Sunday, September 20, 2009

My longest ever nose bleed - Part 1

I am pleased to randomly state that I have fully recovered from a nasal operation I had over 2 months ago.

I now feel sufficiently rehabilitated and courageous enough to actually write/type down a record of my experiences. I was considering doing this on my blog, but felt obliged to place it on this one due to influences medical humanities had on my stay at the hospital.

For some odd reason, the week before the surgery, I was not even thinking about it. This odd behaviour continued until the night before the oh so dreaded day, as I was forced into planning what I was going to take with me, due to being informed that I would spend one night in the wards. I was so wrapped up in planing my luggage, that I even asked my sister's opinions on which pyjamas I should wear. I ended up taking three manga volumes, my A4 hardback art book, a pot of ink, paint brushes, a pencil case, a Harry Potter book, my glasses (which I don't even wear), toiletries including facial wash, creams, and make up (god knows why I took them) an extra headscarf, pink woolly pyjamas (I forgot it was July, but liked the colour) and my journal book.

I thought fear might hit me like Heathcliff bashing his head against a tree trunk... but it didn't. 7.30 the next morning I was at the hospital, armed with various medication and pyjamas, whilst I still had not one ounce of fear, trepidation, foreboding of any other ill feeling, not even excitement. My family on the other hand were rather nervous.

I arrived at the medical admissions lounge, expecting to wait for four hours, but I was not even able to read 3 pages of Harry Potter, when a nurse called my name, I was interviewed for what seemed the 4th time about my medical history, which I am absolutely sure is all in the notes as I explicitly remember telling at least 3 physicians previously of the same details which got recorded into the same set of notes. The nurse would ask me of my name first in case I didn't know it, then gave me a wrist band saying my name on it to enforce my identity, I felt slightly like a prisoner as the hospital number had a much larger font than my actual name.

The questions flowed on to my asthma, medication, and allergies, of which I was awarded a second band, bright red in colour and detailing the murderous allergens. I really liked that band, it made me feel distinguished and special. The nurse kept asking me stupid questions about metal plates, here is how it went:

Nurse: 'Do you have any metal substance in or on your body'
Dessa: 'Just the pins in my scarf'
Nurse: 'ItalicAny metal studs?'
Dessa: 'No'
Nurse: 'Any metal plates?'
Dessa: 'Err... no.'
Nurse: 'Any jewelery?'
Dessa: 'No'
Nurse: 'Any gold teeth?'
Dessa: 'No'
Nurse: 'Any braces?'
Dessa: 'No!' (by this time I was thinking 'surely I answered all this crap at the beginning')
Nurse: 'Any retainers?'
Dessa: 'No' (I pitied her for having to ask all these questions to every patient by this stage)
Nurse: 'Any metal body piercings'
Dessa: 'No.'
Nurse: 'Anything metal that might fall off during surgery?'
Dessa: (I actually paused to think about it here) 'Err... no.'

I was then dismissed and called again 30 minutes later by the anaesthetist, who spoke to me in clear simple language, I enjoyed shocking her into understand of my medical knowledge. Then we discussed my susceptibility to vomiting at the hands of analgesics; glamorised by medical jargon.

10 minutes after this interview, I was again called by the nurse to do the only thing I was afraid of: changing into the hospital gown, I'd like to describe them like a sheet of material that's only purpose in life is to make you feel uncomfortable, thank God for the dressing gown they offered! Despite the rather exposed feeling that accompanied wearing the 'gown' I made a new found discovery involving my feet. Being made to wear tight white stockings to prevent thrombosis, I was pleasantly surprised to find that white socks remarkably suited my feet and made them look very daintily cute, all I needed was a pair of heels and I'd be sorted. The effect was somewhat ruined by the trademark label on one side of the stockings and 'Property of the NHS' written on the other.

The worst was still to come, I had never thought that wearing these revolutionary stockings and horrid gown might prevent me from wearing my trainers, and so, I had to wear green spongy sort of flippers which were too big for my good-looking feet and made me feel like a genetically modified penguin. The idea of wearing the highest possible heels, never seemed more tempting. It was in this embarrassing state that I walked down corridors filled with normally dressed people, in normal shoes and who could possibly have metal plates, whilst feeling incredibly out of place, even though I was in a hospital.
At the lifts, I parted from my slightly smothering family, and remained without any significant emotion. My indifference and nonchalance was even surprising me at this stage, the only thing that was running in my head was how I was going to get into surgery with my hair covered....

Friday, September 18, 2009

Barry's colonoscopy journal

My Mum passed on this viral, which I thought our Resident Colonoscopist in particular would appreciate!


I called my friend Andy Sable, a gastroenterologist, to make an appointment for a colonoscopy.

A few days later, in his office, Andy showed me a color diagram of the colon, a lengthy organ that appears to go all over the place, at one point passing briefly through Minneapolis .

Then Andy explained the colonoscopy procedure to me in a thorough, reassuring and patient manner.

I nodded thoughtfully, but I didn't really hear anything he said, because my brain was shrieking 'HE'S GOING TO STICK A TUBE 17,000 FEET UP YOUR BEHIND!'

I left Andy's office with some written instructions, and a prescription for a product called 'MoviPrep,' which comes in a box large enough to hold a microwave oven.

I will discuss MoviPrep in detail later; for now suffice it to say that we must never allow it to fall into the hands of America's enemies.

I spent the next several days productively sitting around being nervous. Then, on the day before my colonoscopy, I began my preparation.

In accordance with my instructions, I didn't eat any solid food that day; all I had was chicken broth, which is basically water, only with less flavor.

Then, in the evening, I took the MoviPrep. You mix two packets of powder together in a one-liter plastic jug, then you fill it with lukewarm water. (For those unfamiliar with the metric system, a liter is about 32 gallons). Then you have to drink the whole jug. This takes about an hour, because MoviPrep tastes - and here I am being kind - like a mixture of goat spit and urinal cleanser, with just a hint of lemon.

The instructions for MoviPrep, clearly written by somebody with a great sense of humor, state that after you drink it, 'a loose, watery bowel movement may result.' This is kind of like saying that after you jump off your roof, you may experience contact with the ground.

MoviPrep is a nuclear laxative. I don't want to be too graphic, here, but: have you ever seen a space-shuttle launch? This is pretty much the MoviPrep experience, with you as the shuttle. There are times when you wish the commode had a seat belt. You spend several hours pretty much confined to the bathroom, spurting violently. You eliminate everything. And then, when you figure you must be totally empty, you have to drink another liter of MoviPrep, at which point, as far as I can tell, your bowels travel into the future and start eliminating food that you have not even eaten yet.

After an action-packed evening, I finally got to sleep.

The next morning my wife drove me to the clinic. I was very nervous. Not only was I worried about the procedure, but I had been experiencing occasional return bouts of MoviPrep spurtage. I was thinking, 'What if I spurt on Andy?' How do you apologize to a friend for something like that? Flowers would not be enough.

At the clinic I had to sign many forms acknowledging that I understood and totally agreed with whatever the heck the forms said. Then they led me to a room full of other colonoscopy people, where I went inside a little curtained
space and took off my clothes and put on one of those hospital garments designed by sadist perverts, the kind that, when you put it on, makes you feel even more naked than when you are actually naked.

Then a nurse named Eddie put a little needle in a vein in my left hand. Ordinarily I would have fainted, but Eddie was very good, and I was already lying down. Eddie also told me that some people put vodka in their MoviPrep.

At first I was ticked off that I hadn't thought of this , but then I pondered what would happen if you got yourself too tipsy to make it to the bathroom, so you were staggering around in full Fire Hose Mode. You would have no choice but to burn your house.

When everything was ready, Eddie wheeled me into the procedure room, where Andy was waiting with a nurse and an anesthesiologist. I did not see the 17,000-foot tube, but I knew Andy had it hidden around there somewhere. I was seriously nervous at this point.

Andy had me roll over on my left side, and the anesthesiologist began hooking something up to the needle in my hand. There was music playing in the room, and I realized that the song was 'Dancing Queen' by ABBA. I remarked to Andy that, of all the songs that could be playing during this particular procedure, 'Dancing Queen' had to be the least appropriate.

'You want me to turn it up?' said Andy, from somewhere behind me. 'Ha ha,' I said.

And then it was time, the moment I had been dreading for more than a decade. If you are squeamish, prepare yourself, because I am going to tell you, in explicit detail, exactly what it was like.

I have no idea. Really. I slept through it. One moment, ABBA was yelling 'Dancing Queen, feel the beat of the tambourine,' and the next moment, I was back in the other room, waking up in a very mellow mood.

Andy was looking down at me and asking me how I felt. I felt excellent. I felt even more excellent when Andy told me that it was all over, and that my colon had passed with flying colors. I have never been prouder of an internal organ.


Dave Barry is a Pulitzer Prize-winning humor columnist for the Miami Herald.

On the subject of Colonoscopies...

Colonoscopies are no joke, but these comments during the exam were quite humorous.....
A physician claimed that the following are actual comments made by his patients (predominately male) while he was performing their colonoscopies:

1. 'Take it easy, Doc. You're boldly going where no man has gone before!
2. 'Find Amelia Earhart yet?'
3. 'Can you hear me NOW?'
4. 'Are we there yet? Are we there yet? Are we there yet?'
5. 'You know, in Arkansas, we're now legally married.'
6. 'Any sign of the trapped miners, Chief?'
7. 'You put your left hand in, you take your left hand out....'
8. 'Hey! Now I know how a Muppet feels!'
9. 'If your hand doesn't fit, you must quit!
10. 'Hey Doc, let me know if you find my dignity.'
11. 'You used to be an executive at Enron, didn't you?'
12. 'God, now I know why I am not gay.'

And the best one of all.
13. 'Could you write a note for my wife saying that my head is not up there?'

Thursday, September 17, 2009

How women go down in surgery - in the former eastern bloc

I have been to the first women in surgery seminar at an international meeting of surgeons in the former eastern bloc. I perhaps set an unfortunate precedent by being naive enough to think I would just be plugging in my laptop and away I went. By the time I'd discovered the little men round the back who orchestrate it all (cf Wizard of Oz) whose English was not up to my question as to whether open office would do, I had to hand them my stick to translate into the dreaded powerpoint and disappear. My talk was not, thankfully, in the main hall with 2000 people but in the little session right at the back of this vast circular building (concrete, "a landmark in the history of reinforced concrete architecture", hilarious) but wasn't hilarious when my talk came up all - well, slightly - mucked up on powerpoint. I had left it too late to fuss about the line spacing. After all that preparation! And it had strangely lost all the photos of the kids. Had to hotfoot it, racing round this concrete famous structure to my talk at the back.

so, not a complete disaster but a really rubbish beginning. Got there, late, and the introduction was in full swing - but not in English. She put me straight on, and I talked ok, in English of course, without notes, apart from forgetting the name of one of the women surgeons in a photo - I had been going to talk about her but couldn't as forgot her name. complete blank. so had to move on.

Winced through the crap layout of 3 slides and the one of my partner looking official in his work photo (in none of my own does he look presentable like that) but without the one next to it of the
kids and finished it ok.

The plan was to have 4 talks in English followed by a question session. I had been told that there was some antagonism regarding any meeting specifically for women in surgery in this country from other women surgeons. This I have also met in the UK. But it isn't about the women who are already established and happy they are on the same level as the men. It is about encouraging normal female medical graduates - not crazy extreme workaholics but normal types who want a family, some work-life balance AND an interesting job, to consider surgery. I think. So I was looking forward to the discussion panel that I was expecting to sit on.

First there was a good talk by an Austrian surgeon, who had looked at the German speaking countries' proportion of female surgeons. They are better than us, anyway, with some highlights in paediatric surgery (50%!) and plastics. What are they doing right? Rest of surgical specialties all around 10-15% , with the same failure to increase numbers like the non-surgical specialties, so nothing spectacular. A talk on the history of women's involvement with the foundation of the Mayo clinic followed, then we had a crazy talk by a woman in black and white dogtooth suit with bright red hair which was all not in English either - so probably not crazy at all, I didn't have a lot to judge it by - and all rhymed but no idea what it was apart from obviously quite humorous.

This was followed by a quiet girl who'd interviewed some of the country's women surgeons (8 of them) and presented, battling somewhat against the wound-up now-raucous audience, her findings including quotes like "private life has to take second place to professional life, that is the way it is in surgery". I personally wanted to take issue with this, but there was time to talk at the end. Then our organising surgeon who is dashing all over running everything from the company who gave us free vodka (!) and the choice of chocolates to managing the eminent visiting surgeons from the Mayo (there is a historical Mayo brothers connection) gabbled through her questionnaire of women surgeons with no translation. I'd not been given a name place at the panel so had sat in the audience.

(but we'd already been interrupted by the president who had spoken for a while - after translation, the only thing translated, because he was dogged faithfully by his own personal translator as he moved around the conference halls - about how surgery was changing to be more delicate, like women, and had then interrupted again after the second talk to very pleasantly hand us out all great socking medals - including those who hadn't spoken yet - as he had to go off to welcome the international laparoscopic expert who was up next in the big hall. I sat there, wishing I could go to that instead of watching these somethings in a foreign language, nice as it is to listen to..)

We then had to put up with a big red-faced self-important bloke who stood up and started talking - not on the menu, but okayed by our leading vascular surgeon. He went on and on for at least ten minutes, cracking jokes, (none of it in English of course) stroking the vascular surgeon's hair fondly every now and then. Then he burst into "What a wonderful world" (I understood this) to which we were treated along with two whole verses. Not a bad voice, as he knew. But it was not the evening performance yet. I feel fairly sure this would not have happened in any other meeting of surgeons around the hall.

The panel discussion disappeared as there was only a female professor who started some kind of argument to which our organising surgeon replied in the same language then it was all over.
We got given chocolates to cheer us up. Great chocolates.

So, very let down not just by my naivety in not checking and rechchecking my talk, and in not being more proactive (no one TOLD me I had to go to the guys organising to get it on their computer, but then I didn't seek it out either) but also in the shambles and joke that the session turned into. I can't believe how far we have come in women in surgery in the England in that this would never be tolerated in our meetings, nor in those in Austria as I have heard. It is of course a cultural thing (the man-handling of women in particular), but to have a man stand up and dominate the meeting, (whoever he was) patronising us with his song when there were serious things to discuss is just incredibly disappointing.

there, had to get that off my chest.

Monday, September 07, 2009

The Brain Unravelled

A short season of events and art installations kicks off today, entitled 'The Brain Unravelled'. Taking place at the Slade Research Centre Woburn Square, London, there are a number of interesting talks, workshops, screenings and performances, bringing together brain anatomy, neuroscience and anthopology. For the full programme, see here.

Sunday, September 06, 2009

Healthy scepticism

Despite my lack of recent blogging (due partly to working full time last year which nearly broke me and partly to a qualm or two about patient confidentiality, given the traceability of bloggers), I have still been talking about medical humanities and even have discovered, to my delight, a secret poet amongst my surgical colleagues, along with a self-published children's book author.

I have explained the concepts to my family and friends, waxing lyrical over the benefits of adding the arts into the nooks and crannies of medical life, where things reverberate.
However, there are some amongst my acquaintance who are clearly not convinced...

I publish these verses, by a friend:

(in the style of W.S.Gilbert)

At the outset I must mention
it is not my 'vowed intention
to deplore the intervention by a creche of Keyhole Kates
into Medical Humanities,
or other such urbanities
('though similar insanities add tuppence to the rates).

It's a brotherhood of sisters
(devotees of Joseph Lister's)
who extol the works of Misters: Milton, Coleridge and Keats
as an aid to better rounding
of a surgeon's basic grounding
or, at least, that's what it's sounding like: an aid to greater feats.

A colostomy, gastrectomy,
a routine appendectomy,
or, p'raps the odd vasectomy to brighten up their day.
Then maybe, if they feel the itch,
a final fling with blanket stitch
before a song (at concert pitch) to chase their cares away.

They'll be oh, so sympathetic
(not a bit of it synthetic)
while prescribing an emetic, 'though, as sure as “Heinz means Beans”,
this firmly rooted notion
of such lit'rary promotion
will result in their denotion as a bunch of “Milton-keens”.

Signed : Sceptic, of Sale
(With tongue firmly embedded in cheek), to my favourite left-handed Registrar.