I’ll show them I’ve got guts

It started late on Christmas Day – a sharp and continuous pain in my lower abdomen. At first I put it down to having eaten a larger than normal meal for Christmas and assumed it would pass. Even as I went to bed, I thought it would be gone by morning, but instead I spent a restless – and sleepless – night. Early on Boxing Day I called 111. Aside from the standard question about how much blood there was, they were courteous and efficient and dispatched an ambulance. The paramedics took my vital signs and probed around, and asked questions about the scar from my 55-year-old appendectomy, but thought it might be a muscle spasm and arranged an appointment at the local hospital out-patients for that afternoon. Things got worse – more pain and vomiting – so the 14 mile drive was a nightmare – even as a passenger! After what seemed like an interminable wait, the doctor saw me – and I was immediately wheeled around to Accident and Emergency. I was seen by the consultant surgeon and had an X-ray, and once again there was a lot of questioning about my appendectomy, but at least they put me on morphine, so the pain was dulled. I slept fitfully, and in the morning saw the surgeon again. Their theory was that “adhesions” from my 55-year-old operation had caused a twist in my small intestine to cut off the blood supply and my gut was slowly dying. They would probably operate, but needed a CT scan with contrast agent to pinpoint where the problem was and save time in the theatre. I was asked to drink about a litre of blackberry flavoured contrast agent, but it came back up again. I also got a contrast agent injection just prior to the scan to show where the blood wasn’t going. I was on my third or fourth morphine injection by now so becoming used to the anti-emetic needed to counteract its main side-effect (for me at least). I met the surgical team in pre-op and felt the anaesthetic come cold through the cannula and then the world left me.

I woke up the next morning with a huge dressing on my stomach, hitched up to a variety of drips and catheters. They explained to me that they had removed 3 feet of dead small intestine (near the end of the 24 or so feet I now know I used to have) and resected the ends. The external impact (hidden by the dressing) was an 8-inch laparotomy scar and 39 staples holding my guts in. I lost all sense of time and much of my mental focus, but family and friends visited and tried to distract and entertain me. At first I ate nothing, but after a few days graduated to “clear liquids only” and everyone seemed obsessed with whether I had passed wind (it turns out that it's a useful indicator that the resection was gastight and so viable). The surgeon who had operated disappeared but his posse of junior doctors explained not only what had happened but that he had worked Christmas (for which I was grateful) but taken New Year off. The nurses were (mostly) nice but obviously overstretched. After a few more days, I graduated to “soups and sweets” – no real structure to the food and the next stage in the journey of re-educating my battered intestines. I realised that I was the only acute patient in the ward and I that I would eventually go home – the others had what are now called “life-changing” problems. After 8 days of hospital care (but no sleep – wards at night are not restful places) I was discharged to home. After a couple of days, I visited the GP Practice Nurse and she removed half of the staples (with a really neat tool that took (most of) the pain out of the procedure). I woke 2 days later with a dressing soaked in what looked like dilute tomato soup. I was rushed to the GP’s, where the nurse drained another 100 or so millilitres of serous fluid out through the not completely healed scar, cleaned me up and put on a new dressing. Apparently, this sort of thing is not that uncommon, but it scared the daylights out of me. My wife, and a friend who is a nurse, had been scouring the Internet for how to continue the education of my digestive system. What they found was that the NHS is a bit confused and fragmented over such advice but many US hospitals give clear and unambiguous advice on the best diet after a bowel resection. Interestingly, their advice suggested that rhubarb crumble (my first sweet in hospital after the operation) was exactly the wrong sort of thing to feed me. To be fair, there does seem to be a spectrum of advice from gentle to rough on how to eat after this sort of operation.

The first month passed in a bit of a blur – although I had spent about a week on morphine and I was now on paracetamol (which appears to be the painkiller of choice for smooth muscle?) to dull the pain, I had difficulty focussing on anything. I thought I was doing well, but the responses to my texts suggested I was not fully functional as a communicator.

After the first month I got my brain back (I claim) but the physical side of things astounded me. One of the tests I had to pass before I was discharged from hospital was to walk up and down stairs (it is worth noting that much advice suggests that although walking is good, climbing stairs puts too much strain on the abdominal cavity and should not be attempted before 4 weeks!) and I only just managed it. By now, I had not used most of my muscles for 4 weeks and they all seemed to have gone – along with the 10 kgs of body weight I lost. I started a gentle regime of exercise – on a good day I managed 3000 steps. Once again the Internet gave me every option from competing in a marathon after 6 weeks to not really being back to strength in 6 months. The NHS Trusts all seem to offer different advice – and mostly focussed on those recovering from a Caesarean Section (a not dissimilar operation, I am informed by several female friends). If I set my recent experience alongside the dim and distant memories of having small children, I am now in awe of women who give birth this way.

It is now 3 months since the operation and I can mostly do things I did before Christmas, although I tire more easily. I am contemplating a gym and a personal trainer who understands the necessary recovery pathway in the attempt to regain some stamina.

Now the “project” is over, I feel forced by habit to examine what I have learned. The first thing is that my digestive system is a more precious and fragile thing than I thought, and that the passion for wholesale surgery to fix childhood problems which seemed to have been prevalent in the 50’s and 60’s when surgeons were perhaps not so enlightened, was not necessarily a good thing. Most of my peers are now nervous because they too had appendectomies when they were young. The second is that the NHS, which I have now seen close up, is full of (mostly) good people who care about their responsibilities but are badly organised. Finding anything out – either from inside or out – is difficult because they are busy and disorganised, there appears to be no clear prioritisation (after life threatening) and often jobs are left unfinished because something else came up. And don’t get me started on the number of “managers” they have! Finally, I have learned (admittedly late in life) that patience is a virtue. Trying to get better too quickly has all sorts of potential side-effects – from de-hiscing (the wonderful new word I have learned to describe when wounds come undone) to cheese-wiring (what sutures do to the surrounding tissue when you over exert). That patience has given me time to read, absorb and think about issues I used to react to more-or-less on instinct. I am sure this will pass!!

Societal Challenges
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