Tuesday 28 August 2012

21 - The next procedure cometh

The request came through for the next operation date, and it was a welcomed appointment. The metal in my left elbow, though supportive in that it kept my arm together, was painfully restrictive.

"my entire left side had been crushed and subjected to the most severe forces one could imagine"

Range of motion in my arm was limited for it now could not straighten nor fully bend beyond 90 degrees. You'd be surprised how often your arm needs to bend beyond 90 in normal life; whether that is eating, dressing, or doing simple tasks that everyone takes for granted on a daily basis.

In my situation, during the collision, my entire left side had been crushed and subjected to the most severe forces one could imagine. Both my left leg and left arm are restricted in their range due to their imapct damage so, you can imagine the problems.

Take one day in your life, say do it tomorrow, and make a mental note to log everytime your knee and arm need to bend beyond 90 degrees; from going up and down the stairs, eating breakfast or any meal, kneeling on the floor to access a DVD player or plugging something in where you might lean against a wall. You'll be surprised how many times you'll need to bend your limbs.

Whilst in hospital, I was sent to a nerve specialist who reported that the radial nerve in my left arm had been damaged in the collision so I was hoping that, once this operation was completed, that I might have a bit more movement and the feeling return in my hand.

"My frame of mind was one of desperation"

I was taken in to the Trauma ward with high anticipation. This turned out to be a wasted journey however as there had unfortunately been, the day before, a terrible car accident locally (ironically) and there was little room or time to be able to work me into the schedule. Heading home again that day, I was somewhat deflated. My frame of mind was one of desperation to get moving forward again and this operation was a step in the right direction.

Luckily, a few days later, I received a call to say I was to be added to the operational register for the following week and the metal would be removed then. Once more, I can recall the clinical smells of the anaesthetic room flood over me and the face mask of the 'knock out' gas over my mouth.

" my nerve that had become 'fused' to the plating"

After another long operation I awoke with a cast on my arm. This was to hold my arm in a single position while the skin healed to a point and my movement was restricted to ensure no further damage took place. The report from my consultant was that he had been able to meticulously pick free my nerve that had become 'fused' to the plating during the time it had been placed there. This improved the feeling in my arm and hand considerably. It did not totally cure the numb sensations in all spots on my hand but it helped.

A few weeks later, I was having the cast removed. I can tell you, it is a little un-nerving having a nurse, armed with a pair of industrial scissors, advance on you. It was a relief to have it removed, however, and meeting with the trauma team consultant, I was told that there was still a lateral screw left in my elbow joint which would have been a too traumatic ordeal to remove it.

Still with the tube connected directly to my colon, it was decided that it was time for that to be removed and it was one minor clinic appointment I was not looking forward to.

Thursday 16 August 2012

20 - A long time coming

" .. my legs were still not really strong enough .."

By this time, in February 2011, I had spent 10 months in hospital with a brief 'moment' at home. The regular daily grind of the hospital routine had chipped away at my sanity for many an hour.

My mobility at this stage was moving from a gutter frame to crutches, a strenuous and bold move considering my legs were still not really strong enough to support my weakened frame. Bringing crutches in to the equation was demanding on my balance and strength but, working tirelessly and through determination, I was able to succeed at making a little headway.



My next major goal I set myself was to begin to manage stairs. Again, another action that the totally mobile masses take for granted on a daily basis; going upstairs in their home to a bathroom, the bedroom or study. As the stairwell was still a distance for me from my ward bed, the physios took me by wheelchair, often my wife in tow to observe my progress.

"This triumph drove me on .. "

I guess that, psychologically, the fear of falling was a duanting prospect for me. Having broken the majority of my bones in one singular event, I didn't want to stumble and cause more injuries by careering down the stairs.

To begin with we worked on a single step, using my 'good leg' to step up first and, pulling on the bannister, driving through the other hand on the crutch, I managed it. This triumph drove me on to two steps, then three, four, and then six. Tiring though it was, I was not going to let this beat me.

" ..I had spent 11 months in 2 hospitals (and) 11 different ward environments .."

Having this new ileostomy proved, once more, a factor to be considered into the timings of my physio. I was still unable to care for it myself as the range of movement in my left arm was still restrictive. Pain still racked my limbs and the many different oral pain killers I was taking did little to remove the sensation.

When I was finally discharged from full time NHS care in March 2011, I had spent 11 months in 2 hospitals ranging from the coma in Critical Care, High Dependancy, Liver, Trauma and Colorectal totalling 11 different ward environments. But my time was far from over! I still had a further 5 surgeries planned in the coming months. So far, I had endured 19 operations, all under General Anaesthetic, not counting the minor ones I had in CT and Ultrasound.

Its funny but, the other month, I was attending a clinic in hospital and had decided to visit one of the old wards I had been 'resident' in, catching the lift with a lady and ambulance staff. The lady was somewhat annoyed, explaining to the ambulance crew that she had been in hospital 3 weeks, which made me smile internally to my self. Obviously, the three weeks to this unknown woman was subjective to her, coupled with the reason for her stay, but to me, it didn't seem like a long time at all.

My next operation, the 20th, was the waiting for me in May.

Wednesday 15 August 2012

19 - More time at the NHS' pleasure

" .. a vent bag plugged directly into my colon .."

I had awoken with a new ileostomy pouch on my right side, positioned, according to my surgeon, at the end of my small intestine. I did have an added extra; a vent bag plugged directly into my colon through my stomach on my left side. Attached to a pipe that ran directly into my bowel, this was there to prevent any further problems arising from the fistula on my hip. I was told that at some point this would be pulled out, with no anaesthetic, which filled me with angst but I would worry about that later.

The surgeon had also remved my appendix at the same time. Not that there was anything wrong with it, it was just a precautionary measure to limit any future trauma.

My now extended stay, at the NHS' pleasure, seemed more and more to me like a prison sentence than a period of recouperation. Although the bed location changed and the ward room changed, the experience was still familiarly repetitive.

" .. a typical day on the ward .. "

Let me walk you through a typical day on the ward in an average hospital in the UK.

Regardless of the evening before, whether you were successful at getting to sleep prior to midnight or not, you will be woken regardlessly at 6am when the nightshift has to take the first of the days 'obs' ('observations' to you and I), which consist of body temperature taken using the ear probe device and a blood pressure reading using the traditionally velcroed arm band and noisy machine that is wheeled about the ward from patient to patient.

"Bleary eyed and non compus metis .."

Should you be one of those unique individuals that is able to instantaneously drop off to sleep again following a disturbance, then you will be fine at this stage. However, if you are anything like myself, once disturbed I find my mind engine begins to start up and the difficulties of retrieving slumber again elude me until the next phase of the morning routine.

At 7am, the morning shift of nurses arive .... and the lights go on. Not only at the ward nurse station, but the corridors (if there are any) and the ward rooms. Bleary eyed and non compus metis, the ward swings into action with a 7:30am start at the individual patient washing gambit. Those patients again lucky enough to be able to walk are a godsend to the nurses and healthcare assistants; a quick command to march off to the sinks with their washbags is a tick on the list. Those unfortunates who are restricted to their beds are another matter. When it's your turn to be honoured in this daily ritual, a healthcare nurse descends into your bedspace, draws the discretion curtain and brings the bowl of hot water and wad of wipes. If you have shower gel, it will be added to your bowl, frothed, and applied to your naked body following being stripped of your nice green, one-size-fits-all (ed.-like heck it does!), NHS pyjamas.

However, regardless of whether you're unable to move a great deal or not, it is the 'prime directive' to have neat looking wards and so it is of the utmost importance that patients aren't lounging about on their beds, rather, sitting nicely in the somewhat uncomfortable seats next to their cabinets for the day. So, once washed and dressed in a clean set of (not) made to measure pyjamas, you're sat in your chair awaiting breakfast and the tea trolley.

" .. not the most glamourous affair .."

On the ward in those months, you can see the weight loss I suffered

Breakfast in hospital is not the most glamourous affair, very basic and simple. Added to that, it is also regularly the same. On the breakfast menu is:

  • Cold toast (its frigid temperature owing to the fact that it is made en-masse prior to the trolley coming into the ward from the small kitchenette. If you're looking for an adequate weapon to throw at people, save this item and use in a modified frisbee action at 10 paces)
  • Cornflakes
  • Rice Crispies
  • Bran flakes
  • Ready-brek porridge
  • Orange juice in an unbelieveably difficult to open carton which, if navigated unsuccessfully, will decorate the ward floor in front of you in a nice orange swatch
" .. and a phalanx of trainee doctors .."

From the drinks trolley, you have a choice of either tea or coffee and your choice of milk (whole fat, semi, or skimmed).

While you are still consuming your breakfast, the teams of doctors flood the ward. Each primary consultant (that you have been assigned to, and there could be as many as 3 or 4 consultant surgeons on the ward) has a team of associated doctors, secondary surgeons and a phalanx of trainee doctors in tow. Depending on the severity of your individual circumstances, the curtain may or may not be drawn while you are visited.

Your notes consulted from the mobile notes trolley, the team leaves you alone for the day having requested blood tests, x-rays or other specialist actions. Following the doctors rounds, which should conclude at about 10:30am or 11am, the phlebotomist swoops into the ward like a vampire in a white coat. My phlebotomist was great. With the veins I had, she always knew how to tap my veins to obtain blood if it was needed. We used to have many a discussion on all topics.

" ..like a vampire in a white coat."

Your blood having been drained, if you were lucky enough to be on the list, you should now be in receipt of your menus for the following day. These, if you are in a hospital that has outsourced its meal supply to an external contractor, are a sheet of tick boxes for your lunch and dinner. I found this very bizarre. It was difficult enough knowing what to eat on that day, let alone having to choose what you want for the next day. Peoples taste can change hourly; what you fancy to eat one hour might be something completely different the next. The menus used to be arranged in a three week rota. This changed to a two week rota where I was able to begin to predict what meals were offered on what days. This then seemed to be reduced again to a weekly rota so that every Monday the meals were the same, every Tuesday the same, and so on.

It did get to a point where my wife was bringing in rotisserie chickens from the supermarket, soups not available on the menu and we even sent out for evening pizza, chinese and indian on a few occasions.

Digressing from my daily breakdown for the moment, let me touch on the food aspect. It was at this time that a documentary was completed on television about the NHS outsourcing their meal supply to external contracting companies. The hospital that I was residing in had their contractor featured heavily on the programme. Being in charge of the television remote control for the ward, I was in the unique position to ensure all patients in the room saw the show.  Such was the programme, the following day the hospital catering department urgently sent around 'Satisfaction questionnaires' for all patients to fill in. I can say that filling it in was very satisfying. I recanted all my problematic issues with the system; the poor quality, the importance of nutricious meals to aid recovery and previous meal disasters.

"This was, in my view, totally inadequate"

So, to return to the daily diary. After the tea trolley returned for a ward sweep at 11am, the ward physios now cascade through the ward doors and begin their tireless activity of moving the more mobility needy patients. In my case, I was one such person requiring the attendance of these teams. One of my gripes with some of the physio sessions is that, owing to the nature of the circumstances of the NHS, they have to get around so many patients in an allotted amount of time which was 10 minutes per patient. This was, in my view, totally inadequate. With most in this time frame, it was only possible to get the patient to their feet, walked 10 feet in the ward room, turned and walked back to their bed.

Another of my exasperations was one of ability. Some of the physios I encountered were unable to both interpret and understand restrictions from a physical perspective. Rather than analyse how the injuries I had sustained limited my movement in differing ways, they instead expected that I should be conforming to their taught practices and ways of conventional movement. I feel that a team should be able to look at a patients file, note the injuries sustained, and develop more ideal ways of adapting movement to yield the best outcome, rather than just expect that all patients are 'equal'.

If you were lucky to be seen by the physios before lunch, then count your blessings. If not, you'll be scheduled afterward.

Since my original move to this hospital 6 months ago, the way of serving meals changed. Lunch would now arrive at 12:30pm by way of a heated food trolley, rather than reheated in the kitchens. The previous days meals selection tick sheet is referenced and your meal is served.

" .. a woefully inadequate filling .."

Lunch over, physios receeded, there was then some adequate respite before the first of the visiting hours with another return of the tea trolley at 2:30pm. On some occassions, the porters (also sub contracted with the cleaning staff to the same company that handles the meals) would take you to x-ray if required. At 4:30, it was visiting time for an hour, giving you a little time to catch up on events on the outside.

At 6pm it was tea time. Tea usually consisted of a combination of:
  • A sandwich (which already on the Use by date on the packet had a woefully inadequate filling and barely any butter. If there were any left over, these sandwiches would be collectively sold to the nurses the following day)
  • A salad (consisting of a large proportion of coleslaw, beetroot, lettuce, a cut tomato and an added extra which was either processed turkey, ham, plain tuna or corned beef)
  • Soup (tomato, vegetable, chicken, mushroom if you're lucky or a local specialty that left you aching to rub a scouring pad over your taste buds)
  • Cheese and crackers (a packet of two Cream Crackers and a small shrink wrapped centimetre square by 4cm rectangle and a pack of butter)
At 6:30pm it was visiting again, until 8pm.

The nurses on the night shift would arrive at 7:30pm and the handover would commence. This was either done by senior nurse to senior nurse or, if time was going to be an issue if staffing levels were low, by a recorded message detailed by patient and bed number.

8pm saw the drinks trolley of coffee, tea, Horlicks or hot chocolate be dispensed. Then the night team would busy themselves with preperations for the nightshift; obs, catheter bag emptying, urnine bottle replenishment and other tasks.

Depending on when you wish to sleep depends on whether the television is switched off in time. Additionally, the noise levels are tried to be kept to a minimum but this is not always possible. Nurses will still have jobs to do, the lights are dropped but not switched off and unforseen problems with patients in the middle of the night still arise.

That concludes the daily grind of a typical ward!

Saturday 11 August 2012

18 - Yet another trip into general anaesthesia

"This was, for me, a big day"

The ambulance came for me early in the morning on the 5th of January. This was, for me, a big day. The ileostomy reversal.

Both my wife and I had been thrown into the life of care with this medical solution to the tear in my bowel and, to be rid of it after almost a year, was a blessing. We imagined restful nights, not having to wake up every two hours, not having to spend many a day weary from the previous night. The thought of that alone was shear bliss.

I was taken into the admission ward and checked in with all the usual checklists and questions, meetings from the anesthetist and the surgeons team. I was first on the operations roster and was taken down to theatre at 8:30am.

" .. placed over your face like a plastic parasite .."

Even now, going to the operating theatre is a bizarre experience for me, even for the amount of operations I have had to date. By my count, I had had 18 operations with the 17th being my knee reconstruction, so I was getting rather used to the procedures involved. When the breathing mask is placed over your face like a plastic parasite, it is then that the time in that side room is short for your waking conciousness. Breathing in the 'air' they give you, you rapidly come to the conclusion (as the feeling starts to go from your limbs) that the descent into arranged sleep will be quick. My only advice I can give to those seeking solace from this blog if they have a pending surgical procedure and are nervous is, simply, don't be. Breathe deeply and you will come out the other side. Faith and trust is key. Belief that you will awaken in the recovery room, the procedure all completed, helps to cope with the experience.

After a few deep, lung filling breaths, the familiar feeling of inky sleep flooded over me.  I slowly awoke, an indeterminable time later, hearing the noise of movement and voices reading paperwork. Forcing my eyes open, I recognised the recovery room and a nurse looking at me with a smile.

I had made it through another operation and I smiled at the nurse that came to collect me to take me to the ward for observation. With this type of reversal, it was common practice to stay in hospital for a few weeks until it was noted that digestion was working correctly.

My stomach after the operation
" .. not even morphine, oral or otherwise, was effective in controlling the pain .."

Staples, as a form of closing incisions, have a tendency to pull somewhat and, on their removal 14 days post surgery, can be a little painful. Even the dressings used were painful to apply with the nerve endings coming alive again. It was during this time that not even morphine, oral or otherwise, was effective in controlling the pain and was decided that Entonox gas (Nitrous oxide and oxygen) would be useful to help me control it better. I can truthfully say that it doesn't make you laugh and doesn't mask the pain much, it just helps to distract you.

One of the most painful experiences I have endured was awaiting for me on this ward, however. My blood samples were showing signs of some infection and the senior nurse practitioner was called to the ward to take a sample of my blood. Not from my usual veins which were now shrinking fast, but arterial blood. There are a few locations to obtain that sample, and a few were tried. My memory of that event still lingers, I can still see her face as she withdrew what looked to me like a knitting needle length syringe. The first location she tried was my wrist, bypassing the surface veins to access the artery below. Unsuccessful, another location was tried; my groin. Nothing prepared me for this.

Anguish was rife, just like the guided CT minor operation I endured in the previous hospital. I was unable to move again, having to just remain motionless whilst the needle was slowly pushed deeper into me to reach the artery. The fight or flight response is meaningless here, being unable to move, and all I could do was sink into myself and grimace through the pain. Unsuccessful again, she tried my wrist once more, this time reaching the artery and drawing off enough to complete the requirements for the test.

"Seeing death is humbling to ones own existence."

Once again, I made many friends during this stay, from the man who watched 24hours a day news to the young lad I gave emotional support to through sharing our experiences. I also saw death in this ward. The poor gentleman opposite, for whom I was unsure of the diagnosis, one night did not make it. I watched helplees as his curtain was drawn and numerous doctors and nurses tirelessly moved back and forth but to no avail. I heard, the next day that, despite being moved to Surgical Support Unit, he did not make it.

Seeing death is humbling to ones own existence. I was very lucky to be alive. So many times I could not have pulled through, so many times it could have been my wife in unconsolable grief looking at an empty bed that she regularly visited. I thought much on this during my stay.

After 4 weeks, I was released back home. This was, unbeknown to us, to be a temporary reprieve. There was still the fistulation from my side to my intestine. While my digestive system was in trying to cope with the sudden reboot following almost a year out of action, there was a tract of escape for feacal matter to come out of my hip abcess. After 10 days my pallor wasonce again turning a lighter shade of grey. The district nurses that attended our home, on a daily basis to dress my surgical wounds, suddenly found a need to call the emergency 'hotline'. The ambulance turned up, the sun had faded low on the horizon, and I was once again taken back in to hospital.

" .. good and bad news .."

My surgeon was called and he met me on the ward with both good and bad news. The bad news was that I was going back under the knife for a replacement ileostomy. The difference being, and this was the good part, it was further around my small intestine giving me more bowel to digest food. I wept once more, having the rug pulled out from under my progress again.

We had become such frequent friends he took me down to the theatre himself, which was the best bedside manner I had seen from any surgeon since my stay thus far. Lets face it, he'd seen parts of me that even I hadn't seen!

At around midnight, I was returned back to the ward. It was becoming more and more difficult for me to put on that 'happy face' but my determination was astronomical. I was driven to the extent that nothing was going to defeat me, I would endure whatever life decided to throw at me and come out on top.

Tuesday 7 August 2012

17 - Jingle Bones, rattle all the way

So on the 20th of December, having been able to pull myself from a seated position with help from a physio and being able to just about make a 20 foot assisted walk with the gutter frame, I was temporarily discharged for Christmas!


"..I was unable to walk at all .."

My knee, now containing the large titanium plate and screws holding my knee together, was not able to bend more than 90 degrees and was painful when reaching its maximum range of motion. My arm, still with the plating and cables, was still uncomfortable not being able to rest it adequately on any surface nor bend it beyond 90 degrees as well. The plating, now removed from my shin but still present in my ankle, was causing undue swelling. Owing to the amount of surgery I had experienced to date, I was having daily injections of Deltaparin, which is used primarily to prevent blood clotting in this scenario. My stoma was still needing daily care and I was unable to walk at all without the aid of the gutter frame and even then only 20 feet. Stair climbing was a prohibited act so I was to spend Christmas sleeping on the sofa.

Being handed over to the District Nurses for my care from home, I arrived home at 8pm at night to a tearful reception, not only from myself but my wife waiting at the door. I ask you to picture the situation that has now presented itself, having been married for only 9 months before the collision, my wife was nearly a widdow but, owing to the masses of inner strength unbeknown in my possession, I survived a horrific crash. She was now, having been ad-hoc trained by various departments in the hospital as a helper (the physiotherapists, tissue viability, healthcare assistant, stoma nurse and general nurse), suddenly promoted to my full time carer.

" ..I still wanted to regard my wife as such, not as a nurse .."

Both our knowledge of medical processes, dressings and application, and bodily care had increased 200 percent due to my stay thus far in the hospital environment. Personally though, I drew the line at the Deltaparin injections for my wife to administer to me. I still wanted to regard my wife as such, not as a nurse, so I was very specific in desiring that District Nurses resume the role of injections.

Which brings me to the next NHS failing that I believe exists: the after care. Speaking to a nurse that attended our home one morning, it has now been the 'unwritten' request to hand over as much care of patients in the community to the relatives. This comment was met with much chagrin by ourselves. Quite simply, this short sighted decision to encourage relatives to become more 'actively involved' basically means that there is a clear staffing level issue in the community that cannot be met. Additionally, the extent of my injuries, and the dressings in place to help combat them, confounded some of the experience of the nurses. We felt that a good, active policy, would be to rotate the District Nurses to spend time on the wards with the patients they may eventually care for. That way, they can be kept up to date with modern practices of health care and provide more active solutions in the residential area.

" .. the after care by the NHS is one that needs considerable attention."

In general, from many other patients I have spoken to, ones with traumatic injuries and ones with mental health issues, the after care by the NHS is one that needs considerable attention. To me, it seems that once discharged, the after care is lacking in support; from specialist transportation back to hospital for clinic and appointments, to out-patient physio. The emergency services and Critical Care front end of the NHS is amazing. It is effective, efficient and life saving (I am proof of that). It is only when the long term care begins, from some wards, to the community, is when the issues arise.

I will cover more aspects of this as I talk about when I was discharged.

Back to the tale.

Christmas 2010 was both a physically demanding affair and an emotional rollercoaster rolled into one. Comfy though our sofa was, looking back in hindsight over my desperate need to see homelife over a hospital ward, I don't think I was fully ready to be at home. In order to work into my daily schedule of washing, walking and resting, my wife had to shoulder a great deal of the burden that was once fulfilled by teams of nurses on a shift pattern.

".. can be a blessing in one hand and a nightmare in the other .."

Nights were the worst. Neither of us were able to get much sleep; myself on the sofa downstairs and my wife in our bedroom upstairs. This was primarily because of the ileostomy. It seems to me that those with intestinal problems and have an ileostomy / colostomy to cure them, they can be a blessing in one hand and a nightmare in the other. A blessing as they can give people the freedom to live a semi-normal life, but there's always a concious cloud on the horizon in that your approach to life has to adapt.

The first thoughts on attending any social activity, when having one such colorectal solution, is "Where are the nearest toilets?". Being able to cope with these medical solutions is challenging. With my experience of an ileostomy, it was continually working, throughout the night and day and our adaptions to this resulted in scheduled 2 hourly alarms to wake and ensure it did not need attention.

"Broken sleep leads to broken spirit.."

Broken sleep leads to broken spirit and both my wife and I were constantly tired during this phase. It became a willful necessity to deal with this, when, in a hospital environment, I could reasonably rely on the nurses working a nightshift to assist. If during the night it needed attention, I would use my mobile to send a message up to my wifes phone.

Christmas Day arrived and I opened my parcels on the sofa. Despite the frustrations of my situation, I felt  more mentally strengthened by being in a home environment. We ate a Christmas dinner, even though my food intake was not what it once was, and New Year's Day passed in much the same vein. It was then time for me to be re-admitted for my ileostomy reversal.

Little did we know that it would not all go as planned.

Monday 6 August 2012

16 - Insanity from lack of minerals strikes!

My knee surgery was immense. 



As you can see from the above 3 dimensional snapshot that formed one of the many CT scans, the condyle of my thigh bone had broken free in the collision. It's splintered shape ran the risk of severing my main leg artery at any time during, after, or since the collision in hospital. This was the first task during surgery.
Second, the resetting of my knee bone (what was left of it) to its correct position was next on the list for the operation. It appears that the patella was shattered to almost nothing and the largest piece that remained had tried to heal itself to the end of my thigh bone. This had be cut free and then repositioned back to its original location.

Then, the placement of a large piece of titanium plating was added to my knee to help keep it all secured in place.


The knee plate viewed from the top, finishing mid thigh
(Looking at the 3D image, you can still clearly see the holes in the bone from the exterior fixator on my thigh that rant to my shin!)

"The operation lasted for hours"

The operation lasted for hours. My wife was getting somewhat aggitated in the waiting room of the ward, hoping all was proceeding well. After a long and agonising wait, I was brought back to the ward from the recovery room. 

My recovery from this operation was the worst. Under orders from the surgeon, I was to have, on my leg day and night, a CPM machine. This is a Continuous Passive Motion machine that bends the leg for you and can be preset to move to increase the speed and finishing angle. 

Image borrowed to highlight the machine used in my case
A similar functioning machine, like the one pictured above, I had to have working even when I slept to avoid my leg becoming static and ceasing to function properly. Or, as the surgeon put it, "I don't want your inability to walk to undo all of my good work!"

".. forced down your nose and into your stomach .."

My body reacted to this operation in another unforeseen way, however. For it was owing to the general anaesthetic and extended period I was under in theatre that shut my digestive system down. My bowels went on strike! 

I couldn't eat, nor drink, without being sick and, to really make my stay in hospital that more enjoyable, I had to have an NG tube. Again, for those not clear on medical practices, an NG (or Nasal Gastric) tube is a tube that is forced down your nose and into your stomach to drain its contents. As a consequence, I was only allowed sips of 60mm of water per hour to keep hydrated. Boy, was I lucky!
Another borrowed image to detail the NG

This went on for several days. I had to have regular blood tests to ensure my chemical balance was achieved but my veins receeded when these tests increased. It would have been easier to get blood from a stone than dip into my veins for a sample. 

Then, after an infection, I was moved to a single room on my own and that's where a chemical imbalance made me go loopier than a circus clown. You see, the body requires a delicate balance of minerals in order to function properly; sodium, potassium, magnesium and a whole host of others. My wife had arrived one day for visiting hours, only to be intercepted by the Sister of the ward who proceeded to tell her, "He's not himself today."

".. completely 'lost the plot'.."

Further investigation from her proved the Sister's comments to be right. I had completely 'lost the plot'. From my delusional perspective, I had died. For some reason, I had formulated some waking dream that I was needing to get to the next world by way of interstellar travel. I remember only two hours or so from those two days that  I was mentally impaired. They had assesed what the cause was: potassium deficiency. Such an innoccuous mineral could cause such a mental imbalance. 

I was quickly put on a potassium rich intravenous drip and by the morning on the third day, I waved at the Sister as she came in to the ward. An action, I can assure you, relieved her to the utmost. 

Me in the private room after my mental episode



By this time it December and it was rapidly approaching Christmas. I was determined to spend it at home and be temporarily discharged to have some time in my own environment. Working with the physios again, I had an arm gutter frame to support my weight and I had begun to stagger short distances. 

It was planned that I be discharged on the 20th of December and return for my ileostomy reversal on the 5th of January. Christmas was even more of a challenge than we dared to guess!

15 - The A to Z of wards

"..  moved wards once more.."

I was moved wards once more after the transfer between surgeons. By this time I was seriously gathering material for an A to Z reference book on both hospitals, wards and service! Having seen 6 wards and 2 hospitals already in my stay, from Critical Care, HDU, Trauma and Colorectal wards, I was meeting many people, nurses, doctors, surgeons, students and patients.

It seemed my case was something of a medical student requirement. My surgeons were refering ward students to sit with me and learn the severity of my injuries from a patient point of view. Oddly, I found great solace in retelling my story thus far to students. They would sit with me for great lengths of time, scribbling their notes and comprehending the emotional trauma I had experienced.

".. visible dye needed to be pushed into my bowel.."

The time came for me to be taken to theatres for the surgeon to remove my stomach abcesses. Prior to this, I was taken to x-ray for a detailed analysis. They needed to see exactly what they were dealing with and, to do this, visible dye needed to be pushed into my bowel and into the abcess pockets. My ilieostomy pouch was removed and a tube was inserted into it, pumping the dye through while the scan took place.

All the time I was thinking, imagining, what the driver of the other vehicle was feeling. He was lucky enough that his irresponsible driving behaviour did not injure him in any way and, within days of the collision many months before, he was probably back at work and earning his wage.

The scan completed, my operation took place. The effects of the general anaesthetic wore off and I was taken back to the ward. The hip abcesses, my surgeon advised, were too difficult to deal with at this stage, for the fistulation track apparently was intertwined over my hip bone and not easily resolved. That had to be left for the time being.

".. keeping the nurses on their toes.."

It was now a month wait until my knee was rebuilt by my Trauma and Orthopaedic consultant. During those waiting days, my sense of humour kept me sane. The ward had residing there, a rather scatty brained individual who was famed for his antics in keeping the nurses on their toes. I heard stories that, during the night, he had gotten into bed with other patients claiming they were in his bed, taken some of their possessions with a similar excuse, and found in the bathroom with his face covered in shaving cream while running his finger down his face in a shaving action. His absent mindedness was a breath of fresh air! On many occasions he walked an invisible dog around the ward and could be heard talking to it, not to leave out when he didn't want to be there anymore and simply walked out the doors. I remember one day, one of the healthcare assistants had to run down the main road outside the hospital entrance to catch him before he reached the next town!

He and I got on well, in that I was his visual reminder he had another two rooms to walk around the ward before he reached his own bed. I would be watching a DVD on a portable player when he would poke his head around the door, look at me and say, "Still another room to go!"

".. the comode, and the aroma of ... well, you get the idea"

Breakfast in a colorectal ward was an interesting challenge to. By the very nature of the ward, people had bowel issues and, those with mobility issues, had to use the comode to service a vital function. One big drawback with this was that those bodily necessities occured at mealtimes and, one such memory of mine was trying to eat breakfast, the next door bed curtain drawn around the seated patient on the comode, and the aroma of ... well, you get the idea .... drifting through the curtain while I am trying to eat but 2 feet away.

Thankfully, smells aside, my time had come to be moved to the Elective Surgery ward for my knee reconstruction. It was now November 2010, some 7 months after the collision. 

14 - Scrunch your fingers, make a 'fistula'

"..we all were determined to try to get me to my feet."

Again, I had the pleasure to meet a fantastic team of physiotherapists. These guys and gals really made improvements to my less than adequate mobility. Despite my injuries that plagued me, still including at this stage a broken leg, we all were determined to try to get me to my feet. Interspersed with being deposited into my wheelchair for the occasional trip outside to the car park to see the trees, where my leg had to be tied to the chair to stop it from dropping and causing more damage, a mechanical standing machine was utilised to help me to stand.

The trick, at this stage, was raising my bed toward the vertical as far as possible for brief periods prior to their arrival at my bedside to ensure my equilibrium was balanced. These periods, by my own determination, were ever extended to help.

The machine that helped me to my feet
".. weak with all the muscle wastage from inactivity.."

These sessions were very physically demanding for me. I couldn't put weight at all through my left leg because my knee was stll smashed, my right leg was so weak with all the muscle wastage from inactivity, which meant that I was solely dependant on pushing my weight through my arms. That would be fine if one of my elbows didn't have metal cables running across the joint (see below x-ray) which made it vastly uncomfortable to lean any weight on it whatsoever.



My progress with this was always going to be limited with a broken knee but it was rapidly brought to a halt when the domino effect that was started in the previous hospital took hold and that delicate house of cards that was my health suddenly had an earthquake.

If you recall my previous post that described the physical pain endured with the two CT (computerised tomography) and ultrasound guided drainage attempts on the internal abcesses. Access to the infected pockets was through my side and over my internal organs. My body's reactions to this trauma were to create a further multiple abcess cluster on my hip. The additional twist to this event was that the two clusters (in my stomach and on my hip) had joined themselves through a term known in the medical profession as 'collar studding'. Basically, this means that the two clusters had a tracked connection between them.

".. it can cripple mobility.."

Not only that, the hip cluster had another medical assocaiated term that was to be a major hinderence for me, a colonic 'fistula'. A definition of this term for the non medical readers out there is a connection to my large intestine. I strongly believe that this was the result of those initial attempts to drain the pockets. Anyone who has suffered an abcess will know how it can cripple mobility on their own. So for me to have two clusters in different areas of my mid section, an area vital for any sort of movement, my deliberate tries and attempts to get myself mobile from my consistently prone position.

This was not taken too well by the ward manager, who believed I should have been progressing far faster than I actually was. This over-estimation and obvious pidgeon holing I was refering to, led to a heated arguement between her and myself. She was clearly arrogant in her assessment and, because I was not making progress that fitted in with her guidelines, it must have seemed like a failing on her part to which she would have been held accountable, so she 'lashed out' at the only one who did not need that kind of stress.

These abcesses and fistula would need to be addressed in further, additional and unplanned, operations before I could progress further. I met with my colorectal surgeon, an excellent and knowledgeable individual, who agreed to transfer me to his own ward to sort them out. Before that could take place, the metal in my right leg needed to be removed as it was reacting with my skin. So, in my 17th operation, I was taken down for surgery.


Saturday 4 August 2012

13 - From hi-tech to 'third world'

"From hi-tech to third world"

The move was swift, the nurses accepted me onto the ward and, having introduced myself through a veil of tiredness, I settled into my bay of the 6 patient ward room that was to be my new environment for the next month and a half. The ambulance crew, as they wheeled me in, made, in jest, the comment associated with the title of this blog entry. The new hospital I had left, with its polished walls, patient entertainment system and impressive external vista, was suddenly a distant memory as they looked around the corridors and rooms of this older building.

For the benefit of the timeline, this move occurred 4 months after the collision and it was now August. Four months in the previous Primary Care Trust (PCT) care, including a month and a half in Critical Care in a coma, had been challenging enough but my move to the new PCT would herald a further extended stay.

"..many issues and fresh new problems"

It was here, at this new NHS PCT, that I encountered many issues and fresh new problems. Although this was a Trauma ward I was brought to, the managerial staff were not aware of my case history. It seemed that the consultant I was initially transferred to was on holiday during my move and my files were in the possession of his secretary. This caused an initial problem as the ward staff did not know the severity of my condition and, as a result, had not experienced a patient with so many orthopaedic and colorectal injuries combined as I had. As I did not fit into their pre-arranged 'pidgeon hole' for a patient, I was often overlooked and incorrect and, quite often, frustrating assumptions made about my condition.

Making friends with your ward room compatriates is a vital role for a patient with long term injuries. I saw many people come and go, their injuries not holding them back from their normal daily lives and, each time a patient in my ward room was discharged, it brought home the feelings of overwhelming solitude to me. Thoughts flashed across my mind, assumptions like, "Will I ever get out of here?", "Will I ever see our home again?" and  "Why can't I go home too?". It used to break my heart when 'friends' I had gotten to know very well in that short space of time left to return to their lives. 

"..my left leg was still damaged, my knee having been smashed.."

At this point, my left leg was still damaged, my knee having been smashed, was still needing corrective surgery and rebuilding. Although I had metalwork in my right leg, the wound on the surface was now becoming infected and needing removing. I was still bed bound and unable to walk which made things very difficult. The abcesses in my stomach were still painfully there and restricting every move, but, as I will go into later, a further complication was developing that no-one could have foreseen. My arm, again still with metal reinforcing the joint, was restrictive and uncomfortable.

"..at this time, that I saw it the worst: ... hospital food."

Let me now touch on an issue that has been covered many times before, for it was in this part of the hospital, and at this time, that I saw it the worst: ... hospital food. Now, to me, and I would hope many other people out there would agree, that a nutricious diet in a hospital environment to encourage healing and well being was a vital component of recovery. A person with so many injuries as I had, although my body found it difficult to absorb a great deal due to the physical amount of bowel that I had in operation, having a good wholesome diet of fats, proteins and carbs would be desperately important. Try telling that to a PCT financial board where the monetry cost of actually using the kitchens that exist in a hospital far exceeds the necessity of healthy patients. In my experience at this point in my recovery, the food was extremely dire.

Allow me to paint a mental picture for you. Now, this is a true story, nothing invented and no exaggerations have been emphasised in this retelling:

It was a Sunday. Part of the weekly "choose your meal for the following day" menu was a nice roast dinner; slices of beef with a Yorkshire pudding, gravy, roast potatos and green beans. The mental image of such a meal was very attractive. My opposite bed friend had ordered it the day before for just such a reason. 12:30pm rolled around and the sounds of the senior nurse ordered the healthcare assistants to rally around as the dinners had arrived on the trolleys. As our room was the final room on the ward, we had to wait for the other trays to be distributed to other patients first, but our time soon came around. My friends tray was brought in and set down on his table. I watched his face turn from a happy, expectant and hesitant face to one of surprise, shock and dismay. The corner of his mouth turned up in disgust, his nose scrunched and he translated a look of "What the f*** is this?" to me across the room. At that moment, I began lauging because he proceded to do something incredibly funny: he lifted his whole plate off the tray, with one hand, using nothing but the Yorkshire pudding as the grip. The gravy and food had congealed to the extent that his whole dinner had become an amalgam of cohesive ingredients that had fused themselves to the plate. Clearly an inedible meal!

"..tipped it 90 degrees and the food never moved."

This was one such event that highlights the issue but it wasn't isolated. Again, another dinner and another patient, this time it was a pasta meal. This friend of mine lifted his plate and tipped it 90 degrees and the food never moved.

You see, as in most hospitals now, the PCT's are outsourcing the food, staff, and other duties to external companies. The one such company that had the contract for this Trust has already been documented in a television program that covered the state of food in hospitals, a report that was not too glittering and which I saw when it was televised at a later stage (but I shall talk about that later).

"..(transported) partially cooked from the warehouse where they were made.."

The procedure, at meal times, was to transport the dinners from their conveyor belt construction, partially cooked from the warehouse where they were made which were, in this Trusts case, at least 40 miles away. On arrival to the hospital, those dinners would be unloaded, wheeled to the kitchens that were relatively unoperative and finished off in the kitchens, then kept warm until delivery to the wards. By this time, the result could only have been as I have described above.

 It had come to a point where both my wife, and the wife of one of the new patients opposite me, were bringing in additional food for the pair of us. The pannini shop for the visitors always served nice sandwiches and the Oatcake shop down the road made excellent Breakfast boxes. What really made my anger boil was that hospitals, even those newly built, all have kitchens provided but the PCT's don't seem to invest in home cooked meals, opting instead to pay external contractors to fulfil this so vital of duties. When securing the contract with the PCT's, we were told that the managers in charge had eaten items off the patient menus to agree the contracts and ensure that quality was of importance. However, either they were given exceptional meals as a one off just for the contract or they had let their quality 'slide' somewhat, complacent with the contract, but it was the patients that suffered at the expense of their financial decisions.

Thursday 2 August 2012

12 - Moving again!

".. not having much in the way of income.."

Weeks blended into months and my lengthy time at this hospital had reached its current conclusion. My wife, having been staying intermittently between the nurses station and her Aunt and Uncles house, was pleased to be moving back to a hospital near to where we live so that our cat could resume some normal living routine again and she could stay at home.

With not having much in the way of income now (statutory sick pay for me and no job for my wife having been made redundant a month prior to the accident), we had demolished our savings to stay afloat with accommodation, TV bedside 'time' purchases, magazines, food and living expenses, emergency mortgage payments and many other financial considerations that the medical professionals don't have to consider. They all do such an important job but I do feel that some consideration would be beneficial to understand things from a patients point of view.

"..the door to my room was suddenly opened.."

We had been planning to move hospitals and had put a request in to accomplish this but one day in August, the door to my room was suddenly opened by an enthusiastic military official whose position was to organise transportation of patients to alternative hospital locations. He had suddenly managed to secure a bed at our local hospital close to where we live, one in the Trauma Ward under the expert care of a Professor. The catch was, we had 2 hours to decide to go that evening to get the bed reserved and the transportation to be organised.

After a wheelchair excursion outside to ponder on all pros and cons, we decided to go for it. One of the main problems is, across the course of a hospital stay, like mine, as a patient you have a tendency to 'collect' emotional items, things to populate your "world" with, your world being your bed and immediate surroundings. Emotional ties are important, they give a long term patient a feeling of home from a distance, a ledge of safety to sit on during the cliff climb of their recovery.

".. my wife had to transport the bulk of items herself.."

The gathering of items provided us with difficulties though, for to move them all to the new hospital, my wife had to transport the bulk of items herself and with no transport but her car a 40 minute train journey away, we had a problem. That day, I think luck was shining its faded light on us for a colleague from my place of work turned up. He was able to take my wife and the bags of items to her car to continue the journey home and to the new hospital to meet me. That was at 4pm. By 6pm the ambulance crew arrived and, my notes collected from the ward reception, I was on the road in the ambulance.

An hours drive later, and in the dark, we reached my new 'home'. An old infirmary building part of a bigger complex, one of those 1940's / 1950's constructions that NHS Trusts still relied upon to provide beds and wards.  Most Trusts are investing in new hospitals these days, building new and fancy edifices that do not have the same effective patient care delivery as the older buildings. My assumption would be is that the government is taxing the NHS Trusts quite heavily for these old buildings, which although can be very attractive in their design and have many architectural features that are then lost when the Trusts have the buildings knocked over to avoid being taxed. Only my unsubstantiated assumption but it is my guess I'm not far from the truth.


11 - More days

".. intensely emotional times."

Those early months after the move were recorded by two major social events; the celebration of my birthday in late June ... and our first wedding anniversary in July. Both were intensely emotional times. I felt lucky to be alive, having almost not made my 34th birthday. My wife and I celebrated our first wedding anniversary in my hospital room with the nurses and the hospital chaplain. They even bought us a cake!

Most newly married couples celebrate their first wedding anniversary with a holiday, a break away, wining and dining with gifts and cards, picturesque scenery or hot sun. Us? We celebrated ours in a hospital ward, my room view hardly an adequate setting, with my dressings being changed as part of the routine and our evening meal one brought to me from the common daily menu.

".. those things are difficult to steer and control.."

All the lengthy physio sessions in the gym had managed to develop my right arm muscles enough to use a one arm drive wheelchair over short distances. To say that those things are difficult to steer and control is an understatement! I can only compare driving them to being as inhebriated as a student with a pocket full of free money at Happy Hour, trying to manoeuvre a supermarket trolley through a series of a tight traffic cone assault courses for a free pint of beer.  For those that do not know how one of those'demon' contraptions functions, your good arm is in charge of all the forward motion, and in turning both left and right. "How is that possible?" I hear you grumble at your screens. Well, the wheel on your good arm side has two rings around it. To go straight, you have to drive both rings at the same time, to move left its the smaller one on its own and to go right, well, you work it out!

To get into my assigned chair was a task in itself. Whenever my wife and I wanted to get some fresh air or a change of scenery, a team of three nurses / physios were required to help me into my chair in the usual method of "spin and drag" from the bed. That was, at least, the manual version. On some occassions, a mechanical hoist was utilised to 'scoop' me off the bed in a giant sling (see picture below) and deposit me into the chair.

The hoist sling!

Many times, during those days, I reached serious depression. Seeing my wife leave me every night tore me to pieces, leaving me to my thoughts with the distraction of the TV attempting to drown out my sorrows and trying to find out which nurses I knew and could rely upon during the nightshift to come to my aid if I needed it. Being unable to even get off the bed proved frustrating enough but with an ileostomy that never ceased, never stopped filling the bag at my side, needing constant emptying, I needed to be able to rely on the able staff to help me.

"..another NHS issue was noted: staffing levels."

This was where another NHS issue was noted: staffing levels. Moving to a new hospital took its toll with 'natural wastage' when ward nurses could, prior to the move, apply for different departments . So, to make up the numbers on the ward and fill the deficit, "Bank Staff" where employed. Whilst this is a good idea for general care wards with common needs, Trauma wards can have a plethora of different conditions and patient needs which did not conform to the general occupational duties.

So, in my case, I had to see who was covering the night shift so I could ask for help with my ileostomy. Not being able to get out of bed to reach the emptying bowls, gloves and cleaning materials, nor was I able to bend my arm sufficiently enough on that side to aid in its maintenence, I became somewhat reliant on trusted individuals. Having to press my nurses call alarm in plenty of time, hoping for someone to come before the seal was 'blown loose' and causing a major clean up operation. It was part of the requirement for the nurses to answer room bells within 5 minutes. However, on some occassions after pressing for assistance,a Bank Nurse would arrive after 20 minutes and merely switch off the bell, promising to return and not coming back. Again, this was a result of the design of the hospital, the layout being conceived by non-medical practitioners which made it difficult to get to all the patients, coupled with the nature of the ward dependancies.

The stress of these anxieties all added up. Being in a state of perpetual alertness during the day, by the night I was mentally tired which was made all the more difficult by having a night shift of Bank Nurses on who were not aware of / had prior experience of someone with my injuries.

10 - A developing, lasting, problem

".. undergoing frequent, daily dressing changes.."

So there I was, undergoing frequent, daily dressing changes for my laparotomy and other recently scarred wounds, when something happened out of the blue.

A hole, the size of cotton bud, opened before my, and the nurses eyes, in my stomach incision track. As if that wasn't bad enough, (make sure you have had your dinner already) copious amounts of yellowing puss began to ooze from the site. Further examination revealed a cavity under the scar, an enclosed pocket of infected 'material' that had now breached the surface of my newly forming skin.

I was scheduled for a CT scan to discern accurately what this was and how it could affect my recovery. What they found was a complication that would impair my slow, but steady, convalescence and have quite a commanding dominence that dictated a whole new schedule for delayed operations.

"..something must have been left behind, some infected material.."

To explain what they found, during my original laparotomy to add the iliostomy, something must have been left behind, some infected material, that went on to develop abcesses in my stomach. And it wasn't just one, there were three in the centre of my stomach alone, chosing to form like several Maltesers fused together. Across the course of time, these expanded their exit holes, my body clearly reacting to the infection and trying its best to evacuate the poison from where they lay.

My stomach showing the laparotomy wound and the abcess opening




To help my body along, it was decided that the abcess pockets would be drained. Whilst this sounded like a good idea, it did not succeed. The proceedure was one that I was not looking forward to at all, it was all going to be completed with local anaesthetic and with the combination of a CT scanner in that, after the local had been administered and begun working, the surgeon would make the incision in my hip and go in from the side. The tube being slowly guided inside my body cavity, by the continual scanning of the CT to obtain a relative three dimensional position of where the probe was at any one time and how far away it was from its target.

"..this was a waking torture."

Truthfully, this was a waking torture. Pain was burning my whole hip area, and the tube inside my body cavity was probing past my intestines and other organs to get to the pockets at my stomach, which had the effect of serious discomfort. In order to get through the operation I had to remain perfectly still to ensure its success. To deal with the pain that swallowed me that day, I was reduced to severe emotional turmoil that I had to let 'wash' over me. It is difficult to describe my feelings of intense rage at this situation. My thoughts were barraged with anger but I had to suppress them. It felt like frustration amplified a hundred times with lashings of acrimony tipped over me.

".. I was not only subjected to one minor, but gruelling, procedure but two.."

After what seemed like a lifetime, the procedure was over. The news from the surgeon was that the pockets beneath the one the nurses could reach, were empty, however, was not the only time this procedure was attempted for I was sent down to the Ultrasound scanning department on another occasion after the CT attempt to try again. So I was not only subjected to one minor, but gruelling, procedure but two. The wounds were still producing fluid and, although the Ultrasound procedure was moderately successful, it was still not able to help me.

Lady Luck had been on my side upt until this point but the CT procedure had started a domino fall that would evolve into further complications that I was not ready for.