Now here is an interesting thing, an indication of how stupid I can be at times.
Recently while at the Norwich & Norfolk University Hospital for a pre operation assessment, I got myself in a tangle over the request that, when admitted for surgery, I bring my medications with me, and in their original containers. Perhaps because my medications are few, and I don't think hospital, that helps to explains how I came to be confused, and certainly the nurse on duty must have thought me profoundly stupid when I queried this request. As I told her, "everyone knows what an Aspirin looks like, and most people know what a Statin looks like." But she agreed that there was no point in my bringing them, if, as I told her was the case, that I don't keep them in their original packaging, but instead, in a especially designed wallet. Well back home and in more reflective mood, and knowing that I was to be admitted on the following day, (for two lots of surgery on the same day), I decided that regardless of my point of view, I would bring them with me, only to forget when the time came..
Well, what was profoundly stupid, on my part, was my failure to see the obvious: the situation from the hospital's point of view, as the reason why they were asking for my medications in their original containers, wasn't so that they could see what they looked like, but rather, so as to be able to dispense them to me from the securely locked medicines cabinet.. Silly! silly! me!
Now another experience that I must share with you, about this pre operative assessment, is, that while there, I had thoughts about death row. As the nurse went carefully through the list of questions so as to determine my general state of health, I couldn't help thinking that if I was on death row and they were looking for an excuse not to give me a lethal injection, they wouldn't find it; because in relation to the questions being asked, (and allowing for the fact that I had a stent fitted into an artery in my heart in 2006), I was simply far too healthy. And after I had been subjected to the handiwork of two surgeons, and was lying in my hospital bed, I had a more profound thought. Looking at the curtain in front of me, that had been drawn around my bed, (leaf patterned and in pastel shades of green and yellow), I found myself reflecting on the fact that I would not want this to be my last view of the world. And I was reminded of something that I had heard in a radio broadcast many years ago. It was of a young man who, at the point of death, asked the hospice staff to carry him out into the garden, where he died, close to nature, and in the warmth of the sun.
And now I am sitting here feeling sorry for myself, with my computer set to large print, as I cannot wear my reading glasses, and unable for the time being at least, to go for my long walk each day. So by my standards, I am having to learn to be idle, and to be satisfied with things as they are.. You see, I have lost an eyebrow, have a large patch and stitches on my forehead, and a very ugly and askew bandage on my nose; and I have stitches through and behind my ear, from where cartilage has been transplanted to my nose. In time the stitches will dissolve, and my nose regain its shape, and by some miracle of modern surgical technique, my eyebrow will be restored, which is a roundabout way of saying that it is only a matter of time! until I am restored to my handsome self.
Now continuing on this hospital theme; there was a time when I thought that I had a high pain threshold, an illusion shattered, when, some years ago, I went for a bladder examination. Thankfully, (and as I suggested to the doctor at the time), there were no issues: but the tears were rolling down my cheeks while the probe was in use. And this time, when the needle carrying the local anesthetic was injected deep into my nose by the surgeon, the pain far outweighed any desire on my part, to be heroic. And if you think that a burka is a restricted form of dress, let me tell you that it has nothing on the garb in which I was clad during the Mohs surgery. Fully conscious, and with people rattling cutlery around my head, the only part of my anatomy exposed to view, was my nose. And apart from the cutlery, there was a sound-effect that perplexed me until I worked out what it was. It was the type of sound that you get when liquid is flowing from a pan on to a hot stove. It was of course a gentle suction pump that was following the course of the surgeons knife.
So why was I there? And what is Mohs surgery.?.And what of the plastic surgery, under general anesthetic that I had later that day?
For quite some time I had been aware of a small nodule on the tip of my nose, between the nostrils, that was new, and its shape struck me as odd; but as someone who has been known to fight his way into trees with one hand while dragging a saw in the other, it seemed not unreasonable to conclude, that somewhere along the way I had acquired a wound that had healed untidily. Not only was there no pain, but a stranger would have been hard pressed to notice that anything was wrong. But what finally persuaded me to visit my GP, (doctor), was the very occasional speck of blood that appeared when I blew my nose;. And when biopsies were taken, it was confirmed that I had what is known as a Basal Cell Carcinoma. A (BCC) is a slow growing, and non life threatening cancer, that if left untreated, results in the breakdown of tissue, and in my own case, if neglected, would have resulted in significant damage, if not to the actual loss of my nose.
Now we have a saying, "needs must," and this was the point at which I was made aware of Mohs surgery: an intricate and painstaking process designed to keep the disfigurement from surgery to a minimum. Having determined the likely boundary of the cancerous cells, and going slightly beyond them, the surgeon removes the tissue, and by a process of mapping, dying, and freezing, prepares it for the laboratory. The idea in going beyond the boundary of the cancerous cells, is, of course, to ensure that all the cancer, (including the caner roots), have been removed. But in truth, it is not an exact science, which is why, after waiting two hours for the laboratory results to come through, the patient might require a second, third, or even fourth incision to be made, before the all clear is given. And this is the point at which the mapping is important, for it guides the surgeon to where these remaining cancer cells are located, and keeps the areas of additional incisions to a minimum.
Well l was the first of three on that morning's list, and as we sat waiting for the lab to come back with their findings, we kept each other company. We exchanged notes on the instructions that we were given in respect of fasting before the operations, with myself explaining how, before midnight, I had managed to have today's breakfast, yesterday. We talked about our respective pasts, about children, and dare I say it, politics, and about whatever else readily came to mind. But with the two hour deadline past, and my dreading the prospect of another incision, and yet another two hour wait for the results, you can imagine my relief when the nurse appearing at the door told me that Dr Garioch had been advised that all the cancer cells had been removed. "Good", that imaginary voice in my head said, "they have got it early, and you will be home in time for tea." But, when she next appeared and invited me out into the corridor, I had a feeling of foreboding, and rightly so, for she had come to tell me that Dr Moncrieff, wanted a word.
Now as someone who is frequently looking beyond the immediate, and though I know him to be personable, on this occasion I had a sense of Dr Moncrieff as a man in a hurry: someone who was wholly mentally engaged on the tasks in hand. So with my back to the wall, (or so it seemed), I knew that it fell to me, at this decisive moment, to remember everything that I was now being told: that as Dr Garioch had had to cut in to the cartilage on my nose, reconstruction surgery would be necessary, and with cartilage transferred from from my ear. And that I would remain in hospital for several days, until the persistent bleeding associated with this type of surgery had stopped. And no less important was his closing remark, that if in the future I was in any way unhappy about the outcome, that was something that we could discuss.
Well I was lying there gazing at the ceiling and waiting to feel relaxed, as the anesthetist said I would, when I woke up in the recovery room, with a nurse asking how I was, while she pulled a warm thermal blanket around my shoulders. As out of nowhere I was wide awake, and thinking, every house should have one - a thermal blanket.
As for hospitals more generally, I have long had the view that no one should want to go there, and that if they must, it should be for as short a time as possible. And I am just as disregarding of the media, who, when the political climate is right, refer to nurses as "Angels". As I lay there, I was reminded of how they are just like us, women, and in many instances men, who are making their way against the ups and downs of life. Some, without doubt, are passionate lovers, while others despise their spouse or their partner, or break into a cold sweat when they realize how little money is in the bank, or are too afraid to think too much about their children; as to whether or not they might be going off the rails. But there was a sense in which I admired them greatly, and considered them special, for their life's work requires them to care for people when they are at their most vulnerable. And I wrestled with the dichotomy: the personal care and attention to detail, as applied to the patients around me, as compared to the absolute disregard of human worth, and need, in so many parts of the world. And while there, I did something that I would never do at home.
On my second day and when I was almost, but not quite restored to health, and the trolley shop was passing, I asked Jenny to get me three bars of chocolate, the sort of stuff that I would never eat at home. But as I explained to her, and later to Leo and Lynsey, I wanted them, "because the nurse's didn't love me any more;" a mischievous way of saying that I was so improved that I felt like a fly on the wall, while the nurses, understandably, were giving their time and attention to people whose needs were real. And that's a thing about hospitals; just as things can go quickly from bad to worse, or dare I say it, alarming, the converse is also true, as I observed in a patient more advanced in years than myself. On my first night there, and permanently on oxygen, he kept all of us awake as he endured extreme pain when needing to urinate. On the second night and in "the wee small hours," I was lying there and marveling at the transformation: with all five wards seemingly sleeping like babies, when the buzzer in my own ward sounded. It was my friend from across the way, and in the distance I could hear the light steps of the nurse as she came towards him. Notwithstanding his torments from the night before, and having wakened from a restful sleep, what he wanted was not oxygen, painkillers, or even to use the toilet, but rather, (and without anxiety,) to know where he was. - And I was smiling.
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© Cormac McCloskey
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