Introduction
Well, things can certainly change in your life very quickly. This time last week I had a swollen stomach with an obvious and uncomfortable lump due to the presence of the “Alien” in my intestines. The “Alien” being some form of tumour, perhaps a GIST. I was feeling very uncomfortable, short of breath and was under a special diet and medication regime to ensure my health was good enough for the surgery to be carried out. The prognosis was a total unknown as my medical team considered a biopsy too much of a risk, hopefully, all would be revealed post-surgery. How far would they find the cancer had spread, if at all? How much of my intestines would have to be removed? Was it benign or malignant? What future treatment would be required? In summary, many issues which were unknown to the medical team let alone to a layman like me? What was in Pandora’s Box? I dealt with all these questions over the last few months with my prescribed “Bee Treatment.” That is, I locked them out the hive, the hive being my brain. There is nothing you can do with the unknown, although along the way, through the “good offices” of the medical team, we knew a lot more than from the time I fell ill in October.
Less than a week later, many of the answers have been found or will be revealed shortly. I got rid of the “Alien” by C-Section, not natural birth. Actually, let’s be honest, it was just a necessary abortion. The tumour, although very large, would appear to be localised and the surgeon only had to remove about a metre of my small intestine. Most importantly I can breathe freely now and a slight pain has now replaced the discomfort. The operation has really made a positive impact already. The one thing I did not expect was for someone to steal my belly button. It has gone! How is that going to look when I am on the beach in my Speedo?
I am not going to write about my Life Story or Investing in African Agriculture this week, but rather update you on medical events. So if your interest lies in my life story or farming, you may feel short-changed. Perhaps you are relieved and can stop reading now.
"Any experience adds to your knowledge. Try and be aware at all times to ensure you capture them, even if they are bad, often they are a once-off." Peter McSporran
Last week I did not write the blog, however, it still went out under my copyright even although I did not have anything to do with it. More than half of its content was a poem by Robert Burns. Kids and wife are very capable hackers. Even worse, it has had more hits than I ever got!
Medical Update
Having been on a high protein diet and completed all the required scans, tests, and exercises in preparation to enable my entry into the Enhanced Recovery After Surgery (ERAS) program. I duly set off to Coimbra mid-day last Thursday. I had taken a Covid test to allow for admission into the hospital. Fortunately, it was negative.
What followed was the most difficult entry into the ERAS unit at Coimbra University Hospital (CHUC). On arrival, I encountered the rudest person and most unhelpful front desk dragon since arriving in Portugal. As it turns out, it did not help that I was directed to the wrong surgery department by the downstairs “Covid guard”. I could have avoided her completely. Notwithstanding this, there was no excuse for her behaviour. On approaching the dragon’s counter outside the surgery department, the lady behind the desk had a look at my papers and then let rip in Portuguese. In informing her I did not speak Portuguese enough to understand her, she then almost shouted at me, “Do you not understand me? I am speaking English!” I know I am deaf but on Rozanne’s advice that day, unusually I was wearing my hearing aids. Until that last sentence, I had not recognised any spoken English. She then said the doctor was unavailable as he was ill. I should go home. I knew that could not be right. Communication with the medical team to date had been excellent. If this was the case, they would have informed me by telephone. In trying to argue the case, I then got the silent treatment. For goodness sake, I was not even married to her!
I calmed down, found a quiet corner and phoned the ERAS nurse allocated to me during the preparation. When I explained my dilemma, she, Annabella, said immediately “Wait there, I will come and find you.” What a relief. So on occasion language can be a problem, here I think it was someone whose own self-importance far outmatched their station.
Once in the safe hands of Anabella, I was escorted to ERAS B Ward and duly processed for entry. This ward consisted of about 10 rooms, most with two beds, the largest with four. I was allocated to a room with three beds, two of which were already occupied. I got to know these two gentlemen who made my health problems insignificant. I will not mention their real names, but just call them Jose and Silva. I immediately noticed there were no privacy curtains between the beds in these recovery rooms. Carrying out normal hygiene, ablutions, medical treatment and wound dressing could be viewed by all. As they were treating Jose’s wound on my arrival, I realised he had his leg amputated above the knee that day. It was not until later that evening when they treated Silva’s surgical wound, I realised he had undergone stomach surgery. A much larger wound was in evidence than I ever expected to require. Seeing these two stoic gentlemen taking their treatment silently assured I did not feel sorry for myself. Later that night Silva dislodged both his dressing on his stump and his arterial cannula. Blood everywhere including on my slippers. Of course, as soon as it occurred, the nurses were to hand.
I had now gone from high protein to high carbohydrate liquid food intake orally and then at night intravenously. I had two cannulas put in. One they started drawing blood from regularly, the other injecting various medicines, including antibiotics in preparation for surgery the next day. All my ten pills daily medication was stopped. I was also taking laxatives so a very sleepless, active night followed, not helped by a patient in a room further down the corridor who started howling like a wolf. I thought he must be in recovery, as it happens he was also awaiting surgery. I am not sure what caused him to howl, surgery definitely did not fix it, he continued to howl every night for the duration I was there. Strangely, he did not howl during the day and there was no full moon. The other distraction was the snoring in my room. I am certain both of my roommates were on heavy medication to ease the pain. Even in the army barracks after a heavy drinking session, I never came across such snoring. A cacophony that would have put the sounds that “Tam O’Shanter” heard in Alloway Kirk to shame.
Actually, as an aside, totally unrelated to my medical update, the one night coming home late one evening from the “Red Lion” at Harare Sports Club following a tobacco sale, I stopped for a pee at the Darwendale turnoff on the Lomagundi Road. Looking in full flow, I saw some ghostly figures approaching. I did not hesitate, zip still undone, I leapt back into the car and headed home full throttle. I do not know what I had seen, but they seemed to be able to walk unhindered through the roadside fence. Diane, my wife at the time was not impressed by my tale of woe when I arrived home. She put it down to drink, I was not so sure, being convinced I had seen and not imagined. I leave it to you to judge who had the right conjecture.
First thing in the morning of the operation I was off to shower with a special gel, aided to don some compression stockings from toe to groin, and awaited my departure to the theatre. I was expected to leave at about 08:30, this was delayed due to some earlier scheduled procedure that perhaps had complications. I had not met the surgeon since coming to the hospital, although over the last few months had continuous communication with the various teams involved. Due to the delay, I had to endure another shower and change of stockings. At 10:30 they came to collect me, so sent a quick text to Rozanne letting her know I was on my way into theatre. At that time we were unaware that she would be unable to speak to me for more than 30 hours. Very hard for her and the family, although she did eventually find a nurse who knew where I was that evening confirming the operation went well.
I am giving quite a lot of detail here, as the blog includes my cancer treatment, I hope you will bear with me. On arrival at the entrance to the theatre wing, I had my first surprise. There was not a door, rather an oblong hatch in a stainless steel wall. This was serviced with a hydraulic, highly mobile table which raised me to bed height. Other than the cannulas and my newly acquired tights, I was transferred in the “state nature intended” through the stainless steel hatch. The easiest way to describe the table is it was like one of those lifts on the back of a truck but with much more versatility in its movement capabilities. In passing through, I thought to myself, “Is this what an animal feels like entering an abattoir?” Once through the hatch, there would be no escape, in my case hopefully, I would return. In fact, I came out the very same hatch.
I was dumped by the “hatch table lift” onto a super-duper theatre table and wheeled into the actual operating theatre where I was welcomed by my team of surgeons, anaesthetists and nurses. My second surprise, I had not met any of them before. The surgeon, assistant surgeon, anaesthetists and senior nurses introduced themselves. The surgeon explained that it was going to be open surgery as the tumour had continued to grow. I was told previously this would be the case, so that was not a surprise. I asked him if he would take a photo of the “Alien” for me once he removed it. He refused and got quite animated when I coerced the senior nurse to ask a second time on my behalf. I thought he was grumpy, but meeting him post-surgery the exact opposite was true. His name was Professor Montero and was probably in his late fifties. The anaesthetist was slightly older and very much concerned about my heart to the extent I began to worry if they were going to operate. Needless to say, I should not have worried and before I knew it, extensions were attached to support my arms. They asked me if my arms were comfortable after adjustment. I now looked as though I was about to be crucified. At the time it felt comfortable, the next day my shoulders were absolute agony. Lesson learned, make sure you are really comfortable with arms aligned if you are being prepared for a long operation.
The next thing I knew some five hours later, I was waking in the same theatre with them all shaking my hand, saying the surgery had gone well. I was taken to the surgery recovery room at about 16:30 and given a dedicated nurse to supervise me. I was freezing and in much pain. As I said, I felt as if a horse had kicked me in the stomach. They had warned me I would have pain. Due to my medication for thrombosis, they could not give me an epidural to control the pain. They covered me with an electric inflatable blanket and two young doctors came along and informed me they were going to help relieve the pain. They explained it was a simple procedure. They had a portable scanner to locate the nerve ends at each side of my wound and once located inject a local anaesthetic into them. Magic. This certainly dropped the pain level. Following surgery and during your recovery they repeatedly ask your pain level. I put mine at 8 immediately post-surgery, although very painful, life has taught me things can always get worse. I reckon their efforts lowered my pain level to 6. Of course, everyone’s judgement of pain is subjective. I should mention a further cannula had been added, this one into an artery. I now stayed there an extended time, probably about two hours after the operation. At about 1800 the nurses and the person in charge got very animated and sent off for some different medication urgently. I realised later that the surgical team was monitoring my recovery remotely as well, the anaesthetist had become unhappy with my latest blood sample results. Anyway, that was soon fixed, I spent another three hours there. By then I was the only patient remaining in the post-surgery recovery room. I felt lonely and a bit concerned. Got a little bit of postnatal depression? It did not last long. At 21:00 they were finally happy, I was sent off to the high care unit. This was also to a very high standard and I was introduced to my recovery team. All the names I immediately forgot, it was only the next day did names begin to stick. I got no sleep that night. I was still being fed high carbohydrate solutions to help my recovery, plus many other medicines. They had stopped all my daily routine medications and was now being administered via cannula. Of course, all these high energy drips coupled with the removal of my diabetes prophylactics saw my blood sugars rise. To deal with this, they needed to administer insulin. I should have mentioned I also had a catheter, this did not stop me feeling like I was desperate for a pee all the time. They kept asking for my pain levels. I did not sleep due to pain and noise. I could medicate myself extra painkiller through the cannula by means of a trigger strapped to my left hand. The sound of monitor alarms going off continually, people's moans, at times you could hear people screaming due to pain and, or fear, were all not conducive to sleep.
The next morning after various people (medical experts) visited me, I was given a bed bath by not one, but three young female nurses. Why do these things always happen at the wrong time? I had other things on my mind mitigating any enjoyment of three young ladies washing my private bits. Once washed, they removed my catheter and I rested until 09:00, then transferred me to a chair. In high care, you have to use either a portable urinal or bedpan. I did not have to use the latter as my bowels were well empty. At 12:00 I was told I could return to the recovery ward in doing so rejoining my original room-mates. I was finally reunited with my phone and immediately called Rozanne, much to her relief. I was up and about for the first time after surgery and walked down the unit corridor later that afternoon.
I started taking some oral medication in the evening in the form of painkillers and heart medication. After the usual query, I said my pain level was now 4 against my original 8. They said I could take the painkillers if and when required at my own discretion and must not try to suffer too much pain. I had determined in my simple mind the quickest way out of there was not to complain of any pain, feelings of nausea or other ailments. I was given a high protein shake drink to take orally and the high energy liquid intravenous food was halted. I managed some sleep that night despite the numerous visits to the toilet due to the efficiency of the laxatives. The next day I still refused painkillers but continued the laxatives. On my early morning walkabout down the corridor; it was cut short as a patient had just been diagnosed with COVID-19 in the unit. A new real fear to perhaps impede my release? That day 13 separate specialist professionals came to speak to me and review my treatments. Silva, after eight days, was released and left happily. I wished him luck. I kept pestering the nurses about when I could be released. That night, I had another COVID test which was again fortunately negative, my second within the week.
The next day, the nurse informed me there was a possible chance of release, the surgeon and other senior medical staff would visit me shortly. Sure enough, the surgeon arrived and turned out to be a very pleasant man, not the grumpy one that denied my photo of the “Alien” for posterity. We had a long discussion, he said the tumour had been larger than expected. He said he had to turn it to remove it from my twenty-centimetre wound, this being the shortest cross-section dimension. In addition, he explained the tumour had not metastasized as far as he could see. He had only to remove a little less than a metre of my small intestine where the blood vessels supporting the tumour had been. He thought he had removed all the cancerous cells and was very positive. Of course, the long term prognosis would rely on the laboratory findings. If there was no problem, he would not contact me until we met in a month's time. He said you can go home. In my excitement, I forgot to ask him what he had done with my navel.
At 12:30, my darling wife picked me up and took me into her care. I probably overdid it a bit that day, as I did not take to my bed until 21:00 that evening. The next day, less pain and disappointingly ingestion of liquids only. I could move around in a shuffle similar to a crippled crab. The cardiologist, who was going to visit me in the ward before release, reviewed and changed my heart medication remotely. He was surprised I got released so quickly. We will start trying to fix my heart issues at the end of February he informed me. I am sure my quick release was as much to do with COVID-19 as was my recovery, which was excellent. Thanks to the surgeons and their teams and most especially, a big thank you to the team on the ERAS program. I have so much respect for all doctors and nurses in these difficult times.
"The nearest sensation to what I felt arriving home was that I used to feel each time we drove into Salisbury on army trucks after a tour of duty in the bush war. Huge relief." Peter McSporran
This was all done under the auspices of the Portuguese NHS. I could have opted to go private as I do have insurance, but having been dealt with very well in my original emergency decided to stay with them. In hindsight, I think it was the best choice. Thank you one and all at CHUC.
I asked Rozanne if she would like to add a paragraph, to which she declined, saying it might impede my home recovery. She has asked for a ‘rain check’ as presently, she is daunted by her newfound responsibilities. She is under much more stress than me. Having said that, she has also voiced her thanks to everyone in CHUC who worked so hard and treated me with such kindness and patience. She also thanks all our family and friends for the positive messages that she received and still continues to receive. I echo this in the same measure. Our sister-in-law, Anna Cary, has been fantastic in her nursing advice to Rozanne. Thank you from us both Anna. Rozanne feels much more confident after speaking to you and I can say that she has followed your advice to a “T”!
Disclaimer: Copyright Peter McSporran. The content in this blog represents my personal views and does not reflect corporate entities.
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