Marcia has been arranging an Angolan passport for Alex. Why, I hear you all ask, does Alex need an Angolan passport if he is British? Well, he is living in Angola as an Angolan. For that reason, unlike me, he does not need an Angolan visa. It does mean, however, that he can neither leave, nor enter Angola on his UK passport. This also means that he cannot travel to and enter UK (even though he holds a UK passport) unless he applies for and is granted a UK entry visa by submitting an application to the UK consul in Angola. At the British Embassy in Luanda, this process takes ages, weeks, can involve interviews, the payment of a bond and innumerable letters of responsibility and documentation to prove liquidity. The last time I flew my family back to Europe, and knowing what the British Consular Service is like, I went to the German Embassy, was immediately shown in to see the Consul who apologized to me for any inconvenience (it is very difficult to find a parking space near the German Embassy) but assured me that if I could return at ten the following morning, I could collect the passports complete with visas. Apart from the obvious chasm that exists between that which the English consider bureaucratic efficiency and the Germans consider satisfactory service, a notable difference between the two is that when I walk into the British Embassy I am greeted with, ‘Allo Tom, yu awiight? Be wiv yu in a tic!’ (at which juncture, they fuck off), whereas in the German Embassy the rather more formal and confidence inspiring greeting is; ‘Guten Tag Herr Gowans. Wie kann ich Ihnen behilflich sein?’
Today, Marcia had to take little Alex to the Angolan passport office in town to have his fingerprint scanned so that his biometric details could be included in his passport. The Angolan immigration officer was very nice. Marcia tells me he made a fuss of Alex, tried to make Alex feel very important with the special treatment he was getting. The official told Alex just where to place his finger on the machine so that he could get his… Angolan passport.
Alex snatched his hand away.
‘ANGOLAN passport!’ he yelled, ‘I don’t want an Angolan passport’, he continued in fluent Portuguese, ‘I am ENGLISH! I want an ENGLISH passport!’
I wasn’t due to have my vac dressing changed until tomorrow. Naturally, after the last time, it wasn’t something I was especially looking forward to. I know that last time I was wide awake and able to influence to a surprising degree just how the new dressing was applied so I was confident that its removal would be marginally less stressful.
We, and when I say ‘we’, I mean me and all the staff on the Infectious Diseases ward, have been waiting for the plastic specialists from the Royal Free to visit so that they could see the wound for themselves and decide on the next steps toward a rebuilt Hippo. I can fully appreciate that plastic surgeons don’t grow on trees and that their expertise is very much in demand so wasn’t the least bit surprised that they were not in any particular hurry to see me, especially considering the cause of my affliction has still not been positively identified. It would be disheartening all round to perform a skin graft only to watch it dissolve to slurry if the infection reared up again.
The ward sister is a busy lady but she usually finds time to pop in and see me at least once a day, a visit I look forward to as she is usually blessed with snippets of generally accurate intelligence. And so it was this morning. According to her extensive network of espionage agents spread through the NHS, there was a very good chance that a responsible individual from the Royal Free would pop in to take a shufti at the old port undercarriage. She had been advised, therefore, to have a team in to remove my vac dressing.
‘I’m not going to do it, though,’ she said, ‘because they all lie. You’ll spend all day sitting here with your wound drying out, best you stay comfortable and we’ll remove it when he gets here.’
Now that sounded like a plan to me so I settled back into my book.
A short while later, there was a tap on the door and a gentleman walked in.
‘Are you Mr. Gowans?’
‘I am.’ I confirmed.
‘I’m from plastics at the Royal Free, come to take a look at your leg. I’ve heard quite a story about this and seen all the photos…’ he paused mid-sentence, ‘Oh God, haven’t they removed the dressing? For Goodness’ sake! I’ll go and find somebody.’
Clearly, he was a man in a hurry, why shouldn’t he be, after all he is much in demand. Afeared I might lose the benefit of his long awaited advice, I ripped the dressing off. I am getting quite good at that.
He came back in telling me someone would be along in a minute. ‘Oh!’ he said, ‘that was quick!’
He peered at and prodded the wound. ‘Hmmn,’ he mused. ‘Doesn’t look bad, good granulation, all in all, pretty reasonable, all things considered.’
‘The view from your room really is impressive,’ he said as if noticing the existence of a window for the first time.
‘Yes,’ I said, ‘perhaps a little inappropriate for a hospital but certainly a view to die for.’
‘Yes, quite. Well look, Mr. Gowans, the sort of general plan is to whip you out of here in due course and into the Royal Free where we’ll shave some skin off you somewhere, probably your legs, stretch it out over the wound, slap another vacuum dressing on for a week and see if the graft takes.’
The one good thing about being around doctors is how one’s grasp of medical terminology improves.
The surgeon pushed off and the lovely Mia came in. Mia is a half Chinese Filipino and looks like an exquisitely hand crafted doll. Her voice leaves me with the delightful sensation of having just been caressed by angels.
‘The plastic surgeon has been in to see the wound so I had to remove the vac dressing,’ I told her, ‘now I need to fit the new one. I have the replacement vac dressing,’ I indicated a dressing that had been lying ignored on the top of the fridge these last few days, ‘but I will need gelnet, gloves and saline and something to put under my leg while I wash and dress the wound.’
‘You change your own dressings?’ she asked in astonishment.
‘Of course I do!’ I assured her, ‘one of the nurses actually videoed me changing the last one, do want to see?’
‘What is it you need?’ she said.
‘Gelnet, saline, a few small bottles of that, something to put under my leg and gloves.’
Mia returned with the kit accompanied by another Filipino nurse, a bloke.
‘You’re going to change your vac dressing?’
‘Yeah, dya wanna watch? Mia, can you lend me your marker pen, please?’ I addressed the male nurse, ‘and would you be so kind as to pass me a paper hand towel from the dispenser over the sink?’
He fetched me a towel. Bugger me, I thought, I’m actually going to get away with fitting my own vacuum dressing!
I took a long puff on my eCig, blew the vapour out contemplatively and then with the mouthpiece end of the eCig prodded a few bits of leg muscle.
‘Take a look at that, see,’ I said in my Sandhurst briefing voice, ‘nice pink colour and good granulation, no sign of infection and plenty of healthy circulation.’ I gave a particularly rosy looking bit of flesh a prod and then withdrew the eCig so they could have a good look.
I took another luxurious puff on the eCig and continued.
‘The dressing will need to be cut down to fit. In my wash bag, you’ll find my hair dressing scissors, these medical ones,’ I indicated the little tiny snip like things they had brought still sealed in their sterile packet, ‘are no good for our purposes.’
‘But your scissors aren’t sterile!’ Mia pointed out.
‘Give them a wipe with a steri swab,’ I said.
I took the paper hand towel and laid it across the wound. With Mia’s marker pen I drew around the extremities of the wound thereby creating a template.
‘There you go,’ I said, 'just lay that on the sponge of the vac dressing and cut it to size.’
‘We should be doing this,’ said the male nurse.
‘We are pretty much done now,’ I told him, ‘you can lay in the gelnet if you want but make sure you lap the gelnet up and over the edges of the wound as well as covering the muscle tissue.’
‘I have been doing vac dressings for ten years and I have never used gelnet,’ complained the male nurse.
‘It’s a new technique, it was published in the Lancet last month,’ I explained, ‘the surgeon and I were discussing it the last time my dressing was changed. The reason you use gelnet is that its open structure does not compromise the vacuum and allows dressings to be changed on the ward without the necessity for pain management. Don’t forget, some patients like me cannot have morphine.’
He did a good job of laying in the gelnet. It reminded me of laying up fiberglass in canoe molds. He made to position the sponge of the dressing.
‘No, don’t do that yet because pressing that into the wound is going to be painful so you leave positioning the sponge as late as possible. First, you need to be ready to stick it down so take one of the sheets of adhesive film and peel a little of it back. Now line up your film and stick the first bit on the leg far enough away from the wound so that you know you’ll have a good seal but not so far away you tape my testicles to my thigh. Good, now position the sponge and draw the film over it peeling off the backing as you go. Simple. Eh?
And it was, and he agreed it was.
I let him fit the tube, not in a sudden fit of team spirit but because that was the one bit I hadn’t yet figured out how to do. It turned out to be dead simple.
The whole procedure was painless and quick. I lie here tonight in extreme comfort with my bespoke vac dressing. Unless someone else pitches up for a look, it will be changed again on Saturday.
I trust you are all satisfied with this update. Now, if you will excuse me, I must do a bit of reading as I have my skin grafting finals next week.