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Using autobiographical material, the patient experience of major surgery (panproctocolectomy and ileostomy) is described. A number of stages are identified in the patient experience: the development of dependence before surgery; disconnectedness from the social world immediately after surgery; and reality shock as grief and loss became apparent. The data are analysed using a theoretical perspective originally developed to describe reactions to bereavement. The practical nursing and counselling implications deriving from the theoretical model are elaborated.