Life Exists Outside of Room 4

Mr. T arrives early and diagnoses paralytic ileus - a common aftermath of abdominal surgery. "This is why you are in so much discomfort. We just rest and wait for your gut to start working again" he says. On the plus side, the oxygen, morphine and NG tube is removed (thank f**k) and I feel much less restrained. I still feel sick and utterly exhausted. I am lying on the bed willing a mid-morning sleep to carry me away when Debbie arrives. She is a middle-aged, experienced physio, kind and sensitive. She immediately picks up on how shit I feel and tells me that movement is the key to getting things moving - I don't believe her for a moment and tell her as much; walking seems like aeons away. She responds, a little more curtly, telling me that a positive mind will also help!

Debbie teaches me to do a few pelvic tilts without using my tummy muscles. This is knackering. She  sits on the bed and I rest, while she talks:

"When I left school I had all science grades and went to college to study physiotherapy, further confirming my belief that everything in life could be completely controlled by chemicals and physical forces alone. 25 years on she realised there was something else, another force beyond (but clouded by) the thinking mind - a life force. I can't explain it, but I have hundreds or cases to demonstrate this". She quickly adds: "Of course, you couldn't have this conversation with a doctor. But you do need both, if your consultant were to say 'I haven't seen this before, don't know what to do. I suggest you have a positive attitude'... that wouldn't inspire much confidence.
You are fearful, close to giving up and out of control - the medics control everything you do or consume. You need to take back control and re-establish your confidence.
We will take a walk and you will feel better."

And I did.

I had turned a corner.

Sarah visited. She'd had a tough night, a tough day and hadn't been able to bring herself in earlier in the day. My gloom over the past few days had infected her and she was struggling to see clear sky. We hugged and I was able to tell her that I was going to be ok - another beautiful moment and a junction in my recovery. We decided I was ready for visitors again.

I'm still tired, but feeling positive that things are changing. The sickness was improving and I was allowed to start drinking again - 10mls water each hour!

Anything but the dreaded NG tube

Today is just one long, slow continuation of yesterday. Gloom.

I'm talking with two nurses, Pippa and Anne. Both are of the slightly bossy, efficient, know-it-all variety that keep the country's NHS establishments ticking along, but they are good fun and I (now) know them well. My conversation is light-hearted betraying the way I actually feel, but I am aware this is helping me. Sarah arrives to join the 'fun' and all three of them are talking through options to jolt my gut out of it's reluctance to fulfil it's intended purpose of transporting food. Most of these options involve food and drink - none of which have any appeal or promise of success. Then Anne suggests an NG tube. I don't know what this is, but I can tell from the look on Sarah's face that I am not going to enjoy it. The process of inserting a nasogastric tube through my nose, down my throat and into my stomach is slowly broken to me. Sarah is reassuring and the nurses tell me: "It doesn't hurt, it's just a little uncomfortable". Roughly translated, this is nurse speak for "This is really going to hurt, you're going to really baulk at this and I would never, never let anyone do this to me"!

Pippa says to Anne (whilst looking at me, with a wink): "I'll get the tube. Do you want to push or hold him down?" We are still making light hearted, easy conversation to keep my fear in check and I naturally assume that this is a joke. Moments later, Pippa returns and they really do go for me! I'm too weak to resist as much as I want, and it is so retchingly uncomfortable. As always, I feel Sarah's hand in mine. I am aware of her past nursing career and her reassurance tells me that this attack is normal.

Once I have come to terms with the retching a little, a syringe is applied to the NG tube and an unfeasibly large quantity of dark green liquid is drawn from my stomach. Within only a few moments, I do start to feel a little less nauseous but it is not easy to say that this relief outweighs the constant discomfort and swallowing attacks stimulated by the NG tube on my nose and throat.

It is not a very comfortable night.

Bottom of the world

Awoke very early feeling very rough. Grappled with phone and texted Sarah: "When are you coming?". I'm completely exhausted and heavily restrained to the bed bound by a multitude of tubes. I'm uncomfortable, but it hurts to move.

I was sick during the night but not enough to relieve the nausea. I called for help and was impressed with how quickly the night staff responded, deftly wielding a vomit bowl like an american baseball catcher. Regular nurse visits continued through the night and into the early hours. Some are officious but not helpful and others have time to sit and talk. One in particular, sees that I am terrified, and calmly assures me that I will be well very soon. I am scared, I can see no way forward. My gut has stopped working; peristalsis is not happening and my abdomen is gas cylinder firm. I am nil by mouth again and living off my fat reserves assisted by electrolytes dribbled into a vein.

These are very miserable days. I have no visitors except for Sarah. I question myself about what they do if the gut doesn't start moving again - re-operate or just stop. Both seem equally terrible and, to my surprise, I don't seem to care. I can't remember ever having felt so low, but Sarah stays with me a lot and is a beacon in the gloom. It must be a huge strain for her.

On Top of The World

The feeling of aliveness carries me well into the next day - I feel great (relatively speaking). During the night I am moved back to the ward where I sleep fitfully amongst numerous visits from the nursing staff. In the morning, I pluck up the courage to explore my injuries and paraphernalia. The operation was a laparoscopic assisted anterior resection - a deep operation to remove a low section of the bowel and rejoin near to the rectum (apparently this is the hard bit). I have a 6" main incision just below my bikini line (to ensure that I still look good on the beach). It's bloody but pretty visible due to the use of thick glue instead of a long zip of stitches. I also have 3 laproscopy wounds in my tummy button and either side of my belly. I have a stoma, aka front bottom (an early exit from the colon to rest lower bowel), but I can't see this because it's covered by a bag of runny, greeny-brown fluid (every bit as disgusting as your are imagining). There is a cannula in my hand with two lines - one for a fluids drip and the other for the opium (morphine) through a syringe pump under bolus control (push button for hit). Ah yes - maybe there's another reason why I feel good - it's a 'class A' feeling of being alive. There's a weird yellow pipe taped to my leg going over the side of the bed - I don't want to think where that goes - nobody warned me about that, but I'm relieved that I wasn't aware of it's insertion.

Mr T arrives early - he thinks he got all the cancer and reports it went well but it was long and difficult. He encourages me to eat and drink freely and to try and move about.

It's like Picadilly Circus: -- on top of the two hourly obs (blood pressure, temperature and blood oxygen), there are yet more nurse visits to take blood, reload the drip, infuse paracetamol and "hotel staff" (private see!) to bring tea, food and more tea. On top of this I have too many visitors and too many at once: Sarah and the kids; my mum; my elder brother and sister in law. I try to be chatty, but it's hard work and when a conversation strikes up between them - I can't follow it. As the day wears on, I'm starting to feel much worse. There is discomfort from the wounds and the morphine takes me somewhere else and leaves the pain where I was. I find it disorientating and get to dislike using the bolus switch for a shot. I feel sick. I can't read, watch telly or listen to the radio - it's all too confusing.

The physio arrives and tries to get me to stand up which I kind of manage (bolus before and after) but really don't want to. I had a text message from Nick a few days before the operation wishing me "some pretty nurses" and this physio certainly qualifies, but she is young, inexperienced and doesn't know what to say or do. I feel very tired and I just want her to go away.

It's lunch time and I find myself being taunted by some food - I feel very weak and it seems logical that it will help. I try some consomé soup which is disgusting and I can't drink it. I fancy some orange juice, but my stomach doesn't and complains strongly with acid reflux. At tea time I try a bite of cheese sandwich but I can't manage it. The nurse encourages me to try an energy drink but it is very creamy and very disgusting.

I begin to realise how much of the decision making is taken away from you in hospital. My bladder empties into a bag; my colon empties into a bag and any negative response to the question "How are you felling?" seems to generate a new drug. On top of the drips and infusions, I have pain-killers (voltarol), anti-emetics (metoclopramide) and anti-reflux (ompeprazole) drugs - none of which appear to help.

Some of the nurses are practical, some are incredibly sensitive and look after the person instead of the patient. As am tucked up for an uncomfortable night, talking to one of the Nightingale kind. I'm pretty low and I realise that the on-top-of the world has completely faded. She tells me how common it is to have a very good first day post-op and a bit of a down to earth bump as the long road to recovery stretches out in front of you. I'm very tired and I quickly fall off to sleep.

I'm alive!!!

I slowly become aware of my surroundings. I can't make anything out clearly as I'm pretty short-sighted and my glasses are back on the ward. I begin to remember... I've had an operation... I've been under... I must be on the high dependency (recovery) ward... hang-on a friggin' minute - if I'm thinking this I must be alive! The full realisation of the repressed fear of the operation hit's me and I notice that I am relieved to be here, the relief surprises me - this is bigger than I had let myself believe.

My mind is completely cloudy, but I am lucid. I explore my surroundings and try and make out some of the things around me, the ward the other beds. Nothing is sufficiently close to make out clearly even when closing my eyes to pinholes in an attempt to focus. [I once did this trying to read the menu board at my local Chinese restaurant, when I lived in Bristol - took quite a bit of explaining!] A nurse appears - but I can't really talk properly - tired and woozy. She does my 'obs' and then disappears. This happens quite a few times and then suddenly I recognise a face... it's Sarah. Not satisfied with a phone call, she has managed to blag her way into HDU (visitors not normally permitted) just to check that I am really alive. I don't remember much: She tells me it's 10pm; the operation was successful, but difficult due to the location of the polyp and took longer than expected (4 hours). We both have wet eyes - one of those beautiful moments I will never forget, to be tucked alongside first pint, marriage, children's births, etc.

The Day of Reckoning

6:30am - prisoners last meal - small bowl of cereals and clear fluids then nil by mouth in preparation for the operation which is scheduled for 5pm (seems a bit late, I hope he doesn't start early). Apprehension slowly builds over morning - so good to have Sarah around; the kids are off to my mum's for a couple of nights of grand-parent spoiling which, not surprisingly, they rather enjoy.

Admitted to Bath Clinic at 12:30, bit of hanging around then straight up to Claverton ward with the news that my op has been brought forward by 1½ hours. That's good right? (his knife might still be sharp!), but hold on - I'm not psyched-up yet. What about the bowel prep? nurse doesn't seem to think this has been written up (could be a bit messy?) - she scurries off to check. In comes Mr-T (the consultant): he's pretty matter of fact:

"All set? Sign here!

I have to say, my signature is a bit shaky - suddenly weeks of calm acceptance has all but deserted me. No sooner Mr-T has left, the anaesthetist arrives. Sarah checks that he is aware of the untested risk of suxamethonium apnoea (patient doesn't recover breathing following muscle relaxant) which I may have inherited from my father. We have written this on several forms and discussed this with the consultant weeks ago. The anaesthetist looks shocked:

"Nobody tells me anything ... but we shouldn't need that, we only use it in emergencies!"

Sarah mentions that I am a yellow chicken and am terrified of needles and that I am anxious of the operation. The anaesthetist offers me a pre-med which I feel I should decline because I'm a man - but Sarah insists and also asks for some of that local anaesthetic gel they use for kids on my cannula hand.

Efficient nurse re-appears loaded down with gel, Temazepam pre-med and a red armband (??Sux apnoea??) and plastic bottle with pointy looking squirty thing on lid - this is the infamous enema which is rapidly applied where the sun don't shine. It's one hell of a job to keep ones buttocks clenched after that, while efficient, hurried nurse applies gels and armbands. Anaesthetist re-appears to insert cannula: the acid test on ring piece control. Finally I can relax and my bowel is considered 'prepared'.

A porter arrives and I am whisked away to theatre - Sarah holding my hand right up until the lift doors. We steal a final kiss - I can't remember ever having been so terrified, but I'm still putting a brave face on it for some reason: laughing with the nurse and the porter - I should be screaming! We arrive at an anté room in front of some double doors with a big circular window allowing a glimpse of the bright lights within. Dr. Sleep appears with some more meaningless words of assurance and squirts something into my cannula and I am left wondering what the last half hour would have been like without the pre-med. Moments later I have gone.... somewhere else.

... time passes ...

Pre-op day

Rather than working up to the wire it seemed sensible to find some head space to contemplate the impending butchery, spend some much-needed time with the family and do something that I wouldn't be able to do for many months -- such as queuing for 2 1/2 hours outside Bristol Museum to see this unique exhibition. Sas and I took turns to join a very friendly queue while the other sampled the huge choice of café life available on Park Street with the kids. Without the impatient ankle-biters, queuing with the Times seemed quite pleasant - I think I got value for money from Murdoch's empire having read every almost word and completed the Sudoku before my mum arrived from the bus station [reading an entire daily newspaper seemed like a rare treat at the time, although now, post-op, it's not unusual!]

The exhibition was extremely well worthwhile, and once inside - no crowd and no hurry. The ground floor galleries were devoted to Banksy works and the main gallery contained the now-famous automata which have been well publicized on YouTube and the BBC following Banksy's fake petshop in New York last October. These were the kid's favourites, but for me the paintings distributed throughout the main galleries of the museum by an "unknown local artist" were the best.

Banksy is clearly a modern day genius, although I do struggle a bit with criminal damage just a tad. Part of the mystique is his anonymity, and now that he can afford to, he goes to great lengths to preserve this: when the exhibits were first being laid out a throng of museum staff lay in wait to try and catch a glimpse of the artist only to be thwarted by the arrival of 20 identically hoody-clad Banksys all equipped with steps and measuring tapes.

A very relaxing day, with close family around and plenty of time to talk through what lay ahead - an important part of the kids acceptance of my condition and for me a great chance to de-stress after a busy week of handover and trying to catch all the loose ends. Our contribution to the local exhibition was the purchase of a coffee table book of famous if mindless vandalism called Wall and Piece. My favorite piece (not exhibited in Bristol), seems strangely applicable to my condition and reads as follows:

"Once upon a time there was a Bear
and a Bee who lived in a wood and
were the best of friends. All summer
long the Bee collected nectar from
morning to night while the Bear lay
on his back basking in the long grass.

When Winter came the Bear
realised he had nothing to eat and
thought to himself 'I hope that busy
little Bee will share some of his
honey with me'. But the Bee was
nowhere to be found - he had died of
a stress induced coronary disease"

Stenciled to the side of a bin in Notting Hill, London 2005.