Yes, I know these posts need proof-reading. I will get to it but I’m finding long periods of concentration to be quite difficult at the moment so it probably won’t happen until later in January. Thanks for letting me know.
In part 1 I told you all about my 2022. It was pretty long (both the year and the post) but you may want to read that first to make sense of my journey to being due in the hospital at 7am on December 14th.
Hospital transport is a bit of a crap shoot. Don’t get me wrong, the drivers are absolutely fantastic but what they’re doing can get quite complex, expecially when it comes to short notice changes. As soon as I had confirmed that the operation was going to happen on December 14th I called their booking line, but I didn’t yet know where I was going to in the hospital, and neither did the department I was going to. They needed to find me an available bed.
So I booked transport to take me to reception. I assumed reception wouldn’t be open at that time of the morning, but I assumed I’d know where I was actually going before I got there, and the transport driver would get me there. Well, you know what they say about making assumptions.
6am on December 14th and I’m ready to go. I have a large bag with 7 days of clothes and a wash bag, a rucksack with my iPad, Macbook Pro, and various charging cables, and a bag containing my CPAP machine. It was a lot for someone who wasn’t supposed to be putting much weight through his right foot, but I had assumed the transport driver would be used to this sort of thing for admissions.
My phone rang shortly after 6am; they’d sent a taxi.
Now again, don’t get me wrong, I understand the nature of the challenges the transport coordinators are battling with, but my record states quite clearly that I currently need a wheelchair from the ambulance to my actual destination. Taxi drivers don’t commonly do that. The other thing I’ve noticed with most taxi drivers doing hospital transport jobs is that they don’t like doing anything extra, like grabbing a wheelchair and taking you into the hospital. I don’t really blame them, but in this case it would have been helpful if he had stuck around to make sure I got to where I needed to be instead of just dropping me at the hospital reception and getting away as soon as possible.
I wasn’t expecting a hospital reception to be operating at 7am so I had to flag down one of the people coming in at the start of the day. I told them the ward I needed to get to and they pointed down the corridor and gave me directions. Bear in mind that I have the bags previously mentioned and I’m walking with a crutch. I understand these people were arriving for work but a little more help would have been appreciated.
Slowly making my way in the direction she had indicated I managed to get, as I later discovered, approximately a tenth of the way to my destination. It was on the other side of the hospital, but I didn’t know that at the time.
Eventually, after stopping every 30 seconds to catch my breath and get a better hold on my bags, I passed a lovely nurse who asked me where I was going. It should be noted that despite being shortly after 7am the hospital was not empty; a lot of staff passed me as I attempted to get there, but it took a while for anyone to help me. The nurse who did stop to help hurried off to find a porter to help me. Shortly after that she came back, pointed back down the corridor and said “that guy with the wheelchair will help you.” I am eternally grateful to that nurse; she restored my faith in humanity at that extremely anxious and exhausting short period of my life.
The porter finally reached me (it was a long corridor), got me in the wheelchair and loaded my bags on to it and himself. We then started making our way down that same corridor towards the ward at which I was due to check in. It took a few minutes, even at the pace of a busy porter, but eventually we got there.
The ward was a private suite, owned by the NHS trust but taking private patients. It seems they also take some overflow from the main hospital. It’s still not clear to me how I wound up there, but I definitely wasn’t a private patient. Either the operation my surgeon was due to perform that day was on a private patient so the room was already booked, or this was the only room available that met the requirements for my recovery. Either way it was a very nice room in a very nice ward.
I settled into the room, unpacked and plugged in all of my chargers, and explored where I’d be living for the next week.
Given that I was required to be there at 7am I had expected to pretty much go straight to the operating theatre. That was not the plan. Apparently I was scheduled to go in at 2pm and I was there so early because all of the prep they usually do ahead of admitting someone for an operation still needed to be done. Many obs and other checks followed, and everything looked fine.
I’d had an MRI to check the circulation in my right foot a few weeks ago and I got the results of that. Apparently there was a blockage but they were confident that it wouldn’t cause any issues.
The consultant/surgeon came to see me just before lunch (not that I was going to get lunch just before an operation) and he told me everything was looking good. He took me through the consent form and detailed all of the risks. There were two that were unsurprising but did raise my anxiety seeing them in black and white on a form I had to sign.
First, there is the risk that once they get into my foot they realise that a reconstruction is not going to work. In that situation they’ll proceed with a below knee amputation as there really would be no other choice. That was fully expected.
The seconds was death. Obviously with any operation, much like crossing the road, this is a risk. A very small risk, but it never fails to make me chuckle that they make you sign something to say you’re ok with taking that risk. I wouldn’t have been there if I wasn’t!
So, I signed it. With a mouse. It did not look like my signature, but he said that didn’t matter; it’s rare that they do with that system. Lovely.
Next was the anaesthiologist. I should have expected her to say exactly what she said, but in the moment it caught me by surprise. Due to all of my medical conditions general anaesthesia is a very big risk for me. I know this as I’ve had a previous operation when I was told the same thing. On both occasions I was told a spinal block would be much safer.
The previous occasion had been to remove a titanium rod from my left tibia after a break from being hit by a moped. The screws in the ankle had broken so it had to come out. I remember that experience very clearly so I wasn’t overly keen on repeating that, but if needs must and all that.
On this occasion the spinal block would be joined by a nerve block at the top of my right leg. I ended up being extremely grateful they had done that; you’ll see why a bit later on.
So I was going to be awake; panic mode immediately engaged, but not because I was going to be temporarily paralysed from the waist down. I realised I had no headphones with me that would work with my phone. The idea of spending 3-4 hours actually listening to my foot being pulled apart and put back together did not fill me with joy.
I proceeded to open every bag I had brought with me in the hope that I had packed the emergency headphones I take to dialysis. These were Sennheiser in-ear wired headphones with a USB-C adapter in the small case. They were also noise-cancelling but I expected that the battery would be dead. Thankfully I found them, confirmed that it was ok for me to take my iPad in with me and set about finding some content to fill the time.
On plugging them in and turning the noise cancellation on with all the hope I could muster I found that the battery was not flat, so maybe I would not need to turn the volume up too loud to drown out the noise of the operation.
Content-wise I checked Spotify but decided 4 hours was way too long for that. I briefly considered a tried and tested TV show but knew that the battery on the iPad was unlikely to last all 4 hours with video running. I then checked my Audible library. At various times over the years I’ve had subscriptions so I’ve got a pretty extensive library of books that I’ve never finished.
I settled on Barack Obama’s autobiography. I’d listened to the first hour or so and had found it engaging. I knew I probably wouldn’t be able to stick to it for the full duration but I had Spotify lined up with one of my favourite playlists as a backup.
With that all queued up and the iPad fully charged I was ready. I would have charged the headphones but everything I have is not either USB-C or lightening, so all I had was USB-C chargers and USB-C to lightening adapters. MicroUSB doesn’t really feature in anything I use day-to-day. Forgetting my AirPods Pro was something I swore I would never do again!
By this time it was about 1:30pm so in theory I only had half an hour to wait. I struggle with waiting for things that I’m anxious about so this half hour was one of the most difficult for me of the whole experience.
Eventually it was over and they came to get me at around 1:55pm. I would say I was relieved when they finally came, but that would be a giant honking lie! I was transferred over to the trolley, which also turned out to be the operating table, and we started making our way through the maze-like hospital corridors.
So this was interesting. I had passed the door to the theatres several times that morning while going for various tests so I knew where the entrance was, but that didn’t prepare me for what was behind that door.
The doors slide open and you descend down a short slope to a corridor. That corridor is fairly stereotypical NHS but different to the rest of the hospital that I’d seen so far. The main hospital looked clean, polished, and aside from the building work pretty well-maintained. This corridor from the slope to the anaesthesia room outside the theatre was what I expect abandoned NHS hospitals to look like.
The roof tiles (the main thing I could see from the bed) were all falling apart, some were missing, others had unmentionable stains on them. There was equipment lining the corridor on one side, looking like it had been discarded for want of a proper place to store them, and a lot of it didn’t look very modern.
As we rounded the corner into the anaesthesia room everything changed, and I’m very glad about that. It was white, very clean looking, and had what I can only describe as a very clinical odour. It was reassuring, but only a little.
So anaesthesia prep for the operation was to involve the following: putting in a line in my wrist for arterial access, administering the spinal block, and finally administering the nerve block. Sounded pretty straightforward until they tried to put the line in my wrist.
My veins are messed up, especially on my right arm. I know this because they always struggle to take blood or put in canulas, and they can only use my right arm because my left has a fistula for dialysis access. Two anaesthesiologists tried 4 times to put the line in, and when I asked what the problem was I was told my artery is crusty! The needle tip was bouncing off it. Eventually they gave up saying they can continue without it. My wrist looked like a pin cushion by that point.
Spinal block time. As mentioned above I’d had this done before so knew what to expect. They told me to sit up on the bed and turn 90 degrees. Then they gave me a pillow to hug and told me to bend forward as far as I could to open up my spine. Once open they numbed the area, and it always makes me laugh that the Lidocaine they use to do so stings. Always keep in mind that the sting is mild compared to the pain it’s going to let you avoid!
So I’m bent over, hugging a pillow for dear life, and being told to relax. You first!
Needle goes in, and I feel something. I can’t put my finger on exactly what I felt but it wasn’t painful, just a little uncomfortable. This continued for about 30 seconds (estimate - time is difficult to measure in that kind of situation) after which I’m told to lie back down.
As the temporary paralysis takes hold I’m reminded of the most uncomfortable effect of the spinal block: I cannot clench my buttocks, and for some reason I find that very difficult to deal with. I think because I’ve had some very bad cases of diarrhoea in the past, and that sense of not being able to control that opening is embarrassing for me even before anything bad has happened. Also the added knowledge that if something does happen I’m not going to know about it, and I doubt they’d tell me.
As with everything that’s happening in this process it only takes me a few minutes to accept that loss of control and make my peace with the situation, something I’ve worked hard on over the past 10-15 years. But this is the new champion of the longest few minutes so far today.
As they poked and prodded me to find out how the numbness was progressing they said they now needed me to turn over on to my front so they could administer the nerve block. I don’t like lying on my front as it makes me feel nauseous over time. I told them this and they said it would only be for a few minutes.
They want me to turn myself over if I can. At this point I couldn’t feel or move anything below my ribcage so I was pretty adamant that I wasn’t going to be able to do that. They gathered around me, someone counted down and suddendly I was on my front feeling very uncomfortable despite not being able to feel half of my body. I was very aware that my arse was now probably completely expose to everyone due to the way the surgical gown had been tied. Making my peace with situations I can’t control is something the hardest part of the situation!
I didn’t feel any of what happened during those few minutes but I imagine they injected something into the top of my leg, and based on how long it took it was a fair amount of that something. I was then flipped over again back on to my back and was wheeled into the theatre.
For some reason it always surprises me how big theatres look from the operating table. I’m sure it’s not as big as it looks, but this one looked huge. Lots of people about, but my focus was on the nurse who was asking me if I was comfortable while my legs were getting painted with iodine.
It’s an odd feeling that I’ve seen (yes, that may not make sense) twice now to look down at my legs and discover that one of them is being held aloft when it feels like it’s just resting on the table. Very odd sensation.
Going back to the nurse who was kindly trying to make me comfortable, I told her I’m going to need something to rest my arms on. At the time they were just dangling down either side of the trolley. She disappeared for a while and came back with an arm rest for the left side, attached it and asked me at what angle I wanted it to sit. I rested my arm on it, made it comfortable and she tightened it up holding it in that place.
This was repeated for my right arm, and I then felt ready to lie there for up to 4 hours. I fiddled with my iPad, conneted the headphones, switched the noise cancellation on and put them in my ears. I then fumbled around while the green screen was erected in front of me ready to start the audiobook. I got there in the end but I did feel like I was fighting with the nurses and the piece of cloth for a while.
Yeah, I get a dry mouth, always have, but especially when stressed. This was stressful so it wasn’t long before I needed a sip of water. The anaesthesiologist was sitting to my right so I got her attention and asked if there was any way I could sip some water. She nodded and a few minutes later a cup appeared with a straw. I had to request it occasionally, and she offered it fairly regularly without prompting, but from that point on my mouth was always sufficiently lubricated.
I started the audiobook and did my best to tune out the entire environment by focusing on his words. It worked, thankfully, but only to a point.
In his description of what he was going to do to my foot the surgeon had told me roughly what was going to happen, but I don’t think I had fully taken on board what that actually meant when combined with me being awake.
Suddenly I felt and heard a gentle tap. I say heard because despite being pretty tame it cut through the noise cancellation extremely well. And I say felt because I felt it up my spine and it resonated slightly around my skull. Just one gentle hit.
Well, he was just lining up to make sure he was tapping into the right place, just as you would with the first hit of a nail. What followed is something that really will stick with me forever. Harder taps that did the same thing: up the spine and echoing around my skull. And they got harder as it went on.
I didn’t feel like I could say anything as first, I knew this had to happen once I realised what he was doing, and second, I don’t think me complaining would have done anything but make them feel bad, distracting them from their task. The last thing I wanted to do was distract the team that was currently rebuilding my foot!
Here’s what I’m pretty sure was happening in that moment: the main structural part of the reconstruction was to be a titanium nail that went up through my heel and into my tibia. This, I’m fairly certain, is what he was hammering in during those couple of minutes. It was not a pleasant experience, but again I must stress that I felt no pain, just knocking throughout the centre of my body, or rather the part of it I could feel.
Once I realised what he was doing I think my brain filled in some of the things I should have been feeling. I felt it in my right knee despite not being able to bend it. I could feel my thigh wobbling with every knock, and I started to feel it in the lower part of my spine. Of course I couldn’t feel any of that, but my brain generally hates me at the best of times.
As the operation progressed I experienced similar things, usually starting with some noise cutting through the noise cancellation. Drills were the other main player I heard, which I really tried to distract myself from.
As with all of these things I tried to focus on the fact that I couldn’t really feel any of what was happening, and worked on focusing on Barack’s voice in my ears. It worked, but only to a point as previously stated.
This should not be news, but given how long those headphones have sat in my dialysis bag without being charged I was actually impressed with how long it lasted. When it died I switched it off for no particular reason and rapidly decided I needed something that filled my ears more than an audiobook. Spotify to the rescue. When music started playing I turned it up as far as was comfortable and managed to drown most of the noise out.
I was still very aware that something was happening but it was as effective as the noise cancellation had been.
It turns out 4 hours would not be enough. At around 3.5 hours in the anaestesiologist put her hand on my should and had me remove my headphones. She explained that things were more complicated than expected and the operation was going to continue past 4 hours.
I asked how much longer but she couldn’t tell me. I didn’t really see an issue here as my iPad battery had done very well just playing audio so I had plenty of juice left, until I thought about the spinal and nerve blocks, so I asked whether this was going to require some sort of top-up. She said no with that air of confidence that inspires confidence in others. I settled back into my music with my mind as at rest as it could be.
About an hour or so later I realised I could move my hips. Shortly after that I could move my left knee. So I said the above to the anaesthesiologist. She asked if I could move my right leg at all. I could not. This meant that while the spinal block was wearing off the nerve block in my right leg was still working. She didn’t seem worried about it but told me to tell her if anything changes.
Back to the lovely music.
When they started taking everything down I was taken by surprise. I had become so lost in the music I hadn’t realised they’d finished. The screen came down and I was encouraged to take my headphones out and rejoin the room.
I was told everything had gone well but had lasted for just over 5.5 hours. The reason for this was that when they got into my foot they saw that a lot more of my bones had disintegrated than originally thought so they had to add some additional supporting structures with the titanium.
No problem for me, by the end time had started passing without me noticing.
Confusing term since I was told recovery would take 6 weeks, but this recovery was just the post-op recovery room.
I was wheeled into place, curtained off and told to relax. In a few minutes they’d give me some food and a cuppa, which was very welcome because at this point I hadn’t eaten since 6am that morning. The time now was just after 8:30pm.
Apparently I dozed off pretty quickly and they had to wake me for the refreshments. I wish I could be more surprised about that.
After a few hours the lights went off and I fell asleep in record time.
I woke up at just after 3am feeling very nauseous. Asking loudly for a sick bowl one quickly appeared and I filled it like a pro. This had happened with the previous spinal block I had to I should have expected it.
My right leg was still pretty dead. It seems they had given quite a large dose of nerve block. I was grateful as the spinal block had nearly completely worn off by the end of the operation.
I eventually got back to sleep and woke up at 6:45am to a nurse asking to take my obs. Breakfast time was 7:30am, toast with butter - I was a little hesitant to eat much more than that.
Some time later I had visits from both anaesthesiologists and a couple of orthopaedic doctors to check on my condition. They all seemed very happy with how I was. I was feeling a little tightness in my foot and occasional shooting pain. This was normal and they offered me paracetamol and oxycodone to cope with that. I accepted the paracetamol but didn’t feel the need for the oxy at that time.
Later on that day the surgeon came by to see me and approved my return to my room.
Once more I’ve rambled on for a while so I’m going to make another post for the actual recovery process so far. If you’ve made it this far thank you for reading, and I apologise for droning on for so long. There’s a lot to it, and these posts are as much to aid my memory as they are to entertain you.