Une Semaine de Bonté: A Week in Papworth Operation and Waking: Procedures, Routines (2)

I lose track of which night was which in those first days, but one episode, probably the first night in intensive care, impressed itself on me. There was a conversation going on which grew quite loud and long. It was between an elderly male patient and various members of the nursing staff. It ranged widely, which at that time of night is itself unusual, though I couldn't actually follow it but, mostly, it consisted of the man telling anecdotes about his stoicism in the face of pain. At the same time there was a note of desperation in his voice. Nurses, and then a doctor, were trying to persuade him to something. Don’t you touch me! he cried. And Not enough morphine! And It isn’t taking effect! These cries would then settle into further conversation. Eventually I understood that the nurses were trying to take out what they call 'the drains'. I had read about the removal of the drains in the pre-operation literature and, honestly, the process sounded potentially painful. It wasn’t something I was looking forward to myself: now here was an older man clearly terrified of it.

Drains are where “blood, serum, lymph, and other fluids” accumulate during the operation. If such material were allowed to accumulate outside the drains it could put pressure on the surgical site and on various organs, so drains have to exist and have to come out.

The old man scared me but he also made me determined to show no fear. I would not let myself down by complaining. Eventually, after about an hour of cajoling and drugging, the old man gave in. There was no cry of pain. When it was over he fell asleep and so did I.

When my own drains did come out a couple of days later it was not at all painful. I lay down on the bed and the nurse told me to breathe deeply then out, and to do this three times but on the third to hold my breath in. As I did so he pulled the thin piece of wire from just above the stomach holding the drain together and out it slipped, with a faint whisk. It was a strange sensation but there was no pain. It may be, I thought, that the old man had a different kind of drain, or that he had a particuarly low pain threshhold. Maybe if I had to accommodate his pain I would not feel so smug now at having undergone the manoeuvre so easily.

What the removal of the dressings over the drain revealed was a scar some 30cm long. It was a scar that seemed almost to deserve its own name and character. I did not yet know that the scar on my leg was much longer, the length of the leg in fact. I was, of course, aware of the principle of the operation, whereby the narrowed blood vessels (in my case the four of them) feeding the heart should be replaced by others taken from elsewhere in the body. usually the leg. My surgeon had explained this to me and I had read it in the literature. The old vessels are not removed: they are, literally by-passed, as a road might be in order to relieve traffic. I don’t know how the grafting is done or how the sternum is opened. I imagined a small precise version of a Black & Decker for the latter job. They have to stop the heart for a while and use an external mechanical heart instead.

But there is no awareness of any of that. All you have once you come round is sensation and scars.

And the detested catheter. I kept asking when it could be removed but they couldn’t give me a definite time until one of the nurses on day shift told me it would be the next day. That night was very broken and one of my fairly regular night nurses, the kindest, said she could do it there and then. Do you have the authority, I asked in awe. Yes, she said, and with the usual magic instruction of Three deep breaths! she drew it out. It didn’t hurt: as with most other moments of anticipated pain it was a simple, slightly strange sensation that lasted less than a second.

*

Routine is everything in hospital. In intensive care there is the constant measuring of heart rate, blood sugar, blood pressure, urine analysis, the taking of temperature, of body weight, the intravenous feeding through of anti-biotics, and the regular ingestion of tablets, of which there are many, as well as a constant supply of oxygen..I had two complications that had to be treated: an early infection that led to a rise in temperature and, once I started walking, a rise in the heart rate accompanied by a certain irregularity, both treated with drugs - drugs I continue take now, after my discharge.

Meals are part of the same routine. You are given a menu sheet for the following day and tick what you fancy. There is always a variety of fruit juice, a soup, one very straight meal, one slightly more exotic one (a sweet and sour chicken for example), five or six varieties of sandwich (corned beef being the most popular, said one of the catering staff) and a choice of sweet always including jelly and ice cream. The time between these courses can be quite long, so lunch or dinner can take an hour and a half. I fancied very little for the first two days, choosing the minimal amount of the blandest and warmest, before moving on to proper means. Cups of tea and coffee are available throughout the day. You’re always asked if you want sugar. One of my fellow patients wanted four spoonfuls with each cup of coffee.

Day is far busier than night and I wasn’t the only patient in the ward. Day consists of pill taking, blood testing, some exercise, and patches of conversation alternating with silence. The various grades of nurse arrive, go about their tasks, then go. I will speak more of the staff later, just to indicate at this point that the team is big and there are many names to learn, some three-quarters of them foreign. Day is easily manageable if you have reading or newspaper puzzles to solve. There is neither TV nor radio. My mobile phone - once Clarissa had brought it in - offered some musical breaks, chiefly chamber music and jazz, both very welcome at night.

I was ambitious in the books I brought for reading while recognising that it would be best to focus on relatively light matter.. Here is the list: Stefan Zweig’s Casanova; Joseph Roth’s The Radetzky March (a re-read but rather too heavy in hardback); Graham Greene’s The Ministry of Fear; A Nicholas Blake ‘Nigel Strangeways’ thriller, A Question of Proof, The Penguin Book of Light Verse, edited by Gavin Ewart; and, received as a loan from my daughter, Denis Johnson’s Jesus‘ Son, a book of contemporary, short, funny yet terrifying stories set among highly articulate yet spaced-out, potentially violent junkies, and much praised by Jonathan Franzen.  Of that lot I managed only the Graham Greene and the Johnson. I tended to fall asleep over books in the middle of paragraphs or sentences. The Book of Light Verse would have been great but it was probably with Clarissa in the room she was renting nearby and I inevitably forgot to ask her for it. As for the books in general,  the criterion was not so much page-turning narrative, but small easy blocks of clear prose. I did toy with Evelyn Waugh’s Vile Bodies (another re-read) and I wished I had brought it because early Waugh is one of the glories of 20C English ficiion.

And, of course, I myself was writing, partly to keep myself focused, partly because that’s what I do anyway.

Night can be haunting and disturbed, altogther a trial. The beds have their own bedside lights but the curtains are not drawn so putting the lamp on could disturb others. Meanwhile other patients are finding the night a similar trial so the time is full of coughing. I had only one decent night the whole time and often had to call the nurses to provide me with an oxygen mask or, better still, a nebuliser, to deal with the painful coughing which always felt worse lying down. Encounters with night staff under such cirumstances are very dreamlike and maternal. You are a sick child again being tucked up by your parents. I grew very attached to some of the night staff as a result, particularly to those who acted most like kindly parents.