Saturday, March 21, 2009

How it was in hospital

This is a chance to get off my chest the experience of the past two weeks while it is still fresh in my mind. The first thing I have to say is that I have never known such kindness and care as that I received from the nursing staff at my hospital.

I was admitted to the Royal Bournemouth Hospital early on the morning of my operation. This is the hospital that I worked at for my entire career. When I was first appointed in 1974 it was Victorian Establishment that had just 'growed like Topsy', with major developments in 1911, 1927, 1936, 1968, 1982 and 1986. The building that I originally worked in was demolished in 1993 and the new hospital built on the edge of the city opened in two phases in 1988 and 1992. It is a bright, airy, modern hospital that seems to have seen continual improvement since it opened. I was the first Medical Director of the new hospital.

The colorectal surgery department has an enviable reputation for high quality outcomes and low mortality and morbidity, a tribute to the meticulous planning and forethought of the head of department Dr Basil Fozard (you will see some of his innovations later). Dr Fozard has been at Bournemouth for about 12 years, having completed his training at the Mayo Clinic. I had already been pre-clerked before admission; so on the morning of the operation I knew precisely what awaited me as I sat and read in the day-room. I was able to walk to the operating theater suite. The anesthetist inserted a pink cannula in my wrist and injected a few drops of Hypnoval. He then sat me up to insert an epidural into my back and that's the last thing that I remember until I woke up in recovery. The surgeon came in and told me his findings, but I was still under the Hypnoval and I was in no fit state to fully understand.

My wife and daughter came in to visit me in the evening and here they encountered the first problem. It is now apparently the case that relatives can be given no information by the staff unless the patient has expressedly said that they might. There was therefore no-ne able to impart the news to them when they arrived, and it was I, in my drugged state, who blurted out the diagnosis. It was a terrible shock that they had not been expecting.

The rule has come in as an instruction from above because some patients have complained about their relatives being told. I have always thought that that was an unreasonable attitude to take unless there was some sort of estrangement involved. I have encountered husbands who wished to protect their wives from the news, but I have always countered that view by saying, "You have spent the past x years in the closest relationship it is possible to have, do you really intend to spend whatever time you have left telling lies to each other?"

The best person to break bad news is not the patient, but the doctor in charge, if he or she knows the job. He can speak from a position of knowledge, not only of the pathology, but also of how people react. He has an eye for the physiological reactions that accompany shock and is prepared with acts of comfort from a hand held to a cup of warm sweet tea.

To my mind the new rule is just one more of the vicious consequences of unthinking pandering to PC.

The major consequence of bowel surgery is paralytic ileus. This means the bowel stops its onward contractions (peristalsis) and just hangs about idly loitering. This always happens, especially if the bowel has been much handled (as when searching for a small primary). Post-operative treatment is aimed at making the period of ileus as short as possible. For many years morphine has been the mainstay of control of post-operative pain relief. However, morphine makes you constipated. Indeed, morphine alone can cause a paralytic ileus. Therefore, for Dr Fozard, the policy for pain relief is to use epidural anesthesia.

The problem for me was that the epidural only worked on the left side and the right was still painful. It happens occasionally and when it does the problem is more difficult. There was some Fentayl in the epidural to keep me in a haze, but I needed a PCA pump (patient controlled analgesia) to supplement this. This is a pump that delivers 1 mg of morphine at the press of a button, but then shuts out the patient for 5 minutes befor any more can be delivered. It is very effective, but the most immediate effect of morphine is nausea and vomiting. Generally, we offer an anti-emetic with morphine, but the choice is limited. Metaclopramide is a prokinetic agent that stimulates onward movement - possibly dangerous when the bowel has been resected and then rejoined, and ondansetron is constipating. Cyclizine is effective, but very sedating. As a result I had the morphine neat. This caused me severe spasm of the gullet.

Esophageal spasm produces a pain like angina, but can be relieved in the same way with glyceryl trinitrate, either under the tongue or as a spray. The new young doctor and I worked this out by Googling in the small hours of the morning, so she arranged to get a spray from the CCU. I tried it with instant pain relief. Then I vomited a couple of pints of brown fluid. What had been happening was that the body had contrived its own anti-emetic by constricting the gullet so hard it hurt. As soon as that was released - upchuck.

The response was to put down a naso-gastric tube and tomorrow I will tell you about that.

A great comfort to me throughout the period of hospitalization were the visits of Dr John Falkner Lee. John is a retired general practitioner. He and I were baptized on the same day in 1975 at Lansdowne Baptist Church. He is about 20 years older than I and shortly about to enter hospital to have one of his hip replacements replaced. Please pray for him. We were deacons together, elders together and always very close. For the past several years he has been on the staff of the hospital as Pastoral Visitor. On one of his visits he read to me from Zephaniah chapter 3.

The LORD has taken away your punishment; he has turned back your enemy. The LORD, the King of Israel, is with you; never again will you fear any harm. On that day they will say to Jerusalem, "Do not fear, O Zion; do not let your hands hang limp. The LORD your God is with you, he is mighty to save. He will take great delight in you, he will quiet you with his love, he will rejoice over you with singing."

Notice all those 'wills'; there is no 'might' in God, except that He is ‘might’y to save.

6 comments:

Anonymous said...

I share your appreciation of this passage of Scripture. One of my current favorite songs is "Mighty to Save". I put a link to it on my blog, if you would like to listen to it.

http://ajourneytowardhealingandheaven.blogspot.com/2009/03/mighty-to-save.html

Stacie

Peter Lewin said...

Get well soon, Prof, you're a great guy.

Elizabeth said...

Terry,

You are admired and loved by so many. Your personal commitment to giving under all circumstances is extraordinary. Please know that you are in my thoughts and prayers.

Elizabeth Locatelli Turgeon
Guelph, Ontario, Canada

Marcia said...

I do hope your wife and daughter are over the shock. I rather liked your approach of no lies to each other much better.
I appreciate your willingness to give us the details of your hospitalization, and I await the next installment!
Marcia

Paul Maguire said...

Terry

Whilst I can't offer prays you are in my thoughts and you have my hopes for a good outcome.

Paul

Pat said...

Thank you Dr. Terry for sharing your hospital experience with us. My thoughts and prayers are with you and your family for success in treatment and strength during the process.