How I got out of that
02 August 2016 by David Bott
In the late 80’s there was a trend for “teamwork” training for management teams based on popular activity based TV programmes. So it was that in late 1989, I ended up in Theakston with my colleagues at a nice hotel on a Friday evening poised for a weekend of active team-based problem solving. On the Friday evening there was a sumptuous dinner, and in the briefing afterwards the leader of the organisers gave us a pre-weekend pep talk. Part of his spiel was that no activity we would undertake over the weekend would be more strenuous than a brisk afternoon’s gardening. There was a pause before our Research Director announced from his table that ”he had a man to do that for him”.
I was reminded of this event on the late afternoon of 7th May this year when, after a brisk afternoons gardening, I realised something was not right with my abdomen. The back-story is mostly contained here, but essentially I was by then almost 19 weeks on from major abdominal surgery and had been following a strict convalescence routine, but should have been well beyond any danger point. Nevertheless, I had a bulge under the top of my suture line that disappeared when I lay down and wobbled when I walked. The following week I visited my GP and he gave it a name – an incisional hernia – but seemed to think that I should learn to live with it (I was disappointed with his approach, I admit). I Googled incessantly over the weekend and called a private medical supplier on the Monday. By Friday I was seeing a specialist and having a CT scan. This sort of hernia is a moderately common (10-15%) complication of the sort of laparotomy I had undergone at Christmas, and has many causes. It could have been surgical technique (it had been an emergency operation at Christmas), I could have pulled a stitch when they tried Tramadol on me (I had a very strong retching response) or the infection that caused the discharge from my wound after 12 days could have weakened the muscle tissue – whatever had happened, I had a hole about 2 by 3 inches in the upper part of my abdominal wall. As a lapsed materials scientist, I knew that any hole in a structure concentrated stress and the hole would grow. The surgeon now treating me thought the same and advised closure surgery. I was duly booked in for a few weeks hence.
I arrived around lunchtime, changed into a theatre gown and watched daytime television for 5 hours until an unhappy surgeon came to apologise to me that over-runs with previous patients meant I could not be operated on that day. I duly dressed and returned a week later for a morning appointment!!
The following week, I was booked in for the first slot in the day and went through the “putting you to sleep” routine before 9 o’clock. I woke up to some bad news. They had gone in laparoscopically (commonly known as keyhole surgery) but had not been able to close the hole and cover it with the mesh that would carry the load until natural processes rebuilt the muscle. Instead they had cleaned up a number of “adhesions” and closed me up. I suspect the surgeon pulled a lot of strings, but I was booked in again the following week for “open” surgery at the nearby NHS hospital. I was discharged that evening. Whatever they tell you about day surgery, you should realise that it takes a lot longer than a day to recover from it, so I was still stiff and sore the following week when I reported for the next stage. I was to have a thoracic epidural for “pain management” (I am not sure I liked this description!) and can report that the patter from the consultant anaesthetist and theatre nurse was very diverting as the registrar threaded a small plastic pipe down my spinal column. They do this when you are awake to check on pain (a good indicator that the tube is not in the right place!) and I did feel so odd sensations as the tube went in. Once finished I went through another general anaesthetic and woke up 5 hours later, with the feeling that someone had driven a large truck over my stomach, but with no real “pain” since the epidural was feeding a measured amount of local anaesthetic and opiate into the nerves that would tell me someone had seriously messed about in my belly!
The first day was easy, but on the second, when they tried to start me mobilising, I came over all dizzy and started to sweat profusely, so the physiotherapists went away unhappy with me. The same happened the next day. It turns out that the reaction I have to morphine was the same whether it was administered by needle or epidural, so I came off the epidural and onto a regime of cyclizine and ondansetron to quell the nausea. On the third day, I was “managing the pain” better and the nausea had gone, so I got to walk around the ward. This was just as well because the ward moved lock, stock and barrel downstairs on the fourth day! By now I was suffering from a common side-effect of abdominal surgery and painkillers – constipation – so they added another set of medication to free me up. On top of everything else I had a daily anti-coagulant injection – which meant I started to bruise like ripe fruit. My new suture line started 3 inches above the bottom of the original but went on for 7 inches – which meant that it will be 10 inches long when all this is finished. I also have 3 holes in my left side from the keyhole surgery and the remains of 3 drain holes. It looked a mess and was still stiff and sore. The suture line was held in place by 30 staples, which gave the appearance of a 7-inch zip fastener snaking up by belly. The staples came out after 14 days and my convalescence proper began. I also have a localised numbness around the top of the suture line. With all the cutting and re-arranging of my abdominal muscle to fix the 20 by 15 cm plastic mesh which holds my abdomen together, a number of nerves were cut or otherwise damaged. Some will heal but also the brain will re-map my nerves and it will go away after 3-6 months (they tell me).
I think (hope?) the repair will overcome the previous problem, but I am (naturally) apprehensive of too much exercise too soon – and any repeat of the last few months. The good news is that I have watched “a man” cut my lawn once (actually it was 2 men and they were a lot more efficient than I normally am) and am resigned to the rest of the year being on “light duties”. I hope this is the final report on my experiment with the medical profession, and I can get back to my semi-retirement. And I need to relearn patience!!