John McLellan: Step for medics, giant leap for me

The flow of patients coming in and out of surgery is routine stuff for the professionals

The snores, groans, buzzers, monitoring machines and nurses’ chatter are the theme tune of a regular night on most hospital wards, and on the ERI’s Ward 102 those facing operations the next day are offered a calming tot of whisky or sherry and sleeping tablets, something I’d been determined to do without.

But the night crew had also been ordered to clean up so the percussion was provided by pail handles, scraping furniture and clashing drawers.

It’s all normal workplace stuff, but it’s 11.30pm and I’m having a heart operation tomorrow. Gimme the bloody tablets . . .

And so six hours later, Nurse Big Dave* gets me up with some tea and remarkably fresh and warm buttered toast. The bustle of the previous night continues with further checks and visitations, especially as Norrie in the next bed is having his operation at the same time.

“It’s a very big day for you, but a very routine one for us,” says the assistant anaesthetist, something I’d rationalised myself over and over, but it was still good to hear it said again and be able to see the sincerity in his eyes. He’ll say that at least twice a day, every day, but it will never matter less with each repetition.

Our room of four has two on the day’s list, another chap from the Highlands going tomorrow and another, Graham, back from intensive care to recover.

With three of us facing ops, the tension is tangible, broken when Graham tries to move and bangs his head on the overhead TV.

“He survived the operation but he got killed by the telly,” roars Norrie, whose gallows humour is as welcome as the anaesthetists’ reassurances. Norrie says the stuff which we all think but which makes the staff’s eyes roll.

“Oh here we are, the banquet before the guillotine . . . Aye, we’re the condemned men . . . We’re for the butcher’s knife today . . .” That sort of thing.

He’s been in for a fortnight since a suspected heart attack, so knows the routine and all the staff and this  afternoon is the first slot available for his operation.

Poor old Graham has difficulty communicating; not only is he almost completely deaf but speaks with the dense Borders accent heard at places like the Kelso Ram Sales. The nurses have trouble getting through to him, and when they do they don’t understand his replies, so Norrie tries to act as interpreter.

Ordering breakfast proves almost impossible. “Gie him porridge,” says Norrie. “He likes the porridge because he’s got nae teeth . . . Well he has got teeth, but ah’m no putting them in for him.”

10.30am is shower time, with a strange watery, disinfectant shampoo more like sheep dip to minimise the risk of infection. The thin towels are like sandpaper and getting dried is more scrubbing off a layer of skin.

So we’re washed and gowned and ready to go when a nurse dashes in and whisks the curtain round Norrie’s bed. “I’m afraid I’ve got some not-so-good news,” she says. “There has been an emergency admission and as your surgeon is on call your operation has been cancelled. I’m really sorry.”

He is devastated and the banter stops. The room is silent and I’m gutted for him. It feels wrong that they carry on with someone like me who is not unwell as such and has only just arrived, but put back someone who has been there for so long after falling ill, but that’s the system.

Moments later I’m wheeled away and Norrie wishes me luck but the devastation on his face could not be clearer.

Down at the theatres, the assistant anaesthetist finds it awkward getting a line into my left arm and eventually goes for the right. “You won’t remember any of this,” he says. Wrong.

What feels like sticklebricks, but which must be brain monitors, are pressed into my forehead and we’re all set. I haven’t noticed the effect of the Temazepam I’ve been given earlier, but that must mean it’s worked.

“We’ll just put you out now and the next time you see us it will all be over,” says the anaesthetist. It’s about 1.30pm but the next thing I know I’m half-awake in intensive care, wires and tubes coming out of orifices which weren’t there before and one which was. It’s about 6pm.

A nurse tells me the operation has been successful but I get confused and think they have had to replace the dodgy valve, which would mean a lifetime on blood thinners, rather than just repair it. She is quick to reassure me.

And then she puts Mrs M on the phone. The ordeal for the family has been far greater than mine, I’ve been asleep after all, but a few words from me are more reassuring than anything a doctor can say. I don’t have much news – I wasn’t expecting calls in intensive case.

From a customer’s point of view, with drugs coursing through every corpuscle the windowless ICU is always going to be a very strange place. Time has no meaning and what seems like an hour can actually be only a few minutes; real conversations swirl with imaginary encounters and the flow of staff is almost constant.

Each of the 11 patients has a dedicated nurse, perched at the end of the bed like a gnome, watching the monitors, carrying out checks and being on hand to reassure the conscious.

By Wednesday morning I’m recovering well enough to return to 102 and by chance it’s also back to Room 8. Graham and the Highlander are still there but there’s no Norrie. “He’s just gone for his operation,” says the Highlander. I’m so pleased for him.

The full impact of the operation only sinks in with the need to move, and finding the simplest tasks need pre-planning when attached to half a dozen tubes and lines. That and the foot-long scar down the middle of my chest.

My first shower involves me sitting on a chair with a male nurses washing my back. Like they said, a different kind of day for me, routine for him.

Wednesday is a blur of pills, tests, examinations, meal times and visits, all shrouded in the fuzz of the morphine drip administered at the push of a button when the discomfort gets too great. The gurgling of fluid around the wound doesn’t sound too great but no-one seems overly concerned.

The food is what you’d expect and that hot toast on op day turns out to be a high point. The porridge is a gloop for hanging wallpaper and the safe option is to stick with sandwiches. Happily, I lose half a stone during my stay, but I don’t think that’s the idea.

By Thursday the routine is clearer, but change is constant. Patients go for their operations, new patients arrive, staff on three-day shift patterns come and go and it feels like I’ve never met so many new people so quickly.

In comes Donald from Tayside, in his early 50s and looking like he runs marathons but has the same condition as me and has hit the wall. James from south Edinburgh has had a lung removed because of cancer and has an ounce of rolling tobacco to sell as a result. His condition deteriorates and another vacancy is created when he returns to high dependency.

He’s replaced by a lad in his 20s with a significant weight problem who does very little all day except stare at the wall. Life on the outside is going to be tough for him.

Getting around becomes a bit easier when the chest drains and the morphine drip are removed and full freedom comes on Friday when the urine catheter is whipped out. Ooya . . .

Pain is much less than I expected and although I’m a bit wobbly on my feet I can manage a walk. And there is Norrie in one of the other rooms, struggling with a minor post-op infection but looking ok and by the Saturday he’s back on top form.

The last act is to take away what they call trace and wires, effectively the jump leads for electric shocks to be delivered direct to the heart if something goes wrong. They come out on Saturday and it’s home on Sunday morning.

I am wheeled all the way to the exit – they take no chances until you’re off the premises – and less than five days after the operation I get my first breath of fresh air.

Well, not quite. An ERI inpatient hasn’t truly returned to the outside world until they have passed through the unavoidable fug of cigarette smoke permanently enveloping the main door. It’s a bit like the transformation in Stars in their Eyes; take a deep breath, walk through the mist and you’re back in civilisation a new person.

*Names of all patients have been changed to protect confidentiality

Sincere thanks

My sincere thanks are due to every member of staff involved in my care, all of whom displayed great professionalism and good humour while under the pressure of helping lots of people far more unwell than I. It would be unfair to single any one of them out.

But my best wishes go to junior doctor Finbarr Maguire who is off to Glasgow’s new Queen Elizabeth Hospital to continue his training. I’m no expert, but I reckon you’ll have a great career.