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.