If I ever get out of here … (2)

As you do, the night before the operation, I wrote a list of things to do for Partner in case I never made it off the operating table.

In fact when I looked at the list of outstanding things to do, I figured not having to deal with them all was a small bonus. And I would know nothing about it either.

Tuesday was busy, busy, busy.

I’d asked my surgeon where I was on the list. ‘It’s shortly going to undergo a massive change,’ he boasted. And added naughtily, ‘you aren’t on the list’. Later in the conversation he told me I was fourth.

A nurse told me it didn’t work quite like that. An emergency might come in and take precedence, well yes, obviously. A bit like me 12 days previously, except as it was bank hol, there was no theatre. Wonder what they do with real emergencies on a bank hol or weekend? Call out a surgeon? Rush the patient to Algeciras? People with diabetes tended to go to the top of the list too. Who cares? Not me. The only reason I wanted a vague idea was to make sure I’d had chance for a wash, teeth brush, and not be rushed.

Fracture blisters

But let’s backtrack a bit. If you read part one you will know that the reason for delay in surgery was due to the appearance of fracture blisters. On the Friday morning when I first met my surgeon, he explained the optimum time for surgery after an accident like mine was 1.5 to 2 hours.

Well given how long it took me to get help, the ambulance to strap me up and stretcher me down from the disused military bastion, get to hospital, sit in MI, have X-rays, chat with smiley doctor – that rapidly used up that precious time interval. Had surgery even been available on a bank hol.

Now, like most of you, despite all my many previous ankle injuries, I’d not heard of fracture blisters. Hardly surprising. One source I looked at said that less than three per cent of joint injuries involve them. A rarity no less.

Add this to the fact that Gib is basically a cottage hospital with bells on. It serves a population of 30,000 people. As a kid, hospitals abounded in my local towns in the UK. Most towns had not one but two hospitals.

But time moves on and hospitals close. So my local towns’ populations of 60 and 70+ thousand have one hospital each now. Another town, population of 50,000 no longer has a hospital. My childhood town of 20+ thousand never had a hospital – apart from a fever hospital, closed before I was born – and the market town I lived in, pop’n 35,000 (more than Gib) when I was commuting to London, never had one either.

So, serving a small population, and yet doing CABGs, and cancer ops, is yet another indicator of the anomaly that is Gib.

It’s hardly any wonder that staff came to peer at my uncommon fracture blisters. Reading around, your average specialist orthopaedic surgeon should always assess a fracture for blisters. But I wasn’t dealt with initially by an orthopaedic surgeon. Merely the doctor in A&E. His not to look for potential blister areas, but to stabilise a broken ankle. Had he ever seen a fracture blister I wonder?

In this (not very good) pic you can see the raised area that became the blister. It’s basically damaged tissue that’s arisen from a badly sheared fracture. Would the surgeon have noticed had he seen it on the first day? Who knows?

The raised area on the lower leg is what became the Bluster Zone. I mean Blister Zone …

Because they are quite rare, there is no agreement on treatment. Time, aspiration, cryotherapy are options. My surgeon told me NOT to pop it and we would go down the time route.

Dateless doctor from A&E suggested ice. Nurse attached ice, added yet more bandage and eventually I was not only lugging a leg of plaster, I had a bag of water to drag around as well. I ripped it off. It was never mentioned again. Me and my surgeon agreed on fresh air.

There are two types of blister. Those filled with clear fluid and those with blood. I had both of course. The blood ones are worse.

The main problem is the potential for infection during and after the op with some sort of coccus being prevalent.

So, all you needed to know about fracture blisters, and let’s hope you don’t need to put it to use.

And for no particular reason, the culprit.

Awwww! So cute.
Who me? Causing problems?

PRE-OP

Pros and cons of op – or – risks and side effects

Back in the early days of limbo, I’d asked what about not operating. Surgeon looked at me as though I hadn’t left kindergarten and said it wasn’t an option. Early onset arthritis and lots of pain. Rattled through operation of plate in lateral side plus screws, and screws in whatever they call the inside. I wasn’t impressed.

With the onset of limbo I didn’t bother enquiring any more about the op. However when it suddenly became The Day, I figured it was time to take a renewed interest.

I asked surgeon about risks and side effects. See I didn’t waste ten years in the NHS for nothing. The bastards are supposed to tell you this. It’s called being an informed patient. You need to be informed before you can consent to an op.

‘Oh I thought we’d discussed this before,’ he said loftily.

Oh no we jolly well hadn’t. What would happen if I didn’t have the op, but not what the risks of the op were.

‘But we’ll do it again anyway,’ he added smarmily.

He rattled it off. Bleeding (from the double incisions), pain (huh?), poss DVT leading to PE (good thing I was up on deep vein thrombosis and pulmonary embolism eh), arthritis, post-op infection and I can’t remember the rest. Wherein lies another story.

And off he went.

I’d already seen the anaesthetist. Scandinavianssen or some such name. Did I want to have a spinal injection and stay awake to watch? Yeah, that sounds a great idea. I just love to sit up and watch someone slashing my ankles, blood spurting everywhere, clamps being used and screwing my delicate bones up with bits of metal. Not to mention hearing the usual crass theatre chat.

I went for the GA. Just put me out like a light sweetheart. If I come round, great. If I don’t, I’ll never know. I like GAs.

Later that morning, I was chatting to one of my regular nurses. He’d gone for the spinal injection. It screwed with his body and his metabolism so much that he was flat on his back for two weeks afterwards. Sure GA carries a risk. So does fucking with your spine.

Patient consent

OK. I have to admit this was mildly fun. One of my nice smiley medic friends came around with the form, and said ‘sign here’.

WHOA! Having a laugh? Would I sign away money like that? No. And while my body may not be worth much, it is still mine.

I went through everything. Twice.

‘These are the relevant bits,’ he pointed out.

I was signing for all of them, so as far as I could see they were all relevant.

Meanwhile Cherie in the bed opposite was pissing herself laughing. Poor old medic wailed, ‘But nobody ever reads it!’

This may possibly explain some of the problems in the health service because you precious gits should spend more time explaining instead of trying to get signatures on forms.

We reached a consensus that I would end up with arthritis whether I had the op or not. I would suffer pain either way. Without the op I would be in plaster for eight weeks. Um, I’m in plaster for six weeks after the op.

I wanted to discuss percentage risk factors for the most dangerous. Bleeding he said. Oh dear. No, I didn’t want to know the most likely one. I wanted to know the worst one and what the chance of that was. I looked at him patiently.

‘No. That’s the most common one isn’t it? I want to know about the most serious. I think it is DVT leading potentially to pulmonary embolism while on the operating table.’

Aaaaagh!

‘Oh, yes.’

Medics never could communicate.

‘Can I have a copy of these notes,’ I asked as I flicked through my file.

‘Yes, ask for them when you leave.’

A favourite nurse brought me a gown and a white stocking (to prevent DVT).

I waited. And suddenly a porter appeared and up we went to theatre.

Theatre

It was freezing in the anaesthetic area. A perky woman came in. ‘Hello, I’m Kate, I’m a medical student.’ That was hardly inspiring. The theatre nurse admitted to being a student too. I took courage from the Indian who looked as old as me and didn’t proclaim his student status.

Med student jabbed me to find a vein. I’ve always had junkies’ veins so her botched attempt at screwing a needle every wherever was getting too bad to bear. ‘I do have other veins,’ I offered. In case she hadn’t noticed.

A new vein was attempted. Mr Scandinavianssen appeared and said you are growing sleepy, sleepy, sleepy.

OK, he actually said I’m going to inject the anaesthetic soon.

And then it was bloody freezing and I was awake in the recovery room. Back up to important post-theatre room so I could be monitored every 15!! minutes. And NO! I did not want painkillers.

Partner turned up for a fleeting visit.

Post-op people seem to be allowed to receive visitors at will.

I ate tea. I felt as OK as you do after an op. No GA after effects.

Pain relief

I had a choice of drug cocktails. Never mind boring old paracetamol. I now had a wider choice including tramadol (mild opiate whose effect was strengthened with an NSAID such as para or ibuprofen) or … oral morphine.

Morphine. I harked back to the ops of the past and remembered floating on the ceiling with morphine. I’d even joked about morphine with some of the nurses and here it was, prescribed right there for me.

So, as ever, I lay there. Not too much pain. No paracetamol needed. And then, in the night, OUCH! OUCH! OUCH! Something was screwing right into the inside of my ankle. I waited for it to disappear, or for me to mentally make it disappear. It didn’t. I took the tramodol and two ibuprofen left by a nurse who said I might need it. And if I wanted something stronger … Of course like an idiot I never did ask for the morphine.

I listened to the woman next door and her visitor. She’d had a breast op. ‘You don’t want to use morphine. It’s addictive.’

Hell, if my pain was bad, morphine would suit me down to the ground. I couldn’t justify it though. Tramodol and boring ibuprofen worked perfectly well. Maybe I don’t need to float on the ceiling any more? So near and yet so far to/from that sublime out of body experience.

The next morning I was the first to be decanted from the theatre ward. Back to the three-bed room and my window view. A bit later two of my post-theatre companions were wheeled in.

How long would I be here post-op? Another two weeks?