Tibial Nail Replacement - Part 1

6am Wed 15th April. My brother's birthday and time to get up to head to the hospital. My mother kindly drops me off at ODP 6 at 7am and I hobble to the ridiculously located orthopedics department. At reception I am told to go into the waiting room. No good mornings, no welcomes, no calming of nerves. In the waiting room there are already around ten people - each with their little overnight bag and reading material. There's a strange camaraderie in the room - no one wants to impose but everyone is warm and friendly.

Within 15 minutes I am called to see the nurse. Go through the check list again. Then through to the changing area.... Picture the scene. Small narrow room. Down the left wall four large wheel chairs, each with a blanket, a theatre gown, and theatre pants (ugh!). On the right a number of large plastic boxes piled onto a theatre trolley - each with a patient's name and a ward number. With horror I see that I am heading to Ward 109. This is a trauma ward - in essence the same as 108 where I was the last time. There is no god - no justice. The room is reminiscent of a mental health institution circa 1940. I am about to get changed when the nurse rushes in. There is some confusion. I am not first on the list after all. I am second, or actually, perhaps I am sixth - there are two competing lists and no one seems to know which is the correct one. I am sent back to the waiting room - to wait.

A nurse turns the TV on and we are subjected (mostly against our will) to GMTV and then day time telly. There is some dreadful show (Jeremy Kyle?) where couples fight about their collapsed relationships and then take a lie detector test so that Jeremy can shout at them in front of a studio audience (and presumably another 1000 odd people watching in hospitals around the country). No one wants to be seen to be watching this - but where else to look? There is no window in the waiting room and we cant really stare at each other...

We form friendships in the waiting room depending on where we are sitting. Bill, beside me, has a hip flask of whisky in his bag and is ready for his right knee replacement. The friendly woman beside him is having her hip done. The youngish deaf guy down the end has just been told that his operation has been cancelled - for the second time in two weeks.

As we all get to know each other, the procedure unfolds. Each patient is seen by a nurse, one of the theatre medics, and an anaesthetist. Once the theatre teams leave for the theatres - they don't return - thus the need to be in early to see them. So even if an operation is scheduled for 2pm, the patient still needs to arrive around 7. My junior doctor sees me in what can only be described as a store room - there is a wheelchair for me and no chair for him. So he stands and I sit. He draws a black arrow on my leg with a marker, asks me if I have any questions and then leaves. I think I knew more about my operation than he did.

An hour or two later I am called by Dr Swan. He is my anaesthetist. This is a good sign. He has decided I will have a general anaesthetic as there is a one in ten chance I would have severe headaches if he gives me a spinal. This is news to me - especially as I was recommended a spinal for the last orthopeadic operation. Perhaps I needed more pain relief that time? He is kind and helpful. I am to take my painkillers with a sip of water.

20 minutes later, at around 1pm, I am sent to the changing room - again. I struggle to get the gown on and complain about the theatre pants. Apparently these monsters are to protect my dignity. A green oblong of nappy type cotton with a tie at each corner. I protest that it would be more dignified not to bother with the pants at all. A silent response.

I sit in my chair, wrap myself in my blanket and watch my right foot turn purple with cold. Then suddenly I'm called. I recognise my theatre porter immediately - same guy as last time - tats and chewing gum - I love him! We race down to the theatre in a disorderly fashion - burst through the double doors and arrive in the theatre complex. More familiar faces. My anaesthetic technicians are again the same as the last time - and they remember me. There's plenty of backchat and its not polite. I relax. This is all going to be fine. I transfer onto the theatre trolley and am wheeled into the anaesthetic room. I show off my 'free flap' skin graft - I'm hoping they will be impressed - the last time they saw my leg it was a bloody open mess. I am pricked, tubed and stickered, the mask goes on and within a few minutes I am out for the count - my last mumblings oddly requesting Bach to be played during my operation.

I wake up in the recovery room some three hours later and am wheeled to Ward 109 to meet my three fellow inmates - the youngest is 87. This doesn't bode well.

First on the list (at the moment)

Its the day before my fourth operation. I failed to attend my physio session (this time the transport balls up was entirely my fault) and so had a final sweat at the local gym instead. 5ks on the exercise bike (with a bit of an incline - although I don't think its Dundas Street equivalent yet), an hour of weights and stretches and the gym ball and then, too lazy to swim, plod home.

Reread my admission instructions. Note the ambiguity about taking clothes. (A friend or relative is supposed to bring them in after the operation). Should I just go to the hospital then in my (borrowed) nightie? Its tempting - given that I have to leave home before 7am. But I still have some dignity intact - and I might get a row from the nursing staff - they weren't the friendliest the last time - and I've no reason to think that their mood might have improved (unless of course the NHS has been forking out for charm school - unlikely given the astronomical cost of new cancer drugs...).

Test out the charm by ringing them. Ask where I am on the list. You are first, she said, at the moment. I noted the caveat with care. The Ryanair model of healthcare. If all goes to plan, I should be in theatre by 9am. Out by lunch time and sitting up in time for my delicious hospital food at 5pm. If, however, there is a successful terrorist attack, an earthquake, or the entire operative team phones in sick - I'll miss my tea. And you can bet that if that happens, it will be black tea and digestives - if I'm lucky.

I don't have to start fasting til midnight - but given that I've eaten enough chocolate in the last four days to pay off the debt off a medium sized Latin American country, I may just start earlier. A broken leg attracts chocolate like a magnet.....

Rogue Ambulance Driver

Last physio appointment before Easter. Its an important one - because after that its a four day break. The appointment is scheduled for 2pm. This means I need to be ready by 12 for the ambulance - which in essence wipes out the whole day. At 12 I am ready. By 1pm I'm a bit hungry - but daren't start preparing food. Eat a couple of muesli bars. by way of lunch. At 2pm I phone the hospital to tell them I'll be late - and to ask if they actually booked the transport. Yes they did. At 2.30 the buzzer rings. I meet the driver half way down the stair. Where there problems with traffic? No, he says, innocently. I missed my appointment I say petulantly. He offers my some medical advice on crush injuries as a response.

Its 3pm by the time we get to the hospital. The driver says he is now heading home and someone else will pick me up - he doesn't say when. My appointment is long gone but usually the physios manage to fit me in. I start on the exercise bike, then get round the rest of the equipment. At 3.15 my physio offers me 15 minutes - then promptly disappears. By the time she returns the 15 minute slot is lost. She then offers me a five minute slot. Its not that I'm ungrateful, but I refuse - five minutes?? Then she offers me a slot at 4.30. I am resigned to spending the rest of my life in this department. I accept - and then wander round to reception to check whether I can get an ambulance home around 5pm. It appears nothing is guaranteed. I wander back. No sign of my physio.

At 4pm another ambulance driver turns up to take me home. By rights I can refuse this ride, wait for my physio at 4.30 and then wait for another ride later. But its not auguring well. I dont know whether I will actually get the 4.30 slot. I curse under my breath, gather up my belongings and get in the ambulance. An entire day of hassle for a ten minute ride on an exercise bike.

I record this not because its interesting for anyone else - I know its not. Its very dull. Its just that these things never seem to get reported. This is not an isolated incident. It wont be long before I can start getting the bus and I can say farewell to this service. In the meantime I'll be packing my tea and a book and practicing mindfulness with zen like concentration.

Locker Vigilantes

It was one of those days. Didn't realise that the pool closed every Wednesday for staff training. Did the gym for an hour and then, with the fitness instructor, dreamt up ways to fill the gym at quiet times. Had just struggled into my togs when the siren went. Wondering idly whether there was a fire and, if so, would I have to hobble outside in my swimming costume. God forbid. But no. Just the pool closing. Clothes back on, and a promise from reception to let me in for free later in the day. Kind.

At 4.30 I returned. Back into the disabled changing room. Togs on. And the search for a pound coin for the locker. Damn - couldn't find it anywhere. Knew I had had it earlier in the day. Considered options. Clothes back on and a trip to reception? No - it would take too long. Into reception in my togs on my crutches. No for obvious reasons of dignity. Leave the stuff in the locker and risk theft. Yes. Theft of moonboot highly unlikely - and no valuables except for flat keys. Took the final option and went into the pool.

A couple of lengths of breaststroke later I looked up and saw a fattish guy walk through the disabled doors into the pool area waving my moonboot. How odd. I swam towards him and gestured. I had tucked my towel into the boot (luckily not my pants!). He started to remonstrate. I should have locked the locker. I explained, from the pool, that I didn't have a pound coin. was on crutches and blah blah... what was the problem? He continued to harp on - there are thieves around etc etc. I should have locked the locker. He was quite insistent.

Now that everyone was looking, the lifeguard came over and intervened. Sent the guy away, and went to reception to get a pound. He then locked my locker and gave me the key. The other people in the pool turned away - back to the business of swimming. I continued on too - another dozen lengths. And then the usual walking up and down to practice a more normal gait.

Back in the changing room I puzzled over the incident. Was the fat man honestly trying to be helpful? Or was he deliberately out to humiliate the disabled? Was he in fact a professional locker vigilante - trained and hired by the Home Office to keep us radicals from breaking the locker rules? Who knows - I guess I should just be grateful that he didn't walk into the pool area with my knickers on his head...

Pre-asssessment - Orthopaedics admission

The 'urgent' appointment for my titanium nail replacement takes around three weeks. Not bad for the NHS. First, though, I have to attend an outpatients clinic. This takes places the week before the operation and is presumably designed to ensure the patient is ready for theatre, and to reduce the burden of the admitting nurses. By a strange turn of fate, my pre-assessment appointment is on the same day as a friend's, although his is in a different department. We go in together - and later compare notes.

First, find the clinic. Being an old hand at the RIE in Little France I know my way around now. Still, its a long walk to the clinic and the word 'adjacent' (to ward 109) is a little optimistic. The waiting room is small - only about ten seats. There's a television in the corner and a table with hot and cold drinks. The accompanying poster says that these are provided by the nursing staff and so donations are welcome (I wonder silently if this is allowed in the PFI contract - I've been told that the WRVS women are no longer allowed to sell drinks and snacks - and thus that particular source of funds has been cut off). Its kind of the nurses to provide this - the cafe is a long way from the clinic.

First I'm seen by my consultant. He spends around 20 minutes considering the details of my operation, examining my on-line x-rays and pondering where my artery to my graft is plumbed in. He promises to check this in theatre with his doppler. I am reassured and confident. Consultants sometimes get a bad press for poor communication skills or arrogance - but there has never been any of that - quite the opposite in fact. Mr Keanan explains that I will need to stay one night in the hospital, and to lay off the physio for a fortnight after my operation The nail replacement is a straight forward procedure, and he will not need to lift up my skin graft. I may end up with a plaster cast depending on how stable my tibia is when he opens it up. Its not possible to tell from the x-rays.

Back in the waiting room its another half an hour before I am called to see the staff nurse. We get off to a bad start, possibly because of my ill advised comment about data protection when I see my name writ large on a white board outside her room. The usual questions about medical history, swabs for MRSA, urine sample, weight and blood pressure, no small talk (despite my efforts to engage her) and then onto the discussion about my operation. And this is where it starts to go wrong.

Despite my protestations to the contrary, she insists that I am coming in for day surgery, and that I will need to report to the Day Surgery counter, somewhere else in the hospital. She hands me my the instructions. These conflict with the letter I had received, and the information from my consultant some half an hour earlier. Then she tells me that my operation is on the 14th of April, and when I protest she says that my consultant doesnt have a list on the 15th. Finally she starts listening to me, and heads out of the room 'to check'. On her return to appears that I am right and she is wrong. I am on the trauma list, not the Day Case list. Start again. Different forms. Different instructions. Same principles though.

Come alone. No valuables. No home cooking. Bring your own medication. Phone numbers for relatives. Fasting from midnight. Shower before arrival but no fancy products. Minimal jewellery. No valuables (and if you do have the audacity to bring any, 'we will not be held responsible if you lose them'). Drugs at 6.30am. Bring a book (presumably for the hours and hours of waiting). Assured of a physio check before I am discharged (re stair management) - and that's it. I escape, not forgetting to say thank you several times (important to mend bridges) and head off to the other side of the hospital to hear how my friend has got on.

Several hours later I am now contemplating my experience. I think overall it was positive. Attending the clinic should reduce the bureaucracy on the day of my operation. All the information has been provided, and I am well prepared. The leaflets on infection control and anaesthetics are concise and useful. All I need to do now is talk to the anaesthetist about a choice of anaesthetics, and we will be ready to go. But I was struck by the lack of humanity in a couple of aspects of the procedure. Particularly in relation to my experience at St Johns. Perhaps its not a fair comparison. I didn't, after all, go in to St Johns from home as an elective patient.

But the unwillingness of the staff nurse to listen to me, or at least check earlier in our conversation on which list I was on, demonstrates a lack of empathy. I know her job must be laborious at times, and patients' questions annoying. But still..... And the rules on arriving alone seem ridiculous. Operations are frightening experiences for everyone, even when you have had them before. Costs of course are behind a lot of this. Managing limited and tight resources in every increasing political and public expectations is really tough. But in the end the patient must come first. Patient centred care must be delivered in practice, not just on paper.

My friend is going for a much more complex operation than mine. And I (and I presume he!) am pleased to report that his pre-assessment clinic was excellent: timely, informative and compassionate. There are, then, an awful lot of staff at the RIE getting it right despite difficult working conditions. And a final turn of fate? My friend and I are both being admitted on the same day for our operations. He, unfortunately, will be in for a lot longer than I. It remains to be seen whether we are successful in smuggling in delicious home cooking to speed his recovery...

On fashion

Last night I went to a fashion show. Yes, I know - a bit ridiculous, but I'll field any genre of entertainment these days. It was my first solo outing on a bus too. All I had to do was get to George Street on the Number 26. With one or two minor mishaps (change of drivers not good for the mobility impaired - the instructions get lost at the handover...) I arrived in one piece only one block away from my destination. Dressed up nicely too, except for the sodding moonboot (and the oily cycle gloves...). Important to maintain standards at all times.

£15 for a ticket. Included champagne (which I couldn't drink) and a lurid patent pink clutch bag (which goes with my eyes). Apparently this little number is retailing at over £65. Mmm - I ponder what I might raise on eBay for it...

"Ladies... patent is the absolutely must have this season.. in shoes and bags... team it with block colour and one of our handy little short sleeve tops ..." The rather fabulous store manager, in a block yellow 60s dress, black leggings and rather flattering patent white wedges., gives us the lowdown and then the 'models' strut their stuff. (The models were actually the staff, but they did a pretty good job teetering around in their mostly pretty clothes. All shapes and sizes too).

After about ten outfits, the show is over. We win nothing in the raffle, which is just as well, and then we are invited to shop til we drop, with a special 20% discount just for the night.

As I have vowed to buy no new clothes this year except for underwear, I don't buy. I intend to live this recession like its supposed to be lived, despite Gordon's endless entreaties to do otherwise. But I do look. I finger the little bright frocks, the pretty skirts, the dainty cardies. And I realise that, even if I did want to buy this stuff, I couldn't really wear it with my leg in the state its currently in. I explain this idly to the photographer, the only male in the room. He doesn't argue, so I surmise I am correct. The swimming pool is one thing, but going public with my disfigurement is quite another.

I don't want to overplay this. I didn't rush home and throw myself into the sea. I didn't weep and wail. I did rather enjoy the fashion show. It was hoot in fact. I just have to acknowledge that my 'fashion' choices will be more limited this year. And this feels a little sad. I rather like retro frocks. Especially the block colour ones. And bowing to this also means I have to question my acquiescence to the public curiosity, and on occasion revulsion, of disfigurements.

I know, that if I wear the pretty frocks, with my right lower leg exposed, people will stare. They will wonder. They might even ask (based on my wheelchair experiences). The pretty frock will be rather wasted. Many disability groups would perhaps say I should just wear the frock. Stand up. Be proud. Pretty even. But I'm not quite up to that yet. I still care what people think. I'll need to work on that. And Im not sure I'll ever get there. On a lighter note, though, think of the money I'll save...

From strength to strength

Something has changed in the last few days. Suddenly I have a lot more energy. Twelve laps of the pool is effortless. An hour in the gym before hand is relatively easy. And when I get home, I'm ready for more action. Between physio and the gym I have five work outs a week - and I'm still looking for more...

My first bus trip, the No. 42 to Stockbridge, was seamless and successful (apart from the arrogant twit in the BMW parked in the bus stop - forcing the bus driver to stop in the middle of the road - why, why is it always BMW drivers...?). Now that I can get the bus I am mobile although I still have to manage the hobble to and from the bus stops.

And now that I can get the bus, I can ween myself off patient transport - which means less waiting around and a lot more certainty (bus timetables permitting). There are only two buses an hour direct to the hospital but at least I can choose which one I take.

I am feeling better. I can do more things. I am less tired. So here lies the rub. Boredom is a real and present danger. How to manage my time in the period where work isn't quite possible but my brain and body think they are ready for a more 'normal' lifestyle. And will my next operation knock this on the head?

It must be time to pick up the Spanish books...