Surgery For Colon Cancer: Stages II, III, IV

• As a general matter, the length of your stay in the hospital depends on whether the surgery was through a traditional larger entry or a small laproscopic incision. As a general matter, with laparascopic surgery, the hospital stay is 3 - 5 days. With open surgery, 5 - 7 days. The ultimate decision about how long you stay in the hospital is your doctor's. 
  • The doctor determines when your condition is medically stable so that you can be discharged. 
  • If your insurance company pressures you to leave earlier than the doctor and you think is reasonable, you don't have to go quietly. Appeal. 
  • On the other hand, press firmly if you want to leave earlier than your doctor thinks advisable. 
  • Do not leave a hospital AMA (against medical advice). If you do, you may be stuck with the bill for your entire stay as if you do not have any insurance.
• Do not hesitate to ask for pain medications. 
  • Studies show that people who take pain medications after an operation do not become addicted. 
  • The vast majority of patients get good pain control with narcotics delivered intravenously (through an i.v.) for up to 36 hours after the operation, and pain pills by mouth thereafter.  
  • Patient advocates suggest that you take maximum pain relief as prescribed rather than waiting to feel the pain at least initially to stay ahead of the pain. To learn more about pain and dealing with it, see Pain 101.
  • Also consider medications or stool softeners to counteract the constricting side effect of pain medications.
  • There is no reason to be in pain in the hospital or after you get home.  
• Before you leave the hospital, discuss your pain management plan with your doctor. Take prescriptions as offered and have them filled either before you leave the hospital, or as soon as you leave, so you have them when needed. 
• Fatigue is normal. 
• Coughing: If you have an incision in your upper body, you may feel that your incision is going to break apart when you cough – especially if you had open surgery with a large incision. Using a pillow and holding it against your incision area when you cough can help decrease the pain and feelings of discomfort. Where to hold the pillow depends on where the incision is. 
  • If your incision is in the front, hold the pillow against your chest or stomach. Fold your arms across the pillow. Then cough. 
  • If your incision is on your back, lean against the pillow. Then cough. 
• You will be allowed to have visitors on a limited basis - usually limited by hospital policy as to what visitors and how long they can stay with you. If you want a person to visit who is not a blood relative or a legal spouse, consider executing an advance directive known as a Health Care Power of Attorney appointing that person your Health Care Proxy – the person to make medical decisions that may need to be made if you become unable to communicate. (A Health Care Proxy is recommended for everyone to have. For more information, click here).
• While hospitals are places of healing, mistakes happen and people can pick up infections. For tips about preparing for a stay in hospital, as well as staying safe and maximizing time in a hospital, see the documents in "To Learn More."

The following are myths:

• You are at the mercy of a hospital bureaucracy to provide what you need when you need it.
• The patient doesn't have any part to play in taking precautions to avoid medical error and infection. 
• There is no need to keep track of the services provided in a hospital  because they are included in the basic charge or they will be billed correctly by a computer. 
• The bill is irrelevant because you are insured.

In fact:

• In addition to the hospital staff, it is up to you to do what you can to avoid medical error and to avoid getting unnecessary infections which can be potentially deadly. For information about how to avoid medical error and getting an infection in the hospital, click here. 
• It is up to you to be sure you get what you need in a hospital.  
• It is also important to keep track of services provided because a large number of hospital bills are wrong. Even if you are insured, you pay a large share of the bill either through co-insurance and/or through an increase in future premiums.

Until you are feeling up to taking care of these tasks by yourself, it is advisable to have a family member or friend with you to act as your advocate as much of the time as possible. The person is known in hospital speak as a Patient Advocate. You or your advocate must make your needs known and see that they are met. (NOTE: If you do not have someone to act as your Patient Advocate, professional patient advocates are available. See "To Learn More.")

The steps you and/or your patient advocate should take are described in the documents in "To Learn More." In general, you and/or your advocate should:

• Be informed about your health condition and treatments to be sure you are getting the treatment you are supposed to be getting, when you are supposed to be getting it.
• Learn who the various professionals are who treat you, and what each of their functions are. For example, a doctor known as a Hospitalist may be in charge of coordinating your medical care while in the hospital.
• Be alert to what's going on.
• Know your rights.
• Be assertive. You can be assertive without being obnoxious.
• Keep in mind that you do not have to be in pain.
• Do what you can to help avoid unnecessary infection.
• Keep track of treatments and services provided to you as they are provided.

If you have health insurance, do not rely on the hospital to check that all medical care providers are covered by your coverage. If your insurance only covers in-network doctors, it's up to you to be sure all medical personnel contract with your insurer. Otherwise, you may be stuck with the bill for that person's services. This is known as "Balance Billing." (To learn about the steps to take if you get billed under "Balance Billing", see "To Learn More.")

If you executed a Living Will or a Health Care Power of Attorney, ask a nurse to check to be sure they and the name of your health care proxy are noted in your chart. If you have executed a Do Not Resuscitate Order (DNR), it should be prominently noted throughout your chart so everyone who is involved with you will see it. (It also helps to hang a DNR sign above your bed - even if it is handwritten).

NOTE: 

• You can keep family and friends up to date easily through such alternatives as free web sites designed for that purpose or simple phone trees. As noted above, if you think you may change jobs or seek a job in the foreseeable future, it is preferable not to use the internet to keep family and friends posted - or at least not with your real name. (For more information, see the document in "To Learn More.")
• Historically, when visitors have been limited by a hospital, same-sex domestic partners have not been included. In addition to the right to have visits from your immediate legal family, your right to receive visitors has been extended in hospitals which receive money from Medicaid or Medicare to include a domestic partner - including a same-sex domestic partner.

For additional helpful information about a hospital stay, see the documents in "To Learn More."

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