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.
‘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?