Pre-admission assessment

To be honest I found this a rather unpleasant experience. It wasn't because of the people, they were all doing their jobs, it was because it makes you focus very clearly on what is going to happen and it really brings home the fact that it is going to happen.

The first person we met was a Stoma nurse, who talked us through the mechanical details of a stoma, the procedure and other such details. This made feel faintly sick and actually consisted of information that to be honest I mostly already knew. I could see that is important to have this conversation from a systemic point of view.

There was one slightly strange bt of dialogue when John said

"We are very good at causing pain, and we're very good at taking it away again . . ." which I have to say I found a little unsettleing; reminding me of a scene from the "Marathon Man" - the torture scene between Dustin Hoffman and Laurance Olivier:

Olivier to Hoffman:
(Having just drilled into Hoffman's tooth)

"Simple oil of cloves and how amazing the results. Life can be that simple; relief - discomfort. Now, which of these I next apply, that decision is in your hands, so ... take your time and tell me. . . . is it safe?"

There was also considerable discussion of, and viewing of bags. This made me feel even more odd, although I had seen some before. We discussed how to maintain, empty, replace, pay for these "fashion" items.

"Now I have to site you" he said

"Pardon?"

"We have to decide the site of your stoma"

I had to pull up my shirt and the position of my waistband, was noted. We had a brief conversation about lifestyle which included things such as my daily swimming, and he drew a black blob on my tummy to the right and below my navel. That done we were off upstairs to another department.

Upstairs I was welcomed and we were shown into another small office where a very professional, intelligent and human nurse went through more details.

I have been put on a fast recovery plan, and I was given some drinks with lots of "good things" in them to drink before the operation. She took my pulse and my blood pressure as well.

Then she brought up the question of MRSA - had I had it at all? and other such questions. Then she said I was going to screened for MRSA and that this would involve a swab up the nose (fair enough) and a swab of the perineum (How do they manage to come up with such elegant forms of humiliation?) I started to feel really nervous about that.

Then another nurse came in to do the MRSA swabbing- the swabber. I was OK with the nose which tickled but all the time I was thinking "Yeah . . . ? And . . .what about the next bit . . . " Luckily I was allowed to retreat behind a (hideous) curtain and do this myself.

Next it was a doctor who came into the room and interviewed me. The stuff you would expect really. Medical history, relevant medical history of relatives, smoking, drinking, allergies, etc. Then there was an examination on the little bed.

On spotting the dark circle made by John she asked

"How long have you had this mole?"

"What mole?" I looked down my body - "Oh! Hah! you got me there- anyway it will be bigger next Wednesday. Ha Ha!"

"Why?"

This time I wasn't sure she was joking, and I reflected that she seemed very young and that many of her questions had seemed a little odd. Not only that I had seen her with an older doctor earlier and he appeared to be briefing her.

It is a teaching hospital, and I of all people believe in learning and teaching, but I have to say I felt a shiver of . . . well actually it was fear.

FEAR for my tiny little fragile self. How pathetic! "Pull yourself together man!"

And here is the thing; I might look like i am 53, 6 foot, hairy, and all that other grown up stuff; but inside we are all vulnerable and emotional children. That includes the doctors.

After that it was just a matter of blood tests and an ECG. A piece of piss you might say - oh no I did that earlier.

I am fit for surgery!

I can't wait. . . .

The Hypnotherapist

This morning I went to see my hypnotherapist. Does that sound a bit new age and odd? As they say - don't knock it till you've tried it.

 I first saw her sometime ago as I was trying to deal with the prospect of a colonoscopy (that seems mere bagatelle now) and I can tell you that for me it was very powerful.

A beautiful and peaceful antidote to what I saw as the clinical brutality of the modern medical machine.

Hypnosis in reality is not like it is in films. They don't wave a watch on a chain in front of you, and the world doesn't go all wavy to the sound of a Theramin.



Instead I found myself a very comfortable chair in a warm room, speaking to a quietly spoken and understated woman. She uses the technique of progressive relaxation. You close your eyes and she asks you to relax; your neck, your shoulders, and so on all the way down your body. Then she asks you to go more deeply still.

Here is the interesting bit, you know what's going on, but you are very much in a small perfect world of your own. Everything is clear and possible. She gave me "anchors" and these got me through the colonoscopy really well. I was able to get through the experience without even sedation.

Even now, 3 or 4 years later, if I drive past the hospital I feel some of the anchors come into play. A medicine to equal Medicine.

Hypnotherapy gives me a way of using my own mind and strengths as a repost to the procedural coldness of the medical experience.



So, I have seen her quite a few times on my journey to this point, and it has been a most gentle and effective way to deal with very brutal and intrusive experiences.

 Today I went to see her for the second time on my approach for the much feared, and anxiety inducing colectomy. I arrived in the grip of the heeby jeebies with the prospect of being disembowelled boiling angrily in my psyche.



I sat in the familiar chair and felt the warmth of the hissing fire on my face. As always, we had a bit of a conversation first - a conversation which as usual brings me into close connection with her, and which is in itself calming, non threatening, and positive.



Then I closed my eyes and I relaxed and went into the strong and enabling world that she brings out of me. And although I still feel anxiety, and although I understand I have new and difficult borders cross, I drove away feeling that I had a way of coping that belonged to me, More able psychologically to deal with the impending challenge.



So if you too are about to experience something really challenging and difficult I suggest that you consider finding a really good hypnotherapist.

For me it has been good.

I hope we all live to be 100.



Peace

Dear Roger Knott-Fayle . . .

"Please attend the Pre-Admission Unit on F floor, west block on Tuesday 15 December at 1400.

You will be examined by the doctor and any necessary tests such as blood samples, X-rays, or ECGs will be undertaken to ensure you are prepared for admission. You will have the opportunity to discuss the details of your operation and hospital stay with the nurse and doctor in the unit. The appointment could take up to four hours depending on tests required."

Letters like this are really frightening in their casual and bald statement of fact.

The letter goes on to tell me that on the day of admission for surgery I should arrive at between 0700 0730 hours and that I will go straight into theatre from the admission lounge.

Lounge? how do they come up with these phrases? Do they think I'm going to be casually lolling about in my slippers reading newspapers and chilling out?

Well at least they didn't start with the words

"We are pleased to inform you . . ."

The heeby jeebies come and go.

My head tells me I will be OK but the primal part of me feels as if it is going to be executed.

Nicky Nacky Nocky Noo

For A laugh and joke on the topic please follow this link to a documentary song of jollity and fun that enumerates all the things that have gone wrong with me this year.

"Nicky Nacky Nocky Noo"

"Hello . . this is Mr Fitch's Secretary speaking . . ."

As I lay in bed, in the secure and safe surroundings of my own house, all wrapped up in my own little life. The phone cut through the morning quiet, and it was the surgeons secretary.

My heart rate changed, although I had had a message from her on my phone the day before.

She wondered if I wanted the operation before Christmas?

I was just umming and gaping like a fish that had just landed on the deck of a boat.

"How about the 22nd of December?" I gasped a little more and tried to say something sensible

"It wont be Mr. Fitch, it will be Mr. Shanks . . . is that alright?" How would I know? I don't know anything?

"would you like to think about it for a bit?"

You bet I would. I would like to think about it for the rest of my life.

"Yep . . . that would be great . . . I'll have a think about it . . ."

"Will you be getting back to me today? It's just that I would like to sort out all the lists today. I go at 4 today by the way"

"Ok I'll ring you later"

Oh shit.

The day continued - I went shopping, I went swimming. Constantly calculating and recalculating the days, and trying to estimate the earliest I could get out of there by. Clare rang lots of people up who knew people who worked as nurses etc. She ascertained that the care would be as good at Christmas as any other time. She started to make jokes about the surgeon being dressed as santa and all his nurses etc dressed as elves. Very funny.

Later I rang the secretary back and I committed myself to 22nd December 2009. Shit! Shit! Shit! I feel as if I am suddenly very high up in a plane and very soon they are going to open the doors and throw me out.

It's going to be an interesting Christmas.

Luckily I bought myself o hat on E-Bay, and it arrived yesterday. I have found that wearing it makes me smile a bit, and that in turn pushes away the heeby-jeebies.

Yikes! The hospital just rang me again. They are on my case already. I have to go for an assessment to make sure I am fit to undergo surgery. Next Tuesday! Yikes and double Yikes!

My "Stoma Buddy"

The bed I was in at Queens Medical Centre earlier in 2009.

I had been given the number of someone who had been through the operation that I could ring and ask questions. My "Stoma Buddy" as my wife referred to him.

It was with some trepidation that I rang, as it's not usual to discuss the minutiae of personal plumbing with someone you have never met; however one thing that UC can help you with, is coming to terms with yourself and your bodily condition. So I rang the number.

A busy and positive voice answered the phone. The first thing he said was that I could ask him anything I wanted, and he reassured me that there was nothing that could embarrass him.

His story, in brief, was that he had had Ulcerative Colitis from 1987 - 2004; and as he said (and as I have discovered over the last 12 years), you can adapt to anything.

During his time with UC he was not really in pain most of the time, such is the case with me. Nevertheless he developed a load of coping strategies. Just as I have done; just as anyone with such a disease will do.

In 2004 it all came to a head for him, and he was admitted to hospital where he was administered to for 2 weeks. Then the consultant (my consultant as well) said it was really time for him to have the op. He was in a very bad way, and he had no choice. I, at least, am not in an immediately bad way; I'm not in pain, and I have got a kind of choice.

He described how the consultant waited with him for the ambulance to take him to the hospital where the op would take place. He spoke with great admiration of how she looked after him, administering the Temazepam at just the right moment. I tried to imagine her doing that.

So my "Stoma Buddy" had no chance to prepare himself physically or psychologically for the operation, as I have.

He said something very interesting about forums and researching Ulcerative Colitis. The trouble was, as far as he could see, that the forums were dominated by the same questions and the same problems, and these were mainly negative. He felt it was shame that there were very few positive experiences of hospitals, doctors and surgery described on these forums.

He was offered a choice of anaesthetics, but of course he didn't know what was best, so he asked the anaesthetist what he recommended. Epidural was the choice, so he took that. Afterwards he was on morphine with some kind of pump that he could control himself to give pain relief.

Recovery, he said, in his experience consisted of about three horrible days, and then you feel better. However he developed a hole in his stomach - a fissure - and this meant that he spent more time recovering.

But he also said that after the operation he felt amazing, and felt as if he could run a marathon.

Life with a bag, he says, has its problems. Learning to accept it is the most difficult thing, he felt that everyone was looking at him all the time, and that it was difficult to be intimate with his wife. He had a few accidental leaks, and sometimes a bag would come off. But this was solved as he got more used to dealing with and using the bag. Cutting the hole in the neck of the bag the right size seemed to be crucial (2mm wrong and it could be a problem). He would always have a towel on the floor when he was showering as he could easily spring a leak and he talked about it taking about 45 minutes a day to get sorted and dressed.

He has since had a pouch constructed, and now feels absolutely fine.

Meeting the surgeon

Today I met the surgeon. It is a strange feeling having a rational conversation with the man who will cut your guts out. It was OK, and he even cracked a couple of jokes. So I felt a bit better.

So here's the hard information:

1 ) I am having a number of drugs such as Infliximab, Asacol, Thiamin etc. I am going to be carrying on with these until after the surgery.

2) I was concerned about my level of fitness, and I explained that I do about 1 hour of cardio vascular most days, and I am told that I am more than fit for the op. In fact many people who have this are in a pretty bad way. The good thing about being fit is that you get out quicker. That is what I want. In quick - out quick.

3) I'm also hoping to actually meet someone who has been through this surgery and I was assured that this would be possible soon. That will be really helpful I think.

4) I am warfarin as well, so this is going to have to be addressed before surgery.

5) I don't have to take bowel prep! Brilliant - I hate that stuff. It's like drinking cold sweat! Yeaach!

6) It is going to be open surgery. They will cut down between the stomach muscles - the ones that form a six pack if you have one. He said if it was him doing the op it would take about 1 hour. You get the op the day you go in and it takes about 6-7 days to get out. The fastest he ever saw was a woman who was running an aerobics course 1 week after the op. Wow!

7) They will take out most but not all of the Colon.

8) The position of the stoma depends on your lifestyle and your clothing. It is a bespoke scar just for you.

I hope this may help anyone else facing this experience. It really is a bit odd. If you too have UC I hope you live to be 100 and I sign off until I have more news.