Sunday, 27 July 2014

Top surgery 1: pre-op and op

I had top surgery on Monday 21st July 2014. This is a record for me, and for anyone who would find an account of the process useful.

Consultation, pre-op assessment and surgery

I had my surgery with Andrew Yelland at the Brighton Nuffield Health Centre. I met him on July 1st for my consultation and pre-op assessment. He was really nice and relaxed: chatty, informative, unfazed by questions and concerns. In fact, according to my mum (who attended the pre-op with me), he was a little too blasé - but my mum is a worrier and his casual attitude didn't worry me or put me off. He had a look at my chest and told me I'd need double incision (which I had already assumed) and showed me how it would be done. He drew pictures and took me through a list of facts, risks etc.

At my pre-op assessment I had my blood pressure taken, was weighed and measured, swabbed for MRSA, and told how to prepare myself for surgery: remove nail polish and jewellery, wash with a special sponge they gave me, don't wear deodorant  / moisturiser / makeup etc. The nurses were lovely. Oh, something I wasn't told in advance was that they'd need to take a urine sample. So save some up for that!

My admission letter told me that I'd be admitted at 7:15 on the morning of my surgery, but when I spoke to Ginny (Andrew Yelland's secretary) the week before, she told me I was last on the list for the day, so could actually check in at 11. That made for less of an early morning, but also meant that the 6 hours of nil-by-mouth occurred over a much less convenient time. I didn't have anything between 9pm on the 20th and 5pm on the 21st (when I came out of surgery). I was starving!

When I was admitted, I was immediately asked to choose my menu for the stay. It made me even hungrier, but at least I could look forward to my tea - pasta primavera and a cheeseboard. Then I was seen by a nurse (she had a student nurse with her as well) who took another set of "obs" as they called them (observations: blood pressure, pulse etc) and measured me for my sexy surgery stockings. She took me through a pile of questions about when I'd last eaten, if I had any allergies, had I washed, had I followed all my pre-op instructions, did I have my binders, etc, and then supplied me with a wristband with my details on it. 

After that, I changed into my gown and delightful paper knickers and stockings, and hung out until Andrew Yelland arrived to draw on my chest. Soon after, my anaesthetist (Martin Street) arrived to say hello, check again that I wasn't allergic to anything, and it wasn't long after that that two porters arrived to wheel me off down the corridor. Nothing makes you feel sillier than being wheeled down a corridor under a duvet on a hot day, when there's nothing wrong with you. 

I was fitted with a cannula and then given the anaesthetic, which felt exactly as the anaesthetist said it would: cold in my arm, then a strange taste in my mouth, then nothing. I was a bit disappointed I wasn't asked to count back from 10. I guess that's just in the movies.

When I came round I was pretty panicky. There was a mask on my face and I couldn't breathe very well - I was very cold and uncomfortable, and I think I was thrashing around a bit. I asked if I could sit up, which made me feel a bit better, and then they gave me a bunch of morphine, which helped me calm down pretty fast. The nurses there were very kind and attentive, giving me little sips of water and chatting gently about music and weather and the like. It seemed like no time at all before they wheeled me back to my room.

The time after that is a bit of a blur. I know I was pretty woozy for quite a few hours - my mum and partner were there and apparently I was quite incoherent and fell asleep a lot. I also told them about four times (allegedly) that I intended to have a pedicure when I was better. They suggested I skip dinner (which was to come round at 6) as it might make me sick, but I wasn't having that! They brought it as promised, and it was the most enormous portion of pasta I've ever seen, and I slowly ate about a third of it. It was the best meal. After that I was allowed a pot of tea, and I managed to not spill any of it on myself, which was amazing. During this time I had a lot of care and attention from various nurses who took more 'obs' and kept my temperature sensible (I was freezing, then too hot, and generally just a pain in the arse). I had an automatic blood pressure check every ten minutes or so, thinning out as time went on. 

My visitors left around 8:30, and I spent the evening listening to the Proms on the radio, slowly eating my way through the cheese and biscuits, reading my book (well, looking at my book) and watching something with Trevor Eve in it on ITV3. I was given some antibiotics at around 10pm, and some time after that I called a nurse (as I had been told) to help me get out of bed for the first time. I was dizzy but it was ok - totally failed to pee though. I tried to change into my own clothes for sleeping, but eventually decided that the gown was probably more comfortable. I had been told - and this surprised me - that I should stay fairly upright for the duration. It wasn't as uncomfortable as I thought - and it meant that I never strained myself trying to get out of bed or reach for things on my table. 

I fell asleep easily enough, and was woken at about 1:30 for pain relief and more obs - after that, I slept straight through until about 6:30, when I had more obs, pain relief and the final shot of antibiotics. Then breakfast at 8, followed by a revolving door of visitors: Andrew Yelland came to see me, told me it had gone well, and undid my binder - blessed relief! He had a look at my dressings, poked around a bit, and told me I could leave it open until the nurse came to fit my post-op binder. It was nice being able to breathe for a bit. The anaesthetist popped in, checked I was ok, and left again; a physiotherapist came and walked me through some exercises to do once I was home. The nurse who had admitted me came to fit my binder, give me my prescriptions and talk me through my post-op care. I wish I could remember her name, because she was particularly great - although absolutely everyone I met at the Nuffield was lovely and helpful and reassuring and friendly. 

I had a nurse carry my bag downstairs, and sat on the terrace with a glass of water, enjoying the sun, until my dad arrived to pick me up. The drive home was appalling. DO NOT ignore the advice to bring a pillow to protect your chest from the seatbelt. I had one, also a very comfortable seat and a very good and considerate driver, and I was still in quite a bit of pain (my journey took about 2 hours). I dozed most of the day when I got home. 

I want to flag up the benefits of using absorbent lint to line the rough edges of the binders (you can buy these from the Nuffield for £10, but they're cheaper from Sports Direct). If I wear the binder as tightly as I feel I should, the edges chafe painfully, especially around the top (I'm very broad-shouldered, so your mileage may vary). If I'd known to do this before the journey home, I would have been in far less pain that day!

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