My father recently had open-heart surgery, shortly after two other major surgeries.  While caring for my Dad and observing other patients in recovery, I became keenly aware of a complication known as Post-Operative Delirium.  I am sad to say that this is a common complication that may affect the majority of patients following major surgery. 

If you or a loved one are preparing for a major surgery, I offer the following tips:

1. Discuss the risks with the medical team before the surgery. Chances are that if the patient is going to be sedated, heavily medicated, previously experienced any symptoms of post-operative delirium, is likely to be immobilized, may not be exposed to sunlight on a regular basis, and/or is elderly, they are at great risk for post-operative delirium. Ask the medical team for their risk assessment of post-operative delirium and their mitigation plan for the patient.
2. If your friend or loved one shows signs of delirium after surgery, try to implement the following actions:
   1. Ensure the patient has a room with a window. A lack of sunlight after surgery contributes to the chance of delirium. 
   2. Make sure artificial lighting is minimalized at night and maximized during the day. In my Dad’s case, the staff was insensitive to lighting issues.  It would be 2AM and they would have all the lights on to take his vitals.  Conversely, after a night of fitful sleep, they would turn the lights off so he could nap. 
   3. Get the patient an illuminated 24-hour clock.
   4. If the patient is not in significant pain, encourage the doctor to substitute narcotics with Tylenol or other appropriate medication.
   5. If possible, encourage the patient to get out of bed and move around during the daytime. Going for a walk with views of the outdoors can be very helpful for resetting the internal clock. In addition, sitting in a chair for meals is preferable to eating in bed in a reclined position. 
   6. Encourage the members of the medical team to talk to each other and streamline their efforts. My Dad had a different team every 12 hours, making it very difficult to coordinate his care effectively. 
   7. Encourage the medical team to make major changes while the patient is alert if possible. My father was moved from the ICU to recovery at 5AM while he was asleep.  When he woke up, in strange surroundings connected to unfamiliar IVs and blood transfusions, he was dangerously confused.  He actually ripped out all the tubing and got out of bed. 
   8. Ensure a friend or family member is with the patient as much as possible. My father was fine when I was with him, but when he was alone in strange surroundings, the delirium would resurface.
   9. Ensure the patient receives clear, concise instructions before the surgery. My dad was provided with over 100 pages of instructions, which were incomplete and riddled with inaccuracies and inconsistencies. 
   10. Find out who the case manager is and hold him or her accountable. There was no case manager to assist my father and coordinate his care, which contributed to his confusion and distracted from a holistic, effective healthcare approach.  

Unfortunately, the current state of our healthcare system often requires friends and family to step up to be healthcare advocates for our loved ones.  I hope you never have to implement these tips, but, if you do, I hope they help.