In Sunshine and in Shadow: Post-op Update

"One cannot enjoy sunshine and light without also accepting and embracing shadows. There cannot be the one without the other--they are equal halves of a whole." ~Anon

   We arrived at the Royal Free Hospital yesterday morning at seven a.m., and reported to the same place as last time: Day Surgery and Surgical Admittance, to the same hostile, unprofessional woman as before, staffing the desk, and Les proceeded to check in again. The same pandelerium reigned with a sloppy queue of day surgery patients mixed in with folks like Les waiting to be admitted to hospital.

   About ten minutes later a nurse with a very heavy foreign accent called what could have been "Mr. Biggs" or any of twenty variants on a theme. No one responded so Les stepped up and said, "I am Mr. Biggs?" Yes, yes, of course, come this way... and off we went to an exam room for a Deja Vu ride into the uncertainties of the British NHS. 

  There was still no guarantee of a bed in the ITU (Intensive Therapy Unit) for Les! We were told however that we would know one way or the other by eight a.m. The anesthetist was a lovely young Eastern Indian woman with impeccable English pronunciation--thank The Goddess. She went into great detail on what Les could expect which was very helpful. 

   One of the surgeons on Professor Davidson's team came in and introduced himself. He explained that the scans had indicated two lesions on Les' liver but during the ensuing weeks since the scan was taken things could have changed. While they were planning to take 30% of Les' liver, they might need to take more and there was a possibility--although he thought it slight-- that they could go in and find "there is nothing we can do for you, in which case we will stitch you back up without removing anything." Chilling words indeed for me to consider as I pondered in helpless anger, the weeks we've lost to the progress of this disease in the face of the NHS' inability to cope with a level of efficient care in our case.

   Meanwhile a shy young woman with a strong Polish accent who we also found difficult to understand, came to take five vials of blood. Les has a deep phobia of needles. He is fine once it is in but the process almost undoes him every time. 

   This time the technician could not seem to find a vein and she poked him three times, digging around with the needle, until finally she managed to draw blood.

   We sure wished Sparky had been with us. My youngest daughter is a trained and experienced Certified Nursing Assistant/Phlebotomist and she can tell you--some technicians have the touch and some don't. Sparkala has the touch and can seamlessly insert a needle and draw blood from a turnip. This young woman working on Les was too timid and she didn't have the touch--at all. I thought we were going to have to hold Les down at one point. All the color leached out of his face and he went pasty white. I was worried he might faint.

   We were told to go back out in the hallway and sit until someone called us. Back we went  to watch the scene of hyper manic medical business unfolding and within five minutes the nurse came and got us. There was a bed and Les needed to strip down, put on a gown, paper panties that resemble nothing so much as one of those paper food service worker's caps, and a pair of navy Ted hose to prevent blood clots. 

   We were unceremoniously shown to a locker room where the items were shoved into my hands and the nurse turned and left. As I was tying up the back of his gown, she returned and stepped in front of me to take over the gown tying, then she urged him to get into his stockings.

   Now anyone who has ever worn Ted Hose knows they are super tight and harder to put on than women's pantyhose--something akin to attempting to slip a membrane thin finger protector over an engorged erection. This process is made more difficult yet for Les, whose stoma bag is in his way when he bends down. We tried to explain this to the nurse while he struggled to get a leg up and work one sock on. The nurse urged Les to get a move on it in a staccato burst of words completely lacking in any meaning for us (although I am sure she was confident she was speaking English) until she could see Les actually struggling and realized he needed help.  

   Stockings on, we were herded back out in the hallway where medical staff were calling out patients names for day surgery, family members trailing along behind their loved ones as traffic bottle necked in the narrow hallway near the nurse's station. Our nurse grabbed me by the arm and led me off to the end of the hallway to select a large locker for Les' belongings. Items secured, she took the locker key, marched off to the nurse's station and put it in an envelope with Les' name on it, then hurried off to attend to other things. Meanwhile Les was still standing in the drafty hallway as a milling throng of sick people and their families swirled past him accompanied by their medical staff. 

  We wanted to know how I was supposed to collect Les' things after his surgery. Les asked another nurse at the station. She replied in broken English with a heavy Polish accent which we had to hunker down and attend to every syllable in order to understand. She hadn't grasped Les' initial questions either and she assumed he was a Day surgery patient so her instructions were meaningless. 

   Our nurse returned to say it was time for Les to come along and follow her. We wound down the hallway and stood across from the per-op doors. The frenzy and seeming disorganization coupled with a round of foreign accents that were hard to follow, and the fact that my husband had been standing in the hallway in his flapping nightgown for fifteen minutes did not inspire confidence in me at all.

   Finally a pre-op nurse came out to collect Les. I took his face in my hands and kissed him, saying, "Remember--I am waiting here for you, so you come back to me do you hear me--you come back to me." I kissed him again with tears in my eyes and they walked through the pre-op doors at 8:45 a.m.

   I was told someone would call me to offer an update on his status near the end of surgery. Both the nurse and the anesthetist had written down my phone number. I was left at loose ends as the morning passed, sitting first in the hallway amongst the throngs of day surgery patients and their loved ones. 

   I took a brief walk at ten a.m. to the Belsize Park Underground station five minutes away, to redeem an extra Oyster card and get our money back. I stopped in the hospital canteen run by Marks & Spencer for a breakfast sandwich and coffee which were terrible and totally unappealing. The latte was weak as rainwater despite my having asked--yet another person with a thick foreign accent who I found as hard to follow as she found mine--for a triple shot latte with double caramel flavoring. It took two other employees to explain to her what I had actually asked for and she had to cancel my order which she had interpreted incorrectly and run it again.

   Finally my latte arrived with a breakfast sandwich that had been nuked to death. One half was hard as concrete and the cheese had become molten lava, flowing out all over everything. I took two sips and one bite and threw it all in the garbage.

   Back up on the Day Surgery floor I sought out a quiet place to rest--four hours of sleep and a rising time of five a.m. meant I was exhausted. I discovered the Day surgery patient lounge we had waited in on October 8th. It had large, overstuffed recliner chairs on wheels all around the walls with a bank of windows opening up to Hampstead Heath in the distance. I settled in and closed my eyes, listening to the sweep of voices in the room. 

   I have always been good a identifying accents. It comes from having had a HAM radio operator for a father. I used to sit on his lap as a little girl back in the early 1960's and talk with other HAM operators all over the world. I also had a Norwegian grandfather and a Welsh grandmother so I grew up in a world peopled by the music of foreign accents.

   Around me now, I heard Albanian, Italian, Spanish, Chinese, and Farsi. Each language was spoken by a day surgery patient accompanied by a family member who acted as an interpreter and signed medical paperwork to this effect. I am a foreigner in a foreign land and although is it England I cannot count on the national language being spoken clearly enough for me--whose ears have always been sensitive to the nuances of a foreign accent--to understand or indeed for my flat American accent to be understood in return.

  I stood and looked for the time. I had become a clock watcher now as the hours crawled by. The surgeon had said Les might be in the theatre for as little as two hours or as many as six depending on what they found. By 1:45 I could sit no longer. For me, the passing hours did not bode well. I went to the Day Surgery nurse's station and asked if someone could update me on my husband's status--was he still in surgery? The nurse called around and discovered that Les' surgery was just finishing up and I should go up to the 4th floor and ask for bed nineteen. 

   Imagine my surprise when I arrived to the ITU floor to discover a beautiful--and empty--waiting room with over 40 chairs and two vending machines. I could have waited up there in quiet and comfort if only someone had directed me hours ago. There was no one at the reception desk but the notes taped to the glass indicated that bed 19 was in the south wing. After ten minutes search I found it and then stood and read the lengthy directions on how to use the phone to call the bed number. Calling bed 19 a nurse picked up and I explained who I was. She asked me to hold please, and came back a few minutes later to tell me my husband was still in surgery which was just finishing up and he would be in bed 33 when he came in to the ITU. I should wait and someone would find me. 

   Back out in the ITU waiting room I sat with eyes closed for thirty minutes until a door swished open and one of Les' surgical team came over to me with his hand outstretched. He shook my hand, and said, "Your husband is in ITU now. Everything went very well. We found the two small lesions and removed them with about 10% of his liver. Everything we took had very clear margins so that's good. We found a third very small lesion which we also took. We don't know if it is cancer--it looked to be a calcification--but we took it and it has been sent off to pathology."

   I asked about Les' gall bladder and he told me they didn't need to take it. I started to say, "Thank you Mr. Kumar--" he clutched my hand warmly and said with a smile, "Call me Satch--everyone does. Wait about another twenty minutes and you can go in to your husband. He's doing really well."

   It was clear this young surgeon was feeling very happy at the outcome of Les' surgery--"Satch" was relaxed, happy and had a spring in his step. His demeanor would have been quite different if there had been a less than desirable outcome. 

   I spent the time texting friends and relatives with a brief update. I offer my heartfelt thanks to everyone who kept in touch with me and who kept Les and I in thoughts, prayers and meditation throughout the day. 

  I reported to the South wing and rang bed 33. The nurse answered and I explained I was Les' Bigg's wife and asked to be admitted. The door clicked softly and in I went. 

   Just around the corner and there he was--my Best Beloved!! One nurse was assigned to him and she was all business, ordering me to put on a plastic apron. I washed up to my elbows and stumbled through unfolding the plastic bag apron and getting it on.

   Still groggy and barely out of surgery, Les felt me lay my hand on his arm. He opened bleary eyes in slits and stared intently at me as though I were an alien with three heads, then slipped back into sleep again. I stood by his bedside while his nurse checked and re-checked his paperwork, the surgeon's instructions, and keenly monitored the eight or so machines which were clicking and beeping, following Les' blood pressure, oxygen level, breathing, heart rate and medicine dosages.

   Slowly, slowly Les came back to me, as his anesthesia began to wear off.  He had IV cannula's in both hands, a urinary catheter, and a large tube sticking out of his neck on the left side, to which were attached a snaking half dozen thin plastic tubes carrying medicine and other life sustaining things directly into Les' carotid artery.  A large oxygen mask was strapped to his face.

   As the hours passed I got to know his brilliant nurse Cynthia, who speaks with excellent English diction and has been an ITU nurse for fifteen years. She was right on top of everything and stayed there, watching and listening intently as Les came 'round and began to use sign language to indicate his pain level was a nine and his mouth was too dry. 

  Cynthia gave Les some pain medication by IV and squirted drops of water into his mouth. She got his medicine on demand box set up so all he had to do was push a button every five minutes. He struggled to sit up and could not find a comfortable position. Cynthia rearranged him a half dozen times at Les' request, in a gentle, efficient manner. I warned her Les has a very low pain threshold and as he comes 'round he will begin asking a thousand questions--which he did. She told me he thrashed around a lot when he first arrived from the operating theatre.

   I knew he was fine when he began to negotiate for release from the oxygen mask. He hated it and it made him very uncomfortable. Cynthia told Les he needed to keep it on for 24 hours. Les bargained for an oxygen cannula in his nose instead and won. As she slipped the plastic cannula hose around his ears to hold it in place, I said, "Darling its a very good thing you've got the ears to support this hose." Les came straight back with, "It's mean to take the piss out of a new surgery patient!"

   We laughed and Cynthia relaxed as she watched Les and I banter with one another.

   "I can tell you to have fun with each other don't you?" 

   "Yes, we carry on like this every day, laughing and having a good time together."

   Within three hours of coming back from surgery Les was alert, happy and raring to go. He too was over the moon at the surgeon's pronouncement about his surgery outcome. Cynthia took me aside and said, "It's such a pleasure to have a patient who is alert, happy and ready to get well. Most of our patients in ITU are very ill and not very happy."

By the time I left at six p.m. Les had eaten a pot of yogurt, drank some water and was attempting to cajole Cynthia into letting him get out of bed!! I told her to be careful or he would have her out in the garden doing Pancake races in a few minutes. Emotionally threadbare and exhausted, I left for home, knowing Dear Sir was in competent, caring, professional hands.

   I managed to catch the correct bus to Euston Station, eat a bite of dinner, spot the train I needed, get on the correct train despite the thronging hoard of travelers heading out of London, and I was met at the other end by Robert from WB Wind in the Willows, who took my bags and walked me home though the dark. Thank you Robert!!

   I am off to visit Les now and I should not be at all surprised to find him leading Step-dancing classes for the ITU staff!