The following should not be taken as gospel - or indeed fact. I have not read my medical notes or researched the Internet for the sciency stuff. This is simply my recollection.
1. On my first night in St Johns I have a visit from my surgeons - Mr Addington and his (I think) senior registrar. The latter is tired and pale but did her PhD on the technique I will undergo. She is kind and reassuring. Mr Addington explains what will happen. They will look for a donor site on my body - starting first with the left thigh, and if that isn't suitable, consider other sites including my back. They will then patch the hole on my right leg with the donor tissue - which will include the blood vessels - so not just a case of grabbing a bit of skin and moving it, but connecting all the blood vessels up to the ones in the leg. This, in the trade, is not a skin graft, but 'a free flap'. The operation, he warns me, could take up to 12 hours. I will wake up with lots of tubes and drips and the dreaded catheter. I ask him what my role will be - what I should I do to make it all go OK. Nothing he says 'leave it to us'. This is the wisest advice I have ever had - and heeded. I ask them politely to have an early night. I am first on the Sunday list.
2. My next visitor is the anesthetist. I am to have an epidural, not a general. This I think is partly to do with the potential length of the operation and more to do with pain management after the procedure. For the uninitiated - this does not mean I was awake for the operation! However, having the epidural meant that I would have to go to HDU (High Dependence Unit) - the Ward staff would not have time to look after me. I asked him politely to have an early night too.
3. I meet the night staff - they are kind and gentle. I take my pills and I think something to help me sleep. The weather forecast is dreadful - snow and black ice. I worry my theatre team won't make it to work. The night staff reappear at 6am for the pre-theatre wash. This is not like the old days - no shaving or scrubbing or mad pants. or suppositories Just a hospital gown, ring off, a wash and a plea to keep my glasses on til the last minute. Then my pre-med and a doze with the help of a friend's ipod (thanks Scott!).
4. Around 8.30, the theatre boys arrive to take me down. The staff nurse comes too - to help alleviate my nerves. We wheel into the little room where all the anaesthetic stuff happens. I am told later that I was in this room for 90 minutes - I only remember the first ten. Takes a while to get all the tubes in and the monitors on. I chat to the theatre orderlies - sit up on my trolley for the epidural and obey all instructions - there is no pain and no discomfort. Someone says 'this is the last thing you will remember' - they are correct! I still have my glasses on - eyesight, if not dignity, intact.
5. I have my operation See http://en.wikipedia.org/wiki/Free_flap It takes only 6 hours.
6. I wake up in HDU - my own room and 50% of a nurse (we get one between 2 patients unless the patient is ITU in which case they get one of their own). I am terrified and over heated. The nature of the operation means the patient must be kept warm at all times to give the flap the best chance of working. I have a duvet on and the heating is on full blast. I have no pain but hallucinate wildly. When the surgeons come round all I want to talk about is my mad head - the leg has become someone else's problem for the moment.
1. On my first night in St Johns I have a visit from my surgeons - Mr Addington and his (I think) senior registrar. The latter is tired and pale but did her PhD on the technique I will undergo. She is kind and reassuring. Mr Addington explains what will happen. They will look for a donor site on my body - starting first with the left thigh, and if that isn't suitable, consider other sites including my back. They will then patch the hole on my right leg with the donor tissue - which will include the blood vessels - so not just a case of grabbing a bit of skin and moving it, but connecting all the blood vessels up to the ones in the leg. This, in the trade, is not a skin graft, but 'a free flap'. The operation, he warns me, could take up to 12 hours. I will wake up with lots of tubes and drips and the dreaded catheter. I ask him what my role will be - what I should I do to make it all go OK. Nothing he says 'leave it to us'. This is the wisest advice I have ever had - and heeded. I ask them politely to have an early night. I am first on the Sunday list.
2. My next visitor is the anesthetist. I am to have an epidural, not a general. This I think is partly to do with the potential length of the operation and more to do with pain management after the procedure. For the uninitiated - this does not mean I was awake for the operation! However, having the epidural meant that I would have to go to HDU (High Dependence Unit) - the Ward staff would not have time to look after me. I asked him politely to have an early night too.
3. I meet the night staff - they are kind and gentle. I take my pills and I think something to help me sleep. The weather forecast is dreadful - snow and black ice. I worry my theatre team won't make it to work. The night staff reappear at 6am for the pre-theatre wash. This is not like the old days - no shaving or scrubbing or mad pants. or suppositories Just a hospital gown, ring off, a wash and a plea to keep my glasses on til the last minute. Then my pre-med and a doze with the help of a friend's ipod (thanks Scott!).
4. Around 8.30, the theatre boys arrive to take me down. The staff nurse comes too - to help alleviate my nerves. We wheel into the little room where all the anaesthetic stuff happens. I am told later that I was in this room for 90 minutes - I only remember the first ten. Takes a while to get all the tubes in and the monitors on. I chat to the theatre orderlies - sit up on my trolley for the epidural and obey all instructions - there is no pain and no discomfort. Someone says 'this is the last thing you will remember' - they are correct! I still have my glasses on - eyesight, if not dignity, intact.
5. I have my operation See http://en.wikipedia.org/wiki/Free_flap It takes only 6 hours.
6. I wake up in HDU - my own room and 50% of a nurse (we get one between 2 patients unless the patient is ITU in which case they get one of their own). I am terrified and over heated. The nature of the operation means the patient must be kept warm at all times to give the flap the best chance of working. I have a duvet on and the heating is on full blast. I have no pain but hallucinate wildly. When the surgeons come round all I want to talk about is my mad head - the leg has become someone else's problem for the moment.
to be continued....
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