Op Day – 9th March 2015

The weekend before surgery I thought I would be an agitated mess but surprisingly I wasn’t. I kept busy seeing friends and family and it was only when people asked how I was feeling about Monday, would I then feel rather anxious. Last time, all I could think about was the op and could well up at the drop of a hat. This time I think a combination of denial and knowing what to expect helped me keep it together. 

Andrew and I stayed at our friends, Georgie and Gary’s, house the night before the op so we had a shorter commute. They live in a gorgeous house in South East London and we had a lovely evening involving food, films and catching up.

With my alarm set for 5.15am, and crunch time fast approaching, I thought I would struggle to sleep. However, I nodded off around 10.45pm, and despite waking in the middle of the night, I settled quickly again. The hospital supplied some pre-op antibacterial scrub which I was instructed to use thoroughly during my last wash. So when the alarm sounded, I had to remember to use that, I had forty-five minutes left to drink water only, and I had to order an Uber taxi. At 6am, Uber only had Mercedes available, so at least we arrived to the Hospital in style.  

Our driver, Henry, dropped us off next to the Shard, and in we walked to Guy’s Hospital. The surgical admissions lounge, AKA the SAL, was fairly crowded and I just hoped I was first on the surgery list again. Having over indulged the previous night, I figured my slightly stretched stomach wouldn’t cope with nil by mouth for very long. Luckily, I was first again, and I was handed my attire and informed which room to change and wait in.

Once changed into my paper pants, TED stockings, surgical gown and non-slip red socks, I had a quick pre-op check with a nurse to record blood pressure, heart rate, and for blood to be taken. Then waited in my little room for different people to come in and ask me the same questions… When was the last time you ate/drank? Are you allergic to anything? Do you have any jewellery or metal in you? Etc. The anaesthetist was first to quiz me and I remembered him from last time. He commented on my lack of nervousness before such a big op, and I reminded him that I hide it well, and I need that sedation again. To which he didn’t object. Then one of Banksey’s minions, Jonathon, came to say hello. Then another Nurse. Then the big dawg himself, Banksey, made an appearance. Banksey performed a PAO on an old Uni friend of Andy and I’s in November so we discussed how well he’d done and mutually agreed on how much of a nice chap he was. I reminded Banksey of how strong my bones were (to prepare him for some hard hammering), and he commented on how chirpy I was; even asking the nurse whether she’d ever seen someone so smiley before PAO surgery before.

At 8.30am, it was time for Andy and me to say our goodbyes. We hugged. I cried. Andy held it together. And we walked away in opposites directions. The nurse joked “Mr Bankes will wonder what I’ve done to you as he left you in such a happy mood”, as we walked into the anaesthetist’s room. It was the same room as last time; adjacent to Banksey’s O.R. I’d stopped crying as quickly as I’d started and the anaesthetist started prepping my sedative. My memory is a little hazy, but I remember rambling on about my friend and hip twin, Natalia, and how we have this close bond having met in hospital last time… and how we assisted each other through our recovery from the last PAO… and how she came to our wedding… and how she’s been messaging me leading up to the op… and then I was out for the count.

I was woken up by Nurse Agnes in the recovery room around 11am. Agnes hadn’t yet hooked me up to my local anaesthetic machine, nor the morphine pump, so I was rather annoyed at Agnes. I felt she could’ve woken me after doing this as I could feel a fair bit of pain. My mouth was incredibly dry and my teeth were uncontrollably chattering, so lovely Nurse Maureen kept replacing my hot blankets and feeding me water through a straw. Credit to Agnes, she didn’t argue with me when I requested anti-sickness through my cannula as I had explained the morphine makes me very nauseous. I was desperate to get up to the ward to see Andy, mum and dad, but Agnes said until my pain was under control, I wasn’t allowed to leave the recovery room. After a couple of hours, and Agnes telling me how ill she felt, and how cold she was, They called up to Sarah Ward for a couple of nurses to collect me.

At 2.30pm I was wheeled upstairs into Sarah Ward and as soon as the door opened, I saw Andrew step out into the corridor. We smiled at each other like Cheshire cats and he high-fived me as I glided passed. The nurses wheeled me into bay B6 which I initially believed to be Natalia’s bay. It wasn’t until later that I remember we were in the neighbouring ‘C’ ward, but effectively I was in Natalia’s corner of the six-bay room. My mum, dad and Andrew surrounded me and we exchanged stories on the day’s events.

My plan for the evening was to prepare as much as possible for my Tuesday physio, and after last time, I knew exactly what not to do. I knew that I needed to avoid lying flat to restore my upright blood pressure, and I knew I had to try and keep my food down so I had some energy, and I knew I required as much anti-sickness as possible. Therefore, every couple of hours, I pressed the ‘up arrow’ button to raise my bed slightly, and as instructed, kept sipping my water. I know my morphine pump made me very nauseous last time, but Banksey and I thought we’d try it again and see if things would be different a couple of years later. Apparently nothing has altered, and it made me feel very nauseous and itchy once again. The pain was bearable and I would always rather pills than pressing my morphine pump. This was picked up on by the nurses and they kept commenting on how little I’d used it.  When I press the button, it administers morphine into my bloodstream via the cannula in the back of my hand. The machine records every press of the button and it’s impossible to overdose as you can only press it every five minutes. I never felt like it gave me any pain relief, but I pressed it occasionally to keep them quiet.

Mum and dad left before dinner but after Banksey popped by to show his face. He explained that surgery couldn’t have gone better, it was straightforward with no complications, and he must’ve gotten stronger; as it didn’t require as much brute force to break my pelvis. I suggested my bones may have in fact gotten weaker, but Banksey insisted he was definitely stronger, so we went with that. He left with a parting comment: about how nice it was to see me so smiley and happy, considering what I was going through.

At 6pm dinner arrived and Andy fed me a few baby-sized mouthfuls. I couldn’t manage much and vomited roughly six times between 6 and 9.00pm. I was able to keep some food down, and remained fairly hydrated so I thought I would still be ok for the following day. Andrew left at 9pm and planned to return when visiting hours opened again at 2pm on Tuesday.

Thanks to my ear plugs and eye mask I slept incredibly well, and did not mind being woken to take meds and have blood pressure checks, or was I fazed with the lady opposite me snoring like a steam train. I had a wonderful nurse, Anna, who assisted with my catheter issues. It didn’t seem to be draining unaided so I kept waking up with an uncomfortably full bladder. If only I could have Nurse Anna for the rest of my stay.

When I woke Tuesday morning, I witnessed the nurse handover from night to day staff, and was introduced to my new lead nurse, Christina. The chirpy, Caribbean food and drink man, Leonardo, came whistling around the ward and asked for my breakfast order. I wolfed down my jam on toast and dozed in and out of sleep until 12pm. My lunch didn’t go down quite as quick and I was a little bit nauseous again, so Christina gave me a dose of anti-sickness through my cannula. Another nurse finally asked me at 1.30pm whether I wanted my sponge bath. I wondered what had taken so long but explained they may as well wait until my husband arrived at 2pm so he could assist. It was good to get cleaned and change gowns, having partially puked up on myself the night before.

Physio arrived shortly after and I was extremely determined to get out of bed and into the chair. Gemma was my physio and I was so happy that Andy was there to witness the session as he was unable to see my step-by-step progress last time. My four bed exercises were the same as last time and included: squeezing my glutes; squeezing my quad and pushing my knee into the bed; attempting to move my leg outwards (hip abduction); and raising my leg with my knee bent (hip flexion). I could manage the squeezing exercises, but could barely activate my hip flexor to lift my knee, and failed to move my leg outwards even slightly. Gemma assisted with these two tough exercises so I could encourage the muscles to work again, and began questioning how I knew so much about the rehab. All made sense when I explained I’d had PAO on my right hip and then her attention turned to getting me out of bed. I’d explained that when I attempted this last time, I felt very faint and had to be returned to a lying position as quickly but as carefully as possible. With that in mind, Gemma and I took it very steadily and she held my legs as I shifted towards the edge of the bed. We got both feet on the floor and I felt very queasy. I was adamant I wanted to stand up on my right leg, but it took a minute or so and some sips of water until I was ready. Whilst holding the handles of my zimmer frame I gradually stood, and ten seconds on my shaky right foot was enough for me. Happy with my achievement, I returned to bed, as I could feel an imminent need for the sick bucket. With Gemma impressed, and myself and Andy overjoyed, we called it a day and I would see Gemma on Wednesday.

Andy and I nodded off for less than an hour, and both awoke to the sound of my local anaesthetic machine bleeping. Still in a daze, we didn’t think much of it, and never in million years would I suspect the same events to occur as last time. Oh how wrong was I? It was Déjà vu. The bleeps turned to one continuous bleep and very quickly I was in a considerable amount of pain. It seemed my machine had once again run out of battery as someone had unplugged the machine from the mains and removed the power lead. Andrew immediately leapt up and attempted to get the attention of one of the ignorant nurses. There was no sense of urgency and two nurses fumbled around the wards trying to find a spare lead. I was extremely unhappy and dumbfounded that history could repeat itself and the nurses failed to apologise or even seem to realise the severity of what had happened once they plugged it back in. I suspected it would take a short while for the local anaesthetic to kick in again but an hour later, I was still in extreme pain. We called for the nurses, who refuted the issue and insisted the machine was working, and therefore I needed to use my morphine pump more. I explained that I can differentiate between the pain and this was still the type of pain that I believed was caused from a lack of local. The nurses were so dismissive, until three hours of agonising pain ended in tears.  I finally had their attention and they called for a doctor. An anaesthetist arrived from theatre and he explained that once the local machine stops, a restart requires a bolus to kick start the effectiveness again. So he gave me a little boost and seemed confused that the nurses hadn’t realised that and called him sooner. (To be fair, last time this happened, my body went into shock, and I was so confused and not fully conscious, that I hadn’t realised I had received a bolus before. It was only later in the evening when I relayed this to my dad that he explained the exact same thing had happened while he was with me during the last recovery).

Tuesday night was brightened up with visits from friends, Stephanie and Tanisha, and they couldn’t believe how neglectful the nurses had been. It was pretty shocking that I suffered unnecessarily for three hours, and that they failed to respond until I cried because they didn’t believe how much pain I claimed to be in. Anyway, I said goodbye to the girls, and then to Andrew and off I went to sleep. 

At midnight, I was woken up with the same intense pain in my wound and leg, and instantly turned to my local anaesthetic machine. It still said 10ml/hour and the lead was plugged in so I pressed the morphine pump. Five minutes later, I pressed it again, and pushed the call button for a nurse. When she arrived, I explained my dilemma and emphasised how certain I was that there was something wrong with the local machine again. Her response was I needed to use my morphine pump as I’d only used it twice so of course I would be in pain. So then we went through the rigmarole of how I’d been through something similar the previous afternoon and I know what the pain feels like, and that morphine doesn’t really do anything for me and I can bare that pain easily, and that I needed an anaesthetist to come and provide a bolus. All of this went in one ear and out the other, and she insisted that I keep pressing the morphine pump for half an hour before she could believe me. I retorted that I would do as she suggested, but I guaranteed it wouldn’t be the solution to my pain. Funnily enough, it didn’t fix the issue, and I called her back in even more pain after about twenty minutes. I insisted that she call a doctor or anaesthetist this time, which she went and did. However, I have my suspicions that she influenced the anaesthetist’s view as apparently, she exclaimed I would need to use my morphine pump for another hour before she would come upstairs to see me. So there I was in the middle of the night, in tonnes of pain, pushing that damn morphine button every five minutes and it was doing jack all. There was a really sweet student nurse who kept coming into my bay to resolve the catheter draining issues, and perform the blood pressure and temperature checks. She admitted that if it was up to her, she would have demanded the anaesthetist came up ASAP to give me the booster of local anaesthetic; however, her opinion didn’t carry much weight in the matter.

An hour of tears and useless morphine passed, and the nurse realised I wasn’t just exaggerating the pain and going to drift off to sleep, so she caved in and called downstairs again. The anaesthetist was in surgery and claimed she would be up as soon as. A further thirty minutes and the total duration of suffering had now reached two hours. I had to beg her for a bolus just so I could get some sleep, and after a fair bit of dithering, she agreed to do it; despite her doubts that it would work.

I woke up to a singing Leonardo entering the ward asking for breaky orders. Today I fancied some Weetabix and as I started to raise the top end of the bed to sit up, I felt extremely nauseous. That surge of morphine for two hours in the middle of the night had put me back to square one. I lay back down and called for some anti-sickness. The judgemental night nurse explained that she wouldn’t prescribe it into my cannula as I hadn’t actually been sick, so she fetched me some tablets. I tried to warn her…

The nurses were completing their handover and as they opened my bay curtain, I gave the night nurse a disapproving but ‘told you so’ look as I threw up my Weetabix (and the anti-sickness pills) into a cardboard sick bowl. Seconds later I received a dose of anti-sickness into my cannula.

One of Banksey’s minions came to check up on me and I didn’t hold back. I blubbed my way through my version of events and explained how fed up I was of having to try and prove when I was ill or in pain. She empathised and we discussed my preference of pain relief. We agreed that the local anaesthetic machine would remain for another day, and that they may as well disconnect the morphine pump as it wasn’t required. In her opinion, I’m actually allergic to cannula administered morphine due to the vomiting and itching it causes, so she requested I commence the morphine tablets at the earliest opportunity.

By the time Gemma appeared for my morning physio, I had stomached some sweets and managed to sit upright in preparation. Today was the day that I wanted to get out of the bed and into the chair. And that’s exactly what happened. Gemma was thoroughly impressed with my progress, yet mortified to hear about my evening of horror. 

Gemma left me in my chair and I couldn’t wait to surprise Andrew when he arrived at 2pm. I had already messaged him to detail the appalling evening I’d had, but who knew there was even more to come…

At midday, Head Nurse Christina was in the middle of detaching the morphine pump and the corresponding cannula when my local machine started bleeping again. The pouch inside the machine, containing the anaesthetic, was almost empty so she stood up and informed the nurses to arrange a replacement. The lady in bay 3 was summoned for surgery, so instead of finishing her current duty, Christina assisted with wheeling the lady down to theatre. Minutes later, my machine once again bleeped continuously, and of course, I felt this extreme pain rush into my wound and down my leg. I began to panic and pushed the call button for a nurse. In walked a different student nurse who patronisingly told me “There was no need to panic as Christina had requested the replacement pouch already, and they didn’t have the exact one on the ward, so they’ve ordered it from pharmacy and it’ll be twenty minutes.” I blurted that there was a need a panic as I’m currently in pain and it gets worse every minute that I don’t have that anaesthetic pumping into my wound. I could not contain my despair anymore, and combine that with a load of drugs and a long night, and you get a hysterical mess. At least four nurses must have come in to check the commotion and each time they suggested I use my morphine pump. I had to explain everything multiple times and kept asking why they could let this happen and expect me to suffer three times within 24 hours. Apparently Christina noticed in the morning that I would require a replacement pouch and checked their stocks. There was one spare pouch but she hadn’t managed to verify that the contents weren’t identical. By this point, I just could not believe it and was so fed up. There were only three of us on the ward, and the other two ladies felt extremely sorry for me and welled up with sympathy. They were more supportive than all of the nurses combined. From previous occurrences, I’d worked out that I would require another anaesthetist to perform the bolus once the pouch arrived, so I asked the nurses to call down in preparation. Of course they didn’t, so when the correct pouch arrived an hour later, Christina had reappeared by this point and she tried but failed to replace it.  So I waited a little longer while they called for an anaesthetist to provide the booster and Christina completed her earlier task of detaching my morphine pump. This anaesthetist was lovely and within minutes I was pain-free and relieved. She couldn’t have been more apologetic for the inadequate care I’d received over the last 24 hours and gave the nurses a severe dressing-down. She did comment on the fact that many PAO patients rely on their morphine pump more than their local anaesthetic machine, so this could explain the lack of urgency from the nurses. Subsequent to their ear-bashing, I didn’t have to deal with the shoddy nurses again. They avoided me all together and I think they were pretty annoyed I’d gotten them into trouble. I honestly think I would’ve got the necessary care and attention had I just cried at the first sign of pain, and didn’t refer to my previous PAO. But rather than listen to me and my suggestions from experience, which would’ve saved them time and energy, they decided they knew best and caused more issues for themselves in the long run. Apart from the handful of amazing nurses, the majority were shocking this time around and I hope they were just having an ‘off’ week for the sake of others. Correct me if I’m wrong but I don’t think typical qualities of a nurse include being patronising, rude, neglectful, and impatient. As you can imagine, I couldn’t wait to get discharged from hospital, and I made it my goal to be out by Thursday.

Andrew arrived and was equally as shocked to discover what had happened. Unfortunately though, complaining achieves absolutely diddly-squat in a hospital, so we just focussed our attention on my recovery. Andy was very impressed to see me sat in the chair but a little sad he’d missed the milestone. Without a tube attached to the back of my hand and having just had my catheter removed, it meant washing and dressing was considerably easier. Andy assisted with the delightful sponge bath, and I was finally able to change into my own clothes. Just as we finished, Gemma popped in with a zimmer to see if I was ready to walk. Last time I was completely unable to initiate movement in my operated leg until the Thursday evening. My brain was telling my leg to move forward but it just couldn’t budge. Whereas this time, as soon as I stood up and attempted to walk, I was able to engage my muscle. It felt amazing to be out of bed and moving again, and we zimmered the short distance to the toilet, with Gemma manoeuvring the local anaesthetic machine as I went. When I’d finished, Gemma declared that I was advanced enough to progress to crutches.

Once back to my bay, Gemma demonstrated the standing exercises I could add to my current list. They involved just moving my leg in each direction, so I gave them a go before jumping back into bed. It had been a long day and my appetite was back in time for dinner, so I was ready to just eat and chill. Our friends Jenny and Bobbie were coming to visit so unlike Tuesday, Wednesday definitely improved from 1pm onwards.

Wednesday night was peaceful, with the odd call for a commode. Thursday morning, Banksey and his minions dropped in for a catch up. Again he mentioned how bubbly I was, to which I confessed hadn’t been the case the previous day. I summarised what happened and he profusely apologised. I requested that I be discharged that day, to which he said was possible if I had my X-ray, passed my physio stair test, and had successfully managed the pain. They arranged for my X-ray immediately after breakfast so the other two factors were down to me.

The stairs I knew would be a doddle, however I was worried about my pain once the local machine was removed. Gemma brought a physio friend to the stair test, and they both claimed to have never seen someone ‘walk’ so well post-PAO. They offered me a wheelchair ride down the corridor to the stairwell as it was quite far, to which I declined as I was happy to work my legs. They were very impressed with my stair ability and both agreed they’d never felt so useless to a post-op patient. On the way back to the ward, I was discussing my previous job in the rehab clinic in London and my last recovery at Wimbledon’s Parkside clinic. Funnily enough, Gemma had been to a seminar that my previous boss delivered and liked what she heard, and she has just handed in her notice and accepted a job at Parkside. One of those ‘small world’ moments, and we shared our opinions on both experiences. Having listened to my feedback about Parkside, she couldn’t wait to start there and felt less hesitant about the whole move. Gemma reminded me of the legend, Deborah (from Parkside), throughout my stay at Guy’s, so good luck and well done to her.

The only nurse that would come near me that afternoon was actually pretty good, so when I returned from physio, it was time to remove the local. It was reduced to 5ml/hour first, and when she returned 45 minutes later, it was removed all together and it was the first time I’d seen my wound.

We came to the conclusion that stitches hadn’t been used this time and it looked like Banksey had superglued the wound. I was partially sceptical that it would hold, and partially glad that I wouldn’t have any issues with ‘dissolvable’ stitches not dissolving and contributing to infection again.

Soon after, Andrew arrived and we prepared for discharge. The only thing left to do was wait for pharmacy to deliver my bucket load of meds. We knew this would take an age, so just had to play the waiting game. My dad was on his way from Reading to help collect and deliver me to Reigate. Dad arrived at 3pm and I was finally discharged after 7pm armed with needles, morphine and dressings galore. It was an arduous wait but so worth it to not spend another evening incarcerated.

Shortly before 8.30pm we pulled into Andrew’s driveway; my home for the next six weeks with Eli and Kevin. So far, my agenda for the coming month included: going to hydro; watching TV series; and writing my blog. All in all I couldn’t have asked for the surgery to go any better, and although the nurses weren’t very caring and attentive, my friends and family are just awesome. They help me breeze through everything and I could not ask for more. I’ll be back on my feet in no time and who knows; maybe I’ll be ready to run the Desert Warrior Challenge with the rest of the gang later on in the year.