Lock-down Diaries #6.

Hello again to all my lovely readers and welcome to anyone who may have stumbled here by accident, I hope it won’t prove to be too harrowing an experience for you. I see that I have 70 followers now and that is certainly not something I was expecting when I rather rashly took the decision a couple of years ago to buy a domain name and start my own website. I really do the stupidest things sometimes but I must admit I do rather enjoy it.

On then to Lockdown Diaries #6 in a series that has the potential to run as long as the Archers (look them up if you are not British) and it seems to be getting no better despite the positive noises being made by the authorities. Nothing has changed and until some pharmaceutical company becomes even more obscenely rich by creating a vaccine which is widely administered, nothing will change. After that it will mutate and we’ll start all over again. Welcome to the 21st century (and you are welcome to it!).
There is a good reason why there has been such a hiatus since the last episode here, so if you want to know what it is, please click the “read more” button.

I know there is nothing quite as boring as listening to someone else’s medical woes but, as I am sitting here on the afternoon of Sunday, 5th July, 2020 in Ward 3E of the Royal London Hospital, where I have spent a considerable amount of time recently, I think it is appropriate but if you don’t want to know about hospitals please feel free to skip to another page. Although i am consciously trying to make this brief, it is a bit of a long story and I fear there will be nothing of the usual nonsense diary nonsense contained in this post.

It all starts on the morning of Monday 22nd June when I woke up quite normally and went to the bathroom, no problem. Being under CoVid house arrest (let’s call it what it is) I had nothing particular to do and certainly nowhere to go. Whilst I was trying to get back to sleep I noticed that I had a “pins and needles” sensation in my left foot. OK, maybe I was just lying on it the wrong way but no and within an alarmingly short space of time I had lost all sensation in my left leg from the knee down. I self-diagnosed it as a return of the thrombosis in my left femoral artery which they had accidentally discovered on my last hospital jaunt in Margate. If you have not read about that particular little adventure you can read all about it here.

I tried to stand only to discover that not only had I no sensation in the leg but it would not even bear my weight and I had to resort to crawling for the rest of this period of the story. I knew how potentially serious the situation was and so I ‘phoned 999 for an ambulance and. after a long time explaining my situation and recent medical history to the operator she took it upon herself to determine that it was not an emergency and told me to call 111 which is the non-emergency number for the National Health Service (NHS). The complete incompetence of this woman was almost to cost me extremely dearly as you shall see.

The 111 system is shambolic. Yes, I know there is a pandemic on but after three ‘phone calls and answering the same questions repeatedly for different people I eventually got to speak to someone that was actually medically qualified, a nurse practitioner. I explained the situation and he immediately determined that it was an emergency and said he’d send an ambulance straight away. I had to crawl to the front door to leave it on the latch so they didn’t have to kick it in.

My leg was starting to get a bit uncomfortable by now but I knew that I wasn’t coming home that night and how awful hospital can be with nothing to do so in went the computer and accessories, a couple of lengthy books I hadn’t read and I was ready to go.
I have nothing but admiration for ambulance crews, they are magnificent which makes it even more of a shame they are so woefully served by their support staff. A crew of three turned up and that was a good thing as I had no power whatsoever in my leg and I had a set of stairs to negotiate. It took two of them to virtually carry me down to the ambulance whilst the third paramedic carried my bag.

It was a glorious day and the back of the ambulance was stinking hot until we got moving and the air-con kicked in but they did what they had to do before depositing me in a wheelchair in A&E (British term for ER) where I sat until one of several people came to speak to me, do tests, send me for scans etc. By this time the pain in my leg had become unbearable, easily as bad as when I slipped the disc in my back all those years ago. They gave me something for the pain which helped a bit and also prodded me a little further into the cloud-cuckoo land I normally inhabit.

At some point I ended up talking to Mr. Crinnion, who seems to be something of a top man in his field which is vascular surgery, he even has his own website! He confirmed that my self-diagnosis had been spot on and that an immediate operation was called for. He then went on to describe the options to me. The best result was that they could open me at the groin and physically remove the obstruction. If that was not possible they would try to construct some sort of bypass to provide blood to the lower leg and the worst case scenario was that they were going to amputate below the knee.

I asked the Doctor to be honest with me and tell me what realistically were the chances and he replied, “I think if everything goes well, we have a 50% – 60% chance of a good outcome”. Of course the unspoken subtext was that I had a 40% – 50% chance of losing my leg, even I can manage that much arithmetic. I asked him if he was operating and he said he wasn’t as he was going off but his colleague was coming on who would be “nice and fresh” (his words exactly). I signed the consent form and it was on.

The good Doctor was completely honest with me for which I thank him and he also told me that if I had arrived three hours later it would have been straight to the bone saw. With the whole affair being so absolutely time critical, I did feel a bit of resentment at the three hours I had wasted because of the incompetence of the 999 operator and the NHS non-emergency “service”.  When all this finally blows over I shall be making noises in the appropriate place. I do not like making official complaints but their combined failure could have cost me dearly.

Mr. Crinnion’s prognosis focused the mind a bit I can tell you although strangely I did not feel any sense of panic or dread, rather I was completely calm and even a bit detached from the whole thing. It may have been shock, a natural fatalism or the effects of whatever they had pumped into me by way of pain relief but on reflection now it seems really odd to me how completely devoid of emotion I was at the concept of a potentially life-changing operation.

The surgical team needed some time to do whatever it is they do to prepare and I was wheeled up to the 10th floor and a West facing ward where I was treated to a most glorious sunset over the familiar London skyline, it really was rather pleasant. As night fell I was obviously thinking about one thing only and again my mental processes seem odd to me now. I was wondering if they would discharge me with one leg and if so how could I get up the stairs to my flat or if they would fit me with a prosthetic and teach me how to handle stairs before they discharged me.

I was wondering how I would cope with long-haul travelling and all sorts of practical issues faced by amputees and I was thinking that amputees run marathons and climb Everest (I think) and do all sorts of amazing things and it appears my mind had already accepted this as at least a possibility. Again, I felt no fear or even anger, merely resignation that whatever was going to happen was going to happen and the alternative was a whole lot worse. It must have been the drugs.

Shortly before midnight I was taken down to the “prep” room at the theatre where I was met by not one but three anaesthetists, a chap and two ladies. It was strange as they were all wearing masks and visors, presumably a CoVid precaution as I am sure I had spoken to the unmasked face of an anaesthetist last August before surgery.

Whilst I talked to two of them the young lady on my left was trying to stick the biggest cannula (needle) into my skinny left wrist and that was probably the most painful thing that happened to me in my whole stay in hospital, it was agony. It led to a bruise extending from the heel of my hand to almost my elbow, the remnants of which are still there two weeks later. It did turn out rather colourful later on when they took it out and I removed the tightly taped on “arterial” notice on my inner forearm. I took it off when it had irritated my arm enough to blister me, that stung a bit. The images below is not great but it gives some idea, it is a bit like an internal Jason Pollock.

Speaking of images, I am giving fair warning here that there are going to be a few images later on which the more delicate of you may not wish to look at and so I am writing this in order that they do not just appear as you scroll, it is certainly not my intention to shock or offend anyone. I’ll be writing a few more paragraphs before then so if you don’t want to see the images then please head to another page (hopefully one of mine) first.

The female anaesthetist told me there was potential for a delay as there had been an air ambulance case come in concerning another young man stabbed somewhere in London. Knife and gun crime in London really is a disease at present, especially amongst black youth and it is difficult to know what to do about it but that was not my first thought. With every minute vital to the chances of me keeping my leg it really annoyed me that some young tearaway might be given medical precedence over me by falling victim to something he had very probably brought on himself by way of criminal gang and / or drugs activity.

Yes, I realise there are cases of mistaken identity and innocents becoming victims but they are very few and far between. I realise that Doctors have to make decisions based on purely medical considerations and so I was extremely relieved when the anaesthetist said we were good to go.

I admit I did take a (last?) look at my left foot and asked the other anaesthetist if I had to count from ten to 1 as I had done before and he just shook his head. That was the last thing I remember, I was out like a light.

I began to wade through the thick treacle that was separating me and consciousness some time later (I eventually found out it was over three hours) with someone very persistently asking me if I knew where I was. If you have read about my previous medical exploits which I linked above you will know that the last time I came round from being anaesthetised I had entertained the somewhat ludicrous notion I was in a fish market but no such nonsense this time.  I knew where I was all right but I was damned if I could open either my eyes or my mouth.  I was still pretty much away with the fairies so I don’t know exactly how long it took but I eventually got everything to function, gave the correct answer and was told to go back to sleep. I went back to sleep.

When I next woke up I was being wheeled along a corridor with a fairly sharp pain in my left groin and further discomfort in my left calf. I wiggled the toes in my left foot and felt them move but even in my completely disorientated condition the concept of “ghost limbs” whereby amputees “feel” removed limbs for years after amputation came to mind. I really don’t know how it could have as I could have barely told you my own name at that point. I tentatively looked down and there was one of the best sights I have seen in my life. All ten little piggies seemed to be present and correct. That was a start.

The theatre chaps parked me in my own little side room and I remember feeling rather privileged but I found out later it was because they had not had my CoVid results through yet and didn’t want me potentially infecting a whole ward. So far so good.

I must have slept a bit more, which is hardly surprising and the next thing I knew it was morning, it was light and I decided to have a proper look. Yes, everything looked to be there albeit I had literally about three inches depth of bandaging on my left leg from calf to ankle which you’ll see in a moment if you don’t run off.  OK, the upper portion of my left leg looked a bit swollen, I had a dressing on my left groin and my toes still looked a strange colour to me but at least they were still there so I reckoned that I was ahead of the game whatever else happened. With the bed tidily made around me it all looked very promising and fairly normal.

DON’T SCROLL ANY FURTHER IF YOU ARE OF A “DELICATE” NATURE.

That first morning I met Melissa the Staff Nurse and Ray the Health Care Assistant (HCA) who were to feature heavily in my care, they are both great people, as indeed are all the staff on Ward 3E where I am currently writing this. 3E has become something of a home from home as was Cheerful Sparrows in the QEQM Hospital in Margate although sadly I have no interesting story to tell you about the name 3E. It is purely prosaic and the ward has not been here long enough to have gathered any decent stories that I know of. I know it makes sense to do it this way but I do rather miss the days of wards named for birds or trees or whatever else.

I looked out my window to a panoramic view of a wall full of windows from which I deduced (get me, Sherlock) that I was on the North side of the building just to the South of Stepney Way and that proved to be correct. I always like to be orientated and now that I was I felt a bit easier for which there is probably no rational explanation. I don’t know why it should be so and I certainly don’t believe in nonsense like feng shui but I was quite content so I just lay there quietly and waited for something to happen.

Lots of things happened, in fact things seemed to be happening all the time. There are very regular obs. of Blood Pressure (BP), pulse and temperature which happen at least every four hours. A Doctor came round and introduced himself as Aaron but who I call Doc out of respect, he is Doctor Aaron Goh and he told me he was the man who had performed the major part of my surgery. He looked Asian to me but it was difficult to tell with most of his face obscured by a mask although he did tell me later that he was indeed Singaporean, had trained in the UK and had been here for many years.

Doc Goh explained to me that he had opened my groin and removed the clot whilst his partner had performed two fasciotomies on my calf which was why I was so heavily bandaged there. You can see the bandaging above and even with that amount of crepe and gauze on you can see how much I was “leaking”.

A fasci what? I had never heard of it so he explained to me. Because my calf muscle had been deprived of blood for so long it had shrunk / wasted and with the return of full blood flow there was a chance that the muscle would swell dramatically and dangerously and, in extremis, it could effectively “blow itself apart” from inside. Not what Mr. Crinnion would have described as a “good outcome”, I feel.

The solution to this is the afore-mentioned fasciotomy which is as brilliantly simple as it is brutally crude. The surgeon simply makes a bloody great incision where necessary and I use the word bloody in it’s correct sense here. The image above proves this as you can see that even the amount of bandaging mentioned wasn’t enough to stop me “leaking” like a stuck pig. This was to go on for some time for reasons which I shall explain shortly.

I dread to think how much NHS bedding I have destroyed since that first night after surgery. Eventually they came up with the idea of putting small incontinence sheets under the wound but even that wasn’t foolproof although it helped.

I’d like to jump ahead now and mention another Doctor who was to come and visit me the next day but I think it appropriate to mention her here. As Doc Goh was working “topsides”, another surgeon was working “down below” doing the fasciotomies. When I did meet her I enquired her name so I could thank her properly and she very humbly answered, “Frances”. I have done a bit more Sherlocking and she deserves her full title of Dr. Frances Ledesma who comes from California. I swear I have had the United Nations looking after me one way and another.

Doc Goh didn’t want to disturb Doc Ledesma’s recent work so soon so decided to “let it bleed” (that should be an album title, oh wait, it already is) and the poor nursing staff just kept wiping up the blood, changing the incontinence sheets and wrapping another clean bandage round the worst affected areas. Bizarrely, given the fact that I had a goodly number of (thankfully dissolving) stitches in my groin and open wounds to port and starboard of my calf I was in no pain whatsoever. A little discomfort certainly if I moved injudiciously but I started to decline pain relief after about two days as I just didn’t need it.

There I was then, in my splendid isolation with no idea how long I was going to be there or what else might befall me before I finally went home but I wasn’t in the least bit worried. As I had the camera to hand I took a couple if images so you can see what my little kingdom looked like. Apologies for my legs in one of them and the bloody sheet but I wasn’t exactly in a position to get up and take decent images.

Thankfully I had had the foresight to pack my “hospital” bag, it was not as if I had any pressing commitments and I even got to talk to people occasionally.  I got all my meals in bed and didn’t even have to cook them so all in all not a bad deal.  Well, the meals were but I’ll explain that later.  I settled down to the first of the three large books I had brought and the time went quickly enough which was just as well as I barely sleep in hospital.  OK, to be honest, I don’t sleep a lot at home either but I survive on maybe two hours a night on the ward and the occasional afternoon / evening nap but you never get more than an hour because of being woken up to take medication, have your obs done, have your blood drawn or whatever else they dream up to interrupt your sweet dreams.

Melissa and Ray went off at 2030 to be replaced by the night crew who were equally friendly and professional although I cannot remember now which two were looking after me that night. I do know most of the nursing staff on the ward now and both the catering ladies, not to mention just about every vascular surgeon in this massive hospital and they are lovely people all, not to mention hugely professional and skilful with two exceptions who shall remain nameless.

Wednesday 24th June came round and when the Doctors did their morning rounds (there was a right gang of them including some obvious trainees) I discovered that I was going to get to have a bit of a look at the handiwork of Docs Goh and Ledesma.

Doc Goh explained to the younger Doctors about the running stitch system they had employed and which those of you who are familiar with embroidery will understand. They had left it deliberately loose to allow for potential expansion of the calf muscle which, if it had occurred at all, had now subsided. The two wounds were both wide open, perhaps half an inch at the widest points.

The Doc examined the wounds and noticed a couple of small blood clots which he removed by scooping them out with his gloved finger. I had received no anaesthetic at all and, whilst it was not painful it was a most odd sensation to feel him touching your calf muscle from the inside as it were. Very strange.

If that wasn’t painful, what happened next most certainly was. Doc Ledesma had left two long ends of the “thread” (it was the dissolving filament they use nowadays) and he took hold of the two ends and pulled which caused the wound to close like some sort of nightmarish monster slowly closing it’s maw. It was excruciating and utterly fascinating all at the same time.

The young nurse in attendance was at the wrong end of the action to hold my hand which I suspect she may have done and was doing her best to comfort me by stroking the front of my uninjured leg. An ultimately useless action in terms of pain relief but hugely appreciated anyway. Doc Goh kept asking, “OK Mr. Campbell?” and all I could manage through gritted teeth was to grunt, “Go on Doc, go on”. As I mentioned, we see so much of each other he calls me by my first name now and has invited me to do the same to him but I feel more comfortable calling him Doc as I think it shows respect for the man’s position and obviously hard-earned expertise.

The images you see above were taken after the closure so you can see what tidy wounds they left. I would have liked to have some images of the “before” as well as the “after” but I didn’t like to disrupt the Doctor’s rounds by taking “happy snaps”! I don’t know if it is ghoulish to want to take images of your own wounded body or not, I certainly don’t derive any morbid delight from it but I am completely fascinated. As I said to Doc Goh a couple of days later, it was like watching a TV documentary with the difference that I was the subject.

If you look closely on my left foot you will see four marks like you might see through a gunsight.  I only found out later that the centre of that matrix was the optimum place to find a femoral pulse in my foot and stop them having to search about “in the heat of battle”.

For a man with a reasonable medical training in the Forces (much better than a standard First Aid course but nowhere near paramedic level) many years ago, I have learned so much about medicine and the human body in recent excursions to various hospitals it is unreal. As I say so often here, every day’s a schoolday although it seems that quite a lot of it recently has been medical school! I find that all medical professionals, Docs, nurses, radiographers, physios or whoever else are more than happy to explain things if you show any sort of interest and you probably know by now how obsessive I am about having to find things out.

The rest of that day passed relatively quickly with me reading my book as I had not yet broken out my computer. Again I didn’t sleep a whole lot that night, not due to any huge discomfort but just because I didn’t feel like sleeping.

The night gave way to another day, as it tends to do, and it was now Thursday the 25th. my fourth day in hospital and it had passed in the blink of an eye. I understand it would be very easy to get bored in hospital but by now I had got the laptop up and running and was simply gorging myself on BBC iPlayer documentaries, everything from the history of British art to the history of world art to a three parter by Lucy Worsley about the Hanoverian Royal dynasty in Britain and a whole lot more besides. My interests are eclectic to say the least and I have just been bingeing.

I don’t know why I was watching so much about art as it really is not a favourite subject of mine bar a very recently (post-house arrest) acquired interest in the pre-Raphaelites but I did find them all fascinating.  I am currently two thirds of the way through another three parter presented by Bettany Hughes OBE which I am very much enjoying relating to Lord Buddha, Confucius and Socrates.  I had been previously unaware that these three intellectual titans had all lived within 100 years of each other about 2,500 BC.  Must have been something in the air!

Everything was going well. The leg was still leaking although less so and the Docs were pleased with my progress, I had plenty to read and watch, I was being looked after very well and the only fly in the ointment was that I was permanently starving. This turned out to be a communications breakdown (did anyone get the Led Zep reference there?) rather than a kitchen failure. The lady who came round my section of the ward with the food trolley obviously didn’t have English as a first language. I doubt if she had it as a language at all. At this point I had not discovered the menu hidden away in a drawer and nobody had explained the ordering system to me so I’ll explain it to you now. I have shown the menu here so you can understand better.

After breakfast they come round to take the lunch order and, without a menu, I would ask her what was available that day. There are ten main meals always available plus two daily specials and also items like jacket potatoes, sandwiches and salads. She would simply name me the two specials of the day and nothing else. I was quite convinced it was an either/ or option and was bemoaning the fact that the food compared so badly with the QEQM where it was very tasty on the couple of occasions I was actually permitted to eat it.

If you look closely at the menu you will see that Thursday’s specials are chicken Kiev and cheese and onion pie so I ordered the former for lunch and the latter for dinner. The images above tell you the whole story. Presumably someone in the kitchen had the wit to put a few potatoes on the plate or I would have literally gone the rest of the day on a single Kiev and a small portion of completely forgettable pie.

With a great deal of patience and being now in a different part of the ward with a different food lady (one who does speak English) I have even got their heads round the concept of large portions which are available and, by way of contrast I have included below tonight’s offering of shepherd’s pie, carrots and savoy cabbage. Very tasty and at least I won’t keep the other guys in the ward awake with my rumbling stomach. I got my first large portion on Friday so it has only taken me a fortnight to get through to them but better late than never never I suppose.

Of course the system still isn’t foolproof. When we had the tea run this afternoon the lady produced the coffee which she even know to make strong for me now and accompanied them with two apparently randomly selected minipacks of “biscuits”.  One was a slice of gluten free chocolate cake and the other two dry cream crackers.  I swear I am not making this up, the evidence is above and I promise I did not stage it in any way.  Perhaps dry cream crackers are regarded as a de rigeur accompaniment for the afternoon brew wherever the tea lady comes from, who knows?

The title I have given to the image above is a straight paraphrase of either James Joyce or Dylan Thomas depending on which branch of Celtic literature you prefer. I have entitled it “Portrait of the Author as a Not So Young (and not so well) Man”.  I know I look dog rough but I assure you that I felt considerably better than I look.

Firstly, I was obviously overjoyed that my musical career, such as at is, was not going to return to endless sea shanties (much as I do like them) whilst doing a passable Long John Silver routine. I had no pain although a look at those wounds and the one I didn’t show you would suggest I should have had. Despite my current position I wasn’t at all depressed or downhearted and in fact (I have said this before), whilst nobody actually wants to be in hospital I do not find it a huge trial at all.  I think I just look that rough because neither the ward nor I possessed a comb (they generally have disposable ones) and so the hair and beard were looking a bit more windswept and interesting than usual. My lack of sleep was accentuating the normal bags under my eyes and giving me that slightly cadaverous look.

The only other thing of note that happened that day was that my CoVid results finally came through and I am glad to say I don’t have it. I would have been surprised if I did as I had kept myself fairly well isolated at home even though I have had no symptoms. I was consequently  moved into a bay of four with Victor, Tony and Clement.  Clement didn’t say much as he was pretty ill and I think he was doped to the eyeballs most of the time but Tony and Victor were great fun and it turned out we all shared an interest in history generally and Tony in particular had a specific interest in military history.

It turned out that Ray the HCA I mentioned earlier also liked military history, especially World War Two and, whilst he was usually busy, he would join in when he was working in our bay. He told us some great stories about his trips to the D-Day beaches and the associated military cemeteries.  We had a proper little military history society going after a day or two and it really was quite fun. I had been OK in the side ward but it was a bit better being in with the others.

Another day had slipped by followed by an equally peaceful night spent reading and watching even more documentaries and we were into Friday. Yahoo, fish and chip day. The fish turned out to be pretty nice actually but the chips were awful. Swings and roundabouts I suppose.

The ward round this morning was led by a very pleasant youngish Doctor (clichéd, sad but true that as you get older policemen and Doctors tend to look younger and younger) whose name I have never known despite having spoken to him several times. He had a few juniors in tow and he hit me with the news that the bloods they had taken the previous day had shown a platelet count of 32 which apparently is not so good. I asked him what that meant and he said he would have to speak to the “blood Doctor” and he’d let me know. It’s OK Doc, I do know what a haematologist is, you can use the big words. He’d let me know, fine. I didn’t speak to another Doc until Sunday morning and he knew nothing bout any results.

There had been talk the previous day about me going home on the Friday and, to that end, two physios came round to give me my “walking up and down stairs” test.  No problem, I walked with them to the end of the ward up one flight of steps and back down unaided as that is what I would have to contend with at home. No problem and as one of the ladies said, I had passed with flying colours. We are back to the UN nature of my care here. This physio was from Australia and her mate was from the city of Londonderry / Derry / Doire depending on your political outlook and where I spent the first 11 years of my life so that was a bit of “old Home week”.

If the stairs were no problem, something else was. As I turned on the landing I looked down to check my footing and saw a few drops of blood on the last three steps. Apaprently the exertion had caused me to “leak” again.  By the time I got back to bed I was dripping like crazy and leaving a trail that it would certainly not have taken a trained police dog to follow, a five year old could have done it, it was such a mess. I was so embarrassed especially when the poor cleaner had to be summoned especially to redo the spotless floor that she had mopped a couple of hours before. I was apologising left and right but everyone was lovely about it and told me not to worry.

I was “leaking” for hours and this is the crux of the problem, it is a proper Catch-22. They have to keep my blood very thin so it does not clot again but if they do that my blood gets weak and also will not allow the wounds to heal properly. It is a problem.  With thinning the blood, you are damned if you do and damned if you don’t. It was obvious the wounds were not healing as the images show and the stitching on the inside of the leg had started to give way so the wound was opening up again, as you can see.

Saturday and Sunday passed unremarkably and then on the Monday I was told I was going home and that they would arrange to have my dressings changed by the practice nurse at my local surgery but I would have to ‘phone up and make my own appointments.  That would be no problem as I know Debbie and we get on well.
The non-emergency ambulance guy duly turned up and wheeled me in a chair to the ambulance where there was only one other passenger due to this antisocial distancing I suppose. We had both been masked up. The poor woman was returning home after 51 weeks in hospital. Obviously I didn’t ask what was wrong but it must have been fairly serious.

I lived closer and was dropped off soon. We wished each other good luck and I made my way gingerly up the stairs, into the flat and sat down on the sofa almost exactly one week to the hour from when the ambulance crew had hoisted me out of it.

It had been quite a ride and one that I obviously wouldn’t want to repeat but I have to re-iterate that it was not all that horrendous despite the possible outcome and and the initial agony, it was even quite fun on occasion.

If you want to know what I got up to next, stay tuned and spread the word.