How long does it take to get strength back after hospital stay?

Usually I write about the legal industry, the future of the industry, technology, and other fascinating topics. But, as a result of my recent cancer diagnosis and treatment, I found myself in a hospital’s Intensive Care Unit twice. I offer these tips in the hope that others who find themselves unexpectedly going into the hospital will have an easier adjustment to hospital living than I had.

Most of us assume that a stay in the hospital means you are under the care and supervision of doctors and nurses. After all, being in the hospital implies you have a serious medical condition. For those who have never stayed in a hospital, it can be a scary thing. Hospitals work according to their own protocols and the thought of being in an environment where someone is monitoring you 24 hours a day can be a bit frightening.

I was in the hospital the first time for about 11 days and the second time for about 10 days. Both times, I was in a “flex” intensive care unit. This unit could handle a spectrum of patients who needed low-end intensive care to extreme intensive care. It was different than a normal hospital room that could not handle, for example, the complicated breathing apparatus I needed during my first visit.

I don’t claim to be an expert patient. But, I did learn a lot about how to survive those visits and what to do to protect myself while in the hospital. For those of you who may be facing your own hospital stay or who have a family member or friend who will be in the hospital, I offer the following tips.

1. Remember that everyone you encounter is well-intentioned and is trying to help you. Hospitals are filled with individuals who have specialized jobs. Nurses, doctors, personal care assistants, respiratory therapists, physical therapists, radiology technicians, and on and on. While at times they may seem hurried or even brusque, they are there to help you. Being polite, helpful, and not unnecessarily fighting with them will go a long way towards making your stay go smoothly. Often, the person you are working with is carrying out “orders” given by someone else (e.g., one of your doctors). Beating up on a phlebotomist for drawing blood doesn’t help if your doctor ordered the blood draw. If you have concerns about something being done, ask who ordered it, what the purpose is, and then take up your concern with the correct person not the messenger.
2. Remember that at the end of the day, you are still in charge. Many patients do not realize that they retain the ultimate right to refuse treatment. Just because you are in the hospital, you do not lose control over the right to control what happens to your body. With great power comes great responsibility, so be careful about wielding this weapon. But, equally, don’t forget about it. While I was in the hospital, there were times when I was about to be given a medication that I knew the doctor had intended to discontinue. For whatever reason, the chart had not been updated so the nurse saw the medication as something I was still receiving. I refused the medication and the chart finally was updated. I had the same experience with blood draws (the timing was switched from once every four hours to once every twelve hours, but they still tried to draw every four hours), and even imaging (they wanted to do an x-ray that was unnecessary). Stay aware of what treatment and medications you should receive and be willing to raise your hand if something seems off.
3. Get to know and respect hospital routines and understand where there is leeway in the system. Hospitals work on systems. Your room will be in an area with certain protocols. For example, some areas may require the nurse to take your “vitals” (blood pressure, temperature, pulse) every four hours. Others, may use eight hours. You are monitored 24 hours so don’t be surprised if the nurse needs to awaken you at midnight or 4 am to check your blood pressure. Nurses also check patients throughout the night, so even if they don’t need to wake you they will check on you. In the meantime, pharmacy techs may deliver medications at all hours, environmental services will pop in to clean your room, others will check supplies in your room, and of course you may have blood drawn at strange hours. You should also expect doctors or physician’s assistants to stop by on rounds. In other words, recognize that your room will be a hub of activity day and night. At best, you may have stretches of three or four hours without interruption.
4. Get ready to be frustrated. You will find many aspects of hospital life frustrating. For example, you may find yourself tethered to several pieces of equipment, such as an intravenous machine, a heart rate monitor, and breathing apparatus. You will have a tangle of tubes and wires running from you to the machines. Going to the bathroom will involve a nurse or personal care assistant disconnecting you from some machines or bringing others with you as you move from the bed to the bathroom. You will have to call for assistance, and depending on how busy those individuals are with other patients you may have to wait a while before they can help you. The best rule is plan ahead. Don’t wait until the urge to use the bathroom is irresistible, signal for help as soon as you think you need to go. Watch for things like shift change times when the staff is busy transitioning duties and plan to go before or wait until after the change.
5. Don’t expect to leave the hospital in the same condition you were in when you arrived. The rule of thumb for a hospital stay is that it will take you one week to recover to pre-hospital condition for each day you spend in the hospital (some say 3–4 days recovery for each day in the hospital). In my case, I spent a total of 21 days in the hospital so it should take 21 weeks to recover. Your muscles lose strength, you lose agility, and you lose overall body tone while lying in a hospital bed. This is normal even if you can get up and move around (and most of us can’t, which is why we are in the hospital). You will need help when you leave if you stay for more than a few days. That could mean you will need a walker and other assistive devices when you go back home. You may also need physical therapy. The sooner you recognize these facts, the better off you will be.
6. Be prepared for setbacks. Although we may refer to medical science, medicine is as much art as science. Every drug has side effects and two similarly situated individuals may react very differently to the same drug. Drugs also can work against each other. I was taking an antibiotic that was considered the best treatment for my pneumonia, but it gave me insomnia, loss of appetite and affected the taste of all foods. When I dropped to a prophylactic level of the drug, it caused my liver enzymes to climb (bad). We switched to a second drug, solving the liver enzyme problem, but the second drug could suppress my hemoglobin level (another area of concern for me). In other words, there is no free lunch. You will face drug side effects, conflicts, and unknown problems. Some days will go well; others not so well. If you can accept and roll with the punches you will do much better than if you get frustrated by each downturn.
7. Have a support crew if at all possible. Being in the hospital is a lonely experience. While there are many interruptions day and night, there also are long periods where you are alone in the room with your thoughts. You are not well, and it is easy to let your mind wander down paths that are not helpful. You also will find that you have forgotten to bring things with you, that it would help to have an extra pair of hands arrange your tray table or help you eat, and there are times when you just want some company. If you can, arrange for a support crew. They don’t have to be at the hospital during all hours, but even having someone there a few hours a today can be a tremendous benefit both physically and psychologically.
8. Play an active role in your care. Usually, nurses and doctors like it when the patient is actively involved in their care. When you are going to receive medication, ask which medications you are being given and compare them to what you have been told. I found that I was often about to receive a medication which a doctor had discontinued, but the doctor’s order had not made it into the chart. If the nurse takes your vital signs, ask for the readings. You know your condition — if your blood pressure suddenly spikes or drops, flag the change for the nurse (they should see the change from what the chart tells them, but they have lots of things to check so don’t assume they will catch the change). Hospitals have strange schedules for nurses and even then change nursing assignments during shifts. Over my two stays in the hospital, with nurses day and night, I had only a few instances where I had the same nurse for two days or nights in a row. Generally, each shift was a new nurse. Sometimes, I had two and even three nurses during a shift. While nurses do review your chart, the more complicated the information the harder it is for the nurse to catch everything. Or, put another way, the only constant is you. Work with the nurses and doctors to make sure they are aware of your current state and treatments.
9. Beware interference from the insurance companies. This admonition may apply outside the hospital as much as in the hospital, but get ready for insurance companies to interfere with your treatment. Each time an insurance company gets involved, costs go up, diagnoses can get delayed or your treatment level can go down. At one point, the insurance company I use met with one of my doctors to demand he follow their safeguards for prescription drugs. The insurance company learned at the meeting that their safeguards were far less than what my doctor already required, that they had this information available to them before the meeting, and that their safeguards were flawed. During my brief (8 months) exposure to working with insurance, I have had the following issues:

• The initial diagnosis of my cancer was delayed for months because the insurance company refused to approve the MRI needed to “see” my tumor.
• Most of my medication prescriptions get delayed, at least for a few days, because the insurance company refuses to approve them (for a variety of reasons). The reasons range from wanting specific wording on the prescriptions (each insurance company favors specific wording), to second-guessing the doctor’s judgment (yet each time, the insurance company ultimately approved the prescription).
• For one of my medications (an opioid) the insurance company refused to approve the less addictive version and required that I get the more addictive version.

10. Understand what works best for you and bring it to the caregiver’s attention. I had blood drawn often when I was in the hospital. By often, I mean several times a day and night. I always had an IV in my arm, so at first the floor nurse would use the IV to draw blood. But, as you will quickly find out, this trick works for only a few days. After that, IVs continue to work if you are getting something (e.g., saline solution, medications), but do not work for drawing blood. At that point, someone has to insert a needle into a vein and draw the blood. Floor nurses know how to draw blood, but do so infrequently compared to certain specialists. Phlebotomists, for example, may draw blood 10 or 20 times an hour, whereas a typical floor nurse may go a week before they make that many draws. My left arm is tricky (the veins roll) which left my right arm as the preferred one for blood draws. But, when you are getting stuck with a needle as often as I was, finding a suitable vein can be a challenge. I was a “tough draw.” I quickly learned to explain to the nurses that they and I were better off having a phlebotomist draw my blood. A nurse could make three tries and not succeed, but a phlebotomist always succeeded on the first try. If you need a specialist to do something, let the nurse know. Nurses have no desire to cause you pain and, in my experience, are happy to let the specialist handle a tricky case while the nurse goes off to perform other duties.

These tips are based on my stays in a hospital. The hospital I stayed in was not a major teaching hospital in a major city. It was a smaller hospital in a medium-sized city. Yet, the experience I had was terrific, both times. All of my caregivers (doctors, nurses, etc.) knew each other and worked well as a team. My care was coordinated, and I felt that everyone was looking out for my well being. Sure, there were moments when everything did not go as planned. But, overall, I would recommend the hospital to anyone without hesitation. In my opinion, the key to your hospital stay is recognizing that you are part of your own client experience. Some patients are not able to participate much if at all in their care. Hopefully, they can have someone else (e.g., a family member) who assists them. If you are able to participate, then do so. Your hospital stay will go more smoothly and be less stressful if you participate.

When not undergoing treatment for cancer (or side effects from treatment drugs such as pneumonia or bleeding ulcers), Ken is an author on innovation, leadership, and on the future of people, processes, and technology in the legal industry. He also is an adjunct professor and Research Fellow at Michigan State University’s College of Law. You can follow him on Twitter, connect with him on LinkedIn, and follow him on Facebook.