On the other side of the fence

Tagged Patient experience; Posted 12 years ago

For years I battled with varicose veins on both my legs. First, they looked awful when I was in shorts but more recently they also started to cause a dragging discomfort.

I woke up from my anaesthetic very slowly. For many hours, I simply could not keep my eyes open.

I felt nauseated and vomited a couple of times. In contrast to who I normally am, I was simply not in a position and well enough to make myself known to nursing staff. My anaesthetist rang in to check on me 5 hours after surgery.  I told her that I just vomited a few minutes ago but was otherwise fine. She ordered Droperidol i.v. over the phone. My nausea and vomited almost instantly stopped. How good was that.

I was given a bottle with the expectation that I empty my bladder into it. As hard as I tried, I was unable to do it. I was not allowed to get up on my feet  and simply could not empty my bladder in the lying position. At that time I felt some serious discomfort building up in my pubic area. Being a doctor myself I was trying to palpate my bladder but was unable to because it simply hurt too much. A bladder scan revealed a reading of >999 ml in the bladder. Was the reading accurate?

“How long is it OK to pump iv fluids into me and at the same time I am not able to empty my bladder?” I asked one of my nurses. That was about 10 hours after I peed the last time. My surgeon was called and he suggested an indwelling catheter. A female nurse who prepared things for the IDC told me her story how she had her gallbladder removed a few months ago and what her experiences were as a patient (on the other side of the fence). She had so much sympathy with me, placed the IDC so competently, that I am still extremely grateful for such a professional job well done.  The IDC drained 1000 ml in the first half an hour and another 1000 ml in the next 60 minutes.

Postoperatively I had no pain whatsoever. Apparently, my surgeon used lots of local anaesthetic.  I only developed pain in the groin a few days after surgery.

I write this because I was surprised being an experienced surgeon myself how little I was able to take care of myself. I know, I was not meant to take care of me anyway, but I kind of expected it of me. If I can’t take care of me, how much do we expect patients then to verbalise their needs?

I would have been unable to even request more anti-emetics when I vomited and felt sick. I was unable to request a catheter when my bladder ached because of distension. I could have interfered more with the decision-making and this is probably one of the mechanisms why doctors and health professionals in general are at increased risk of developing complications after surgery. People who look after us probably believe that we are not only patients but also experts and grant us higher interference rights with medical treatment. While we all give patients opportunities to interfere with medical decision-making, this issue is tricky when patients are health professionals.

In both situations, people made decisions for me. Those decisions were great and I benefitted from them.

I also had great difficulties adjusting to the hospital bed. I am a tall man and the bed simply was too short. The mattress was too soft and I was woken every few hours so that nursing staff could take my pulse, blood pressure and check the surgical wounds. My legs were bandaged and it would have been a lot easier if I were able to sleep on my back. However, I am used to sleep on the side and moving from one side to the other was simply an ordeal.

The guy on the other side of the corridor started singing military marching songs. DimDeedledoo ….

I was in hospital only for one night. I was in a great hospital, everyone was very obliging, I had great care and a single room. How do patients adjust who need to be in hospital for 7 to 10 nights? How would I have coped if I had had additional issues, such as pain? How do our patients cope with their needs being subject to triaging? It must be a nightmare for many of them.  

(I had a phone call from one of my referring gynaecologists yesterday. I women with a pelvic mass, negative markers to start with, but turned out to be cancer. She requires another operation … - do the whole thing again)

When we compare surgical outcomes we capture only those outcomes that we can actually measure, such as analgesic consumption, surgical complication rates, or hospital bed days. The meaning of those outcomes on a personal level is quite different, though.

Having made a personal experience, symptoms such as nausea, vomiting or pain mean something different to me now than before my own surgery. Behind outcomes that we measure and verify, there is another dimension that we normally don’t measure but that is equally important.

If we find a new medical treatment that is less invasive, involves shorter hospital stay or a hospital admission may not be required at all – wow!!! Shorter hospital stay may mean one thing (mainly dollars saved) to technocrats but it means a heck of a lot more to actual patients who prefer to sleep in their own bed.