Welcome to 2012, some answers at last

Happy new year. 


Yeah, I know I am a bit late, but hey, better late than never!!!


Today I have finally got some 'closure' on the fiasco that was my pain relief after my surgery in July. 


I can't believe it has taken this long to sort out, but appears that despite me having been to East Surrey Hospital to have Imogen (she'll be 2 next month), twice for the abdominal pains in the summer & twice in November for the 'blockage' and telling them my phone number on each occassion they still had it incorrect. They finally thought to use my mobile number so I managed to give them the correct number & arrange an appointment with the head anaethitist and the senior pain nurse.


To summarise what happened after surgery, and to save you having to trawl the pages of this blog to find it. 

• My epidural was turned off and then not turned back on for about 6 hours despite repeated requests for it to be turned on
• When my PCA (patient controlled analgesia) ran out during the night. I was told that I couldn't have anymore and I would need to have paracetamol.

Well, I actually felt that I was being taken seriously now. 

I had three questions I wanted answered. Here they are, along with the answers I was given

1. Why was the epidural turned off? It turns out that epidurals move up the body and if they get too high, they can cause problems with breathing. My epidural had moved too high and so it had to be turned off. However this was not explained at the time and once it was turned off and the nurse walked away the call button was not left in my reach so I was unable to attract the nurses attention. 
2. Why did it take so long for my epidural to be turned back on? The combination of pain relief that I had, eg PCA and epidural, is not common and so there is a high probability that the staff did not realise how much pain I was in. Also 'out of hours' there are only three anaethetists on duty - 1 for emergencies, 1 on the labour ward & 1 for theatre. If the theatrical anaethetist was busy then it would have taken time for them to come to me. I can accept this. But once they had started to contact them why did no one communicate to me that they were trying to contact them, rather than leaving me waiting and wondering.
3. Why was I not given more morphine when I needed it? I was 'written up' for more morphine so the only explanation given was that the junior doctor who was on duty was worried about giving me too many 'opiates'

I also talked about the lack of communication during that first evening and how I felt that sometimes the staff thought that I was exaggerating things or that because I was younger I would be able to cope rather than treating me how they would treat a more mature person. However I also need to remember that there would have been people in the surgical stepdown unit that may have had breathing difficulties or other issues that were potentially more important than my pain. 

However because I was admitted as an emergency and already suffering pain my threshold would have been lowered and my pain receptors already firing. This meant that I needed a higher level of pain relief, hence the combination of epidural & PCA. The anaethetist and the pain nurse also agreed that more training was needed for the nurses on this type of situation. 

The experience has made me more nervous about trusting healthcare professionals. I used to trust what they said regardless. Now I ask more questions and do not take everything at face value. Despite this I still have a huge amount of respect for what you do and know that I could never do it.

One of the things I have learnt over the last 6 months is that there are stars in the health service but there are also things that can be improved. A one size fits all approach does not always fit. I always feel like an anomally. I always feel too young when I am on any ward and sometimes feel rushed or ignored by the doctors or nurses. 

I have, therefore, resolved that if I get readmitted to hospital for any reason I will ask questions and questions and questions. I actually don't care if it annoys people. I am an intelligent young women and also a customer and I deserve to be taken seriously and have my questions answered. 

20th - 22nd July - The Operation, the first night & agony

Wednesday was fairly uneventful. I got something to unblock me, I signed the consent form for the operation, A right hemicolonectomy, and I had to drink the worst drink I have ever had known as 'preload'. It was just really sugary water, but it was very unpleasant. 


I became fluids only from 6pm, other than the preload, I had one lot at 6pm, another at 9pm then was woken at 5.50am the following morning because other than a sip of water to take my pain killers I was now nil by mouth.


Thursday morning things were still up in the air. I was still an emergency operation so I could have been bumped if something else came up. Luckily nothing did so I had a visit from the anaesthetist, then the colorectal nurse, who I had seen a couple of times before to talk about things came along & then the porter arrived at about 9.45.


I settled down in my bed and was whisked off to pre op, where I had to repeat myself over and over again and confirm it was my signature about 3 times to ensure that they definitely had the right person and weren't going to remove a section of some poor unsuspecting persons bowel and associated lymph nodes.


At 10.15 I was taken to be anaesthetised. Here the constant pricking of the last two weeks caught up with me. Having had 4 canualas in when I had been in hospital previously as well as some stand alone blood tests both on the previous visit and current visit my veins had decided enough was enough!!.


Initially they couldn't find a tourniquet so one of the surgical nurses acted as a human tourniquet starting with the back of my left hand, then the back of my right. Nothing, Nada, No luck with that, my veins declined to play ball.


The anaesthetic doctor than bought out the big guns - the ultrasound machine - he scanned the inside of my left elbow, 'oh, lovely veins' he said, took out a needle and Nothing, Nada, No luck there either. So he scooted him and his machine around to the other side, scanned my right elbow and again 'Oh, more lovely veins' I even got to see them on the screen. He took his last needle, put it in, wiggled it around (yeah that sounds rude I know) and again Nothing, Nada. 


They had a little muttered conversation behind me, it was now about 10.30am and I was starting to worry about how they were going to anaesthetise me if they couldn't find a vein.


Then they came back. 'We're going to have to put a central line in'


It turns out a central line goes into your neck. 


This was one of the scariest things I have been through, at this point anyway. My head was covered with a plastic sheet, I had, in total, 3 injections of local anaesthetic into my neck and then was manipulated, proded, poked and manhandled for about 25 minutes while the anaesthetist inserted the central line. I was terrified. All your instincts tell you that needles and necks don't mix, but here I was voluntarily allowing someone I had met about 2 hours ago inject me and manhandle me to put something in. I am not ashamed to say that I squeezed the nurses hand incredibly hard, and cried quite profusely too. It got really hot under the plastic sheet and you feel very claustrophobic. 


After that I had to then roll onto my side while they put the epidural in. I didn't have much faith in this as I had had one when I had Isaac and it hadn't worked all that well. I don't remember much after that.


My next vague memory is of being made to sit forward, and I think they put something behind me and took an X-Ray, but I am not sure.


I did eventually come round and was in a slightly more sitting position and felt very drowsy and uncomfortable. 


I spent about 3 hours in recovery. Periodically I remember someone touching me with an ice cube and a needle. I think this was something to do with the epidural. Eventually the consultant came in and he told me that he had phoned Tony and told him I was out and then I asked the question that I was not sure I wanted to know the answer too.


'Was it a success?'


He told me the tumor was the size of a golf ball and he had removed a lot of the surrounding lymph nodes and tissue and that he was fairly sure that the tumor was cancerous, but it would have to be sent off for histology before we would know.


At the same time he set up one of mans greatest inventions, a PCA. PCA stands for patient controlled analgesia. It is basically a morphine drip that you, as the patient, control. You get a button that you can press and it delivers morphine into your blood stream. I could only press the button once every 5 minutes but that was enough.


About 5.30pm I was moved into the High Dependancy or Surgical Stepdown unit. 


This was a most unpleasant experience. It started with my epidural being turned off after about an hour in there. It eventually got restarted about midnight despite me being in tears due to the pain despite pressing my PCA button almost constantly. On top of this, I received all my belongings from the ward along with a note from Tony telling me Becci and Phil had had their baby at 3.30pm and he had decided to take mum and the kids to Somerset to see the baby rather than coming to see his wife in hospital. As soon as I got this message I tried to call him. He didn't answer his phone. I managed a one word message on his voicemail. I then called my dad at home and told him what ward I was on, what the hospital phone number was and to get Tony to call me as soon as possible. Tony didn't call me til 10.30 because they had been to the hospital first - again New baby comes before sick wife. Yes I was annoyed about this. 


After speaking to Tony and telling him what the surgeon had told me about the tumor I thought that I might get some sleep. This was harder than it sounds. I was in a lot of pain, I had to have my blood pressure, temperature and O2 SATS taken hourly throughout the night. As I said earlier someone finally came and restarted my epidural about midnight, and I managed to get about 3 hours sleep, until the morphine ran out. Then I encountered another power hungry doctor who obviously did not like night shifts. This doctor refused me more morphine and I had to make do with liquid paracetamol. 


This was not good and I think I might have blanked out what happened next because I want to speak to my consultant and see what actually happened so I  know rather than relying on my memory.


Writing this, although cathartic, has made me sob several times so I shall let you know about my day in surgical stepdown unit soon.