Thursday, 30 October 2008

Am I Becoming 'Disgusted of Paddock Wood'?

As regular readers will know, I've been off work for some time and one of the ways in which I pass the time when m'Julie is a work is with the television. I don't purely watch DVDs, but have kept up to date with (fairly) current affairs by watching the BBC News channel.

Generally, I find their coverage very good and better than most of the other available sources, although I am at a loss at the present time about the Ross and Brand affair. Whilst I agree that what they did was unacceptable, I fail to see, with everything else that is going on in the world, why they are receiving so much coverage on the news programmes, being the lead story on most.

However, that is not why I think that I am becoming 'Disgusted' (20 months ago, I could have been Disgusted of Tunbridge Wells, but now I'll have to settle for Paddock Wood).

In the UK there is a man called Jack Straw, who is currently the Lord Chancellor and the Secretary of State for Justice. Three days ago he gave a speech to the Royal Society of Arts, covering Punishment and Reform which received lots of publicity as it was allegedly him complaining about 'cushy prisons'.

In a nutshell he seems to be saying that although we shouldn't return to the old days where prisons were dingy revolting places with prisoners forced to slop out, it should not be forgotten that prisons are the severest form of punishment available to the British justice system, the removal of the offenders liberty being the punishment, with an emphasis being on rehabilitation and education of offenders as well as assistance in dealing with drug problems. He also states that the victims of crime should not be forgotten, which appears to be happening as far as penal reformers are concerned.

At the time that this speech was being publicised, there was also a lot in the media about the fact that in many prisons the prisoners have access to satellite television and games consoles in their cells. Whether this is true or not, I cannot say as these were tabloid headlines, and I think we all know how reliable tabloid journalists are/n't. However, Mr Straw did talk of an unacceptable Halloween Party taking place in a prison.

So, putting my 'D of PW' head on, where do I stand? I think that our biggest problem with the justice system in this country is sentencing. Last week, a man was convicted of murdering his 16-month old daughter. She was malnourished and had been badly abused before he finally put her over his knee and snapped her spine in two. His sentence was life imprisonment and he was told that he must serve at least 22 years. WRONG! I firmly believe that if a person is sentenced to life imprisonment, then they should serve at least life imprisonment. This man should, as we no longer hang murderers, remain in prison until he dies, not be walking the streets again when he is 47 years of age.

In exactly the same way, I firmly believe that if a person is sentenced to 3 months or 10 years, they should serve 3 months or 10 years, no parole, no time off for good behaviour. If you don't want to do the time, don't do the crime.

In many American states, they operate a 'three strikes and you're out' policy. Anyone who commits offences that would result in their being jailed on three separate occasions automatically receives a life sentence on that third occasion, which is something that I would like to see operate in this country.

I know that there will be certain penal reformers that will feel this is wrong and that I must be a terrible person, but I haven't finished there.

Prisoners must be identifiable as such and should therefore wear a uniform that clearly identifies them, even those serving life whom I believe are currently allowed to wear their own clothes. There is a prison in the US where the local Sheriff insists that his prisoners wear everything, tops, bottoms, underwear, in pink. Degrading, perhaps, but they can be easily identified as prisoners.

I also believe that those serving non-custodial sentences should be made to wear a uniform that identifies them when they are litter-picking or scrubbing graffiti, or whatever their punishment is. If they don't like it, the simple answer is don't commit the offence that gets you put in that situation.

Once serving a sentence, prisoners must abide by the rules. In the press there is much made of the fact that illegal mobile phone use is rife in prisons. The simple answer is that there is technology available that will jam all mobile phone signals in a limited area. This should be installed in prisons. Any prisoners who still attempt to use mobile telephones and are caught automatically have one year added to their sentence for each offence, even if their original sentence was only three months. If this doesn't discourage the practice, I would be very surprised.

Drugs are also apparently a major problem in all prisons and Mr Straw states that as many as 13% of new inmates enter prison with a drug problem. In this situation, all those with a problem must be given rehabilitation to wean them off the drugs. However, once they are weaned off the drugs all prisoners must be subject to weekly drug tests. If they fail they are punished, the punishment would be dependent upon the type of drug for which they have tested positive. Sentences will be the same as for possession of that class of drug, because to test positive the prisoner must have been in possession of the drug. Testing positive for a Class A drug will result in 7 years being added to the prisoner’s sentence for each offence, Class B will result in 5 years being added to the prisoner’s sentence for each offence and Class C will result in 2 years being added to the prisoner’s sentence for each offence.

As for conditions within prisons, I strongly agree that we must not return to the days of slopping out, but it must be remembered that prison is a punishment. At present, many prisoners live in conditions better than British soldiers serving on operational tours. Whilst there is the argument that the soldiers have volunteered to serve, so they cannot complain, I would argue that the prisoners have volunteered to be imprisoned by committing the offence, so also have no cause for complaint.

Satellite television, gone, games consoles, gone, communal television rooms with limited hours and a communal games room, yes, perhaps even a small gym so that prisoners can keep themselves fit, but definitely a 'no frills' approach. Prisoners would also be expected to work, however, at present I believe that they earn a few pence for any work that they do. I believe that this practice should stop. Any profit made from their work should be ploughed back into the prison. If the prisoners want 'pocket money', this would be provided by their families, no more than £10.00 per week, for them to buy what they need.

There was also a report recently of one prison where the prisoners were unhappy about the conditions and the authorities were concerned that there may be an outbreak of violence among the prisoners. To this I have a simple solution. There is a radio DJ in this country who, as one of his features, does a quiz whilst wearing an electronic dog collar on his arm. Every time he gets a question wrong, he gets zapped, the force increasing each time.

So why not make all prisoners wear something similar, although impossible to remove. If they wish to take part in disorder, then they get zapped. If they escape, then there would be an area around the perimeter of the prison that if they step outside they get zapped. It may seem harsh, but no more so than the Tasers issued to most UK Police forces.

The only concern may be that there would be some prison officers who would inappropriately use these devices, so for that reason there would have to be very senior authorisation, although still within the penal establishment, perhaps the Governor, who would give this authorisation, with very severe penalties, from dismissal to imprisonment, for inappropriate use.

The other thing that has been in the news very recently is that the Home Office has decided to make it more difficult for extremists to enter the UK, particularly those that intend to preach hatred.

The UK is a multi-cultural country, which I believe must always be the case. However, I also believe that although we are a multi-cultural country, it is essential that those that have entered the country from abroad must respect the laws and traditions of this country, in exactly the same way as I or m'Julie would be expected to do in certain countries, rather than demanding, in some cases, that the law be altered to fit in with their beliefs or that their form of law be allowed to run alongside British Law be it Halakha, Sharia or any other form of law. I firmly believe that in Britain, we should be subject to and abide by purely to British Law. If there is anyone that wishes to be subject to other forms of law, they should move to a country where that law is practised.

A good example is the couple that were recently convicted in Dubai. The lawyers argue that the Judge believed that they were innocent of the charge of having sexual intercourse in public, but were guilty of kissing in public.

If they were in this country, kissing in public is not an offence, but in Dubai, which operates Sharia Law, it is. I find it extremely difficult to believe that these people were not briefed prior to commencing work in Dubai, so they have no grounds to complain. Ignorance is no excuse in any case. If you can't do the time, don't do the crime. They should also remember that under Sharia Law they could have been subject to corporal punishment, so they got off lightly.

However, returning to my original point about it being more difficult for extremist preachers of hatred to enter the country. I believe that freedom of speech is important. But, like most of Europe, there are certain things which go beyond the 'Freedom of Speech' umbrella. Holocaust Denial is illegal in most European countries. In this country, it is an offence to incite racial hatred. However, we still see it happen and no-one act on it. There are what can only be described as neo-Nazi speakers in this country who advocate a 'white only' Britain. Unfortunately, at present, I believe that not enough is being done to curb these extremists. We have also seen Islamic extremists preaching in this country, and although more has been done to curb these people, more could still be done.

The new law that is to be introduced will name and shame these people, their names will be shared with other countries, and they will be denied entry to this country. However, that does not deal with the home-grown extremists who are already here. Perhaps the Government should act more forcibly on those that preach hatred against a person because their skin colour is different or because they have a different religion and those that issue death threats to a Muslim woman who has painted a self-portrait wearing a hijab and cradling a piglet.

The last thing to have 'got me going' is illegal immigration.

In the UK, we have a large immigrant population, almost all of whom entered the country legally and with permission. The majority are working to earn their keep and are useful members of society.

However, I recently watched a programme about the UK Border Agency. I was amazed to find out first of all the number of people that attempt to enter the UK illegally as well as the number that actually succeed. I was also amazed to find out that even if an illegal immigrant is discovered, if he or she has no passport, they cannot be deported. So what seems to be happening was demonstrated in the programme. In this instance it was a Nigerian who had entered the country legally on a tourist visa. That visa had expired 2 years prior to his arrest by the Border Agency. He informed them that his passport had been sent back to Nigeria. Therefore, until new travel documents could be obtained for this man from the Nigerian High Commission, he has to be allowed to remain in this country. Because there are limited custodial places for illegal immigrants, and only those that are considered a risk are locked up, he was released and told that he must report on a weekly basis to the Border Agency. He reported once and was not seen again. There's a surprise.

The simple solution would be that all immigrants are placed on ships within UK waters, perhaps old cruise ships, that are due to be broken up, but somewhere where they could have suitable accommodation. Each person would receive a 24-hour ration pack daily (If they're good enough for British troops on operation they must be good enough for people who have illegally entered the UK). The advantage is this. On occasion, there have been cases of immigrants setting fire to their detention centres. If they are on a ship that is two miles out, starting a fire is not a good idea as they are unlikely to survive. Also, if they still try it, all fire lighting equipment is taken away, as the rations can be eaten hot or cold.

It would be interesting to see how quickly these people sort out their travel documents and are asking to return to their country of origin in these circumstances. And when they are deported, the bill is then sent to the appropriate High Commission/Embassy, as why should the British tax payer meet the bill.

The same would apply to asylum seekers. Whilst there are many genuine cases, there are also many that seek asylum to avoid deportation, again seen on the programme, as the Nigerian, once caught and told that he would be sent back to Nigeria when he had travel documents, immediately suggested that he may claim asylum as he feared for his life in Nigeria because of a family feud.

Even those that enter the country legally as immigrants would have to meet certain criteria. No job/means of supporting themselves, no entry. I would also not allow them to claim benefits for at least five years post entry. If they lose/resign from their job prior to that 5 years and are unable to support themselves, they must return to their country of origin and reapply.

So there it is, my 'manifesto'. Am I turning into Disgusted of Paddock Wood, am I becoming an extremist or do I just have way too much time on my hands?

Saturday, 25 October 2008

Recovery and Trauma

So I've been home for two weeks and the good news is that I've even managed to avoid being re-admitted to any hospital. However, the frustration remains and was brought home to me on the first Monday that I was home. I had to go to the surgery to have a blood test. The surgery is just over half a mile from home, and the first day that I walked it, it took 15 minutes and when I arrived I was wheezing like an an asthmatic at a burlesque show. However, that has gradually improved and I can now do it in 5 minutes and I wheeze a lot less.

The sleep pattern is also settling down. Initially I was finding that no matter what time I went to bed, I was wide awake between 4 and 6.30am. I am not a morning person, and until recently had always believed that there was only one 7 o'clock in a twenty-four hour period, so these early morning awakenings were not well received. Often it was as a result of discomfort (pain would be too strong a word), although again there is now pain which will be investigated when I have an x-ray next week.

I have had regular phone calls from Stan, who always manages to cheer me up, among others and I am slowly getting back to 'normal'. I even took a trip into Tunbridge Wells yesterday to meet m'Julie from work.

But the thing that has had the biggest effect on my recovery was last weekend, when Maggie and Drew came to stay for the weekend. Obviously, I'm still not allowed to drive, and m'Julie doesn't drive, so she had to negotiate with my ex about the children being dropped off, which she did on the Saturday, collecting them again on the Sunday. Oddly, my ex now refuses to communicate with me at all, and has even told the children that she doesn't have my telephone number, although until recently she seemed to be able to send me text messages. Personally, I find this quite amusing and completely pathetic, but then she is very unstable.

It was quite a surprise for me. Drew, who had been quite upset when he saw me in hospital, seemed much less concerned and carried on as normal, but Maggie, who had been completely the opposite when she had seen me in hospital, was clearly very affected by everything that had happened and was very cuddly all weekend, not that I'm complaining. However, it was still very difficult to say goodbye to them on the Sunday and allow them to return to their mother.

However, they are being dropped off again tomorrow and going back Tuesday as its half term and will be here again next weekend.

So now its a case of just taking each day as it comes. I still need to have an afternoon sleep on some days, but not every day, I'm able to walk greater distances (even if I did have to stop once on the hill up from the station in Tunbridge Wells yesterday) and people tell me that I'm looking much better, so I 'must' be.
I also now have a date to start my cardiac rehab (10th November) by which stage I'll be driving again and have been to Dover to the Old Boys reunion.

And the trauma? The evening before I was discharged from the London hospital I decided to watch a bit of television. Imagine the trauma I experienced when I saw this

Who'd have thought it? Sell out perhaps? I thought that I'd had to many drugs at first, and nearly had a relapse!

Monday, 20 October 2008

A Busy Month Part 4: The Home Straight

Not a great deal was achieved on the Sunday after I was admitted, although I did discover that the incompetent SHO had, when clerking me, written that I had discharged myself from the London hospital. Later in the week I got the opportunity to put him right on the matter, as a result of which I am sure that he will be very much more careful about the accuracy of what he writes in patient notes in the future.
On the Monday, I changed consultant from the one who had been on-call for the weekend to one of the cardiologists, although I was only to see him on the one day as he was attending a medical conference (golfing jolly) in Biarritz, and I was passed on to his fellow cardiologist (who was the one who told me that it was a golfing jolly).
I was also sent off to have the first of the radiological examinations, which in this case was an ultrasound. This showed that I had a small pleural effusion, which contradicted the X-ray, which showed a moderate amount. However, the radiologist explained that on X-ray, areas of collapsed lung can appear as an effusion. She also told me that the amount of effusion that was present was unlikely to be drainable.
The downside of everything that was going on was that I was regularly spiking pyrexias, making me feel really unwell. However, IV paracetamol is, in my opinion, the best thing since sliced bread.
One good thing was my visitors. m'Julie had tried to negotiate with my ex-wife that the children could visit me on the Sunday, but my ex had refused as there was some sort of churchy thing going on. However, she did agree to their visiting on the Monday for an hour, so from 4 to 5 I had the pleasure of Drew and Maggie visiting.
The evening and night was to prove much less agreeable. The ward where I was was supposed to be a male ward, however, the female ward was full and a certain amount of 'overflow' had found its way to the male ward, including a woman who I would say was in her fifties and had the definite look of someone who liked more than just the occasional drink, and who was opposite me.
Unfortunately, she chose that Monday to lose it completely, perhaps, a la Father Jack, all the alcohol had finally left her system. She became abusive to the staff and patients, made several attempts to escape, succeeding on one occasion and being brought back having collapsed outside A&E. Following the collapse, and her being brought back to the ward, there was then the debate about what should be done.
When I was a student and also first qualified and working on wards, patients could be sedated, even against their will, if the medical and nursing staff agreed that it was in the best interest of the patient concerned or the other patients in the ward with them. However, it now appears that no matter how mad the patient is, to sedate them may be a breach of their human rights, even if not to do so results in their physically or verbally attacking a fellow patient.
So I lay in bed listening to the various junior doctors, nurses and site practitioners debating what to do whilst the security guards kept an eye on the shouting madwoman who at this point was convinced that everybody, staff and patients, was plotting to kill her, and only her friend Emma, whom she, and she alone, could see further up the ward could save her, resulting in her screaming 'Emma, I'm here' at the top of her lungs.
The staff even tried oral medication. I did point out to them that I didn't think it would work, but they asked the madwoman if she would take some pills and she said yes. They gave her the pills and she threw them as far down the ward as she could, accusing the staff of trying to poison her. Surely I can't have been the only one that had seen this outcome.
Eventually the decision was made to sedate her, and there then followed the debate of who would actually inject her, as all seemed to be frightened that they may be putting their registration on the line by doing so. Just as I was about to say 'Give me the bloody syringe and I'll do it,' someone had the courage to inject her. But it didn't end there, as the madwoman made one last attempt to escape via the (very loudly alarmed) fire exit before finally settling down.
The following day, the madwoman had settled and I was sent for a CT Scan to confirm the location of the effusion. After the scan had been performed, the Radiographers came into the scan room and asked me about the surgery that I'd had, specifically whether I'd had abdominal as well as thoracic surgery. I knew where this was going and decided to have a bit of fun, and pointed out that I'd only had the thoracic surgery. When they asked if I'd had previous surgery I confirmed this, and added that if they were looking for my spleen, it had been removed 20 years ago. Cue sighs of relief all round, as they couldn't find it and were concerned that it may have ruptured, which was why I had the pain and they couldn't find it.
The CT Scan also showed that I did indeed have quite a small pleural effusion, and the decision was taken that it should be drained under radiological guidance.
That evening my eldest son visited, although he seemed to spend most of his time instructing the staff that they should give me a hard time. However, they apparently pointed out to him that they wouldn't do that as at some point I would be back at work, and would therefore be in a position to get my revenge.
Wednesday day passed off uneventfully, however, there was more entertainment in the evening. There had been a man admitted, in his fifties, who looked like a drinker, and whose legs were apparently completely paralysed.
Possibly years of experience helped, but watching this man's behaviour during the course of the evening, I knew what was going to happen. I even said to the staff that I thought that not only was he going to go loopy overnight, but I would bet them any money that he would re-discover the use of his paralysed legs.
Sure enough, by 11pm, this man was shouting about the fact that everybody was plotting to kill him (why is it that alcoholics become so paranoid and convinced that everyone wants to kill them when the alcohol wears off), and by the early hours, in an almost miraculous move, he had indeed re-discovered the use of his legs. Unfortunately, the on-call doctors did not have the courage of their colleagues from the Monday night and did not do anything, so the rest of the patients were subjected to this man's paranoid delusional shouting for the remainder of the night and much of the following day. In fact, the following day, his legs had recovered to such an extent that he could walk several yards before crashing to the floor. Again, the staff are not allowed to restrain patients, and other than telling this man to sit down, they could not prevent him from going walkabout and falling over, they could only fill out the incident reports afterwards.
On the Thursday, the decision was made to drain my effusion under radiological guidance, so I was off to the X-ray department, where a spinal needle, under ultrasound guidance, was inserted into the centre of the effusion and an attempt at drainage was made.
Sadly, the result was severe pain for me and approximately 1ml drained. It appeared that what had been an effusion was now a haematoma, and the only thing for it was to leave it to reabsorb on its own.
Back on the ward I was feeling very much better, even though only 1ml had been drained, but mainly because I hadn't spiked a temperature since the early hours of that morning.
However, the evening and night threatened to be a repeat of the previous evening and night with the madman. So, because I was so tired, as were the other patients, and prior to going to bed I informed the nurses and doctors that myself and the other patients were not prepared to tolerate another sleepless night, and that if they didn't have the balls to make the decision I was sure that I could find someone who did have, and if necessary I would be happy to personally administer any medication that was prescribed. This man was sedated and myself and the remainder of the patients got a good night's sleep.
The following morning, on the ward round, I was told that I could go home. Whilst this was the best news that I could have had, the downside was that m'Julie, Hannah, her friend and her friend's daughter had gone to Lincolnshire the previous day to a Pumpkin Festival, and they weren't coming home until the Saturday. However, m'Julie's mum agreed to be at the house until m'Julie got back.
Next was the question of transport home, and here I was very lucky, as one of the ward staff very kindly offered to give me a lift home.
So at 3pm, armed with a small pharmacy, I made my way out of the hospital to the car park and by 3.30 was sat on the sofa at home having a cup of coffee and catching up on the rest of the Sky+'d stuff.

m'Julie was home at 3.30pm on the Saturday, and I was able to settle in and concentrate on recovery, even if that did mean going to bed at 9pm, getting up at 6am, having an afternoon nap and generally behaving like a geriatric (remember, I moderate all comments!). At least I was home!

Sunday, 19 October 2008

When The Wife Doesn't Listen

I got sent this by a friend. It appealed to my odd sense of humour and I thought I just had to share it. Enjoy.

Saturday, 18 October 2008

A Busy Month Part 3: The 'Fun' Continues

Despite the fact that I had felt so good after the kids had visited, the next couple of days were to be fairly miserable. When I had been transferred back into the HDU, I really had felt so bad that I was sure that I wasn't going to get out of the hospital. When I look back on it, I wasn't actually that unwell, the evidence being that a. I didn't need to be re-ventilated at any time, b. At no time was I transferred to the intensive care unit and c. At no time did I require inotropes.
In the early hours of the Monday morning I woke up. I had severe pain in the lower left side and I couldn't get my breath. I was helped out of bed and into a chair, and as I moved, I experienced the most excruciating pain that I have ever experienced in the whole of my left side, and again I couldn't get my breath. Even with the CPAP in-situ, it was some time before I was able to breathe anywhere near normally
This continued for the entire day, with another severe bout of the breathlessness and pain at lunchtime. Fortunately for me, the Cardiac Matron witnessed this episode and got things moving. Before long, I was given a large dose of painkillers and an x-ray was performed that confirmed that I had a pleural effusion. Therefore the decision was taken that ultrasound would be performed and there would be attempts to drain the effusion.
A radiologist performed the ultrasound and marked the 'best' access point for drainage, then one of the surgeons decided he'd have a go at drainage. So, an hour later, and having stuck approximately eight needles into my back, he had managed to drain off 80mls of fluid.
Although it doesn't sound like much, it was a significant enough amount that it improved my breathing and lessened the amount of pain that I was experiencing, which meant that I had a much better night.
The following morning, one of the other surgeons arrived with a portable ultrasound and informed me that he, too, was going to have a go. Having ultrasounded and injected local anaesthetic, he then proceeded to insert one needle and start to drain the effusion. Forty-five minutes and several syringe changes later, he'd drained 450mls of fluid. If I'd thought that the 80mls made a difference, this last lot made a huge amount of difference, and I felt absolutely brilliant. However, the downside to all this was that I had to start on intravenous antibiotics and suffer all of the side effects that go with them.
The other thing that I found rather strange was the number of visitors that I received during the course of the week. Some travelled long distances and some I hadn't seen for a while. Whilst I was extremely grateful to see all of them, I couldn't understand why they were visiting, and also why they were so surprised to find me either sitting out or, in one case, not in the HDU because I was out in the toilet. It was almost as if their expectation was that I was on my last legs.
A little later in the week, I was to find out why. It transpired that my ex-wife had taken it upon herself to telephone all of our old friends, including those in the States, to inform them that I was seriously ill, in imminent danger of dying, and if they wanted to say goodbye, they'd better get in quick whilst I was still around. The payback. Here was I, feeling much better, with all these people visiting and expecting me to die.
In fact, following the drainage, I was feeling much better to the extent that on the Thursday I was fit enough to be transferred out of the HDU and back into the main ward. Yes, I was still a little breathless, and yes, I was still a bit sore, but compared to the week previously, I was 100% better. In fact, I began to think about going home.
The thoughts of home increased overnight on the Thursday night. Unfortunately, the Hobbit was on duty. This meant that I had to be on the ball as it was me that needed to remind him when I was due my medication, including the doses of IV antibiotics. In fact the evening one that was due at 10pm wasn't given until I reminded him at 1am. When I asked him why it hadn't been given at the correct time, I was informed that it was because 'You looked asleep' and he seemed unable to grasp the concept of whether I was asleep or not, the dose should still have been given. I started to realise that if I remained in the general ward, there was a distinct possibility that, through omission, the staff could cause further harm.
The following morning, because I was feeling much better, I informed the doctors that I wished to be discharged. Provisionally, they agreed, the provisions being that I would need another chest x-ray and also prove that I could mobilise without keeling over. So, as soon as I'd had my shower, I headed off to the shop.
The biggest surprise was when I stepped outside. This was on 3rd October, and was the first time that I'd been outside since 17th September, over two weeks previously. The drop in temperature in that period of time came as quite a shock.
Having walked down the stairs to the shop, I cheated and got the lift up the two floors. By the time I got back to the ward I was a little breathless but I had proved that I could mobilise about the hospital (I'd walked to another wing to get my first decent coffee in two weeks) without keeling over and dying. That box was ticked.
Next was the chest x-ray. This showed that there was still a small pleural collection but that it was too small to be drained. Next box ticked.
Some of the junior doctors were a little unhappy that the registrar had agreed to discharge me, and made their feelings plain. However, I was supported by the senior doctors, the cardiac matron and the cardiac rehab manager (the latter two of whom I'd worked with in a 'past life'). However, when my observations were done, they also showed an improvement. Box three ticked.
Lastly, I had to be supervised doing the stairs. Now this was quite amusing as the nurse that accompanied me in a 'supervisory capacity' was both elderly and overweight, so when we actually did the stairs, I had to stop half way to make sure that she was OK, as she was puffing and wheezing more than me! And when we got to the top, she declined to walk back down and insisted that we get the lift back down! Last box ticked.
I was now definitely being discharged, so I telephoned my friend David who'd very kindly agreed to give me a lift home, and he collected me at just before 6pm.
Considering that it was a Friday evening, at rush hour, and we were driving through London, it actually took us less time than I was expecting to get back to Kent and I was home by 7.30, feeling absolutely shattered.
At 10pm, I couldn't stay up any longer, and m'Julie settled me into bed and I went out like a light. Unfortunately, two hours later, I was wide awake, and there was nothing for it but to make my way downstairs, make a coffee, take some paracetamol (I had a temperature) and watch some of the things that I'd Sky+'d before I went into hospital.
A couple of hours later, temperature had come down and I felt tired again, so I went back to bed, but only for another two hours. However, this time when I woke up, I was a lot more breathless and experiencing quite a bit of pain on the left side again. I dosed myself up, but without success, and realised that there was a distinct possibility that another pleural effusion was forming. I settled onto the sofa and watched the remainder of the stuff I'd recorded.
m'Julie woke up at 7, by which stage I really was suffering, in excruciating pain again and really struggling to breathe. I then got the lecture from her for not waking her up earlier. However, I'd felt that it would be unfair to wake her as there was very little that she could have done. Sadly, the only solution was for me to be back in hospital and, for the second time in less than three weeks, an ambulance was called.
First on the scene on this occasion was a single Paramedic, followed minutes later by the ambulance. Unfortunately, I knew all of them, but they were very good and didn't laugh or take the mickey as much as I would have done had the roles been reversed.
Once I was in A&E my main priority was pain killers, as I was in absolute agony. In fact, after 50mg of both oral and IV morphine, 75mg diclophenac, 100mg of tramadol and 1G of IV paracetamol (I'd spiked a temperature) I was still in pain. And it was at this point that the medical SHO came to see me, his opening line being 'I understand you're the resus officer, well I failed the ALS (Advanced Life Support) course two weeks ago and I'm not happy'. Despite my instinct being to say 'I'm sorry, you must have mistaken me for someone who gives a sh*t, and you are clearly an incompetent tw*t, please get me someone who knows what they're doing', I felt so rough that I managed 'Well, it's obviously your own fault as it’s not a difficult course, but can you please concentrate on sorting me out'.
So bloods were taken and an x-ray was performed which showed that I did indeed have another pleural effusion and the decision was taken that I would be admitted. What followed was rather surreal, as various people came to see me to inform me that they were sorry, but if I was admitted I wouldn't be in a side room, but out on the main ward. What they didn't realise was that the way I was feeling, they could have put me in a corridor in full clown make-up, as long as something was done to relieve the pain and breathlessness.
Consequently, I was moved to one of the medical wards and settled in. A little later, the registrar appeared and attempted to drain the effusion. Unfortunately, he only managed to drain 20mls, but even that had quite an effect, relieving both the pain and breathlessness a little. However, the decision was taken that everything would be sorted under radiological supervision, and that there would be no more 'blind' attempts. I also started on a different IV antibiotic to the one that I'd received in London, this one being known as 'Domestos', and its side effects were to be worse than the previous lot.
So, having been home for only 12 hours, I settled down for the night on a medical ward in the hospital where I work, being looked after by a staff nurse whom I'd known since he was a brand new student nurse, which I think freaked him out far more than me.

But this was to be the home straight, more of which in part 4 soon.

Wednesday, 15 October 2008

A Busy Month Part 2: The 'Fun' Begins

I had no visitors on the day before surgery, but I still had 'tasks' to keep me occupied. I was given a couple of razors and told that I needed to shave my chest. Shave my chest! I'd had previous thoracic surgery 20-odd years ago and had had to shave my chest then. It had taken 20-odd years to grow the 17 hairs that I had, and here I was being instructed to shave them off. Heartbroken. It was also suggested that I shave my arms as there was a possibility that veins would be taken from them, so this I duly did.

When I went to bed that evening, inevitably, I found it difficult to sleep with lots going on inside my head. My cunning plan had been that once I had a date for surgery, I would make DVDs for all my 'significant others' in which I would take the opportunity to say goodbye should I not survive the surgery. However, because of the nature of my admission, I never had that opportunity; so much of the night before my surgery was spent writing 'just in case' text messages to friends and family, which I stored to be sent the following morning. The problem was that with the DVDs, they would only come to light if I did kick the bucket, whereas the texts were read no matter what.

The most difficult of these were to m'Julie, because a text message is such an inadequate way to say what you feel, and to my eldest Son, for the same reason, but also because we had had a bit of a falling out at the start of the year and everything was not completely cleared between us.

I was woken bright and early, had my second shower in the antiseptic stuff, sent the text messages and handed over all my kit for storage until after the surgery. Then it was the wait for theatre. I'd been told that I'd be going at about 7am, but it wasn't until 7.45 that I did go, after being visited by the anaesthetist, whom I'd worked with just a couple of years ago when she'd been at the hospital where I work.

The trip down to theatre was the start of what was to be, for me at least, a fairly sketchy few days. The first surprise was that the theatre didn't have an anaesthetic room, and I was wheeled straight into the (bloody freezing when you're just wearing a gown!) theatre.

Now, this was the start of the sketchy bit. A week later, I was told by the anaesthetist that as she'd been putting in lines etc, we'd had long conversations about the hospital where I work among other things. However, my final memory is her saying to me 'I'm just going to give you a little bit of midazolam.'

My next, very vague memory, is of my eldest son, Alec, and his friend Casper, although at the time I was convinced that I'd dreamt it, sitting out at various points and having a CPAP mask on. In fact, I was to be CPAP dependent for the next week or so.

CPAP (Continuous Positive Airways Pressure) is often used by people who suffer from sleep apnoea. In these circumstances, it is a small mask that fits over the nose and is worn when the sufferer is asleep. It delivers air under pressure to ensure that the airways stay open when the person is asleep.

In my case, because of previous treatments and the smoking, my lungs are what is technically known as 'buggered'. Therefore, immediately post-op, I wasn't able to maintain my oxygen levels. The CPAP used in hospital covers most of the face and is applied very tightly, so as to force the oxygen in and keep the alveoli in the lungs open to 'facilitate gaseous exchange'.

Although it’s quite uncomfortable, it is a better option than the alternative (hypoxia, confusion, possibly death).

I did find out that , because of the previous radiotherapy, rather than using the mammary arteries, as planned, they'd only been able to use one, the other being too badly damaged, and so I had had leg veins taken from my left leg. I also found out that rather than having two vein grafts , as expected, I'd needed four.

The day after the surgery I was moved from the cardiac recovery to the ward's high dependency unit. I continued on the CPAP, but there were more rest periods where I was just on 'ordinary' oxygen.

These breaks gave people such as the physiotherapists the opportunity to visit and inflict their own particular brand of sadism.
Unfortunately, it was also very tiring, so the day after arriving in the HDU, when I was visited by m'Julie, Hx and my friend Jeremy, I was not the greatest host in the world, falling asleep constantly the whole time that each of them was there.
However, it was just as well I did sleep as that night, directly opposite, the patient arrested. Now that was difficult. I could hear what was going on and knew that the person that was actually running the arrest didn't actually have a clue what they were doing. Tempting though it was to jump out of bed and take over, I had to lie there and pretend to be asleep.
On the Friday, I was assessed by the physio and deemed fit enough to move from the HDU to the main ward. So I was moved. It was then a case of being geared up for discharge over the weekend. I was sent to x-ray, because there was a possibility of a small pleural collection (x-ray confirmed this) and attended the pre-discharge talk given by the Cardiac Rehabilitation nurses.
So having been all geared up for discharge, things then went a bit awry the following morning, when I woke up at 0530. I knew that my temperature was sky high and I was struggling for breath. I told one of the HCAs, who performed observations that showed that my blood pressure was low, my oxygen saturation was 83% (normal = 96-100%) and my temperature was 38.7 (normal = 37). However, rather than getting a trained nurse, she informed me that she intended to leave it for an hour or so and would re-check it. In the end I had to put my Charge Nurse head on and order her, quite forcibly, to get a staff nurse.
Much of that Saturday was a blur. The doctors came, but seemed decidedly uninterested, until they saw me after I'd walked to the toilet and back and had gone mauve (not a good colour!), and then it all happened and I was rushed back into the HDU, CPAP'd, lines re-inserted etc.
Unfortunately, all this happened at the time that m'Julie, her daughter Hannah and her mum had come to visit, so although they were at the hospital for about 3 hours, they spent almost all that time waiting to see me whilst I was being sorted out.

Once the CPAP was back in place I did start to feel better and I felt quite a bit better on the Sunday, although I was still struggling to breathe at times. However, I received a visit from Alec, my eldest son, who informed me that he had a surprise. The surprise made me feel 100% better as it was my other son, Drew, and my daughter, Maggie, whom I hadn't seen since the week before I'd had the MI.

What I hadn't realised was that behind the scenes m'Julie and my friend Bruce had been in delicate negotiations with my ex-wife and, as a result, she had allowed Alec to bring his little brother and sister to the hospital to visit me. However, there was to be a payback, but more on that next time.

Sunday, 12 October 2008

A Busy Month Part 1

It’s been quite a while since I last updated this and the reasons for that will become clear fairly shortly. Also, because there has been quite a lot that has happened as well as the fact that I'm knackered, I'm going to do this in several parts.

So it all started almost a month ago on 14th September, a bright sunny, Sunday. So bright and sunny in fact that the decision was made that we would visit Scotney Castle. So we all piled into the car, picnic lunch packed and made the twenty minute drive to Scotney. Once we got there, we picked up the timed tickets for the house and then went to the picnic area for lunch. Unfortunately, this was where it all started to go wrong.

As we were eating, I developed a little chest pain. Unfortunately, I'd left my GTN spray at home, so I tried the old fall backs of adjusting position and having a little walk, and, surprise, surprise, neither of these worked. In fact, the pain increased and started to radiate down my right arm.

My next suggestion, with the benefit of hindsight, was not the greatest, however I made it anyway, and we all piled into the car to make the twenty minute drive home to get my spray, so that I could have it and then we could drive back and go round the house. And before anybody makes shouty comments, I realise that this is not the most sensible thing that I've ever done, but as I'm the only driver, it had to be done that way.

The drive back was 'interesting', as the pain was gradually increasing, both in my chest as well as my arm, but we got back safely, I found my spray and took it. Now GTN works within seconds, usually, but in this case, nothing. In fact the pain got worse, and I began to suspect that this was a little more than just angina. Another spray, nothing, so it was time to call an ambulance.

In Paddock Wood, we don't have an ambulance station, but we do have co-responders, so when we called an ambulance, the first on the scene were two of the local retained firefighters with oxygen (much needed and appreciated) and an automated defibrillator (bit premature).

The ambulance arrived about five minutes later, I was put in the back, given more GTN and taken to my local hospital. By the time we got there, this last load of GTN had worked and I felt fine, but I was still put in Resus with a fair few odd looks and comments (this being the hospital where I work), and subjected to all the usual 'tests'.

After a couple of hours, the decision was made and I was moved to the CCU (different room to last time, but still a private room). Fortunately, I had packed the portable DVD player and the Michael Palin DVDs before the ambulance arrived, so the boredom wasn't as great as it could have been.

When I saw the consultant the following morning, the blood tests were back and confirmed my suspicions that the pain that I'd had was more than just angina, and had been an MI, albeit a fairly minor one. I was also told that I would not be discharged, but was to be transferred to London and would have my surgery as an 'urgent' case once there was a bed available. I therefore had 24hrs of DVD watching and boredom before a bed became available and I was transferred.

Transfers are now performed by 'private ambulance services', which means that some of the employees are 'characters'. The two that transferred me were no exception. The driver was about six foot eight and looked like he'd once been employed as a wrestler. Then there was the attendant, the guy that I was subjected to during the trip to London as he was sat in the back with me.

During the trip to London, this man, who informed me that he was badly asthmatic and had once nearly died due to a gastrointestinal complaint, also informed me that he had been a Commander in the Royal Navy and spent most of his navy career working undercover in Northern Ireland and other trouble hot spots throughout the world and that after leaving the navy had trained as a paramedic, but following his near fatal gastro trouble he had decided to work purely as an Emergency Medical Technician as there was less stress. In the meantime, the longer that the journey continued, the more certain I was that we would never arrive at our destination as my will to live ebbed away faster and faster.

The whole episode was beautifully summed up by the driver when we did eventually arrive at the hospital and he offered me a towel as he was sure that my ears must be bleeding.

I then had the indignity of being placed in a wheelchair (the crew insisted that I had to be wheeled) and I was taken to the surgical ward, where I was eventually shown to my bed by a staff nurse with a more than passing resemblance to a Hobbit (I'm sure that there was hair poking out of the top of his shoes!) One snippet of information that he did give me was that I had been on the operating list for that day, but because I hadn't turned up the day before I'd been cancelled. When I explained that I had been in another hospital awaiting the call to say that there was a bed available, he informed me that 'Oh no, there weren't any beds yesterday'. I considered it pointless to question why he'd told me about being on the list.....

The ward staff were a completely diverse mix, as reflects the area in which the hospital is located, with the majority of them being African, West Indian or Asian, or more specifically Nigerian, Jamaican or Filipino. However, there was one member of staff who caused me some concern. This was the Senior Staff Nurse from Portugal. Don't get me wrong, I have nothing against the Portuguese, but I was concerned that this chap, nice though he was, was in a position of some responsibility, and through attempting to talk to him, it appeared that his command of English was just marginally better than my (non-existent) command of Portuguese.

It didn't really come as any surprise, but unlike the CCU, once on the cardiothoracic ward I was no longer in my own room, but in a four-bedded bay. At the time that I arrived, this did not seem to be a problem. However, that night, the reality hit home. In the bed to my left sat a man who had had his surgery, Koran in hand and chanting the same thing over and over, until the early hours. There was also a distinct smell that suggested he may have been unsuccessful in his bid to secure the use of a commode.

Diagonally opposite from me was an Italian man. He too had had his surgery. He spent much of the night shouting out random words and phrases, in both English and Italian. However, whenever a member of staff approached him he claimed to be perfectly alright and seemed surprised that they had gone anywhere near him and woken him up.

Directly opposite me was a man who had also had surgery, although it was just the insertion of a pacemaker, but to listen to him, they had clearly opened his chest, without anaesthetic, to insert it, and he was very vocal about it. This made the experience of the first night comparable to sleeping during the height of a Tourette's convention.

On top of this, it was decided that I needed to have IV access, so the locum SHO was sent to achieve this. He looked very upset, after he'd missed the world's biggest vein for the second time, when I told him to go away and find someone who knew what they were doing. He seemed even more upset when he asked me if I was questioning his technique and I told him that, as he had no technique, that would not be possible.

I ended up being cannulated the following day, but unfortunately not in ordinary circumstances. As I had on my previous visit, I decided to take a trip to the shop for a paper. So, I walked downstairs, went out of the entrance and phoned m'Julie and then got a paper. However, as I was queuing to pay for the paper, I developed a bit of chest pain. Unfortunately, as I made my way back to the ward in the lift, this pain increased, and even after taking my spray back on the ward, the pain still increased. Result = ECG done (no changes), more GTN, cannula (not by Dr Mong!), more painkillers and Rick confined to ward until post-op, which I found out was to be the following Monday, 22nd September.

However, I was cheered by a visit from Hx in the afternoon where she went into secretary mode and screened/answered all my calls. However, we did managed to upset Stan (author of Naive Zebra) because he sent us

and we sent him

But Stan got his own back when he visited the following day, meeting m'Julie for the first time, and photos of my bruised belly have now made appearances on the forum, with suitable comments.

Unfortunately, I again proved that the angina that I was suffering had become more unstable during the wait for surgery when I again suffered some very severe chest pain during the night after a visit to the toilet and again when I was woken up by the pain have made no exertion at all. I still needed to wait until the Monday for the surgery though.

Probably the most difficult day was the Saturday as this was the day that m'Julie and Hannah visited, and was to be the last day that they visited before the surgery. The old paranoia reappeared and as I said goodbye to them, I was very aware that, as the surgery was less than 48 hours away, this could well be the last time that I see them. Not a pleasant thought.

So that's what I was up to in the first week, and I'll continue at a later date in Part 2.