Right Hemicolectomy with Cystectomy [12.05.16] – Pt I

So last time, I had just had my pre op assessment for my surgery.

I’ll admit, that appointment was extremely helpful – it calmed me more than I had expected and I finally felt relaxed for my operation and I knew I had made the right decision.

On the morning of my surgery – Thursday –  I packed my overnight bag with some pyjamas, face wipes, my phone charger, kindle and dressing gown. I was told I was being admitted via the Day Surgery Unit at the hospital at 1pm. My dad had kindly taken the day off, so we arrived with enough time to relax before I would be call through and hopefully I wouldn’t get too anxious. We walk into the unit and up to the desk to get checked in, just as my surgeon and his two registrars come waltzing in from the ward and saying he needed me right away; he had been waiting for me! I was very quickly booked in with the clerk and then taken into the ward. I have to admit I was quickly getting emotional at this point, I thought I had time to sit with my dad to get mentally prepared but it all happened so quick…

I got taken through to a large ward – a mix of an actual ward and a discharge lounge – to a massive chair in a bay to begin consent to my two procedures. My surgeon took me through them again, explained the risks and how long I was going to be staying in hospital for. Then the Stoma nurses came around and marked me up for two possible stoma sites on my belly – this part was terrifying. I knew there was a very small risk of waking up with a stoma but it made me feel incredibly nervous again about having actual surgery. Luckily, the nurses were wonderful and helped me relax. Then my pre op nurse came in with a student nurse and took me through all my details and the op – I found myself repeating my name, date of birth and address alot – before explaining about what was going to happen next.

It was then turn of the anaesthetists to come around and assess me. We discussed my operation, the length of it, my medical history and how I would be kept under and what pain management I would receive in post op. Because of my hiatus hernia; I would be receiving an epidural for pain relief which they would administer before my operation and this would last for a good couple of days after my operation on the ward. Pain management was my big worry because I didn’t want to be in pain once I woke up. He reassured me they had lots of options and to trust them; that once they had removed the chunk of bowel and the cyst that was causing me so much agony, I would just be so relieved the cloud of painkillers would be the icing on the cake.

I then got changed into a gown, surgical stockings and disposable pants – a sexy look if there ever was one – and told to just relax and they would call me when they had got everything ready. It wasn’t long because at 1.30pm the lovely anaesthetist came back and collected me. I walked down into theatre, took my place on the trolley and got my IV placed, all the monitors connected – I could hear my heart going like the clappers – so they pushed some Fentanyl before the anaesthesia. The last thing I remember is being told to fight the urge to sleep for a couple seconds so my hiatus hernia didn’t cause a problem and I was fast asleep.

It is very weird handing over control of your body to someone else.

I vaguely remember waking up on the recovery ward but not sure where I was or what time it was. Then the next blurry memory is of being on an actual ward, seeing my parents in blurry outlines and still unsure of what had happened. To check, I felt my belly and there was the proof; a swollen abdomen with four dressings, no stoma bag. I was happy. I wouldn’t know how well the operation had gone until the next morning on the ward round.

Like most people, I’ve always found it difficult to sleep on the wards in hospital but this was something else. I was still experiencing anaesthetic and receiving pain relief, I didn’t mind being woken up every 4 hours for my observations. I had a catheter in and I was on fluids so I was pretty immobile that night. But about 3am I woke up to pain in my left hand. This had my cannula in but my forearm and hand had swelled so much that my IV pump was going crazy because it was unable to deliver my fluids. I’d just had a dose of IV paracetamol on the last drug round, so they decided to remove my cannula and let my arm rest. An on-call doctor would be called to get another IV started in my other hand. I dosed off again, thinking it wouldn’t be long and someone would wake me.

The next thing it was breakfast time. No new IV, no fluids, I was feeling pretty awful. I knew I was dehydrated and starting to feel pain. The good thing about the surgical ward, the surgeon’s round on their patients early. My surgeon was there from 7.45am and once he had checked my abdomen was soft – ouch, lots of pressing – and my dressings were still covering and not leaking he asked about my pain. I said it was pretty bad and no one had been to replace my cannula overnight. My left arm was still swollen and painful. He wasn’t happy about the IV not being done yet but hit the roof when he found out my epidural had failed. I’d come up to the ward without a PCA pump attached my stand with my fluids. His registrar left the closed curtain and went to order morphine. She came back not too long later to try my right arm for a cannula but couldn’t get anything to work after a couple attempts. I needed an anaesthetist to come and place one. He arrived pretty quickly, and after half a dozen attempts –  most of the time he kept checking I wanted to continue, because he knew it was hurting; but I needed the pain relief, we had to get one to stick – I had a new IV and my PCA pump was set up.

My surgeon explained that he was able to complete the surgery as planned; laproscopically without any complications. He took away 30cm of my small bowel – my terminal iluem –  that was very badly diseased and checked the rest of my small bowel and my colon for any lingering signs of potential Crohn’s. There wasn’t any! The GYN surgeon then removed a tennis ball sized cyst off my left ovary. These are my incisions a couple days after surgery, when they removed the dressings. I was quite swollen and sore but I felt so grateful it had all gone to plan!

They were going to continue to rest my bowel for a a day or two before I could try some soft food. Now that I was full conscious, I would be able to manage my pain with my PCA.

Which brings me to Morphine. There is nothing like it. This was my first experience with it and it is incredibly easy to get use to but it did make lots of seemingly simple things more difficult. I needed to have my nasal oxygen on constantly whilst having it, it affected my taste and appetite and really slowed my bowels down – not that there was much inside of me to come out! Most noticeable was how much it confused me; I was having trouble trying to say the right words in the right order; much to everyone’s amusement.  I had my PCA pump for a total of four days and coming off from morphine was very hard. I’m very glad I had that over the ‘failed’ epidural and it really did enable me get up and out of bed and eventually become more mobile. But I knew they wouldn’t let me have it at home, I would be switched oral painkillers: paracetamol and codeine.

Part two to follow…