Catheter

By Friday lunchtime I've got a severe pain in my bladder and I can hardly take a pee. All I can do is lie on my back, wince with each stabbing pain, and groan. A nurse comes by and I tell that I think I may have a bladder infection. They fetch a doctor. He prods, pokes and taps at my abdomen. A light tap is enough to make me shout in pain. A small group of doctors and nurses discuss what is to be done, there are veiled suggestions of checking the prostate, but the conclusion is drawn; no infection.

The blue curtain is whipped into place and minutes later I've got my bits sticking out of a hole in a large sheet of waterproof paper. The doctor applies some lube, and pushes a plastic tube inside me. I can't say it was gentle, though it probably was. It's supposed to be painless... On the second attempt I was "arrrrrrghing" at the top of my voice and eventually the tube entered my bladder. He had not yet connected the bag and so urine starts to pour everywhere. The nurse rapidly connects me up and then all eyes are on the calibrations on the catheter bag to see how much comes out.

It's a Foley catheter which has a small balloon inside the bladder to stop the tube falling out, or in my case, to stop the patient extracting it! Catheters are scaled according to "the French Gauge".  The French gauge was devised by Joseph-Frédéric-Benoît Charrière, a 19th-century Parisian maker of surgical instruments, who defined the "diameter times 3" relationship. 
The catheter is now my constant companion. I can feel it every time I bend at the waist. It's the strangest thing; not being able to stop yourself peeing. You can feel it draining out drip by dribble, non-stop. All day, all night. Periodically, the nurse measures the contents of the bag, and sometimes she empties it.

The Ward - H Bosch was 'ere

When I come to some sort of sensibility on Friday morning I find that I'm sharing a ward with 3 others.

There's an old Irish guy who knows everything. He tells the consultant what he should be doing. He tells the nurses how to do their jobs. He phones people and tells them how the nurses and doctors don't know what they are doing. He mutters to himself, probably to argue that he knows better than himself. He says one thing to one person and two minutes later he says something else to another. Total bullshitter, the whole time, non-stop. There's no peace. If I could move I'd go and shut him up.

There's a young father who wanders about carrying his catheter bag. It's full of a mixture of urine and blood, splashing about in a frothy mix for all to see. He speaks an East European language. His wife and small child come to visit. The child plays on the ward floor whilst her parents cuddle and my monitor alarms go off and the pain or drugs move my mind to strange places.

There's a guy, maybe late 40's, who has a fractured skull. He fell over and banged his head, but he doesn't know where or how. There's blood from his ears, but it's apparently a minor injury and they will send him home. He doesn't have any family. His mother died a few year

s ago. He lived with his mother all his life. He has a friend who might help. He has a speech impediment and maybe he's not the sharpest stick in the box. He's a floor polisher who used to work at a nearby hospital, but he lost his job. He stares, mainly at me. He stares whilst the nurses do things for me. I'm trying to take a pee in a bottle, and he stares. He stares while I'm in pain and about to get a catheter installed. He freaks me out. Shudders go up my spine.

The food is so bad that I can't eat it. Dry, over cooked, tasteless, and not enough to drink. There's no attempt to substitute for milk. A diet like this will have me losing pounds!  (After-thought: Why did nobody talk to me about nutrition for bone growth?)

They move the Irish bullshitter out of the ward. Not much later they wheel in a guy whose

bed is festooned with monitors, oxygen bottles, etc. He has a mask on, covering the site of the surgery, presumably a broken jaw, but he seems to be able to speak. The gas hisses and monitors beep. Maybe I looked like that the previous evening. Later some friends come to visit him. It's like a party. Joking, laughing, eating and drinking.

Pete appears at the door. At last a friendly face. He brought me ginger beer, jaffa cakes, and other sweet eats. It's nice to hold a relatively normal conversation, but I'm wired, a very strange over-alert state of fight or flight. It's a state of near panic. I really want to get out of the ward as quickly as possible. The nurses seem annoyed when I ask if Pete could have a cup of tea. I realise that apart from mealtimes, and my small plastic glass of orange just, I'm not drinking anything. The p

leasure of a cup has been absent for quite some time. I've been living on a drip.

Pete leaves.

The new patient needs to use the toilet so the nurse gives him a bed pan. He misses it, and then tries to clean up the mess ith his hands but just makes it worse. The nurses are angry, the ward stinks like... I don't know, but it stinks and nobody opens a window. I feel very ill.

A couple of hours later I am told that my request to move to a private ward has been granted. A nurse helps me move to a chair with wheels. She piles my bike gear, smashed helmet, and other chopped-up belongings in plastic bags on top of me, I feel like a bag lady. Then she wheels me off to another part of the hospital, (jeez the corridors are cold) and into a tiny single room that's full of furniture. But at last I have peace and quiet.

I tell the nurse that I don't want anythig and that I'm going to sleep. She tells me that I have to wait until I have had my obs done, and she's given me my drugs for the night.

She comes back a couple of hours later. I refuse the Tramadol because it gives me wierd spooky dreams. Imagine Hieronymous Bosch creatures and scenery on a sort of board game filled with little boxes each containing Bosch's monsters and moving around like

some 2-dimensional Rubik Cube.

I refuse another painkiller because it's an anti-inflammatory and shouldn't be used for bone fractures (according to the therapist). The nurse argues with me because she has got her instructions and the doctor knows best. I tell her to speak to the doctor and consultant and the therapist. Next day the drug regime has changed.

That night I sleep well. The catheter means that I can't roll over, but I do so in my sleep and the bed gets wet.

After the Op

I wake up in hell.

When I say "wake" I mean that I have become vaguely aware. It's dark. There are quite a few people standing around talking.

Beep beep beep beep beep beep beep beep...

I seem to talk to anyone who talks to me. When we talk the beeping stops. When they stop talking, I go away, the beeping comes back. It's not that the world goes away, instead I go down, falling into nothing. Again they talk, I know they are there. They stop, and again I go away, falling, sinking, stopping.

Beep beep beep beep beep beep beep beep....

There's a discussion.

"When we talk he's here, but then he goes..."

"Better do blah blah." "Blah blah". "Blah"

Going, gone. Stopping, stop.

I can feel my arm move, they're fiddling with something.

Beep beep beep beep beep beep beep beep....

Cold in my arm.

AWAKE!

Suddenly I'm in the room. There's four or five people here. My head is clear but I'm busy taking it all in. I get the impression that I'm in corridor under the hospital, in a basement. (I'm not. I'm in a ward.) I'm alert and talking. They ask me how I am, but I can't work out the answer, I'm completely stunned. I don't know if I'm standing, sitting or lying down. There's just too much to work out. What's happened, where am I, when is it?

"Better give him one more." Eh? What? Hang on...

Cold in my arm... a blinding heat goes across my chest, I think my heart is going to burst, there's a sharp pain in there. They're going to kill me! Help! Get a doctor! And now I'm shouting, going completely wild, I think I'm about to die. I have no idea what I said or did, but I know it got discussed with a few chuckles afterwards. Everyone seemed to know.

A young guy turns up, and tells me he's a doctor. He asks what's wrong and I tell him that I am panicking, I hurt, my chest hurts, I don't know what they are doing, I don't know that they know what they are doing. I want someone who knows what he's doing. Take these idiots away.

I tell him my colour is wrong. My hands are the pale yellow of old candle wax. Things aren't right.

He wants me put on an ECG. The nurse wheels in an ECG machine. It has a heck of a lot of wires. I've already got 4 or 5 wires attached to sticky pads across my chest, oxygen pipes up my nose, a drip in my left arm and an arm band on my right for blood pressure checks. The nurse tries to add more sticky patches, but I'm hairy and they won't stick to the skin. The hair gets in the way and they hang off me like moths in a web. She's pushing uselessly at the pads and they steadfastly flutter away from my skin. Then she tries to attach the wires. She can't work out which one goes where. Even I can see the numbers, why can't she do it? I tell her to shave it, but she just pushes fruitlessly at the pads. She pulls off the failed patches and tries more, tries different types. And the more she tries and fails, the more scared I become. Now I'm trussed up like Gulliver. I must have 15 cables attached, plus all the drips and oxygen, etc. One slight move and the sticky pads rip out a few more hairs. (I don't think the ECG ever produced useful information.)

I'm decide I am going to stay awake. I don't trust the nurses. There's a night nurse sitting at the end of the room.

I need to urinate. The nurse gives me a bottle, but I can hardly pee. My guts are turning over, so maybe my bowel needs to move. She gives me a commode and somehow I shuffle onto it. I pee a bit, but that's all. All night, pee a bit, a bit more. The nurse measure how much I pee, and is not happy with the results. I'm on a drip, but I haven't drunk anything, so maybe that's why.

She gives me painkillers. The world seems very strange, it's a dark and scary place. Why am I in a dungeon? I'm covered in cables, my leg hurts. I have some very dark and desperate thoughts.

It's still dark when the daily routine begins. Nurses taking "obs". Painkillers and antibiotics being handed out like sweets in paper cups. Every time they give me morphine there are always two people present. And every time they check my patient tag ask the same questions; "What's your date of birth?" before giving me the drug. The morphine doesn't have an obvious effect, but presumably it's reducing the pain. There are none of the more pleasant effects that people have told me about.

The nurse arrives with a massive syringe. Good grief! Is she going to stick that into me?! Luckily the answer is no. She connects it to the pipe on my wrist (they had to remove the elbow cannula because it kept bending and coming free) and pushes the plunger. My arm goes cold, and then I can taste and smell the chemicals even though nothing has gone anywhere near my mouth or nose.

However, the daily warfarin jab does go straight into flesh.

It's light, I've survived the night. But now a new level of hell is revealed.

15-17 December, or thereabouts

My memory of the next couple of days is somewhat blurred. Rather like a long journey through similar towns, I can't remember the order of events, and there are gaps in between the memorable places. A few days later I realised that not only was there are problem untangling the days after the op, but also that I'd lost most of my memory of the few days before the crash.

I seemed to be in a pleasant peaceful ward. The nurses would give me morphine and other drugs according to a laid down schedule. They measured my blood pressure and took my pulse routinely; what I now know to be "obs".

I discover that I have "Tib + Fib" written on the top of my thigh in large black indelible marker, and an arrow pointing towards where my tib and fib are normally kept on the end of my femur, and just above the foot. It reminds me of the Voyage to the Centre of the Earth, and Arne Saknussemm who marks his route with the letters AS and an arrow just like mine.

He asked me if I was in good general health and whether I played sports:

A consultant arrived with a small team of followers, rather like the trail of students following the opinionated and self important consultant in "Doctor in the House".

"Fitter than most, and I love kitesurfing, snowboarding, dancing, cycling..."

"Ah. You should be aware that this is a life changing event."

Silence.

He explained the damage and the two options;-

1. A post inserted down the fibia, and some pins across the knee.

2. Some metal rings around the leg, with pins to support the bone.

"The first option will have you up and about quite quickly, but there are more risks because we make more cuts. The second option will take longer."

"Which would you advise?"

"I can't tell you that because it would influence your decision."

Huh? ...Must look up the meaning of consultant.

I asked some questions, and then said I'd have to think about it.

A girl came to ask lots of questions about allergies and diet. I explained I don't drink milk because it gives me migraines. It all seemed OK.

Later that day another consultant arrived, this time without a troop of white coats in tow.

"So, I think we should put two screws in across the knee, and mount two rings around the break. After about a month you will be able to bear weight, and after 4-6 months we'll take the rings off. Then you'll wear a big plastic boot for a month."

It seemed that accepting the extra time in re

covery would insure against long term deformity, and meant less risk of complications. I agreed, and the long wait started. "We might fit you in today, or maybe tomorrow morning." I guess this was Wednesday, the day after the accident.

A very pleasant and friendly young lady wheeled a computer

into the ward and showed me the Xrays and the CT scans:

Tibia fractured with bits of bone surrounding the break.

Fibula shattered into 3-4 pieces.

"Nil by mouth" is imposed, and I wait for the call to the theatre. Late in the day I'm told that I can now eat, because I won't be needed until next day, but that "Nil by mouth" will be reimposed at midnight, so eat.

A guy came to ask me what food I wanted. The menu was brief, and a bit plain, but I opted for the jerk chicken. As it turned out, that was the only reasonable food for several days, or maybe I was just hungry. (The suggested substitute for milk was... you guessed; water! And if I didn't want cereal then I had to specifically request something else. I got toast and butter. errrr wow.)

I can't remember sleeping, or not sleeping. But I can remember thinking "Why haven't I needed to urinate?"

The next morning passed. More painkillers arrived on schedule. I called the insurance company. I spoke to my sister or mother on the phone (can't remember). I suppose I dosed.

Then I hear my name called. I'm not exactly ready to leap out of bed, so I wave an arm. We're off to see the wizard. ...And boy am I scared!

It's a long journey. I ask how many theatres they have, and the porter counts on his fingers. When he runs out of fingers he looks toward his toes. They've got a lot of theatres. As we roll into the pre-op area, the blue clad wizard and his apprentice are leaning nonchalantly against the door posts. "Here he is at last." The anaesthetists begin work. Tubes go into my arm, and as usual, they miss first time. We chat, and then someone is waking me up, I say something, apparently everything is ok.

I have no idea that almost 4 hours have passed since I entered the theatre.

Then I wake up in hell.

The Accident

Normal sort of day... leave the house at about 8 a.m. and chose the Ariel (vintage 1946) to ride to work. I could have used the Lambretta, but the speedo had been making a nasty grinding sound and I need to replace it.

Besides, it was a cold day and thermals under leather seemed a better idea than jeans under waterproofs.

Somewhere on the other side of the world a butterfly flapped its wings...  Trivial thoughts can change your world.

Normal route... up to Clapham North and join the Clapham Road toward Stockwell. No rush., just toodle along.

Normal traffic... well, that is to say that rhe car lane on the right was very slow, and the blue cycle highway was as crowded as ever, with bikes riding two and sometimes three abreast. I tailed a cyclist in the right hand half of the bus lane (yes, motorbikes are allowed) doing 15-20 mph. 

The cyclist in front gave me a thumbs up signal and pulled over to the left, presumably a sign of thanks for not pushing him by getting up close. Nice guy. (Just a second faster, or a second slower... If only.)

Suddenly a car bonnet appeared from the right through the traffic queue. I had no time at all, I barely even braked, and my only thought was "Oh no, not the forks!". I couldn't even say what type of car the bonnet belonged to, or what colour it was. I didn't even see a driver's face.

As it happens, the forks survived, but the bike bounced off the front bumper and my leg got between the bike and the car.

I can still hear the sound of the crash; the plastic bumper breaking, the headlight hitting the tarmac and smashing to pieces. My next thought was that I had landed strangely. (If you fall over a lot, then you get used to breaking your fall by rolling. But this time I slammed into the road surface like a rag doll.) Maybe bashing my helmet on the road pushed my head, or maybe I quizzically looked to where I had come from, but what I saw next was my boot arcing over to hit my knee. That is; my right boot containing my right foot, swinging over to hit my right knee. I grabbed the foot and threw it back to where it should have been. Well, at least it was still attached.

I shouted; "Get an ambulance!"

Then there was the smell of petrol, and someone asking if I was hurt.

"Broken leg, both bones! Ambulance!"

"And leave my helmet on."

A cyclist made a phone call, but amazingly the medics seemed to be there as fast as if they'd been teleported. Lot's of poking and prodding; "Right leg broken, both bones! Nothing else (I think)." The cyclist asked me if he should call someone. I gave him the name of another PM at the company, it would just have been too complicated to try to explain my boss's name.

I'd often wondered how much it hurt to break a bone. The act of breaking it is not painful at all. But few moments later... Argh.

The medic tried to give me gas. I refused for a moment. I got the cyclist to extract my phone from my pocket, and I called the mechanic who fixes the bike for me. "Ned, I've had an accident, come and pick up the bike." "But I haven't left home yet." "Just come and get it please." And I told him where it was. Then I grabbed the gas and breathed deep, deeper and faster than I have ever breathed.

The familiar oily taste of nitrous (it doesn't really taste of anything, it's all in the mind) and the buzzy ears told me that I was now narc'd. http://en.wikipedia.org/wiki/Nitrous_oxide

An idiot tried to remove some plastic wreckage from under my broken leg. If I could have hit him, I would have.

The petrol really stinks. The cyclist turns the bike lights off.

"Can we cut your trousers?"

"Cut the ******g trousers!"

"On a scale of 1-10, if 10 is the most pain you've ever experienced, what are you feeling now?"

"errrr..... seven."

"I'm going to give you morphine. Is that OK?"

"Yes, yes, yes..."

I see policemen, and an arabic guy standing around. Lots of people, and stationary traffic.

I've used the term "scraped of the road" before. Now I find that it's true. They use a scoop to gently roll me onto a stretcher. Several people gather round, pick up the stretcher and I'm eased into the back of the ambulance. Something hits my leg, and it hurts.

Then the gas runs out. I can tell because the taste has gone and my head is clearing. I tell the medic. There's some discussion about a kink in the hose, but then they change the cylinder, and I'm cooking on gas again. I'm slightly perturbed to hear the medics discussing the bones in the leg, but they don't know the correct names.

Ambulances were not built for a smooth comfy ride. I seem to feel every bump.

Then we pull up at A&E and I think I'm at Guy's hospital (wrong), but it's changed... I'm wheeled into the A&E and they transfer me off the wheelie stretcher. The scissors come out and my clothes are cut away. Someone says "I'm going to give you Ketamine", and then the ceiling dissolves into dripping blocks of colour and moving lights. A ceiling tile drips down toward me, covered in beautiful patterns...

I wake up in a moving bed, on the way to a CT scan. Into a lift, along corridors, banging doors cause pain. I can see a cradle of plaster enclosing my right leg. Eventually I'm wheeled into ward, given some oral morphine, and left to sleep.