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By Dr. Kourtney Kemp MD, FACS

Should I really go on this journey?

According to the US Census Bureau, more than 12% of the total US population is >65 years old, and over half will undergo at least one surgical procedure. For many individuals, surgery can significantly improve quality of life. For some, it can come with unexpected pain, suffering, and sometimes premature death. Most people over the age of 65 have perceived good health, yet their organs, cells, and tissues have seen 65 years of life and 65 years of fighting/repairing the damage.

you get one vehicle in your lifetime

Comparing your body to a vehicle/car, you get one vehicle in your lifetime. How do you care for it? If you are going on a long road trip, how would you prepare your 65-year-old car? We know your vehicle has been very reliable for getting around town, to the grocery store, and even on a long road trip for many years. But how comfortable are you on a journey across the country now? Surgery is the cross-country journey your body will undergo.

Our role as surgeons/physicians is to prepare one for that cross country journey. In addition to preparation, we aim to help with obstacles and challenges along the way... the potholes, road blocks, construction zones, and speed traps of the journey. One must prepare with safety factors in mind. Is there a back-up driver if you get tired? What if your car breaks down along the way?

Where will you pitstop/layover to rest or recover if necessary? Have you planned for the cost of food, shelter, and other unforeseen surprises? Are your family/loved ones aware of your journey? Unfortunately, in planning this journey, you do not get to pick your car. You can only use the one you have.

How well did you take care of that car in the past? How does that car run now?

Before setting out cross country, consider preplanning with the steps below...

Step 1: Is this journey necessary?

It is crucial for all patients undergoing surgery to trust and feel comfortable with their surgeon. Determine your own individual health goals. Most individuals seeking surgery are looking to prolong life, preserve function/independence, relieve symptoms, cure a condition, or establish a diagnosis. Ask your surgeon about the best/worst-case scenarios. There are no guarantees in surgery, and one is playing the odds of expertise when undergoing surgery. Listen carefully to the possibilities and decide if the odds given are worth the possible outcomes. Remember, if you do not undergo surgery, there is always an alternative. It might not be a perfect solution, but it might be possible to meet your goals of care. It is essential to understand that fixing a problem does not always meet your goals of care. Having a clear answer to a problem may bring peace of mind but may come with the cost of pain/suffering. Stay focused on your life goals.

Step 2: Where do you want to go?

In surgery, you have a planned destination, but what if you cannot get there? Are you ok being stuck in the middle? You might not be where you were, but you may not be where you want to be? Before you proceed towards surgery, write down and answer the following questions to guide your decisions for yourself and family members as you prepare for this journey. I encourage you to share these answers with your health care team.

  1. What brings you strength?

  2. What does “living well” mean to you?

  3. What activities are so important to you that you cannot live without?

  4. What treatments do you hope to avoid? What are your fears?

  5. What is the most favorable outcome of surgery?

  6. What is a satisfactory or livable outcome from surgery?

  7. What is your preferred way of dying? This may be a tough question, and we do not know when our time will expire, but we do have some control over our surroundings during the dying process. Most hope for a peaceful, loving process surrounded by loved ones. What does that look like for you? Is it someone holding your hand? Is it a warm blanket? Is it a prayer, song, or poem? The reality of people dying from surgical complications comes with a cost of death with tubes/lines in their body, along with pain, bruises, and scars throughout.

Step 3: Who is going with you on this journey?

Family/friends are impacted by your health choices. A study from 2018 indicated that only 26% of people had advance directives going into major surgery. There are many situations in which one may be temporarily incapacitated and rely on family, friends, and healthcare providers for decision making. Without prior discussion or directives, many family members have extreme stress and guilt over the agonizing decisions they are asked to make. Help your loved ones by talking with them frequently. Write down your wishes and directives. Establish a surrogate/representative/ power of attorney to make decisions if you are temporarily or permanently unable. There is more to planning an advance directive than just “would I want to be on a ventilator or receive CPR.” It is essential to discuss your overall health goals, treatment goals, the anticipated impact of surgical/non-surgical treatments, care needs with survival, living situation, and death planning.

After you have determined your intent and who will be on this journey with you, the next step is preparing for this journey. Preparing your “vehicle.” For the individual, it involves mind, body, and soul. Remember, you may change your mind at any time during the preparation phase, but once you start the vehicle and get moving, the journey begins!

Our next discussion will be aimed at the preparation of your vehicle.

Dr. Kourtney Kemp is a board-certified general surgeon and medical director for Twin Cities Heartburn Center at Specialists in General Surgery in Minneapolis, Minnesota. Dr. Kemp has a special interest in hernia surgery, robotic-minimally invasive surgery and reflux/esophageal diseases. Since 2017, she has held several hospital leadership positions on the Medical Executive Committee, Chief of Surgery and most recently, Chair of Peer Review. Dr. Kemp is dedicated to supporting both patients and physicians in providing the best quality of life for patients in our communities.


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