Surgery During Covid

This week I underwent surgery.  It was similar to a procedure I went through 2.5 years ago.  Same hospital.  Same medical team.  The only difference? COVID-19

Unfortunately, this virus is not going anywhere, and as surgical procedures cannot remain at a standstill, perhaps this will help to highlight those differences from the patient perspective – improvements in some cases – that ought to be carried forward, in a post-COVID world.  There was also one key breakdown in communication which hopefully could be fixed for future patient interactions. 

SAY GOODBYE TO PLANNING

My surgery, originally scheduled for this summer, was postponed indefinitely back in May as uncertainty about the virus and its impact on healthcare resources was being assessed in Ontario.  When I received a call in June to notify me of the new date, well, I was expecting to hear September, or October as a new timeframe.  In fact, I was given a date less than 2 weeks out. I did not hesitate to accept as there is no telling when the next window of opportunity may arise.

Bear in mind, I will be unable to walk for 8 weeks and unable to drive for longer.  Most people cannot make such a big change that quickly.  I am lucky that the work I do can be heavily online and I am somewhat familiar with what recovery looks like. 

This may be the case going forward.  As windows of resource availability become known, surgeries will be scheduled with shorter advanced notice.  If you are a patient who had a surgery postponed, recognize that you too may have only a few weeks’ notice.  Anything further out is likely subject to more postponement as case numbers flare up in various regions.

TELEHEALTH OPTIONS

This was by far the single best change, and one I hope remains post-COVID.  Two of my four pre-surgical appointments were conducted over the phone.  There was nothing missed or skipped compared to the last time, only saved time and fuel as I did not have to drive to the hospital more than once before surgery.

For both calls, the staff clearly identified themselves, verified my identity and went through the usual screening questions regarding my health.  There is no reason for this to occur in person (again, from a patient’s perspective – healthcare workers feel free to comment).

The process was secure too.  I was emailed the generic pre-surgery forms (what to eat, what not to eat, when to stop medications etc).  Nothing contained my name or medical information, and I was discouraged from using the email address to ask further questions.  Instead, I was given the number to contact the pre-surgery office for further information.  This is a key point regarding telehealth usage.  If it is not safe, if our patient information is compromised, then we cannot leverage it to reduce the strain in-person visits and interviews place on the system.

The two appointments that I had to keep were radiology and mobility training with a physiotherapist.  As I do not have an X-ray machine handy in my house, I completely understand the need to attend to those in person.

COMMUNICATION BREAKDOWN #1 – PATIENT CARE

The first hiccup I encountered, in all of these pre-op interactions, was figuring out how my husband would know to come to get me.  Part of the new healthcare experience is no visitors are allowed into the hospital.  I am not arguing against this.  In fact, I found the day-of intake process much faster than a few years ago.  There are far fewer people around (also fewer surgeries) so everything moved along quickly.

Yet, leading up to the day-of, I did not receive the same answer twice as to how my husband would be notified that he could come to get me.  In fact, at one point, I was told that I would contact him and that I would be given the instructions regarding my prescription. 

I don’t even recall getting home last time, the anesthetic left me so incapacitated.  If they really wanted me to call my husband afterwards, it was like some official form of drunk dialling.  Headed into the hospital I joked with my husband that maybe all of us “pick-ups” would be rolled down to the lobby in wheelchairs with prescriptions pinned to our shirts.  We would be left there and claimed like lost luggage.

So, as we checked in, and were informed that my husband could not accompany me any further, I stated unequivocally that until he spoke directly with someone who gave us a satisfactory answer, he wasn’t going anywhere.

Now, again, I understand why extra people are not wanted inside hospitals right now, and our very next stop in pre-op gave us the answer we needed to hear, it is simply a failure in communication that the correct answer was not provided to any of the 4 different healthcare workers whom I interacted with up to that point.

For the record, I was not left to be collected like luggage and the post-op nurse who contacted my husband (several times as it turns out) was outstanding.

COMMUNICATION BREAKDOWN #2 - ANESTHESIA

As mentioned, the day-of intake process was smooth as silk.  Within a half-hour of registering I was in a bed, all pre-op tests complete and the IV line inserted.

It was only at this time that I learned of the other big change that had been made due to COVID: I would be receiving an epidural.

The reasoning is straightforward – the healthcare system is trying to reduce the amount of non-emergency intubation use.  It makes sense, not suggesting otherwise. 

Now, the idea of a needle going into my spine was not particularly enticing to me and I would argue that a patient ought to find out about this before the IV line is being hooked up.  In fact, as this is specifically a change due to COVID, it should have been discussed as a possibility during either of the two pre-surgery interviews. 

Anesthesia is a critical component during surgery and adding unnecessary anxiety by playing the old “switcheroo” beforehand was a clumsy oversight that can easily be fixed.  In fact, in post-op, some of the nurses expressed frustration that day-surgery patients were not being told in advance. 

Without getting into too much detail, there is a big difference in the post-op experience if you have had an epidural vs. leaning more heavily on a general anesthetic.  There are benefits (clear head) and downsides (longer in-hospital recovery time)

Not to mention the inability to stand on my good leg which is actually quite critical considering my other leg has a cast and pins sticking out of it.

Filling those gaps in patient communication is easy to do.  As we are in this for the long haul, I hope that the healthcare system encourages more communication about these changes, because otherwise, my experience was excellent and the use of telehealth could be a permanent fixture that speeds up the pre-op patient experience.

If you are a patient scheduled for surgery, I encourage you to ask questions until you get the answers you are satisfied with.  Hopefully sharing my experience will reassure you that the changes in place are for the best, but also that you will want to follow up on how the hospital will connect with your contact person and, if you are expecting to go under anesthetic, that you clearly know the options available to you that day.