Hospital humour

A gynaecologist had become fed up with NHS paperwork, the cost of malpractice insurance, the long hours, and was generally feeling burned out. Hoping to try another career where skilful hands would be beneficial, he decided to become a mechanic. So he went to the local technical college, signed up for evening classes, attended diligently, and learned all he could.

When the time for the practical exam approached, the gynaecologist prepared carefully for weeks and completed the exam with tremendous skill.

When the results came back, he was surprised to find that he had obtained a score of 150%. Fearing an error, he called the instructor, saying, “I don’t want to appear ungrateful for such an outstanding result, but I wonder if there is an error in the grade…”

The instructor said, “During the exam, you took the engine apart perfectly, which was worth 50% of the total mark.

“You put the engine back together again perfectly, which is also worth 50% of the mark.”

After a pause, the instructor added, “I gave you an extra 50% because you did it all through the exhaust, which I’ve never seen done in my entire career!”

Waiting for a sign

Today is 11 days since my operation (on the 20th), and also the day of the week that the colo-rectal surgical care team hold their regular multi-disciplinary diagnosis meeting.

I suspect that sufficient time has passed for the pathology labs to have done their work on the dissected tumour, and have reported their results back to my consultants. I believe that based on a combination of factors such as the number of lymph nodes and blood vessels that contain signs of pre-cancerous cells, the degree of malignancy of the original tumour, and some other factors, the consultants can then score the tumour and come to a decision on whether or not I will need subsequent chemotherapy treatment.

So hopefully when I see my consultant this afternoon I’d like to think I’m going to get some feedback on both my progress towards being discharged, and also on the likely need for chemotherapy.

Here’s hoping that it’s all positive news. Though it wouldn’t be the first time that things have taken longer than expected, which would probably mean another weeks wait for the chemotherapy result.

Update: No news yet on the pathology results. It’s going to be next week before I hear the results.

Latest progress

I saw my consultant again yesterday, and had another examination. His view was that I’d had a bit of a rollercoaster recovery. My stomach is apparently “nice and soft”, which I think in this context is a good thing, even if a rather unflattering description. He was however very concerned at the time since I’d last been able to actually eat anything properly, and to that end, he wanted me to take another try at eating, while remaining on the IV fluids and minimal-fluids-by-mouth routine.

The threat behind this (from my perspective) was that if this didn’t start to produce some results then I would need to be fed intravenously. Which doesn’t sound too bad until you understand that this would require that they install a central line. As threats to a man who is needle-phobic go, they don’t get much more severe

So yesterday I made a pretty good attempt to eat anything that came within reach. I had some breakfast, I had some lunch (which I actually found myself enjoying) and some dinner (which I didn’t). And in-between I snacked like mad, working my way through 6 or 7 biscuits. Ok, so maybe it doesn’t sound like a lot, but see how much you can eat after nearly two weeks of not eating…

My wife came to visit in the afternoon, which was great. And shortly after she left, my parents called in to spend an hour or so with me, which was lovely.

I suspect that like a lot of sons, I have a fairly easy relationship with my mother, but my father and I find it hard to express our feelings. We know what our feelings are – it’s the saying them that’s difficult. So just for the record, thanks for always being there Dad – I love you lots.

And when I checked all the numbers on my medical charts this morning, the results so far appear quite promising. My stoma output is going down, though it still has some way to go, and I’ve had no sign of sickness or the hiccoughs that indicate problems with the ileostomy.

So maybe, just maybe, we’ve got this thing cracked.

Its a wonderful life

One of the last things I did yesterday was wave goodbye to a couple of the people on the ward who were being discharged. It’s always nice to see people leave, as you know they’re all looking forward to getting to their homes just as much as you are to yours. They’re just a bit further ahead of you in the queue. In this case however, it freed up the bed by the window. And I know it’s wrong, but I wanted that bed. I wanted to be able to lie in bed and see outside the ward. I wanted to be able to have the window open, and smell the fresh air outside. I wanted to be away from the noisy main corridor that runs past the ward.

So I pleaded to move beds. And the nice nurses dutifully moved all the beds and bedside tables around so I could have my bed beside the window.

Then this morning, I woke late; or rather I was woken up from a deep sleep by the nurses wanting to do my observations. Perhaps this was due to the change of the clocks, or my body deciding more sleep would help it heal, but whatever the reason, I found myself woken to a wonderful view out of the window.

A pure azure-blue sky, with scarcely a cloud visible, and bright clear sun streaming into the ward, pooling across the bed. Outside I could hear the sounds of the builders working on the hospital, and smell the fresh morning air. By closing my eyes I could easily imagine I was waking up in a villa somewhere on the Mediterranean coast.

So thanks for moving my bed last night ladies – it was all worth it just for those few wonderful seconds this morning!

Acceptable behaviour

One of the things that I’ve found interesting while spending time in hospital, is watching the other patients around me. I’ve seen quite a few people with varying illnesses, and their attitude to their condition and the people looking after them has been fascinating.

Perhaps the biggest contrast has been between the old and the young; in general I’ve found that the younger patients (into which general category I would include myself) have less patience, less tolerance for pain, less consideration for those around them, and distinctly less gratitude for the efforts of the people caring for them. I’d hold up Mr. A (an ex-civil servant, who at the age of 53 is already retired) as a prime example of this. He’s suffering from a long-term problem largely of his own making that is eminently curable without surgical intervention. The hospital have been working on that for him for the last week, and during that time he has complained constantly about every minor issue, setback and problem (perceived or real) that has affected him.

Whereas Mr. B is in his late 70’s, admitted with a case of prostate cancer. And that’s on top of his already diagnosed incurable liver cancer and (previously successfully cured) bowel cancer. The hospital are working to provide him with the best possible quality of life, so he can go home and spend the remaining time that he has with his family. And I’ve never heard him complain once about anything – apart from the food, and we all complain about that! He’s always ready with a smile and a joke when someone else needs cheering up, and always makes the effort to thank people for their help.

So I wondered if this was some sort of change in society. Part of the DNA of Generation X and Y. Is this a case where people under a certain age believe that they should have the right to the best of everything without consideration for anyone else?

And then I met Mr. C.

Mr C is my age. He’s in hospital because of complications arising from his situation as a paraplegic resulting from a motorbike accident from many years ago. He’s in hospital (this time) for at least 3 months to undergo treatment for a variety of problems, all of which seem to be invasive. He needs to be turned in his own bed every 3 hours, and needs help with many of his most basic needs. If anyone deserves to rail against the world, it’s him. And yet he doesn’t. He’s friendly, kind, generous and polite. Nothing seems to get him down, and through it all, he’s still interested in the world around him, and being a part of it. His spirit shines through.

If I ever wanted a role model for how to live my life in difficult circumstances, Mr B and Mr C have provided it to me these last few days.

Time flies when you’re having … fun?

Sorry for the lack of updates. I don’t think I quite understood what I was about to go through when I composed my last post.

I’ve largely been continuously awake since Wedneday night trying to drink enough water to remain hydrated. In general, I was failing. Output from my stoma was significantly exceeding anything that I could drink, leaving nothing for the rest of my body, resulting in a gradual backwards slide.

Thursday I did pretty well, as I was largely well hydrated to start with, and had a great visit from my wife and kids. Even though I was feeling a bit under the weather when they arrived, it’s amazing the impact that the sight of them had on me, and I was able to be much more outwardly cheerful and positive while they were here than I actually felt. Of course, when they left, I slid the opposite way, and felt very “down”, and in the end went back to bed mid-evening.

I remember very little of Friday beyond being asked to show the nursing staff that I could change my own ileostomy bag; a no-brainer for anyone who can follow instructions. I do remember that my pain-relief was low at the time (ie, it hurt when I changed the bag) but not a great deal else. The nurses must have been satisfied though, as I’ve been signed off as competent to self-manage my stoma, which is one less barrier to eventually leaving hospital.

My wife and kids visited again, but this time I was unable to keep up the level of pretence; I could see that they were worried at my appearance, but at the same time, I didn’t have the reserves left to do anything about it.

Another early night.

Saturday morning saw a visit from a registrar (a “consultant in waiting”) who was providing the weekend cover for the ward. He suggested some slight changes to my treatment, but basically emphasised the need to drink more water to remain hydrated. Which was not helpful, given my experiences to that point. This was probably my lowest point do date, as I genuinely began to question my ability to ever drink enough to keep up with my stoma, which was producing 3 litres a day at that point.

Fortunately my consultant decided to pay a visit early on Saturday afternoon, and spent a busy 20 minutes checking me out, reversing the decisions of the registrar, and the previous few days. So the latest diagnosis is that I probably have a partial blockage of the ileostomy. This is unlikely to be a physical blockage, but instead where part of the bowel has not properly restarted after the surgery. Apparently the symptoms are that whatever I drink will go straight out the ileostomy; the more I drink, the more stoma output I will produce – a classic vicious circle, and hence my inability to get anywhere with the old treatment regime.

So, my new regime is to go back onto IV fluids, with minimal oral water and food (“only sipping and nibbling”, as he put it!) and spend as much time as possible relaxing, giving the bowel time to naturally recover, without putting me under any more stress. Which sounded great from where I was lying.

Unfortunately, this required that I have a new cannular inserted, and amongst the chaos of the day ward, it seemed impossible to get my cannular replaced, an IV line connected, and the doctors and nurses to recognise that my treatment programme had changed, and therefore to stop trying to force me to drink ever more water. For the first time, I came very close to really losing my temper with the people who are trying to care for me – not that that would have probably made much difference

In the end, the day shift switched over to the night shift, who were more experienced, and less over-stretched, and I got my cannular/IV line about 7 hours after it was prescribed, which seems like a scary delay to me. However, I’ve now had 12 hours on IV fluids, had my catheter removed, the output from my stoma appears to have dropped marginally (let’s hope its the start of a trend) and I’m starting to produce urine again. Oh, and I got several hours uninterrupted sleep. Life seems like it might be getting better again.

Turn up the volume to number 11

Seems like I was getting on far too well, and needed a little challenge again. So with that in mind, my stoma has become “high output”, which means that it is basically working in overdrive, and sucking all the water out of my system, leaving insufficient for urine & proper hydration. I guess its the equivalent of a massive diahorrea attack for someone in my situation. For once, being in my situation (with the stoma) actually makes this a lot easier and infinitely less messy to deal with

However, I’ve been put on more drugs to counteract this, and told that I need to be even more vigilant about my hydration levels. Which is code for “you need to drink a lot more water, young man”.

It’s also pretty exhausting to cope with, so I’ve pretty much dozed my way through the day and evening, and expect to do the same tonight. Just hope I am well enough to see my family tomorrow, as my wife is bringing the kids in to see me now I’ve had the naso-gastric tube removed.

Looking more normal at last

Today started well; I woke up around 5am and felt really refreshed, and feeling unencumbered by so many drips and lines, decided that starting the day with a good wash and brush up, and a new gown (I’m still not in my own PJ’s yet) would be ideal. And then I tried to actually get out of bed. Ow. Ow. Ow!

Note to self: The pain relief tablets seem to only last about 6 hours.

Still, I did manage to get up, and to get my wash and brush up. But it was a lot slower and less comfortable than under the epidural. I suspect for the next couple of days I’m going to be operating slightly more slowly again. Which is fine – I have time on my side in this game.

I also decided to continue adding food to my diet, so had some porridge for breakfast, along with some cups of tea. Seemed to all go down fine with no signs of sickness that I’d been told to expect if my digestive tract was still too sleepy. So I’m taking that as a good sign.

My consultant came to see me at the end of breakfast, and tells me that I’m making good progress again. I can officially have the gastronasal tube removed today, so I push my luck and ask about the catheter; apparently that can come out tonight, provided we continue to accurately monitor fluid input/outputs. So good news; the two most awkward to live with tubes are coming out today; by the end of the day I should only have one permanently attached tube (a drain).

And so saying, the nurse actually removed the gastronasal tube immediately after my chat with the consultant. You’ll be glad to hear that removal is a lot less unpleasant than fitting.

The stoma nurse called after that, and I got to have my first go at changing my ilesotomy bag. Apparently I did very well, which is good – they won’t let me out before I’ve mastered that.

One problem at the moment though – I’m finding it hard to drink enough fluids … I really need to up the volume a lot, probably doubling it, which is proving hard. I really don’t feel that thirsty. But needs must when the devil drives

And with that, I’m going to take a short walk before lunch, and then get ready for my family to visit early this afternoon.

More steps forward…

Things continued apace after my post yesterday; almost immediately after signing off I got taken down to the CT scanner for my scan. This involved a couple of really nice chaps from the portering service turning up and taking me, my bed, and all my drips and monitoring machines down to the basement, where we were comprehensively queue-jumped by the A&E department who were coping with multiple casualties from a traffic accident. However, this turned out to be a good thing, as it allowed time for my surgeon to find out what was going on, decide that the fears that had prompted the original decision to order the CT scan were misplaced, and get down to see me, and cancel the scan, saving me another dose of radiation.

So I got to ride back up in my bed again, with my machines and drips etc in tow. Still, it’s nice to get out and about

My wife then arrived to visit – always wondeful – and while she was with me the nurses took out my epidural. Which forced me to be brave. I wonder if they timed it deliberately?

I then had my infusions cancelled, meaning I now have to drink for myself, and that I no longer need a permanent intravenous feed. So for most of the time, my tube count has now gone down by two, which is great, as it’s going to be much easier to not get tangled up while getting in and out of bed.

I then had to have my cannular swapped out to a new vein, as best practice is to not use the same cannular/vein for more than three days. Unfortunately the lady doing this had a real hard time finding another “good” vein, and in the end had to give me a break. Apparently my lips were going pale and she thought I was about to pass out. She was probably right. When she came back 5 minutes later she got one almost immediately, so we obviously both needed that break.

Unfortunately my naso-gastric tube had to stay in, as did my catheter. But I must admit that just being free of the infusions was a big step forward, allowing me to move around much more easily. So I decided to have some food for tea, and chose some soup and a custard. Which apart from the soup being rather salty, went down really well.

And finally the day was rounded off by a great selection of visits from friends, which is always nice.

Two steps forward again…

And today I woke up at 4am, feeling refreshed, but still with a pretty swollen abdomen. After 30 minutes lying in the dark, I decided to get up and see if the nurses were at the nursing station down the corridor.

Getting out of bed was even easier, and unplugging all the electrical equipment (that goes “ping”!) from their chargers and collecting together all my tubes is becoming second-nature. I don’t think I need worry that I may start to actually miss some of this stuff though – it’s a pain to be so encumbered.

And then I noticed that my stoma seems to have been working overnight. Not much affect on the swelling, but definitely working. So perhaps these are unrelated? Maybe the swelling is just standard post-operative swelling etc? Apparently today I will get a major checkup from my surgeon, so that might reveal a few answers. To celebrate I had a couple of cups of tea with the nurses at 5am. Celebrate your successes while you can, I say.

In the meantime, apparently they are considering removing my naso-gastric tube, my epidural, my catheter, and my main line (cannular) later today. At a stroke today I could be reduced to a single wound drain. Which would be nice, even though a couple of those removals are like to involve some eye-watering moments