Pre-op

My daughter just went through her second open heart surgery last week, a successful repair of the mitral valve which her surgeon, Dr. Karl Michael Reyes, said could last a lifetime.

I hope you won’t mind then if I don’t write about the elections or national politics.  Instead, I’ll do two pieces on preparing for surgery, pre-op today and post-op on Friday. The focus is on pediatric patients, but the advice can well apply as well to older patients, and to any major hospital confinement with or without surgery.

‘4 Bs’

In lectures and discussions with Filipino hospital administrators, we focus on the “4 Bs” that capture the way we deal with hospitalization: bantay (watchers), bisita (visitors), baon (things brought into the hospital), and bayad (payment).

Bayad (or budget) is the most formidable of challenges, given that health expenditures are mostly out-of-pocket in the Philippines. Check with your attending physician about professional fees, and with the hospital, PhilHealth and your health maintenance organization (HMO) about confinement and surgery charges.   Ask what’s covered and what’s not. Be direct and ask what the maximum expenses might be. Inquire about terms of payment (i.e., cash, check or credit card).  Senior citizens, don’t forget your card (but this can’t be used for your children or grandchildren).

Be prepared, too, for continuous billing in private hospitals, where you have to replenish your deposit almost daily as the charges accumulate.

Be sure your PhilHealth and HMO payments are up to date.  For PhilHealth you need nine successive monthly payments for the self-employed, three out of the last six months for those covered through an employer. Even if you have paid your premiums, do check if your records are updated at PhilHealth and the HMO.  You will need anyway to check with PhilHealth to get your member’s data record and certification of contributions to bring to the hospital.

Telling a child

Now to the patient and the big question: Do you tell children they’re going to have surgery?  My opinion is that generally, if they can carry conversations with you, it is better to explain that “we” (tayo) will be going to the hospital because of a health problem that needs to be solved. Not telling them may be more traumatizing; they may even think you’re punishing them for some unknown reason.

It helps if your child loves and trusts his/her pediatrician. (With my daughter, I could say, “Dr. Pia (Malanyaon) and other doctors and nurses will be repairing your heart. After this, you’ll be even stronger and won’t get tired as easily when you bike or swim.”)

My daughter, who is six, seemed to understand, even telling me a few days before hospitalization: “Dada, I’m going to be brave when we go to the hospital, even with injections.”

Now to baon, or what to bring.  For hospital confinements, personal belongings are minimal.  The hospital provides the gowns but you should have enough underwear, and it’s good to have your own toiletries.  Kids can be very finicky and look for familiar things—in my daughter’s case, her Minnie Mouse, a particular brand of toothpaste, and even strawberry-flavored paracetamol.

Even more important are the stuff to help them pass time. I had a surprise for my daughter when we got into the car to leave for the hospital: a bag full of books, stickers, coloring books, crayons, a small white board and pen. Also in the bag was “Polly,” a tiny plastic doll you can dress up. A gift from a colleague at the University of the Philippines, Polly turned out to be my daughter’s favorite during her hospital stay.

I’ll tell you on Friday about other stuff that proved very useful in the post-op period for the patient.

Prepare the patient, but also prepare yourself. You know what works best with you: prayer, meditation, gym work, jogging, comfort food, or all of the above. You just cannot afford to get sick, especially of a respiratory illness, because you would then be banned from the patient’s bedside.

Be sure to be around for the more difficult procedures, like the insertion of an intravenous line, or being moved from one room to another.  A hospital can be bewildering to children (and adults), with all the people, contraptions, even lights in the operating room.  I am so glad our anesthesiologist, Dr. Abelardo Prodigalidad (I’m not plugging but bragging about the best doctors on earth), came around the night before the surgery to prepare my daughter, including how to breath in and out when they’d put a mask on her.

With my daughter’s two surgeries I found that the most difficult time was the part with the sedation and anesthesia, because it signaled having to leave her soon.  It’s tough telling a child, “You’re my brave little girl, right?” as they inject the anesthetic, knowing your voice is cracking and that you’re not quite as brave as she is.

There was a bit of a comic part this time, though: As the sedation began to set in, my daughter’s frowns gave way to an ear-to-ear grin, making me smile as well because I knew she was “tripping” on the drug and drifting to la-la land.

The surgery itself is the most tense period.  I knew this would be tougher than the first surgery, which took four hours.  This time, it wasn’t until six hours that I got word the surgery was over, and that she was being observed.  Then it turned out there was still a problem, and they had to go back in.  The surgery took all of nine hours to finish.

Work-life balance

Part of the pre-op preparations should be work shifts.  There’s no sense, for example, in having everyone wait at the hospital during the surgery.  The tendency in the Philippines is for everyone to want to be involved.  For good reason, hospitals discourage too many of these bantay and bisita because of the problem of infections being brought in. Often, too, the wannabe watchers and visitors just aren’t very helpful: They wait around to be fed or get people more tense with remarks like “Hey, she’s been in there a long time” and giving dire predictions.

One way to reduce bantay and bisita is to announce, a few days before surgery, that you’ll need people to donate blood, lots of it.

Seriously, hospitals are always running low on blood and it can be a major source of distress when hospital staff come around to tell you, a few hours before surgery, that you need to find donors.  Know what your patient’s blood type is, and who among your friends may be available to donate.

Finally, do realize there’s no such thing as “work-life balance” when it comes to hospital confinement. If the patient is important to you, you have to leave work behind. If you have a business, or have several jobs, you will have to prepare way ahead for contingencies.  I had extra columns prepared for last week but because I had to rush to the hospital Thursday morning (the deadline for Friday columns), I left my computer at home, with the columns. I couldn’t leave the hospital that day and learned my lesson: better to have a batch of “emergency” columns already with the newspaper.

On Friday, we talk about post-op care, which can be even more demanding than pre-op.