So to the day before the surgery, which I’ll call “S-1”, and I was fasting from midnight. Two things happened to change my hospital plans for the next day – “S-Day”. Due to the fasting, I just had seemingly endless cups of boiled water throughout the day. In the evening I was due to take four bottles of a lemon flavoured high-carb drink, followed by another two bottles first thing in the morning. That was it.
The first thing was a call from the admin people at the hospital, asking if I could possibly manage to get in for 6.30am instead of 7.00am tomorrow. It isn’t really a major difference, and let’s be honest, I was expecting to be fast asleep most of the day anyway. So I agreed, then I told Cathy, and she agreed too.
Then at about 6.00pm I had a call from the surgeon. He was checking that I really was aware of what he had planned for me tomorrow, as when we had last met he said I was rather preoccupied with my brother’s death along with other bad things happening in the family. I told him I was, and that I had been practicing with the sample bags; he was worried that I might have obliterated the blobs the nurse had drawn on my belly, but I reassured him that I hadn’t.
He then went through some of the surgery team that I’d have working on me tomorrow. Anaesthetist, urologist to sort out my kidney/bladder needs, himself (obviously) who would be trying to do as much as possible by keyhole, for which he had drafted in a keyhole surgery specialist to help him, and a plastic surgeon. The plastic surgeon was there as they have concerns that my previously radiotherapy-treated muscle and skin around the prostate area might not heal well, and they might have to take skin grafts from my thighs to support the healing of the main wound. I mentioned the skin grafts on my left shoulder, and that that had been shaved off my inner left thigh about 65 years ago. He said it would be more substantial than just shavings if it’s needed this time.
Then I told him I was just about to start drinking the first of the pre-op drinks, at which point he said I should treat myself to a glass of wine or a beer. I told him I couldn’t as I had been fasting all day. Then he said that it was only from midnight tonight that I was meant to be fasting. What? “Oh,” he said, “get yourself something to eat, and have a glass of wine. But make sure you don’t come in pissed in the morning!” So I did as advised.
We left the house at 06:00 on S-Day, Thursday 28th November. We were separated at surgical reception, when I was allowed through the door, but Cathy wasn’t. We had a big hug, and she wished me well, promising to pray for me. Then it was changing into gown and field grey flight socks, and being briefed by anaesthetist and surgeon while signing off permission forms, before I was walked through to the theatre. Oh, and no sign of the promised enema.
I laid myself on the table, there was a cannula put into the back of my hand, and next thing I knew I was in a bed on a ward somewhere. It turned out to be the Surgical High Care Unit. Apparently Cathy visited that evening, but I was well and truly out of it.
I don’t know what combination of drugs they had pumped into me, but the next three days were completely interchangeable. I mean that in a déja-vu and déja-entendu kind of way. Sunday seemed to happen before Friday, and Saturday slid in and around before and after them both. Conversations on Friday were repeats of those on Sunday, and Saturday’s could have taken place anytime or day. I remember looking at the clock on the wall opposite, which always seemed to be reading 1.10 (a.m.? p.m.? Who knows?), except that a little while later it would read 1.05. There was a weird thing going on with my legs as well, as they had put compression pads on my calves to alleviate any threat of DVT. And they had given me a button to press which was morphine on demand.
It wasn’t until Monday morning that I began to be able to make sense of things. That morning the Ward Round consisted of every consultant in the world coming round, each with a little flock of junior doctors in tow, all to admire my plastic surgery. Apparently it was a work of art. By the end of the morning I was recovering my wits, and suggested that tomorrow I’d be selling tickets.
As I began to be more aware of what had happened to me, so I realised the extent of the surgery. I had no less than eight knife wounds that I could count. Three drains, three keyhole surgery points (one of which was through my belly button), the stoma itself that was now on my belly, and of course the main incision through which they had amputated my anus. Spoiler alert, but it felt like I been cast as the victim in “Murder on the Orient Express”.
I decided that my surgeon will henceforth be referred-to as “Mack”. As in “the Knife”, obviously. Less obviously, the Plastic Surgeon has become “Banksy”. The triangular flap that he had created might have been a work of art, but it wasn’t Hollywood glamour plastic surgery, far more like gritty statement-making street art.
Days came and went; a pretty reliable routine of waking up early, having blood pressure, pulse rate (usually in the region of 93bpm as my body fought to heal itself), and temperature checked, then going back to sleep. Then waking up again for the first of four batches of medications for the day. Once a day they would check my B.S. level – not my bullshit level, apparently, but blood sugar instead. Somewhere in amongst it was breakfast, lunch and supper. Cathy, bless her, came to visit every day, and she often stayed for several hours, sometimes until about nine in the evening. She got a discount parking voucher from the nurses’ station.
There was some concern that nothing seemed to be coming through my stoma. I hadn’t really eaten much, as my senses of taste and smell had been ruined by the anaesthetic and other drugs, and my appetite had diminished accordingly. I couldn’t drink the tea they provided, as to me it was way beyond builders’ and had become pure tannin. So they put me on various drips and dosed me up with milk of magnesia.
I was seen by the Physiotherapist on S+9, a Saturday. She basically told me how to move myself onto the edge of the bed to then stand up and grab the Zimmer frame and go for a walk. It was a pretty basic manoeuvre, one that planted my feet on the floor with my bum flush on the bed. This worked well until about 11:00am on the following Monday, S+11, when I stood up, and then, as previously directed by Banksy, and keeping my thighs together, sat myself gently on the bedside chair for my 5 minutes of sitting for the day.
The moment I sat down I felt the stitches in my bum part. I stood up gingerly and looked behind me to see a puddle of blood and clear fluid on both the chair and the floor. The nurse who was supervising me got me back onto the bed, and went to get the duty doctor. They cleaned me up, then very soon Banksy’s apprentice turned up to have a look. He estimated that I’d popped 30% of the stitches. They arranged for me to go to surgery that afternoon, and I was wheeled into theatre at 2:00pm.
I woke up two hours later in a recovery area. It wasn’t the usual calm sort of recovery area I was used to. I had only had a light anaesthetic, and I think I may have woken up before they had expected me to. The best way to describe the red-lit scene I saw would be to combine MASH with an industrial revolution cotton mill all set up in the hangar deck of an aircraft carrier. It was incredibly noisy and busy, and dozens of people in their maroon scrubs were dashing about all over the place. And it seemed to be a really huge space.
On the evening of S+10 I had told one of the nurses that my right hip was beginning to give me grief. Cathy was visiting at the time, and suggested I needed an air mattress. Due to the way the plastic surgery was orientated I was under strict instructions to remain on my right side. As the amount of painkiller I was taking reduced, so the discomfort in my hip increased. The nurse agreed with Cathy, and made a note for the day shift to action next day.
Happily for my hip, on S+11 I was given the first of three air mattresses. Why three? Well, sometimes they don’t work as perfectly as they could. At least when I got back to the ward after being re-stitched, I had a comfortable bed to lay my aching hip on. Banksy himself came to see me, and said that I couldn’t get out of bed the way I had been told to before, due to the delicate nature of the repair. I remember saying to him that if I’d popped 30% of the stitches, that meant 70% were intact; if your child came home from school and said they got 70% in an embroidery exam, you’d be quite pleased for them, wouldn’t you?
Naturally I expected to be seen by Physiotherapy to tell me how else to get out of bed, as they still wanted me to be mobilised, and to go for a shower instead of having bed baths. However the woman from physiotherapy was a let-down. Apparently “Mr Russell knows how to get out of bed.” Followed a little later by “Anyway, I don’t know how to help you and I haven’t got any equipment that would help.”
I don’t like to brag, but I’m a moderately intelligent person; I’ve got a Master’s Degree. Eventually I worked out how to get out of bed without rupturing my stitches. It was complicated, due to the various tubes and such that I had attached to me – catheter, multiple drip lines, and at two separate stages a drain from my stomach that was inserted through my nose (and just as a matter of interest produced lots of bright green bile).
I realised that I had to roll over onto my front, somehow pulling my right arm underneath me, then wriggle down the bed, turn 90 degrees, and wave my feet in the air until I felt my toes touch the floor. The final move was to push myself upright using what little strength I had left in my arms. I was absolutely shattered just getting out of bed. Then they expected me to walk the Zimmer up and down the corridors, and maybe even have a shower. Frankly all I wanted to do was collapse back onto the bed; at one point when Cathy was there I asked her to leave the bed area and not watch as I was so embarrassed by the struggle I was having just to get out of bed. My arm muscles (like all of my muscles) had weakened dramatically during my stay in bed.
Meanwhile I was trying to reduce the amount of painkillers I was taking, as my hip had become less conspicuously sore and the surgery wounds had become more of a general dull background ache. Long before I left hospital I tried to exist on two lots of two 500mg paracetamol each day. They continued to offer me a choice of plenty of painkillers though, four times a day: co-codamol, ibuprofen, paracetamol, and the flavour of the month painkiller of choice, tramadol.
Tramadol is an opiate, and seems like the obvious choice. By all accounts a lot of people swear by it. I was however trying to reduce my dependency on painkillers full stop, never mind opiates. But I thought a nice drop of opium before I went to sleep at night might help me sleep better. So I tried that, twice. The first time I had a really disturbed night’s sleep, but still gave it one more shot in case that had been a one-off unfortunate instance.
The second night of tramadol, at about midnight, we had a new admission on the ward from surgery. He was accompanied by the surgical team, who were handing over to the ward staff. So a lot of medical staff were milling around the bed next to mine. In my opiate-distorted world, this seemed like it must be some kind of disaster zone, and I found myself still in my bed, but somehow in a Paris Metro carriage which had been involved in a head on collision with something immovable. The other beds were piled higgledy piggledy on top of each other, and my bed was near the bottom of the heap. I remember calling out for help, I’m trapped. In the morning one of the nurses asked me if I was OK, as I had had a bad night. I turned down any offer of tramadol after that.
On to S+15, which was a big day in another way, as they decided to insert a PICC line (percutaneous indwelling central catheter, but you knew that, didn’t you?) into my right bicep so that they could get intravenous supplies (painkillers, antibiotics, and food) more directly into my system. Before they could use it, they had to get me to x-ray to check it was properly placed. So at about 1.15pm they sent down a request for me to be taken down for an x-ray.
Now every patient in the hospital – thousands and thousands of them – generates dozens and dozens of bits of paper and wristbands each. And each and every one of those items has their name printed on them in the form “Family Name”; “Given Name”. Or “surname”; “forename”. Or whatever. So why is it that my name – Russell; Stewart – suddenly makes me into “Mr Stewart”? The x-ray department are looking for some patient called Russell Stewart to take an x-ray of, and of course there isn’t one anywhere in the hospital. And that was far from the only time I was greeted by “Are you Mr Stewart?”, or “Hi Russell, how are you today?” “No, I’m Mr Russell, but you can call me ‘Stewart’.”
So I didn’t get the x-ray until about 11:30pm, and that meant that the PICC line couldn’t be used until the doctors had checked the x-ray the following day. Of course S+15 was Friday 13th, so I suppose something had to go wrong. S+15 was also the day I was hoping to hear about my histology results, and therefore the result of the operation in terms of my anal cancer. But Mack told me it wasn’t through yet, and might not be for a few days. Suddenly the promised hospital stay of less than two weeks, coupled with histology results in a fortnight were both completely thrown out of the window. The work of art was taking longer to heal than anticipated, and apart from rolling waves of wind, my stoma wasn’t yet working properly. So Mack gave me some more laxatives.
I wasn’t surprised that there was nothing substantial coming through the stoma, as I hadn’t eaten much since the operation. Once the PICC was authorised and useable I was put onto TPN, a drip-fed food. It was multi-nutrient, able to give me everything I needed. But I couldn’t work out how, if it was absorbed through my bloodstream, it could translate into the faeces I needed to prove that the stoma was working. I chatted to the nutritionist about TPN, and she said it was a combination of ingredients, including some whale products. It gave her a real fright when I jokingly asked if there was a vegan option. Later on Mack said that the TPN had saved my life; I don’t know if he was joking or not, but it certainly shrank my stomach.
Sorry if this is repetitive to those who have followed my progress of Facebook, but on 15th December (S+17) I posted “The stoma has landed! One small shit for man, a giant leap for Stewkind!” Finally there was poo getting through. Not much, but enough to give grounds for optimism that my battered and bruised bowels had recovered from their ordeal and were getting back in shape.
Now that the evidence was there of my stoma working, and of my ability to get out of bed again, on S+18 I was moved out of the Surgical High Care Ward and into a general surgical ward, sharing a room with three others. Oddly enough it was only then that I began to feel in any way sickly, or frail, or even ill. I guess it was because I was looking around at the other three and seeing old men who just didn’t seem to be terribly positive role models. On the brighter side, I was able to have more visitors now, and that certainly cheered me up, although it surprised me how tired I was afterwards.
With Christmas looming, there seems to be an assumption that everyone wants to be home in time for it. My take on it was that actually I wanted to be home when I was ready, not just because of some random date in the calendar. But once my catheter came out on the Saturday before Christmas, I knew they were looking to get me home quickly. And let’s be honest, I had had well over my fortnight’s-worth of hospital stay. The PICC line also came out. And the calf pumps came off, replaced by flight socks.
Then on Monday 23rd, S+25, I was seen by Mack. He had the results of the histology. He said things about bits of anatomy (fourteen lymph nodes?) that didn’t mean a lot to me, but then cut to the chase. There was no trace of cancerous cells on the outside of the sample. That meant that they had contained them all inside the tissue they had removed. That meant that the surgery had worked, and I was effectively free of anal cancer. Of course it’s cancer we are talking about. There are no guarantees. They will continue to monitor me, with regular scans, for the next five years. But what a great bit of news. Mack shook me warmly by the hand; it almost felt like a Paul Hollywood moment.
The day still held one massive concern for me though. Banksy had been round earlier, and today I am once again meant to be sitting in a chair for five minutes. After the last experience of trying to do just that, I was incredibly nervous. It took me a lot of courage to do it. I stood in front of the chair, knees together, hands on the arm rests, and slowly, so slowly, lowered myself onto the seat. Nothing happened. I looked at my watch, and started to time myself. Five minutes can take an awfully long time to pass when it wants to. Eventually I pushed myself up, reversing the tentative motion I’d sat down with. I looked back at the chair, no sign of blood.
I have to say that with those two events my mood lightened immensely. The depression, which I thought I’d worked through, reminded itself to me, but now I felt that there were positive things to look forward to. I was managing my stoma bag quite well, my wounds were healing (although the big one was still taking an understandably longer time), and my mobility was greatly assisted by the fact that just getting out of bed no longer wiped me out. And I could sit down without rupturing the wound. It was time to go home. The next day, S+26, Christmas Eve, I was to be loaded onto a stretcher for Patient Transport to take me home.
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