Tuesday, 15 September 2015

Urology - How The Whole Thing Has Changed

Prednisolone is at last and forever in the backseat.  New joys arrive to take that wonder drug's place.

Check urologyforreal.blogspot.co.uk  to keep up

Wednesday, 29 July 2015

Oral Morphine

 In the big bottom drawer by my bed at home are the boxes.  These are my stacked supply of prednisolone in 5 mgs and 1 mgs tabs, dozens, enough to de-polymyalgia a whole street.  The boxes are dated and aging.  I haven’t touched them since my dose rate dropped to zero.  They are the reserve, held against the pains returning.  I should take them back to the pharmacy but they are my psychological prop. 

In the drawer by my bed where I am now there is no prednisolone.  In fact there is not even a drawer, just a mobile cabinet containing my clothes  with a box of Kimberly-Clark Professional Tissue sitting on its top.  In style these  are hygienic  regulation NHS.  In reality they are little different from the serviettes offered to me last week at Lobster & Burger in Hills Street.  No printed menu, three items only served, same price for each, all of them containing lobster. 

I’m in an otherwise empty side ward at the back of the being rebuilt Short Stay Surgical Unit.  The corridor outside is sealed with plastic sheeting  held in place with gaffer tape.  This is the University Hospital of Wales, built in 1971 and now showing signs of wear.  I’ve taken oral morphine, given to me in a self-dosing syringe.  It’s put a great bank of soft glory between me and the pain.  The catheter with its bloody bag recedes into the clouds.  The ceiling glows.

I’ve been under having samples taken from inside my bladder and several tumours  removed.  I’ve no idea how long I was in there.  One minute I’m talking to the anaesthetist who is administering dope into the cannula inserted in my wrist  and next I’m seeing two versions of everything in post op.   Now I’m languishing in that half world between crisp reality and the safe haven of fog. 

The night rolls.  I drift  through it.  At 3.00 am in the near distance an alarm sounds and the winking equipment around me flickers off before coming back on.  Fire alarm.   I realise in the total dark that there’s not much I can do about this, secured as I am to the bed by tubes and drips and full  with somnambulant drugs.  I call but no one hears.  I reach for my phone and try to check current UHW status on the UHW web site.  Nothing.  There’s an emergency phone number.  I ring that, at least I think I do.  No one answers.  I search for things like “what to do in hospital when there’s a fire” and “large building evacuation procedures” and finally “how to get down a corridor with a catheter inserted into your old man”.  The results I pull up all suggest that help will come.  It doesn’t.

I’m worried, I suppose I am but the dope takes off the edge.  The alarm which has rung for at least half an hour suddenly  silences.  They’ve put the fire out.  The alarm system itself has been consumed in a conflagration.  I’m in heaven on the other side.  One of those.  Eventually a nurse carrying a torch turns up to check on me.  “You alright love? ”  I nod.

The following day, which is not long in arriving, the staff nurse reviews my case.  The catheter is removed.  “There’ll be a bit of sensation as this comes out.” Jeez and a half.  The deal is that so long as there is someone with me and so long as I can lie down and be looked after for a few days I can go.  That and the fact that I am able to pee again.  Sounds so easy doesn’t it? 

Down at the SSSU latrines, one working, two out of commission, one with a sign up showing that it is currently being cleaned, I get into the queue.  There are two blokes in front of me both aged beyond, using the walls for support and generally looking terrible.  Once it’s my turn I stare at myself in the mirror.  I look pretty much the same.

Pee is beyond me.  I return to my bed dispirited and depressed.  The nurse advises drinking more.   “That’s the answer.” I’ve already done two jugs of water and four polystyrene cups of  hospital tea.  “Why don’t you go down to the concourse and have one of their giant coffees?  The walk will help.”

In the real world of the concourse, such as it is, everyone seems so business-like and aware.  I’m still full of fog.  I do a Grande something, hot brown liquid sold for an exorbitant price and then walk myself slowly back to the ward.  I join the latrine queue and manage a miserable eighth of a cup.  Nurse says no.  Not enough.  Drink more.  Keep trying.  She hands me another tea.  I can feel it, this flood of liquid, swilling around inside me.  I’m filling up like a tanker.

Eventually  after a few more failures there’s relief, of sorts, a trickle that the medical staff declare to be just about sufficient.   They need the bed, after all.  I’m clogging the system slowing   the flow of patients.  So long as I can just about cope I should go.

It takes a good two days before proper flow returns and a whole two weeks before the pain subsides.   It’ll happen again, I’m told.  These things, benign mostly, have an 80% likelihood of regrowth.  What causes them?  Exposure to certain chemicals, being Caucasian, getting older.  Two out three then.  Rock on.

SSSU: Short Stay Surgical Unit

Wednesday, 7 January 2015

Cardiff and the Vale Health Care as an Episode of Jules Holland’s Hootenanny

Down at the practice the usual hootenanny is in progress.  The waiting room is full.  There are queues from those nationalities who do queuing and great seething  mauls among those who don’t.  It’s hard to tell if this is an international airport waiting lounge or a doctor’s surgery.  Only the lack of plush carpeting and stores selling luxury goods gives it away.  There are people here who are not registered, don’t know how to get registered or who do not understand the concept of registration and imagine swaying about in front of the reception counter will suffice.  Many have language issues and get by with hand signals.  Some shout.  Others have brought along younger family members better at english than they are to try to help.

In a line in front of the glass window are three aged, baggily oversized pensioners, huddled in coats and scarves and wanting urgently to get in there to present their back pains, swollen feet and chest aches.   The receptionist points to a flat TV screen on a side wall and yells something along the lines of “it’s over there, say you are here on the screen” to which she gets the uniform response of “doan work”  and the shaking of pensioner heads.    I check it out.  Press.  Enter your date of birth.  As if by magic the system knows who you are.  “Welcome Peter Finch.  Your appointment is with Dr Williams at 10.45,  You will be seen at 10.46.”  It’s 10.40, 6 mins to wait.  I go stand at the far side among a gaggle of screaming children and mothers who are bent on covering the entire floor surface with toys, prams, wet wipes, blankets and other child clinic attending paraphernalia.  I am seen at 11.22.

But I am seen.

Inside it’s slick.  There are machines that measure my pulse, and blood pressure.  Screens that show my entire medical history including MRI scans, X Rays and attendances at hospital clinics.  The room is bright lit. Diagnosis is swift and thorough.  Smoking is forbidden.  A sign tells me this.  It is forbidden outside in the waiting area too.  Cardiff and the Vale Health have a policy against.  They train staff on how to use appropriate body language when approaching recalcitrant smokers.  They don’t actually impose fines or take the lit fags off you.  Instead they offer you give it up leaflets and tell you where you can attend the nearest quit smoking clinic.    

At UHW Heath Hospital right next to the large sign which announces that this is a smoke free zone, just where the smokers in bathrobes and angel gowns usually cluster, they have now positioned a tabard-wearing smoking warden.  The one I saw last week was reading a newspaper.  Just round the corner from him was an old woman in a wheel chair going full at it with a king size Lambert and Butler

When I was young and the family doctor held his surgery in a cramped room half way along Albany Road next to where the Fish Bar currently stands everyone smoked.  In winter you’d enter the icy room heated with a single bar electric fire and lit with a 60 watt bulb to find lines of the aged huddled in their greatcoats all smoking furiously.  There’d be copies of the Daily Sketch and last week’s Sunday Pictorial lying about among the fag butts.  The air would be dense enough to hold in your gloved hands.

When you got there, facing the actual doctor, smoking was not allowed.  Drinking, however, appeared to be.  The doctor kept a bottle on his bookshelf badly hidden behind and edition of Grey’s Anatomy.  My mother said she was disgusted.  He always smells of drink, she’d complain.  But still we kept going.  The cure for whatever was wrong with me at the time was always the same.  Either a tonic, a large NHS bottle of fishy-tasting cure all, one large spoonful to be taken daily, or an ear syringing.  This was carried out with warm(ish) water and a steel bowl held near the bottom of your ear.  You went back out in the winter cold for 30 seconds a new person  after which the side of your face froze.

More effective, it turned out, than today’s cures.  Today I get words of concern and antibiotics.  Out in the street the rain is coming down like burst water tanks.  Passing cars are like speedboats.  I sail home.  Despite the privations, lack of computer records and the tobacco I’m sure the past was easier.  But then people of my age always say that.