Preparing as a family – supporting someone through major surgery

For partners, adult children, siblings, friends, and everyone else stepping in to help. Companion to our patient-facing guide at prehabforsurgery.com/what-is-prehab.

Daniel, six weeks out from his mother’s surgery

Daniel is 42. Two weeks ago his mother Margaret was told she needs major abdominal surgery for cancer. Surgery is six weeks from now. Margaret lives alone, an hour’s drive from Daniel’s house. Daniel has two children of his own, a demanding job, a partner who works shifts, and a brother who lives overseas. He has read everything he can find about the surgery itself. He has not yet stopped to think about what HIS next six weeks need to look like – and what his next three months after surgery will need to look like – to actually support his mother well.

If you have just learned that someone you love needs major surgery, you are likely somewhere in Daniel’s position. You are absorbing complex medical information about someone else’s body. You are anxious. You are trying to be useful without overstepping. You probably have a job, possibly children or other dependants, possibly your own health issues, and now an additional set of responsibilities you didn’t ask for and may feel unprepared to handle.

This article is for you. It walks through what the prep window looks like from the caregiver’s side, the work that genuinely helps a patient prepare for surgery, the work that helps the caregiver THEMSELVES prepare, how to ask for and accept help, what to expect in the immediate post-operative period, and how to look after yourself across the weeks and months that follow.

Two things up front. First – caregiving is harder than people expect. It is acceptable to find this difficult. Second – you don’t have to do it alone, and arranging shared support early is one of the highest-leverage things you can do.

Why your role matters more than you might think

Patients facing major surgery who have engaged, prepared caregivers genuinely have better outcomes than patients who don’t. The effect runs through several channels: better adherence to pre-operative advice (eating well, exercising, managing medications, stopping smoking), better emotional regulation in the prep period, faster post-operative mobilisation and recovery, fewer readmissions, faster return to function. None of this means the responsibility sits entirely on you – the patient’s own work is the larger part – but the caregiver layer is real and well-documented.

Equally important is the other direction: caregivers who arrive at the day of surgery burnt out, undersupported, and emotionally depleted struggle far more during the recovery period than caregivers who have looked after themselves through the prep window. Your own preparation is not selfish — it is what makes you capable of being useful when it matters most.

What genuinely helps a patient prepare – your role across the six pillars

Our companion article explains the six pillars of prehab in detail for the patient. Here is what each pillar looks like for the caregiver – the practical ways you can support without taking over.

1. Physical conditioning

Walks with them, especially if they wouldn’t walk alone. Drive them to a swimming pool if they like to swim but don’t want to drive home wet. Sit with them while they do simple resistance exercises at home. Encourage on tough days. Don’t lecture. The patient often knows what they need to do – the obstacle is motivation, not knowledge.

2. Nutritional optimisation

Often the single highest-leverage caregiver contribution. Specifically:

• Shop with them or for them. Stock the kitchen with protein-rich, easy-to-prepare options.

• Cook together if you both enjoy it. Eat with them if they live alone – eating is a social act, and many people with low appetite eat better in company.

• Track unintended weight loss honestly. If they’ve lost weight without trying, flag it to the medical team.

• If oral nutritional supplements are prescribed, help them make these a habit. Most people forget without prompting.

• Be honest with yourself about your own cooking time. If you can’t cook for them three times a week, see if other family members or a meal-delivery service can fill the gap.

This pillar is also where you can quietly help reduce alcohol intake – by not bringing alcohol when you visit, by ordering non-alcoholic drinks when you’re out together, by filling the fridge with things that aren’t beer.

3. Psychological preparation

The pillar where caregivers most often want to help and most often get it slightly wrong. What helps:

• Presence. Sit with them. Watch a film together. Eat a meal together. Don’t always have an agenda.

• Listening without trying to fix. Most of the time the patient doesn’t want a solution – they want to be heard.

• Acknowledging fear honestly. “This is frightening” is often more useful than “Don’t worry, you’ll be fine” – which can feel dismissive even when well-meant.

• Helping them think through specific questions for their team. Writing down questions together before appointments is a simple, high-value joint activity.

• Being patient with mood swings. Pre-operative anxiety can show up as irritability, snappiness, withdrawal, or unusual decisions. It usually isn’t about you.

• Helping them notice what’s actually helping. Mindfulness, walking outdoors, time with grandchildren, particular music, certain friends – patients often don’t notice their own coping patterns. A caregiver who notices can gently encourage more of what helps.

What doesn’t help: forced cheerfulness, minimising their concerns, comparing their situation to others, sharing horror stories from acquaintances, or insisting they engage with support resources they’re not ready for.

4. Medical optimisation

The administrative-medical pillar where caregivers can carry substantial load:

• Help them get the pre-operative medical review with their primary care doctor.

• Make a written list of every medication and supplement they take, including dose and timing. Bring it to every appointment. Update it as things change.

• Attend major appointments with them if they want company. Take notes. Two pairs of ears hear more than one, particularly when difficult information is being shared.

• Help them track blood test results, scan dates, and follow-up appointments. A simple shared paper calendar or phone calendar with reminders works for most families.

• Be a useful intermediary with the medical team if needed – but only with the patient’s explicit permission. Some patients want this; some find it infantilising. Ask first.

5. Smoking, alcohol, and substance use

If your loved one smokes, the smoking-cessation question is the most consequential single intervention available. Caregiver support here is meaningful – but be careful with the approach. Nagging usually fails; quiet, sustained encouragement and removing the cues (don’t smoke around them; don’t keep cigarettes in shared spaces) tends to work better. Helping them access nicotine replacement, prescribed cessation medication, or counselling is a concrete contribution.

Alcohol reduction follows similar logic. Practical changes to the household routine – what you order when you eat out, what’s in the fridge – make change easier than willpower alone.

Honest note: if your loved one’s smoking or drinking is genuinely heavy and has been for years, abrupt cessation needs medical supervision. Don’t pressure them into stopping alone if they have signs of dependence. Speak to their doctor.

6. Social and practical preparation

The pillar where the caregiver’s role is most explicit and most extensive. This is the bulk of caregiver work and where careful planning weeks in advance prevents crisis moments later. Areas to address:

• Home environment – prepare a comfortable rest area on the ground floor if they live in a multi-storey home. Move daily-use items to waist height to minimise bending and stretching while wounds heal. Clear trip hazards. Stock the bathroom with what they’ll need.

• Discharge transport home – plan it now. Identify a backup driver in case the primary person can’t make it on the day.

• First two weeks after discharge – daily-needs cover. Who’s cooking? Who’s shopping? Who’s helping with washing, dressing, toileting if needed? Children, pets, the garden? List every domain and assign responsibility before surgery, not after.

• Practical aids if relevant – raised toilet seat, shower chair, walking aids. The hospital occupational therapy team can advise; some areas have lending schemes; some items are worth buying outright.

• Documentation – make sure power of attorney for healthcare and / or advance directive documents are in place and the medical team knows where they are. Have a brief conversation about preferences now, when there’s no pressure, so you’re not making assumptions later in a stressful moment.

• Finances – sick leave or income protection paperwork should be set in motion now. Bills that fall due during the recovery period should be set up on direct debit or delegated to someone. Online banking access shared appropriately.

• Insurance and healthcare paperwork – clarify what is covered, what isn’t, and what the family is responsible for. This varies enormously by country and policy; do the homework before surgery, not after a bill arrives.

You need to prepare yourself too — this is not optional

Caring for someone recovering from major surgery is harder than most people expect. Lifting, supporting, managing medications, attending appointments, providing emotional support, holding everything else in your own life together – it adds up. Caregivers who arrive at the day of surgery already exhausted, isolated, or undersupported struggle badly in the weeks that follow. Caregivers who have prepared themselves do significantly better.

Specific things to do in the prep window for YOURSELF:

• Talk to your employer about expected time off. Sick leave, carer’s leave, flexible working, working from home – what’s available depends on country, employer, and circumstance. Start the conversation early, not on the morning after surgery.

• Identify your OWN support network. Who are the people you can call when you’re overwhelmed? Tell them what’s coming. Permission to lean on others is given in advance, not requested in the moment.

• Plan respite. The caregiver who has nothing else in their life for three months burns out badly. Schedule activities that give you breathing room – a coffee with a friend, an exercise class, an evening out – even when it feels selfish. It isn’t.

• Look after your own health. Don’t postpone your own appointments, your own medications, your own exercise. A caregiver who collapses helps no one.

• Sleep. Genuinely. Sleep deprivation makes caregiving harder in ways that compound. Protect your sleep ruthlessly in the prep window so you have reserves for the harder weeks ahead.

• Eat properly. Caregiver nutrition is often the first casualty of stress. The body that’s about to be running on adrenaline for three months needs fuel.

• Consider speaking to someone yourself. A counsellor, a peer support group for caregivers, a trusted clergy member, a friend who’s been through similar – whoever your version of this is. Anticipatory grief and pre-surgical anxiety can be heavy for carers too. Acknowledging this is a strength, not a weakness.

If there are several of you – coordinate, don’t duplicate

Many patients have multiple potential caregivers – partner, adult children, siblings, friends, neighbours, sometimes paid help. This is usually a blessing but can become chaos without structure. Some simple principles help:

• Agree a primary point of contact for the medical team. The team can’t keep three people equally updated. One designated person liaises and shares with the rest.

• Use a shared written tool. A shared Google document, a family WhatsApp group, a shared calendar – whichever fits your family. Whoever does what, in writing.

• Distribute by strength, not equally. The family member who’s good with finances does finances. The one with the strongest stomach handles wound care. The geographically closest does day-to-day visits. Even-distribution by guilt usually creates resentment later.

• Hold a brief family conversation about the plan before surgery. Air disagreements now, in a calm moment, rather than under the pressure of the post-operative period.

• Build in handoffs. The primary caregiver should not be the only person who knows the medication schedule, the team contacts, the home setup. One person being indispensable is fragile.

• If one of you lives far away, you can still help – finances, online research, coordinating with insurance, calling the patient daily, organising delivery services, managing visiting-family logistics. Distance doesn’t preclude meaningful contribution.

What to expect in the early days after surgery

The first 48 to 72 hours after major surgery are usually the most concerning to family. Knowing what’s normal helps:

• The patient may be in high-dependency or intensive care for a day or two after major HPB surgery. They may have multiple tubes, drains, lines, and monitors. They may be drowsy from anaesthesia and pain medication. None of this means anything has gone wrong – it’s standard.

• They may be confused, irritable, or emotionally labile in the first 24-48 hours. This is usually anaesthesia and pain medication, not a personality change. It passes.

• Pain after major surgery is usually well-controlled but rarely zero. “Comfortable” is the realistic goal, not “painless”.

• They may not want visitors in the first day or two, or may want only one or two close people. Respect what they want. Visitors are for the patient, not the visitor.

• Recovery is not linear. Day 3 may be better than day 5. There will be good days and harder days. This is normal.

• Discharge planning starts the day after surgery, not the week before going home. The team will tell you what to expect and when.

After discharge home, the first two weeks are typically the most demanding for the caregiver. Plan for this. Don’t book holidays, take on new projects, or have major events during this period if you can avoid it.

Looking after yourself across the recovery period

Recovery from major HPB surgery typically takes 2-3 months for most patients to return to normal function. The caregiving load is heaviest in the first 2-4 weeks and eases gradually after that. Sustained over weeks, the demands add up – and the caregiver who doesn’t pace themselves often crashes badly around weeks 4-6, just as the patient is starting to need less support.

Pacing yourself looks like:

• Asking for help is a strength, not weakness. People generally want to help – they wait to be asked. Specific asks (“could you bring dinner Thursday?”) work better than vague ones (“let me know if there’s anything I can do”).

• Saying no to non-essential commitments. Three months of saying no to optional things preserves your capacity for the things that matter.

• Maintaining one or two things that are entirely yours. An exercise class, a coffee with a friend, a book group, time in the garden. These are not selfish; they are what makes you a sustainable caregiver.

• Watching for caregiver burnout signs in yourself – sleep disturbance, constant irritability, loss of interest in things you usually enjoy, persistent low mood, physical symptoms. If you spot these, escalate — to your own doctor, to other family, to whichever support resource fits your situation.

• Accepting that you will have bad days. Crying in the car park after a difficult hospital visit is normal, not a sign of weakness. Snapping at someone you love because you’re exhausted is human. Don’t compound the difficulty by holding yourself to impossible standards.

Resources and support for caregivers

Several types of support are worth knowing about. Specifics differ by country; the categories are universal:

• Caregiver organisations relevant to your country – most countries have national carers’ organisations offering information, helplines, and peer support. They are usually free and underused.

• Patient-condition-specific organisations – most cancer and chronic disease organisations have caregiver-specific sections. The peer community there is often the single most useful resource caregivers describe finding.

• Your own primary care doctor – book a check-in for YOU within the first 4-6 weeks after surgery. Make sure you’re sleeping, eating, exercising adequately. Acknowledge to your doctor that you’re caregiving – many adjustments can be made if they know.

• Your loved one’s specialist nurse – they have heard every caregiver question before. Use them.

• Counselling and therapy – accessible privately or through some health systems. If you’re struggling emotionally, this is treatment, not luxury.

• Hospital social work and chaplaincy services – most hospitals offer these regardless of religious affiliation. Particularly useful for the practical and emotional dimensions of major surgery.

• Workplace employee assistance programmes – many employers offer free counselling, legal advice, and other support that employees never use because they don’t know it’s there. Check yours.

If you are struggling with the emotional weight of caregiving – not just managing it but genuinely overwhelmed by it – speak to someone. Caregiver depression and burnout are common, treatable, and largely preventable when addressed early.

A final note – you are doing something that matters

Caregiving across a major surgical journey is one of the most consequential things a person can do for someone they love. It is often invisible – much of it is done in private, much of it is unpaid, much of it is unacknowledged. But the patient outcomes literature, and the lived experience of millions of caregivers, both confirm the same thing: it matters enormously.

Do the work that helps. Prepare yourself as well as preparing your loved one. Ask for and accept help. Pace yourself. Look after your own health. Lean on the support that exists. Speak to professionals when you need to. And be patient with yourself when it is hard – because it will be hard sometimes, and that is normal, not a failure on your part.

The other two articles in this series – the patient-facing guide and the clinician-facing companion – sit alongside this one as the foundational set on prehabilitation. Read whichever ones are useful to you. Share them with the rest of your loved one’s support network. And come back to them as the journey unfolds.

This article was written and reviewed by Mr Tom Gallagher, Consultant Hepatobiliary and Pancreatic Surgeon. It is for general information for families and caregivers and is not a substitute for advice from your loved one’s clinical team or your own healthcare providers.

Last updated: 8 June 2026.