Friday, 30 May 2014

Of Communists, Fascists and Others Born Out Of Wedlock


My skin graft operation did not go exactly according to plan Saturday last.  I knew I would not be in theatre before 1800 hrs because the Rather Attractive Lady Surgeon Registrar had programmed me for the last op of the day allowing me to have breakfast that morning and spend most of my waiting time in the comfort of my room rather than in excruciating agony on a hard chair in a waiting room desperately clamping my cheeks together to contain the potentially catastrophic effects of the sudden release of wind I suffer when a) unable to move and b) am in a public space.  I only went over to the Royal Free at lunchtime.

(The nurse has just come in to take my temperatures and pressures.  Yesterday the machine went berserk and tried to crush my arm, even the nurse was alarmed as I yelped with surprise and lost contact with everything below my elbow.  Apparently it needed recalibrating.  Anyway, I have just asked this nurse what setting she had on the machine today; bone crushing or merely flesh bruising).

While waiting I was seen, as usual before going into theatre (I am an old hand at this now) by a nurse consumed with a desire to know all about me; my habits, my foibles, my general state of health and whether I indulge in recreational drugs and anal intercourse.  I shan’t bore you with all the subtle variations I managed to weave into my replies on three separate occasions but they generally ran along the lines of not knocking anything until one has tried it and that sex with girls is OK but you can’t beat the real thing (I always left my definition of the ‘real thing’ vague).  We did discuss British Airways cabin crew being whacked out on drugs (it is the only reasonable explanation of their behaviour) and whether such use, as they were on duty, could be considered recreational.

The nurse wanted to take a swab from my wound.  This solved a problem for me.  The vac dressing had failed so the vac pump was alarming all the time, thus alarming those suffering alongside me in the waiting area.  So, out of consideration, I had switched the pump off.  Now that the dressing had officially been peeled back compromising the seal, I had a fairly rock solid excuse for switching the machine off and, while subsequently being seen by the Rather Attractive Lady Surgeon Registrar not long afterwards, I suggested I might be allowed to unhook myself from the machine altogether and stuff it into my rucksack.

When my time came, I was not afforded the usual luxury of changing into a hospital gown in my room before being wheeled in my bed down to theatre but had to walk to a changing room where I was instructed to place all my possessions into a plastic bag which would be secured in a locker, the key to which would be pinned to my gown so that no one would have access to my kit.  I accepted there was an element of trust expected from me as we both knew I would be unconscious for the better part of the time my clothes were secured.  I asked the nurse about the vac machine.  It was my understanding, I told her, that I would be fitted with a vac dressing after the skin graft.  Nothing unsterilized, she informed me, would be allowed into theatre.  I presumed that surgical patients were granted an exemption to this rule along with medical staff who wished to procreate in the future.  I did not give a toss about the vac machine to be honest but I was very disappointed I could not take my camera along.

Having walked the distance from the waiting area to the changing room (the hospital looks smaller than it is from the outside) I now had to walk to the theatre.  Happily, the nurse was from Madeira so we chatted away in Portuguese and I really did not mind too much when we found that the lifts had broken.  I suggested that having come this far I could probably manage a few flights of stairs but this too, apparently, was against regulations.  Clearly she felt I deserved an amplification of the reasoning behind such an edict so explained that if I fell on the stairs or was otherwise injured, she would get into trouble.  I no longer saw the irony of anything that happened to me in the Royal Free accepting as I had that it was staffed by communists.

I was just about to be anaesthetized when the Rather Attractive Lady Surgeon Registrar popped in to chat to me.

‘Where’s the vac machine?’ she asked me.

No sense blaming the nurse, it’s not her fault she has been indoctrinated into the art of sustained chaos, so I told the surgeon I had forgotten it in my locker and that since, according to the regulations no one else was allowed into my locker, I would nip back and get it.  Just to really twist the knife home I added, ‘All the money I have, that I brought with me from Angola, is in my rucksack.’  There was shocked silence as they all stared at each other in a desperate bid for inspiration.

‘It’s alright,’ I said unpinning the locker key from my gown and handing it to the nurse, ‘I was only joking.  When you unzip the rucksack,‘ I told the nurse, ‘the vac machine is on top.’ 

As she made to leave, I called out after her, ‘and don’t forget the power cable, that’s right at the bottom, underneath the big envelope full of money!’

When I woke up, the Rather Attractive Lady Surgeon Registrar was there.

‘I did not do the skin graft,’ she told me while I tried to figure out where I was and where all these white people had come from. ‘When we took the dressing down, the wound was infected so there was no point trying for a graft, it would only have failed and then we would have to find some other part of your body from which to harvest more skin.’

I could see the sense in that but I was still bloody disappointed.  A successful skin graft was the only tick in the box left the parole board needed prior to releasing me.  I briefly considered being depressed but then decided I much preferred a cup of tea and a packet of Jammy Dodgers.

‘We debrided some more tissue and gave the wound a good scrub before putting a vac dressing on,’ she finished.  Later, as the anaesthetic wore off I realized she had not been joking about giving it a good scrub, she must have used a bloody Brillo pad.

I was wheeled off into what is ambitiously referred to by the leaders of the People’s Republic of Free London as a recovery lounge.  I found myself jammed into this broom cupboard between an Iranian who really was having a bad time with the anaesthetics if his projectile vomiting was anything to go by and a man who I assumed could only have been a diamond buyer labouring under the very misplaced confidence that no one around him knew what he meant as he babbled on down his mobile phone about ‘juice in’ and ‘Smarties out’ of Libreville.

A nurse came in with my tea and biscuits and asked me how I was getting home.

‘I’m an inmate at UCLH out on surgical day release,’ I told her, ‘I need to go back there.’

‘We’ll have to order transport then,’ she said, ‘there’s no mention in your file about a return journey.’

Bleeding Hell!  They weren’t exactly overcome with confidence about the outcome of this operation, were they?

‘Order it from G4S,’ I said.  (That way I could get out of the vehicle at the first set of traffic lights, get a MacDonald’s and a ride back to UCLH in a taxi before they noticed).

Two hours later, me still lying there naked but for a hospital gown having passed the time persuading the poor Iranian (who was on his second bucket) that a mixture of yoghurt and Jammy Dodgers washed down with sweet tea really did cure nausea, two guys in fluorescent jackets turned up with an electrically adjustable stretcher.

‘You can go now,’ said the nurse.

‘What about my things?’ I asked.

The nurse pointed at the rucksack that had come down with me from theatre.  So the nurse from Madeira had wanted witnesses before delving into my bag, I thought.  Clever girl.

‘What about clothes?’ I asked.

‘We do not give clothes out, you must go in your gown.’

‘Hang on a sec,’ I said, ‘I was fully dressed when I came in here so where are my clothes?’

‘Where did you put them?’

‘In a locker in the changing room.’

‘Where’s the key?’

It took them an hour to find it and then it wasn’t me who emptied the locker, they did.

The two stretcher bearers insisted I lay on the stretcher.  They had a smart electric stretcher so they were damn well going to use it.  It came with restraining straps so they could hurtle around London without dumping patients onto the floor of their van so they were going to damn well use those too.

Although not as bad as on some previous occasions, I had not eaten since breakfast so had a go at persuading the guys to stop briefly at the MacDonald’s just next to UCLH.  They ignored me, deep in loud conversation as they were, so I spoke up a bit.

‘It’s alright, Sir,’ snapped the driver testily, ‘I know my way,’ and he continued yabbling.  Socialist swine.

I briefly considered kinking the vac pump tube thereby forcing it to alarm so I could claim it had detected dangerously low blood sugar and only a Big Mac with large fries and a chocolate milkshake could save me from terminal coma but realized that this would only give them an excuse to flick on the blues and twos and drive like maniacs to A&E instead of In-patients where no doubt I would have an awful lot of explaining to do.

(I have paused for lunch now but earlier today some doctors took my dressing down in order to inspect the wound and I am still sitting here with no dressing covering a gaping hole while scoffing my way through a plate of beef stew and dumplings.  The nurses were told to dress the wound again but I can understand them taking a stand.  They cannot be expected to alter their busy routines at the drop of a hat merely to rectify the results of the idle curiosity of a bunch of doctors)

That treacle pud and custard was nice.

So, as I was saying, the graft did not happen and I was back in UCLH and on intravenous antibiotics again.  I am a bit hazy on the days because the Ward Sister has confiscated the bent nail I kept hidden under my mattress which I used to scratch the passing days on the wall but about three days later I was back in theatre at the Royal Free and this time they did the graft.  It wasn’t the Rather Attractive Lady Surgeon Registrar doing the job, it was some bloke who I briefly noted when he stuck his head round the door and told the anaesthetist to hurry up.  First impressions were deceiving for he turned to be very kind.  Evidently noticing that I had an obvious limp as a result of a wound on the left side, he harvested the skin from my right thigh thereby balancing me up a bit.

Back at UCLH, the team got together in my room to assess the latest.  There wasn’t really much to see.  The wound on my right thigh was obscured by what looked like a massive white Elastoplast.  The original wound on the left was covered by a new vac dressing but it was this dressing that had us all enthralled.  Never in my now considerable experience of vac dressings have I seen shoddier workmanship.  I have been unfortunate enough to have sat through a few TV medical dramas so I know it is normal for the surgeon to do the tricky stuff he is paid so much for before tossing his spanners over to some junior with an instruction to finish up but this job looked as if it had been concluded by a one armed janitor in serious need of psychiatric intervention.  The sponge had been cut too small for the hole so they had stuffed cut offs into the wound to fill the gaps.  Even that effort was half hearted and portions of the wound were covered merely by adhesive film. The adhesive film barely stretched onto the flesh surrounding the dressing and the vac tube had been fitted so it ran down my leg and not up underneath my underwear and out over my waistband almost guaranteeing that sooner or later I would tread on it and rip the tube out of the wound.

(Someone has just stuck their head around my door saying they were looking for my nurse.  ‘I’ve eaten her,’ I said, ‘she was delicious’)

The idea was to give it a couple of days then bowl up to the Royal Free, get confirmation that the graft was infection free and had taken and everything was tickety-boo, get the vac off, get my release forms signed and push off.

With a vac dressing sucking air and some of the wound exposed, it was hardly surprising that it got infected again. The nurses here did their best to plug the leaks with sheets of adhesive film but they might has well have been trying to patch the Titanic.  Naturally, no one wanted to pull the vac dressing off and change it lest all the new graft skin came with it.  So I festered until the day before yesterday when, after a further eight hours of confusion over at the Royal Free (‘Nurse, I’ve been waiting to see the plastics registrar since eight this morning, it is now four in the afternoon.  Are you sure they know I am here?’) an admission was finally made that no one knew I was there and that besides, I had been told to come to the wrong place (making it all my fault, I suppose).  I rang the Tropical Diseases guy at UCLH and within minutes I was being ushered to the right place and was seen by a doctor who bore an uncanny resemblance to Timothy Spall.  I cheered up instantly.

Of course he had never seen me before, was wholly ignorant of my recent medical history and was only seeing me because he had been in the wrong place at the wrong time when someone in authority at the Royal Free suddenly realized they needed a plastics specialist.  Never mind, it was worth the wait just to meet him.  Come on, you all must have met at least once that kind of person who cheers you up just by being in the same room.

‘You’re on a vac pump I see,’ he said.

‘Don’t buy one’, I said, ‘it’s fucking hopeless for cleaning rugs’.

‘We get them from Amazon,’ he said, quick as a flash.

Amazon’s bloody rubbish,’ I replied, ‘I bought a painting from them once.  It looked great on their website but the one they sent me was upside down.  The wife cried for a week.’

He decided not to put me back on the Vac.  The two socialist nurses argued with him.

‘But I’ve been to the stores and have a new dressing and reservoir!’ one of them protested.

‘Still…’ Dr, Spall ventured.

‘The patient can’t go back without a vac dressing!  Look at the wound, it’s disgusting!’ said the other.

‘Yes but…’

‘I quite like the idea of not being on a vac pump,’ I interjected.

‘You have no say in the matter, you’re just a patient!’ chorused the nurses.

And a disgusting one at that, I thought.

The last time I saw such a marked contrast between two institutions in the same city was when checking out of a hotel in West Berlin and into another on the other side of Checkpoint Charlie.

‘You should ask for a transfer to UCLH,’ I advised Dr. Spall, ‘you’ll shrivel up and die here.’

Dr Spall, as he managed to squeeze an opinion in edgeways every now and then, told me there was no need for a vac pump, that 80% of the graft had taken so it looked good to go and, after talking to UCLH, it was felt that a couple more nights in UCLH under observation and frequent dressing changes should see me OK for discharge on Friday (today).  I would have to come back to the Royal Free on Monday where the graft would be checked and I would then be handed over to the care of my local district nurse.  Cool.

Yesterday I went for a walk.  I was desperate to get a haircut.  My hair was already long (for me) when I left Angola.  A month later my head was skidding around on the pillow at night.  First I had to change some money.  The nearest place I could find on Google Maps that wasn’t a street corner tourist rip off was the Post Office up by Russell Park, a gentle half mile walk away.  Just short of the post office on the corner of Woburn Place and Corum Street there was a seedy looking currency exchange shop with a handwritten cardboard sign in the window which read, ‘We give £56 net for $100 notes!’  1.78 US to the pound I calculated, robbing bastards.

I arrived at the post office to see a bloody great queue of American tourists all wanting to change money.  I needed to know whether it was worth joining the queue (my legs were aching in stereo) or walk further to a branch of my bank where I knew I would get the best deal.

‘Excuse me,’ I said to the Americans, ‘I just want to ask the teller a simple question.’

They all very politely let me limp through to the front.

‘How much will I get net if I change a hundred US?’ I asked the young man behind the counter.

’49 and change’, he said.

Blimey, one block down the road I’m nearly seven quid better off!

The Americans had been nice to me so I felt it only fair to return the favour, after all, I was an Englishman in London and one of the things colonials want to experience in the Smoke is a bit of civility.

I gently drew one of the Americans to the door and pointed diagonally across the A4200 and said, ‘You see that place there?  They’ll give you 56 quid net for your hundred bucks so long as it is in cash.’

I limped painfully out of the door and started to make my way back towards the seedy money exchange.  Seconds later I was overtaken by the 7th Cavalry as they hurtled off towards my destination.  When I got there, the queue was a mile long.

‘Jeez!’ shouted one Yank, ‘it’s the old guy who sent us here!’

They let me straight to the front of the queue so I forgave the young punk for calling me old.

I changed fifteen hundred bucks and came away a hundred quid better off than I would have done had I used the post office.  That’s the trouble when you privatize essential government services, the Fascists take over and rip everyone off.

There was one thing I had to do.  I was going to leave it until I got out but since it was still early afternoon, I decided that there was no time like the present.  All through this blog you will find references to what was top of my priority list if ever I got back to London.  Rather like a wistful prisoner of war I dreamt of sitting in a real pub drinking a pint of London Pride.  I am teetotal now but I had to know if I could stare temptation in the eye.  Having now given up smoking, it was a case of double jeopardy.  Could I sit in the smoking area (out on the sidewalk) of a London pub serving London Pride and be content with a coffee and a bar snack while all around me were choking the weed and pouring booze down their necks?  Would the stale smell of second hand smoke, the o so familiar, friendly aroma of whisky and the hoppy smell of real ale get to me?

The good thing about pubs in London is you don’t have to shuffle far to find one but I knew where I wanted to go because it seemed so appropriate and I was willing to hobble an extra mile to get there.  Twenty minutes or so later I was in front of the Old Explorer just off Regent Street near Oxford Circus tube station, a traditional pub the sign over the door claimed and exactly what I wanted.  The atmosphere and the smells inside were intoxicating.  Hunched like some old pirate I made my way to the bar and got myself a tonic water with lemon and a packet of pork scratchings. The smoking area outside was packed but there was a chair free at a table for four so I asked if I could join the three gents who were happily quaffing their ale and smoking cigars.  Even better!  There was nothing I liked more than a damn fine cigar.  Sitting down wind, the scented breeze caressed me like an old lover,  I sat there quite contented for half an hour, nursing my tonic water and munching happily on my scratchings.  And I was happy.  Not once did I feel the urge for a drink nor the desire to a smoke.  What is left of me will return to Marcia as a new man.

While looking on Google maps I had noted the location of a traditional ‘Bob a Cut’ barber up the Tottenham Court Road so I headed slowly over there.  Nowadays a Bob a cut is ten quid but I didn’t mind, I was still ninety quid and a free haircut up on the post office.

By the time I returned to my room in the hospital, I knew something was wrong.  My leg was on fire and, I realized as I took my raincoat off, my trousers were soaked around the dressing.  Sure enough, when I dropped my strides, I could see the dressing hanging off and the wound oozing.  The nurse called the doctor.  He said he would come with the specialist today.  I was supposed to be released today. 

This morning they came and had a conflab.  In principle, most of the graft, enough of the graft was OK if runny.  They decided that for the sake of a couple of days until the appointment at the Royal Free it would be foolish to risk it all going awry by sending me home; best to stay until Monday.  Much as I want to get out of here, I was relieved.  I’ve done just over a month inside, it would be a shame to balls it up at the last hurdle.

So that is basically where I am with this now.  I know I have said ‘two days to go’ before and been wildly off the mark but this time I think it’s for real.  Still, two days will give me enough time to hand wash and dry all my kit.  I am due to run out of clean skids by Sunday so I had best get scrubbing…

I really miss Marcia and the boys.  I’ve had my fun in London, can I I go home now, please?

 

Saturday, 24 May 2014

A Good Day For A Close Shave

You may have noticed that I have recently broken with tradition and am not replying to every single comment I receive. I always felt that if someone was kind enough to go to all the trouble to comment (and in so doing make a remarkable public admission to having actually read a post of mine), the least I could do was have the courtesy to acknowledge them.  Of course, I am fortunate (?) not to have a zillion followers like a certain Affable Gay Welsh Raconteur I could mention (who acknowledges his commentators not so much with courtesy as a curtsy) so my burden is light compared to his, especially as he is a prolific poster.  And it is because I am now posting little and often that made me ask myself, why spend time replying to all the comments when any matters arising can be addressed in the next day's post?  The truth of the matter, I suspect, is that having too much time on one's hands can lead to quite an alarming lethargy.  That, coupled with ever changing goalposts and the resultant uncertainty is, I fear, starting to tell on my usual bonne humeur. To mine own ears, my repartee is beginning to sound crass.

Yesterday I went over to the Royal Free clutching my documents.  My driver told me that he had been instructed to deliver me to the surgical ward.  As usual this information, as so much of the information I was receiving lately, was at odds with my understanding.  As far as I was concerned, I was on my way to the dressings clinic where I was to allow no one, under any circumstances, to redress my wound without the presence of NB, the Lady Surgeon Registrar who would assess the viability of a skin graft.  Being a very decent chap from Jamaica, he did not argue with me (as I suspect those communist white drivers of the ambulance the other day who, returning me from the Royal Free after surgery refused to stop for a MacDonald's would have done) and accompanied me to where I wanted to go and not where some ill informed shiny arse thought I should go.

Now the appointment letter the Royal Free had given me clearly stated that NB (so written on the form) was to be present at the dressing change.  NB had been kind enough to warn me that she would be busy doing trauma so I should prepare myself for a long wait.  I was pleasantly surprised, therefore, when the receptionist informed me that my appointment was for eleven.  Eleven came and went.  A young lady, also from Jamaica, sat down next to me (because I looked normal and did not smell, she confessed to me later with charming frankness and breath-taking naivety) and we passed the time in enjoyable conversation.  She was a game girl and our chatter became unbelievably un PC and went not unnoticed but we got away with it by convincing everyone who cared to object that we were man and wife so could they kindly wind their necks in.  Janet Thomas was her name and, she wittily observed, it was fortunate that men did not take their surnames from their wives as had we been married, I would be Thomas Thomas.  You have to understand, we were very bored.  We were busy discussing the impediments to us marrying but the possibility of us voluntarily enjoying conjugal rights anyway when at 1pm my name was called and I was taken into a bay.

I was introduced to a very bemused NB who asked me to explain why her presence was considered necessary.

'Easy,' I said, 'because it isn't.'

I had no idea whose NB this was but it certainly wasn't mine.  I had been waiting four hours for the wrong NB.  Once they realised that the NB I wanted was the rather attractive slim Lady Surgeon Registrar they agreed with me that perhaps I should return to my seat and resume 'waiting mode.'  Happily, Janet was still there but I had lost the comfy chair next to her so had to sit opposite her, an extra distance that required us to raise our voices bringing even more people within shocked audible range.

At four, the Lady Surgeon Registrar arrived and the nurse, an ex exotic dancer from Malta who had worked the Far Eastern tourist spots (believe it or not, she told me.  I did), removed the dressing.

'Those muscles really do have the appearance and texture of freshly skinned duck's breasts, don't they?' I enquired of the registrar.  She and her colleague agreed my muscles looked healthy.

'You recall,' I said, 'how murky the liquid was in the vac pump reservoir last time we met?' I indicated the vac pump, 'look at it now, it resembles a fine rose and, as I am sure you will appreciate as much as a connoisseur of fine wine, colour and bouquet are good indicators of quality.'

Happily, she and her colleague concurred, my wound was good to go so scheduled me for surgery today.  Demonstrating extraordinary consideration for the mental and physical welfare of her patient, she told me not to bother coming over to the Royal Free until midday and that, by all means, I could enjoy an early breakfast.

So. I sit here, replete after my light breakfast of porridge, four slices of toast and marmalade, a bowl of cornflakes, a Twix I had bought in the hospital tuck shop on my way back yesterday, all washed down with several mugs of tea and coffee, writing this.

Sadly, the good surgeon could not tell me if there was sufficient space on my left thigh to 'harvest' enough skin for the graft but she promised she would try to keep all injury confined to the same leg.  At least she promised not to skin my arse so that's something. 

Right, I shall go and scrub up and climb into fresh waiting clothes and let you know as soon as I can how it all went.  I am hopeful she will let me take my video camera into theatre.

Toodlepip!

By the way, I wonder if the surgeons know I am weighing myself after every theatre trip?

Friday, 23 May 2014

Why I'm Voting UKIP - You Gotta Read This!

http://www.theweek.co.uk/uk-news/58641/whyimvotingukip-ten-best-responses-to-the-hijacked-hashtag

Back off to the Royal Free (again) after skin graft abandoned in theatre on Wednesday as more infected tissue discovered.  Surgeon settled for more debridement (I am down to 77 kilos) and a good scrub of the wound (this time with a Brillo pad to leave it squeaky clean, it certainly felt that way when I woke up).  If everything checks out today, will hopefully get skin graft over the weekend.

I see the lovely Nurse Mia commented on my post 'Patriotism and Bespoke Tailoring', you should see her avatar... sweeeet!  She'll be on duty this weekend so hopefully I can get a decent photo of her and a few other of the medical stars here.

Must eat my porridge now as transport is in ten.

Sunday, 18 May 2014

Ha Ha! What a Glorious Day!

The sun has got his hat on, Hip-hip-hip hooray!

Actually I need to be careful there, don't I?  I have already been censured once for being wildly non pc when (you recall the kosher fish and the better vegetables?) I asked Her Majesty-Majesty why the Jews here get nicer peas.

Clearly, the Very Well Dressed Lady Registrar's heart is brimming with compassion for quite obviously the raw emotion I threw into my bottom lip trembling performance must have left her deeply moved.  This morning she came to see me and told me that instead of being transferred to the Royal Free, they would keep me here and on Wednesday take me over there where I will be operated on as a day patient before being brought back here to recuperate (note to self: take a good book along).

Naturally, in a community as close knit as that found in an infectious diseases ward, news travels fast.  'Oh God!' wailed one nurse, overcome with joy.  Another sank to her knees to give Him thanks, tears of happiness coursing down her cheeks, 'He's not going!' she cried.  It all brought a bit of a lump to my throat.

I received a bunch of mail as well including one from as far afield as Camarillo, California.  It did not look like a communication from the IRS so I risked opening it.  Thank you Ann.  I am gratified you want to visit Fort Hippo when it is up and running but would draw your attention to the section of my last post dealing with being sectionable. Nevertheless, if you are a comfortably well off masochist, by all means visit but my place is really only aimed at those already in Angola for their sins and for whom anything is an improvement on Luanda.  Addy, recognising that I still had one addiction to deal with thoughtfully included a packet of the strongest mints I have ever tasted.  Through streaming eyes I squinted at the packet and read 'Exocet' but as my eyes cleared I realised the words were 'Extra Strong'. Frances sent me the most singularly appropriate card, sadly I have no scanner to hand to share it with you but it shows a patient in bed with a doctor saying, 'Hmmn, someone has been fiddling with their medical notes, haven't they?'  Hanging on the foot of the bed is a sign saying 'Nil by mouth' to which has been appended, 'Except Chocolate and red wine'.  As a multi hitter, this card gets home runs for we all now know of the days I endured nil by mouth, my weakness for chocolate and my school boy efforts to interfere with my medical notes.  Lettice Leaf forced me to cast my mind back 36 years to my basic signals training which really did not help me until I discovered the key on the back of the card so Lettice Leaf, -  ....  .-  -.  -.-  ...!  My good friend Paul and his lovely soon to be wife Karen sent me a most interesting card.  Now that I have read it I am reasonably confident I will be able to tell the difference between an orgasm and a heart attack, useful as the frequency of both for me are about the same...

I have had many visitors bearing gifts and I am sure they will waive the need for me to thank them all here but special mention must be made of the Idiot Gardener and the Suburban Bushwacker, neither of whom I had ever met before; we know each other through our blogs.  So determined was IG to satisfy a craving I had he scoured the wildest corners of the home counties until he found the last remaining herd of wild biltong and through stealth and guile was able to cull a fine example bringing me back an entire marinated and air dried example raising, on the way to my room, a few eyebrows as he dragged it, bleating plaintively through the corridors of UCLH.  IG's endurance was matched by that of SBW who took on the apparently simple task of arranging mobile broadband for me.  My brother Micky had fixed me up with what T-Mobile assured him was the solution to my problem but, and I shan't go into it now or we'll be here all day, suffice to say that choosing T-Mobile and their service partner EE was a very expensive mistake which left me certain that their criteria for employing customer service agents depended to a large extent on how close a resemblance applicants bore to a certain part of the female anatomy.  SBW gamely submitted to the intimate internal examination, blood and DNA testing the retailer demanded and was able to return to my room with his dingle shredded and a Virgin dongle for me.  I can now access the Flordita.com mail server and send emails again so if you received an email yesterday that seemed strangely out of date, you now know the reason why; it was my outlook outbox relieving itself at last. 

Now, with all this extra time, I can turn my thoughts once again to mischief.  I wonder if I can convince them that I am really a 'ghost' patient sent in by 'Bob the Builder', Sir Robert Naylor, CEO of UCLH, to report on the standards of service and patient care in his hospitals.... Nah.  Can't see the point really, they're already waiting on me hand and foot.  Any witty suggestions you may have gratefully received, you know the address.

A much recovered blogger at work.
Note sterile surgical eCig pointing device.

Saturday, 17 May 2014

Oh Dear! Only Two Days Of Mischief Left At UCLH...


Yesterday afternoon I was visited by the Very Pretty Bubbly Specialist With The Sectionable Husband.  Pleased with my progress she made to leave but then added:

‘Now you are avoiding sweet things, aren’t you?’

‘Given my confinement and that half the female nurses and doctors working here, including you, are drop dead gorgeous,’ I said, ‘that’s proving rather difficult.’

‘I meant sweets, sugary things, Mr. Gowans.’

‘Oh.  Does that include chocolate?’

It did I am afraid.  I have been blessed with innumerable visitors all of whom have brought me something.  Normally, the choice of what to bring me would be easy, just a flask of Scotland’s finest but now that I am boringly teetotal, my dear friends and family fell back on my notoriously sweet tooth.  Chocolates are available in Angola but I'm not really keen on Alex developing a craving for them.  He is a big lad for his age anyway so I don’t want him to add unhealthy fat to his bulk.  It would be incredibly insensitive of me to scoff chocolate in front of him while denying him the same pleasure.  At home, therefore, chocolate is a treat, usually given as a reward for sustained good behavior.

Unfettered by such constraints in the splendid isolation of the Infectious Diseases ward of the UCLH, I have indulged myself.  Naturally, I was now concerned that through ignorance (I was unaware of the beneficial effect sugar has on bacteria) I may inadvertently have been retarding my recovery and commensurately increasing the length of my incarceration.

They do say that people tend to nibble more if they are inactive or bored.  I was both so thought I would quickly tot up my chocolate consumption over the 16 days I have been in hospital:

6 packets of Cadbury’s Dairy Milk Biscuits

2 large bars of Galaxy chocolate

2 packets of Cadbury’s Chocolate Fingers

1 packet of Jaffa Cakes

1 Packet of Fig Rolls

1 large pack of Galaxy Cookie Crumble

2 Packets Cadbury’s Double Choc cookies

2 packets Cadbury’s Oat and chocolate chip cookies

32 bars of Twix (I like Twix)

That only works out to a packet of biscuits or chocolate and just two Twix per day so not really what any reasonable person would call excessive, and surely not enough to have appreciably improved the performance of bacteria, however voracious.

I have just been visited by the Very Well Dressed Lady Registrar.  Apparently I am to be transferred to the Royal Free next week to undergo plastic surgery there after all.  This is a bloody nuisance.  Apart from the fact I will lose my spectacular view, it has taken me just over two weeks to train nurses and ancillary staff to the high standard of personal service I expect. I  can change my own dressings, I get my cup of tea at five in the morning, I have extra blankets and pillows and generally get away with murder.  I now feel like a lag who has successfully ingratiated himself with the screws and enjoys all sorts of normally unavailable concessions only to discover he is being transferred to a gaol notorious for the brutality of its staff (for Christ's sake they flay people alive there!). 

I asked the Very Well Dressed Lady Registrar for permission to tremble my bottom lip which was granted with palpable sympathy.  I gave it the best I had, a truly RADA performance but it cut no ice.  I will be transferred, no doubt kicking and screaming constrained by a badly tailored jacket with a zip up the back and overly long sleeves similarly secured, to the Royal Free sometime early next week.

It has just occurred to me, with my international readership, that some of you may not know what ‘sectionable’ means.  To ‘section’ someone here in UK means detaining them under the relevant section of the Mental Health Act 1983 and 2007.  Under a Section 2 you are detained in hospital for assessment of your mental health and to get any treatment you might need. Anyone so detained is deemed as having been ‘sectioned’ and anyone warranting such detention is deemed as ‘sectionable’. I classed the husband of the Very Pretty Bubbly Specialist as sectionable when I first met her because, until I disavowed her of the wholly optimistic impression of Angola fed to her by her husband (who has never been to the country), she told me he had every intention of taking her there for their exotic luxury African holiday.  She has done so much for me so I was pleased to be able to return the favour by suggesting they sat down together to read my blog and delighted when she told me yesterday that they will be going to the Maldives instead.  My blog is, therefore, not only (I like to think) entertaining, it saves marriages as well for God knows what she would have done to him within hours of their arrival.  It is ironic to ponder that had he been sectioned, he would probably have ended up on the top floor of the very institution to which I am being transferred, which would have given me the opportunity, no doubt, to regale him with tall stories and repartee thereby sending him irrevocably insane.

The soup dragon has just been.  I shouldn’t call her that really because she is neither green nor huge but which child of the Sixties could forget the Clangers?  Instead of an inch in a small plastic bowl, she gives me two large mugfuls to nurse until the next mealtime.  They make the odd mistake.  For supper yesterday I ordered bangers n mash with baked beans.  I received a baked potato with cheese, beans and salad.  This evening I had ordered salmon filet and they brought me a multi-layered plastic package which, once I had fought my way in, I discovered was a Kosher salmon filet.  Can anyone tell me what the difference is between an ordinary salmon filet and a kosher one?  Or is it because we are in London where ‘kosher’ means genuine?  Perhaps that’s it, the salmon I was eating before was farmed while this, being kosher, was wild caught.  It certainly was better quality and the vegetables I noticed were more al dente peas than carrots whereas the goy vegetables I was being served before were more mushy carrot than peas.

Somebody left an unusual looking chair outside my door (I usually sit here during the day with the door open).  Fitted with small wheels, it was the wires and what looked like a control panel that sparked my interest and a desire to see just how painful shock therapy might be.  It was, I discovered, nothing more interesting than a set of scales for those too lazy to stand.  I have not weighed myself in ages but I knew I was well over 80 kgs and had set myself a mental target of getting below that as soon as possible (hence my restraint with the chocolates),  I was delighted to find I weigh only 78 kilos.  That delight was short lived when Her Majesty-Majesty, the nursey looking after me tonight (who bears an uncanny resemblance in both appearance and manner to Black Adder’s Queen Elizabeth I) pointed out that I could not count that weight loss as due to any effort on my part since it had been sliced off me 'and that my dear little Sir Thomas is cheating!  And we all know what happens to cheats, don't we?  They get their little heads chopped orf!'.

The temperature and pressure man came in at six.  He has wised to me taking a swig of hot chocolate as soon he turns his back on me after sticking a thermometer in my mouth and now uses a device that involves sticking something in my ear.  To be honest, that is pretty damn sporting of him.  Had I tried that trick with Nurse John Gray I am sure I would now be sitting uncomfortably with an equine use only thermometer shoved where the sun doesn’t shine. 


The poor man has still not cottoned on to my skill at influencing the readings of the blood pressure machine though.  By flexing my arm muscles at just the right moment, I can come out with some incredibly low blood pressures.  There are rules to the game of course (by definition a game has to have rules).  Any fool can muck up the readings but they don't count unless the nurse records them in the notes.  I was rubbish at this to start with and the nurses would take one look at the reading, think to themselves, ‘that can’t be right!’ and repeat the test, but I have had plenty of practice refining my technique enhancing it with deception plans and distractions. Today I watched with exquisite glee as the nurse recorded in my notes a blood pressure of 74/43.  A genuine reading this morning was 120/78.

‘That’s a bit low,’ I said.

‘Ya bin sittin’ aran too much,’ he replied.  How the fuck I keep a straight face!  Shit, I should have been a poker player.


An hour later the lovely Mia came on duty and marched into the room towing the temperature and pressure machine.


'It's been done at six o'clock!' I protested.


'I know Thomas, but since you're obviously not in hypovolumic shock I am going to do it again.  I also know,' she added, 'that somehow, you had something to do with it so lay your arm there and keep it still!' 

I half expected her to lift the hem of her uniform to reveal a cocked pistol secured by a garter to her thigh and say, 'If you so much as breathe your blood pressure really will be low!'  The girl is going to go far.  At least it shows that oncoming duty nurses review patient notes.


I really am going to miss this place, best few weeks I've had in ages!

Thursday, 15 May 2014

Patriotism and Bespoke Tailoring


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.

Tuesday, 13 May 2014

Hospital Snippets


Actual conversations I had with hospital staff...


‘How’s the pain, Tom?’

‘First Class, best I’ve had’

‘Good.  Now you will ask me if there is anything you need?’

‘Well I could do with the gentle application of a soothing cream…’

‘You’d like cream for your leg?’

‘Well, you can use trifle if you like, I was just hoping you’d give me a massage.’

 

During a discussion on oral pain killer doses

‘You’re not very big, Thomas’

‘Not even my wife would be inconsiderate enough to make such a deeply personal observation.’

 

Very attractive female anaesthetist just before I go into theatre:

‘I am going to give you a powerful pain killer,’ Mr. Gowans.

‘Will it take me to a nice place and make me feel all warm and fuzzy?’

(laughing) ‘Yes, Mr Gowans, I’m sure it will.  In a minute I will give you another injection to make you sleep.’

‘How long before I am asleep?’

‘Only five or ten seconds’

‘If in that time I made a remark to you laced with sexual innuendo would the judge at my sexual harassment trial consider the drugs a mitigating factor in my defence?’

 

‘I know it must seem a little silly but you do understand why we put a name band on each wrist, Mr. Gowans?’

‘In case I misplace one of my arms?’

‘No, silly!’

‘I was just joking, of course I know, it is for administrative reasons.’

‘That’s right.’

‘Yes, one tag stays with the body and the other goes back to the NHS war graves commission marked as killed in action.’

 

While inserting a cannula

‘Now don’t go asking me to hook you up to a bottle of whisky or anything like that, Mr, Gowans, I have heard them all before.’

‘Actually, I was thinking more along the lines of certain well known hallucinogens fashionable among the sixties celebrity chic…’

 

While checking my wrist band before administering intravenous drugs

‘Can I just check your name, please?’

‘Thomas Gowans’

‘Why does it say Thomas Andrew?’ 

(My name is Thomas Andrew Gowans)

‘Andrew is my maiden name, if you look on the next line down, it says Gowans, that’s my surname now that I am married.’

 

The surgeon in A&E having performed an initial debridement of the wound and having marked the extent of the infection and having informed me that if in two hours the infection had spread beyond the marked boundary he would operate immediately and remove a lot more flesh than that and, should he feel it warranted, would not bother to halt the procedure just to wake me up and tell me he was going to amputate my leg

‘I’m sorry that’s a bit blunt but that’s just the way I am.’

‘That’s alright Doctor, I am sure the hospital has a department well versed in providing emotional counselling to your patients’

 

While having a vacuum dressing removed without anaesthetic

‘Oh my God, I can’t watch!’ (This is the nurse speaking), ‘Does it hurt?’

‘It is a little uncomfortable’

‘Is that all?  Gosh, I thought you’d be in agony!’

 

Questions before going down to theatre (bearing in mind I have been three days nil by mouth waiting for a slot)

‘Have you any loose teeth, dentures, caps or crowns?’

‘I have a loose tooth at the back here and a false one screwed in here.’

‘Oh,’

‘Why, is that a problem?’

‘It is.  You see we have to put in a breathing tube and we cannot afford the risk of any loose object causing an obstruction.’

‘Hang on a sec, I have completely misunderstood this question.  Can we go back?  Ask me the question again.’

‘Have you any loose teeth, dentures, caps or crowns?’

‘No.’


OK,OK, I can see everyone is less interested in my wit and more in the gory details so an update.  All looks good, I feel great.  They still do not know exactly what caused it but they now have me on the right antibiotics and signs of infection are receding.  I am waiting for the plastics people to decide what happens to me next but it will likely mean me being discharged from this hospital and being transferred to the Royal Free Hospital where they will do skin grafts or whatever reconstructive surgery they feel appropriate and then, once they are sure the graft has taken and remains free of infection, I will be discharged and treated as an outpatient until I am fit enough to travel back to Angola.

To keep you ghouls happy, a short video of the last stages of me removing my own vacuum dressing yesterday:

video