.דער מענטש טראַכט און גאָט לאַכט

So yesterday morning the alarms (yes, several – I didn’t want to be late) all went off at 5:30am, and we commenced the day with military precision. I dashed downstairs to have my last couple of glasses of water before the nil by mouth regime cut in at 6am, more in the hope of giving the anaesthetist a fighting chance of finding a vein than for any real sense of thirst. Back upstairs to dash through the bathroom, and then the last minute packing of my hospital bag, before heading out into the traffic at 6:30am.

We did well, negotiating the motorway traffic and early morning rush into Portsmouth without too many problems. When I’m travelling at those times, it always surprises me how busy the roads are between about 5:30 and 6:30; almost a precursor to the main rush hour between 7:30 and 8:30. I must admit I wasn’t paying much attention yesterday though.

We arrived at the hospital with about 5 minutes to spare, so I walked up to the ward to check in while “L” parked the car. It was strange going back into the ward where I spent nearly 5 weeks last year. Nothing had really changed, including the staff, who had seen my name on the admission sheet and were looking out for me. It’s strange (and probably on some level, just plain wrong) to be greeted on sight, by name, in those circumstances. But it’s also hugely reassuring to realise that the people there know me and care.

We were ushered off to a consultation room where my enormous folder of notes made an appearance, along with the duty nurse, and we went though the admission paperwork. I was issued with a set of hospital-standard surgical stockings, and the dreaded hospital gown. Then the nursing staff changed over to the day staff, most of whom I also knew from my previous visits, which was really nice – there was a steady flow of visitors popping into the room just to say hello and wish me well, which helped to distract me from thinking about the operation to come.

The anaesthetist stopped by to see me at about 8:30am, and went through my personal history again, and then looked back through the notes from the previous anaesthetists who had looked after me. I really liked him – a cheerful chap, who also managed to be completely no-nonsense and focused at the same time. Just as well really – you want the guy keeping you asleep but alive during a long operation to be on the ball!

Then shortly after he left, my new Urologist dropped by to talk to me. We’d not met before, so the dynamic was interesting; feeling for a mutual level to talk at, while also going through the social thing, and getting the job done in terms of explaining what he needed to. Again, I came away from the conversation very reassured that I was in good hands. His problem is that they don’t really know why my kidney isn’t working properly, and what he would have to do to help me would depend very much on what he found when they got me open. As he rather wryly pointed out, my surgeon had consented me for practically every urological possibility that might arise.

And then we waited for my main consultant to drop by. And waited. And time passed. An hour. More.

Oddly, I remember thinking I wonder what happens if my consultant has been taken ill? Killed in a car crash on the way to work? And then looking at the time again (10:30am) and thinking that something clearly had to have gone wrong for an operation that was scheduled to start at 8:30am to not be under way yet. And as though my thinking that thought prompted the reaction, my consultant arrived and explained that he had had to cancel my operation.

The problem was that due to the scale of my operation, the surgeons wanted me to spend the first two nights and days after the operation in intensive care (now apparently called ITU, or Intensive Therapy Unit) where I can be constantly monitored. And there were no ITU beds available for me to go into yesterday. While we had been waiting around for the operation to start, the surgical team had been trying to find a way to get me an ITU bed (and had failed), or to go ahead without the need for the ITU stay (and had decided it was not safe to do so). Which finally only left them with the option to reschedule me to another date.

You might ask why (since this is being funded privately) hadn’t the ITU bed been booked in advance? The answer is that ITU beds are stupendously expensive, and are always in limited supply. They are a resource that is so precious that clinical need always overrides everything else. As I understand it, there is a booking list for ITU beds for elective patients, but true emergencies (bad car crash, for example) always come first. So, before an elective operation starts, they make sure there is going to be enough space for the patient in ITU at the end. If there isn’t then the operation doesn’t start. And that’s what happened to me.

In the grand scheme of things, this makes sense. If it was me (or one of my kids) in the road accident, then that’s exactly what I’d expect to happen. But it does feel a bit frustrating at the time. And my consultant was obviously frustrated too, as it meant that the team he’d assembled to operate on me all day were now all running around trying to rearrange their surgical lists to pull other patients into the space that I’d just vacated.

And the title of this post? You don’t speak Yiddish? Me either – but apparently it’s a Yiddish proverb that roughly translates as “Man plans and God laughs”. So true.

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