Abstract: Lung-form blogging at its cheesiest.

Tags: thoracotomy, empyema, decortication, cheese, collapsed lung, chest infection, pleurisy, NHS,

Last week I met a beautiful young Hispanic woman and we spent the night together. She cared for me deeply and carefully, and I gazed upon her lovingly as the morphine (d)ripped through my veins. She checked me out and made sure that everything seemed to be in working order.

‘Hi, I’m Sofia,’ she said.

‘I’m going to be looking after you tonight.’

Thanks to the morphine, I carried on smiling and Sofia carried on with her job of nursing me through my first night after my thoracotomy on the high dependency unit of the five star NHS hospital I was staying in.

I had quite a good time despite drinking nothing but water the entire evening. We shared a few bottles together - Sofia would hand me an empty one, pull the covers around me and I would half-fill it and hand it back to her so she could measure and record, discard and disinfect. She checked my tubes and drains to make sure they weren’t getting clogged up with ‘cheese’ or any other unwanted dairy products. She made sure that my drains were working properly and that I was getting enough suction (stop it!). In the morning, she washed my back. My only regret is that half-way through the night somebody much more attractive ill than me was trolleyed through and Sofia spent more time with him than she did with me.

A good swing

So, Sofia had taken over from Gilbert, a beautiful young Chinese-looking man who I woke up with after my general anaesthetic. Gilbert was every bit as diligent and caring as Sofia and I don’t think this is just the drugs talking. I was amazed by the level of care I received throughout my stay, with one or two relatively minor exceptions, which I’ll come to later. And it’s not just because I was probably quite a good patient - I was calm, polite, not in any great pain or discomfort, doing well - eating, drinking, breathing, coughing and I had a ‘good swing’. Most of the other patients around me appeared to be quite a lot older than me and if not older then certainly in more pain or experiencing more problems after their operations. They were cared for with equal if not more time and attention as far as I could see and hear.

Who else do I need to thank for treating me so well? On admission to the hospital at 7 am on Friday morning I was met by nurse Martin, who seemed more nervous than me, but who handed me over to the highly organised Lindsay. Lyndsay wasted no time in getting me half-naked on to the bed so that she could attach clips and cables to my chest and stomach to run an ECG. Then she made me strip completely and wear a flowery dress. To complete my humiliation, she had me walk down to the diagnostic testing department in full public view where I had an x-ray. When I got back she wanted me to wear some thigh-high stockings, too. How could I resist her helping hands to put them on for me? Thank you Lyndsay!

Thanks also to Rick, the porter, for your sense of humour in wheeling me up and down and up and down again to the operating theatre where I’m sure everyone had a good laugh at me in drag. No doubt the pictures are all over the internet by now. And thanks to Dorcas, the clinical nurse specialist who spoke to me on the phone before I went in to tell me how bad it was going to be and who greeted me in the hospital before the operation with her hands - literally a nice touch, and one repeated by Lyndsay, Rick, Gilbert and Sofia later. A quick, simple touch to the hand, the shoulder, arm or elbow is extremely reassuring I find. Thanks for your humanity.

The cheese factor

Pre-operation, I also spoke to several doctors/surgeons/registrars or whatever they call themselves. They may even have had first names, but somehow if they did those names haven’t stuck. All I can really remember is being told that the operation would take 90-120 minutes rather than the 30-45 minutes I was expecting. This was due to the fact that they would be doing a conventional ’large’ incision of about 10 cm rather than the keyhole 2 cm cuts I’d been told I was going to have. The change of modus operandi was because of the ‘cheese’ factor - they needed to scrape the rind off the lung, not simply drain fluid. I signed the consent form. By this time they had me where they wanted me and I had resigned myself to my fate. What else could I do but submit? Yes, there’s a risk with everything, but carrying on with a lung full of cheese didn’t seem like a good bet.

Finally, Rick got me into theatre again after an aborted first attempt because my blood results weren’t back in time. This also meant a delay of an hour and a half, which didn’t affect me too much. I was kind of in a semi-meditational state I reckon. Either that or just frozen with fear. Now it was the turn of the anaesthetists to do things to me. Thanks to Belton (not Ben Elton) for painlessly finding my veins first time and inserting the cannulas that would feed the juice to knock me out and sustain me with fluids. All I can remember is a bit of aimless chit-chat, breathing deeply into the gas mask that was placed over my face and….

Chris the Crafty Cockney

Less than two hours later I woke up on the high dependency unit with Gilbert looking after me. At some point I remember my surgeon coming round to tell me, quite madly in his Chris the Crafty Cockney way:

‘You’re fixed!’

‘Thank you!’ I said.

Thank you, thank you, thank you!

After Gilbert and Sofia, I was handed over to Tara, who was a bundle of fun in our short time together. Tara couldn’t wait to get rid of me, though, and pushed the wheelchair herself to get me on to the main ward so that she could go and have lunch or something. I had been looking forward to moving wards actually. The high dependency unit was a bit noisy and a bit dull and now I would have access to my belongings that I brought with me - mp3/video player, internet, email, phone, etc. But when I was shown to my room (it’s on old private hospital bought by the NHS) I felt strangely disheartened and lonely. On the high dependency unit, Gilbert, Sofia and Tara were always within eyesight or earshot, but on the ward my new nurse Nas and everyone else was gone within seconds. I was still attached to two drains and my morphine drip, so I couldn’t go anywhere. I felt as helpless as a baby.

At least I was on the ward in time for the Manchester derby, the most important game since the last one. And my mum and step-dad John were visiting at 2pm. Lunch was forgettable - one of my few complaints is that the food was largely very poor quality. As I discovered on my discharge from the hospital, there is a very good coffee bar and staff/visitors’ restaurant in the hospital, which I believe is managed by the same company that provides the patients’ meals, yet the comparison is dreadful. I didn’t have much of an appetite due to the morphine, but it doesn’t help when you are served up slop that is worse than school meals of thirty-odd years ago.

Back to the footy. My mum proudly explained that my brother would be texting her with news of any goals.

‘That’s great, Mum. But I’m getting text updates from the BBC every few minutes on my internet tablet.’

BBC text updates on one of the most uneventful ninety minutes in the history of football aren’t much fun, but sustained conversation more than my brother’s updates.

BLEEP!

Crikey, a text from my brother to my mother.

‘15 seconds left. Scholes header. Game over.’

My mum read the text out loud.

‘What does that mean?’ she asked.

Oh, christ.

‘It means,’ explained ever-patient John, who is not a football fan:

‘United have won the game with a last minute winner yet again.’

‘Oh.’

‘What do you think it means?’

This remote victory barely raised a smile on my dry lips and hardly registered an increased pulse according to Nas when she took my blood pressure. It is surely my least celebrated United goal ever, although I did manage a laugh and a cheer the next morning watching the highlight on Match of the Day.

Sunday I had three separate visitors morning, afternoon and evening and I suspect I was fairly grumpy/tired during at least one of those, so apologies certainly to my dad. I have to say, though, that visits are extremely tiring and quite emotional. It’s no wonder hospitals advise no more than two visitors at a time. And when you’re in that state of post-op pain or discomfort, lack of mobility, tiredness, feeling sick etc., you’re really not much company. It’s great to see people, of course, but as a visitor you can’t expect too much from your relative or friend. And thanks, dad, for leaving me with the advice to get a hair cut and a shave so that I don’t look so much like Frank Gallagher!

A quick thanks also at this point to some more lovely nurses - Sarah, Yvonne, Nadia, Esther - sorry if I missed anyone.

Minor complaints

I mentioned earlier a couple of minor exceptions to the high level of care I received while in hospital.

One would be that the cannula on my wrist became loose, swollen red and painful. I asked one of the nurses about it and she said it was ok and bandaged it up (after dropping the bandage on the floor!) to hold it in place. Later another nurse came to use the cannula to inject my antibiotics. Now this can usually feel a little uncomfortable, but nothing more than that. This time I was screaming in agony. I pointed out the problem again and she said that it was ‘unacceptable’, removed the cannula, patched me up and fixed the cannula in my hand so that it could be used for both the morphine drip and the antibiotics, painlessly.

My second minor complaint would be that the same nurse who dropped the bandage came in gloved-up to remove my second drain, then went out again touching the door handle to call for assistance (two nurses are required - one to pull the drain out, one to tie the stitch, the painful bit). I asked her to change her gloves, which she did so willingly and acknowledging that she should do so. The point is that she should be taking the initiative not waiting for patients to prompt her. It’s fairly basic stuff.

My only other quibble is that I was discharged on Tuesday morning (four days after my op), barely able to walk more than a few yards without getting out of breath so basically forced to book a taxi home. They gave me some paracetamol, ibuprofen and dihydrocodeine for the pain, but for three out of the five days I’ve been home so far that hasn’t been enough to control the pain. It’s really been quite distressing for me and for my family to see me in so much pain and to be able to do nothing to help. I’m seeing my GP on Monday so maybe I’ll get some extra help with that.

The drugs didn’t work

I’m not sure how long it’s going to take for me to recover and go back to working full-time. As far as I know, I’m expected to make a full recovery, although I was a more than a little perturbed to read that post-op pain from a thoracotomy can take months or even years to go away.

I’m still not sure how this all happened. In January I had a chest infection and pleuritic pain similar to that which I’d had in March 2009 when I had a really acute episode of shortness of breath, fever and a consolidation on the same lung. That cleared up quickly with antibiotics and an inhaler. This time around, the drugs didn’t work, so my body responded by sealing off the infection in my lung by surrounding the lung with fluid.

Unfortunately I tried to work through this in February, which left me feeling too exhausted to go get an x-ray right away. Once I got the x-ray I was admitted to Accident and Emergency immediately where they did some tests to rule out heart problems, I think, before sending me home. Then I had to wait five weeks before seeing a chest specialist and another week or two before getting the results of fluid samples and a CT scan.

Hard cheese

As luck would have it, all of these tests were negative (ruling out the likes of cancer and smoking as possible causes, as far as I know). But the build up of fluid had continued and I had progressively felt more and more physically and mentally tired. My surgeon was certain that I had what is known as empyema (the hard ‘cheese’ as he called it and that I talked about earlier) and this required decortication (scraping the rind off the lung) via a thoracotomy (an incision along the underside of the shoulder blade).

As it turned out, I was told that the scraping bit wasn’t required, which is great news as that would likely have damaged the tissues of the lung. I’ll be seeing my surgeon again in a week or two I think and the chest specialist next month. I’ve been told it’s still possible that I could have tuberculosis, although there is no evidence of that yet (it takes a while to show up apparently). Meanwhile I’m taking antibiotics for pneumonia - if I don’t breathe deeply and cough well enough I’m at risk of getting a chest infection. And, despite the lovely nurses, I don’t want to go there again!