy. I ended up watching Netflix and dozing a bit on and off, but I didn't really ever sleep for more than a few minutes at a time. My mom, who is a nurse, recommended getting up and walking around every couple of hours to avoid bloodclots. Plus I think it's a good test to see how you are feeling.

One thing I noticed this time that hasn't happened before is that I had a headache all afternoon. I don't know if it was the anesthesia or dehydration but I think it was the dehydration. I tried to drink as much water as possible, but eventually supplemented that with some Vitamin Water XXX and lemonade. I think having options helped but it really wasn't until about 9 p.m. that the headache quieted down. By that time I'd had quit a lot of fluids and I've been trying to keep that going.

15) HAVE FOOD OPTIONS READY AT HOME: Last week I had no problems with eating afterwards. This varies so plan for all variables here as well. You may only want liquids, may want very bland foods like some soup or toast, or you may be dying for a steak or burger. Have some options at home.

16) FOLLOW INSTRUCTIONS AND REST: You'll come home with a list of directions from your doctor, number one of which is rest. They are all important and it's good to review them when you get home because you won't really remember anything they told you at the surgery center in recovery. But most importantly, get your rest. I am so bad about this but I really try to rest as much as possible. I never do quite rest enough. Enough this past week, even thought I was trying to rest I still think I did more than I needed to. I have noticed that I am still feeling a little ragged and I think it's because I have not been sleeping really well since last week. Not sure why but I'm letting myself have a little more time to recover this time.

17) BE GENTLE WITH YOUR BODY: After you've had a breathing tube in your throat it may be sore for a few days. I have found it starts to bother me if I talk too much so I've been trying not to talk. I also noticed my ribs were sore the day afterwards and in a follow-up hone call, my doctor explained to me that I'd been coughing while under anesthesia. I also later found a bruise on one of my arms from an IV I didn't know I'd had. You'll notice little things as you recover. Be gentle with yourself and don't push it. Ask your doctor questions if you have them. If you notice anything that doesn't seem right, call and talk to your doctor to make sure you're on a good path to recovery and to quell any worries you may have.

So those are my thoughts on what to experience when you go to a Same Day Surgery Center. My experience has been different every time and I think that's the case, everyone will have a different experience every time. But I will say that every time the staff has been great and I have felt well taken care of. When you know a bit what to expect that takes some of the anxiety out of the experience and when you can plan in advance and for a variety of post-op needs it sure does help. If you are reading this because you are anticipating surgery I wish you the very best. I'm sending you best wishes for a very speedy recover. I hope too that these tips are helpful if you are the caregiver for someone going through surgery.

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