Radiators and Drains

It's nearly seven weeks since my liver surgery. 

The hosepipe in my side which was draining bile/yellow stuff/bile/nothing/yellow stuff periodically was finally extracted this week. The man said, "Ooh, it's longer than I thought" as he was pulling it out. Hmmm. I'm terrible at measurements, but it was about the length of a standard wooden spoon handle. Pity I didn't get to whack him on the backside with it afterwards. 

I felt bloody great the day it came out. I felt quare as bejaysus the next day. It was like someone had suddenly removed a very stiff corset. My poor back, which is crook at the best of times, got very put out by the change in circumstances. My "core muscles" have left the building, and may never return. My scar is high up on my abdomen, curving from my xiphisternum to my iliac crest (breastbone to hip, non-medicals). Fans of the Great British Sewing Bee know that cutting across the grain of a fabric causes no end of trouble, and my muscles have been sliced diagonally and sideways and skew-ways, and have puckered like a badly sewn gusset. 

"Six weeks" is what I always say to people when they ask how long it takes for a body to heal after surgery. I say this regardless of what kind of surgery they have. I say this, thinking in my head, "6 weeks for wusses, 3 weeks for me." But it turns out that removing the big half of a vital organ is a bit much for a poor little human to deal with. Even a stubborn, allegedly resilient, one. 

I wrote after my bowel surgery about how I'd lost my mojo. 
Ah, the naivety of the laparascopee. There was me thinking that just because I'd had a foot or two of bowel removed, that I had somehow experienced the full whack of Major Abdominal Surgery. 
That was like a trip to the chiropodist compared to this. 
No keyhole fancy-dancery this time. The boyos must have had been up to their elbows in me, scraping bits of liver off major blood vessels, wrestling with mangled tumours. They even got the radiologist man to come and have a poke around with his ultrasound machine while I was panned out. No wonder it took six and a half hours. And five grams of haemoglobin. And seven weeks of aching recovery. 

The hardest thing about being debilitated for so long is that you start to believe it. You start thinking this is as good as I can be. You have people telling you how great you are to be up and about, or looking so well. You have people lifting your bags for you, or getting you to sit down all the time, or asking if you slept okay. These are all lovely kind things, but they are a bit addictive. Our little brains are very clever at holding on to the things that make us feel good and safe and protected. They make us run away from the things that challenge us. 

I was left alone to mind my own children this weekend. I was the sole adult in charge overnight, for the first time in months.
I had a panic attack after about an hour. 
I think most people know what a panic attack feels like, but for those who don't, it is basically a bombardment of physical symptoms that make you feel like you are going to die, but obviously you don't actually keel over. 
Which is all well and good, except when you have a medical history that makes it reasonably likely that you could be having a bombardment of medical symptoms that mean you ARE about to die.
I was able to talk myself down from it, and avoided calling the cavalry and/or ambulance. 
And then I felt about a million times better. 
I realised, you know what, I am actually capable of being me, doing the kind of things that Me is good at, lifting my own bags, getting up off my arse, sleeping or not sleeping and not caring either way.  



There are two kinds of people in life, radiators and drains.


I had become a drain.


Personally, I prefer radiators. 

Come On Now Camel, It's Only a Straw

I had to press Reset the other day.

I was being sucked into the self-pity vortex. Stephen Fry would have disapproved. 

I was sore. Cranky. Sleep deprived. Beginning to mutter things about pulling the drain out myself if the doctors wouldn't do it. Suggesting I would have taken my own discharge if they hadn't let me out.

I chose to offload this emotional cargo in my surgeon's office. 
Poor man. 
He had been looking forward to showing me the scans which displayed what a great job he had done, and the histology results which showed how little cancer was left. 
He had been anticipating one of those consultations, few and far between in his line of work, where everyone is delighted with everything and we all pat each other on the back. 

But oh no, actual here-and-now emotion had to come along and ruin it. He did try to use the phrase "bigger picture" to stop me snivelling, but he may as well have said "there, there."

{Which, as an aside, brings me to a revelation I had about Pain Specialists. Their job, fundamentally, IS to say "they're there." Yes, those painful sensations you have DO exist. You are experiencing them, therefore they are real. Pain is not a palpable, visible thing, it is a state of being which is hard to quantify and even harder to accurately describe. It is an intensely personal experience, and the worst thing about it is being unable to "prove" its existence to other people. So acknowledgement of its presence, and its impact, is often all that someone needs. 
Anyway, that's my profound thought for the day.}

So I wept and I snotted and I heard words catching in my throat as I tried to describe how hard it had been for me to go back into hospital and leave my family again. 

He listened. He acknowledged. He berated me for not having called him sooner. 
He was so right. The "Don't mind me, I'll be fine" trick really doesn't help anyone, and could have saved him a box of Kleenex. 

I did feel a hell of a lot better after an old inconsolable wail though. Once again, the children have the right idea. Play around, get hurt, bawl your eyes out, shriek the house down, then go back to playing away happily again three minutes later. 

I had made my escape from hospital a few days earlier thanks to the wonderful OPAT service, which meant a nurse was calling out to me three times a day to give me IV antibiotics. She waded her way through dirty washing and discarded Lego and half-eaten Weetabix to hook me up, check my temperature and chat about how great community medicine is. There was something nicely reassuring about having a personal healthcare provider in your own home three times a day. I felt like some kind of 18th century duchess.

I got the sutures removed from my drain site. Oh the bliss, the indescribable bliss, of being able to turn more than two inches to the left or right while lying in bed, without searing pain. They discovered I had fluid on my lung, which had increased significantly since the week before. That would explain the breathlessness then. 

I got home again, and the temperature went up again. Bugger.

But aha, clever me, this time I know what to do! I text the Man in Charge. He phones me back, tells me what to do overnight, arranges for me to get fixed the next day. 
I avoid the Emergency Room, I avoid abandoning my brood, I save more Kleenex. 

I go and see the Antibiotic Man first thing, he sorts me out with some more of those. 
I go to the Can Fix Anything With A Scan And A Needle Man, and he drains off a litre or so of lung fluid (which looks remarkably like the home brew we made once that nearly sent us all blind.) 
I head off home again after a couple of hours. I am beginning to wonder why they bother with hospital beds at all - Outpatient Inpatient Care is the way to go. 
I get a phone call while I'm in the coffee shop to go back for a quick dose of different antibiotic to tide me over until my home delivery arrives the next day. Another 30 minutes, in and out, job done. Two and a half hours. Probably 90% of the patients lying in beds in there had less than that amount of actual medicining done to them in the past 24 hours. And it has cost 90 times more to keep them there. 

Having a needle stuck through your ribcage is a very sore thing. Nobody I said this to seemed the least bit surprised, yet I never once thought about it when I did it to patients myself. But it improved, and I slept, and I rolled over in the bed without waking up. Such a good feeling. 

I tore into life the next day. Grocery shopping, fridge cleaning, laundry sorting, library visiting, dinner making. 

I crawled out of bed the day after. Ooops. May have overstretched myself a wee bit. 




But it felt a damn sight better than feeling sorry for myself.

Live from the Trenches

I nearly always write this blog in retrospect, after the fact, not a blow-by-blow minute-by-minute livetweeting affair. How old-fashioned of me.

But now that I am here, at the coal face, bang in the middle of the ever-topical trolley crisis, I feel it is my duty to post a report from the Front. 

I have passed the 12-hour mark on the trolley. 

The formula for newsworthiness, aka the Sympathy Coefficient = Age (years) x Waiting Time (hours) + Human Interest Details (severe disability/terminal illness/dog just died)

I don’t score particularly highly here so I am not going to make it onto TV3 news just yet. 

It started off well enough, empty waiting room when I arrived, pleasant man at the desk (though he didn’t introduce himself, #hellomynemesis would be disgusted). Nice nurse with a Jedi name and bustling efficiency got my bloods and whatnot sorted in a few minutes. Put me in a side room. Called the team down to see me. Not a huge amount of listening to my story or examining of my belly or any of that other GP nonsense. Just, “get a scan, wait for blood results”.

I was brought down for my scan quite quickly. At this stage I had decided to feel sorry for myself, and to regret having brought myself back into this circle of hell. I had to drink a load of gack and wait in my wheelchair, slumped over, in pain, nauseated, cranky. 

The move onto the CT table was excruciating. It’s funny how pain really does have a threshold, and when that is breached the misery gates are fully open, letting the waves of self-pity flood through and wash away any resilience you may have. I cried away inside the machine until they were done. When I came out, my wheelchair had been pinched. The radiologist of whom I was most terrified when I was an intern came in, looked around, went out, then came back in again and asked me if I was me. He said I didn’t look like a patient. I gave him my wan smile that means “you bloody try being me, buddy”. He asked if I could walk and the smile got wanner. He went off and found a wheelchair. He brought me round to another room and I met, again, a poor registrar who is sick of looking at me - as a tutor, then a patient in one hospital, then a patient in another hospital, and back here again now. They were very patient with me while I winced and ooched my way onto another table, stuck a bit of dye into my drain, and then ouched and eeked my way back into the wheelchair. All good, no blockage of the drain, no abscess, no bile leak, no major intra-abdominal pussiness. That cheered me up. Home now so, I said to myself.

Yes but. This is not an in-and-out kind of place. I had already been “admitted”. That means someone has written down a few pages of stuff about me on special sheets. They have put the surgical stockings on me. They have invested good time and effort into asking whether I have a bedroom downstairs at home, and all my own teeth. This is not to be wasted, just because I want to get home to roast the chicken before it goes out of date tomorrow. 

So I get moved to the Observation Room, which must be further up the admission ladder than the nice quiet private side room. It’s a nice bright place with four cubicles but eventually five patients, and a massive clear plate glass window facing out to the nurses’ station and the rest of the ED mayhem. Now I know what the meerkats in Fota feel like. I was even lying on my back scratching my belly nonchalantly after an hour or two. 

My three room mates are obviously pros. Two of them have already spent the night here. They were chummy. But then the third chap arrived and the mood went from polite conversation to all-out hilarity. Number 3 was from Kerry originally but had moved to the north city suburbs. “Tis a long shtory”. By god it is, but I have gleaned most of it in the eight or so hours that have followed. 

Privacy is not a feature of the Observation Room.

Given that I am nosier than an aardvark, this suits me quite well, as long as I can keep myself to myself in the corner with the curtain mostly closed. Thankfully my hacking cough sounds particularly tuberculous. And the grunts and groans every time I move are indicative of someone who is Fierce Sick Altogether. So I reckon I have gotten away with being the anti-social weirdo, and can eavesdrop away in peace. 

I should put in a disclaimer to say that the following account has been altered to remove any potentially identifying features, in the interests of patient confidentiality. But since I didn’t know any of them, and barely saw their faces, I think we are safe enough. 

Lady in Number 1 has been vomiting for weeks, no one knows why. She sounds very chipper to me. She is waiting for CT scans and OGD and something else. She’s from West Cork, which really means she’s from another country but lives in West Cork. She has to arrange various lifts with various people depending on what day she is being discharged. But her phone battery is low so she can only talk to two people per hour and for the briefest of ten minute chats.

Number 2 when I arrived was a middle class chap who was getting into the spirit of the place, fair play to him. He was whisked away to a ward before I could figure out what was wrong with him. He was definitely an experienced patient though, he had that air of knowing how the place worked. 

He was swiftly replaced by a 20-year-old woman with pyelonephritis and a mother. 

This was very much to the liking of Number 3, who has already made at least two female healthcare professionals do that laugh which means, “If you make one more suggestive comment I will get a clumsy male colleague to catheterise you with a hosepipe." Her mother doesn’t seem to mind. 

Number 1 thinks he is hilarious, and has been referring to him as “Healy-Rae” for the past six hours, laughing uproariously at her own profound wit each time she does so. 

In all fairness to Number 3, he is a bit misunderstood. He is a single man, with a brother as a next-of-kin whom he last spoke to about a month ago, and whom he has no intention of informing of his current admission. We have learned over the course of the day that he lives alone, used to drink too much, was homeless for a while, gave up smoking a year ago. 

A Teutonic doctor told him fairly loudly and fairly brusquely that there was a shadow on his chest xray. Any eejit knows what that means. She told him his inflammatory markers were high, and his white cells, so he may have pneumonia. 

She told him lots of other stuff but this, I expect, is what he heard: blah blah blah SHADOW, blah blah LUNGS, blah blah PNEUMONIA, blah blah blah MORE TESTS, CANNOT BE SURE, CANCER, BLOOD.

He was quiet for a while. So was everyone else. 

He made a comment to the next nurse who came in about getting him a bed on the ward. He told her he wasn’t physically or mentally well enough to be in A&E. She, and his trolley buddies, laughed, because they assumed he was continuing on with his Gas Man ribaldry. He gave in. The next time he said something about getting a bed because “shure, I might be did tomarra!”

His consultant came in eventually and said some of the same things, but prefaced by, “We are still in the dark, we won’t know anything until the tests are done, so it may be serious but it also may be just a simple infection."

At this stage, number 5 had joined us. Number 5 is a patient in my practice. I don’t know him, but I know of him. I know his wife. I know he has had significant health issues in the past three years, involving cancer, and that we share consultants. I didn’t know that he recently had had further spread and that that was one of the main reasons he was in the ED today. 

He spoke to number 3 after the consultant left. He told him that he had lung cancer, too. (Maybe missing Dr Whatsit’s point that there was no actual diagnosis of anything yet). He told him that the worst part is the waiting, the not knowing, the initial shock. He said this was the lowest point, and that things would get easier from now on. He was generous with his advice and reassuring in his tone. The fact that he looked like hammered shite and not a million miles from death’s door may not have been so useful to Healy-Rae’s optimism, however.  

So in our room we have two definite metastatic cancers, one possible lung cancer/lymphoma, one potential gastric carcinoma and a poor young one who needs her mother to help her to the bathroom and brush her hair. 

Outside the Observation Room, looking in, we have a young mum with a screaming baby (another patient of my practice), two drunks (one who has urinated merrily on the floor while sitting in his seat), a posh lady with a sore foot, and an ancient looking fella with a tilt to one side who is being sat on a particularly unsteady looking chair while having his blood pressure checked.  There is another patient of mine who I have previously suspected of Munchausen’s by Proxy. She has no children with her as far as I can see, so we can downgrade that to plain old Munchausen’s. She looks at me, and looks again, and wonders. 

The greatest source of amusement in our room is the incessant alarms from the drip machines.  Number 2 (the First) had trained them all how to press the Silence Alarm button, so they are all at it now. Number 3 keeps saying how much like Guantanamo Bay it is in here. Our Cuban nurse says nothing. 

A debate starts about the safety of men wearing jewellery while operating heavy machinery. We are blessed to have in our presence, one World Authority on Nearly Everything, one Kerry Authority on Most Things, and three willing listeners (I’m counting the mother, not me). Nuclear devices, brain transplants, watching telly on your iPad - there really is nothing these boys don’t have opinions about. No great knowledge of personal hygiene is apparent, however, and the place is beginning to hum. 

The nurses change shift. I draw the new one towards me with a conspiratorial whisper. “I’m a doctor and one of the patients in here is a patient of mine [not strictly true] so can you pull the curtain around me a bit more?” “Oh I will, and I’ll see about getting you moved.” 

Result. 

I’ve called in another favour and the Night Sister is aware of my “need” to jump the queue for a bed, on no grounds other than I Can Take No More of This. 

             *********************************************************************************

I got out. At half past midnight I was wheeled by a very pleasant Eastern European porter back over to the old part of the hospital. I told him I had worked here when the nuns were still around. He rolled me gently over the bumps. 

I got into my pyjamas and into the bed. Not a fancy bed, but 30 centimetres, two pillows and one sheet better than the trolley I had been on. The nurse was kind and caring, offering toast and analgesia, chatting about serious and not-so-serious things. 

I fell fast asleep. I dreamed about being in A&E which sort of defeated the purpose. 

I was wakened at 6 for the antibiotic. My lovely baby had woken at home at a similar time and I imagined her little toothy smile and her demand for “brakkie”. It is so much better being there than here but I’m going to go back to being brave and stoic. 

I am on the day ward, where I have been many times before. There is a steady stream of people coming in for colonoscopies and OGDs and excisions of skin lesions.

A young fella in the bed next to me came back from his scopes and was put in the bed by the nurse. Two minutes after she left the room he hopped up, put on his clothes and scooted out the door. He came back from the shop with a packet of crisps, a can of Coke and the newspaper. Oh to be so rebellious, or so ignorant of nurses’ wrath when you disobey the rules. He scoffed down his Tayto and slurped back the fizz. 

The SHO came in to him after he had stashed the evidence. She told him about his Helicobacter infection and his slight hiatus hernia. He burped a bit. 

He phoned his mother to get her to collect him. He tried to leave the ward again but got caught. He said he was going to make a phonecall. She told him he could use his phone in his bed. He was foiled. 

He sat in the seat and read his paper. She came in to get him to sign his discharge forms. “Where did you get the paper?” 

“I got it on the way back from upstairs.” 

“No you didn’t.” 

“I got it in the shop.” 

“What part of ‘don’t leave the ward’ do you not understand?”

I giggled from behind my curtain.