Surgeon Report 6 – Half the man I was

Never let the Wolfman perform surgery. Green stockings. Nice!

It is the crack of dawn on a bright, sunny Tuesday morning. 

I fear I have been conditioned by the hospital system of waking people at 06h00 to take their pills. Either that or the pipework, still very much attached is, dragging me back into consciousness, just like it is dragging my willy in a southerly direction.

I finally feel well enough to sit down and spend a bit of time writing this; the last general ‘thank you mail’ I sent out took me almost an hour to write and was only about eight lines long.

I am still not entirely clear-headed and forget things; what day is it? Did I put on deodorant? (Easy enough to figure that one out!) Have I brushed my teeth? (Ditto, although I think I did do them twice yesterday morning.) I also forget if I have spoken to people and require frequent naps. Maybe it isn’t the anaesthetic; I hear this is what happens to old people.

I am listening to my new Amazon purchase while typing this; Noah and the Whale’s “Last Night on Earth”. On the one hand, it is a great CD, reminiscent of the ‘80s and, unusually, each track is a good one.

On the other hand, I find it a sad indictment of the level of religious education provided in this country. Noah?

So, on to the health front:

The hospital was lovely (thank God for private health care) and all the (mainly South African) staff were an absolute pleasure and looked after me extremely well, even though I threw up on two of them in the recovery ward. I couldn’t talk so asked for a note paper to tell them I was feeling nauseous. Forgetting I was not left-handed, I wrote “sore” and “feel sick”

The nurse said “I don’t know what you have written."

I thought that it was odd that someone who was illiterate would be able to qualify as a nurse until she showed me the page. It was a meaningless, incomprehensible doodle without a single recognizable letter. The anaesthetic was obviously stronger than I thought.

At this point I realised the pointlessness of even trying to explain and threw up on her and the other nurse who was leaning over me trying to read my scrawl.

They took it quite well although I suspect not all the bruising on my stomach is related to the actual surgery.

The procedure took about four hours and was done keyhole, except for the large incision in my side through which they removed the offending parts. The surgeon said that the cut was just large enough to put his hand inside me to grab what was needed. At this point, I wished that I had chosen a petite, five foot female surgeon instead of the six foot guy with massive hands.

The first two days were spent in a self-medicating haze of morphine which, as I mentioned previously, does NOT eliminate pain, it just takes the edge off. Frankly, at times it felt as effective as a couple of Paracetamol.

On Wednesday morning, some homicidal sociopath with ingrained masochistic tendencies and a deep-rooted hatred for men (I think I overheard one of the nurses call her a “physiotherapist”) came to see me to teach me how to get out of bed. I am still not exactly sure what she did, but it felt like she had taken a red hot poker and methodically placed it against each of my wounds. I can say without any hesitation that while this last week was the worst of my life, getting out of bed was the most painful thing I have ever experienced.

I managed to shuffle to reception (about 15 feet away) and back to bed before further branding took place. Then I had to have another nap. According to the brand marking, I am now the property of the Lazy D Ranch.

By midday Wednesday I was eating via my mouth as opposed to via the needle in my arm; I managed four spoons of soup and two spoons of jelly, the latter being obligatory in a hospital. If you refuse jelly in a hospital, people look at you like you just swore in church.

I also had my first bowel movement around this time. I would love to say it was unassisted, but the truth is a rather forthright nurse put not one, but two suppositories up what is traditionally a one way passage. She then ran out the room and ducked behind the door frame before removing a tiny little remote control device from her inside pocket. She crouched down and hit the little red button. Next thing I was airborne. After the cramp and colic, I have never been quite so happy! Who would have thought…?

On Thursday the surgeon came to visit and resignedly waited for me to ask my usual questions. He told me that in all his years as a surgeon, no patient had EVER asked him as many questions as me, which probably explains the £200 consultation fee. He also asked if I was a vegetarian. An odd question, but he said it was not medical and “all would be revealed.” I spent all day Thursday and Friday pondering the meaning of this question and all I could come up with was that he was researching recipes and was going to return my donated organ in the form of a paté.

By Friday I was able to shower and the drain was removed through the hole in my chest. I managed not to look, but it felt like someone had tried to remove my catheter from the inside. As far as I was concerned, the less I knew, the better, and kept my eyes closed throughout the removal process. Unfortunately, when explaining the feeling to a nurse, he cheerfully explained that the feeling in my Netherlands was caused by the 25 cm long pipe which extended all the way down to the lowest point inside my torso, presumably alongside the C. I felt sick.

Being the sensitive flower that I am, I displayed a mild allergy to the bandages and now, alongside my four surgery scars, I have blisters, additional scarring and rashes all across my back and side. Nice.

By Saturday the nurses were tired of pandering to my every whim and demanded that the surgeon authorise my discharge. The drive home was interesting and I could feel every single piece of tar on the road. I don’t remember much about Saturday or Sunday although I do remember sneezing on Monday which set me back three days and reminded me of the physiotherapist.

When the surgeon did come in to see me off on Saturday, it turned out that his vegetarian question related to a small gift he purchased for me; some biltong. What a guy! What a hero! Biltong; my best!

So, if you have read this far, I suppose I should give you the facts. The biopsy and pathology reports came back and confirmed the following:

I had a tumour in the renal pelvis (look it up) and Transitional Cell Carcinoma, which is cancer of the lining of the urinary tract. It was a Grade 2 cancer (out of a possible three) which determines how aggressive it is. It was also (fortunately) a Stage 1 or T1 cancer (out of a possible four) which determines how far it has spread. In my case it had penetrated the surface lining of the kidney but was still completely contained within the kidney itself. Lucky it was caught early! As a result, he is confident that it has been completely removed and that there is no need for chemo or radiotherapy which is jolly good news. I do however have to go for regular annual checks and scans for the rest of my life. It would also be a good idea not to become diabetic although he did say I could eat and drink exactly what I did before.

So, that is where we are today. I am hoping the C will be removed this Thursday after an X-ray to determine if my bladder is watertight. Urgh! It doesn’t bear thinking about, especially if it isn’t completely sealed. I have insisted on prescription strength sedatives (the type usually given to recovering heroin addicts) and a pre-med just to take the edge off the removal.

Right now I am sitting rather carefully in a position that can only be described as ‘legs akimbo’. No one warned me of another side effect; swollen testicles. I feel like I am walking around on a pair of space hoppers.

I have not yet left the flat and my only contact with the great outdoors since the 6^th of June was on the walk to the car from the hospital. I am not quite up to receiving visitors, but perhaps that will change after Thursday if the pipes come out. Please do not laugh at my knee high green stockings. No, I have not become a cross-dresser with poor taste; I have to wear compression socks until the end of the month!

For a morning’s amusement, you could always visit early and watch me try to get out of bed. Imagine a walrus trying to flop itself off a rock and back into the sea. That is pretty much me, but only not quite as graceful.

I sincerely hope there won’t be a Surgeon Report 7.

Surgeon Report 5 – I kid you not

No kid pictures. Goat will have to do.

Most of my post-procedure symptoms lasted quite some time. It made me worry but fortunately I got a call from Webster’s Dictionary's secretary. We had a long chat and told her all my problems (although some had since resolved themselves.

Webmaster himself called shortly after to answer my questions. 

Re weeing like a severed artery at a crime scene 

He said this is quite normal, to be expected and looks far worse than it is. He said it could continue indefinitely until removal (my kidney, not my willy) or could taper off (the bleeding, not my willy).

The good news is that my wee is now like a good oil painting; mainly water-based, but with evidence of rust. Perhaps he left an old pair of scissors inside me during the first procedure? 

What exactly do I have? 

I have Transitional Cell Carcinoma (TCC). By definition, this is cancer of the lining of the urinary tract. The Thing is also, by definition, a tumour, in that it is a tissue growth that should not really be there. Fortunately a soft tissue growth, as opposed to a hard one, which is a good sign! 

Strength 

I am at a GRADE 2 Intermediate stage. Not as good as a Grade 1, but it could be a whole lot worse. Much, much worse according to him!

The GRADE is what is determined under a microscope, just by having a look-see. Perhaps they count tentacles?

They cannot tell what STAGE it is at until the kidney is removed and properly analysed. The biopsy sample is not suitable for this purpose.

The STAGE tells how far along it has developed in terms of laying down roots in the surrounding tissue.

It is therefore good news that it is a floaty sea weedy thing in the liquid which means it is less likely to have laid a solid foundation, something that would have been more likely had it been in the tissue part. 

Benign or Malignant 

Irrelevant, really

Benign just means that it is there, sitting around uselessly, taking up space and being annoying; basically, your average Member of Parliament.

Malignant means it has the ability to spread, so, by definition, what I have is malignant as it can grow and spread.

All previous scans have not shown any abnormalities apart from what has already been identified in my kidney. 

Other 

Further good news is that my cytology results all came back negative. This means that The Thing is either not shedding cells, or is shedding very small amounts or cells with very low levels of annoyance factor / carcinogens / bad 'uns.

After the lady visitor had left my office, I asked him how safe my penis was, vis a vis him having potentially scratched/cut/damaged the pipe work (piep work?) en route to the kidney and then having potentially dangerous cells passing over these open cuts on their journey to the porcelain. He said this was not a problem at all; and even less so based on the cytology reports.

It is clinically normal to separate the biopsy from the removal and space them apart; had the subsequent spread of cells across damaged skin or tissue been a problem, they would not operate (so to speak) in this way.

He also confirmed that had it been necessary to act more quickly (rather than wait the ten days) he would not have given me the option of date or surgeon; he said he would simply have made the necessary arrangements to do it earlier himself or get another surgeon to do it. My opinions or feelings on the subject would not have been taken into account; rather it would have been a clinical decision.

Now we wait.

Surgeon Report 4 – Devilled kidneys

Appetite. Lost.

Ingredients

• 6 lambs’ kidneys, about 375g/13oz, skinned
• 2 tbsp plain flour
• 25g/1oz butter
• 1 medium onion, finely sliced
• 1 tbsp tomato purée
• 1 tbsp English mustard
• 1–2 tbsp Worcestershire sauce
• 4 thick slices of crusty bread
• butter, for spreading
• small bunch of fresh parsley, chopped (optional)
• sea salt and freshly ground pepper 

Preparation method 

• Rinse the kidneys under cold running water and pat them dry with kitchen paper. Using scissors, carefully cut the white cores out of the kidneys and discard them, then cut the kidneys into chunky pieces
• Tip the flour into a freezer bag and season well with salt and pepper. Add the kidneys and toss them until well coated with the flour
• Melt the butter in a large non-stick frying pan. Add the onion and fry gently for 3–4 minutes, or until soft and slightly golden-brown, stirring regularly
• Shake off any excess flour from the kidneys and add them to the pan. Cook them with the onion over a medium-high heat for 2–3 minutes, turning every now and then
• Add the tomato purée and mustard to the pan, then gradually add 300ml/10fl oz of water, stirring constantly
• Bring to the boil, add a tablespoon of the Worcestershire sauce to the pan and season with salt and freshly ground black pepper
• Reduce the heat and simmer gently for 15 minutes, or until the kidneys are tender and the sauce is thickened, stirring occasionally. Add a little more Worcestershire sauce to taste if you like
• While the kidneys are cooking, toast the bread on both sides, then spread with butter and put on four small plates. Spoon the kidneys and sauce over the buttered toast and scatter with freshly chopped parsley (if using)
• Serve immediately while piping hot.

(Recipe and image with thanks to The Hairy Bikers and BBC’s Food Recipes; I could not bring myself to make my own devilled kidneys and photograph it.)

Tests completed, procedures performed, locks oiled, keys cut. Time for action!

I received a call from Webfooted's secretary to confirm that my surgery is booked for Monday; a nephroureterectomy, which is better than a female to male sex change which is an addadictomy.

I asked about the actual biopsy results but at this time, Webtoe had not yet received them.

The hospital called and confirmed that the insurance has been approved for a five night stay so it looks like I will be leaving with my C in place. The only advantage is that I should not need to hang around for hours trying to pee (on tiptoes, holding my breath, trying not to cry) before they release me.

I also had to go for pre-operative testing. Here they give you an ECG, blood tests, blood pressure, pulse, oxygen levels and height and weight. The nurse says the height and weight information is needed by the anaesthetist. I told her the same information is needed by hangmen.

I also had to complete an extensive medical history report. One of the questions was “Are you suffering from any anxiety or do you have any concerns about the procedure?”

I wrote: Catheter. Death. Pain.

In that order. 

Just awaiting actual biopsy results and whether or not I should have my Netherlands waxed before the procedure.

Surgeon Report 3 – Kid knees

(First past) The Post-Procedure Report: (A little referendum joke)

Birthday. Begins with a pipe being pulled from my Johnson

I checked into the rather pleasant hospital (much like the Constantiaberg, for any Capetonians who may be reading. Hi.)

Everyone was very nice and most of the staff spoke with South African accents. A quick meet with the surgeon fish and anaesthetist before being wheeled into theatre. Next thing I knew, I was being woken up in recovery and had a whole lot of blue duct tape wrapped around my Netherlands. A quick glance was sufficient; blankets were pulled back and I tried to un-see what I had just looked at.

I stayed overnight because of the lateness of the procedure and had a rather broken night’s sleep; I was too scared to move or turn over in case I pulled the C.

Was up bright and early and felt well enough to go to work. That feeling lasted about half an hour before I had to lie down and rest again. For the record, having a C removed, even by the nicest person, is not pleasant. The most basic functions, like breathing, suddenly seem to be quite hard.

I was slightly surprised to see one of the nurses wearing a t-shirt that said: “I Love Golden Showers.” I did not even know what that meant until he brought me a trolley containing 82 jugs of water and said “drink!”

400 gallons of water and three pees later for the pervert of a nurse and I was allowed to leave. Peeing after a C has been removed involves standing on tiptoes, constant reminders to breathe in, breathe out while experiencing a hundreds of razor blades passing through you. Each time I went to the loo, the results looked like a crime scene. CSI: Enfield?

Clearly then, returning to work was not an option and a further short nap was required before heading out for a family dinner to celebrate my birthday. With hindsight, perhaps it should have waited until I was more awake. It did not feel like a celebration. Still, nice of Siblings J and G and TLS to pay for my very nice Kulbasti (lamb fillet) dinner. I can heartily recommend Meze Meze (so good they named it twice) in North Finchley.

Earlier, the nurse said that I should keep drinking until the early evening to get the system flushed out, but not to drink too late as getting up during the night and disturbing sleep would possibly aggravate the recovery process. Rather, have a glass of water on waking to get some "back pressure" to force out any blood clots. Horrible!

I decided to ignore him completely.

It is not that I am not a compliant patient, but if I did not drink, and the blood started to clot prevented me from peeing in the morning, I would need to go back to hospital for another C. As this one would not be installed under general anaesthetic, I decided it was simply not a consideration and drank two beer mugs of water before going to sleep to ensure I woke up during the night.

The nurse also said the bleeding would probably persist until the final surgery. I cannot imagine going through this for another two weeks or three weeks; feeling nervous and nauseous every time I go to the loo is not feasible.

So, six days later and I have not managed more than two consecutive hours of sleep. I am a broken man.

Surgeon Report 2 – Kidney Beans

I received a call from the doctor's secretary saying he would like to see me again.

No Value brand for me. But will they help?

The sturgeon fish was at his Enfield rooms next door to the NHS hospital where I had my (fourth) scan. My original private (Harley Street) CT scan took two and a half hours. The NHS version took 3 minutes 59.3 seconds; 0.1 second faster than it took Roger Bannister to run the mile.

I asked the secretary bird if there was anything wrong with my results that he wanted to see me and she said that I should not read anything into it; he meets all his patients, regardless of results, to go over them. She also said he will discuss surgery options at this time which are provisionally still scheduled to go ahead next week.

Meanwhile, I feel like I am back in Brazil where life always provides you with half the story; you only find out the full story once you have reached the front of the queue. Having gone through all this grief, my insurance company does not seem to be prepared to pay for my full surgery; it would appear that they will only pay for half the procedure and presumably want him to just leave the unpaid for loose tubes floating in my midlands.

Technically, the problem is as follows: (Skip this paragraph if you are easily bored by detail)

Mr W wants to do a procedure code 82 which is a laparoscopic nephroureterectomy (I practise saying it regularly to avoid stuttering and making phone calls last any longer than is necessary) which is removal via the stomach of the kidney and the ureter. The insurance company only seems to recognise a code 80 which is a laparoscopic nephrectomy, i.e. removal via the stomach of the kidney only. My concern is that they expect my ureter to remain intact in my innards and float around like a piece of seaweed; surely it would tickle and there would be no way of scratching this one.

Like I don't have enough to worry about...

So, more waiting and arguing. At least I am not in the middle of renewing my cell phone contract or trying to change my bank account, both of which are more stressful than divorce or moving home.