In the front office at Southwest Plastic Surgery we sit at a long table, and the phone calls never stop. A high percentage of them begin the same way. “I am so sorry to bother you.” “I know it is probably nothing.” “I really did not want to cause a problem.”

I want to make that apology impossible, and this is my attempt to explain why.

In a recent interview with MDLinx about infection after surgery, I was asked what I tell recovering patients, and they chose to lead with the same message I want you to hear. The boring, early warning signs, the ones that get so easily rationalized away, are the most critical ones to catch.

The Signs That Worry People Come Much Later

If I asked most folks how they would know an infection had taken a serious turn after surgery, they would describe something visually dramatic. Collapse. A sky high fever. Undeniable evidence.

Medically, those symptoms are a dropping blood pressure, cool and clammy skin, a rising lactate level, a white blood cell count that is changing dramatically in either direction, and rising creatinine, which means the kidneys are struggling.

Each is a legitimate finding. Each also describes a patient who is already in distress and often well past the point at which the problem was most easily treated. When we see these, we are no longer catching a developing issue. We are pulling somebody out of a fire.

The early warnings are subtle. A heart rate that has been trending upward. A temperature that has not crossed into fever range but is above normal. Urinating less than before. A slight increase in the breathing rate. Feeling confused or generally off. After abdominal surgery, increasing pain that spreads beyond the site, bloating, nausea, vomiting, or not having passed any gas.

In isolation, these signs are usually not alarming. That is the problem. Each sign individually might be innocent. They become a serious cause for concern when a trend emerges.

Sepsis Lives in the Trends

The statement I made to MDLinx, that sepsis lives in the trends, is meant literally.

A single pulse of 104 is just a number. A heart rate that trended upward from 82 to 90 to 98 to 104 in a single day is not an isolated event. It is a progression, and a progression indicates direction.

In a large hospital system things are necessarily fragmented, and communication is typically task based rather than trajectory based. The person who picked up on something at midnight is not the person providing your morning care. So a trend gets interpreted as a series of isolated data points. Each nurse or physician looks at the heart rate as a number. Since each single number usually has a benign explanation, you just got out of bed, you are in pain, you are anxious, the room is hot, each provider may reasonably choose to accept it. That tendency allows a rising curve to be silently smoothed into a string of observations that never raise an alarm.

How We Handle Follow Up

Dr. Agullo completed a general surgery residency at Texas Tech University Health Sciences Center before his plastic surgery fellowship at the Mayo Clinic, and he is board certified by both the American Board of Surgery and the American Board of Plastic Surgery. Those years on the general surgery wards are where this instinct was formed, because in general surgery, infection after an operation is not a rare event.

We try to pass that lesson along by making sure our patients can reach us. We would far rather see you in person than read about you on a form, because a form gives us a value and a visit gives us a direction.

Our patients can call the office directly or text us. We have never been frustrated by a patient who called about nothing. We would rather take a hundred calls that turn out to be nothing than miss the one patient whose quietly worsening problem we would not otherwise have known about until it was almost too late.

When patients do reach out, we ask a specific question. Not “how bad is it,” but “are you worse than you were yesterday?” Severity is a single snapshot. A change across several days is information.

When to Call Us

Here is the genuine list.

• Pain that is getting worse instead of better, or pain that is starting to spread beyond the surgical site
• A heart rate trending upward over several days, even if no single reading is abnormally high
• A fever, or a temperature that is climbing toward fever range
• Confusion, uncharacteristic sleepiness, or a general sense of not feeling right
• Urinating less than normal
• Breathing a little faster, or a sensation of breathlessness
• After abdominal surgery, significant bloating, nausea, vomiting, or the inability to pass gas
• An incision with increasing redness, warmth, or drainage rather than steady improvement

We do not expect patients to be certain. We do not even expect them to be correct. Deciding what a symptom means is our job. Letting us know which direction it is moving is yours.

If you are recovering in a hospital bed instead of at home, the most helpful sentence you can say to your team is this. “This has been getting worse every day for three days.” That statement conveys a trend, and the trend is what the system is least adept at holding onto.

What This Post Is Not

This is not meant as a commentary on any particular case or any particular hospital. As Dr. Agullo said in the MDLinx article itself, he does not know the details of the case in question, and he was not asked to adjudicate it.

This is about the general lesson, and the general lesson applies to every surgical patient everywhere, including in our own practice.

Vigilance is rarely flashy. It is checklists, phone calls, early visits, and a tolerance for being bothered.

Ready to Talk?

If you are planning surgery, with us or anywhere else, ask specifically how you will be followed afterward, who will be assessing your recovery, and how quickly you can speak to a human being. You deserve a concrete answer.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.

For Dr. Agullo’s surgeon-facing review of how trends get lost in hospital handoffs, see the related post on drworldwide.com. For the patient-facing version, see the post on agulloplasticsurgery.com.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.