The first morning sans nose throat stomach pipe the doctor and his entourage looked on with less of a confident gaze than usual. Numbers were mentioned and questions requested.
In my yoof I was pretty good at the smart Alec one liners and caustic put downs. In fact I was very good but this did not make me popular with management or colleagues as my interjections invariably extended the meetings. It wasn't smart and it wasn't clever but the day came when the smart retort was there but the moment had passed. Some thought it long overdue sign of maturity but really it was just decay.
So it was most days with the doctor and the opportunity for questions. I thought of them about 90 seconds after they'd gone. Fortunately one of his youthful entourage was a pretty petite doctor with a ready smile and understanding eyes. She would usually casually return later ostensibly to browse the ring folder of notes at the foot of thd bed but i think she was just saving me the embarrasment and providing opportunity for queries to be explained.
She it was who explained about the new me. I told her that my mum said I could eat a horse and chase the driver. Rider, she offered. Driver I assured her. Growing up the only horse we ever seen was strapped into Ben Phillips' cart with Ben Phillips holding the reins as he lurched off the sand, up the slip and proceeded to fill in the gaps between the cobbles with ray slime. It made the wharf a very slippery place. I used to think it was why the rays were called skate. I was wrong about that, too.
Anyway, I explained that the only time I felt proper full was Christmas or Chinese take away nights. She informed me that I'd get used to feeling full because the lower part of my stomach, the stretchy springy bit capable of mighty expansion was by now, ashes. The top part would stretch, a bit, given enough time but seeing as it was all I had left I'd better get used to it.
She also expounded the doctors comment about wind. He said it was important that if breaking wind I should do so with maximum gusto. Gosh, after a lifetime of exercising a degree of genteel decorum I was now expected to let rip. How ever would I manage? It was to shake the digestive tract into wakefulness. Alas, a lifetime habit was hard to break but I managed, albeit with what had to be considered pathetic results.
Today she explained that with no ng tube we had to ensure that the tract from mouth to t'other end was complete and functional otherwise it would be back to tubes and china clay in a bag. To this end a x-ray had been scheduled for this afternoon and I was nil by mouth from now.
She was lovely but a warning would not have been inappropriate. When wheeled into x-ray room 16 some six hours later it was somewhat different to the x-ray rooms previously encountered. It was dominated by a table that i was invited to lie on and relax. The former was a chilling experience the latter impossible.
Once on it a lady hiding behind a serious screen offered a glass tumbler with 20mm or so of clear liquid for me to take. I was asked to drink it, hold it in my mouth and swallow when asked. This I did. The man in charge told me it wasn't that bad and people were known to exaggerate its unpleasantness but It wasn't as bad is they make out he assured me. It was viscous and would take a determined swallow he said. It was the most vile stuff imaginable.
No sooner had I done as asked my head was tilted with the rest of me dramatically downwards. More foul liquid.
Next I was tilted head up, feet down for the next dose of nastiness. This was more of a struggle than I'd expected as I was tilted back again as I swallowed. Unfortunately, as I was tilted back I caught a glimpse of a glass beaker full of fullness. I quaked and urged at the thought of what was coming next.
Sure enough, once back to level he explained that for the encore I would have to swallow as smoothly as I could as I was rotated longitudinally ending up sideways. I valiantly did as I was told.
Once flat on my back and feeling a tad unsettled he allowed me to sit up and watch the movie. He showed me my digestive track being polluted with silvery shiny stuff but it flowed smoothly from mouth to you can guess where. This led to the obvious question. He suggested any time soon. I also told him what I thought of his views of the foul concoction. I know, he said, its utterly awful, isn't it?
The important thing was that x-ray the movie had established that the plumbing was neither leaky or blocked.
Back on the ward the young lady doctor "happened" along and sips was wiped off my ID plate. I had a plastic disposable beaker of tomato cuppa soup placed in front of me.
Less than half of it's content left me feeling strangely full up and once the disappointment of having to leave most of it had been overcome I was overwhelmed by a feeling I hadn't felt in a long time.
The vile viscous liquid was on the move and so was I.
Monday, May 29, 2017
Friday, May 26, 2017
Conscious uncoupling
It seems to me that being a patient in our NHS is a tremendous privilege. If we listen to the despicable BBC we are given the impression hat it is on its last legs chock full of elderly bed blockers. As usual the wicked BBC agenda doesn't concern itself with observations beyond the witterings of the permanently dissatisfied on Facebook or the grammatically challenged twitterati.
However, a rant is best left till later, for now I have to report that progress was smooth and mostly painless. Uncomfortable at times, but never disheartening except when fellow patients were horrible to their nurses (and everyone else) but the nurses never failed to do anything but that which was for the best.
In my case they kept telling me how well I was doing, to which, once my tongue was loose and enough sips had been sipped, I had to confess that progress had little to do with me. As the Psalmist says, "we are fearfully and wonderfully made" and all I did was offered my arms to the phlebotomists every time they wanted blood which was at least once a day and every 3 or 4 days the cannulas needed replacing.
I offered a place to put needles, they hung bags on the drip rails, I lay there and improved. Not exactly a lot of effort on my part, is it?
On Monday a couple of nurses came to remove the driver and tubes which had supplied local anaesthetic so valiantly. This was about the first time I had to lean forward but they gave me a heads up to let me press the morphine button but, alas, every time I managed to press it 3 or 4 times I forgot to carry on pressing.
They removed the redundant hardware and laid out before me were a pair of small bore tubes easily 200mm long as I guess they had to be to circumscribe the not inconsiderable arc. What amazing technology but far more amazing are the people who know how to use it. Whilst they were at it they peeled off a few more electrical contacts as well. They missed a couple but that's not a complaint!
The next day a nurse came looking like she was going to undertake a serious bit of
surgery. Which, indeed, she was. Stitched in the side of my neck was a plastic lump with electrical contacts and a few flying leads. Much swabbing, dabbing and the application of sterile blue sheets about the shoulder and neck ensued. A scissors delicately handled and expertly wielded removed the stitches as another nurse arrived on cue to hold a large absorbent pad over my neck. I was advised that I wasn't to move for at least 1/2 an hour so I offered to apply pressure myself. In a swift move a black worm about 3mm or so in diameter and 200-250mm long with a shiny silver cap on the end was extracted from my neck.
This had been in contact with my heart and had been giving a continuous readout of blood pressure, heart rate, oxygen saturation and a myriad other things. It wasn't till it went that I was aware of how uncomfortable it had been.
I was allowed to apply my own pressure. It was so nice to be allowed to do something.
Next, the right hand abdominal drain was removed, it hadn't been doing a lot compared to the other but it was still nice to get rid of it. I assumed that it would hurt a bit but not at all. The nurse asked me questions and every time I breathed out he gently extracted a bit more. In no time he held it aloft. I was waiting for him to start.
The catheter was next to go and at the same time I had a cannula removed and not replaced. Unfortunately, we had got to the point where my veins ran away at the sound of the phlebotomists footfall. I had a picc(?) line inserted. This was 550mm of thin blue plastic tube which was inserted in the inside of the upper arm and using ultrasound is guided to a point in the centre of the chest. It was terminated with a pair of flying cannula terminals. This came out on the day before my leaving.
After a week or more I was hydrated so the thirst had abated but sips were still all I was allowed. Eventuality a dietician appeared by my bed. She proudly wore a badge of a white cross on a black background. I was at ease. She was going to feed me.
Hooray! In truth I wasn't hungry but I asked her for a pasty, Hampson' s hogs pudd'n sandwich and so on. OK, she said. It'll be mixed up but mostly there.
It was all in a grey bag the label of which is opposite. She assured me that lots of the contents were constituents of a pasty. The next bag would have a load of s cones in it and the jam would be under the cream, proper like. I think she may have been winding me up but there are a lot of chemicals on that list so I didn't argue although I said I thought it more like kaolin, China clay.
This stuff kept me going for over a week. When I say going I wasn't going in all areas.
Bit by bit I was becoming mobile. Not very and not independently but sitting in a chair was a big deal and walking two metres was a major achievement.
My almost constant companion was a great source of encouragement most mornings
But come the afternoons I had to vacate the chair whilst she slept. I lay down and did likewise but usually for much longer.
All this time the ng tube was filling a beast of a bag. It was the single most inconvenient attachment. After nearly a fortnight the tube fell out as I got up from the chair. It was replaced. Unsuccessfully as shown by an x-ray so another was put in.
A most unpleasant experience but at least the beast of a bag gave way to a more modestly sized bag. Shame it wasn't a little more discreet.
Alas, a day later the new one slid out so slowly I didn't even notice.
The doctor was consulted. We need to get his stomach working and his bowels, too. Leave it out and we'll see what happens.
I cannot begin to describe the feeling of not having a tube up your nose but I'm sure you can imagine it, I just hope that if you've never experienced it you never have to.
It felt like getting better ought to feel.
However, a rant is best left till later, for now I have to report that progress was smooth and mostly painless. Uncomfortable at times, but never disheartening except when fellow patients were horrible to their nurses (and everyone else) but the nurses never failed to do anything but that which was for the best.
In my case they kept telling me how well I was doing, to which, once my tongue was loose and enough sips had been sipped, I had to confess that progress had little to do with me. As the Psalmist says, "we are fearfully and wonderfully made" and all I did was offered my arms to the phlebotomists every time they wanted blood which was at least once a day and every 3 or 4 days the cannulas needed replacing.
I offered a place to put needles, they hung bags on the drip rails, I lay there and improved. Not exactly a lot of effort on my part, is it?
On Monday a couple of nurses came to remove the driver and tubes which had supplied local anaesthetic so valiantly. This was about the first time I had to lean forward but they gave me a heads up to let me press the morphine button but, alas, every time I managed to press it 3 or 4 times I forgot to carry on pressing.
They removed the redundant hardware and laid out before me were a pair of small bore tubes easily 200mm long as I guess they had to be to circumscribe the not inconsiderable arc. What amazing technology but far more amazing are the people who know how to use it. Whilst they were at it they peeled off a few more electrical contacts as well. They missed a couple but that's not a complaint!
The next day a nurse came looking like she was going to undertake a serious bit of
This had been in contact with my heart and had been giving a continuous readout of blood pressure, heart rate, oxygen saturation and a myriad other things. It wasn't till it went that I was aware of how uncomfortable it had been.
I was allowed to apply my own pressure. It was so nice to be allowed to do something.
Next, the right hand abdominal drain was removed, it hadn't been doing a lot compared to the other but it was still nice to get rid of it. I assumed that it would hurt a bit but not at all. The nurse asked me questions and every time I breathed out he gently extracted a bit more. In no time he held it aloft. I was waiting for him to start.
The catheter was next to go and at the same time I had a cannula removed and not replaced. Unfortunately, we had got to the point where my veins ran away at the sound of the phlebotomists footfall. I had a picc(?) line inserted. This was 550mm of thin blue plastic tube which was inserted in the inside of the upper arm and using ultrasound is guided to a point in the centre of the chest. It was terminated with a pair of flying cannula terminals. This came out on the day before my leaving.
After a week or more I was hydrated so the thirst had abated but sips were still all I was allowed. Eventuality a dietician appeared by my bed. She proudly wore a badge of a white cross on a black background. I was at ease. She was going to feed me.
It was all in a grey bag the label of which is opposite. She assured me that lots of the contents were constituents of a pasty. The next bag would have a load of s cones in it and the jam would be under the cream, proper like. I think she may have been winding me up but there are a lot of chemicals on that list so I didn't argue although I said I thought it more like kaolin, China clay.
This stuff kept me going for over a week. When I say going I wasn't going in all areas.
Bit by bit I was becoming mobile. Not very and not independently but sitting in a chair was a big deal and walking two metres was a major achievement.
My almost constant companion was a great source of encouragement most mornings
A most unpleasant experience but at least the beast of a bag gave way to a more modestly sized bag. Shame it wasn't a little more discreet.
Alas, a day later the new one slid out so slowly I didn't even notice.
The doctor was consulted. We need to get his stomach working and his bowels, too. Leave it out and we'll see what happens.
I cannot begin to describe the feeling of not having a tube up your nose but I'm sure you can imagine it, I just hope that if you've never experienced it you never have to.
It felt like getting better ought to feel.
Daylight on e-Bay
My recollection of the side room sojourn is (probably) forever lost in the rarefied synapses of a somewhat comfortably numb brain. All I can remember is that if I opened my eyes they met a ceiling tile on which was painted an iconic ex-lighthouse but, of course even that is a suspect observation.
However, my almost constant companion is, as always, an indispensable fount of all knowledge. It seems that a surgeon offered the wise appraisal that I was ready to be put on E-bay, the operation had been a success, the tumour was deeper than expected, I was more awkward than anticipated and that my recovery would traverse a somewhat rocky road.
Unaware of any of this I was duly wheeled into E1.
Awareness doesn't come with a bang but a whimper. First thoughts relate to the impossibility of normal movement, the reasons for your predicament and what to do about it. Bits of me could move but such bits were of no motor significance. I was aware of being thirsty. "Sips" was written by my name on the wall I was told. Sips it was then. For 2 1/2 weeks!
The reasons for my immobility were now illuminated by daylight. The cannulas in each wrist were fully piped up, a few wires still wandered about but the most obvious reasons were hanging from the security rail along my left side.
From foot to armpit they were a large bag connected to a catheter, a slightly smaller bag connected to an abdominal drain traceable to my right hand side almost a hands length from my navel, whilst from almost the navel itself was another drain which was in the space recently vacated by items once a valued part of my digestive tract. This tube would stay for another 6 weeks and necessitate 2 trips to A&E in an ambulance. Finally, the beast in so many ways, a huge bag catching the outpouring of my nasal gastric (ng) tube. For a stomach that was but a portion of it's former self and a non working one at that this bag when not full was filling rapidly.
Having digested the reasons for my immobility the issue of what to do about it was easily answered.
Life in E-bay wandered along in a rhythm of semi lucid moments interspersed between lapses into semiconsciousness and sleep. Frequent interruptions came in the shape of persons who wanted to put needles into me, those who wanted to see how my heart/lungs/temperature were responding to recent events and those enquiring after my wefare.
Not having a working stomach all medication bar one was intravenous, the one that wasn't was a vile tasting orangey yellow paste in a syringe that had to be swallowed each evening. It, sadly, wasn't the most vile stuff I had to swallow but that was a fortnight away.
I do remember on Saturday a nurse came along with a spring in her step and cheerfully announced that I wasn't going to like her. With that announcement she turned off the local anaesthetic driver putting pain killer into the tubes in my back from where it was piped round to the front where it was doing it's job. Just how well it was doing it's job became apparent in a fairly short while.
Just as well I had the strength to press the morphine button, even better that someone put it in my hand but as I would see everyone did all they could for me and if there was an extra mile to go on my behalf they went without complaint.
However, my almost constant companion is, as always, an indispensable fount of all knowledge. It seems that a surgeon offered the wise appraisal that I was ready to be put on E-bay, the operation had been a success, the tumour was deeper than expected, I was more awkward than anticipated and that my recovery would traverse a somewhat rocky road.
Unaware of any of this I was duly wheeled into E1.
Awareness doesn't come with a bang but a whimper. First thoughts relate to the impossibility of normal movement, the reasons for your predicament and what to do about it. Bits of me could move but such bits were of no motor significance. I was aware of being thirsty. "Sips" was written by my name on the wall I was told. Sips it was then. For 2 1/2 weeks!
The reasons for my immobility were now illuminated by daylight. The cannulas in each wrist were fully piped up, a few wires still wandered about but the most obvious reasons were hanging from the security rail along my left side.
From foot to armpit they were a large bag connected to a catheter, a slightly smaller bag connected to an abdominal drain traceable to my right hand side almost a hands length from my navel, whilst from almost the navel itself was another drain which was in the space recently vacated by items once a valued part of my digestive tract. This tube would stay for another 6 weeks and necessitate 2 trips to A&E in an ambulance. Finally, the beast in so many ways, a huge bag catching the outpouring of my nasal gastric (ng) tube. For a stomach that was but a portion of it's former self and a non working one at that this bag when not full was filling rapidly.
Having digested the reasons for my immobility the issue of what to do about it was easily answered.
Life in E-bay wandered along in a rhythm of semi lucid moments interspersed between lapses into semiconsciousness and sleep. Frequent interruptions came in the shape of persons who wanted to put needles into me, those who wanted to see how my heart/lungs/temperature were responding to recent events and those enquiring after my wefare.
Not having a working stomach all medication bar one was intravenous, the one that wasn't was a vile tasting orangey yellow paste in a syringe that had to be swallowed each evening. It, sadly, wasn't the most vile stuff I had to swallow but that was a fortnight away.
I do remember on Saturday a nurse came along with a spring in her step and cheerfully announced that I wasn't going to like her. With that announcement she turned off the local anaesthetic driver putting pain killer into the tubes in my back from where it was piped round to the front where it was doing it's job. Just how well it was doing it's job became apparent in a fairly short while.
Just as well I had the strength to press the morphine button, even better that someone put it in my hand but as I would see everyone did all they could for me and if there was an extra mile to go on my behalf they went without complaint.
Thursday, May 18, 2017
A Hard Days Twilight
When casualty handling you must always be aware that hearing is the last of the senses to fade. It's also the first to return. The comforting voice of the surgeon declared that I was breathing on my own. It would seem that although I have no recollection of it I asked him to phone my wife with news. Next day she told me that he had done as requested at about 2100, one of the other surgeons had phoned a bit earlier.
The ICU is in a twilight zone and you are constantly monitored. My first memory is of machines and a maze of wires which would do a Spanish property developer proud. They were coming from everywhere and I was lying between a canyon of digital and graphical displays. There were also tubes. Loads of tubes. And an oxygen mask. I couldn't move which was just as well.
A young lady asked if I was OK and how would I score my pain on a scale of 1-10? Not much, hardly any, in fact. I was told to let her know if that changed. She was busy doing something but it was dimpsy and I slept.
The next recollection is of wires being disconnected and a machine being wheeled away. She was joined by a young Scotsman, an RAF sergeant studying physics so this was the day shift changeover. I wasn't in pain of any serious note but the discomfort level was in the ascendant.
Gently, wires were moved from under me although it was over a week before their pad connectors were removed, the now unused pads on my chest were peeled off to leave a set of stamp sized smoothly shaved patches randomly adorning the upper belly and chest. The ones around the heart remained for a few more hours.
Trying to speak when your tongue is stuck fast to the roof of your mouth, your throat feels like it's concrete, you have a tube up your nose and your face is the resting place to store an oxygen mask is difficult. My wrists were recipients of drips and drivers. To my right was a local anaesthetic driver with tubes to my back and a too familiar morphine driver to my wrist. Last time I saw one of those it was covered by a cloth and placed beside mum in the hospice.
Further memories were ignited once my industrious attendee lifted the oxygen mask and offered me a moistened pink sponge on a stick. It may be nine years ago but it doesn't take much to reignite precious memories. I got to relish those pink sponges.
A settled moment was delightfully interrupted when he pulled a chair up beside me and my wife filled it two hours before she should have. It was suggested that a few minutes wouldn't matter but come back at 11.
No sooner had she left than my attentive sergeant was over at the next bay where things were not going smoothly. As more personnel arrived, then more technology, machines and yet more personnel it was difficult to not hear the import of the instructions being given. My ever attentive sergeant returned to monitoring my functions and noting assiduously.
A life hung in the balance. No effort was spared. No grain of expertise that could be brought to bear was withheld. Being only a few feet away was soberly inspiring. Prayer doesn't guarantee the outcome you want but it does guarantee comfort.
After two hours the fight was lost. A lady in her late forties had died. The atmosphere changed and all the technology, machinery and personnel melted away. A middle aged man in shorts was led to a corner and given something to drink.
The doctor in charge was almost the last to leave. As he passed by the end of my bed he paused, turned and came over. Crouching down by my ear he asked if I was aware. I nodded. He asked if I was OK. I nodded. Was I sure, nods, did I want .... No. I'm not unfamiliar with death and I couldn't speak at that time but before I left the unit I was able to thank him for his courtesy and consideration toward me at such a time as that.
As soon as possible the chair was replaced by my side and filled.
The day drifted sombrely along, pink sponges wrung out between my tongue and the roof of my mouth, but never enough, not even remotely enough. Wires continued to be removed, gadgets wheeled away until eventually it was just drips and two drivers. I was assured that progress was as good as it was likely to be and by late afternoon I was ready for the ward.
Eventually a couple of porters arrived wheeling a bed. I had to be transferred to it. My wife was ushered away. I was belatedly given the morphia button to press. Too little, too late. The transfer to a board by rolling me was excruciating and by far the worse pain I experienced throughout.
Once transferred I was wheeled along cold corridors with windows letting in the darkness until eventually I was in a side room, familiar visitor by my side with luxurious dressing gown and cable tied slippers in tow.
On the door was written "Sips".
The ICU is in a twilight zone and you are constantly monitored. My first memory is of machines and a maze of wires which would do a Spanish property developer proud. They were coming from everywhere and I was lying between a canyon of digital and graphical displays. There were also tubes. Loads of tubes. And an oxygen mask. I couldn't move which was just as well.
A young lady asked if I was OK and how would I score my pain on a scale of 1-10? Not much, hardly any, in fact. I was told to let her know if that changed. She was busy doing something but it was dimpsy and I slept.
The next recollection is of wires being disconnected and a machine being wheeled away. She was joined by a young Scotsman, an RAF sergeant studying physics so this was the day shift changeover. I wasn't in pain of any serious note but the discomfort level was in the ascendant.
Gently, wires were moved from under me although it was over a week before their pad connectors were removed, the now unused pads on my chest were peeled off to leave a set of stamp sized smoothly shaved patches randomly adorning the upper belly and chest. The ones around the heart remained for a few more hours.
Trying to speak when your tongue is stuck fast to the roof of your mouth, your throat feels like it's concrete, you have a tube up your nose and your face is the resting place to store an oxygen mask is difficult. My wrists were recipients of drips and drivers. To my right was a local anaesthetic driver with tubes to my back and a too familiar morphine driver to my wrist. Last time I saw one of those it was covered by a cloth and placed beside mum in the hospice.
Further memories were ignited once my industrious attendee lifted the oxygen mask and offered me a moistened pink sponge on a stick. It may be nine years ago but it doesn't take much to reignite precious memories. I got to relish those pink sponges.
A settled moment was delightfully interrupted when he pulled a chair up beside me and my wife filled it two hours before she should have. It was suggested that a few minutes wouldn't matter but come back at 11.
No sooner had she left than my attentive sergeant was over at the next bay where things were not going smoothly. As more personnel arrived, then more technology, machines and yet more personnel it was difficult to not hear the import of the instructions being given. My ever attentive sergeant returned to monitoring my functions and noting assiduously.
A life hung in the balance. No effort was spared. No grain of expertise that could be brought to bear was withheld. Being only a few feet away was soberly inspiring. Prayer doesn't guarantee the outcome you want but it does guarantee comfort.
After two hours the fight was lost. A lady in her late forties had died. The atmosphere changed and all the technology, machinery and personnel melted away. A middle aged man in shorts was led to a corner and given something to drink.
The doctor in charge was almost the last to leave. As he passed by the end of my bed he paused, turned and came over. Crouching down by my ear he asked if I was aware. I nodded. He asked if I was OK. I nodded. Was I sure, nods, did I want .... No. I'm not unfamiliar with death and I couldn't speak at that time but before I left the unit I was able to thank him for his courtesy and consideration toward me at such a time as that.
As soon as possible the chair was replaced by my side and filled.
The day drifted sombrely along, pink sponges wrung out between my tongue and the roof of my mouth, but never enough, not even remotely enough. Wires continued to be removed, gadgets wheeled away until eventually it was just drips and two drivers. I was assured that progress was as good as it was likely to be and by late afternoon I was ready for the ward.
Eventually a couple of porters arrived wheeling a bed. I had to be transferred to it. My wife was ushered away. I was belatedly given the morphia button to press. Too little, too late. The transfer to a board by rolling me was excruciating and by far the worse pain I experienced throughout.
Once transferred I was wheeled along cold corridors with windows letting in the darkness until eventually I was in a side room, familiar visitor by my side with luxurious dressing gown and cable tied slippers in tow.
On the door was written "Sips".
A Day at the Theatre
I don't remember leaving for the final trek but I do remember gratefully leaning on a chest high windowsill at the end of a queue in a cool corridor at 0650. There were about a dozen in front of us and by 0700 there were many more behind.
An office opened and each in turn handed in their letters which were scanned and further instruction issued. Yellow room, directly ahead was ours. Gratefully I sat and was so far gone that I didn't even notice the ubiquitous and iniquitous subtitled BBC decrying everything even vaguely deemed ill fitting to their directors worldview.
We didn't wait long. A surgeon informed us that we would process my case as if the operation was going ahead although there was only a 20% chance of it as there were no beds. This was the lowest point I think I reached. Tears were not far away. I couldn't imagine the alternative.
Across the corridor a nurse asked questions, took details, swabs and blood. Others were gowned up but not me. Back to the yellow room. I think I dozed.
Next, another surgeon in a room at the end of the corridor sat us down and talked. I can't remember much but he looked intently at me before summoning another surgeon, the third who would be involved in the op, if it happened. A brief conflab and more blood was taken whereupon the most recent surgeon offered to rush the samples to the lab and wait for the results. Stay here awhile and when you feel able wait in the yellow room.
Two hours or more had passed and just after 10 we were escorted into the room of surgeon number four. Except this wasn't surgeon number four. This was The Man. Tall and thin he carried the weight of authority and the calm of deciciveness like a mace and sceptre.
He was logged on to me on his computer the blood test results were not good and for the first and only time I was shown the tumour. It wasn't very impressive but it woke me from my stupor as did his next question, when did the jaundice return? Saturday, I thought or that's when my brain was out of gear more than in. My wife was invited to look in my eyes. Saffron yellow.
The stent had moved and I had an infection from it. This complicated matters and I was assured that complications would follow. My brain screamed, just do it.
We either have to accept the risk and operate or replace the stent. Just do it.
Numbers were mentioned, risks calculated and explained. Just do it.
What do you think, I was asked? Just do it, I screamed but only a whisper came out.
Now in total command he explained that the infection meant that an epidural was too risky but he'd talked to a colleague who had pioneered another process which involved a pair of needles being inserted in my back into the muscle sac of the muscle to be cut. These would be worked around to the front, terminate at each end of the incision and supply local anaesthetic for immediate post op pain relief. However, this process has never been used before in a Whipples procedure. Was I OK with that? I nodded as vigorously as I could which wasn't much.
Right he said over to Tugs. I'll see you in theatre he said. Overjoyed doesn't begin to do the feeling justice.
Outside the corridor was dominated by a young chap in green, about 5'8" tall, 3' across, 3' deep and extensively tattooed. When he spoke it was firm, gentle and so comforting. Opening a cubicle curtain a gown was folded neatly. I donned it and my wife took my clothes. Won't need them for a while he said, dressing gown and slippers will do and I'll make sure they stay with him.
My new dressing gown was a delight being a very recent gift from a daughter who was ashamed of the dressing gown that I'd worn all her life and longer. So, resplendent in M&S softness and slippers kept together with cable ties I was asked if I could walk. Oh, yes, said I with all the confidence I could muster. We walked along the corridor to a pair of combination locked doors where my wife and I said our goodbyes.
The other side of the doors opened into a locker space and a toilet in which I was encouraged to do my best. My best was pathetic but far worse was the fact that I was too feeble to get up. A large soft paw which took both my hands lifted me up and a strong arm guided me to the bright lights of the Theatre.
I was placed just so, stood by the middle of the table when two arms lifted me like I was a kid and placed me exactly where the surgeon asked. I hadn't even noticed him. A cannula was in my right wrist and I hadn't noticed that either. You'll feel sleepy but you won't go to sleep just yet said a comfortingly familiar voice behind me. Another voice explained what was going on with the ultrasound, this was the surgeons pioneering colleague.
I was asked my name, dob and if I knew what was going on. I saw the familiar diagram of my replumbing and began a description upon which I was complimented and asked to continue.
My hands were on Tugs shoulders and I was exhorted to push. Hard. My hardest was pretty poor so placing his hands on mine he leaned back as things on my back happened. Twisting me left, right, forward and back muscles were stretched and opened to allow whatever was happening to happen.
I think it was just after 1045 that Tugs said I'll lie you back and you'll be asleep.
I don't remember lying back.
An office opened and each in turn handed in their letters which were scanned and further instruction issued. Yellow room, directly ahead was ours. Gratefully I sat and was so far gone that I didn't even notice the ubiquitous and iniquitous subtitled BBC decrying everything even vaguely deemed ill fitting to their directors worldview.
We didn't wait long. A surgeon informed us that we would process my case as if the operation was going ahead although there was only a 20% chance of it as there were no beds. This was the lowest point I think I reached. Tears were not far away. I couldn't imagine the alternative.
Across the corridor a nurse asked questions, took details, swabs and blood. Others were gowned up but not me. Back to the yellow room. I think I dozed.
Next, another surgeon in a room at the end of the corridor sat us down and talked. I can't remember much but he looked intently at me before summoning another surgeon, the third who would be involved in the op, if it happened. A brief conflab and more blood was taken whereupon the most recent surgeon offered to rush the samples to the lab and wait for the results. Stay here awhile and when you feel able wait in the yellow room.
Two hours or more had passed and just after 10 we were escorted into the room of surgeon number four. Except this wasn't surgeon number four. This was The Man. Tall and thin he carried the weight of authority and the calm of deciciveness like a mace and sceptre.
He was logged on to me on his computer the blood test results were not good and for the first and only time I was shown the tumour. It wasn't very impressive but it woke me from my stupor as did his next question, when did the jaundice return? Saturday, I thought or that's when my brain was out of gear more than in. My wife was invited to look in my eyes. Saffron yellow.
The stent had moved and I had an infection from it. This complicated matters and I was assured that complications would follow. My brain screamed, just do it.
We either have to accept the risk and operate or replace the stent. Just do it.
Numbers were mentioned, risks calculated and explained. Just do it.
What do you think, I was asked? Just do it, I screamed but only a whisper came out.
Now in total command he explained that the infection meant that an epidural was too risky but he'd talked to a colleague who had pioneered another process which involved a pair of needles being inserted in my back into the muscle sac of the muscle to be cut. These would be worked around to the front, terminate at each end of the incision and supply local anaesthetic for immediate post op pain relief. However, this process has never been used before in a Whipples procedure. Was I OK with that? I nodded as vigorously as I could which wasn't much.
Right he said over to Tugs. I'll see you in theatre he said. Overjoyed doesn't begin to do the feeling justice.
Outside the corridor was dominated by a young chap in green, about 5'8" tall, 3' across, 3' deep and extensively tattooed. When he spoke it was firm, gentle and so comforting. Opening a cubicle curtain a gown was folded neatly. I donned it and my wife took my clothes. Won't need them for a while he said, dressing gown and slippers will do and I'll make sure they stay with him.
My new dressing gown was a delight being a very recent gift from a daughter who was ashamed of the dressing gown that I'd worn all her life and longer. So, resplendent in M&S softness and slippers kept together with cable ties I was asked if I could walk. Oh, yes, said I with all the confidence I could muster. We walked along the corridor to a pair of combination locked doors where my wife and I said our goodbyes.
The other side of the doors opened into a locker space and a toilet in which I was encouraged to do my best. My best was pathetic but far worse was the fact that I was too feeble to get up. A large soft paw which took both my hands lifted me up and a strong arm guided me to the bright lights of the Theatre.
I was placed just so, stood by the middle of the table when two arms lifted me like I was a kid and placed me exactly where the surgeon asked. I hadn't even noticed him. A cannula was in my right wrist and I hadn't noticed that either. You'll feel sleepy but you won't go to sleep just yet said a comfortingly familiar voice behind me. Another voice explained what was going on with the ultrasound, this was the surgeons pioneering colleague.
I was asked my name, dob and if I knew what was going on. I saw the familiar diagram of my replumbing and began a description upon which I was complimented and asked to continue.
My hands were on Tugs shoulders and I was exhorted to push. Hard. My hardest was pretty poor so placing his hands on mine he leaned back as things on my back happened. Twisting me left, right, forward and back muscles were stretched and opened to allow whatever was happening to happen.
I think it was just after 1045 that Tugs said I'll lie you back and you'll be asleep.
I don't remember lying back.
Wednesday, May 10, 2017
Nadir
Tiredness increased. Waves of nausea swept about but I was never sick. Concentration was non existent. Visitors kept the days from weighing heavily.
The operation meant another pre dawn departure on the Tuesday but the previous Friday, late afternoon I got up from the sofa and it was like every degree of heat in me fell through the floor. Crawling up he stairs I managed to get into bed as the shivering started. I've never experienced anything like it. The violence and inability to control the shivering was a bit alarming but more so for my ever attentive carer who once again did all the right things. The out of hours doctor suggested seeing my GP on Monday. Fortunately we have a very close friend who is a community nurse. By now I was under significant weight of blankets and a fetching woolly hat but the shivers hadn't abated. My blood pressure was alright but my temperature was not. Hospital or not? The risk of being kept in one when my op was due in another was too great a risk. Paracetamol and three hours saw the worst pass into history.
Our nurse advised that it felt like an infection so no more visitors till after the op.
Saturday passed sleepily and Sunday drifted away with little notice. Even eating was too much effort. Monday was a bit brighter even though it was nil by mouth right up until about 4 when the shivering returned.
My carer phoned the cancer nurse whose number we had been given. Just get him here tomorrow morning she said. The shivering was every bit as bad as earlier, I think worse because this time it was accompanied by a violent bout of sickness which coincided with the doorbell announcing the presence of our highly esteemed nurse who was on her way home and though she'd see if all was well. It wasn't but she took charge and it became so.
Another 3 hours and the shivers had become a shake, the temperature reduced and the sweat mere perspiration.
Now I had to face the Carbohydrate Lemon. Four of them in only a few hours. How 300ml in the first bottle doubles in the second, again in the subsequent ones whilst all appearing the same size is beyond me.
Sleep was elusive, the trip down a blank but the final Carbohydrate Lemon was duly poured down at 0630 in the coffee shop in the foyer whilst the car was parked.
We had arrived. I didn't care in the slightest what happened next. It was enough that we had arrived at the time and place specified but I'd had nothing to do with it.
My carer had excelled, again.
Now it was over to the surgeons.
The operation meant another pre dawn departure on the Tuesday but the previous Friday, late afternoon I got up from the sofa and it was like every degree of heat in me fell through the floor. Crawling up he stairs I managed to get into bed as the shivering started. I've never experienced anything like it. The violence and inability to control the shivering was a bit alarming but more so for my ever attentive carer who once again did all the right things. The out of hours doctor suggested seeing my GP on Monday. Fortunately we have a very close friend who is a community nurse. By now I was under significant weight of blankets and a fetching woolly hat but the shivers hadn't abated. My blood pressure was alright but my temperature was not. Hospital or not? The risk of being kept in one when my op was due in another was too great a risk. Paracetamol and three hours saw the worst pass into history.
Our nurse advised that it felt like an infection so no more visitors till after the op.
Saturday passed sleepily and Sunday drifted away with little notice. Even eating was too much effort. Monday was a bit brighter even though it was nil by mouth right up until about 4 when the shivering returned.
My carer phoned the cancer nurse whose number we had been given. Just get him here tomorrow morning she said. The shivering was every bit as bad as earlier, I think worse because this time it was accompanied by a violent bout of sickness which coincided with the doorbell announcing the presence of our highly esteemed nurse who was on her way home and though she'd see if all was well. It wasn't but she took charge and it became so.
Another 3 hours and the shivers had become a shake, the temperature reduced and the sweat mere perspiration.
Now I had to face the Carbohydrate Lemon. Four of them in only a few hours. How 300ml in the first bottle doubles in the second, again in the subsequent ones whilst all appearing the same size is beyond me.
Sleep was elusive, the trip down a blank but the final Carbohydrate Lemon was duly poured down at 0630 in the coffee shop in the foyer whilst the car was parked.
We had arrived. I didn't care in the slightest what happened next. It was enough that we had arrived at the time and place specified but I'd had nothing to do with it.
My carer had excelled, again.
Now it was over to the surgeons.
Fit enough for purpose
Thus a week or so later the car was fired up before dawn for the "final" trip pre op 50 miles down the road. Arriving in the gloom I was decanted at the entrance shortly before 0700 and left in the coffee shop whilst the car was parked. Didn't fancy coffee but I think I had one just to use the seat with a clear conscience.
Before 0730 we had made our way to the ward where the appointment awaited. In the waiting room a large TV on the wall flashed up colourful BBC subtitles. It took only a few moments to remember how awful the BBC has become. I stopped watching the news last autumn and more recently gave up on R4 flagship news programmes. It seems that reporting has gone by the board, now it's all about the agenda of the reporter and their worldview. Frankly, I think that the BBC should be a subscription service and if they don't know what to do with the license fee they can donate it to the NHS but I despise the Corporation and it's fat cat mentality. If you can't do anything meaningful in your life join the BBC get £150k salary and more if you fail in your duties and get sacked. Lord Reiths charter needs tattooing in every senior managers forehead so that when sat in meetings those listening can see what it's meant to be about.
Fortunately, before a photo of Tony Blair wound me up further a name familiar was called. We were led into a room with a tall green clad thin man getting up from a desk and looking me over. When skinny people look at you it's not too difficult to read their minds and so it was. He explained that I was there to assess my suitability for the Whipples Procedure, then a week away. A few questions later he asked if I could manage to get on the exercise bike but added that I shouldn't worry if I couldn't as there were other ways of making an assesment. I offered the opinion that I could only ride his bike if the saddle was higher, the handle bars further forward and lower. He looked very politely taken aback as I continued letting him know that when my wife bought my Specialized hydraulic disk braked wonder I was measured to fit.
The bike was duly configured to make it comfortable and I was wired, front and rear, masked, nose clipped and told not to talk, just to follow instructions. Pedal at 60-70 cadence, if you can. I could and did. Now you will feel like you're going uphill keep the pedalling constant, please. I'm still waiting for the hill but the maintenance of the cadence was only what I always do.
Of course, going uphill on an exercise bike does not involve the vertical lifting of any bulk bar the legs so it's nothing like going uphill at all. He kept making pleasantly surprised noises until after about 10 minutes he asked how long I could keep this up. Two hours, more if it's sunny I said. OK, slow down but don't stop till this number gets to 0 he said pointing to the corner of one of the flatscreens.
I didn't break sweat and I think he was impressed because for the next 10 minutes he pointed out graphs, numbers, charts and tables. VO/VO2 is important, as is the crossover whenever you go anaerobic/aerobic ........
Eventually, realising I was lost he said that I had the heart of an ox and no furring of arteries. The lungs were good, too, not perfect but for a 61 year old fat bloke they were more than the expected average. Espressos every morning and cycling on sunny days I explained. He reduced my risk of complications from 30-40% to 12-15% and mortality risk from a very low number to a lower one. This means that you probably won't need ICU post op but can go onto a surgical ward. Much better from our point of view he said.
I did feel chuffed and he then spoke to a nurse who fast tracked us through the inevitable blood tests, swabs, and myriad other details and we left with 6 300ml bottles labelled Carbohydrate Lemon for ingestion immediately before the op, 4 during the evening prior, one as we left on the morning and the last one when we got to hospital at 0700.
By 1100 we were home.
The last of the really good days for a month or more had passed but we didn't know it.
Before 0730 we had made our way to the ward where the appointment awaited. In the waiting room a large TV on the wall flashed up colourful BBC subtitles. It took only a few moments to remember how awful the BBC has become. I stopped watching the news last autumn and more recently gave up on R4 flagship news programmes. It seems that reporting has gone by the board, now it's all about the agenda of the reporter and their worldview. Frankly, I think that the BBC should be a subscription service and if they don't know what to do with the license fee they can donate it to the NHS but I despise the Corporation and it's fat cat mentality. If you can't do anything meaningful in your life join the BBC get £150k salary and more if you fail in your duties and get sacked. Lord Reiths charter needs tattooing in every senior managers forehead so that when sat in meetings those listening can see what it's meant to be about.
Fortunately, before a photo of Tony Blair wound me up further a name familiar was called. We were led into a room with a tall green clad thin man getting up from a desk and looking me over. When skinny people look at you it's not too difficult to read their minds and so it was. He explained that I was there to assess my suitability for the Whipples Procedure, then a week away. A few questions later he asked if I could manage to get on the exercise bike but added that I shouldn't worry if I couldn't as there were other ways of making an assesment. I offered the opinion that I could only ride his bike if the saddle was higher, the handle bars further forward and lower. He looked very politely taken aback as I continued letting him know that when my wife bought my Specialized hydraulic disk braked wonder I was measured to fit.
The bike was duly configured to make it comfortable and I was wired, front and rear, masked, nose clipped and told not to talk, just to follow instructions. Pedal at 60-70 cadence, if you can. I could and did. Now you will feel like you're going uphill keep the pedalling constant, please. I'm still waiting for the hill but the maintenance of the cadence was only what I always do.
Of course, going uphill on an exercise bike does not involve the vertical lifting of any bulk bar the legs so it's nothing like going uphill at all. He kept making pleasantly surprised noises until after about 10 minutes he asked how long I could keep this up. Two hours, more if it's sunny I said. OK, slow down but don't stop till this number gets to 0 he said pointing to the corner of one of the flatscreens.
I didn't break sweat and I think he was impressed because for the next 10 minutes he pointed out graphs, numbers, charts and tables. VO/VO2 is important, as is the crossover whenever you go anaerobic/aerobic ........
Eventually, realising I was lost he said that I had the heart of an ox and no furring of arteries. The lungs were good, too, not perfect but for a 61 year old fat bloke they were more than the expected average. Espressos every morning and cycling on sunny days I explained. He reduced my risk of complications from 30-40% to 12-15% and mortality risk from a very low number to a lower one. This means that you probably won't need ICU post op but can go onto a surgical ward. Much better from our point of view he said.
I did feel chuffed and he then spoke to a nurse who fast tracked us through the inevitable blood tests, swabs, and myriad other details and we left with 6 300ml bottles labelled Carbohydrate Lemon for ingestion immediately before the op, 4 during the evening prior, one as we left on the morning and the last one when we got to hospital at 0700.
By 1100 we were home.
The last of the really good days for a month or more had passed but we didn't know it.
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