Welcome to day 4, being the third post in a series of posts about my recent injury and recovery. This post contains bodily fluids, pictures of cannula and a lack of dignity. You can read part 1 here and part 2 here. They don’t contain any bodily fluids.
We never got a chance to call the trauma nurse on the morning of Thursday 25th August to check if I was on any surgery lists, because she rang us first. The shoulder specialist had found his foot specialist the day before, and I had a serious lisfranc fracture of the foot – which needed urgent surgery and fixation (again, plates). I really should not have been putting any weight on it all, and the misdiagnosis in Carlisle had put my ability to ever walk properly at risk. Untreated lisfranc injuries can result in instability of the foot and serious issues with mobility. So I was being admitted at 11am, and despite expecting to be going in for shoulder surgery – I was going for foot surgery at round 2pm. We’d prepared a little overnight stay bag the night before when we got home so we were ready to go when the call arrived but it was still pretty fucking scary. I’ve had a broken arm (in my teens) and I knew I could get through the day only being able to use one of them, but foot surgery inevitably meant being off my feet for some time. I had no idea how long for. Also, with both the arm and foot injury being on the left side, I knew I wasn’t going to be using a crutch to get around – it was starting to look a little bleak.
We headed in, found our way to Ward 311 and on Thursday 25th, I’d gone from falling over playing tennis to being hospitalised four days later.
It’s around this point that my dignity became a victim of necessity. It’s also around this point that I started taking a lot more codeine a lot more regularly – and as a result, my memory is shit. All of the things I’m going to write about happened, but lets say that the order in which they took place or the exact sequence is more fluid.
Admission was pretty swift, they had the details from the previous day and the team were very efficient. With the surgery deadline in place, there wasn’t much time to get used to my new surroundings. I had to have conversations with the anaesthetist, the surgeon and the rest of the team. Before all of that though, I had to get ready. And by getting ready, I mean I had to shed my dignity. If hospital gowns are the worst invention of the modern age, then paper surgery pants are the worst invention of any age. Greté helped me get changed into both gown and pants, after washing down my leg with hibiscrub (or something similar), and I lay back in the hospital bed, feeling a bit like a turkey ready for basting. Do you know how easy it is for pubic hair to get trapped in paper underwear? Very easy.
I’ve only had surgery as an adult once, and I found that the person who seemed to care most about my well-being during the whole process was the anaesthetist. That was matched this time (although the surgeon was nice, to be fair). I had a long conversation about the style of anaesthetic I wanted. On offer were full general or, essentially, a spinal injection which would kill any sensation from below the waist and an injection freezing my foot in place. I never realised that general anaesthetics don’t come with any pain relief as such, where-as the other option was all about the lack of pain. However, if I went for the spinal injection, I’d be conscious for the operation – and I’d get something to help me relax without putting me to sleep. The anaesthetist asked which one I would prefer – I think I said, well, I’ll defer to you given it’s your job. He was insistent that I choose though – which I still find weird. In the end, I opted for the spinal injection because I quite liked the idea of being awake during the surgery. It was an excellent decision as my shoulder surgery later would prove. It wasn’t until much later that I realised the reason anaesthetists care so much, is because they’re basically holding your life in their hands, and in most surgeries, have more control over your well-being than the surgeon or anyone else in the theatre. If they fuck up, you don’t wake up.
The surgeon then paid a visit – and explained for the first time what the foot injury was and how it showed up on the x-rays. He also said that the bruising on the bottom of my foot was a classic symptom of fractures, if your foot bruises like that, it’s almost certainly broken. He explained the surgery, and drew three marks on my leg and foot. A massive arrow on my left calf, a dotted line on my foot where he said he was going to make his incision, and then another line on the inside of my foot with a question mark, because he wasn’t sure if he’d need two incisions or not. I finally got to wash those marks off my leg on the 18th of October, 54 days later. I spent some of those 54 days wondering if the ink was toxic when absorbed by the skin.
The surgeon also tossed in a throw away comment, that after the plate goes in, sometimes they take it back out after the swelling goes down, a couple of years down the line. Yep, two years of swelling around the plate.
What didn’t happen during all these conversations, was a proper discussion with the clinical pharmacist or anyone about medication or pain relief. Likely because I was being admitted quite late and going straight to surgery – but it would prove frustrating later on.
Eventually it was time to head out – and I hopped across onto the surgery trolley and told Greté to go home rather than wait since we didn’t know how long it would take. Off I went, paper pants and all toward the operating theatre. I had another conversation with the anaesthetist, we reviewed all the questions again about loose teeth, and then it was time for the injections. Leaning forward was pretty painful (see: fractured humerus) but once the various cocktails were in me it was a lot easier. I was in surgery and looking up at some bright lights. My memory of the surgery is strange. Time was really compressed, and I must have been dozing on and off, but I do remember talking to the surgeon and other people in the room. I remember seeing an x-ray of my foot with the plate and pins in it. I listened to the surgeon discuss where to put the next pins and how to lock the plate in place. I never felt a thing.
I woke up back in the ward, in bed, thankfully with my paper pants still in place. I could not feel my legs, or my back, but my leg had a half cast on it and a lot of bandage, so I knew something had happened. Luckily it was the correct leg as well! I’m piecing a lot of the rest of the day through a mixture of SMS and Facebook messages. Thanks to technology, I never felt far from Greté and friends, and most of the photographs in this post I took to send to Greté to let her know I was okay. I woke up around 7pm and texted Greté as soon as I could reach my phone. There wasn’t much point her coming back in that night so we just spent the time talking on SMS or FB. This is my favourite part of the whole conversation, Greté’s text is in grey, mine is blue.
I hope you appreciate that.
So far, other than some confusion early on, the experience with Derby hospital had been pretty good. I can’t fault the consultant, the anaesthetist or the admission team. However, it was all about to start going downhill. I’d not eaten anything or had anything to drink since midnight and it was now 7pm, long after they serve evening meals. A lovely nurse ((note that I refer to a lot of staff as nurses, they may have specific roles and names, but I don’t know them)) checked with me and asked if I was hungry and wanted a sandwich. She brought two sandwiches back with a drink, and said I looked like I had an appetite. I was then informed that it would be nil by mouth again from midnight, because I was going in for shoulder surgery the following morning, at 10am.
I had a chance for the first time to get to know the other patients in the small ward I was in. Alan was in the bed opposite mine. Alan was in his 70’s, deaf in one ear but mentally sharp as a tack. He wasn’t from Nottingham or Derby, but had fallen down some marble stairs in a building somewhere in the region and broken his hip in three places. He was pretty immobile in the bed, had been in for a few days and had some kind of air-powered compression slippers on to keep the blood flowing in his legs. There was a gent on my far right who’d been in a motorcycle accident, broken both arms quite badly. He’d already been in surgery a few times, metalwork sticking out of his arms. His legs worked though so he spent a lot of time out of the room walking around. In between them was another guy, who I didn’t get to know, he was pretty much asleep and then discharged the next morning.
I had a bit of a chat with Alan which wasn’t easy, we were both drugged up and he was half deaf, but at least it was some conversation. The pain in my arm was getting worse, I hadn’t had any pain killers since the night before but I checked with the healthcare assistant (HCA) while she was doing my observations and she said the nurse would be doing her rounds with the drug cart in a little while. I also mentioned that my cannula appeared to be coming loose, but she didn’t seem very worried. Eventually the nurse with the drug trolley arrived, and we spoke about pain relief.
“There’s nothing down next to your name, I can give you some paracetamol.”
I was a bit frustrated by that. I explained calmly that I was in quite a bit of pain and really could do with something stronger than paracetamol. It turns out that because I was admitted and moved into surgery so quickly, I hadn’t had the review that happens when they work out what drugs you’re going to be prescribed. I told her I had a bag full of ibuprofen, codeine and paracetamol all prescribed to me the day before by the consultant. She said, “you’re not supposed to take your own tablets, but if I don’t see you taken them ….”
So I took them. Along with my diabetic medication.
While I was calming down from that (and enduring ‘hourly observations’) I noticed that Alan’s pressured foot things weren’t on his feet. I was just about to mention it to someone when one of the nurses / HCA’s noticed and replaced them, making concerned sounds about how long they’d been left off for.
I finished the day off with a massive wee; into two cardboard urine receptacles. I’d taken on board a lot of fluids during the surgery, and despite not having anything to drink since the previous night, I’d also not been to the loo since around 11am, so there was plenty of water to get rid of. When the nurse came to collect the used bottle, I had to let them know they were both full – I don’t think she believed me initially, but she took them both and returned with two empty ones. That would be a pattern for the next day or so, where I think I passed a volume of liquid equal to Loch Ness. I can’t quite describe the subtle terror of lying in a bed, not able to feel your own legs or find your own penis by touch, weeing into a carboard bottle which is resting on the bed, trying to work out if you’re holding it at the right angle so that it doesn’t just spill out of the top.
Luckily for everyone concerned, I have great pelvic floor control.
Despite several queries and reminders no one really bothered fixing my cannula, and despite the fact that my arm was seriously painful I eventually just nodded off, ready for day 5. You’ll be pleased to know that day 5 is finally the Night of the Zombie Healthcare Assistant.