Six months ago, I encountered a challenge I never expected: a robotic-assisted radical prostatectomy. Even now, writing about it feels surreal. Cancer rearranges life without warning, and surgery, regardless of how “minimally invasive” brochures describe it, alters you in ways only understood through experience.
The post-op instructions said that, within hours of surgery, I needed to stay active. That sounded simple enough beforehand. But no one asked about my fitness level or my normal activity level before the diagnosis. No one asked what “active” meant to me. Before surgery, my habitual physical training would be considered challenging to most. And that gap, those few missing questions, ended up shaping the hardest chapter of my recovery.
On the first night in the hospital, still connected to tubes and experiencing pain and residual anesthesia effects, I asked the nurse to obtain permission for me to walk. I was not attempting to be heroic; I simply wanted to follow instructions. After my surgeon approved, I completed two slow, painful laps around the corridor. Although it was painful, it felt like progress and a step toward regaining my usual self. After returning home, I resumed walking two to three times daily. However, before surgery, I averaged 15,000 steps per day, my baseline and normal. Consequently, I considered 10,000 steps post-operatively as “taking it easy.” I believed I was being responsible and adhering to instructions. One week later, I was readmitted to the hospital due to a major complication. My doctor told me I had probably caused it, and that what he meant by “activity” was 2,000 steps, not 10,000. Two thousand. A number I could hit by accident on a lazy Sunday before the operation.
This development induced profound guilt, more intense than the diagnosis itself or the physical pain and fear. Suddenly, it felt as though I had caused harm to my own body by overexerting myself during recovery. Previously, the pain and challenges were attributable to external factors, but now the consequences rested solely with me. Looking back, I realize that this kind of self-blame is a common response after physical trauma and surgery. It is well documented that many patients wrestle with misplaced responsibility, believing that complications are their own fault. Naming and acknowledging this helped me see I was not alone, and that these feelings are part of the recovery process for many.
Post-surgical depression is more common than most people realize. Researchers confirm I am not alone in this: studies show that anywhere from 10 to 30 percent of patients develop new-onset depression after major surgery, depending on the type of procedure and the population studied. Some research even suggests the risk can be higher in older adults or in surgeries involving cancer. However, this issue is rarely addressed during preoperative consultations, discharge instructions, or in promotional materials featuring smiling patients.
And speaking of instructions, patients misunderstand or forget a staggering amount of what they are told after surgery. Research shows that postoperative instruction retention is inconsistent, and comprehension varies widely. Some studies have found that patients forget or misinterpret a significant portion of their discharge instructions, especially when they are given only in writing. So, there I was: a guy who thought he was doing everything right, but who actually did much wrong, and who now had a complication, and a heavy dose of shame, to show for it.
Looking back, I wish I had paused and repeated my discharge instructions out loud to my care team before leaving the hospital. It could have helped me catch any misunderstandings in real time. If you are a patient, do not hesitate to ask questions or repeat instructions in your own words to your clinician, even if you feel self-conscious. A minute of clarity at the hospital can save weeks of confusion at home. This shame caused a mental shutdown. I was unable to resume the training I once enjoyed, lost trust in my instincts, and remained fearful that any movement or exertion might cause further harm. Since then, I have experienced post-traumatic depression, a term I use deliberately. It encompassed not only sadness and frustration but also physical, emotional, and psychological trauma enveloped in a persistent, exhausting fog.
However, a few weeks ago, a significant change occurred. My trainer, Marcus, who has seen me at my strongest and my most stubborn, pulled me aside. He didn’t give me a lecture. He didn’t provide me with a checklist. Instead, he gave me a pep talk I didn’t know I needed. At one point, he looked me straight in the eye and said, “You are still that guy. Cancer doesn’t get to decide who you are.” He reminded me of who I was before cancer. More importantly, he reminded me that the person I was before cancer didn’t disappear. He’s still here. Maybe bruised. Maybe slower. Maybe wearing Depends. But still here. He then suggested, somewhat unexpectedly, that I consider signing up for a physique competition, as I had done frequently and successfully in the past. I laughed heartily, but he was serious.
Shortly thereafter, while using my Peloton, an online instructor, Robin Arzón, stated, “I’d rather go too far than go nowhere,” a remark that resonated deeply with me. That statement arrested my thoughts. Going “too far” had caused my postoperative complications, yet going nowhere was the effect of months of depression. I had been immobilized by fear, fear of movement, mistrust of my instincts, and reluctance to attempt recovery. I realized that going too far is not inherently problematic; rather, the issue lies in going too far without guidance, clarity, or informed decision-making, especially when attempting to be the “good patient” rather than an informed one.
I am not the previous version of myself, the pre-cancer individual who could effortlessly complete 15,000 steps daily or who believed recovery depended solely on willpower. I am the version of myself who has learned, sometimes painfully, that healing is not linear; that instructions require contextualization; that “activity” varies among individuals; that postoperative depression is not a personal failure but a documented, common physiological response to trauma; and that seeking help, from a trainer, physician, or even an anonymous Peloton instructor, is not a weakness but a means of survival.
If I could revisit the past, I would ask more questions, request clearer instructions, and inform my surgeon: “I walk 15,000 steps daily. What does ‘stay active’ mean for someone like me?” I would advocate for myself as I now encourage all patients to do. However, I cannot return to the past; I can only move forward. Moving forward entails showing up, gradually trusting my body, releasing guilt and fear, and allowing myself to believe that healing is possible both physically and mentally. Therefore, I am ready. And perhaps ready to participate in that physique competition once more. Depends and all.
Francisco M. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine and can be reached at Florida Spine Institute and Wellness.
Dr. Torres was born in Spain and grew up in Puerto Rico. He graduated from the University of Puerto Rico School of Medicine. Dr. Torres performed his physical medicine and rehabilitation residency at the Veterans Administration Hospital in San Juan before completing a musculoskeletal fellowship at Louisiana State University Medical Center in New Orleans. He served three years as a clinical instructor of medicine and assistant professor at LSU before joining Florida Spine Institute in Clearwater, Florida, where he is the medical director of the Wellness Program.
Dr. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine. He is a prolific writer and primarily interested in preventative medicine. He works with all of his patients to promote overall wellness.
