Adventures in A & E: my appendisectomy.

So, on a regular Wednesday afternoon I started getting some mild stomach pains. As afternoon turned to evening they got more intense, but not anything I hadn't felt before. Over the course of Wednesday night they got worse & stopped me from sleeping. I still wasn't unduly worried on Thursday morning, as they had wore off a little. Stupidly, I decided to go to work. By lunchtime I was suffering rather acutely. While I'd had similar stomach pains before, they had never gone on for quite this long. I managed to make it until 3pm before leaving work & headed for a drop-in centre. This is a doctor's office where you can just turn up without having to make an appointment with your own GP & they are super useful. For that reason I'm just waiting for the coalition Government to cut them. But I digress; the doc checked me out & prescribed me some co-codamol for the pain and some IBS drugs to settle my stomach down.

I was also warned to keep a close eye on where the pain was actually coming from. At the time it felt fairly general, but if it became localised down the right hand side, it could be the gall bladder or the appendix & I should get myself to A & E. No problem, I said; I'll keep checking. It seems as though merely ten minutes pass as I'm waiting for my prescription when I begin to notice the pain is concentrated more down the right hand side. The first instinct is to shrug this off as psychological - I'd been told to check for this & now I'm imagining I can feel it. The pain is so bad by now that I'm ready to weep or faint. Co-codamol to the rescue, then. The pain dims, but it doesn't disappear. Throughout the evening I continue to check on it & I am becoming more & more convinced that the pain is localising near my gall bladder or appendix. My wife remains skeptical. On Friday I wake up at about 6am & the pain is worse than ever. I stagger to the co-codamol and gulp it down. It is then I decide to go to A & E. After all, if I'm wrong, they'll just throw me out, won't they?

The first test is to explain things to the triage nurse, which I seem to pass because he admits me. Rach has to leave at this point, because she has to look after her dad as well as the kids. I change into a gown, pee into a cardboard container and wait for the doctor. He looks me over & sends me on for a surgical consult & x-ray. After the x-ray, I'm left in the corridor for a while as it's pretty busy. I overhear a consultation in a cubicle and am given my first slice of how bad things can be for other people. Talking to a doctor is a woman who has been admitted after having the crap beaten out of her by her boyfriend. She has a bruised eardrum & at least two cracked ribs. She is weeping, but is desperate to stop because the sobs rack her with pain. She talks in a thick Telford accent that makes her sound badly educated, which is a dreadful assumption to make based on only an accent, but it is difficult not to make it. It's like hearing a strong Southern US state accent and trying not to assume the one speaking is a pig-raping redneck. I don't make such assumptions about either accent, but only after giving the part of me that automatically jumps to conclusions a hard slap. She talks about how she doesn't want to involve the police, about how she hates her boyfriend but loves him as well, about how he's only been like this since he added steroids to his daily drug intake. Lying on my bed outside, I may only be suffering from mild abdominal pain, but my heart is breaking for that poor woman. The doctor, clearly knowing how limited his freedom to help her beyond treatment is, barely hesitates before offering advice and moving on. I wonder how he manages to cope being exposed to this routinely.

Next it's time to see a surgeon. I get wheeled into a little room where I wait. By now the painkillers I took at 6am should have long since worn off, but I still only have a mild discomfort where the pain used to be. I've heard that in cases of appendicitis that this is bad and means the appendix has burst. I still can't help feeling like I'm a fraud & wasting people's time when I'm not in any real pain. Then the surgeon comes in. Her name is Annabel. She is the chief surgeon today. She is outstandingly good looking. I am nervous when her hands are touching my skin only a few inches above my crotch while she is asking, in all seriousness, whether I feel anything. I tell her about the pain. She looks at me & says "I think it's time you said goodbye to your appendix, don't you?" As much as I loved Scrubs I knew that much of it wasn't true to life. It seems, however, that the bit about surgeons wanting to cut open every patient they see after a few minutes is absolutely true to life.

So I get taken to the surgical ward, being Ward 12 at the Princess Royal hospital in Telford, to await my fate. It's nil by mouth for me, so I get hooked up to a drip. Over the course of the afternoon I familiarise myself with the staff and patients on the ward. There's a guy recovering from a throat operation following a lifetime of smoking. Hooked up to a catheter and regularly replaced nicotine patches, he can barely speak & doesn't look comfortable. There's the guy that came in with penis pain & is now constantly leaking blood out of his pisser. The others are a collection of old guys who look rather checked out at the moment. The staff are, without exception, upbeat, friendly & clearly very busy trying to keep a lot of spinning plates going. Jackob is looking after me. He's possibly European, but his English is so good I can't be sure. He's assisting the nurses while training to be a paramedic. He's got a three month old daughter so we talk about our kids for a while. Around come the doctors for a brief examination & a quick chat with each patient. One guy has his operation delayed until Monday because his somethingorother levels are too high. Penis pain guy wants to speak to someone in charge because he's been bleeding for six hours & feels like nobody is doing anything about it. Then it's me. Another examination. Another chance for me to explain what's happened to me. He thinks my appendix might be stuck behind something like my colon, because the pain is a bit higher than it should be, but not high enough for the gall bladder. It might be some small thing that's next to my appendix, so they might make an additional incision. We'll do it this evening, ok? Sounds good I reply, while gulping. The final guy being seen is an old dude. As part of his examination, the doc has to explore his back passage for blockages or something. It sounds painful, with the poor old man shouting out and reduced to repeating cries of "Oh dear". You can't help but feel for the guy, for his pain & his loss of dignity. The doctors were as respectful as they could be under the circumstances, but the procedure had to be done. It is an unwelcome glimpse of the far future.

Annabel comes to see penis pain guy. He calmly (and quite reasonably) explains his complaint about feeling like he's been left on his bed to bleed while nobody does anything. Annabel tells him it's because there is no urology specialist qualified to treat him at Telford & she's spent much of the afternoon trying to get him a bed at Shrewsbury, but they are busy & reluctant to agree to the transfer. He still feels like there should be more that they can do. She explains a few procedures that may help to relieve him, but they are painful & probably won't work, which is why she didn't mention them before. She offers him the choice. He decides to wait. He feels better. She is marvellous. A few hours later, he's carted off to Shrewsbury.

10pm rolls by & I start to wonder when the whole thing is supposed to be happening. I've had no food & barely any drink since yesterday. I want it over with. A surgeon comes over to my bed & explains that it's not going to happen until tomorrow. An 81 year old guy has just been admitted whose small intestine has tied itself up in a knot, or something. Anyway, he will die soon without surgery, so my spot goes to him. They want to get to me as quickly as they can, because the longer it goes on, the more likely it is that my appendix will perforate and cause havoc. But for now, I can wait. He can't. It's a bit annoying, but hell, you've got to be pretty soulless to argue with that, haven't you? Imagine if someone you loved needed emergency surgery, but they died because someone having his appendix out got to go first. Not only that, but it was pretty damn cool of the surgeon in question to take the time to come up to see me to explain & apologise in person. So, I'm allowed a sandwich and a cup of tea before settling down to sleep. Back to nil by mouth in the morning.

The thing that's on my mind as well is worrying about how Rachel's going to cope looking after a three year old, a six week old, her father & me all at the same time. She's handling it magnificently, but the previous blog will tell you how I feel about her: http://experiment627.blogspot.com/2010/10/how-my-marriage-saved-my-life-and.html

It's the weekend so it's not surprising that the next patient in penis pain guy's bed is a drunken head injury & another example of the shit the less fortunate must wade through every day of their lives. He's chipper, friendly, drunkenly respectful & desperate to leave. He's pretty much a full-blown alcoholic & often sneaks off for drinks, forcing the staff to waste precious time finding him & taking him back to his bed. And yet, while this probably pisses them off no end, they continue to try to help him & not to condemn him. He signs a form to say he's checking out against medical advice & waits for his wife to pick him up. When she turns up she brings along an adorable little girl, which it turns out is one of two daughters this guy has. The sister (that's the badass nurse in charge) sits down with them & talks about what alcoholism can do to families & offers a number of ways to help him. By now he is a broken man in floods of tears, ashamed for risking the welfare of his family. As he leaves, you get the distinct impression that this has happened before & will happen again; that he has learnt nothing. And yet, the sister takes the time to continue to try. It seems important to her, as though the huge effort is somehow worth the negligible results.

The next guy on the bed is, yep, a drunken head wound. He wants to leave as soon as possible. He can barely focus, he can barely walk & he is contemptuous of any offer of help. Apparently he had about 30 pints last night, but a reliable source of information this guy is not. It transpires that he is a member of the armed forces and is based at Cosford. His CO calls & is apparently unimpressed. The guy still wants to leave and staggers around mumbling about this being a hospital not a prison, clearly in no fit state to go anywhere, with what look like seriously diminished mental and physical capabilities. The sister (the same one as before) cuts through the disrespect and pigheadedness to tell him in no uncertain terms that if he absconds against medical advice his career could be in serious trouble. She finally convinces him to go to sleep. As before, she perseveres with people who on the face of it don't seem to be worth the effort. It seems to be something that the people working here have in common.

And so, following a visit from the anaesthetist, who was nice & explained what was going to happen (and was the six millionth person to ask if I'm allergic to anything), my time comes. I get wheeled down to theatre. A couple of surgeons have a bit of a chat with me to help put my mind at ease. It's my first operation & my nervousness is clear to all. In goes the anaesthetic & it feels quite nice. I feel warm & like I'm on my fourth glass of wine. I'm asked to take six deep breaths. Not long after I pass out.

When I come to, one of the surgeons is checking me over. He asks me how I am. I am in pain. He gives me morphine. It doesn't seem to make a difference. I go back to sleep.

When I wake up again, Jackob is near. I'm back on the ward. He asks me how I am. I am still in pain. He can't give me anything more because I've already had a rather potent cocktail of painkillers. He checks my blood pressure, heart rate, breathing & asks me a few questions. They call it doing 'obs' or observations. He's a bit worried about how shallow my breathing is so he puts me on oxygen for a while. I spend the rest of Saturday afternoon drifting in & out of consciousness. I notice that Jackob is monitoring me very closely. At one point mom drops by. We chat for a bit, but I'm a little too dazed to really hold a conversation. I feel a bit uncomfortable, like my bladder is full, but I'm unable to pee. Jackob assures me it's normal & it's the last thing to start working again after an operation like this. I'm not allowed food yet, but I am allowed tea & water. Plus, I can have more painkillers. Rachel & Katie come to visit, but they can't stop long because Emily is in the car with nan outside - babies aren't allowed onto the ward. It's really good to see them. After they've gone I'm left with my book (Terry Pratchett's I Shall Wear Midnight - highly recommended) and my MP3 player. I settle down for the evening.

An old guy on the ward (the guy whose operation was delayed until Monday) complains about being in a lot of pain & feeling very sick. He is told they will sort his IV & painkillers out. He asks several more times during the next few hours. Finally he projectile vomits all over the bed, the floor & the guy who has just started his night shift. I guess this kind of thing is common in places like this, when everyone is so busy they just can't get to all the patients in time. Still, that wouldn't help me feel any less abandoned were I in his shoes. Eventually, he gets the help he needs.

I wake up in the middle of the night with terrible pains in my stomach - I'm sure it's because I desperately need to pee. The call button is on the desk behind my bed & so far I've only been able to get up twice with great difficulty. The pain is too much, so I force my way out of bed & press the button. I explain to the nurse, between gasps, what the problem is & what I think the reason is. She asks me to lie down on the bed so she can do a scan. It transpires that I am retaining 700ml in my bladder & that is definitely the reason for my pain. I am given a choice: get to the toilet & force myself to pee or have a catheter. I do not want a catheter. The nurse gives me the distinct impression that I am making a big deal out of nothing, so I suck it up & stumble slowly to the toilet where, third time lucky, I manage to pee. A little. It stops & starts a lot. I have to go about every 90 minutes or so for the rest of the night. The nurse was right - I was making a big deal out of nothing. If she'd mollycoddled me I might not have done it, so her approach, although it seemed a little harsh at the time, was exactly the right one. As with everyone working here, she knows exactly what she's doing.

Sunday morning. At breakfast time I begin the route to recovery by devouring cornflakes & toast. The drunken head injury in the other bed has been replaced by a guy who recently passed a kidney stone which, according to my mother is the most painful thing she's ever done. That would include childbirth. He's over the worst of it & is in good spirits. The doctors turn up then for the daily walk round. When they get to me they give me a little info on the operation. They were right about the appendix being behind the colon & one of them had their hand so far inside me trying to reach it that at one point it was buried up to the wrist. The guy is a junior doctor - not surprising as they probably cut their teeth on simple surgical procedures like mine. The scar is bigger than normal. The appendix had perforated as they feared it might, but the unusual location prevented many of the further complications that often arise as a result. I have about a 30% chance of infection. The way they were joking together and in such high spirits made me feel safe in their hands & reminded me again of Scrubs. I think maybe I watch that show too much.

I am moved, with kidney stone guy to a different part of the ward. We get chatting to an old man who in the 60s worked on the building of the Ironbridge power station. He has some fascinating stories. Talking to kidney stone guy later I hear about some of his experiences this weekend at A & E. At one point last night there were 12 ambulances lined up outside the entrance at once - a car crash I think he said. Earlier that day while he was reading his paper outside he saw a man & woman walk out of A & E. They stopped fairly close to him, where the woman said "It's your fault" to the man, to which he replied "No, it's your fault". They then proceeded to pound on each other as hard as they could until they were escorted off the premises by security. The rest of the day and night pass by uneventfully.

On Monday morning I am discharged. I have to wait in the discharge lounge for about five hours before the pharmacy can get my antibiotics and painkillers together. It's quite annoying, but not nearly enough to mar the gratitude I feel towards every single one of those people who helped me through this.

I'm a big believer in choosing the best person for a job & not choosing based on a statistic that says there must be a certain amount of each ethnicity to be sure it is fair. That is not equal opportunities to me, that is positive discrimination & it is crap. Having said that, there was a huge array of colours and nationalities working together over the weekend I stayed at Ward 12 of Telford hospital - English, Indian, Philippine, Asian; white, black & shades in between & never once did it become an issue for anyone. I'm so glad I live in a country that can employ talented immigrants alongside a qualified home-grown workforce within a medical organisation that is funded by taxpayers and run by the state. At the same time, I'm terrified at how the coalition Government & the bigoted Daily Mail appear to be succeeding in their attempts to undo it all. It's going to be a rough decade.