Preparing for open heart surgery often involves as much psychological preparation as it does physical. In my experience, patients heading into surgery report feeling informed about the procedure as explained by their surgeon, cardiologist, and nurse, but they report in the days following the surgery how they did not expect the emotional roller coaster that often accompanies the recovery period. This is why it can be very important to discuss this side of the surgery openly with your healthcare provider and, if possible, speak with someone who has already undergone the operation to get some firsthand feedback of what the days and weeks following the surgery can be like. Granted, this is not always possible since not everyone has time to prepare for the surgery, especially if it is an emergent operation. But even reading about what to expect while you are going through the recovery events may alleviate some of the emotional stress that one tends to experience.
Open heart surgery can involve heart valve repair/replacement or coronary artery bypass grafting—CABG for short (pronounced “cabbage”)—or possibly both. More commonly it is when the breast bone called the sternum is cracked open in order to access the heart, but there are also minimally invasive approaches available today that involve a small incision through the sternum, not a complete splitting, or through the ribs on the side of your chest. In the hospital where I work, the traditional approach through the sternum is used, and this is the basis of my experiential knowledge.
Day of Surgery
When patients wake up in the cardiovascular intensive care unit, they have many tubes and wires attached to their bodies and are heavily medicated with narcotics and cardiac medications. Family members often report having conversations with the patients at this time, but there is a good chance these will not be remembered by the patients because of the anesthesia still in their systems. Most patients report this day being very foggy, perhaps similar to the day of any other major surgery, except there are tubes coming from your chest draining excess fluid from around the heart and lungs. Patients should not be afraid to ask for pain medication. Many worry about addiction, but if there is legitimate pain, there is legitimate reason to use narcotics.
Day 1
The first day after surgery is called post-op day one. If the patient is already off the ventilator, the breathing machine, the first introduction to physical activities takes place, like sitting upright in a chair. This may seem fairly basic, but simply getting up to the edge of the bed and carrying one’s own weight upon standing can be a chore in the days to follow.
What needs to be remembered by both the patient and the family is that this surgery results in a broken bone that is now healing. Bones can take 6-8 weeks to heal. When someone breaks an arm or leg bone, it is quite often casted for that length of time until the bone fuses together. The surgeon does not cast the chest. Furthermore, the patient has to breathe against this broken bone, expanding and relaxing it each time he/she takes a breath. So, quite naturally, for the first few days to weeks, the body is taking in shallow breaths to avoid the pain associated with breathing deeply. Patients may not notice this at first as they will be lying in their hospital beds. But the minute they need to exert themselves, like standing up to get to a chair, they become winded.
Patients need to ask for assistance when doing even the most mundane activities like reaching for a cup that is two feet away or trying to use the bathroom. Some people have a difficult time accepting that their independence is compromised for a short while following this surgery.
Day 2
In my experience as a nurse who recovers people from open heart surgery, post-op day two often brings the unexpected emotional roller coaster. Everyone expects a certain amount of pain and exhaustion following this surgery, and they seem to get it on the first day. Unfortunately, the next day does not follow suit as being a little bit better and more tolerable. In fact, the recovery tends to get worse for a day or two before it gets better, and this is the curveball many patients, as well as family members, are not expecting.
Continuing in an expected recovery pattern from the healthcare standpoint, many patients are transferred to a cardiovascular step down unit on post-op day two. This is where much of the self-motivated work begins for the patient. The recovery from open heart surgery is not a passive one by any means. An incentive spirometer has already been provided, most likely, but using it frequently becomes the patient’s job. This is an apparatus that encourages deep breathing forcing the lungs to expand fully.
During surgery, the lungs are collapsed and mucus collects within all the tiny air sacs called aveoli. So once the lungs have returned to their breathing function, the lower part of the lungs may not fully inflate for a period following surgery unless the patient takes in a deep breath. Remember, patients are more inclined to take shallow breaths due to pain. But the aveoli literally have to “pop” back open from the air expansion within the lungs. If air does not reach the bottom of the lungs, mucus will continue to build up and can possibly cause pneumonia. Because of this, the patient is being told continuously to take deep breaths but doing this hurts, so they battle pain followed by guilt for wanting to skip the breathing exercises. This often turns into frustration and sheer exhaustion.
Also on this day, short distant walks become incorporated into the recovery regimen. A walk can be considered 5-10 feet at first for some patients. Some are able to go 200 feet. This can all depend on a number of factors like the age of the patient, whether chest tubes are still in place, the fitness level of the patient prior to surgery, amount of blood loss during surgery, or whether oxygen is needed to ambulate. Regardless, the walk will start off short and the amount of energy exerted to do such a short distance is quite often difficult for the independent patient to accept.
Using a walker, when an assistive device like this has never been necessary prior to surgery, seems to catch some patients off guard considering they did not have hip or leg surgery. So, on post-op day two, patients tend to hit a mental wall as the gravity of the surgery and the intensity of the recovery begin to take hold. This can be discouraging for both patients and their supportive loved ones who are there trying to cheer them on. The important thing for them to recognize is that this is typical; it is expected; and it will get better. Once they are assured of this, the whole dark cloud that often hangs over post-op day two is easier to accept, and therefore, move past.
Day 3
The morning of post-op day three still carries the remnants of post-op day two. It takes some time to move through the depression of knowing this recovery will not be over in just a few short days. During this time, not only is the body trying to get over the trauma of the procedure, but patients are sleep deprived from having their vital signs checked throughout the day and night, their blood being drawn for lab results, new medications being introduced, and trying to understand the reason for each new drug. All the while alarm bells and phones are constantly ringing; nurses, doctors, aids, friends, family, physical and occupational therapists, and even clergy are entering their hospital rooms all in order to help them recover.
They have all the time in the world to think and over think. What will happen when they get home? What is the cost of all of this? How long will they feel depressed? Will their personalities change permanently? When can they work again? Will they actually play sports again? How can their family depend on them now? What if they die? Exhaustion is at its peak. But it is toward the end of this day when patients begin to scale the mental wall, accepting their limitations, and in turn, finding the motivation to gain that independence back. Yes, assistance is required in the most intimate ways like bathing and using the bathroom, but walking and using the incentive spirometer are steps to doing these activities without assistance.
When the patient begins to see the purpose in all the directions they are receiving from the healthcare professionals, recovery seems attainable and the light at the end of the tunnel, so to speak, becomes visible.
Day 4 and 5
By post-op day four and five, many patients are being discharged from the hospital. Some are heading home with just family support. Some go home with home healthcare to provide additional support. Some patients may require a short stay in a rehab facility to gain their physical strength back but they, too, are moving forward on the recovery road and see the small improvements being made daily.
There are situations that can arise during these post-op days that do not necessarily mean moving backward. Many patients experience irregular heart rhythms following open heart surgery that require medical intervention, like IV medications, prolonging their stay in the hospital. Some patients might end up needing a permanent pacemaker in order to correct the electrical conduction in the heart. Although these are not considered expected outcomes, they can happen to patients who are doing everything right in their recovery and are simply the nature of how their heart is recovering from the surgery. Fortunately, these additional medical conditions do not usually add that much more time to the recovery process. But they do pile up as mental roadblocks.
Recovery
What will add unnecessary time to the recovery process of open heart surgery is lack of motivation. This can be detrimental to patients if they are unable to power through the let-down of post-op day two or any unforeseen medical setbacks. This is why the mental preparation for this surgery is just as important as the physical preparation advised by doctors.
In my experience, when patients receive fair warning of the emotional difficulties that lie ahead following surgery, they enter the recovery period in a different mindset than the patient who is completely caught off guard by the emotional turmoil they will experience. I have to say that in this case knowledge is power instead of ignorance is bliss. The difference is that the prepared patient more readily accepts the limitations they will face and, by accepting this earlier, are able to plow through it better. The prepared patient is more likely to discuss their feelings as well, acknowledging the fact that this is their lowest point. Simply saying this out loud can empower the patient and their families, giving everyone the energy to take the next step to get past the low point.
Quite often I hear from the patient who was unaware of what to expect. “If I had known it would be like this, I don’t think I would have done it,” they often say. These are difficult words to hear for family members and people begin to fear that the patient is giving up. Fortunately, admitting this sad realization is actually a positive step in recovering from open heart surgery, because it is the first step to accepting the limitations and finding that desire to do all that is necessary to work through them.
Once out of the hospital, the recovery continues to move in a wave pattern, but fortunately, in a forward motion. Participating in a support group with others who have gone through the same surgery can be very beneficial for both patient and family. Some people feel awkward about support groups, but finding at least one other person who has undergone open heart surgery can greatly benefit everyone in the months to come. The psychological recovery directly affects the physical recovery. Patients often report that the emotional support they received was just as beneficial to their recovery from open heart surgery as the medical guidance given by their doctors. Patients should not underestimate this portion of their recovery, and that is why being mentally prepared for the emotional roller coaster that one tends to go on after open heart surgery is just as important as the physical preparation.
