Tuesday, May 02, 2006

It just goes to show

Just when you think everything’s going swimmingly, life creeps up behind you and socks you over the head with a lead-filled sock (apologies to P G Wodehouse).

Forgive me if I stray from my usual topics and get a bit personal for once.

Ever since I came to Oz various doctors have remarked about blood in my urine. Scans and X-rays showed nothing, and a particularly vicious cytoscopy under local anaesthetic only – dyno-rod your dick - produced a diagnosis of ‘possible stricture in the urethra’.

Now we know it was in fact a kidney stone. A small fragment of it passed a year ago, much to everyone’s surprise – they were all running around talking of prostatitis at the time. But scans still failed to show up anything else, and we all went back to sleep.

Of late I started saying to my partner that I thought I might have another stone. The waterworks were playing up, and there were ominous twinges from the left kidney after an evening’s wine-drinking.

…………………………………………………………………………………….

The whole production moved into top gear last week, with excruciating back/groin pain, growing to the point where nothing the GP prescribed could quiet it, and we finally summoned an ambulance.

One night in emergency – and a large quantity of intravenous morphine – later, I was back home with some more scans, more pain-killers, and a consultant’s appointment.

My left kidney was twice the size of my right, and there were unclear indications of a stone. The consultant ordered more tests and more scans.

The stone had other ideas. The pain recommenced, and I went back to emergency. Within a couple of hours I was admitted, and found myself in a four-person room on the general surgical ward.

In one bed was G………, 90 years old, post-op bladder cancer. Then there was J…., a farmer from country Victoria, 70-something, also post-op – colostomy/prostatectomy. And me. The fourth bed was for very short term patients.

First there was the elderly gent with a very bad toupee who arrived fretting about his dog, which had been run over that morning. The dog had survived but was badly hurt.. They prepped him for surgery, wheeled him out, then wheeled him back half an hour later saying he was ‘too distressed’ to have his op. Total turnround time three hours.

The following day a similar thing happened, except the guy had his procedure and was gone by the end of the day.

A third occupant stayed two days and rarely emerged from behind the curtains at all.

J… was there the whole time I was. He and his wife and I struck up something of a rapport – mainly because G….. was way too sick to communicate with.

The day’s routine didn’t vary much. The nurses would come round about 9pm to settle us for the night, pump in the drugs, check the drips and drains. Then an hour or two later G….. would begin moaning. He would ring his bell. Moan louder. More often. Louder. Start yelling Nurse! Nurse! Nurse! Pain! Pain!

The rest of us were powerless to help, since we were tethered. On the right to a drip machine full of saline and drugs, firmly plugged into the wall, and some of the time also to a drain on the left, fed by a catheter.

At some point a nurse would respond to G…..’s cries and the bell. Sometimes before he’d reached the screaming stage. Sometimes not.

Depending on the quality of the nurse, she might ask, “Are you in pain? Where does it hurt?. Now we can’t have this G……, you’ll wake everyone up”

Or she might call for more help, start to check drips and drains.

Eventually – say within 30-45 minutes – G…..’s pain would subside. Unfortunately by then, everyone else would indeed be awake – and G….. was not the only screamer.

One woman could be heard in the distance, Aaah! Aaaah! Aaaa-aaah! (on a rising note), in surprisingly pure tones, almost like an opera singer warming up. Once she began, she often went all night. Later in the week, the night before I left, a baritone joined the duet.

Fortunately I had my earplugs. And the morphine.

That didn’t stop me overhearing things like a nurse telling the operatic screamer, “Now what is that noise? What do you think you’re doing? People are trying to sleep” Which did, amazingly, quiet her for an hour or two.

I thought the same nurse then said to one of her colleagues, “She doesn’t like me ever since I burned her.” But that may just have been the morphine.

Anyway, G.....’s wake up call usually got my pain going again, too, so I might get another shot of morphine. Or not, depending on the nurse.

A lot depended on the nurse.

They fell broadly into two camps – the bright and chirpy, rather like the kind of girls who work in pet shops and vets, and the grim. Despite the irritation, you wanted a chirpy.

Take Ersa. Small, bright, bouncy, and very, very Irish, she’d have made a great leprechaun. Fortunately she also made a great nurse. If she was your nurse for the night, and you were in pain, you got your shot, there and then. If need be she’d fetch a doctor to sign off on it. If G….. was in pain she’d summon help immediately.

At the other end of the scale was a slow, fat, bad-tempered part-chinese woman whose name I never quite caught, so I’ll call her Porkbelly. No one liked her. When the supervisor said one morning, “We’re overstaffed today – Porkbelly, will you take a short shift?” Porkbelly mulishly refused. If you rang for Porkbelly often, her response times got slower and slower. Even if you were G......

She lumbered around complaining about everything. “You think this is a five-star hotel, don’t you?”, she said. And if it was not precisely six hours since your last shot – no painkiller. I called her one night and she consulted the chart. She looked at me and said, “You’re too early. Call me in fifteen minutes.”

There was a couple of other nurses who, while not quite the cow Porkbelly was, still had a very cold demeanour and stuck precisely to the rules, no matter what.

One morning after my op I awoke with a sensation of pressure in my bladder and I knew exactly what it was. Either the drain bag was full, or it had not been hung correctly and was not draining freely. This, incidentally, turned out to be the main cause of G.....’s pain.

I turned on my light and looked at the tube leading to my bag. Although the bag was only half full, the tube was backed-up right to my dick. I rang for the nurse. No response. That’s right – Shanti – a very handsome middle-aged Indian woman with a wonderful waist-length braid of thick black hair, and one of the rule-sticklers – was on tonight. I waited. The pressure continued to build, the bell to chime.

I took matters into my own hands. I reached down for the bag and saw that it had been hung too low. The weight of the contents had caused it to stretch and slump in such a way that the fluid draining from me couldn’t get past the valve at the top of the bag.

I unhooked the bag, twisted, it, gave it a shake, re-arranged it, and finally flow was restored and the pressure eased. At which point Shanti appeared. I explained what had happened.

“No, that is not possible. You are mistaken. See, the bag is only half full. “

I explained again that the fluid had been backed up all the way.

“No, see, just a little at the top and the bottom, but it is running freely. There is no problem.”

“No, not now, because I fixed it while I was waiting for you – but it was not running freely before.”

“You’re wrong. That cannot happen. It is fine. Let me take your blood pressure. Hmm, rather high. We got upset over nothing, didn’t we? Anyway, it’s time for your shot.”

I ground my teeth and shut up.

Back to sleep. Until about five am, when G..... awoke in pain again, and the whole circus was repeated.

By the time the nurses had G..... settled it was time for our morning shots and clean-up. As breakfast was being served I looked out the door to see Shanti-strolling by, holding my drain bag at chest height and swinging it coquettishly. She saw me watching, and laughingly pointed to the fluid level, mouthing “Half-full.”

On my last day I was free of drips and drains, so as soon as G..... started moaning I didn’t wait – I got up and went straight to the nurse station. Fortunately Ersa was on duty – and we got help for G..... in record time. Porkbelly was there too, but looking after a different group of patients. She looked daggers at me.

Ersa brought in a whole group of doctors to look at G....., and they changed something – I don’t know what – and he slept right through till breakfast.

…………………………………………………………………………………..

The day of my operation came round. I was scheduled for 11.30. By 11.25 there was no sign of any action, so I strolled out to the nurses station. A man sat here, busy with some paperwork.

“I’m scheduled for an op right now, “ I said, “ but no-one’s come to prep me or anything.”

Without looking up, he said, “You need to speak to the nurses.”

I spoke to the nurse sitting next to him, who reassured me all was well. I went back to my room, got back on the bed, and in walked the guy from the nursing station.

“Hi,” he said, “I’m your anaesthetist. First off I have to tell you that there will be an additional fee for my services which is not covered by Medicare or your health fund. It is not possible to give an estimate in advance as there are so many variables but it should be in the region of $300.”

“Secondly, you have a choice. You can have a spinal injection, which numbs you from about here down” he said, indicating his breastbone.

“You remain awake throughout the operation, though you won’t feel a thing, and you can watch the entire procedure on the monitors.”

He seemed to think this was a great inducement.

“Or you can have a general, which means you won’t know a thing till you wake up in recovery.”

“General, please,” I said firmly.

“Now some people don’t like the spinal for some reason,” he ploughed on, “but it’s much the best option.”

“Not for me,” I said, “I don’t want to know anything about it. General.”

“But it’s much more dangerous. The gas poisons your lungs.”

“Yes, but like you said, some people are unhappy about having needles shoved into their spines, and I’m one of them.”

“And of course there is a risk that you could vomit during the operation, so to prevent you drowning in it we have to insert a tube into your throat, which may give you a very sore throat. And when you’re coming round from the anaesthetic we have to remove that tube. By then you’ll feel us removing it, which is very unpleasant, and may also cause you to vomit – it’s pretty horrible.”

“I still want the general.” By now I was rather hoping I would vomit as I came round – all over him.

He sighed, and gave up.

Then the cash machine that is private medicine swung into action. I was gowned, trollied and wheeled into what looked like a vast underground carpark, all white-painted concrete, divided by curtains. I suddenly thought of the movie Soylent Green. My team – now all gowned in deepest blue – appeared, and hooked me up to this and that.

Trollies were being wheeled to a distant doorway. Trollies were being wheeled back to the booths. A woman was wheeled into the booth next to me – the curtains were open – and then she began to convulse. The curtain was whisked across, some medical code was yelled, a group converged on her and began work.

I was wheeled into another room which looked like the parts department of a garage. The walls were lined with bright blue parts bins, each one with a stash of stents, shunts, valves, tubes etc. A mask was put over my face, and I thought to myself, well, if this is it, at least I won’t know anything about it.

Then I woke up in my bed with a drip on my right, a catheter in my dick, and a bag of what looked like raspberry cordial hanging near the floor on my right. Made it!

………………………………………………………………………………….

My other roommate, J...., was a very gentle man. He chatted when he wanted to, retreated to his privacy when he felt like it, which suited me fine. I was much the same. The phone by his bed kept ringing – is Julia there? No, she’s not, said J..... She must have gone home. We wondered who this woman might be. Seemed to be very popular.

We didn’t always talk. By and large I kept the curtains round my bed closed, especially the one separating me from G...... But the curtain at the foot of the bed I kept open during the day, so I could see what was happening and chat with J.... if he felt like it. Whenever Porkbelly was on, she would of course immediately open all the curtains, whether we liked it or not.

J....s wife came every day, and for some reason took a liking to me, too, so we had a few polite conversations. She did some small thing for me one day, unasked – I can’t remember what – and when I thanked her she just smiled and said, “Well, that’s what friends are for,” and went back to chatting with her husband. I felt very proud. I had done nothing besides talk with her husband from time to time, and pay for his morning newspaper one day when he ran out of cash.

They were the epitome of small town country Australia – him dressed head-to-foot in R M Williams and Akubra – if he’d been from Lancashire he’d have bought his clothes from my uncle - her in neat dark blue suits and well-permed hair.

J.... was struggling with the news that his enlarged prostate had so restricted the flow of urine that his bladder had stretched to three times it’s normal size and lost all muscle tone. He had been wearing a catheter and bag for some time, and had hoped that after his prostate op he could go back to peeing normally.

He quietly persisted until his specialist agreed to operate again to try and improve the problem, take a bit more of the prostate away. The result was a crop of unsuspected stones – but he would still have to use a catheter to pee. He was given a choice – a permanent catheter with bag, which would have to be changed in hospital every three months.

Or he could catheterize himself three times a day – pop it in, pee, pop it out. He didn’t fancy this option much, as he had found previous catheter insertions difficult and painful. We talked it over, and I sympathized. Maybe he’d get used to it, I said, maybe it would get easier. In the end, that’s what he did.

When he left – he checked out just before me - J.... shook my hand and said it had been a pleasure to meet me. I felt this was not just politeness, he meant it. It was good to have met him, too.

……………………………………………………………………………………….

A young guy on crutches with his lower leg in plaster hobbled in the first morning. Very loud, very laddish, introduced himself to everyone, then hobbled off. Doing his rounds, he called it, keeping mobile.

On the second day he told J.... – “That used to be my bed.” A small light went on in my head.

“Your name isn’t Julian, is it?,” I asked.

“Yeah mate, how’d you know that?”

“Oh, J....s just been telling all these people who’ve been ringing his extension that Julia’s not here, she’s gone home.”

We had a good laugh at that.

As I started to improve and could walk about, I started perambulating the ward – and found Julian in a private room. Now his leg was in plaster to the hip, and there was a cage over it to keep the weight of the bedding off.

He invited me in.

“So what happened,” I asked.

“ Oh, I was showing my nephew how not to ride a motorbike,” he said, “I got distracted. I came off and the footrest went through my calf when the bike landed on top of me. Looks like a shark bit me.”

He was a farm lad from somewhere in the country, very fit and handsome, about 30. He told me that for three days after the accident he had lain in the local hospital while the haematoma on his leg grew and grew. They didn’t think to drain it, apparently.

Eventually his parents had him transferred to Melbourne, where the doctors said if he had left it any longer he could have lost the leg.

The day I was checking out Julian saw me all ready to leave, and called me in to say goodbye. His ‘nephew’ had come to visit – and I saw how Julian got distracted. A stunner if ever I saw one – as tall and broad as his ‘uncle’, about 19, with a shock of unruly blonde hair and a killer grin. We shook hands all round, while my partner rolled his eyes and Porkbelly – who was waiting to hand back my morphine pills she had confiscated when I checked in – tapped her foot.

………………………………………………………………………………………..

I had a final chat with my current urologist. My last one was a cold, arrogant 50-ish 10kms before breakfast type, who looked down his nose at people who were stupid enough to get fat and unfit. This one is by contrast a jovial forty-something Indian butterball. I know who I prefer.

He presented me with photos of my stone in situ. Apparently it’s a rare type, not the usual calcite stone. Actually, it looks like a tiny gold pawn embedded in a spiky gold nugget, about 7mm x 5mm. Analysis will tell us the rest. He has left a stent in me to allow my swollen kidney to drain, and I have to call him in a week or so to arrange it’s removal.

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So now I’m home, feeling OK-ish but weak. Spending a lot of time reading or sleeping. There are a million things to do round the house but even small tasks are an uphill battle. I tire fast. And from the way things feel, there might be tiny fragments making their way out. There’s still blood in my urine. And the front of my left thigh has gone numb. That happened after my hernia op, too – something about a damaged nerve – so that may not come back. Time for bed again – and more Panadeine!!!! I’m resting from the radio station but keeping going with the paper – I can do most of the work from home. And we’ll see how we go.

1 comment:

bob newey said...

great stuff, laughed out loud