Your stay in the hospital
After surgery, you will be taken either to the recovery room or intensive care unit. This will be dictated by the extent of your surgery. Once you recover and become more self sufficient, you will be assigned to a hospital room. When you and your doctor are convinced that you are doing well and can be discharged, we will make all necessary arrangement to make your transition home as smooth as possible.
For mesothelioma patients undergoing either pleurectomy and decortication or extrapleural pneumonectomy, the anticipated hospital stay is around 14 days. For patients undergoing diagnostic or staging procedures such as mediastinoscopy, thoracoscopy or laparoscopy, the hospital stay is much shorter. For mediastinoscopy same day discharge may also be considered.
Immediately after surgery
If you have undergone a diagnostic/staging procedure, you may feel groggy and a little “out of it” when you awake. This is normal and the feeling will go away after a short time. Further, you may not see clearly due to a protective lubricant that will be used on your eyes during surgery. In addition, you may feel some discomfort in your throat and mouth due to the breathing tube that was placed during anesthesia. These symptoms are anticipated to resolve within the first few hours after surgery. You will also be connected to some monitors and IV line for medications and fluids will gradually be pulled out as you recover. During a diagnostic thoracoscopic procedure a chest drain is placed in your chest in order to drain any fluid that may accumulating in the chest cavity. The drain is usually removed on the second day after surgery.
If you have undergone either pleurectomy and decortication or extrapleural pneumonectomy, when you wake up, you will be connected to some monitors and IV lines for medications and fluids and pain control. You may also have a special IV in your neck to measure heart function. In many cases your breathing tube will be kept in place, and you will be connected to the breathing machine for the first day or two after operation. This is done in order to optimize your breathing and clear your airways from any secretions that accumulate. As long as the breathing tube is in place you will not be able to speak. This may be somewhat stressful. Our staff is trained in such situations and will ask you direct questions that can be answered by a simple physical gesture such as nodding your head or moving your hand/fingers. Once you can write, we will provide a board and a pen to improve your communication opportunities until the tube is removed.
You might also have the following when you wake up from surgery:
- Foley catheter, a rubber tube that goes into your bladder to drain urine.
- Chest drain, a tube with a bulb on the end to suction out fluid and air from the chest cavity. This is usually removed once the drainage of fluid and air has stopped or substantially decreased.
- Pulse oximeter, a device on your finger that monitors oxygen in your blood.
- Compression boots, elastic stockings, or inflating/deflating sleeves to help with blood circulation in your legs and help prevent blood clots.
- Epidural catheter to control your pain
When you wake up, you may experience some pain or discomfort. You will be given pain medication after surgery to decrease your pain. This may be given through an IV using a patient-controlled (PCA) pump or an epidural. Some patients may receive catheters at their incision site that drips local anesthetic to block the pain. Discuss this further with your surgeon and anesthesiologist. During your hospitalization, if you feel that your pain is not well controlled please inform our team and we will make any effort to ease your discomfort.
Monitoring your recovery
In the intensive care unit at least once a day, laboratory test and a chest X ray are obtained. Moreover a thorough assessment of your condition by our team and by a dedicated intensive care specialist is continuously done to early detect and prevent any potential complications. This routine reevaluation process is the key to setting and modifying the daily treatment goals along the process of your recovery.
In the hospital floors, our doctors round at least twice a day and will keep checking up on you as often as required to make sure that you are doing well and recovering as expected.
Please notify the nurse if you are having nausea or vomiting, if you feel feverish or chilled, if you are coughing up anything red, brown, green, or rust-colored, if there is pain, redness, or swelling at an IV site, if you see bleeding at your incision, and if you are having trouble sleeping. The nurse will also help you with your IVs, medications, sitting, walking, monitoring your wound, monitoring drain and urine catheter output, breathing exercises, and many other things. If you have questions or concerns, don’t be afraid to ask your inpatient team. They are there to help you.
Breathing and coughing exercises
The nursing staff will give you instructions on proper breathing and coughing exercises using a device called an incentive spirometer. These are important to do because they will help prevent lung infections.
Early ambulation is a key to improved recovery and prevention of pulmonary complications such as pneumonia. In our ICU we have a specially trained physiotherapist that will personally work with you on a daily basis to help you sit, walk and exercise as early as possible after surgery. Physiotherapy is also available if necessary once you have been moved to a hospital room.
Adequate sleep is very important for your recovery. Because various aspects of your nursing care must be administered 24 hours a day, you may notice while you are in the ICU that your normal sleep routine is disrupted. As you continue to improve after surgery, your need for aggressive care at night will decrease and your opportunity to sleep for longer periods of time will increase.
Postoperative depression is not uncommon but unfrotunatly it is sometimes overlooked. Our team will always keep an eye on your emotional state: however, if you feel somewhat depressed or moody and in need of help, please let us know. We are here to provide any assistance we can to speed up your recovery as well as to improve your mood.
Your doctor will determine when you are ready to go home from the hospital. However, in order to leave the hospital, we will need to be sure that you are doing the following:
- Starting to eat a regular diet and drinking plenty of fluids
- Pain is under good control with medications taken by mouth
- No fever or sign of infection
- Walking and sitting independently
- Passing gas and possibly having first bowel movement
- You or a family member/friend can take care of your incision
- You have a proper transportation arrangement back home
Upon discharge you will receive your doctor’s personal contact information so that you can contact your surgeon directly in case an emergency has occurred and you cannot reach our on-call team or emergency number.