I’m 44 years old, and I’ve had three surgeries in my life. At the time of this writing, I’m scheduled for a fourth in less than 24 hours.
The first thing you should know is that every surgery is different. I can’t give you precise details on what to expect from a facelift, or what happens when you have an appendectomy. Maybe you’re having a rod put in your leg. Maybe you’re having a tumor taken out. I can only give you what I know, but there are plenty of commonalities in most modern procedures.
My two most recent surgeries were spinal fusions, to fix a fractured spine. A fusion is where one vertebrae is “fused” to another. A few pieces of metal hardware are inserted, including screws, to force the two bones to hold together. It was supposed to be just the one fusion surgery, but there were complications. Hardware they put inside came loose, and somehow I contracted a severe infection that was in my blood and spread to the muscle tissue of my lower back. It had to be cleaned out by hand. This was done during the second, unplanned surgery, which also required a new fusion with bigger screws.
Anyway, if you’ve never had surgery and you’re scheduled for your first, or if you’re just plain curious… Here’s how the process goes.
Important note: I can only speak to my own experiences. Most hospitals will have very similar procedures, because there are legal standards in modern medicine. But this isn’t a perfect blueprint for every surgery ever.
Also: This information only applies to scheduled surgeries. If you have an accident and are taken to the O.R. directly from the Emergency Room, most of the following won’t apply.
One Week Before
I’ve always been told to not take any vitamins or supplements starting a week before surgery. There are other medications you may be asked to stop as well. The reason is that they can interfere with your blood’s ability to clot, and thereby prevent your body — specifically your incision — from healing properly. You stop these one week before because that’s how long it takes for medicines and minerals to fully exit your system.
Your doctor may ask you to take your temperature every day for a week or two leading up to surgery. Keep a journal of your readings. The purpose is to ensure that you have no illness or infection before surgery. That will most likely cause your surgery to be canceled or postponed. (This happened with my third back surgery. It was scheduled and ready to go, and a few days before surgery I was diagnosed with C.diff and Ulcerative Colitis. It screwed everything up.)
These temperature evaluations are more important than ever now, in the age of COVID-19. Speaking of which, you’ll be required to have a COVID test sometime the week before surgery. At the time of this writing, I’ve had two COVID tests. Despite what you’ve heard, neither of my experiences were “scrape your brains out” bad. (Maybe nurses have gotten better at it as they’ve gotten used to doing it?) It’s weird and uncomfortable, but it’s over in about three seconds, and really nothing to fret about.
My doctor strongly recommended putting probiotics into your system in the days leading up to your surgery. This is most commonly done with supplement pills, but can also come from kefir or yogurts labeled with probiotics.
I’ve always had a doctor’s office visit scheduled for about a week before surgery. This is where the surgeon or his or her assistant will explain to you in more detail just exactly what they’re going to do to you. This is best time to ask any questions you have. It can be about the procedure, anything you’re expected to do before your surgery, and what to expect afterwards. This appointment is about answering your questions and giving you peace of mind about what’s going to be done, so take advantage of this time.
Pro tip: Tell your doctor’s surgery scheduler that if possible, you’d really appreciate being the very first surgery of the day. Sometimes this request can be accommodated, sometimes it can’t. Take what you can get. The benefit of being first is that you get it over with in the morning instead of waiting around all morning and possibly all afternoon with nothing to do, while not allowed to eat or drink anything. All. Day. Long.
Another appointment you’ll have about a week before surgery is a required hospital pre-op visit. Various factors about your surgery will determine what takes place at this visit, but you’ll almost certainly have blood tests, probably a urine test, they’ll take your vitals, and probably explain the same “here’s what’s going to happen” information you got from your doctor. They may ask you to sign some liability paperwork. The whole thing takes about an hour or so.
The Day Before
The day before surgery, or “prep day,” as I think of it, has an important list of things you need to do.
When it comes to eating and drinking, I’ve never been given a specific number of hours ahead of surgery you should stop. The standard answer is no later than midnight the night before. Some will tell you that it’s okay to have water or coffee up to four hours before your surgery, but it’s not a universal rule. Not eating can really suck if your surgery gets delayed. This happened to me once.
Sidebar: My very first surgery was several years ago, and it was a very different kind. I required a cornea transplant to correct vision problems in my right eye. It was an outpatient procedure so I was allowed to go home afterward. I went through all of the same preparations required prior to most surgeries, but wound up having to wait until 4:pm on surgery day before the doctor finally appeared and I was wheeled back to the O.R. Needless to say, I was not a happy camper. And utterly starving.
But I digress.
No smoking or alcohol in the 24 hours prior to surgery. No exceptions. Most doctors will let you take your normal nighttime meds, but some may ask you not to.
Wait for a phone call from the hospital. In all likelihood it will come between 3:00 and 5:00pm. This call will tell you the exact time of your surgery and more importantly, what time you’re required to be at the hospital. Hospitals can’t concretely schedule O.R. usage any further in advance than this due to emergency needs.
The most important thing you’ll do the day before surgery is how you bathe yourself. I would imagine this varies a bit from procedure to procedure, but having a significant portion of my back sliced open means that I’m required to wash everything extensively.
Typically your doctor or the hospital will provide you with a special soap called Hibiclens. If they don’t, you can find it at the drug store. Hibiclens is made specifically to be used before surgery, with special antibacterial and antimicrobial properties, so follow your doctor’s instructions to the letter. In my case, I’m given two packets of Hibiclens. You have to use this stuff in a super annoying way. After taking your usual shower with your own soap and whatnot, and rinsing off, you wipe this liquid Hibiclens stuff all over your skin, turn off the shower, and then wait five minutes for it to do its work. After that, turn the shower back on and rinse off.
Like most of the other procedures leading up to your surgery, it’s all about ensuring that the surgery goes as smoothly as possible, as well as protecting you from infections when the doctors open you up in the Operating Room. The doctors and nurses do everything possible to prepare themselves, their instruments and tools, and the O.R. itself antiseptic. But it’s impossible to reach an absolute 100%, so it’s important to do your part.
Be sure and pack your bag(s) the day before surgery. You won’t have time the day of. Hospitals never want you to bring expensive items like jewelry, as they can be stolen from your room. Items you must pack:
- Photo ID
- Insurance Card(s)
- Living will or power-of-attorney paperwork, if you have it
- Co-payment, if you have one
- Medications: Some hospitals or doctors will want you to bring your own from home. Others will provide all of the meds you need. If you opt to go this second route, I recommend taking a printed list of your regular medications. If you rely on the hospital to know everything you take, things can get horribly mixed up.
Also, and this probably goes without saying, bring anything necessary for your survival or daily functioning, like a CPAP machine, glasses, or hearing aids.
Depending on what time your surgery is — and most scheduled surgeries happen in the morning, but I refer you to the aforementioned eye surgery as a reminder of what can happen — set aside some time to take another Hibiclens shower. Follow the same procedures with this as the night before.
After the shower (and I really hate this part) you’re not allowed to use any hygienic products whatsoever. No deodorant, no creams, lotions, powders, or hair products. Nothing. I’m sure there’s a really good reason for this, but for all I know, it could be so that the doctors and nurses don’t pass out thanks to somebody’s ridiculously powerful perfume.
When you get dressed, wear loose-fitting clothes that are comfy and easy to take off — because you will soon. Also be sure and brush your teeth before you leave the house.
As I said before, doctors have different rules about taking your meds. Mine allows me to take all of my normal morning medications before leaving the house. But it has to be with the smallest sips of water possible.
Bring everything you need, and once you get to the hospital you’ll have a check-in process, where your identity is confirmed, your insurance is filed, and so on. Sometimes this is done over the phone the day before, due to Covid, to speed up the process.
In my experiences, next I’ve always been taken to a special waiting room just for patients with surgeries happening today. This space is different than the larger waiting room where my wife spends anxious hours while I’m on the operating table. She gets to stay with me here in this waiting space, and after a little while, I’m called back to the pre-op room alone. I leave all of my possessions with her, except my glasses, watch, and usually I can sneak my phone back with me.
The pre-op room is like a tiny little doctor’s office. There’s room for your gurney, a single chair, and that’s about it. Some of them don’t even have four walls, just curtains that can be opened and closed. Usually a nurse appears fairly quickly with one of those godawful hospital gowns and asks you to change. There will be other patients present in similar “rooms” so be sure to close the door or curtain if you care about modesty.
Pro tip: This is your last chance to go to the bathroom, so take advantage of it. Ask the nurse where the restroom is in this pre-op area, either before you change or after, doesn’t matter. Some of them might get a teeny bit miffed that you’re delaying them from getting your process started. But when you gotta go… Don’t stay in there long if you can help it.
At my first back surgery (and I imagine this next one as well) they next brought in a large set of wet scrubbing towels. I have no idea if all hospitals do this, and I imagine there are many surgeries where it’s not necessary. These towels are thick but disposable, and you use one per body part. If memory serves, there’s one for your arms, one for your legs, one for your front and privates, and one for your back and rear end. They are very specific about how these towels are used, and if I recall correctly, they may even make you wash your hands or apply sanitizer between the use of each towel. It’s insane the level of sanitation they use, especially after the two showers they already had you take.
Then again, they did all of this at my first back surgery and I still managed to get a severe infection. Go fig.
My back was difficult for me to reach, and since this was the area where I was to be cut open, it was important that I be especially clean there. The nurse took care of it for me.
Once this is done, you’ll lay or sit on the gurney. Several nurses will appear, each with a different job. One will confirm your name, date of birth, etc. to ensure that you are the correct person for the surgery you’re about to have. Another will hook you up to the I.V. that you’ll be connected to for the duration of your hospital stay. (Don’t let them put that I.V. in the crook of your arm! There’s an easy vein for them to reach there, but it’s so uncomfortable.) One might double check that you’re not allergic to latex, and so on. Your vitals will be taken, and if the doctor deems it necessary, you may have blood taken for lab work.
Sometime during all of this, the person that came with you to the hospital (usually a spouse) will be escorted back to your little curtain room see you one last time. If you believe in that sort of thing, now’s the time to pray together or say “good luck” and have a good kiss. You won’t get another chance until after.
The doctor and one or more of his or her assistant surgeons visiting you here will be the last step in this process. (Some doctors may not do this.) “How are you doing?” “Are you ready?” they’ll ask. They’ll be all smiles, both to reassure you and because they absolutely love cutting people open and are giddy that it’s about to begin. (This is absolutely true.)
Usually it’s just a few minutes, maybe even seconds, later that some new nurses arrive that you’ve not met yet. They’re here because it’s time. If you have anything left on your person that you don’t want to lose, like your glasses or hearing aids, now’s the time to pass those over to your significant other. Say your goodbyes, and you’re off!
All of this — from check-in to being wheeled to the Operating Room — for me has usually lasted between one and a half to two hours. I would think that bigger hospitals may have longer wait times. But who knows, if they’re well-oiled machines, maybe it will be shorter.
The Operating Room is usually a large room, sometimes all-white, with stainless steel tools and devices hanging from the ceiling. In my back surgeries, it’s been filled with a surprising amount of people, all gowned and gloved-up. Easily more than a dozen of them milling about, waiting for things to get started.
Expect it to be cold. Procedure rooms are always cold.
Once you’re there, some of the doctors or nurses may introduce themselves and assure you that they’re “going to take good care of you.” You may be moved (or asked to move yourself) onto the operating table. You may be left on the gurney until you’re put under, and then they’ll move you when you’re asleep. It probably depends on the patient and/or the type of surgery.
What comes next is my favorite part. Some people get nervous as you enter the O.R., but I love it for one reason: it’s time to sleep! If you’re having a fairly major surgery and you like to sleep, if you suffer from insomnia, or if you have kids that won’t let you get any sleep, boy are you in luck. Think about it: there is no chance that you won’t fall asleep. It’s beautiful, it’s glorious, it’s guaranteed.
You’ll be put to sleep via injection or a gas mask of some kind. My favorite thing to do at this point is wait until right after they’ve injected you or put the mask on your face, and go, “Is it too late to go to the bathroom?!”
I can report that some of them find that as funny as I do.
Don’t let this freak you out, but there are occasions when some patients have been known to wake up in the middle of surgery because the anesthesia wasn’t quite strong enough or something. Everyone is different, every body is different, every circumstances is unique, and doctors can never predict with total certainty what’s going to happen. The good news is that this happens very rarely, and when it does, most people don’t retain memories of it, aside from scant imagery or sounds. It’s never happened to me.
After surgery is over, you’ll be taken to a recovery room. This is a space very similar to the pre-op room, but a nurse will keep a close vigil beside you, monitoring your breathing and making sure you wake up fully. After my first back surgery, I had a very difficult time waking up, and I remember the nurse there continually telling me to wake up, because the heavy sleeping was lowering my breathing and heart rate to unacceptable limits.
Whether you wake up in the post-op room or not, you’ll next be taken to the hospital room you’ll remain in for the duration of your stay. (It’s possible you could be moved to a different room somewhere along the way, for a number of reasons. This doesn’t happen a lot.)
At certain hospitals, you may find yourself sharing a room with one or more other patients. Be nice! They’re just as overjoyed to be there as you are.
The person who brought you to the hospital and stayed in the waiting room will probably already be in your room waiting on you. If not, they’ll be brought in shortly.
Both of my back surgeries took considerably longer than expected, so from now on, the first thing I’m always going to want to know when I wake up is what time it is.
From there, the nurses come and go constantly, monitoring you as you recover, especially if it’s a major surgery. Expect lots of blood samples to be drawn (usually through the IV line you already have), and various tests to determine where you’re feeling the most pain. They’ll adjust your pain medication accordingly.
By the end of the day, the surgeon who operated on you will come visit and give you a rundown of what all was done during your procedure. Anything they encountered that was unexpected will be explained here. Don’t be afraid to ask questions! This is your last chance to ask any questions you have about expected recovery time, how long until you can shower normally, or until you can drive. If you hadn’t already asked about these things pre-op, now’s the time.
Physical Therapy comes at some point — rarely do they come the day of surgery; it’s usually the next day — to help flex your muscles, teach you how to do basic tasks, and probably help you walk around out in the hall if you can. I remember being taught a new way to get out of bed called the “log roll.” They also show you how to use a little doohickey to help put your socks and shoes on. (Again, all of this depends on the kind of surgery you’ve had, and may play out a little differently.)
Expect to spend most of the rest of your stay sleeping, eating, and spending visiting hours with loved ones. Despite what you may expect, the hospital stay really does go by quite fast, and if you’re healing well, you’ll be allowed to go home after a day or two.
You may have more physical therapy at home or at a medical facility. And you can expect to have follow-up visits with your surgeon at their office, so they can track your progress.