An anaesthetic blunder

When I came round in the recovery room last Friday, I enquired what the time was and was surprised to learn that I’d been under anaesthetic for 3 hours. It was only when I was whisked back to my room 30 minutes later that I realised my vision was temporarily blurred. My long-suffering husband arrived shortly afterwards to spend the afternoon at my bedside while I slept off the effects of the anaesthetic.

Before my husband left that evening, I asked him to turn on the television, to BBC2 so that I could follow a Six Nations rugby match. My vision was still too blurred to watch the television but I reckoned I’d enjoy the match by listening to it. Blow me if the television didn’t have every channel except BBC2 available. I told my husband not to worry and he turned off the set before leaving.

Shortly afterwards, the night nurses arrived on duty and the new night sister appeared in my room along with the day sister who I’d met earlier in the day. When they enquired if everything was okay, I responded that I was fine but that I was disappointed not to be able to follow the rugby match on my telly.

I’d no sooner said this when the night sister turned on her heels and disappeared out of the room. She struggled back into my room moments later, carrying a large television set from an adjacent room and soon had it plugged in with BBC2 working perfectly. We all laughed together about how they were looking after my every need and I thanked them profusely before they left to carry on with their ward round. I settled down to enjoy the match.

I waited and waited but there was no sign of any rugby happening on BBC2. Irritated, I flicked the channels using the remote control and to my surprise and acute embarrassment, I discovered that the rugby was actually being shown on BBC1. Oops!

I blame the anaesthetic. Luckily, I didn’t see the night sister again!

Going, Going…Gone

It’s strange the things that come back to you many weeks after having a general anaesthetic. I’ve had so many surgeries at this stage, I barely flinch when told I need another trip to the operating theatre. I’ve noticed over the years that the theatre staff have lots of tricks up their sleeves to keep you calm. You can’t fool an old timer however.

I was the last patient on the list to be wheeled into the operating theatre on that day. My medical condition had deteriorated on the ward and was a real cause for concern. The surgical team looked on as I was transferred to the operating table and prepared for a general anaesthetic.  Worried eyes peered above the masks all around me but I knew I was in safe hands. Within moments, I’d been wired to a heart monitor and a blood pressure cuff was fixed to my left upper arm. My right arm already had a PICC line fitted as I was undergoing prolonged IV treatment. With the blood pressure cuff inflated on one arm and the anaesthetist injecting the anaesthetic into my other arm, an oxygen mask was gently placed over my face. It was then I was asked if I would prefer to hold the mask myself.  As I rapidly began to fade out of this world, I remember thinking “is she having me on?”

Have you any funny memories of ‘going under’ that you’d like to recall? No scare stories PLEASE.

Preparation for Surgery

Here’s another excerpt from my little book of Home Nursing.  It details the preparation of the patient for surgery…

“On the day before the operation the nurse should ask the surgeon how he wishes the patient to be prepared. If no specific instructions are given the patient should if possible be kept quiet the previous day: he should take only light food, have a warm bath and an aperient in the evening. On the day of the operation he may, if the operation is not to be performed too early, and with the surgeon’s permission, have a light breakfast of tea, with toast and butter, and, three hours before the operation, a cup of tea or bovril.

His preparation begins with a simple enema first thing in the morning. Then he may have a warm bath or be well sponged down.  The area of the operation must now be sterilized by shaving and then cleansing thoroughly with either soap or spirit soap, which must be washed off with hot water; the skin must again be washed with hot biniodide of mercury solution, and covered with a compress of lint or gauze wrung out of the same solution: or, after drying, the skin may be painted over with mild tincture of iodine, allowed to dry and covered with a dry sterile towel.

Before the operation artificial teeth, hair-pins, jewellery, etc., must be removed, and if the hair is long in a woman it should be plaited in two plaits tied at the ends. The patient must put on warm flannel clothes which can be removed easily, and long woollen stockings.”

Now that’s what you call pre-operative care. These days, patients are admitted to hospital on the day of surgery and the pre-op preparation is left almost entirely to the patient. I can remember once getting it completely wrong and I paid the price.

I had a young baby at the time and instead of resting the day before my surgery, I rushed around putting preparations in place for during my absence. The following moring I insisted on getting myself to the hospital so that my husband could stay at home to look after our baby. Having fasted from the night before, I travelled by train to the hospital and arrived feeling totally parched and exhausted. I had a particularly difficult post-operative recovery from the anaesthetic on that occasion and it taught me a lesson. In today’s world of conveyor belt medicine, it’s really important to rest the day before surgery so as to optimise your powers of recovery. Allow yourself to be pampered!

UPDATE: I’ve just spotted this letter to the Irish Times from a Consultant in Emergency Medicine, which fits in nicely with the ‘ patient care’ theme of this post.

“And the Minister should focus on the universal need for a familiar smiling face. Let us have carers who have the time to care and the moral support of a loved one in our hour of need. Health economists may have factored these basics out in their many dubious prescriptions, but Mother Nature has not”.

Hole in the Head

When it comes to medical emergencies, it could be said that I’m a bit of an old-timer. You see, I have a long history of emergency admissions to hospital and friends and family tend to joke me about it. I never quite know what lies around the next corner but as the saying goes, “if you’ve gotta do it, at least do it in style.” I do my best.

No one pays much attention to their sinuses until they start to hurt. I’ve suffered from sinusitis all my life so headaches are commonplace but pregnancy really exacerbated the problem. The hormones of pregnancy can have a direct effect on the lining of the sinuses and in my case, it left behind a real legacy. Having successfully delivered my second child after a pregnancy fraught with difficulties, I continued to have severe sinus headaches. A CT scan revealed that an abscess had developed in the frontal sinus, very close to the base of my brain. Endoscopic surgery was carried out to drain the abscess and the relief was instantaneous. However some months later, the pain began to slowly return again until one day I awoke in so much pain, I knew I was in real trouble. On calling our family GP to the house, he immediately decided that emergency treatment was required and contacted the surgeon who had previously operated on my head. The surgeon was in the operating theatre at the time but the hospital he was in, did not have the surgical instruments he required for my head. He recommended that I should be transferred to another larger hospital by ambulance to await his arrival. I was duly rushed to hospital and taken straight to theatre to be prepared for emergency surgery on my skull. Despite being in severe pain, I have a vivid memory of lying on the operating table while one of the theatre nurses took a call detailing the ETA of the surgeon and his anaesthetist as they both rushed across the city to come to my rescue. The drama of the occasion resembled a scene from Casualty except that there was nothing fictional about this episode.  It was all too real.

I awoke several hours later feeling decidedly frail having had several holes drilled in my skull to relieve the pressure. The surgeon appeared looking totally exhausted and announced that he’d needed my emergency operation about as much as “a hole in the head.” I knew exactly how that felt. It hurt to laugh but it was hard not too.

Anything’s Possible

On reading Grannymar’s post One Armed Bandit last week, I was reminded of a time in my own life when I fought a one-armed battle. I have an inherited connective tissue disorder known as Ehlers-Danlos syndrome (EDS) which leaves me with a tendency to stumble and fall a lot. Being right-handed, my right shoulder has taken many blows over the years but it’s still going strong.

When I was in college many moons ago, I slipped and fell dislocating my right shoulder in the process. Luckily it went back into it’s socket spontaneously but the damage had been done. The anterior ligaments of the joint were torn and my arm needed immobilisation in a sling for many weeks to facilitate repair. From that day onwards, my right shoulder was unstable and certain movements were extremely painful. The joint would easily sub-locate and on numerous occasions this happened when swimming, leaving me stranded in pain with one arm stuck up in the air!

When my first child was a toddler, I stumbled one day while carrying him and again badly tore the shoulder ligaments. As my arms were full, I could not reach out to save my fall and landed on my right elbow sending the full force of the blow through my shoulder joint. I was seen by an orthopaedic surgeon who recommended an operation to stabilise the joint. I underwent open surgery (it’s done by micro-surgery these days) to have the ligaments of the shoulder joint re-structured to form a support network and they were also shortened to limit movement in the joint. A large metal screw was used to hold the re-attached ligaments in their new position. When I awoke from the anaesthetic, my whole right arm was tightly strapped across my chest and it was a struggle even to breathe. I was to spend the next six weeks in this tight strapping with only one arm usable. It was a difficult time as I had a small toddler to look after but we soon devised ways and means to get around most problems. I became a dab left-hander at doing most tasks though it took a while to get used to getting dressed one-handed and trips to the toilet took rather longer than usual. You try pulling up and down your clothes with one hand and you’ll realise what I’m talking about!

Once the ligaments had healed, all the strapping was removed and I started on a long programme of physiotherapy to recover movement in the joint. This was a very painful process and as time went on, the pain got worse instead of better so I was sent back to the surgeon for review. He was puzzled by the pain and recommended further rest for the arm, in a sling. A few weeks later I noticed a protruding lump at the top of my right arm which was very painful to touch. The metal screw used to fixate the ligaments had wriggled it’s way loose and x-rays showed that at least one inch of it was protruding from the bone. Back I went into hospital for more surgery to remove the piece of offending metal which I still have to this day, as a souvenir. Yet more weeks ensued with my arm in a sling before I was allowed to start physiotherapy again. You have no idea what pleasure it was to finally eat a meal using a knife to cut my food.

One of the aims of the surgery was to restrict movement of my arm in certain directions, to reduce the likelihood of further dislocation. No matter how hard I try, I cannot rotate my arm outwards and have learnt instead to rotate my body to reach objects on my right-hand side. I used to love playing tennis but my restricted shoulder movements made this impossible. Not to be defeated, I went back to tennis lessons starting at beginner level and learnt to play the game left-handed. Anything is possible when you’re determined to succeed. This all came to abrupt end however with another stumble which resulted in torn ankle ligaments but that’s another story. These days my right shoulder joint makes lots of strange creaking noises but it remains pain-free. I only wish the rest of my joints were as good.

MRSA – A silent stigma

A diagnosis of MRSA (methicillin-resistant Staphylococcus aureus) infection is not something to be taken lightly. It has the potential to become a life-threatening condition and intensive treatment with antibiotics will be required. However, there is another side to the diagnosis which is rarely talked about. There is the stigma attached to having an infectious condition and it forms a significant part of the MRSA journey. Hospital staff are best trained to deal with medical emergencies but their management of patients with an infectious status sometimes leaves a lot to be desired.

When I was first diagnosed with MRSA I was treated with the utmost urgency and received excellent care. I was barrier nursed in isolation whilst undergoing intensive intravenous antibiotic therapy. This involuntary withdrawal from the world took some getting used to but I quickly developed my own coping mechanisms to get through that lonely time. However the ‘fun’ really starts when a patient has to come out of isolation for investigation or treatment. When an MRSA infection is confirmed by laboratory tests, a patient’s hospital chart is labelled with a luminous sticker proclaiming their infectious status. This is a method of alerting staff to take the necessary precautions to minimise the spread of infection. Hospital staff however should be aware of the sensitivities involved for MRSA infected patients.

I had to be taken to theatre for some minor surgery while still being treated in isolation. Patients with a positive MRSA status have to wait until last in the queue to go for surgery because of the very real potential of contaminating an operating theatre. So after a very long wait while fasting all day for the general anaesthetic, a porter finally arrived to transport me on a trolley to my destiny. We were escorted to theatre by a very junior nurse who was given the task of carrying my hospital chart. I was duly lined up in the pre-anaesthetic area alongside a row of other similarly nervous patients to await my turn in theatre. My surgeon and his surgical team appeared briefly in an open doorway and made encouraging faces at me. Suddenly, a loud shout came from another direction and to my horror, I heard the theatre sister roar from a distance “get that MRSA patient out of there, NOW!”. I saw the surgeon raise his eyebrows in disbelief at what had been heard and in an attempt to lighten the moment, we exchanged grins about ‘SHE who must be obeyed!’.  The theatre sister however continued to loudly remonstrate the junior nurse for accompanying me (the infectious patient) to the wrong location and any humour in the situation, rapidly dissipated. The junior nurse was mortified to receive such a public dressing-down and I felt very humiliated to be treated like a leper in front of all the other patients and staff. It was as if I didn’t exist as a person – I was purely seen as a health hazard which had to be quickly removed. A nice welcome back to the ‘real’ world after spending so much time alone.

I have since sat in crowded out-patient clinics and had the clinic nurse make insensitive enquiries in front of everyone else. You do get better at handling the ignorance surrounding MRSA but you never get used to it. MRSA patients have enough problems to contend with without having to tackle the issue of stigma as well. The sticker on a hospital chart may change colour once MRSA clearance has been obtained but it appears that you remain a ‘labelled’ patient for evermore. The legacy lives on.

Nursing Care in Hospital

I was referred to the UK earlier this year to undergo surgery in a specialist unit at an NHS hospital. This operation was unavailable in Ireland unfortunately so I had to pack my bags and head across the water to the unfamiliar territory of the NHS. Having ‘done time’ on numerous occasions in Irish hospitals, I was interested to see how the UK would compare. The conclusion I came to was that nursing care in the NHS has ‘gone bananas’.

My first impression of the hospital was a good one. On admission, my immediate surroundings appeared spotlessly clean and modern – a far cry from the appalling conditions found in many parts of the Irish health service. I was allocated a bed in a tiny room (no en suite facilities) beside the Nurses’ Station – this room had glass doors to it to facilitate observation of the patient. I thought that this easy visibility would limit any hope of privacy but in fact, it worked to my advantage. The glass doors provided a ‘bird’s eye’ view of the daily activities of the ward staff and this was a source of much entertainment throughout my stay. I did wonder however if the fact that I was a ‘Paddy’ with a history of previous MRSA infection (and recurrence) might not be the real reason why I’d been put in this room. Anyway, I was duly installed as a patient and was whisked off to theatre a few hours later, to go under the knife.

When I next ‘came to’ I was back in the same little room but this time I had to share it with all the paraphernalia associated with having had major surgery – the drips, drains, monitors etc. I lay there in a morphine-induced stupor in full view of the nurses and watched the world go by. I waited and waited for a nurse to appear at my bedside to offer some reassurance but as time went on, I realised that this was a false hope. The nurses only came into my room whenever they had to record my vital signs and even then, there was little or no personal interaction. It was like as if the patient was superfluous to the job in hand. When I was originally diagnosed with MRSA, I was barrier nursed but now this was different type of isolation. I could see endless activity at the nurses’ station with nurses filling out forms etc. but it appeared that very little time was actually spent with the patients. In Ireland, the nurses generally (though not always) interact well with their patients despite also being very busy. It soon became obvious that huge differences exist between our two healthcare systems in terms of nursing care. The NHS may be better in some respects than it’s counterparts here but it lacks the personal touch that thankfully still exists in Ireland. I cannot complain about the medical care I received from the NHS but the standard of nursing left me cold. Not once during my stay did any nurse ask the simple question of “how are you today?“. My medication was dispensed at regular intervals throughout the day without any explanations given. I simply wasn’t consulted at all. And there was definitely no humour to be had despite my best efforts to attract a smile. I have a lot of experience of spending time in hospital and so I’m not easily unnerved by hospital procedures but I can still imagine how frightening it must be for inexperienced patients to be left alone to cope in an unfamiliar environment. I appreciate that nursing these days is very hard work and sadly, it is also often a thankless task. However I’m in no doubt that patient care is compromised when nursing loses it’s personal touch.

After several days of observing the activities of the NHS, I devised a plan to put the ‘system’ to the test. Every morning a junior nurse would come into my room to offer a simple breakfast menu of “Weetabix/Cornflakes, Tea and Toast?“. The choice never varied. Each item of food dispensed had to be ticked off on a list by the nurse. I decided to ‘rock the boat’ one day and request a banana with my cereal. The nurse looked at me in despair having studied the menu, and replied “we don’t ‘do’ bananas at breakfast time“. It was hard not to laugh at this reply but I persisted in my request (out of sheer devilment) and the nurse got more and more flustered as she continued to scour her list for a ‘banana’ box to tick. Eventually I had to tell her that I knew that there were bananas in the ward kitchen and all she had to do was to walk a short distance to fetch one. After a long pause, she left the room and returned with the said banana. I felt like I’d scored a victory! Sad, isn’t it? But this is the sort of behaviour you’re reduced to when subjected to hospital care that is not patient-centred. This is a small, but clear example of how target driven the NHS has become. Nursing care it seems, is now all about ticking the boxes. I got such pleasure out of beating the system that day and by the way – the banana was delicious too!