Friday, December 21, 2007
Thursday, December 20, 2007
Requests for the full story
Since my last post I have had a number of requests for the full story so here then is part 1 in more detail:
Tues 9thth October admission to Aldbourne ward in the new Brunel building at Swindon’s GWR. Check in very uneventful nice room though as it seems I managed to blag a private room with on suite bathroom, not dissimilar to a travel lodge but without the trouser press and mini bar. A fairly comfortable night although apprehensive about the op scheduled for 2 pm the next day.
Interesting experience down in the anesthetic prep room. I was having a spinal bock and epidural instead of a general anesthetic, this involved an injection directly into the spinal sheath along with a catheter placed outside the sheath (for the epidural pain relief – this stays in for 5 days) I was lying on my side whilst the injections where put into the base of my spine and IV canulas (cannuli ?) were inserted in my left arm.
The anesthetic took immediate effect in my left leg which I commented on to the anesthetist saying that it was rather clever. He explained that the dope solution worked on gravity and when I turn over I should go numb from the waist down which was rather handy as his next job was to insert a catheter up through the end of my willy and into my bladder, I then informed him that as I was now numb from the waist down would he refrain from volunteering any further details on what he was about to do.
My surgeon then came in along with his registrar when we exchanged the usual pre-op jokes like me asking if I will ever be able to play the Piano again. ‘Of course’ he replied, ‘strange’ I said ‘I couldn’t before’ Boom Boom!
He of course said ‘You won’t feel a thing’ with a maniacal grin, I waited for him to add ‘ever again’ but he didn’t
I then complained that every one had a face mask except me, was I becoming paranoid? So they gave me one just to shut me up. It was at this point I saw the strangest thing; the surgeon who was standing adjacent to my waist had a shaved orange leg hanging over his shoulder in the way a butcher would carry a lump of meat, oddly this made me laugh until I realized the leg was mine coated in Iodine.
It had been explained to me that I would be awake for the whole procedure but I would not feel anything and as it was scheduled for 2 hours I would probably drift off with the help of a mild sedation I would be given. So into theatre we went and the surgeon plunged into me with his scalpel, I couldn’t see or feel anything and so fell in and out of consciousness; however I could see a clock on the wall which currently read 2:45. suddenly the surgeon exclaim ‘Oh shit!’ at which point everyone gathers round, it appears that after having cut out and sawn off my existing knee and inserted the uper rod into my femur the lower rod would not pass an old fracture preventing the insertion of the lower shaft. I know no more until I come round in recovery at 5:00 pm and then taken back to my room.
As I fully come round I feel fine, I do a quick assessment of my status, check that I still have both legs, I have a saline drip, a blood drip, a drain tube from my knee and a catheter from my willy (don’t even think about a morning involuntary erection) and the best bit an epidural drip into my spine delivering a measured dosage of Morphine and heroine so no wonder I feel no pain and have a smile on my face. I’m reminded of the Pink Floyd song ‘Comfortably Numb’
I’m offered food and drink at this stage which I gratefully devour at which point Belinda arrives and is pleased to see me sitting up and so bright.
I finished my meal and chatting non stop telling B all that I can remember about the op when she says that I am looking a little pale and getting paler by the second. I then pass out and she runs out shouting for a nurse who arrives very promptly and proceeds to try and rouse me (B, explained all this later) by gently shaking me and calling ‘Phil, Phil can you hear me’ she repeated this a couple of times then asked B if I responded to Phil or Philip, ‘Neither’ she explained ‘his name is Martyn’ at which point I came too.
Apparently my blood pressure had dropped rapidly causing me to faint, but back on the oxygen it soon returned to normal. The drawback of this meant that I had to have my BP taken every 30 mins throughout the night for the next 4 nights, this is not conducive for getting good nights sleep, but you soon get used to sleeping with your arm hanging out of bed.
A couple of days later a physio comes to see me, fortunately along with the staff nurse who was looking after me. At the time of my admission it had been explained to the staff that due to my Neuro condition that I could go into spasm any time my legs received a sudden jolt or pain shock and that IV Diazapam be kept on the ward in case. Unfortunately there was some part of this that the physio didn’t grasp because he just grabbed my foot and jerked it toward me. Immediately I felt my quads tighten then the whole of both legs, I shouted ‘spasm!’ just before the full effect hit me, fortunately the nurse was ahead of the game, she got out of the door, unlocked a drugs cabinet, filled a syringe with 20ml Diazapam and shot it into a canula in my left arm all in about 15 seconds. Unfortunately she didn’t have time to flush the canula first so had to force the drug through which hurt like hell and I didn’t know which was making me scream most. The spasm relaxed immediately, it was some time before the physio came back.
On the Saturday I watched England beat France in the semi of the RWC, somehow not as satisfying on your own with only a couple of cans of Guinness, watched on a 14” lcd screen 2ft away from your face, all alone. No one to discuss the match with, not quite the same somehow.
Ok now it’s time to get lavatorial, I haven’t ‘opened my bowels’ as they put it for 6 days now and so there is some mention of suppositories which I really do not take on board so I do a deal. I have now had all my tubes removed and so I am sort of mobile so if they can get me on the commode, which is basically a toilet seat on a wheelchair that slides over the toilet, put me in position, I can be left to get on with it. Well there’s a lot of wind but little lese so I pull the bell cord to get some one to let me out and half an hour later I am still sat there. I attempt calling but to no avail.
I am basically nude but decide that if I can at least get to the door I can probably get out and get some attention. To cut a long story short I managed to wheel myself by grabbing wall etc, into the main corridor with balls akimbo only to find everyone had gone for a tea break.
So day 7 and still no shit so will have to have 3 bum pills tonight. The duty nurse that evening was a delightfully funny, large Jamaican woman who explained that she would administer the suppositories for me and make sure that I ‘hung on to them’ so that they would be absorbed properly and to do this she would use a short piece of plastic tubing.
I immediately had an image of her using a blow pipe and said no way. I explained that, should I find it suddenly necessary, it would be difficult to get to the toilet unaided in the middle of the night I would have to use a bed pan – would this be a good idea after 7 days? She saw my point and decided to leave it until the morning.
The first thing next morning I got a nurse to get me into the bathroom and with the image of the nurse with a blow pipe I suddenly passed the equivalent combined weight of the England front row, it felt so good I let out a large cheer, cleaned up and pulled the nurse called.
‘Are you alright?’ she asked.
‘Yes, but you may need to put in a call to Dyna Rod’
I had an incision wound at the side of my knee which wouldn’t heal up and continuously leaked fluid and it seemed whatever dressing they put on it still leaked through, however I was due to go home as I could now fully weight bear on the knee and inspite of leaving a trail of blood from my wound along the corridor after having convinced the physio’s that I could manage stairs, they pronounced me fit and able to be discharged. This would mean that I would be home for the Rugby World Cup Final! However I did mention to the Doc that morning that I had a pain in the calf muscle to which to suggested that they get it scanned before I go ‘just in case’
Getting a scan took another 2 days, Friday, and the result was …. 3 blood clots in 3 veins so if you would care to stay with us for another 7 days we’d be pleased to have you, oh and enjoy all the facilities, sorry about the trouser press. I actually cried
Didn’t enjoy Rugby final started on Warfarin and high dose Tinzaparin injections in stomach.
Sunday was fun, I had my staples out, this made my side wound bleed even more heavly, never mind they just used thicker dressings.
A week later Thurs 25th Doc says I can go as long as my INR is near 2, but only way to stop wound bleeding will be to stitch up. Mr Cool (the registrar, real name Ahmed somethingorother) comes up from theatre to confer and agrees, as skin at that point is so tough it takes 2 of them to get 8 stitches in but it does the job and finally the wound is sealed. Physio tries the steps again and we are successful so he signed me off. INR result comes back at 1.9 which is good enough with a final shot and off I go!
Tuesday, December 04, 2007
An update - if youv'e got a spare half an hour
For those who didn’t get an update on my knee operation I will try and combine the two but mainly concentrating on part 2.
Part 1 involved the basic knee replacement with various complications not least developing deep vein thrombosis which extended my 7-10 day scheduled stay to 17 days the worst of this being that I had to watch both the Rugby World cup semis and finals on my own on a tiny monitor over my bed, with only 2 cans of Guinness each time but there again not having had a shit for 6 days the guinness did help things along eventually, however after 3 days at home I was starting to walk again with the aid of a frame and even made it to the pub, albeit with a lot of help. The only problem being an incision wound in the side of my knee which had been made to reposition my knee cap wouldn’t heal and was being oozing fluid and being checked daily by our finest district nurse.
I was home for a total of 7 days before part 2 of this journey kicked in. I collapsed on a Sunday morning, fortunately in front of the district nurse who was redressing the wound in the side of my knee which wouldn’t heal. I had felt unwell during the night so she took my temperature just before I passed out. 39 c (102F). She called out a Doc who immediately called an ambulance and I was taken to Swindon A&E.
It soon became apparent that the wound was infected and had then infected the whole of the knee joint. I was admitted and sent up to a Surgical Assessment ward, then straight to theatre, (the play was awful – lol) as I’d had nothing to eat all day and it was then 10:00pm I was able to have a general anesthetic, so they proceeded to get as much poison out as possible then pumped me full of antibiotics.
The next morning they told me I would have to have another procedure which would involve opening my knee and scraping and flushing everything out and this would involve another general anesthetic so nil by mouth. I’d last eaten a slice of toast and drank a cup of tea at midnight after the first op.
I lay there all day waiting for them to come for me to go to theatre, eventually I was taken down at 1:30 am almost 25 hours after the toast but at least I was on a drip so that I didn’t dehydrate. It was a 4 hour op and I came around fairly sharply and although it was 4:30 I asked for something to eat and was rewarded with another slice of toast, Unfortunately I’d fallen asleep before it arrived!
In the morning they explained what I’d had done and that as my consultant surgeon wasn’t on the premises someone else had carried out the procedure and should have replaced a neoprene part of my implant but hadn’t. My consultant wanted to open up again, replace the part and flush out again.
So general anesthetic number 3 and a late afternoon visit to theatre again (same play). The next day I don’t know what planet I’m on, all I can say is thank God for the morphine drip.
After 2 days I feel a good deal better and get moved to a room with 3 other beds where I spend the next 8 days along with a number of different bed fellow who come and go as their stays are much shorter. Many different types of people become my neighbour including a chap who had just served 4 years in Belmarsh prison for attempted murder and was a crack cocaine addict – he had a stroke and was relatively docile but extremely paranoid.
I was told that I would have to have a tube inserted in my neck known as a Central Veneous Catherter, or Hickman tube (we call it my hicky) It’s inserted through a main vein in my neck a leads to the Aorta where it is anchored and a tube then comes out through my chest with a valve on the end. This means that my antibiotics can be administered IV at home. This procedure was done the following Friday under a local anesthetic and was fairly unpleasant and would rather stick my tongue up a Camel’s arse but I would now be free to go home.The only problem was that it was now 5.30pm on a Friday and a district nurse would have to attend on me for the first week when I got home and this would not be possible to arrange until Monday additionally all my medication would need to be ordered and delivered to my home so Tuesday was going to be my release date.
However the chap in the bed opposite had been moved into our room the day after me, he was elderly and not quite with it, on his seventh night he died. I was moved to another ward across the other side of the hospital and later learnt that he had died from MRSA. I had been moved as I was the only one who had surgery.
The new room was exactly the same as the old one, 4 beds, same layout people come and go. The following day, a Sunday a chap in his 60’s arrived on the ward straight up from theatre, he was awake and sitting up, I had a brief chat with him he’d had a minor stomach op and was able to get out of bed a walk to the bathroom with his drip stand. His family visited in the afternoon and I chatted to him in the evening. He fell asleep about 9.00pm and was pronounced dead at 1:38am. I had been awoken by a crash alarm and a lot of people came running into the ward with trolleys etc. They pulled the curtain around his bed but I could hear everything that was going on. Apparently the night nurse had come to me to flush my tube with Heparin – an anti-coalgulant- she had told me earlier in the evening that it would need doing, so I told her to just do it and don’t bother waking me. This she managed to do and after me she checked on the chap opposite only to find him still – no pulse – dead! The crash team didn’t bother to revive him as he’d been gone for an hour or so, apparently heart failure due to the anesthetic, so when they tell you there’s 1 in 100 chance of dying from surgery when signing the consent form believe them!
By now I’m getting paranoid, I really want to get out of there so come Monday morning I get nurses on the case with a view to getting discharged asap. Belinda got on to Hungerford surgery from home and they were brilliant, as soon as the hospital rang them they were already in place for me from Tuesday morning, by the end of Monday the medication I would need at home had been ordered and would be delivered along with a fridge to store them all in would be delivered by 8:30 the next morning and an IV nurse to train us all up.
Tuesday came and I was told I would be discharged late afternoon as all my in hospital medication would have to be administered at the correct time. As I’d been having Tinsaparin injections in my stomach for the last 10 days at 4:00 pm I would have to wait until then. Belinda came at 4.00 and the nurse went off to get my Tinsaparin shot and check my dosage which varies according to my INR blood level. When she came back she aid my INR level was to low and I would need to continue the shots for several days more, however they had not taken this into consideration when ordering my supplies and it was now too late to get pre-loaded syringes from the in-house pharmacy, would I mind staying another night? I was sat on the edge of my bed, packed and ready to go – to right I would mind!
Fortunately Belinda recalled that we had been given 4 syringes for emergencies the last time I came home so once I’d had the jab and we managed to convince them that we had enough at home they let me go – only 17 days!
So I am now home, confined to upstairs (I’m not allowed to use the stairs) so spend all day in the office and go to bed at 6:00pm. The nurse comes every morning but Belinda is getting pretty good at administering the 3 IV syringes and tomorrow she is entirely solo as the nurse wants her to do it without her being here.
Some other facts: The bug I got is called coagulase negative staphylococcus, I lost 3 stone in weight, grew a beard which came out grey and ginger (now shaved off), I still have the infection and will have for a further 6 weeks, they measure the level of infection by a CRP count in the white blood cells. The normal level should 0 – 6, 10 days after starting the antibiotic course my count was 133!, the last count was last Friday when it was 88 so it’s coming down, my next one is Monday so I hope it’s half that but it wont be until it’s in single figures that I will be in the clear.
So that’s it – in a nut shell – I would loose the will to live if I was to tell you the full story.