Showing posts with label operation preparation. Show all posts
Showing posts with label operation preparation. Show all posts

Thursday 24 October 2013

The Kidney Donation Operation - Oct 15th to 18th

This is my "diary" of what happened to me in hospital.  It's a bit long but it is intended as a fairly factual account for the benefit of anyone who wants to know what happens! You may wish to ignore it and scroll down to the entry for Oct 21st if you want to read headlines, opinions and emotions.

Tim and I were admitted to St George’s Hospital, Tooting on Oct 15th at 10.00am.  This timing, with a promise that we would be let out for a meal at 7.00pm on condition that we were back by 9.30pm, seemed slightly generous to me as I couldn’t see how we could spend an entire day doing admission.  However, we had a very busy day of interviews, form-filling, tests and a few injections, all of which would never have allowed me to read a book for more than a few minutes. Even Kathy (his wife) and Jane (my wife) did not really have time to be bored, and they were included in the drinks provided.  For the day there were no beds available (and they would have been pointless anyway) and we were given sole use of a day room (with TV) reserved, it seems, for precisely that purpose.  Tim had a small issue to be resolved so although we went for a quick meal at 6.05pm, he had to be back by 7.00pm. Soon after we returned, Tim was allocated a bed but I had to wait for one (in a different bay, deliberately) until after Jane had left with Kathy, and so I did not sort myself out until almost 10pm (after watching England beat whoever it was in the last World Cup qualifier).

My schedule for the 16th was to have a shower and shave as soon as I woke at about 6am, and then get dressed in surgical gown and surgical stockings.  These stockings were knee-length and have a hole at the toes; this hole is really annoying as it gets wrapped around your toes in uncomfortable ways, and needs constant adjustment later – I got very good at asking anyone who came (regardless of their position) to sort them out for me.  I was told later that the hole has a purpose in the operation so that they can see your toe-nails which are a useful indicator of your condition.

Thus before 7am I was sat there ready and waiting for something to happen. Slowly people wandered past and did or said things.  One was the nurse in charge of the night shift who said that she was expecting the anaesthetist as he hadn’t done his form (which she was clutching), and then she looked worried when I said that he came yesterday and definitely filled in a long yellow form; later she returned and said that she had found the completed form filed in the notes in the wrong place! Tim and I had a nurse assigned to (just) us for our time in hospital, and he arrived at 7.30 to check my preparations.  Then he accompanied me as we walked to the operating theatres at 8am after I had a quick goodbye with Tim, who would follow later. St George’s overlap the two operations as much as they can in order to minimise the time that the kidney is uninstalled, so his would not start until they were almost ready to remove the kidney.

The same friendly anaesthetist met me in his room which is between the two theatres. His West Indian assistant reminded me of a friend in Bermondsey and called me “darling” in the same way that she does sometimes. Then he put something into the cannula and the next thing I remember was waking up in “Recovery” (which I keep on calling “Resuscitation” by mistake!), being told to “wake up, it’s all fine” or similar. It turned out that it was about 2.15 and I had been there for about an hour; given that they spent a while sorting me out (intubation, positioning, covering etc) in the theatre, I had actually been operated on for 4 hours, which was longer than I expected. Within 30 minutes I was fairly conscious, in time to see Tim wheeled in beside me and be told that it had all gone fine for him as well. Looking across I could see two large bags of fluid – one was largely blood and the other was definitely urine, so I thought to myself “well, it’s working, so that’s all right”. I think Tim actually came round enough for me to catch his attention before I was away down to the Renal Ward at around 4pm (after a delay getting a porter). Once installed in Bed 5, before I could take stock of my surroundings, there was a relieved Jane, having ignored instructions and been hanging around the hospital since 1030am! 

Now, I knew it was inevitable that there would be a number of things attached to me: there was a catheter, a wound drain, an oxygen pipe under my nose and the supply from the “Patient Controlled Analgesia” (PCA).  I also wanted to have available to me the call button on its lead, the control to use the PCA and the control to do things with the clever bed. I now had two cannulas (“cannulae”?) on my left hand, both of which tended to catch on the bedclothes.  This adds up to a large number of things draped on and around me, so it is hardly surprising that I felt uncomfortable, especially remembering the stockings which were now making their presence known. The PCA is a device which gives me a regulated amount of morphine and also allows me to administer extra doses through the system at my command, but it is set up so that you cannot overdose.  I was encouraged to use it generously before pain hit me, but truth be told the side effects were probably worse than the pain that I was suffering. 

Apart from some abdominal gas pain (mostly indigestion, I think) and the same gases pressing on the main wound, I felt pretty good.  I was also feeling hungry and so the sweet young woman doing the meals found me a yoghurt but this was a mistake as eating less than half of it gave me additional indigestion! 

Jane left at about 8.30pm and I thought about getting some sleep.  However, there was sudden activity and the occupants of the other beds in the bay were on the move; the nurse in charge explained that they needed a ladies bay and that I would be moved to Bed 1 which is a single room! Great excitement – I might be able to get some darkness, peace and quiet. So my bed (with me), my table and cabinet, were wheeled off, accompanied by other assorted items such as the PCA. Shortly after that, the surgeon looked in; she was on her way to do a transplant - somewhere a family was grieving, but someone on the transplant list had received "the call". She also popped in when she finished after midnight, which was sweet of her.

It is not really surprising that I had a poor night’s sleep, with regular interruptions for “OBS” (observations – blood pressure, temperature etc) and “MEDS” (medications, of which I have no real memory but I know that some were to counteract the side effects (e.g. nausea and constipation) caused by other things). It also did not help that once I was propped up, my bedside cabinet was now behind me and I could not stretch or reach, and then, once or twice, my jug of water was left out of my reach. I developed a tactic of asking whoever came in to do anything I needed regardless of their responsibility, so once it was a doctor who closed the blind and adjusted the stockings. Once, when I wanted to know the time, my watch fell off the table and I managed to lower my bed so that I could see it then shine the light on it. Somehow I forgot about the call button for this purpose!

Following an operation, the night is there to be endured rather than enjoyed, so the arrival of the Thursday morning activity was a real joy.  Unfortunately that started with a visit by the duty registrar at 5.05am (I’m not kidding!); twenty minutes after she left there were more OBS and twenty minutes later there were more MEDS, so I had no sleep between 5 and 6 and that was really when I felt I might actually have got to sleep. Drat.

Eventually there was the ward round. This is a semi-formal visit by the entire team plus a number of hangers-on, so it was interesting to see the surgeon plus at least three other doctors, plus three nurses and about four students all try and fit in this small room.  The form is that one doctor (the 5 o’clock registrar above) introduces me and my case, everything is considered (OBS, fluid input/output) and after questions then they decide what to do with me. One question is always whether you have had a bowel movement (Eh? I’ve eaten nothing since Tuesday evening and my bowels are in shock – what do you think?). The decision was to release me from all the connections except for the drain and changes were made to my MEDS – from now on I was only on paracetamol for pain relief. The really impressive thing was that the doctors in turn rapidly say what they want and the nurse in charge does not seem to write a thing down, but it all seemed to happen.

So, soon after, I was almost free (just that wretched drain with the plastic bottle on the end).  The removal of the catheter means that you have to record your own fluid in/out (and there is a lot going out, frequently!).  Come lunchtime, although I tried I could only face a steamed pudding dessert – no main course. It was the same at dinner time.

Just after lunch someone arrived and announced, without warning, that they were going to weigh me.  They didn’t seem to realise that I had not got out of bed since the operation, so it was with some trepidation that I attempted this slowly. After being weighed in a sort of special chair, I sat back on the edge of the bed feeling none too good – that had all happened far too quickly for my liking. However, I resumed my position on the bed and slowly things got better.  A few minutes later the surgeon appeared and asked if I had seen Tim yet? No, I had in mind that I should be waiting for the physiotherapist.  Forget that, get up and see him was the surgeon's instruction so, with the help of Jane and the surgeon, I got to my feet and put on my dressing gown (and the drain bottle fitted in a pocket).  This time it all felt much better and it was good to go down the corridor and see Tim.  At the nurses’ station was the physiotherapist...

Tim was looking good and I only stayed a short while as some of his family had arrived. Back in my own bed, some of my family arrived as well. Then the surgeon, consultant and a couple of other doctors came to see me (not doing a ward round, just a visit) - again, lots of people in the small room. One of my visitors was another brother, Duncan, who is a GP and with whom I was to stay when I left hospital; Jane cleverly introduced him to the surgeon and consultant and I am sure that this had no small part to play in my early discharge. So it was already quite a hectic afternoon when three of Tim’s young adult family came to see me – all beaming and smiling, so happy to have seen their father looking so well, and I felt quite humbled as they each, in their own way, thanked me for what I had done. Words were actually unnecessary as their thanks were visible in their eyes and faces. Later on, everyone left, including Jane, and then I was disturbed by another of Tim’s sons who was not to be left out.  Fortunately his mother took him away fairly soon, as I just crumpled with the emotion of it all. This was an aspect that I had not previously considered at all – the gift was almost as much to these loving kids as it was to their dad.

After all that it would be good to say that I had a contented good night’s sleep, but I didn’t. I was all settled down comfortably when the nurse came in with an “I’ve got bad news” look on her face. “I’m really sorry, Matthew, you’ve got to be moved - we need this room for an infection control case.” “OK, when?” “Well, right now actually.” There was a bed for me in a 4 man bay but she reckoned I would have more chance of a good sleep in the dialysis room which was empty, so there I went, on foot this time.  I lay on my bed with my earplugs in, thinking that I was free of pain, quite comfortable considering and very tired – so apart from the gurgling machines, why couldn’t I get to sleep? The answer soon came, although I didn't realise it at the time. At about 10pm someone came to do my meds and my temperature was up and my O2 level down; the next OBS were done by the nurse (temperature 38.8!) and then, at midnight, the duty registrar took some blood. They thought I might have a slight chest infection and needed an X-Ray, so at 2am I was wheeled by a burly porter through an eerily deserted (and chilly) hospital to A&E where a bored duty radiographer sat huddling under a blanket - at least she could now feel useful! Back to my bed and at about 4am I was given a huge dose of antibiotic through the cannula. 

By 7am my temperature was back to normal and I was back in the proper bed in the bay, ready to face the ward round with confidence. The surgeon popped her head in when she arrived - she had gone into the single room and found that I had been moved, and said that she would be back soon on the ward round. In fact it was quite some time before they came but I need not have worried – the consultant said quite clearly that he thought that my recovery would be faster in my (doctor) brother’s home than in the hospital and so it was agreed. All that was needed was the removal of the cannula, the drain and my dressings, provision of a large bag of medication and some instructions; these were all duly carried out and, by 1pm, I was shuffling out of the entrance to the car park to be driven to Duncan's by Jane, a mere 48 hours after the operation.

Friday 11 October 2013

See you Tuesday, Brother!

"I'll see you next Tuesday then, don't be late."  I think that was the moment yesterday when it hit home to both of us that we are almost there.  It's 20 months since I volunteered and at times things have moved slowly but the last few weeks have rushed past.

We were at the hospital yesterday, and it was the last time for me as the operation will be performed at a larger (and better known) hospital nearby. The purpose of the visit was, as ever, for some more blood samples; these were the ones for the last minute cross-match.  This had puzzled me a lot as no cross-match was done at the start of the process, which seems odd for such an important thing.  This has been explained to me and I think it is something to do with the fact that we are both blood group O, so there are no antibodies present, neither has Tim had any introduced by any treatment. (You can tell I am still a bit puzzled by this.)

Anyway, asuming that is still clear (and there's no reason why not) then we are all systems go to turn up on Tuesday for admission starting with a set of very last minute tests and various interviews/meetings.  They often operate on two pairs on the same day but we are the only pair being done next Wednesday.  This is good because it means there's no issue of being second and having to wait around until noon, so I'll be going down between 8 and 9am with Tim following at some suitable point during my operation.

Life has been a bit hectic as I have been finishing and handing over lots of jobs.  I think I'm finished outside but inside the house still has a few little tasks, and my churchwarden duties (of which there are a lot) are getting dumped on anyone I can!

It now seems that I am expected to hang around near the hospital for a few days until I see the surgeon again; this should now happen on the following Tuesday and, if all is well, I will come home that day. I'm grateful to another of my brothers for looking after both of us for that time - apart from accommodation I think he is also providing a taxi service for Jane to come and visit me (but we'll know more about that on Tuesday).  After I come home, I think they intend to transfer my care to my local transplant centre. I am very happy with this as I was treated really well by them when they did all my initial tests, and it will be good that they have the interest in my long-term care.

Saturday 13 July 2013

The Date is Set - Again

Positive progress at last.  Tim and I met the surgeon again a week ago, and confirmed that we were still fit and healthy.  Then yesterday the transplant nurse confirmed that a date has been set (again - see last time) for the operations, namely October 16th.  This is the date we agreed tentatively at our meeting, but this time (unlike last time - see here) they waited until the team meeting every Friday had confirmed the decision before telling us it was set.  We did have options to ask for a September date but this is out due to family events like a wedding.

Since Tim's eGFR is still just above 15%, what has changed?  I think basically they have accepted Tim's evidence of being less physically fit this year than the same time last year, and therefore on the basis of his reduced quality of life, they have accepted that the operation should go ahead.  I suppose that eGFR is not the only symptom but is used as a convenient measure which covers most cases, but not this one!

Now, I still need to have the HTA interview, and this will be booked for September.  I also need to have another ultrasound - I think they like to have this one really up to date and my previous one was in August last year, so will be 14 months old. Hopefully this will be fixed for the same date to save me too much travelling.  Then we're ready to roll!


Monday 17 June 2013

Possible Progress

My brother reported to me recently that he had taken a few days off and visited the same place as last year at the same time.  So he did the same walks along cliffs and beaches as last year.  And he found that he was far less fit than last year and couldn't do these same activities as easily (or at all).  But according to the hospital, his kidney function is still as good now as it was last year.

Now the kidney disease is the only thing wrong with him, so what's going on here? Why is he feeling worse when they say his condition has not changed?  They haven't given him an answer, but there is now a suggestion from his consultant that as his quality of life is reducing, perhaps he should be given the choice of electing to have the transplant sooner rather than later.   His eGFR is still hovering at or above the level where they would recommend the transplant but it seems that, in his case, they will accept the evidence of the reduced "quality of life" and ignore the eGFR figure.  So, we could be back at the starting gate, looking at a possible operation in about October this year, by the sounds of it. I'm trying not to get worked up over this - they have changed their mind before so, until their team meeting agrees, I won't make any plans.

I once did a parachute jump.  After training, I actually found it quite easy to get in the aircraft and we taxied out; I was committed and accepted the imminent event calmly.  The decision had already been made and I wasn't reconsidering at that stage, just like now.  Then at 2,000ft I waited my turn, and then did all the right things when the jump master shouted at me.  I think that was the military part of me, responding to training and not looking down as I stood at the exit from the aircraft.  In the same way, when I had my colonoscopy (see this entry), I just accepted the treatment and didn't worry at all about what these professionals were going to do to me, or the possible outcomes.

In any case, I think my approach is to take it as a decision made and look only at the practical issues.  Perhaps I should think of it as though I was the one who was ill? In that case I accept that it has to happen somewhen; then my military training clicks in, I ignore the personal thoughts and just do what is needed.



Friday 22 March 2013

And backwards three places...

That didn't last long.  Today there was a team meeting where our case was discussed, and it was decided that the operation should be postponed until my brother has two consecutive eGFR tests of 15% or below.  Which could even be a year, they say.

At least I can get on with my house (see http://houseintheenchantedforest.blogspot.co.uk/)  but it really is quite irritating when you are getting yourself all psyched up for it.  And it's not as though Tim feels perfectly well, he's quite ill but he's just not bad enough!

Just to rub it in, 30 minutes after that phone call, the postman brought the admission letter for April 30th.

Thursday 21 March 2013

More Positive Progress

I've now got the Human Tissue Authority interview booked for next Tuesday.  I've not yet had the list of things to take but it includes a "long" birth certificate (which I can't find) and lots of photographs to prove that Tim and I have been part of the same large and loving family for years.

The "long" birth certificate is the one with your parents names on it, and I can only find the "short" one; this has been resolved by ordering a new one, which I shall pick up at the register office on my way to the interview.  This involved a couple of funny phone calls as the local authority registration office is only about 250 yards from the house where I was born (and where my parents still live); hence when they said "where were you born?", my reply produced a friendly response along the lines of "I walk past there on my way to work"!  At least it made the 7 day response become a bit quicker.  Then on their form they ask for the reason why you want a birth certificate, and I suspect that my reason was unique for them, judging by their reaction.

I've also had some more test results, and a copy of the surgeon's letter to my consultant which sets out her reasons for judging me suitable to be a donor - I think I'll frame it!

The test results include a PSA check - dunno what that means but it was a blood test about my slightly enlarged prostate.  This was the one from my ultrasound last year that was "probably normal for someone of your age"!!  Anyway, the transplant nurse has told me that it is fine, and the surgeon's letter gave me the result of my exercise ECG last week, which was also fine, apparently.  The important bit of that result is that there are "no ST changes" on the ECG; if you search for "ST depression" then you'll find what that means, and I think it's pretty important so that's VERY good.

So, essentially, apart from the result of my fasting lipid profile (i.e. blood test for cholesterol), I'm good to go.  This is good, as my brother has seen his own consultant this morning and she is very pleased with the operation date; had one not been set he might have been looking at starting preparation for dialysis.  I don't think he had actually realized how ill he is, and the setting of a date has been a bit of a shock to him.  So, the waiting really is over, and it's time to sort out the details of how to prepare for the operation itself.