DaiOakley 10 to 13-Jan-2008 - EYES DOWN - LOOK IN
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In To Hospital
Well it is into Hospital for my TURBT
I was asked to arrive at the Royal Shrewsbury Hospital and report to Ward 26U (U is for Urology) at 1400. I was immediately shown to my bed and asked to wait. I was told that someone would come to see me shortly. Whilst I was waiting I was able to take stock of my surroundings.
The ward was a mixed ward with bays to segregate the sexes. I was in Bay 2 which had 6 beds. My bed was next to the main corridor. On the corridor side of the bed was a cupboard with ample space for all my bits and pieces. On the other side was a comfortable chair.
The other patients were all friendly with the exception of the guy next to me who had lost his voice as a result of a stroke, but he smiled a lot. One of the others was from close to my former home in Mid Wales.
I sat down in my day clothes and started to read my book but I found it difficult to concentrate.
Angela, the food and drinks lady gave me a menu choice sheet to complete and a cup of tea.
Rob came to do the admission paperwork and the put the wrist bands on. I had two, one identified me as a patient and the other warned that I am allergic to penicillin by injection. I asked Rob about the 4 questions I had listed in my little note book: 1. What time would the operation be? 2. How long would it take? 3. Would I have a catheter after the operation? 4. Would I be having Chemotherapy afterwards? He was not in a position to answer any of them. He told me that both the surgeon and the anaesthetist would be coming to see me.
At 1715, Angela the food angel arrived with an evening meal of soup; cheese, leek and egg pie with tinned spaghetti (which I haven’t tasted since I was about 10 years old – I still don’t appreciate); a fruit salad and some cheese and biscuits which I hoarded for later.
At 2100 I broke open the hoard store and savaged a cream cracker and the whole 20 gram block of cheese.
By 2200 the surgeon had not arrived so I decided to try to fathom out how the radio worked. I eventually found the headphones at 2230 just in time to miss the last of the 10 pm News. This being missed I decided get ready for bed.
Sleep? I doubt it!
Malcolm the night nurse turned out the lights 2245 and then the problem of getting to sleep started. Unfortunately although I have usually been able to sleep almost anywhere in the past, I seem to have lost that knack. I continued to read and doze until the early hours when I managed a couple of hour’s undisturbed zzzzzs. During my couple of hours Greg L-W. rang to wish me well. He spoke at length with Malcolm and probably knew more about what was or was not happening at RSH than I did!
THE DAY
At 0550 Malcolm came to say that I could have something to drink – water but was not to have anything to eat or drink after 0600. I asked when I would be taken to theatre and he said that he didn’t know because I was last on the list but it would probably be between 1100 and 1200.
I decided to get up and have a wash etc to beat the rush!
At 0800 Mr O’Dell the surgeon came and answered my questions: 1&2. Op at 1300 to 1400 depending how the rest of the list goes. 3. Discuss the gen : epidural question with the anaesthetist 4. Catheter will definitely be in place. 5. Yes Chemotherapy will be given.
0830 Anaesthetist arrived to discuss the general: epidural question 1. With general you know nothing of what is going on. 2. With epidural you are conscious all the time. 3. After a general it takes some time to recover from the anaesthetic alone. 4. After an epidural you can eat and drink straight away. 5. If he had the choice he would select epidural and sedation So that was decided then – Epidural with sedation.
Neil the day nurse came along with a theatre gown for me and asked me to change into it. I also put on the anti embolism long socks I had been given. I was ready for them even if they were not ready for me.
To pass the time, I thought I would look through my file. (It would seem that it is more PC to have all the information about you in a file than on a board hanging at the end of the bed. I noted that they had classified me as obese – OK, so Greg was right - again. And perhaps I should take the point to heart. It is true that there is a higher probability of people who are obese developing a serious cancer. I have to face the fact and try to lose a lot of weight.
But, chwarae teg, fair play, it is only the eating that is down (to) me. The reduced activity is down to an industrial back injury, as is the divarication of the rectus abdomini – the fact that my ‘six pack’ (‘What six pack?’ I hear Greg shouting off page.) has been unzipped like a hernia.
At about 1100, they came to get the guy in the bed opposite. He wasn’t very talkative but I got the impression that he had been through it all before. I began to feel rather more apprehensive – my turn next sort of apprehension. I suddenly began to feel tired, but I don’t think I had been given anything to make me so. It must have been as a weird side effect of ‘first night nerves’.
This was the first time I had been in hospital overnight since I had my tonsils out as a small child before the National Health Service had been invented. That time I got a toy garage which I hadn’t bargained for. I hope I don’t get anything I haven’t bargained for this time because it is likely to be unpleasant now that I am older. That’s the way of the world.
Slight Panic - Here We Go!
At 1145 John the theatre Porter came. He was concerned that I was sitting upright. I wanted to see as much of what was going on as possible, but I agreed to lie down like a good boy and off we went as soon as they could find a trained staff nurse to handle to aft end of the bed because their return journey was to be with a person who had had a general anaesthetic. They took me down the lift and along what seemed to be miles of corridors to the anaesthetic room near the theatre. It seemed like quite a journey but there were some interesting old photographs of Shrewsbury on the walls of the corridor.
Two very helpful nurses, Jill and another lady, prepared me for the anaesthetist amid a conversation of how surgeons looked younger and younger. The hospital equivalent of policemen I suppose.
It is not at all disappointing perhaps, that Sir Lancelot Spratt is no longer alive and blustering –
‘None of this Keyhole Surgery here!' (Laparoscopy)
Anaesthetising
The anaesthetist entered and said that he would it would sting slightly when he gave me a local anaesthetic in the back of my left hand to enable him to get the drip thingy in which he said was larger than normal.
(ed. a Cannula inserted into the vein on the back of the hand, usually with two ports, to use for sedative, or in case of emergency a fuller anaesthetic or in case of breathing problems etc. or shock for stimulants etc. Greg L-W.)
The next job was to administer the epidural. He said that he might have to try three spaces between my vertebrae, the bones in my spine. He said again that he would give me a local anaesthetic which would sting – to my senses it didn’t.
Now, the problem with back injuries, in common with many other types, is that they can accelerate the onset of arthritis or arthrosis or whatever the technical term for it is. My back has become very immobile. It is no longer possible for me to adopt a foetal position – to curl up into a ball. This would tend to open the gaps between the bones in your back. The idea being that it is easier to find a way between the bones to inject the epidural anaesthetic into the fluid in your spinal column.
Well he had a bit of fun and eventually managed after 20 minutes to get me numb from just above the waist downwards. It was all a new and rather strange feeling to me. I was able to tell them that I could sense that the needle to the right of my centre line at one time but beyond that, I could not feel what I would call pain. There was a sense of pressure for some moments though.
The effect was certainly quite marked. First I felt pins and needles in my right leg then it felt cold then I felt nothing. The left hand side was somewhat slower to react. The test of the effect was a cold spray (Alcohol Spray). First I could feel the spray at about half way up my thigh but no higher. The anaesthetist took a moment or two to realise that his spray can was empty! The next can was fine – gradually I had no feeling upto the bottom of my ribcage on my left side.
Along with the drip which was designed to replace fluids which I had not been drinking, the anaesthetist added a syringe of antibiotics. I hope I remember to mention a possible side effect of the antibiotics later! I assume that at some stage he also added a sedative because I felt wonderfully relaxed. This was very comforting after the apprehension I had sensed earlier.
Theatre Time = Let The Play Commence!
All appeared to be ready and the Surgeon entered. He asked if all was OK. I said ‘Yes – but part of me doesn’t want to play and seems to be hiding!’
I was wheeled into the theatre and they got on with it. I felt nothing. I think I was awake for most of the time but I may have dozed off.
(ed. I think you did doze off as you seem to have missed out on 'board' transfer from the trolley to the operating table & stirrups or back onto the trolley when the Green Taliban had finished Greg L-W.)
To tell the truth, I don’t know and, what seems strange to me now, I didn’t seem to care at the time. I can remember being surprised when they wheeled me out of the theatre and into recovery and before long I was being wheeled back up to the ward and my bed space!
Back on The Ward
As far as I can tell, I left the ward at 1145 and returned at 1305. I felt great. At first I could not move anything below my waist. Gradually, feelings started to return. It must have been around 1400 because Sheila had arrived and said that she could see me from the door and that I was wiggling my toes which she thought was my version of a wave at the time.
Importantly, she was comforted by that. She didn’t realise that I hadn’t seen her. I had lost track of time because my watch was still locked into the medications box on my bedside locker. Slowly, feeling returned, progressing from the toes upwards. The last part to return was my bum. I got the distinct impression that I was lying on a water mattress. The bed did not feel like a firm object at all.
At that time I had a catheter fitted and the outflow was still quite pink. I was asked to drink lots to keep the system flowing. Sheila went home at 1600 to get my laptop. I tried to read a bit and had general sense of wellbeing and relief that it would soon be all over and I would be able to go home in the morning, Saturday.
It didn’t seem very long before Sheila returned at 1830. I had probably fallen asleep. Anyway I noticed that the outflow from the catheter had cleared - So had the nurses! That meant that a pantomime of a procedure was about to start:
The Chemo Game
Two nurses began to prepare the field of play. This involved a bright yellow traffic cone ‘WARNING – TOXIC’ – no Cones Hotline Number on it though – It would probably make a fortune from a really keen cone collector on eBay. Also a special Yellow bucket with a purple lid fro Chemo Waste.
Then enter Chemo Woman, Sister Heather Brace dressed in a protective apron, full facial protection including mask and eye-shield and gloves. Her able assistant was Karen who wore only an apron and gloves!
The chemo was brought up.
After much preparation an injector was attached to the Inlet side of the Catheter. The outlet tap was closed. The Epiribicin Chemotherapy fluid was introduced into my bladder.
And then I had to start the Chemo Slow Roll – Very Slow Roll. The idea is that you have to spend about 20 minutes on each of your back, left side and right side. Ideally you need to keep the Epiribicin in your bladder for an hour and give it chance to remain in contact with all parts of the bladder wall for some time.
(CAVEAT: there is a similarly spelt different drug Epirubicin Greg L-W.)
The idea being that it will prevent the possibility of any residual cancerous off-cuts from the resection – (removal by cutting or burning) – process from taking root again. For the first roll I was helped by the nurses because I was rolling away from the bag. I was conscious that it would be something of a disaster if the plumbing was to come adrift. I managed the final roll from right side to left side by myself.
After an hour, my time was up and they removed the }}catheter which was still running red – the colour of the Epiribicin. When she removed the catheter, the nurse said that I must be particularly care when going to the loo for a pee. She told me to sit down for the first few times. The idea was to limit the risk if any of the toxic outpourings ending anywhere other than in the pan of the loo. I was also told to flush the loo twice after each visit to dilute the chemo before it gets into the public sewage system.
I have to say that I do find the thought of this a little concerning. I will say a little more about it along with other contaminants in the sewage system later.
After Effects - After Check!
In the early stages I found that because, I assume, all the control parts of my outflow system had been stretched considerably, I had little or no control over passing water. It is also possible that the effect of the anaesthetic was lingering. Anyway, it seemed that Each time was an emergency, a dash and a near accident at the loo. Preventing dripping seemed almost impossible at first. Each time I turned to take some loo paper to prevent drops, the drops followed my turn.
It was bit like the line on the wall of the loo at the pub. Follow it until you reach the statement which advises that you are now peeing on your right foot!
After a while, one of the nurses realised that I had just returned from one of these relief sessions and said that I should have told them so that they could give my bladder an ultrasound scan to confirm that It was emptying properly. Next time I told them before I went. The nurse, together with the portable ultrasound machine was standing in waiting. Joy of joys – she could see no problems.
Shortly after came the great news. They told me I could go home as soon as the Doctor had signed me out. They said he wouldn’t be long – about 10 minutes. He was dealing with an emergency. I asked them to tell him that he had another emergency to attend to and got dressed quickly. I didn’t need to be told twice, nice as it was, I had no wish to be a burden on their resources for one moment longer than necessary.
Kitted for Departure
The only problem I had was one of incontinence. That was just a matter of some absorbant pads – a triangular version of the figure of eight type made for ladies by Tena. The pads have a removeable strip which enables an adhesive line which attaches the pad to the inside of your Y-fronts.
I was also given 2 tablets Paracetamol 500 mg and 2 tablets Codine Phosphate 30 mg. I also had a bag with some incontinence sheets and a few Tena pads and the hope that all would be back to normal by Saturday. A little after 2100 I was going down in the lift to the car.
Home
All this idea of going home early was great. I had forgotten one thing. We have some very pleasant and very pale fitted carpets throughout the apartment. I had a very unpredictable urinary control system. I did not want to have a trail of droplets to follow to the loo. I had to be particularly careful. Later and continuing through that night, each time I felt that I wanted to go for a pee it became an urgent rush. The sense of need and the inability to control the outflow almost coincided.
On one occasion, I was holding on personfully. As I went through the door into the bathroom, the sleeve of my dressing gown caught on the door handle. My hold was parted and a spray of the bathroom required a considerable clean-up. Forward planning was required – Bathroom door open – toilet cover and seat raised ready – chances of future problems reduced. In spite of all this, I still found that I was unable to get as far as the loo and had to point at the bath.
I am more than happy to say that a degree of control had returned by this, Sunday morning. By Sunday afternoon I am thinking about getting into normal clothes. The real relief is that I have somehow managed to come through this stage without marking the carpet. It has been a bit undignified at times, but nothing that I couldn’t think beyond.
Thoughts After The Event
What I have found concerning since my return home is the fact that I have been passing a red colour in my urine. Initially, I was not sure whether this was Epiribicin or blood. I was experiencing pain as I began to urinate each time. The pain seemed to be half way down my penis. I had the impression that there must have been a small amount of damage in that part of my urethra.
I got this idea because of where and when I experienced pain and the fact that blood appeared at the beginning of the flow and then in drops at the end of the flow, particularly if I tried to end the session by using my muscles to stem the flow.
Another problem which was something of an ‘also ran’ was the fact that my gut seemed to have all but closed down. I had become very constipated with the exception of a loose movement not long after the catheter was removed. I put this down to a side effect of the antibiotics I was given just before my operation.
A call on the GP
On Saturday our GP surgery was not open! So, before I realised that the blood might be a problem, I spoke with Dr Taylor of our local Locum service, Shropdoc. I asked for some pain control tablets and some more Tena pads. He sent an E-Prescription to our local Pharmacy. He prescribed Co-codamol 8mg/500mg - 8 mg of Codine Phosphate and 500 mg of Paracetamol which Sheila was able to collect just before they closed at 1300.
The pads were not quite so easy. Dr Taylor said that he would have to ask the District Nurse to ring me. I did not realise that the District Nurses are now separate from the GP Practices now. Sister Angela rang shortly afterwards to tell me that they no longer carry a stock of pads but that she would see if she could bring some with her when she came to visit another patient, a close neighbour.
With the pain management and the lengthening time between dashes to the loo I went to bed at about 0200 and slept well until 0630 when I went to the loo. No dash this time but a lot of blood at the start and finish, but still clear in the middle. I went back to bed and slept like a log until 1100 when the doorbell went and Sister Angela had arrived.
She brought a pack of pink Tena lady pads with her which would be a great help until I can try to sort something out on Monday. I mentioned the blood problem and she assured me that it would stop but if I still had a problem on Monday, I should call my GP.
That brings me to my latest dash to the loo. I must have tried to go for too long because there was a slight amount of blood again. It was just over an hour since my last trip. I must try not to leave it too long for the moment. It would seem that any muscular effort to try to control myself re-activates the bleeding.
INFECTION CONTROL AND CROSS CONTAMINATION
This ward sticks to visiting times of 1400 – 1600 and 1800 – 2000. They have yet to restrict the number of visitors per bed. There is no lower age limit for visitors. There is alcohol gel in hand squirt containers on either side of the entrance. There should have been an alcohol gel dispenser in a holder on my bedside cabinet, but I suspect that it was too handy for passersby to pick out of its holder to take to wherever they thought they needed one. Mine was replaced several times and kept disappearing. Generally speaking, hospital people and visitors were very aware of the need to use infection control facilities.
I mentioned before about carrying infection from one area to another by sitting on beds. The only person to do this was the surgeon who quickly thought again and went to fetch a chair to sit on.
When I was young, not only were visiting hours strictly controlled, but no more than two visitors per patient were allowed. Also, children under 12 were not allowed. This comes to mind because I noticed an old gentleman with a walking frame making his way along the main corridor towards the exit. He was dressed in hospital pyjamas. I think he was looking for the loo. He passed a couple of times and then I noticed that he was being followed by a wet trail.
All this was very unfortunate and difficult to avoid.
What was not difficult to avoid was what happened shortly after when the visitors arrived.
One family came in I think there were 8 adults and two very young children aged about 2 and 4. The younger was in a push chair driven by the older. They then started to play in a very uninhibited way, crawling along the very part of the corridor where the ‘accident’ above had happened. Children of a young age do not understand the problems associated with what seems to them to be quite normal behaviour. I suppose it is for that reason that the Matrons of old put the 12 year limit on.
DISPOSAL OF WASTE
When the District Nurse came, I asked how I should dispose of the soiled pads she had brought. She said that I should put them in with the normal rubbish to go to landfill. I suppose that as they are similar to nappies. That should not have surprised me. What did surprise me though was to be advised to dispose of some outdated tablets by flushing them down the lavatory. I am something of an angler – course in practice if not in quarry.
I had heard that high levels of things not entirely natural un the water have been having an effect on the breeding of fish. I am sure that the loo cannot be the right place to dispose of surplus or time expired medication. I imagine that the pharmacy world should have a means of safe disposal available. I intend to test the reaction as soon as I am able to.
Comment
Have you noticed large numbers of very rigid fish? It must be all that Viagra, that I see adverts for, being purchased in the expectation of hope over experience and ending up being sureptitiously thrown down the loo by elderly ladies who had become used to a more 'relaxed' life and found there were disadvantages to toy boys of their own age! Greg L-W.
MY OVERALL IMPRESSION
Both Sheila and I are convinced that we would be hard put to find any other system which could have given us a better service. The only really constructive comment I have to make is that it would be helpful if the Epiribicin was coloured blue or any colour other than red if it is to be used in a circumstance where its presence may be confused with the presence of blood.
Both Sheila and I are extremely grateful to the Royal Shrewsbury Hospital for their treatment and care during what is essentially a very concerning period, not just for me, but for those close to me – and by the number of cards I have received, that is rather a lot of people, not just relatives. My thanks go out to them all.
I hope to write to the Chief Executive, Mr Tom Taylor and the Chairman Dr Margaret Bamford to praise each department associated with my treatment. That will be a letter for each department so that each gets its own record of praise.
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