Drama on C3 - part 1
Before the drama commences, just a quick note as to how I came to be on C3 which is the surgical/urology ward at the local hospital.. One Saturday afternoon, I was walking upstairs, when I suddenly had an acute attack of the most tremendous pain that I could imagine for no apparent reason. Hospitals ask you to grade your pain from 1-10. This was a 10, and even childbirth had to be downgraded to a 9 in comparison. The doctor was called, and he gave me morphine, but since
it was a bank holiday weekend, he said to wait and see how I was by the following Tuesday, and if I still had pain to go to my GP. The pain gradually subsided to about a 7, but was still there on Tuesday.
When my doctor examined me, she said since the pain was still very severe I ought to be seen by a surgeon at the hospital. I was admitted to ward C3 feeling a bit of a fraud as I was so much better,
yet relieved that I was being investigated just in case there was something seriously wrong that wasn’t apparent. I settled in and then waited.
Let me tell you a bit about my companions in the room. In the next bed to me there was a tiny little old lady with snow-white hair called Hilda.
Then on the end was Freda, also elderly (I was the youngest by at least 25 years) due for bladder surgery in the morning, and she kept getting instructions about what the routine would be for her. She was first on the list so would be taken to surgery about 7.30. She was very concerned because the gown she was going to have to wear was open in the back, and she was told she couldn’t wear panties. However, the nurses said they would get her some paper ones that could then be cut off her before her operation.
Then across from me Emily, a very sick lady with tubes all over the place, who I originally took for being very old, but now I doubt if she was over 65 and finally, a woman called Eleanor who was
recovering from surgery I think - and had a neck brace on all the time.
It wasn’t long after the evening change of shift that the drama which is the reason for this story started, and it centred around Emily. She was on oxygen and was groaning all the time from pain. She had a catheter from which they took samples every hour, and they now came and told her they had to put down a nasogastric tube to suck out the contents of her stomach. They told her it would relieve the pressure on her stomach and make her more comfortable. She was not happy about having to swallow while this tube was passed down her nose and into her stomach, but the cheerful and pleasant and very efficient nurse managed it with a minimum of fuss. I still had seen no doctor, but every so often someone would report that she was still on her way. It was now about quarter to 11, and Emily suddenly started making a fuss, wanting her "usual tablet." But she of course had this tube down her nose into her stomach - and an IV was running, there was no way they were going to give her the usual night-time tablet. She became more and more agitated - and as it turned out the tablet was “for her fits” and she was very worried about what would happen if she didn’t have one. The nurse tried very hard to tell her that it wouldn’t matter and that she could not have anything that would go into her stomach at the moment. But since she continued to worry and fuss about it, the nurse agreed to have the doctor come and talk to her about it.
Before long, the doctor herself finally arrived. She said hello to me, but said she would deal with Emily first. The doctor was young, and she had long, rather dank, auburn straight hair. She was wearing a black short sleeved front-buttoning sweater and tight beige stretch pants and black boots. She took some blood from Emily’s arm, and then tried to explain to her why she couldn’t have an oral medication. Emily said, “But the consultant said I had to take the tablets every night and if I don’t I will have a fit and I will die.”
Doctor said, “Lots of people have fits and they don’t die. You won’t have a fit, Emily, and you won’t die.” But Emily persisted and was becoming quite hysterical about it. The doctor, who had been sitting beside her holding her hand now said very loudly and firmly, “Look at me Emily. I am the Doctor. I am telling you, you will not have a fit. You are very ill, and if you do have a fit it will be from that, not from not having your tablet. And there is no way I can give you a tablet now.”
But although the doctor then left her and came to me, she was still worried and upset, so after a few minutes with me, the doctor excused herself and went and told the nurse to give Emily a morphine
injection to help her settle down. Now the doctor came back to me, but with her mind still very much on Emily. “Why didn’t you just tell her you would put it into her IV solution?” I asked.
“That would be totally unethical. I couldn’t do that.”
Now the poor tired doctor turned her attention to me. She took a history of this episode, and while she was doing that tried to insert a shunt into my left wrist for the IV which I would be given later.
But she had three failures before she tried on the other wrist and had two failures - I’m sure it was the inefficiency and tiredness of the doctor at fault rather than the needles not being right - and for some reason my veins were not at all cooperative.
All her attempts were very painful - and I could understand people dreading her coming to take their blood. She took a break from that, and using another needle in my right arm, managed to get two large sample tubes filled. I asked what the blood was for and she said one for a white blood count to see if I had an infection and the other for bilirubin - because she thought from my history that I might have a bile duct blockage. Then she prodded my abdomen starting gently and then more firmly, watching the strength of my reaction to her probing. One area, more or less around the naval was the most sensitive and I certainly did gasp with pain on several occasions. Then she dug deeply into my abdomen and very quickly drew her hand out and the pain was enormous.
“That,” she said, “is called the rebound test, and the question is whether it hurt more when I probed you, or when I withdrew my hand suddenly.” No doubt about the answer to that question. She did it a
few more times in various places, but that one central area was certainly the most sensitive.
“Well,” she said, “You are a real puzzle. You are not at all typical of anything. You don’t have all the symptoms of stomach flu or food poisoning, which was the most likely cause of your problems.
You have pain in the region of the gall bladder, although that is not your worst spot - but the worrying thing is your rebound reaction - because how you reacted was typical of someone with peritonitis. I’m not saying you have that,” she quickly went on “because you don’t have the other symptoms like a very rigid abdomen which typically go with that. I will order some x-rays, but I think you need to be seen by the senior house doctor.”
I asked what the x-rays were for. There would be a chest x-ray of the diaphragm area mostly to see if there were any signs of air escaping into the peritoneum, and the abdominal x-ray was to see if there were any holes or unusual bulges. As she was going off she said, “I don’t think you are lying about the pain.”
I said, “No, I am not lying.” So off she went, and I tried to get a bit of rest.
The next doctor, a young Greek man in a white coat came about 15 minutes later and did all the same tests as she had, and asked the same questions. The only new thing he did was to ask me to breathe in his face. “Yuck” he said, “when did you last brush your teeth?”
“About 4 o'clock” I said, "just before I came in here."
"Your breath is awful.” I was very offended but he said he wasn’t meaning to be rude but one of the diagnostic tests for abdominal problems was that the patient usually had fetid breath, and I certainly did. But he also came to the same conclusion - that he didn’t know what was wrong with me. So he said he would have to ask the senior surgeon to come and see me when he got out of the emergency surgery he was doing.
About 2 a.m. this most important and very confident older doctor came. He came still dressed in his surgery blue clothes and again I knew he had had a long day. But it was up to him to make the decision about whether I needed emergency surgery that night - and I knew that it was not a clear cut case. He also went through the history with me, and did the abdominal palpitations - but he was not convinced that I had a real problem. As he finished the exam he said, “I am sure you will not be having surgery tonight unless the x-rays tell a very different story.” But he seemed quite confident in a way his junior colleagues had not been, and I think he doubted the intensity of my pain reactions. In fact once he said to me that he thought I was very sensitive to pain. I forgot to mention that while the first doctor was pummeling me, the little nurse slipped in beside me and held my hand. It wasn’t necessary, but was a very nice comforting gesture all the same.
So the next step then was getting a porter to take me in a wheelchair down to the x-ray department. I was wrapped up in a blanket, and a nurse went along. She wheeled me into the main x-ray room, and a plate was put behind my back while I was still in the wheelchair for the chest x-ray. Then I was helped onto the bed while the overhead machine was brought in for the abdominal one. I was returned to the ward, helped back into bed, and connected up to my IV fluid which was saline and glucose and would take six hours to finish.
I got no sleep at all. There were lights on (because Emily needed an hourly blood pressure reading) and the nurses with spare time used the area directly across from me as a sort of rest area, so you could hear their soft voices all the time. And there were lots of people snoring in varying degrees of loudness. Emily made a lot of noise too - with groaning and snoring and the sound of her oxygen all combined.
But about 7, the real drama started.