Last Friday I had ‘open’ hernia repair surgery. Subsequently house bound, even chair bound though decreasingly so, I have decided to set down my thoughts/experience with the operation as they may be of use to others facing a similar procedure. I also want to record the luck of discovering a Romanian doctor on duty at the time the NHS had deemed I should be sent home. I have to admit that I was somewhat anxious before the event, and searching for advice on the likely post-op situation, how long to recover, etc, much of the information was contradictory. With this background I had been warned by everyone from hernia repair surgeon to most acquaintances who had had the op that I should expect severe pain and to be ‘out of action’ for quite a time, even surprise from Germany that it was to be ‘open’ rather than ‘keyhole’ surgery and that I was to be discharged home the same day. I consoled myself that the pain could not possibly be as bad as that experienced last year, first waiting several hours for an ambulance then for quite a while in A & E with bladder retention; then, by the time a catheter was in, I was pretty much lunatic.
I’ve had the hernia for quite a while but only very recently had it become much of a problem, particularly sometimes limiting one of my favourite activities – walking. I was also concerned that a planned 5 week trip to, around and back from Romania next summer in 43 year old ‘Lofty’, our VW Bay camper, might seriously aggravate it. The NHS nurses and doctors last year having dispelled my fear of hospitals (in the NHS Airedale General Hospital; they were truly superb), and having got the OK from my ‘prostate consultant’, I decided to have the hernia fixed at the earliest opportunity. My GP referred me to the local Yorkshire Clinic, a private hospital but with an NHS hernia repair clinic, as this had by far the shortest waiting time – about 6 weeks from referral to op.
Wonderful but overworked nurses
I’m not convinced that all the paperwork, risk assessments and dire warnings delivered before surgery are in the best interest of the patient; they could hardly be better designed to scare off the ‘victim’. The same can be said of the interminable paperwork which prevents the nurses doing their jobs as well as they might. They are seriously overworked for the most part because of the mindless tick box mentality of organisations like the Care Quality Commission (the same can be said of teachers in education, prevented from doing what they could do so much better without the nonsense imposed by OFSTED). What is it all about? Not patient care and safety as claimed; it is clearly there just to try to avoid litigation. It also results in ridiculous discharge procedures with much needed beds being taken by patients who should have been home hours, sometimes days, before
Reassuring pre-op visits
Back to the Yorkshire Clinic, at 7.00am Friday 23 January. I’m quickly shown to a pleasant room and visited by a nurse, whose function seemed mainly to ensure I am who they think I am, to confirm the answers I had given to a string of questions several times previously, and in writing, and to be assured that I hadn’t eaten or drunk anything since the day before – a lovely, caring lady who also took blood pressure, temperature and assured me they were all “perfect”. The nurse was followed by a very pleasant young man who turned out to be a physiotherapist who gave me a lot of really useful advice on how to behave post op and on pain management should I need it – very reassuring – and a number to call from home “at any time” should I have a problem. Then the surgeon, who confirmed he intended to do the correct surgery in the correct place and marked it, with the remark “Now that’s what you might call a hernia!” – well at least he knows what he’s in for. Then the anaesthetist who, as at Airedale last year, is a very pleasant, communicative, reassuring lady. She has, of course, to go through all the dire warnings about the dangers of general anaesthesia, but I’m not really listening; I remember my first experience as being really quite wonderful, chatting away to a friendly nurse then, wonder, I’m chatting to a different nurse and I feel great – it’s all done. I couldn’t believe it. None of my ward companions in Airedale who had opted for an epidural were so happy. Epidurals seem to be the preferred NHS option (though not, I think, for hernia repair); are they cheaper?
During the visits I ascertained that I was “third on the list”, so scheduled for surgery at about 11.00am and therefore should be discharged “mid to late afternoon”. I texted my wife to tell her to come at about 3pm to accompany me home in a taxi, then settled down to listen to a mixture of BBC Radio 3 and 4 and Classic FM, on the iPad thanks to the hospital WiFi (sadly lacking at Airedale – if I come up well on the Lottery I’ll pay to have it installed there). I’ve no appetite for daytime tv, though it was available.
Pretty much to the minute at 11.00 a nurse arrived to escort me down to the anaesthesia suite. I had already donned the paper pants and anti-thrombosis stockings so it took just a few seconds to put on the hospital gown and my own dressing gown and slippers. Another friendly welcome from the anaesthesia nurse who again went through all the obligatory questions, stuck sensors to various parts of me and wired me up. beep, beep, beep … she assured me all the readings were looking good.The anaesthetist arrived; a cannula was inserted expertly and painlessly in my right hand. After a friendly chat and the obligatory checks she told me she was going to put something in the cannula and I was going to sleep. I vaguely remember floating down like a feather- lightly swing, swing, swi … .
“Do you have any pain?”, I heard someone ask. I said I did, a little. How does it rate, 1 to 10, I was asked. Remembering A&E the year before I think I rated it 5, maybe 7. We’re going to give you some morphine. I vaguely feel it going into my right hand. How’s the pain now? I rated it a bit lower. More morphine. “How’s the pain now?”. I think I rated it zero. I’m not quite sure of all the details here but I know I was happy that I felt fine. Porter called; up in the lift to my room and slid from trolley over on to my bed. Wonderful! It was about 1.30pm I think.
I may have had a nap here; I cannot remember. I do remember being asked if I’d like a drink and something to eat. Brown toast with butter and tea I said. Quickly it came; a meal fit for a king I said.
At some point I put radio on the iPad again. I am delighted when Petronela, my wife, comes in at about 2.45. We chat, I cat nap, we chat, among frequent visits by the nurse.
Oh dear! Where’s the loo?
At this point things began to go wrong from my point of view. I feel I need a pee. Slowly I get out of bed and go into the en-suite bathroom. I stand there, waiting. Nothing. I remember the advice after the catheter had come out last year: relax, don’t strain, don’t ‘try’, turn a tap on, wash your hands. Other advice such as have a shower or a bath are not an option following the hernia op. Walk about; I do. Back to the bathroom, I wait. Nothing. I get back in the bed.
Meanwhile, Petronela is talking on the iPad to a group of friends in a small, private teachers’ forum. My situation becomes an urgent Anglo-Romanian incident. Advice comes in thick and fast: wiggle my fingers under the cold water tap. I do it. Nothing. Pour water noisily from one glass to another; it’s done. Nothing. Make the sound you make to young children when you want them to pee. “Pshsh, Pshsh, Pshsh”. Nothing. Pshsh! Back to bed.
Several more attempts in the bathroom, interspersed with running water, Pshsh, Pshsh, walks around the room, as my bladder increasingly tells me it needs relief but nothing will come; my anxiety is increasing.
Several trips to the bathroom then, wait for it, cold water tap on. Suddenly, there’s a slight, slow trickle as just a few ml, 5?, are transferred from me to the expectant water below. But then it stops, despite the still strong feeling that ‘I must go’. I wait. Nothing. I walk about. Nothing. I go back to bed.
Animals jump for joy
Cheers and congratulations from the waiting forum in Romania. One member sent a video clip of some meerkats jumping for joy. Hilarious; I was rolling about with laughter – surprised I didn’t pee myself! Before clicking the link prepare a change of pants – unless you happen to have post-operative retention.
In comes the nurse. How much? Don’t know, very little but more than a few drops. She gives me a graduated jug to catch it should I go again.
After one or two more trips I do go again. About 50ml, but bladder still not emptying. Nurse is not satisfied; nor me. In comes a pleasant-looking youngish man in doctor’s gear, the duty doctor. “How’s it going?”, he asks. That’s not an English accent; where are you from I ask. Romania he says. “Buna seara”, I say, and enjoy the surprised smile on his face. I resist the temptation to jump for joy like the animals I had seen shortly before; I have good reason to know that while the Romanian national health service is in a pretty poor state – lack of facilities and money – they produce doctors among the best in the world (a story for another day).
An excited brief conversation in Romanian ensues, though he speaks excellent English. We ascertain that he’s from the wonderful city of Sibiu, former capital of the Principality of Transylvania and European Capital of Culture in 2007. He has a wife, a teacher of English, and a three month old daughter, in Romania and commutes every fortnight, spending two weeks on duty in the Yorkshire Clinic then two weeks in a Romanian hospital. He is Dr Aurel Sbarcea. He is just great and I relax. I know everything is going to be OK.
Back into English for the medical chat. He’d like to see the bladder being emptied before letting me out. If not, unpleasant as it is, he could put in a catheter. He advises that for safety I should stay overnight. He’ll leave Petronela and I to discuss and come back in a while to see how it’s going. We have to make a decision soon as the hernia clinic is in a day ward and closes at 9pm. It’s a no brainer: one emergency with bladder retention, ambulance and A&E, is quite enough. When he comes back at 8.45 we move to another very pleasant room, Petronela calls a taxi to go home, I’m settled down for the night by the night nurse – as pleasant and caring as all the others had been – saying she’ll be back at 2.30am to take blood pressure.
I wake up at shortly before 2.30am and, yippee, I do 300ml. Nurse is pleased. Back to sleep.
I wake at 4.00am. 200ml. Back to sleep.
Nurse wakes me at 6.30am. 300ml. She’s pleased. The doctor will probably be happy for me to go home now, she says. I order breakfast: porridge, toast and marmalade, tea.
Dr Sbarcea arrives and is pleased with developments; he wants to see a bladder scan but subject to a satisfactory result I can be discharged. He’s clearly very busy and cannot stay long; new patients are arriving thick and fast and the overnight empty rooms are beginning to be occupied. Nurses and ancillary staff hurry hither and thither in the corridor outside trailing blood pressure machines, piles of bedlinen, bucket and mops, trolleys with tea and coffee. It all beginning to resemble Arnold Wesker’s ‘The Kitchen’ but unlike that, or Gordon Ramsey’s simulation of it, there is, nevertheless, an air of quiet competence overlying it all.
Day nurse comes in. She’ll be back shortly with bladder scanner and do the discharge, she says, but first she has another discharge to do. Maybe that patient was shouting to get out; I was not as I was very comfortable, had music and any other internet facility I wanted on the iPad and there were clearly now a lot of people needing more attention than me. In the NHS hospital I would be concerned as beds are needed desperately; that did not seem to be the case here. Occasionally the day nurse appeared to say she and bladder scanner would be with me soon.
I took occasional walks in the corridor. I was not in pain, enjoy moving about and know that it is good for recovery. On one of my walks I bumped into Dr Sbarcea. He asked if I had had the bladder scan yet. Not yet I told him. He’d try to get someone to me he said. I smiled a thank you.
Shortly after this, Nurse Adriana arrived with bladder scanner. I don’t think she’s English despite the double-barrelled English surname on her badge, so ask where she is from. “Cluj Napoca in Romania”, she answers. “Buna ziua”.
Bladder scan quickly accomplished. Retention is so low she does it more than once to be sure – just 2ml. As she quickly and efficiently completes the discharge papers we manage to exchange a mini bio of each other: she’s been in England nursing for about 3 years and lives with her British husband about 15 minutes walk from where I spent my childhood. Excellent English of course. She calls Dr Sbarcea who says he’ll come down before I leave if he can. I call my village taxi service to come and take me home. Adriana tells me what five English nurses have already told me since the day before: during the two weeks Dr Sbarcea is in Romania he is sorely missed. I can believe it. I’m sure she would be sorely missed too.
I asked her about pain relief medication; the codeine tablet plus two paracetamols with which I had been plied regularly had worked extremely well: no pain except when moving (getting in and out of bed or chair, not walking). But I had read advice to take ibuprofen so asked her why the mixtures. They each act in a different way and can relieve different kinds of pain, she told me. Since being home I have identified three different types of pain I think: pain from the internal surgery; pain from general swelling around the groin; more recently, a different pain, more of a ‘sting’, from the 10cm, clipped incision. I’ve settled on one codeine (15mg), one paracetamol (500mg) and one ibuprofen (200mg) every six hours: waking (6am), lunch (12noon), dinner (6pm), bed (12midnight). It seems to be working very well.
Conclusions – from treatment in two hospitals
1. I am delighted with the treatment and attention received at the Yorkshire Clinic. This is not to say that I would not have been equally happy at Airedale General Hospital had it been able to offer an early appointment; I have received and continue to receive superb care there too, as both in and out patient. Admin and discharge procedures are a little more problematic at Airedale; nurses there seem more overworked.
2. Surgeons and anaesthetists at both hospitals are excellent; lady anaesthetists are quite wonderful.
3. Nurses and nursing assistants are overworked and underpaid; how they manage to stay so caring, pleasant and helpful is quite extraordinary. In large measure the overwork results from tortuous admin with massive paperwork overload. CQC – the Care Quality Commission – has a lot to answer for.
4. Fear of litigation leads to extraordinary, no doubt very costly, inefficiencies.
5. ‘Covering their backs’ with every risk set out in detail tends to instil fear in patients rather than alleviate it. Try not to listen to, or read, it; just sign as they won’t do the procedure if you do not.
6. We are very lucky to have the NHS in the UK. The politicians have to stop using it as a game – I am certainly sick of listening to them, all of them. We have to accept that we cannot live for ever and sometimes things will just be unaffordable.
7. I have no confidence that any of the political parties are able to develop, adopt and implement policies to adapt the NHS to what is required today.
8. I am very lucky. I got to my mid 70s with no serious illnesses, no hospital visits. I continue for the moment, it seems, to heal quickly. I hope it continues for a while longer as I have another hernia, smaller, to be repaired when I’ve recovered from this one. Then I can stride again over more of God’s own country for a while yet.
Mixed tenses? I seem to go back and relive some of the above as I relate it so I go in and out of past and present. I’ve decided to leave it like that.