Soon enough we reached the 11th November, and our date with Surgery School. Cathy came along with me, eager to be schooled in the rudiments of surgery herself. We were greeted with a nice cuppa, and sat with about eight other pairs of people around a squared-off “U” of classroom-style tables. So it wasn’t an intimate session about me, and only me, then? Far from it.
It was basically a lecture on changing one’s lifestyle with a view to promoting better healing come the days following surgery. There appeared to be a number of different parts of the anatomy being planned to be operated on around the room. They were particularly concerned about lung function, and gave us a toy to suck into, which measures the volume of air you are able to inhale. This is apparently rather important as it is an indicator not only of any lung infection (i.e. pneumonia), but also of overall physical recovery.
It seems I am required to lose a bit of weight, as my BMI is 30.15, which puts me in the “officially obese” range. But only just. Anything under 30 is just “overweight”, and I should apparently be aiming for a BMI of just under 25. At my freshly confirmed height of 170cm, or 5’7” in old money, (remember I have been 169cm, or 5’6½”, for the past 50 years – it’s got to be the hormones!) I don’t need to lose much of my 90.10kg to be “only” overweight – about 3kg, or half a stone, which is possibly doable between now and whenever my surgery date turns out to be. To be a “healthy” weight, I need to lose 15kg, or 2½ stones. That won’t happen in a hurry!
So Cathy has decided that I have given up alcohol, garlic rice with my curries, sugar in my coffee (dream on), and seconds at any meal. In return I am to be rewarded with more vegetables and fibrous foods, and a really exciting pint of water on the evening meal table. I am also rewarded with more exercise, just little sessions to make me breathless enough to still be able to talk, but unable to sing a song. Well, anyone who’s ever heard me sing will tell you that I can’t find, never mind hold, a tune, so that won’t take much effort.
But seriously, getting yourself as healthy as you can, from your mouth down to your athlete’s foot, will help you recover more quickly and more thoroughly. I’ll give it a go, but I’m not denying myself absolutely everything. I’m definitely still up for walking football while I can, and played every minute of a Festival our side held on 17th November, and even went to training the next day too.
Then I get the questions from all of the people who care about me… “Have you got the date for your operation yet?” Eventually on 15th November I give up waiting and ring Colorectal. After some searching about, they finally tell me I am due to attend at the Day Surgery Unit at 07:00 on Thursday 28th November. Although it’s Day Surgery, she said I might be kept in for a couple of days. I think it might be a bit more than that! They’ll sort out a pre-op meeting for me for (probably) the 21st, the day after my brother’s funeral. She assured me she’d send out the letter with all the info I need by first class post today.
She also told me I am to be fasting from midnight the day before. Which sounds like no big deal – seven hours, I can deal with that – until you realise that it’s the whole day before, so I can’t eat anything at all on the Wednesday! Then thankfully Cathy remembered that Surgery School had said I would be supplied with some sort of pre-operation fibre drink in little bottles to keep my blood levels healthy.
But first I do have to go in on the Thursday before, a week ahead so that I can be checked over and also given some stoma training. First up was an ECG, which was done in double-quick time, leaving Cathy and I to sit around outside the stoma nurse room for over an hour. We watched people come and go. The surgeon recognised me and said “hello” as he swung by to go into theatre.
Finally the nurse had finished with her previous patient, and saw us into her room. It was the same room as I had seen the surgeon in to be given the “worst case scenario” news a few weeks earlier. She was a jolly lady, enthusiastic and positive in all respects about my forthcoming lifestyle change. I suppose she could afford to be, after all it wasn’t her lifestyle change. Her mantra was that I was embarking on a journey, and that like any journey it needed to be prepared-for.
She had a goody bag for me of bits and bobs. There were a couple of trial stoma bags, one with crystals in to add water to, to simulate the effect of the real thing. She added that cleaning the stoma, the new version of wiping my bottom, would be best performed with nothing more than water and a sheet of kitchen roll. Not toilet paper or wet wipes; kitchen roll is better designed for the job. A job for the appropriately named “Juan Sheet” then, if only I could remember what brand he advertised?
She explained a lot more about the process of being in hospital and beyond (the early part of the journey). Apparently I might get incredibly nauseous the day after surgery, as my bowels re-align themselves following their disturbance; if I do experience this, they’ll shove a tube up my nose and into my stomach to administer a magic concoction to hit the nausea on the head instantly. They’ll want me up and about as soon as possible, being active is important. I’ll be wired up to drip feeds and on-demand painkillers as well as a catheter, but the nurses will make sure I can move about in spite of all this.
When I get sent home, after 6 to 8 days, I’ll be given the balance of four weeks’ worth of daily injections to stick into my belly to ensure that my blood doesn’t clot; while I’m in the hospital I think the nurses will inject this for me. As expected I will have to wear another pair of Wehrmacht Field Grey flight socks, but this time for a whole four weeks from the date of my surgery. Four weeks from surgery date? That would be Boxing Day.
Then it was on to the stoma itself. She took me into another room and got me to drop my trousers while she checked the creases in my abdomen as I was sitting on the edge of a trolley. Then she drew two big round blobs in permanent marker either side of my belly button, but not in the crease. Ideally the surgeon will put the stoma through the blob on my left, but if that isn’t practical, he’ll use the right hand one.
Then I had to cut a hole to size for the practice bag to fit around my blobby stoma with a pair of weird scissors out of the goody bag, and then slap it on in the right place. I was concerned about having sticky contact adhesive on the same bit of skin 24/7/52, knowing that the k-tape for my knee had a four-day recommended limit. Apparently this sticky stuff is very well designed, and doesn’t cause any problems being on permanently.
It felt odd. But not as scary as I had expected. Then I got some diet advice for living with the bag. Cut right down on greens – cabbage, broccoli, cauliflower, sprouts, etc. – and eat generally less fibrous food. You will need to eat like a horse when you are recovering, over the six weeks after surgery you could lose about two stones as healing and recovery is intensely calorie-demanding. Hot sweet full-fat milky drinks would be nice. Finally, she gave me six small bottles of a high energy drink. The day before surgery I can only have plain water, or black tea/coffee, and four of these bottles of drink in the evening. I have to be at the hospital by 7.00am on the surgery day, so I should get up at about 5.00am and have the other two bottles then. Once I’m at the hospital, they’ll get me to have an enema (oh, didn’t we mention that?) prior to surgery.
Then we were handed over to a nurse practitioner at the High Dependency Ward. He had a quite thick and comprehensive questionnaire to be filled in. All of my medical history, ancient and modern, was checked off. He went through my medication, and I was advised that on the day of the operation I can’t have my tamsulosin. To be honest, by the time they’ve stuck a catheter into my bladder, I’m probably not going to be too bothered about controlling my piddle.
He took my blood pressure, which was about as high as I can ever remember having. I put it down to a combination of my brother’s funeral just yesterday, a heavy cough and cold, and simply being where I was and why. He had taken it in a strange position too, on my forearm. He seemed happier with the result when he re-did it on my bicep. Off with my top, and he sounded my chest for any sign of a pulse and a lung, and once again I seem to have passed with the requisite chest and abdomen contents.
He explained again about how I’ll be moved from ward to ward as my healing progressed over the 8 to 11 days I’ll be in hospital. Make your minds up. Colorectal Reception says a couple of days, stoma nurse says 6 to 8 days, he says 8 to 11, and the surgeon said up to 14 days. I’m expecting it’ll be somewhere between one and two weeks then. He reminded me about the injections, the flight socks, and the catheter all being in place for four weeks. The catheter in place for four weeks? And now you tell me. I’ll just pass on Christmas Day, but come Boxing Day I’ll be truly celebrating. One more thing, most insurance companies will insist on six weeks’ recovery before you can drive again. That’ll be the 9th January then.
One of the people I’d seen had said that the District Nurse will be visiting regularly once I’m home. Any worries I have, any pain, any discomfort, any problems, the post-operative team will be available for me to call on and visit at the hospital. I don’t know how painful or complicated removing the catheter will be. Maybe someone will tell me eventually.
Then he got round to MRSA swabs, and wiped one in my groin, before handing me the other one. I assumed it was like a DNA swab, so I rubbed it on the inside of my cheek. He and Cathy burst into laughter. Apparently it was to take a nasal sample; how – why – would I know that? So he gave me another swab, and I poked it up my nose.
Finally he told me that my day out at the hospital was to be completed by a trip to phlebotomy where they were to take no less than five phials of blood, and the two biggest ones had to be full. As Tony Hancock would have said, that was nearly an armful. As ever I presented the “don’t bother even thinking about becoming a heroin addict” difficult vein, but after much wiggling of the needle, the required tubes were filled. I got the feeling I could probably have saved them one – I’m boring old “O Rh+”.
Cathy and I went shopping afterwards. It seems I needed some new trousers for my journey, with baggier waistbands. In my wardrobe I have a pair of “fantasy jeans”, Levis dating from about 1990; if what the nurse said about losing two stones or more is correct, I might just get into them again. Which in turn of course would mean that the new baggy trousers would be redundant… although I’m sure it won’t take me long to revert to shape!
Overall, it was a slightly reassuring day out. The matter of fact way the nurses talked about it, and the actual simplicity of the bag system, certainly helped to put my mind at rest. But perhaps the most reassuring thing was the steady trickle of customers outside the stoma nurse’s door. I’m far from alone in this. And let’s be honest, if my cancer treatment means the removal of a chunk of my anatomy, it could hardly be from a less conspicuous place. I remember back to my first ever appointment at Oncology, and the sight of a woman aged about late thirties or early forties in the waiting area who had had to have her nose removed. It’s a horrible disease.
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