Saturday, 24 September 2016

On the Up

My surgery was three and a half weeks ago and I’ve been home from hospital (the second time) for a week and a half. I’m recovering slowly but steadily. Home is peaceful and T is looking after me very well.

My wound is still sore and I take my full allowance of paracetamol and co-codamol each day, but the skin has fully closed over and is looking healthy. I now possess four large scars on my torso and would have no trouble being a body double for a pirate. I already have the accent. Although swinging through the air on a rope with a cutlass in my teeth might be a bit much for me at present.

After the bowel surgery and the dramatic relapse my guts are very sensitive. I lost ten pounds during my two bouts in hospital. And I’ve been finding it difficult to eat enough to put weight on. I tend to eat little and often. I also have to take soft and easily digestible food. I’m only able to manage a half to two thirds of what I would normally eat at any one meal. I seem to get full up fairly easily. At the same time, T is on a diet and has to watch me munching through full-fat yoghourts, digestive biscuits and organic chocolate bars each evening.

I go for gentle walks a couple of times a day. I amble along, my wound twinging, down the lane from the house. I’ve made friends with the collie dog who lives at the first farm. He now accompanies me on my walks and escorts me back to the house. I reward him with a biscuit before he returns to the farm. I asked T to give him a name. She called him Rex. I saw the old farmer a few days ago and asked him what the dog was called. Strangely enough, he said Rex.

I’m also sleeping a lot, ten to twelve hours each day. Every afternoon, whether I feel tired or not, I close the bedroom curtains and lie down. I usually wake up an hour or so later. My habit is then to watch daytime TV. My favourites have been the reruns of ‘Sherlock Holmes’ with Jeremy Brett as Holmes and Edward Hardwicke as Watson, and ‘Time Team’ with Tony Robinson.

I’ve caught a few matinee films. I saw ‘The Producers’ for the first time for decades and was struck by how politically incorrect its humour was, with a series of jokes about Jews, Nazis, women, gays and so on. It featured the recently deceased Gene Wilder but the star of the show was undoubtedly Zero Mostel. I found myself happily singing along to ‘Springtime for Hitler’.

I was much less impressed with ‘For Whom the Bell Tolls’, starring a wooden Gary Cooper and a vivacious Ingrid Bergman, with little onscreen chemistry. It was a sort of Spanish Western with plenty of action on horseback and the blowing up of a bridge across a canyon. Location shots were impressive but the sets were rather tacky.

‘The Mouse that Roared’ was a curiosity. A vehicle for Peter Sellers (who played three roles) and a weak satire on the nuclear arms race. It was a cross between ‘Passport to Pimlico’ and ‘Dr Strangelove’, with few of the merits of either.

I’m still unable to concentrate very well. I can manage a newspaper article but I’m not yet ready to read a book. The print seems to swim before my eyes quite quickly and my head seems to have plenty of cotton wool inside. I hope the anaesthetic disperses soon.

Friday, 16 September 2016

The Alien Reappears

Dear reader, I am continuing to go to great lengths to survey the healthcare system of NI. Over the past week, I’ve been inside two ambulances and been treated in two different hospitals.

My recovery from surgery at the Mater had been going very smoothly. I went up to Belfast last Friday to get the staples out and the nurse told me my wound was healing well. But on the way back I began to feel unwell and went to bed when I got home. I was having difficulty breathing. In the evening I got worse. T rang the out of hours GP who asked her to check me over and said she should ring them back later. My breathing got worse and I began to have pains in my chest. Then I started vomiting. T called an ambulance.

After getting lost on the way here, they arrived about 10.30pm. Big Arthur escorted me into the ambulance, strapped me into a chair and hooked me up to a heart, pulse and breathing monitor. I was breathing fast and shallow, my chest was very sore right in the centre and I was vomiting up foamy saliva. ‘Can’t you breathe normally,’ complained Big Arthur, ‘you’re stopping the monitor reading properly.’ I panted and moaned. He spent a long time filling in my details on a form, and then we got started.

It was the worst journey I’ve ever had. Even worse than the day I spent on the back of a flat-bed truck in Laos with high fever. Every bump on the road jolted me. The pain in my chest got worse and worse. My blood pressure was through the roof. I was retching with the cold sweats. And it seemed to take forever. After half an hour or so Big Arthur said, ‘we’re in Banbridge, won’t be long now.’ Dear God no, I thought, that’s only ten bloody minutes from my house. The monitor was bleeping out its readings straight in front of me. I gritted my teeth, grasped my knees and rocked myself side to side. I just had to keep going, gasping through the pain. From time to time I glanced over at Big Arthur. He was asleep.

Eventually we drew up outside Craigavon Hospital. The journey had taken the best part of an hour (a drive I had done myself in half the time). Big Arthur helped me down the steps into a wheelchair. ‘You’ll soon feel better with a bit of fresh air,’ he said cheerily. Thankfully A&E took over. They wheeled me into a room called ‘Resuscitation’ and took an Xray of my chest with a portable machine. A young doctor with a Southern accent appeared. ‘You’ve got a 90% collapsed left lung,’ he said, and threaded a tube up my nose and down the back of my throat. ‘Swallow,’ he said. Not easy to do when you are retching. Then a huge rush of air, like a balloon deflating. He had got the tube down into my stomach and was relieving the pressure on my lung. I started to feel a lot better very quickly. ‘That was a big lung collapse,’ said the young doctor, ‘you won the prize for the Xray of the night.’ I gave him a weak smile. ‘You’ll be fine now,’ he said.  I was hooked up with a drip and moved into the main A&E room. Only then was T allowed to come and sit beside me.

We spent the rest of the night in A&E: me on a trolley, T beside me in a chair. In the morning I was admitted to the ward and given a CT scan. I was feeling much improved, my lung volume was already at 75% of normal. But the medical staff decided to transfer me to the Royal Victoria Hospital in Belfast. They were worried that I might need emergency surgery on my diaphragm. Another ambulance journey, but a much more comfortable one this time: they knew the way and Big Arthur was now off duty.

The following day I was examined by two medical teams at RVH. The thoracic surgeons were keen to do surgery to repair my diaphragm and pencilled me in for theatre on Tuesday. I was very concerned to be going in to another big operation less than two weeks after the last. The general surgeons reckoned that the bloated stomach had been caused by either a blockage in my small intestine or late-onset ilius (when your digestive system freezes after surgery). Both of these are common after bowel surgery. They recommended that I be monitored for several days instead of being given more surgery. Thankfully this last counsel was accepted. The next day, they detected bowel sounds and I began to pass wind. The day after, they took the tube out of my stomach and I was allowed to try food. Soon my guts returned to normal and after more tests and scans I was allowed home yesterday.

I’ve spent thirteen nights in hospital out of the past sixteen. It certainly feels great to be back home. I’m very much hoping that I will be recuperating here without any dramatic interruptions for a good while.

Wednesday, 7 September 2016

The Return

I’ve returned home from hospital with some things and without others. I have a sore foot-long wound from the centre of my belly to my right side that is closed by a line of staples, a very upset stomach, a pervasive feeling of bewilderment and an inability to concentrate. I have left behind the tip of my liver, six inches of my small intestine and a tumour.

My surgery was more extensive than planned because the scans taken beforehand hadn’t shown the full extent of the problem. What the surgeon found was that the tumour had regrown from my rear abdominal wall into my liver and it was attacking my small intestine. Fortunately, before he had become a liver surgeon he had been a bowel specialist. He first removed the tip of my liver, then removed a section of my small intestine that had been weakened by the tumour and finally he dug through my abdominal wall into the muscles of my side to try and remove all traces of the tumour. This meant that the procedure was more complex and took more than twice as long as planned. I was in theatre for two and half hours, then in recovery for two hours being given morphine and finally on the ward later in the evening (when this picture was taken).

This surgery was in effect rectifying the deficiencies of the surgery I had in Dec 2015 which removed the tumour but had left cancer cells behind at the margin. Since then the tumour had regrown at the same site. Worryingly this local recurrence had not shown up on the scans, which only registered a problem in my liver. On the plus side, this surgery was completed by an expert surgeon and it was also very timely as the tumour was set to spread into my bowel. You have around twenty feet of small intestine, so losing six inches does not make a difference. Amazingly, after being cut and rejoined the bowel tissues repair in twenty four hours.

I received excellent care in the specialist liver and pancreas unit at the Mater Hospital. If I was comparing Belfast hospitals on Trip Advisor, which I am now in a position to do, I would be giving the Mater five stars. The unit had fewer patients per nurse, as they did mostly very complex surgery. They also provided innovative pain relief, pioneered in Australia. I arrived back from surgery with a small tube sewn into the wound that pumped in local anaesthetic. This line stayed in for the first three days and made a huge difference. On the first morning after surgery the nurses always force you to get out of the bed and sit in the bedside chair. In December I was so sore I managed to sit for just five minutes. This time around, after more extensive surgery, I was able to sit out for three hours. On the second day I was able to do a short walk with a nurse holding each arm. On the third day I was able to walk on my own with the support of a frame. On the fifth day I was able to walk entirely unaided.

My recovery was also promoted by not getting ileus after surgery (when your bowels stop working). This had happened on both of my previous major surgeries. To some extent it is a bodily reaction to the trauma of surgery. It is also a side effect of morphine. Aware of this, I was sparing in my use of morphine over the first few days. But this was only possible because of the local anaesthetic in the wound. As my bowels were working (I was able to pass wind) I was allowed to sip water on the first day of recovery, then to try and eat soft food on the second day. By the third day I was eating half of the small portions that were provided. By the fourth day I was able to eat normally. But despite regularly passing wind, nothing solid emerged. At least I was only constipated.

On the fifth day I was told by my specialist that there was no medical reason for me to remain in hospital. The only issue was that my bowels had not opened. When this happened I would be allowed to leave. That day I had six sachets of laxative and walked up and down the corridor repeatedly. But nothing came. On the sixth morning I asked for an enema. Sister took me into the toilet, inserted a large plastic syringe into my back passage and squirted in a viscous fluid. I was instructed to sit on the toilet and try to hold in the fluid for as long as I could. The fluid stung my anus then cramps began.  As I closed the door of the toilet, Sister looked at me enquiringly. ‘My bowels have moved,’ I confirmed. She smiled and turned to a Staff Nurse, ‘this man is ready to be discharged.’ T called for me in the afternoon. All the way home my guts were grumbling. T helped me from the car into the toilet and the diarrhoea began. Not surprising, given all the laxatives and the enema. But a small price to pay for the delight of getting home.