Cranberry Juice & Saltines: A Menu for Post-Surgical Autonomy

One week ago, I had sinus surgery to clear up and reinforce the air passageways in my nose to help me breathe better. I’d been dreading this for years. Literally. Years.

You see, five years earlier, I’d had a similar operation. Same hospital, different doctor. But it didn’t quite give me the results I was hoping for (aka: being able to breathe).

While I knew one day I’d need to go back one day and try again, I’ve been putting it off. Not because the doctors weren’t sure if they could help me. Not because I wasn’t sure if my insurance could afford it. I was putting it off because of how much I hated the hospital and recovery experience that first time around.

As it turns out, it takes me about five years to forget something terrible and summon up enough willpower to go at it again.

It’s interesting that my perception of a hospital’s effectiveness hinged more on my memory of a poor user experience than on how well they did the job.

But this goes to show why the patient experience is so important.

Now, one week into my recovery, I’m happy to report that things have been a lot better so far this time around. And I’ve boiled it down to one tiny thing my hospital did in my post-op recovery room: Give me a choice of what I wanted to drink when I woke up.

Let me explain.

First Time Around

I’ll admit it: For my initial surgery five years ago, I went in to the operation totally naive. I falsely assumed that, since I’d previously had my appendix — a literal organ — removed from my body, having a few bones scraped off the interior of my nose would be a breeze by comparison.

This was a gross oversimplification of the matter.

What I failed to consider was how many damn nerves there are in your face. And how much more all of the pieces in your face connect and touch and hurt. From what I understand, waking up after anesthesia always sucks. You’re groggy, confused, nauseated, and supremely dehydrated. Add to this the complication of having bandages cover your nose blocking your air passageways and you’ll start to get a sense of the heightened drama of waking up from this procedure.

Obviously, intellectually, I knew that surgeons would be operating on my nose and face. But emotionally, I hadn’t prepared for the implication: When you wake up, you won’t be able to breathe. But don’t panic.

All I knew was, at one moment I was sort of awake. I didn’t really know where I was. I was thirsty, so thirsty that I thought I might die. I was freezing and shivering. I was in in pain, and I was nauseous. And, to top it all off, I couldn’t breathe.

I’m so thirsty.

These are first world problems, I told myself. You asked for this and they gave it to you. It’s not like you’re actually dying.

But I can’t breathe.

People in here are actually dying. They have worse ailments and diseases than you can even imagine. There are people here who won’t be going home today. Or ever. You can’t even pretend to have any problems that come close to that.

Just. Don’t. Panic.

What can I say? I’m an anxiety-prone, millennial woman.

I panicked.

My eyes starting dating back and forth while I tried reasonably to gesture to someone how much my throat was sore, how thirsty I was.

“Don’t inhale,” a nurse told me sternly.

“But it hurts,” I croaked out.

“Then try coughing,” he suggested.

That was quite possibly the worst suggestion someone has ever given me. I coughed. And up came a bloody mess of mucus and membranes all over everything.

Then I panicked even more.

I remember seeing blood all over myself and not being able to do anything about it. I remember feeling like I needed to vomit and then having all of the nurses leave me alone for a period of time. I remember asking for where my family was at least three times before they brought my mom into the room. And I remember asking repeatedly for water and for blankets.

I was so sad. And so frustrated. And so helpless.

It doesn’t feel great to feel like you’re not in control. Even when I knew that all of the people around me were just trying to fix me the inside, there was still a little part that craved some validation on the outside, too.

I want to be seen. I want to feel heard. I want to feel safe. I want to have my needs met.

“Our procedure was a success,” the doctor told me. “We executed the plan perfectly.”

“That’s great to hear,” I replied.

But I didn’t feel great. I felt ignored.

Prepping for Round Two

“You need to listen to me,” I told Jason, my husband, as we were preparing for my procedure last Tuesday morning. “Bring a bottle of water. Put this blanket in your backpack.”

I felt like we were stockpiling for a disaster. But I wanted to be prepared for anything.

“Won’t they have water and blankets at the hospital?” he asked. A very rational question. He’s good like that.

“I don’t care,” I replied. “It might be awhile before they remember to bring them to me. And I don’t want to be sitting there freezing and miserable again.”

“Do we really need to bring our own cup too? Maybe I’ll just bring a bottle of water. They can give me a cup.”

“NO.” I told him sternly. “Bring everything. We need to be prepared in case they abandon me. Then you can sneak me some water.”

“I’m not going to ‘sneak you’ anything in a hospital unless they say it’s okay,” he said.

“We’ll see about that.”

No matter what happens, I thought, at least this time, I’ll be ready.

The Pre-Surgery Checklist

Later that morning, at the hospital, as I was getting prepped with an I/V, my attending nurse brought over the requisite paperwork to fill out.

I looked over a familiar stack of black-and-white legal documents, signing off my consent a half-dozen times. But then she pulled off a blue and red card from her clipboard. It looked something like a lottery ticket or a bingo card. The nurse passed me the card, along with a pen.

“Check off what you’d like in your recovery room.”

I scanned over the options. It looked like this.

Beverage & Snack Menu

Apple Juice
Cranberry Juice
Orange juice
Ginger Ale
Coca Cola
Iced Tea
Iced Coffee
Iced Green Tea
Iced Chai Tea
Saltine Crackers
Graham Crackers

For each drink option, you were asked to select whether you wanted ice or no ice. For Coca Cola, you could opt for diet. For coffee, you were given the choice of cream. Your choices continued even down to the saltines, where you could choose either salted or unsalted.

I stared open-mouthed at this tiny card and definitively checked off “Cranberry Juice,” making sure to retrace my lines a second time to be sure it stuck.

“You can check as many as you’d like,” she told me.

As many as I’d like???

I looked back at the list. There were 11 different options. The idea of offering me an unlimited number of selections on a multiple choice list of prizes just felt crazy. They weren’t going to limit me at three? Or five? What if I went crazy and chose all 11?

I felt a kid in an arcade redeeming my tickets for prizes at the end of a day. It was easily the most humanizing thing that hospital could have done for my experience.

In the end, here’s what my card looked like:

I felt a little mischievous about choosing so many. But mostly, I felt happy to have been given some control over my destiny for later that day.

As my anesthesiologist put me under for the procedure, I thought back to a study I’d read about senior citizens in nursing homes, how people actually lived longer when, upon checking in to the facility, they were given a choice of what plant to care for in their room. There was something about giving them autonomy and giving them something to care for that gave them purpose. You can’t measure that. I idly wondered if these two experiences were related, if I might rate my procedure as more successful as a result of this single choice.

Then I was out.

When I awoke from surgery, everything I asked for (all four of my selections, plus water and graham crackers for good measure) was right there as promised, lined up on a tray within arm’s reach. My husband was summoned immediately, and I was handed another blanket as soon as I asked for one. (We didn’t need to forage from any of our stock-piled goods.)

It made a world of difference.

The Person Behind the Procedure

Medical procedures are inherently stressful. Since the product is literally altering a human in some way, getting the job done isn’t as simple as executing perfectly on a plan.

There’s a person behind the procedure. Sometimes it’s easy to forget about this part. Hospitals and doctors that remember are the ones that stand out.

At first glance, these menu checklists might seem trivial. After all, it’s just a list of drinks they would have offered me anyway. But it’s not about what they did, it’s about how they did it. Having the foresight to ask me in advance, to gamify the way I made my selections, and then delivering on that promise was a true delighter in an otherwise miserable setting.

In the end, this one little tweak to their patient experience built trust and added a little humanity to the process all-around. For me, it also severely reduced my anxiety before and after the procedure. And for that, I am very grateful.

Don’t get me wrong: Waking up with a face full of bandages still really sucks.

But it sucks a lot less when you’re given a little autonomy and control. Even if the only choice you get to make is whether or not you’d like ice with your cranberry juice.

Originally published at Dry Erase.

GM @USV, alum of @StackOverflow and @NorthwesternU, board member at @CompSci_High and @NUalumni, co-founder of #BeyondCodingNYC

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