This past week I’ve been through one hell of an experience. It was one I fully consented to and thought I knew what to expect. I doubt anything other than going through it could have prepared me. There were times I’ve almost regretted turning up at 7.30 last Tuesday morning, almost but not quite. Because the operation is a success and whatever else may have happened there has been no question that it will allow me to draw a line. Eventually, when I’m healed.
Content Warning: This post is about major surgery, the psychological effects of breast cancer and the effects of Covid on our health system. I won’t be offended if you stop here, I’m writing this for me while it’s fresh (ish) in my mind. Also I must warn you that it is a long post.
Ever since I received the call out of the blue from a plastic surgeon I’d never met, I’ve been preparing. Well actually I stated seriously on 1st January this year because I wanted to get fitter and healthier. Also slimmer and wedding fit. At the back of my mind I knew that there was a chance my reconstruction could happen this year, but I had no hunch at the breakneck speed. By the time I got the call my BMI had reduced from 34 to 32, so still a way to go to 30.
But in a health system where so many people have been on waiting lists for so long, there is now drive to get people seen and treated. I’ve been waiting since November 2019. But more of this a bit later on.
This month I took on a walking challenge, that turned into a mission to get fit quick and I think that has helped me recover quickly from the great trauma inflicted on my body. The weekend before surgery we went to Oxford. We went to be by ourselves, to walk, talk, think and listen to music. The latter being the original point of the trip. Staying in an airbnb meant we could restrict how close we got to others. The weather was chilly at times, but fabulous. By Tuesday morning I was as ready as I could be.
The surgery conveyor belt
We had no concept that everyone would turn up at the same time on the morning. Whether you were a day case or like me would stay several days. Whether you’d be off home after a cup of tea or need ITU it appeared everyone queued together.
But a stroke of luck, I spotted my surgeon asking her junior if the patient was here. I piped up that I was and was whisked away. Within minutes I’d been marked up with black ink, seen the anaesthetist and consented to this huge surgery. Less than an hour later I’d kissed Master goodbye and was being put to sleep.
Before my mastectomy I’d never had surgery, now I have a false boob, fashioned from skin and fat from my lower abdomen. I’m cut from hip to hip, but I think it’s going to look pretty good. The funny thing about anaesthetic, if it goes well, is that what seems like 5 minutes after chatting to the anaesthetist you wake up and are told it’s all done. And so it was. Except that about 10 hours had passed, which is longer than the 8 suggested beforehand.
But once I knew Master had been contacted, I put that stuff out of my mind. Instead I concentrated on my lovely nurse and all of the people caring for me over night. There were no beds in the wards, at all. I would stay in recovery. It felt safe, and I was calm.
The longest night (and day)
As well as the usual vital sign observations there are checks on the sites (donor and flap as they call them). Plus the drains etc. I had lots of stuff that I won’t list and never concerned me. After while the intervals between checks increased, but it was light and bright and there is bustling. I kid you not that every minute lasted an hour. I’d close my eyes, imagine I’d drifted off and open my eyes to see that the time on the handy nearby clock had move by a minute, or if I was lucky 2.
Damn the hours took weeks to tick by! Powered by adrenaline and the friendliness of those around me, we filled the hours pretty well. By 6 I was dreaming of tea and a bed in a nice ward. The fact I threw up soon after ought to have warned my that I’d have to wait for both.
The doctors pitched up at 8ish and suddenly people were less happy with the flap. It was less warm than the rest of me (and I was damned hot) apparently the blood vessels weren’t making quite the right doppler sounds. I’d need to go back into theatre so they could work out what might be going wrong.
By 1045 I was back in recovery and being welcomed by my own nurse. From there things went well, except there were still no beds. Over time the beds around me began to fill with others newly out of theatre, many of them day cases. But these were Wednesday cases rather than Tuesday as I’d started out.
At last, sometime during the early evening I was able to have a cup of tea and a biscuit and then finally came news of a bed.
I was lucky enough to be given a room on my own and still at that point warranted a nurse to myself. Only those with specific training are allowed to care for those after this surgery. The ward was actually for private patients, but it seems the NHS is using quite a few of the beds. The staff are all NHS anyway and I am not here to promote or otherwise any such facility. On Wednesday evening I was just grateful for a place for me and my bed.
Milestones over the past few days have been important. The first time out of bed (dizzying but important), cleaning my teeth after 2 days (yes!), first time out to the bathroom, first visit from master. But the best thing of all was yesterday when I was allowed to shower and wash my hair. It looked ok, just felt horrible. I also felt I’d developed a weird hospital smell, which I’ve never encountered before.
This is the start of a very long road, but I’m totally up for it. A mixture of little bursts of activity followed by long periods of rest. Right now, I’m sore but not in great pain. I have a very tight tummy with glue for stitches, but unlike when I first got up I have no feeling I’m about to split in two. I’ll write more about this process as I go through the next few weeks. What I do want to write about though is what seems to be happening in healthcare right now.
The implications of trying to catch up
For 18 months or so very few people on surgical (and other) waiting lists got treated unless their need was urgent, or suddenly became so. Over the course of 3 covid surges all people could do was to fight fires and it’s great that this is changing. Thankfully the most recent increase in cases hasn’t seen a parallel rise in needs for hospital beds. Staff who were previously deployed to covid response are back doing their usual job. But that doesn’t mean that things are normal, because even though distancing has been reduced, it is still in place. Just because patients in their beds don’t wear a mask, the staff all do, all of the time. It means that the experience of working in hospital and being a patient is different from how it was before. Added to that, people are tired.
I know this from my own work in hospital. Tired and also reconsidering their long term futures, bringing forward retirement plans, considering new options. But the government are dangling the carrot of money for innovation and ways where waiting lists can be reduced without the need for thousands of new staff. This is because there aren’t thousands of people waiting to join the workforce.
The hospital providing my care is huge, with a very large staff and big management structure. I’ll hear nothing said against any of it, because I can see that from top to bottom everyone is doing their best. Not just that, but they are trying to find ways to do what’s asked and go beyond. I also know they are trying to support their staff in any ways they can. I work for them and am a patient.
But streaming numerous patients in daily to clear the backlog even with sufficient staff comes at a price. Those providing the care and those receiving it are human beings. Even though it looks like a conveyor belt and in many ways is, kindness and compassion endures. If someone needs a longer explanation, more time to recover, to go back to theatre, then it happens. If it takes 5 days in a hospital ward rather than 3 so be it. Plus if the need of someone win the emergency department is greater than that of a routine admission then the emergency gets there first.
While my surgery team were operating on me, a situation arose that meant there already was no ward space to put me in. Nor others that day. On Wednesday, Thursday and Friday, operations were cancelled and no doubt other difficult decisions were made. A system with little capacity to flex will sometimes (and perhaps frequently) grind to a halt. I can’t imagine how difficult it is to work in those conditions. I only know this because a friend told me. But it makes really good sense and I remain grateful that my surgery took place when it did. Grateful too, that everyone kept my best needs at heart at all times and kept me safe. Glad to be home, to be recovering and to have had such a good experience.