Report back on surgery (13 June 2018)
I've been putting this off - summarising everything that's happened since I went in for surgery on 13 June has been in the much much too difficult box. At the time of my first draft, England had won two world cup matches, lost another and triumphed in a penalty shoot out and I had watched it all - the world turned upside down! Now, as I click the Publish button, everything England and World Cup has returned to the usual disappointment level, reduced to chip paper in the bin.
Pre-surgery reception felt much too early - 7am on 13 June. I knew to anticipate an enema (another first) but anticipated it doubly by experiencing three anxiety enemas all on my own, including one that required getting off the tube at Highgate and finding a very helpful cafe. Worst station to choose - really deep and with a different entrance to the exit. Which was way down the road.
Still managed to get to UCLH on time, unlike my notes. In pre-surgery somehow managed to see a preparation nurse, a stoma nurse, the surgeon and the anaesthetist without remembering very much about any of them, except for the anaesthetist having something of the wild about him. I must have agreed to an epidural to avoid having to take opiates/opioids for pain relief later. Despite my own efforts, still had to have the enema - a word of advice if you find yourself in the same situation - go straight to the loo; don't wait... Other preparations were to get a cannula, get marked up for a stoma, and get fitted into compression stockings, sticky socks, those testing hospital gowns and paper pants - which were supposed to protect my dignity (!) Own clothes all went into a sealed plastic bag and I was then taken to the surgical waiting room by an ex-tube driver who I thought was Irish and Chris thought was Geordie - I've never been good at accents. This was the goodbye moment - swift, surreal and numb rather than panicked.
Then a bit of a perambulation involving lifts and populations of normally-dressed people going to work and appointments while toddling around in those mad clothes. It's amazing how much conversation you can fit in - my escort had experienced one too many suicide jumpers, had married a (was it Romanian? - blame the anaesthetic) and now had a farm with fruit trees there. I really can't remember how we got on to that. I managed to retain a scarf on my wispy head until the last minute, when a very glamorous theatre technician brought me a surgical cap and another sealed plastic bag for the scarf, then took me into the theatre anteroom. It all went very quickly from there - wooziness descended and I missed the count down.
The operation took four hours, not six, was 'uncomplicated', and the internal scenario was even better than the CT scan had predicted a week before. Apparently, the surgeon came round on the same day but I don't remember that. Luckily she came round next day to repeat the message. She was able to remove all visible signs of disease, didn't need to resect any bowel or make a stoma, was able to peel off disease from bowel. Peeling an orange or peeling a carrot, I asked? More like peeling
Severe fuzziness follows. I was on the post anaesthetic care unit (PACU) for around 78 hours and it took on various guises during that time. Quite apart from the hallucinogenic effect, its geography kept changing depending on whether it was night or day, which bays contained beds, which curtains were open or closed, whether I could see the door, and which staff were guarding which patients.
I was pretty connected for most of the time - epidural in back, ECG buttons on front permanently connected to the monitoring equipment and spread out in a many-wired harness over the shoulder, catheter down below, drips feeding in salts, fluids, paracetamol, ondansetron and patient controlled anaesthesia (PCA) (morphine then fentanyl) in one bit of the left arm, cannula for extra bits and bobs in another bit of the left arm, and the remnants of the arterial blood gases line from the surgery. Moving is nerve racking and they want you to move - oh dear! they want you to oxygenate your body and the wound to promote healing, so they want you to breathe - ouch! deeply - ouch ouch ouch! - cough - are you joking? - no, you have to do this to clear your lungs - really really ouch, even with a pillow clutched to the tum.
The epidural must have worked for a bit - they test it by regularly spraying you with cold spray on a ladder of points up your left and right sides. But it wore off, leaving a deep pain like a hard period pain or possibly contractions (thankfully can't remember quite what they were like). Because they want you to move to keep blood flowing and tissue oxygenation, it raises the issue of the need for pain relief alternatives. First up was a morphine PCA which certainly helped and the anti-emetic in the drip kept on top of nausea. However, the insistence on moving was intense and I was somehow persuaded into sitting position on the side of the bed around 24 hours after the surgery, and thence to a chair by the bed. This went OK for about 10 minutes, then all the interested parties left, so when I called out that I was 'going' they just called back to say they would come soon - the next thing I knew was having a bowl full of sick under my chin and being surrounded by 'the team' including the ITU consultant. Apparently, this was a vaso-vagal attack - helpfully explained later as being something like see-sawing blood pressure. Normally your blood pressure reflexes help keep you on an even keel between lying, sitting, standing, standing on your head, doing somersaults etc. If you think about it, this is quite a feat for your haemodynamic system. These reflexes can be lost or slowed after as little as 24 hours lying down, and mine had gone west.
At one point, nausea was a real problem and the solution was a shot of cyclizine - this did for the nausea but it did for me too - it was like being coshed. For around half an hour I had to think very very hard about voicing any word at all, and to create a basic grammatical sentence was a major undertaking.
TBH I've forgotten a lot of this, but I was a day longer in PACU than hoped due to reduced heart rate and searching for acceptable pain relief - they don't like you having hallucinations however benign, because nightmares are only a leap of the imagination away. The team admitted that finding the right balance of pain relief and anti-nausea drugs while keeping you conscious and potentially mobile was more of an art than a science and involved a lot of suck-it-and-see. I left, able to get out of bed and able to sit on a chair, on a mix of paracetamol and ibuprofen although that was second and third guessed later due (probably) to concerns about the anti-clotting effect of ibuprofen on top of the daily Fragmin anti-clotting injections.
I've written elsewhere about wanting a wash on the PACU so I must explain why there was such a yearning for it and why this resurfaced on the ward. The up-and-down and adjustable zig-zag beds with their modern mattresses are v comfortable but both mattresses and pillows are hygienically covered in plastic, and one layer of cotton cover doesn't help much. Sweaty sweaty sweaty.
Despite all this, it's astonishing how quickly you start to recover. More from the ward later, but even on the PACU, in three days, I went from being unable to face the food tray, despite the coaxing of family and friends, to eating the soup and sometimes the salad, to really enjoying the macaroni cheese (four cheeses I think). A largely unprepossessing presentation must result from the creation of huge quantities in short time spans but when I finally escaped from the ward, I definitely regretted missing dinner time and my second order of UCH macaroni cheese.
P.S. Have I mentioned all the farting?
Pre-surgery reception felt much too early - 7am on 13 June. I knew to anticipate an enema (another first) but anticipated it doubly by experiencing three anxiety enemas all on my own, including one that required getting off the tube at Highgate and finding a very helpful cafe. Worst station to choose - really deep and with a different entrance to the exit. Which was way down the road.
Still managed to get to UCLH on time, unlike my notes. In pre-surgery somehow managed to see a preparation nurse, a stoma nurse, the surgeon and the anaesthetist without remembering very much about any of them, except for the anaesthetist having something of the wild about him. I must have agreed to an epidural to avoid having to take opiates/opioids for pain relief later. Despite my own efforts, still had to have the enema - a word of advice if you find yourself in the same situation - go straight to the loo; don't wait... Other preparations were to get a cannula, get marked up for a stoma, and get fitted into compression stockings, sticky socks, those testing hospital gowns and paper pants - which were supposed to protect my dignity (!) Own clothes all went into a sealed plastic bag and I was then taken to the surgical waiting room by an ex-tube driver who I thought was Irish and Chris thought was Geordie - I've never been good at accents. This was the goodbye moment - swift, surreal and numb rather than panicked.
Then a bit of a perambulation involving lifts and populations of normally-dressed people going to work and appointments while toddling around in those mad clothes. It's amazing how much conversation you can fit in - my escort had experienced one too many suicide jumpers, had married a (was it Romanian? - blame the anaesthetic) and now had a farm with fruit trees there. I really can't remember how we got on to that. I managed to retain a scarf on my wispy head until the last minute, when a very glamorous theatre technician brought me a surgical cap and another sealed plastic bag for the scarf, then took me into the theatre anteroom. It all went very quickly from there - wooziness descended and I missed the count down.
The operation took four hours, not six, was 'uncomplicated', and the internal scenario was even better than the CT scan had predicted a week before. Apparently, the surgeon came round on the same day but I don't remember that. Luckily she came round next day to repeat the message. She was able to remove all visible signs of disease, didn't need to resect any bowel or make a stoma, was able to peel off disease from bowel. Peeling an orange or peeling a carrot, I asked? More like peeling
the thin chicken skin under the goose bumps chicken skin off the raw meat, she replied. She poked around behind my liver and didn't find anything. Before the operation, I had enquired as to what mass of tissue would be removed and the team had kindly weighed it - 200g - but in retrospect, I don't know if this was just tumour tissue, or included my organs as well... In due course, it was all set out in long words in the discharge summary, including maybe the only three 'o' word in the language - salpingooophorectomy…
Severe fuzziness follows. I was on the post anaesthetic care unit (PACU) for around 78 hours and it took on various guises during that time. Quite apart from the hallucinogenic effect, its geography kept changing depending on whether it was night or day, which bays contained beds, which curtains were open or closed, whether I could see the door, and which staff were guarding which patients.
I was pretty connected for most of the time - epidural in back, ECG buttons on front permanently connected to the monitoring equipment and spread out in a many-wired harness over the shoulder, catheter down below, drips feeding in salts, fluids, paracetamol, ondansetron and patient controlled anaesthesia (PCA) (morphine then fentanyl) in one bit of the left arm, cannula for extra bits and bobs in another bit of the left arm, and the remnants of the arterial blood gases line from the surgery. Moving is nerve racking and they want you to move - oh dear! they want you to oxygenate your body and the wound to promote healing, so they want you to breathe - ouch! deeply - ouch ouch ouch! - cough - are you joking? - no, you have to do this to clear your lungs - really really ouch, even with a pillow clutched to the tum.
The epidural must have worked for a bit - they test it by regularly spraying you with cold spray on a ladder of points up your left and right sides. But it wore off, leaving a deep pain like a hard period pain or possibly contractions (thankfully can't remember quite what they were like). Because they want you to move to keep blood flowing and tissue oxygenation, it raises the issue of the need for pain relief alternatives. First up was a morphine PCA which certainly helped and the anti-emetic in the drip kept on top of nausea. However, the insistence on moving was intense and I was somehow persuaded into sitting position on the side of the bed around 24 hours after the surgery, and thence to a chair by the bed. This went OK for about 10 minutes, then all the interested parties left, so when I called out that I was 'going' they just called back to say they would come soon - the next thing I knew was having a bowl full of sick under my chin and being surrounded by 'the team' including the ITU consultant. Apparently, this was a vaso-vagal attack - helpfully explained later as being something like see-sawing blood pressure. Normally your blood pressure reflexes help keep you on an even keel between lying, sitting, standing, standing on your head, doing somersaults etc. If you think about it, this is quite a feat for your haemodynamic system. These reflexes can be lost or slowed after as little as 24 hours lying down, and mine had gone west.
At one point, nausea was a real problem and the solution was a shot of cyclizine - this did for the nausea but it did for me too - it was like being coshed. For around half an hour I had to think very very hard about voicing any word at all, and to create a basic grammatical sentence was a major undertaking.
TBH I've forgotten a lot of this, but I was a day longer in PACU than hoped due to reduced heart rate and searching for acceptable pain relief - they don't like you having hallucinations however benign, because nightmares are only a leap of the imagination away. The team admitted that finding the right balance of pain relief and anti-nausea drugs while keeping you conscious and potentially mobile was more of an art than a science and involved a lot of suck-it-and-see. I left, able to get out of bed and able to sit on a chair, on a mix of paracetamol and ibuprofen although that was second and third guessed later due (probably) to concerns about the anti-clotting effect of ibuprofen on top of the daily Fragmin anti-clotting injections.
I've written elsewhere about wanting a wash on the PACU so I must explain why there was such a yearning for it and why this resurfaced on the ward. The up-and-down and adjustable zig-zag beds with their modern mattresses are v comfortable but both mattresses and pillows are hygienically covered in plastic, and one layer of cotton cover doesn't help much. Sweaty sweaty sweaty.
Despite all this, it's astonishing how quickly you start to recover. More from the ward later, but even on the PACU, in three days, I went from being unable to face the food tray, despite the coaxing of family and friends, to eating the soup and sometimes the salad, to really enjoying the macaroni cheese (four cheeses I think). A largely unprepossessing presentation must result from the creation of huge quantities in short time spans but when I finally escaped from the ward, I definitely regretted missing dinner time and my second order of UCH macaroni cheese.
P.S. Have I mentioned all the farting?
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