Monday, October 17, 2005

Pre-op: The hospital pre-op appointment

Often referred to as "the pre-op," this is different from pre-op appointments with your surgeon. At that appointment (or several appointments) you explore the reasons for your hyst, make plans for many optional parts of your surgey and followup care, and sign (after discussing) your surgical consent.

But for "the pre-op" you'll most typically be going to the hospital and/or the office of the anesthesia group that will be providing that portion of your surgical services. Here's what you can expect at each.

At the hospital

You can expect to be spending some time with the billing office, getting your registration and billing information recorded and signing the multitude of forms the hospital requires before accepting you as a customer. You should bring in or be prepared to provide such information as your insurance billing details, next of kin/emergency consent contact, who will be the contact during the time you are in surgery, living will (if you have one), and any special needs you may have (a translator? assistive devices for basic communications? religious practice needs? visitor restrictions for personal safety or preference?). If you are not covered by insurance, be sure to be prepared to set up a payment schedule and ask for a discount for paying cash; bring your credit card as well.

You may be given paperwork to bring back with you upon admission. Be sure to check what the procedures required on the day of your admittance are: when your surgeon told you to be there at 8 am, he meant to begin the stuff he is concerned with; the hospital office may also need your time then, and you don't want to be late for your surgeon because of competing demands for your time. This is also a good time to ask whether you will need to stop at the billing office on your way out of the hospital when you are discharged: at some hospitals this is routine (and tiresome) and other hospitals take care of all of this at your pre-op visit, freeing you to just cruise out whenever your doctor gives the okay. Be sure to ask when checkout is during the day, lest you end up paying for an extra day's stay because you lingered an unnecessary half hour over the limit. If you plan to ask for a copy of your hospital records, this is also a good time to ask the procedure for obtaining them (although you may be referred to another department for this).

If you have not already had these done at your doctor's office, you may also be asked to visit the lab, x-ray and ekg to have routine pre-op studies done. Not all of these are required for all women, but generally some or all of them are simply part of a last-minute check to make sure that other problems will not interfere with your surgical procedure. Aside from the stick for blood, none of them are invasive or especially uncomfortable.

If you are being typed and cross-matched for blood that will be held for a possible transfusion, you may be given an ID bracelet and required to put it on. This is dorky-looking but necessary--it holds your half of the only key that assures that the held blood has been tested for compatibility with your own. If you lose your key, the blood is wasted (and you'll be charged for it) as well as not available should you need it; re-matching you will take time that you may be ill-able to afford in an emergency. If wearing a paper bracelet for several days is especially distasteful for you for some reason, you may be able to negotiate having it placed around your ankle instead. If that is the case, be sure to let everyone know where it is on the day you're admitted (where everyone means your doctor, the circulating nurse in the operating room, and anesthesia) and ask that it be noted on the front of the chart when you are being checked in.


The other part of "the pre-op" is generally a visit to someone from the anesthesia group. This is a special medical practice, separate from your surgeon. Typically this service is provided by a pool of doctors (anesthesiologists) and perhaps nurses (anesthetists), and you will be billed separately by this group for their services. The practitioner you see may not be the one who will care for you during your surgery, but he will write notes and perhaps some orders that will go in your chart for the person actually in the OR.

This appointment is primarily an interview, although it is likely that the practitioner will examine your head and neck, and look into your mouth (or at your back, if you are having a spinal--and some of the following will not be applicable if that is the case). This is to identify any problems that may make putting the tube into your lungs (through which they will maintain your respirations once you are under general anesthesia) tricky. In particular, you will be asked if you have any dental appliances or chipped teeth--it's important to let them know this so that they can avoid damaging them with the instruments being used.

Other things anesthesia will discuss include previous experiences you've had with anesthesia and other health conditions you may have that might affect your toleration of anesthesia drugs. This is also the time to share any fears you may have about anesthesia, review any meds you may be given to relax you beforehand, and to discuss nausea in the immediate postop recovery period. If you are prone to nausea, let them know: it's possible to medicate you before you start puking, which can be A Very Good Thing when having abdominal surgery. If you have had bad experiences in the past with pain medications, like itchy/rash reactions, do be sure to let them know this, even if it's not a real allergy.

Anesthesia will review with you the timing of when you may last eat/drink anything (not what you may eat or drink--this may be up to your surgeon). Fasting is very very important to prevent vomiting during the process of going under--something that can cause pneumonia--so be sure you understand your restrictions and that they are for your benefit. If you plan to take some regular meds or supplements in the fasting hours before surgery, please check these with anesthesia and ask what/how much you may take them with if they are oral meds. Diabetics or asthmatics have a special need to review what they will be taking before surgery, what their normal maintenance regimens are, and how their needs will be managed during surgery and recovery. The whole goal of this appointment is to make anesthesia as successful and little stressful for you as possible, so the more you can help your anesthetist, the better things will go for you.

And one last note about all of the pre-op contacts you may have just before or the day of surgery: don't be surprised if, over and over, you are asked specifically what procedure you are having (and if something is happening only to one side, like only one ovary to be removed, you'll be asked to point to the involved side). This is a constant process of checking who you are and that the right person is having the right surgery--it's a much more positive identifier than asking a nervous or groggy person a question like "are you [mumbled name]?" that they might answer without really grasping. And, because it's a hyst, you may be asked several times whether you are pregnant and if you understand that having this surgery means you cannot ever again get pregnant. While this may seem like an extra added torment to many of us, it does, ultimately, protect the rights of women to understand what they are choosing. If our aggravation pays for one woman getting the message who may not previously have fully understood the implications of what she has consented to, well, don't you think it's worth it for her sake?