Saturday, 26 June 2010

The Emergency Op

I have pieced together what happened over these few days largely from talking to those who were looking after me at the time.

Monday, Tuesday, Wednesday
On the Monday night I started experiencing severe abdomninal pain and my memory blanks out for large periods after this point.

The Sister who attended me that night (who had also seen me through post-op HDU first time round ) came to see me a few days later. "God I'm glad to see you looking OK", she said "that was quite a night we went through with you". I just stared back at her blankly; I had no recollection at all of seeing her on the Monday night. Apparently as my distress increased through the night they had put me on iv morphine but could see the pain was still getting worse.

I vaguely remember being prodded and manipulated on Tuesday morning and the word 'sepsis' being bandied about. Somewhere in the back of my mind I was thinking "OK: there's an infection, they'll put me on antibiotics and that should sort it".

Now of course I have access to Google ...
  • "Sepsis is a life-threatening illness. Your body's response to a bacterial infection usually causes it. Your immune system goes into overdrive, overwhelming normal processes in your blood. The result is that small blood clots form, blocking blood flow to vital organs. This can lead to organ failure. One third of people who get sepsis die from it"
Suffice to day; under any circumstances, sepsis is very bad news.

They CT-Scannned me and decided to operate again; I remember being wheeled around and signing the consent form and then it was back in to surgery.

The post-op recuperation that followed was the longest night of my life. A couple of things made what was a bad situation worse than it needed to be
  • I was not given the iv-paracetemol I should have been (because the agency nurse caring for me didn't read my notes properly) and I was limited to pca morphine. The agency nurse didn't call in a doctor or anaesthetist despite my clear distress; from later conversation it is clear he should have
  • Presumably for reasons of expediency they did not catheterise me for the op this time round.  I struggled to pass water through the night -- I guess because of the pain I couldn't relax enough to be able to
Add to that an iv-drip that would alarm every 10 minutes (I see the nurse wrote in my notes how annoying that was!) and my night of pain and sleepless misery was complete.

During that night I was in and out of consciousness. I thought at one point that several days had passed when in fact it had been a few minutes; I lost all track of time and could make little sense of my environment; I was having mildly hallucinatory conversations with people who weren't there. But mainly I just hurt. A lot.

In the morning the nurses handed over and fortunately I now had a nurse who had cared for me before. I got stroppy: "This just isn't right" I said, "we're not making any progress, I am not getting better, the treatment isn't working ... we need to be doing something that's going to make this improve".

I asked why I had not been given anything other than the pca morphine and fortunately I was compos mentis enough to ask about the iv paracetemol. The nurse looked at my notes and I saw from her reaction that a mistake had been made; she immediately hooked me some up and within 15 minutes I felt a reduction in the pain levels. At last I believed things were going to get better.

Passing water was now a real issue. They theorised that my bladder may be overly full (this made sense to me and was how I felt) but when they used the ultrasound machine that measures bladder content it read only 100ml. This was depressing. After some debate they catheterised me (as I myself said, "why not?") and crikey was my bladder full. Immediate release was measured at 1.7 litres; my consultant still refuses to believe it (the human bladder apparently has a capacity of around 500-600ml).

The worst was now passed. I was still very sore and well doped up; they had left two drains in my stomach this time to monitor the wound site more extensively and these were very uncomfortable. But at least now I felt like I was getting better again instead of worse.

The consultant tells me that during the op they found two large infection sites inside me (I'll spare you the full gory details here) which they were able to flush out and I have been taking industrial strength antibiotics since.

Thursday / Friday
These days were all about recovery, sleeping, dealing with pain ... and emotionally unravelling.

I think it was some combination of the trauma from the pain I had suffered combined with the realisation (from seeing the relief in the nurses' faces as much as anything else) of 'just how close that was'. So a lot of tears were shed, I turned into an emotional jelly for a couple of days.

There was a real Groundhog Day feel about these days. First time round I had handled the post-op irritations pretty well; this time I couldn't help noticing how much weaker I was than before and was continually irritated that "'I've already done this once before".

As I sit writing this on Saturday evening my drains have been removed and I have been able to take some faltering steps around my room. The remaining worry is apparently whether my bladder has been damaged; the catheter is out tonight and so by tomorrow morning hopefully I will know that all is functioning normally.

I am looking and feeling malnourished: the muscle wastage particularly around my legs is distressing to see. Still, that gives me a nice focus and challenge for the coming months -- all going well tomorrow is my first step on the ladder back to full heath and fitness

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