How to come home from the hospital and stay home

The discharge nurse will hand you a stack of paper somewhere around eleven in the morning, talk for four minutes, and wheel you to the curb. That stack is the entire plan. It's written for a reader who isn't groggy, isn't in pain, and didn't just spend three nights being woken up every ninety minutes for a blood pressure cuff.

So don't accept it at the curb. Get it the night before, or the morning of, while you can still find a human being in scrubs who knows your case. Ask for two things by name: the discharge summary and the reconciled medication list. Read both while you're still in the building. If a drug you've taken for eleven years isn't on the list, that's a question you want answered by the hospital pharmacist, not by yourself at 9 p.m. in your kitchen with a flashlight.

That's the whole game, by the way. Almost every trip back to the emergency room in the first two weeks traces to one of four things: a medication mix-up, a missed follow-up, a warning sign nobody recognized, or losing so much strength in bed that you fell. All four are yours to control.

Do the brown bag before anything else

When you get home, before you sit down in the good chair, put every medication in the house into a paper grocery bag. Prescriptions, the ones from the old cardiologist, the vitamins, the fish oil, the drugstore sleep aid, the tube of something from 2019. All of it.

Take that bag to your pharmacist and ask him to walk the hospital list against it. Pharmacists do this for free and they're good at it. The hospital may have stopped a blood thinner, changed a dose, or swapped a brand name for a generic so the bottle in your cabinet and the bottle in the bag look like two different drugs and aren't.

Then throw out the losers. Not "set aside." Throw out. The number one way a sensible man doubles a dose is by keeping the old bottle on the shelf out of thrift.

Load a weekly pill organizer the same afternoon, while you still have the energy. Sunday-through-Saturday, morning and night. If you can't manage the little compartments with a sore hand or a fresh incision, hand the job to your wife or your daughter for two weeks and take it back after. Asking isn't surrender. Ending up back on a gurney because you were too proud to ask is worse.

Book the follow-up before you leave the parking lot

The single strongest predictor of a smooth recovery is seeing your own doctor within about a week. Not the specialist who operated on you. Your primary care doctor, the one who knows your baseline.

Hospitals are supposed to arrange it. Sometimes they do. Call anyway. If the first opening is three weeks out, say the words "I was discharged yesterday and I need a post-hospital visit." That sentence moves you up the list, because the office knows exactly what it means.

Bring the discharge summary to that appointment. Bring the pill organizer too. Your doctor may have received nothing from the hospital yet. Fax machines still run American medicine, which is its own sad comedy.

Pick one number and watch it

Recovery runs on a small number of measurements, and you only need the ones that apply to you. Ask before you leave: what should I be tracking at home, and what number means I call you?

For a heart problem, it's usually your weight, taken every morning after the bathroom and before breakfast, same scale, same amount of clothing. Fluid shows up on a scale days before you feel it in your chest. For an infection or a surgical wound, it's your temperature and what the incision looks like. For diabetes, it's the meter. Write the number on a paper calendar taped to the refrigerator. Apps are fine, paper is better when you're tired, and a piece of paper with nine days of numbers on it's worth more to your doctor than any story you can tell him.

Write the call list and tape it up

Three lines on an index card by the phone:

• Call the office for these signs, and list them in plain language. Wound turning red and hot. Fever. Weight up several pounds in a couple of days. Shortness of breath doing something that didn't wind you last week. New confusion.
• Call 911 for these. Chest pain, trouble breathing, a fall you can't get up from, sudden weakness on one side, a face that doesn't work right.
• After-hours number for your doctor's practice, which exists, and which almost nobody looks up until it's midnight and they need it.

Give a copy to whoever's staying with you. The point of writing it down is that the person who needs to read it will be scared, and scared people don't remember instructions.

Take the home health, even if you don't think you need it

If they offer a visiting nurse or in-home physical therapy, say yes. Medicare covers home health when your doctor orders it and you meet the conditions, and the window for setting it up closes fast once you're discharged. A nurse who comes to your kitchen and looks at your incision and your pill box catches things nobody catches over the phone.

You can always cut it short. You can't easily restart it a week later from your recliner.

Get up and walk, starting the first day

Bed takes your legs away faster than you'd believe. A couple of days flat and the stairs feel wrong. A week and you're grabbing furniture.

Unless you've been told otherwise, get vertical several times a day, even if it's a lap of the hallway to the front door and back. Sit up for meals at the table instead of eating in bed. Count the laps out loud if that's what it takes, and add one every day or two.

Meanwhile, do the boring sweep of the house that you've been putting off. The throw rug in the hall goes in the closet. A lamp within arm's reach of the bed. Nightlight on the path to the bathroom. Shoes with backs on them, not the slide sandals. Phone in your pocket, not on the counter. If the shower is where you feel least steady, a grab bar screwed into a stud is an afternoon's work and it's cheaper than one ambulance ride.

The stuff nobody warns you about

Pain medication constipates you, thoroughly and without mercy. Ask the pharmacist what to take for it on the same day you start, not on day four when you're miserable.

Your appetite may be gone. Eat protein anyway, in small amounts, several times a day. Eggs, yogurt, chicken, beans, a shake if chewing is too much work. Healing tissue is built out of something.

Sleep will be strange for a while, since the hospital wrecked your rhythm. Daylight in the morning and no long afternoon naps will fix more of that than a pill will.

And there's usually a low stretch around day four or five, when the visitors have stopped and the flowers look tired and you're still not yourself. That's ordinary. If it doesn't lift, tell your doctor, the same as you'd tell him about a fever.

Know when going back is the right answer

Don't turn this into a test of toughness. The goal is staying out of the hospital because you recovered well, not because you refused to go when something was clearly wrong. A man who calls at nine in the morning about a hot, swollen incision gets antibiotics. A man who waits until Sunday night gets admitted.

Recovery rewards the same thing everything else in your life has rewarded. Show up every day, do the small dull work on schedule, and keep a written record so you're arguing from facts instead of feelings.

Mark the calendar the day you walk to the mailbox and back without thinking about it. That's the day you're home.