Christopher Morse, MD, reviews care instructions with a patient.
Christopher Morse, MD, reviews care instructions with a patient.

Before Surgery

Pre-admission Visits

You will receive information regarding the date and time of your pre-admission telephone call as well as your surgical date from your surgeon's office. You may be required to have specific lab work and/or X-rays in advance of your pre-admission phone call. These will be scheduled by your surgeon's office.

Physical Exam

You may be scheduled to meet with a physician assistant or nurse practitioner on Founders 7 to complete a history and physical. Pulmonary function tests (PFTs) may also be performed at this time. Your surgeon's office will inform you if this is necessary.

The physician assistants and nurse practitioners are part of the team that works with your surgeon. They will see you routinely after your surgery and be involved in your care under the supervision of your surgeon.

The nurse practitioner or physician assistant will examine you and take a medical history. Please let the nurse or physician assistant know of any medical problems or allergies that you have and any medication that you take and the doses. Please bring a list or the bottles of these medications.

It is especially important that you tell the practitioner if you take Coumadin, any other blood thinners or prednisone.

Other Tests

You may have a chest x-ray, electrocardiogram and blood work if ordered by the anesthesiologist or surgeon


Important Do's and Don’ts Before Surgery

Stop Smoking

Smoking irritates your lungs, decreases their efficiency and interferes with your ability to recover from surgery. Each day that you are smoke free will help your lung function improve. You should stop smoking well before surgery.

For more information on smoking cessation programs offered through Mass General, please call (617) 726-7443.

Continue (or Start) to Exercise

Being active before surgery helps to condition you and often makes you feel better. If you have an exercise program or are participating in a rehabilitation program, please continue this.

If you have been very sedentary, try adding little pieces of activity to your day. Even increasing your level of simple activities of daily living can help. Take a short walk. Vacuum the house. Climb the stairs. Every little bit helps.

Do Breathing Exercises

Breathing exercises will be very important after surgery and can also be a good relaxation technique. If you are coughing up mucus (phlegm) before your surgery, deep breathing and coughing exercises are usually helpful.

If You Are Unwell

If you have a fever or are sick, contact your thoracic surgeon’s office to decide if the surgery needs to be postponed.


The Day Before Surgery

On the day before your procedure:

  • Try to spend a relaxing evening at home and get a good night’s sleep. Patients often find it helpful to listen to soft music, take a warm shower, read, or participate in other calming activities
  • Do not eat anything after 10:00 pm, including mints, chewing gum, etc.

The Day of Surgery

  • Take all of your heart medications with just a sip of water, unless otherwise directed by your physician
  • If you are a diabetic, do not take your insulin unless instructed to do so
  • Bring your own comfortable slippers or walking shoes and personal toilet articles
  • Please leave all valuables such as watches and necklaces at home

Same-day Admission

If you are being admitted to the hospital on the same day as your scheduled surgery, you should report to the Surgical Day Care Unit on the third floor of the Wang Ambulatory Care Center (ACC3).

Surgery Before 8:00 am

If you are scheduled for surgery at 8:00 am, you should report at 6:00 am.

Surgery After 8:00 am

If you are scheduled at a later time in the day, please realize the time given for the start of your surgery is an estimate. There may be delays as the time to complete the case before you may vary.

The time to report to the ACC3 differs among surgeons. The report time is typically two hours before your scheduled surgery, but you should check with your surgeon’s office to be certain what time you are expected to report.

Day of Surgery

Thoracic Surgery Inpatient Unit

The Division of Thoracic Surgery has its own inpatient unit dedicated to the patient who has undergone or will be undergoing surgery in the chest. Ellison 19 is a 30-bed unit located on the 19th floor of the Ellison building.

Multidisciplinary Approach

The team on Ellison 19 includes the surgeons, residents, interns, staff nurses and technicians, social worker, dietitian, nurse manager, case manager, unit clerks, and the physical and respiratory therapists.

The interdisciplinary approach allows us to identify individual needs and personalize the plan of care.

We place great emphasis on your physical needs as well as the educational and emotional support of you and your loved ones.

Nursing Care

You may have experienced palliative, reconstructive or curative surgeries in the chest. The nursing staff is proficient in the care you need as well as the care for those who need major surgery for chest trauma.

The staff has extensive knowledge of the evaluation, diagnosis, the surgery or the procedure being done, and the regular care you require. They also understand the potential complications you might encounter and the subsequent needs of the patient at that time.


Family Waiting Area

Waiting Areas on Patient Floors

There are unstaffed waiting areas located on each inpatient unit floor.

Staffed Waiting Area

For families and friends of patients who have surgery, there is a quiet waiting area located on the first floor of the Gray Building called the Gray Family Waiting Area. This area has small consultation rooms where family members may speak privately with the patient’s surgeon.

Volunteers staff the reception desk from 9:00 am until 8:00 pm, Monday through Friday.

After Surgery

Recovery After Surgery

Telephone Numbers

SICU: (617) 724-5100
Ellison 19: (617) 724-5910
PACU Overnight: (617) 726-2835

After surgery, you will wake up either in the Surgical Intensive Care Unit (SICU) or the Post Anesthesia Care Unit (PACU), also known as the recovery room.

The environment may be cool, moist, and busy. The nurse will be close by and will try to make you as comfortable as possible.

You may wear a face mask that provides oxygen. You may also intravenous tubes and lines — tubes attached to your chest, air boots on your legs, and a catheter in your bladder to drain urine.

Your First Night Post-Op

Depending on the medical care and nursing care you require, you will spend your first night in the SICU, the PACU, or your room on Ellison 19.

Once you have recovered from your anesthesia and are stable, you will be transferred to the Thoracic Surgical Unit on Ellison 19. The staff on this inpatient unit specializes in caring for patients who have had thoracic surgery.

Once on the inpatient unit, your progress will be monitored and the staff will help control discomfort with medications.


Your Progress After Surgery

Each morning the thoracic surgical team makes rounds. Doctors, nurses, and other members of the team will come into your room to examine you and review your progress over the past 24 hours.

Deep Breathing and Coughing

Your lungs need to stay clear for you to breathe well. The nursing staff will have you take deep breaths and cough while you are recovering from your surgery. This will help prevent any problems in the lungs like fluid build up or infection.

A special device called an "Incentive Spirometer" is used to help you breathe more deeply. The nurse will show you how to use this device or similar piece of equipment and have you practice several times a day.

Activities

With your nurse's help, you will be able to get out of bed the day after your surgery.

Each day you'll increase the distance you walk. Your goal should be to increase the distance and the length of time you are walking, but not the speed at which you walk. By the time you leave the hospital, you should be walking 500 feet at least four times a day. You should be able to walk up and down 10 to 13 stairs by the evening of the fourth day after surgery.The staff will make sure you balance your rest and activities.

Your legs should be kept up and elevated when you are sitting in a chair or lying in bed. This is to keep your legs from getting swollen. Don't let your legs dangle over the side of the bed or from a chair for more than 15 minutes. You will also be shown some leg exercises to do to keep the swelling down and improve the circulation in your legs.

You'll probably be able to take your first shower either on the evening of your third day or the morning of the fourth day after surgery.

Constipation

Constipation occurs when your bowel slows down and you are unable to have a bowel movement. This can be caused by anesthesia, pain medication, inactivity, or limited fluid and food intake.

Sometimes a laxative, stool softener or enema can help you have a bowel movement. Constipation is not serious and will get better once you are up and around more and are eating and drinking better.

Patient Education

Your nurses and doctors will explain all procedures and plans with you. If at any time you have questions, feel free to ask.

You'll receive written discharge instructions which will include general guidelines about what you should and should not do at home, information about your medications, and an individualized activity plan.

You can use the Patient and Family Learning Center (PFLC) to learn more about your condition and surgery. The PFLC is located on the first floor in the main hallway of the hospital and serves as a health library for patients and families who want to learn more about their health. Books, pamphlets, videos and Internet access is able to help you research and learn about a health issue. The PFLC is open Monday-Friday from 9 am to 5 pm.


Pain and Pain Medication

We will make you as comfortable as we can. If your pain is adequately treated, you will be able to move around better and do things that will help you recover sooner. Please let the staff know as soon as you have any discomfort or if your pain medication is inadequate.

Sometimes patients are worried about taking pain medication and becoming addicted. This should not be a concern, as you will only be taking the pain medication for a short period of time.

To help assess your pain, the staff will ask you to rate your pain on a scale of 0 to 10. A score of 0 means you have no pain and a score of 10 means you are having the worst pain ever.

Patient-Controlled Analgesia (PCA)

A pain medication pump will be attached to your IV line. You'll be given a button to press to control the delivery of pain medication from the pump. The pump delivers a very small but effective dose of pain medication.

As you feel pain or before activity, you should press the button. The system is designed so you don’t need to worry about getting too much pain medication.

Oral Medications

When you are able to eat, you will be switched to medication that you can swallow, such as Percocet.

Other Medications

In addition to your pain medication, you will receive an antibiotic to help prevent infection. You will also receive an injection of heparin two times a day to help prevent blood clots from forming in your legs. Any other medications that you typically take will be restarted as soon as possible.

After your surgery, you might have a variety of tubes and lines attached to help speed your recovery.


Tubes, Catheters and Other Equipment

Epidural Catheter

Before your operation, a very thin tube or catheter might be placed into your back. Pain medication will continuously flow around the spinal cord decreasing your ability to feel pain.

Urinary Catheter

A catheter will be placed in your bladder during surgery to make urination after surgery easier. The catheter will remain in for a few days.

Chest Tubes

After chest surgery, it is necessary to drain air and fluid from the lining around the lung. Depending on the type of surgery, you may have one or more chest tubes.

The tubes are monitored by the nurses and doctors for air and fluid. A chest x-ray is done one or more times each day to find out if you lung is healing. When your lungs are well expanded, as shown by your chest x-ray, the doctor will remove the tube.

Air Boots for Circulation

To help prevent blood clots after surgery, you will wear air boots while you are in bed. These are made of soft plastic material, which wrap around your legs and inflate and deflate. You'll wear support stockings when you are out of bed.

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