I give my name to the receptionist and a nurse leads us through to the waiting room. I am back in the pre operative assessment clinic which also doubles up as the surgical waiting area. Rather than being admitted to a ward the night before the procedure, everyone booked for an elective operation comes here at 7:30 am to be seen by their anaesthetist, changed into a surgical gown and wait to be called. It is a surreal environment.
There are others here too, waiting to go under the knife and I guess the lady to my left is expecting a new knee as a cheerful young man in scrubs draws a large arrow on her shin pointing to the soon to be removed joint.
If ever a place needs to be somewhere of peace and calm then this is it, somewhere to mentally prepare for what is ahead. This strange room in which I have no idea how long I must wait, doesn’t seem to fit that bill. The television is on, perhaps it is thought that this will be a distraction, a dose of normality in a most abnormal environment. I am distracted but not in a way that can possibly help my gradually rising anxiety. Daytime television at it’s most inane bombards my fragile senses. Piers Morgan, full of his own self importance argues loudly about something no one else cares about and is followed by the contemporary version of Bedlam which is Jeremy Kyle and I am in no mood to visit the asylum for entertainment today.
I have had no specific bowel preparation, no heavy dose of laxative the day before to clean me out ready, but I am to have an enema administered just before to make sure the surgeon has a clear field of vision. There is however nowhere suitable, ie affording a degree of privacy and the close proximity of a toilet, which can be found and so I am escorted back through the long hospital corridor, holding on as securely as possible to my gaping gown, down to the ultrasound department, where a room with adjacent lavatory is available. I think I have moved beyond embarrassment, I know the routine for this, lie down on my left side, knees bent and prepare for something to force it’s way unnaturally into me. “Try to hold it for at least 5 minutes” I’m told. “After you’ve been to the toilet, make your way back to the surgery waiting area”. I am a little confused. They want me to walk unaccompanied back through all the waiting ultrasound patients and up along the busy corridor whilst desperately clenching my cheeks to avoid leakage, I am wrong, I have not moved beyond embarrassment. “Actually, it may be better if we bring a chair and collect you” the nurse concedes, and fortunately that is what happens.
Up until now, Sharon has been with me but now I must walk through the double doors where relatives cannot follow and climb up onto the pre-prepared table. This is the anaesthetic room, wires are being attached and needles inserted and I feel almost as if I’m an observer, watching someone else being prepared. Then the screen goes dark the show is over and time itself seems to stop.
5) Blood Tests and Scans
The consultant surgeon turns the monitor screen towards me and animatedly points out the various bits of my insides. My CT scan, (virtual colonoscopy) reveals all sorts of pertinent information but how he can decipher these swirling abstract patterns into anything other than a contemporary piece of monochrome abstract art is beyond me. “You have a very interesting abdomen” he tells me. Interesting turns out to mean a) something which he is very hopeful is not cancer but a large lipoma, a fatty non-malignant tumour which has the potential to occlude my colon and b) an inflamed perforation which he believes may be causing the bleeding and abdominal discomfort. Most surgeons it would seem, like to do operations, they relish the blade and the cutting into flesh and he tells me this with what almost appears to be a look of enjoyment on his face. I am therefore relieved and surprised that at this stage he believes we should wait a month, perform another CT scan and see if the hole in my bowel is healing on its own.
This is the process, the waiting, the rearranging of normal daily routines to accommodate the appointments for blood tests and scans, the time taken trying to find somewhere to park at the hospital and getting anxious not to be late to see the consultant. All the while the symptoms are becoming worse. Everything seems normal for a few days and then “shit!”, I need the toilet desperately. When I get there, undoing my belt and fly and nearly tripping over my jeans as I rush to sit down. My evacuation turns out to be a bloody, mucous clot. I dare not move, blood clots are like London buses, you wait for ages and then three big red ones come along at once. And now I also know what Jack Nicholson’s character in “The Bucket List” meant when he said “When you get older, never trust a fart ”.
6) Waiting for Surgery
It doesn’t improve. The perforation remains inflamed and does not heal. The as yet, still not definitively identified lump is now causing a constant, nagging discomfort. It’s not acute pain I just know it’s there. It is the unreliability of my bowel that is more and more of an issue. The days when I can go to the toilet in the morning before work and only need to visit again when needing to pee are now less frequent than those when I have a real and terrifying fear that I could actually shit myself. As yet the proximity of toilets and the occasional dose of Imodium have prevented this catastrophe.
My bowels have become the topic of discussion in a multi disciplinary team meeting, and the conclusion they reach is that surgery is necessary. The surgeon draws a diagram, he does this upside down so we can see it and I’m very impressed with his draftsmanship, that level of fine motor control is a good sign in a surgeon. He explains that although keyhole surgery is an option, he believes a larger incision would be more beneficial. He needs to remove about a foot of the sigmoid colon, including the lipoma and perforation. This is a delicate procedure, there are adhesions and inflammation and also a close proximity to important nerves. Yet I am resigned to this eventuality, I cannot continue needing to spend my life sat on the toilet or least always being within easy reach of one.
I do not have long to wait and I am given a date which is less than a month away. Of course this sets the alarm bells ringing, why the fast track? What happened to all those waiting lists? They must think it’s cancer! I am spiralling down into abyss of non logical conclusions, it really is an emotional rollercoaster. At the pre operative assessment clinic the following week, the not particularly engaged nurse informs me that the date is actually a week sooner than originally stated and then as I’m coping with the sudden rush of adrenaline this news brings on, she takes my blood pressure. Guess what? It’s quite high!
I also have to see a stoma nurse, a clinical nurse specialist, who advises patients should they need a bag to collect the bodies waste following this surgery. This happens in about 10% of cases and is usually temporary allowing the bowel to heal before another operation to connect everything back together. She is altogether different from my last experience. She is helpful and explains everything. She takes the time to listen and provide reassurance, my confidence is restored.
I know what they are looking for as I am fast tracked to a hospital appointment, there is one thing, one potential diagnosis which needs to be ruled out. Speed is now of the essence and my initial foolish delay in seeking medical attention now seems so silly. We have a wonderful NHS so I didn’t have to consider if medical insurance would cover what was to come. My reluctance to go to the doctor was purely out of potential embarrassment and not due to any financial consideration, although as I am self employed, that will come later.
In the more than twenty years since I was nursing, much has changed so I have scoured the internet for information and at this stage I’m not sure if this has helped or just added to my worries. It surely must be better to know and be prepared, after all no one wants to be caught short by the explosive effects of the bowel preparation they have given me.
I have to change out of my clothes into an easy access hospital gown and I become a patient waiting in a cubicle to be called in to the examination room. As it sit waiting, I am remembering having a large wound on my hand, stitched by a nurse practitioner in the A & E department a few years ago. That was a cool, macho injury, I could sit and watch the flesh being pulled backed together, numbed by lignocaine and remain stoic and detached. Of course I could, I was still wearing my trousers!
I am allowed to watch, there is a monitor displaying the progress of the camera as it makes it’s way up inside me. This distraction does not stop the discomfort but is fascinating to see. There it is, my bowel completely devoid of it’s normal content being negotiated by an intrepid explorer. Although I am not used to seeing the inside of a human body, the lump when it appears seems huge and I say as much. The nurse who has been up to now a reassurance tells me not to worry, and says everything looks so much bigger when seen on the screen. I know this already, my concern is it’s size in relation to the normal lumen of the bowel, it occupies most of the space and there doesn’t seem as there is much room for anything else. The doctor also seems surprised, he was expecting a small polyp, something he could snare with his scope and cauterise away. He withdraws defeated.
The good news is he doesn’t believe this to be anything malignant, he can’t say 100 percent but he is very confident. My worst fears are not realised, but I won’t be convinced until conclusive test results state categorically in black and white “negative”. Until then I can remain very optimistic. The bad news is I must now be referred for further tests and investigations, and so the rollercoaster ride continues.
I’m sitting in the doctor’s waiting room, it’s only March and the season for colds and flu is not yet over. I am surrounded by sick people, coughing and sneezing, filling the air that I also have to breath with all manner of infectious agents. I can almost see the evil little germs making a beeline for me. The sooner this ordeal is over the better. Finally accepting that my symptoms are not normal, I have made the appointment to see the GP. The trouble with a little knowledge, is I know what is going to happen. I am aware of the first thing that must be checked when a patient presents in a doctor’s surgery like me. It would be far better to lie on my left side on the couch, knees bent and mooning to the room, in blissful ignorance of the humiliation to come. Facing the wall, my attention is fixed on a little mark in the paintwork and as I'm blind to the preparations going on behind me, my hearing seems extremely acute. A latex glove snaps into place with the force of catapult as the noisy cap being unscrewed from a tube of lubricant slowly increases the building tension. I need to relax but every muscle is rigid with apprehensive expectation. “This may be a little uncomfortable” the school child masquerading as a medic informs me. This I soon realise is an undeniable understatement, as the incredibly young doctor who I’m convinced is only a work experience imposter, vigorously and thoroughly checks to see if any abnormalities can be found.
Everything is as it should be, no bleeding piles, no abrasions, no obvious cause for the symptoms that I have presented with and so further tests will be necessary. I am still acutely embarrassed as she writes my referral to the hospital but she is professional and unfazed by the procedure she has just had to do. Even at such a tender age she must have seen hundreds of human sphincters, mine just one more to add to her increasing knowledge and experience and as I am now on this conveyer belt of appointments and investigations, I am going to have to get used to my private, intimate place where the “sun doesn’t shine” becoming just one more on a proctologist’s list.
As a general rule, I do not examine the contents of the toilet bowl, much preferring to flush the evidence of what happens in that most private of places, away. There was a putative television doctor, who claimed to be able to diagnose a multitude of ailments solely based on a thorough examination of a turd. Whether or not her methods stand up to any scientific analysis doesn’t really concern me, it is the fact that every deposit has to be picked apart for evidence of good or bad health, that I find extremely bizarre. It is therefore quite surprising that I did notice when my motions contained an unexpected quantity of blood! Perhaps it was because I was experiencing severe stomach cramps and felt generally unwell that I choose to look but when confronted by a bloody stool I did what most people do and chose to ignore it.
I trained as a nurse, I know the potential significance of such a find. I would recommend, nay, insist that any of my loved ones, visit their GP and subject themselves to further investigations. But after a few days I felt better, the blood was gone and I rationalised away the symptoms as the result of a dodgy curry or an unexpected haemorrhoid. Life carries on, and bowel habits return to normal so why dwell on a minor aberration, a once only occurrence, far better it seemed to forget that episode and definitely not to look inside the toilet bowl again.
Shit! Crap! Even just good old Poo, these are not polite words. Pejorative terms of abuse, expletives to emphasis the negative emotion and not something to mention at the dinner table. It’s not just the lexicon of swear words which cause us to shudder, even terms like “feaces” or “excrement” conjure up the matter they describe in an almost visceral way. It is as if I can smell the very word.
It is such a basic human function, to empty the bowel. We eat, we process that food, derive the sustenance that keeps us alive and defecate the waste. We all do, it is fundamentally human and yet remains taboo in a way that is almost inexplicable. Im not embarrassed by anybody else’s bowel movements, I understand that even the Queen has to poo. I have had two children, mini humans who arrive in the world without the skill of controlling when the body should empty away what is no longer needed and as such have changed many a smelly nappy with the blasé indifference to shit demonstrated by most young parents. I was a nurse, I had to regularly deal with this most normal of bodily functions with patients, I have administered medications into various orifices’ to help it on it’s way and have cleared it up for them if it arrived unexpectedly in the wrong location such as their bed.
So it is not the faecal matter itself which is the problem. It would seem it is only my turds, my waste and the realisation that other people know that I am producing them which fills me with acute, crippling embarrassment. It is something I must do on my own, something private, hidden away behind a closed and locked door. It is done in the security of my own home and not in a public toilet, they may be a convenience for some but I have always been able to hold on and wait. I could not bear the awkwardness and discomfort of being behind the tiny door of a cubicle, trousers around the ankle clearly visible as the barrier does not extend all the way to the floor, struggling not to let a noisy escape of gas reveal my presence as members of the general public are washing their hands. It is done with the toilet window open to let any identifiable orders escape, whilst whistling loudly to mask those inadvertent and comic sounds. Above all I don’t want to talk about it. I do not announce to the world in general that I am about to go and unburden myself, I go quietly, covering my intentions by mentioning something about needing to clean my teeth and then hope and pray nobody notices.