Cholecystectomy
A few months after my fundoplication and with my leg in plaster having broken my ankle, I was to have another abdominable laparoscopic operation.
I recorded my experiences (though have removed names):
In the early hours of a summer Monday, I realised I was probably going to need an ambulance after a night of the severest pain I had ever encountered. Unusually, my wife, K, was away for few days helping her younger son move house. I decided she should go alone as I'd be more of a hindrance than a help; a few days before, I'd discovered the sprained ankle I'd been hobbling around on for four weeks was actually a fractured fibula and now I was in plaster.
I had sufficient presence of mind to grab a few things together and called NHS Direct. After convincing them their suggestion of me getting a taxi to take me to A&E was impractical, they did send a paramedic and ambulance. Each took ECG's (clear) and normal monitoring but could offer no pain meds.
It was about 5:00am I arrived at SGH. I received a lengthy ultrasound (though what was to subsequently become of that record, I don't know – it might have reduced my stay), x-rays and much probing by doctors in the Emergency department (which felt a bit like an underground bunker). I saw so many doctors and nurses, I cannot possibly remember all their names.
As I was being attended to, news was brought in that a crane had fallen at the docks; although concern was expressed as to how many casualties they may expect (fortunately soon to be confirmed as one) and how many bays they made need to keep clear, my attending medics continued with my assessments calmly.
I was transferred to A&E and placed in another cubicle. More doctors came to see me.
The same questions were asked a hundred times: Can you confirm your name? Date of birth? Have you any allergies? Do you smoke? Do you drink? Have you taken any other form of recreational drug? Are you diabetic? Your local GP surgery is? Can you confirm your address? Are you wearing any jewellery? Do you have any piercings? Do you wear dentures? Have you any crowns or loose fillings? Do you wear glasses or contact lenses? When did you last eat? When did you last drink? When did you last pass water? Open your bowels? …
Then they'd ask me to describe the pain. I always find this very difficult. There should be a checklist of words to use. It's easier to ask for coffee at Starbucks: Black or white? Strong or weak? Sugar?
My description of it feeling like a heavy fuzzy bowling ball of pain, where my stomach ought to be, trying to push floorwards was insufficient. “But can you describe it?” I had to say it was like a very intense bruise but felt they might think I just had a stitch. Was there a sharp pain? Did it go through to my back, shoulders, arms? I had to show and describe where it was whilst they pummelled and prodded and tapped to make sure. “And on a scale of one to ten …?” “Twelve!” I replied.
A nurse phoned my wife to let her know where I was. She was very concerned and in a dilemma as to whether to come straight home or finish what she was doing for her son. She made the right decision – if she'd come back she'd not have been able to do anything. She kept in contact with the hospital and our friends S and Z who live nearby.
I was transferred to ward E5, the GI emergency admissions ward.
More doctors and nurses. “Can you confirm …?”
My memories of that day are my least clear. There were beds coming and going, doctors and nurses coming and going, “Can you confirm …?”, prodding and needles. I'd had a cannula put in my right inside elbow in the ambulance with two extension feeds and eventually had another inserted in my left inside elbow additionally so I could receive all sorts of pain relief and antibiotics but they could also continue taking blood samples. Dracula would have had a field day.
“NIL BY MOUTH” hung over the bed and the doctors told me I wouldn't be eating or drinking as they were keeping the surgery options open. That was fine by me: the last thing on my mind was food.
More tests, “Where does it hurt?”, “Can you describe the pain?” … More ECGs, Have you had an x-ray? Yes. Ultra sound? Yes. But they couldn't find a record of it.
The consensus was I had gall stones or pancreatitis. Ultra sound and endoscopies were planned for the next day.
S visited that afternoon and stayed and chatted for a couple of hours. Thoughtfully, he'd been out and bought me toothbrush and toothpaste. When he left, he also left me his Independent to read.
I had already known I wouldn't get much sleep that night. Every few minutes another Baxter pump regulating the speed of intravenous delivery to another patient would start its insistent “Beep, beep, beep.” advising the lead may have been kinked or snagged. These beeps were interspersed with the regular singular beeps from pressed nurse call buttons whilst all the time at least two different telephones would be adding their incessant rings to the general cacophony. Rattles of trolleys, conversations and the noise of people in pain provided additional accompaniment.
I've never understood why some people have to make so much noise about their suffering. I've discovered I have quite a high tolerance for pain but those who make such a noise over even small amounts of pain, I believe are selfishly attempting to persuade everyone else their pain is worse and demand more attention from the over-worked doctors and nurses. A case in point was an African woman in A&E who only ceased her continual wailing when her mobile phone sounded and she verily ran across the room to where the signal was the strongest.
Then there was the man across the ward who felt the world revolved around him. He treated all staff deplorably demanding, “Bottle!” when he was quite capable of walking to the toilets across the corridor. He was overweight, smoked and drank heavily, was diabetic and his only exercise was to walk between his front door and the car. His bilirubin levels were obviously high and getting noticeable as the day progressed. I was amazed at how unruffled the nurses were by his demeaning demands on them, interrupting them when they were obviously busy with another patient.
Tuesday gave me a better opportunity to observe how the ward ran. There was a staff nurse and her assistant nurse who were constantly on the go. They reminded me of a pair of disco light balls that spin rapidly in seemingly random patterns shining different beams of light in different directions and coming together from time to time but never resting. Their tasks that day were not helped by some sort of time and motion study being followed everywhere by another nurse who was recording the exact amount of time taken on each type of activity (except there was no column, apparently, for paperwork): “and can you say exactly what you're doing now?”.
Another doctor came to see me that morning. “Can you confirm …?”, “Can you describe the pain?”, etc. It had been decided I would not have an endoscopy but I was off to have my ultrasound.
“I've come to see if I'm pregnant,” I told the doctor, but he must have heard it all before as he didn't even raise an eyebrow. It was a matter of minutes before he declared it was gall stones and I was trundled back to the ward where another doctor, “Can you confirm …?” etc., whom I had seen previously in E5, said it was as they'd expected: “Acute cholecystitis”. (I was tempted to ask if it were the stones or their pictures that made them look cute.)
I was permitted to eat and drink till midnight from the low fat options. In reality, not having had a meal booked, I was given what they had left over but, although I hadn't eaten for 48 hours and the food at SGH is usually pretty good, I persevered through the “celery” soup that looked and tasted like watery mushroom, only managed a spoonful of the risotto that had unfortunately continued cooking under its lid so the rice was pulpy, but the butterscotch whip was tasty (except it probably wasn't low fat).
I was briefly visited by S and Z who offered me an mp3 player and a mobile phone. I declined. I didn't need stimulation, I needed sleep.
I was then transferred to another ward where I was to rest until my operation the next day.
They didn't seem to have a Baxter pump and the antibiotics that should have been delivered over half an hour seemed to be going quickly. They took just five minutes.
I was in a quiet bay where only three of the six beds were occupied. Feeling relaxed by the drugs, I was soon asleep but it was not be. An hour later, I was awakened by the staff nurse telling me I had to move to another ward. I protested. I did not want to cause her trouble nor was I blaming her, but I did want to record my protest. Worse was to come. Not only was I to be moved, I was to be moved in a chair instead of on the bed (despite my pains being worse sitting up and being jolted over door sills etc.).
[When I had originally gone in a few months previously for my fundoplication, I had spent a day being prepped only to be then sent home because there weren't any beds. A couple of weeks later when I did eventually have the op, I'd had to wait six hours in recovery until they could find a bed for me.]
However, the inevitable happened. When I learned which ward I was being transferred to, I asked them not to reveal detail other than ward number to my wife. Her mother had died of pancreatic cancer two years previously. K knew my problem could be pancreatic and the ward I was despatched to? Oncology!
Somewhere deep in the bowels of SGH is a quiet dark room called C3. Here I was to spend the best night ever in hospital (despite having an older, narrower, style bed that I couldn't raise the head of. The young male nurse who looked after me on arrival there, (“Can you confirm …?” etc.) was efficiency himself. He made my bed as comfortable for me as he could and explained there was already a canvass stretcher under me to transfer me to the operating trolley the next morning. He also gave me my anticoagulant injection almost painlessly and told me to drink as much water as I wanted as there wasn't long till midnight.
Years of reflux have trained me to need little fluid. Before my fundoplication operation, whenever I used to drink, I needed something to eat with it to stop it splashing. As a result, I cannot now drink vast quantities of water. At the stroke of midnight, the male nurse removed my bottle of water.
I had a good sleep away from the noises and lights. I believe the ward is usually mainly used for day patients which seemed confirmed when other patients arrived. “Did you hear of that man that was hurt by a crane falling at the docks? He had two broken legs, a broken pelvis and broken ribs. He was lucky.” I overheard.
A young nursing student arrived and offered to wash me. I was able to wash myself with the bowl she brought me whilst she stayed the other side of the screen.
A doctor, whom I had taken to be a surgeon but later discovered was the anaesthetist, arrived. (“Can you confirm …?” etc.) He told me I was next on the list and should be operated on around 11:15 but they had to find a bed where I would be despatched to afterwards. (Where have I heard that before?) He told me as soon as the operation was over, I'd feel fine and able to eat and drink immediately. I asked him, “If we can live without a gall bladder, why do we have one in the first place?” He'd replied, for the same reason we have an appendix and a spleen.
Eventually, I arrived at theatre. The day nurse from C3 had accompanied me quite excitedly; patients from her ward didn't usually go for operations. The “doctor” anaesthetist was there again. I told him I'd not signed a consent form. He disappeared and a few moments later the surgeon brought one for me. I had seen him earlier in C3. He'd very briefly introduced himself and asked if I'd had any abdominal surgery before whence he'd had a quick look at the previous scars. I hadn't asked him questions as he had had the manner of one that is rushing to catch a bus.
So it was about 12:30, I went to sleep. It was around 4:00pm that I came round in recovery. I felt quite sore and had a drain bag attached. I also sported a new cannula in the more conventional position in the back of the wrist. (This was to prove difficult for me later as it made it impossible to take my weight on that wrist which would be needed if I were to try my crutches.) Eventually a young female doctor / student introduced herself as having been a member of my surgical team. She said it had been a difficult operation and described cutting up leathery pieces of stones and putting them in a polythene bag for removal from the abdomen. I would have liked to talk about it more but was feeling groggy. When I said I was thirsty, she said I was free to eat and drink whatever I wanted.
I eventually re-emerged on the ward I'd been taken from the previous night but this time in a side room for isolation but only because, I was told, there were no other beds. The same staff nurse was there again. “Only sips of water,” she declared.
When I told her I'd been given other advice, she said that was what was written down and if she allowed anything different, she'd lose her licence. I wasn't hungry but had helped myself to a glass of water. That was before she took the jug away. Her assistant came in to take stats and did seem to give a hint of recognition.
K arrived and so did the dreaded “drip”. I only had one more dose of the intravenous antibiotics to come and, because K had complained that they had been delivered too quickly the previous day, the staff nurse had procured a Baxter pump. However, when K looked at, it was set to deliver them over an eight hour period! She complained again and the nurse opened the control to let it through much [almost painfully] faster.
She then hooked up a bag of saline.
Following my previous operation, the nurses,thinking I was dehydrated, had put me on two litres of saline drip overnight; the consequence was I was filling urine bottles every five minutes all night. I did not want a drip this time. “You have to have it,” the staff nurse declared. “You're not allowed to drink.”
K went after her to plead as my advocate. She was told I had made trouble the previous night. (I know “nurse [supposedly] knows best” but shouldn't they also listen to their patients?)
She said she'd try and get a doctor to come but until a doctor told her otherwise, I was not allowed to drink freely and would be on the drip.
After visiting hours had gone and K with them, a tall nurse or orderly with bleached white hair looked in. “Oh hello. Welcome back!” she enthused and asked how I was. When I said I was thirsty and didn't want the drip, she said she'd have a word with “the girls” but I told her the staff nurse was waiting for a doctor to advise her. She did come back with a jug of water a mug and a straw, though.
And it started. I was to be in for another hellish night of wee-ing every few minutes. But it was extremely uncomfortable attempting to haul myself upright on my un-cannulated left hand (the side of the operation which was causing me great pain. It was also embarrassing that the side room without curtains had an open door right onto the corridor and I was in full view whenever I performed.
Around 1:00am, the staff nurse reappeared. She said she'd been unable to get a doctor to come but she'd been concerned about my comfort and had managed to get one on the phone to say it was OK for me to drink freely and didn't need the drip but wouldn't be able to have any breakfast unless a doctor were to tell her otherwise. So the drip went. Hurray! And, after half an hour, the need to keep getting up also went away. I got some uncomfortable sleep.
The next morning, it was the new shift that welcomed me. I didn't get to learn the name of the blonde, smiling staff nurse. “You know you're only in here because there were no other beds,” she said. “We may have to move you later.” “Tell me about it,” I replied.
She realised I had not had breakfast and arranged for me to have some orange juice and cereal right away. I was also brought the lunch menu. “We'll make sure you get a decent meal inside you before you go,” she said.
The young male surgeon came to the door with a young student. “How are you feeling this morning?” he asked from the hallway. “Sore,” I replied, “and this cannula means I can't use my crutches.”
“Fine,” was his response. “You're going home today.” and disappeared again forever after that same bus.
The new staff nurse's assistant, a third year nursing student, was particularly pleasant and chatted with me about all sorts of things – including my cycling, our shared love of swimming and dislike of running but that her family had entered her in the draw for places for the next year's London marathon. I was still in pain but felt much cheered. Oh, the death of innocence. How long will it be before she learns she hasn't time to make patients feel better in themselves but has to follow the rule book to the letter and undertake a dozen different tasks at once?
The student removed the cannula from my wrist and, under supervision from the new staff nurse, the drain. I didn't feel a thing. I struggled into my clothes, K arrived, a porter wheeled me to the car along those corridors cluttered with equipment, boxes and confidential patient records and I went home to get better.