Drama on C3 - part 2

Part 2.

One medical team came on rounds and when they came to Emily’s bed, they spent quite a time discussing together and looking at x-rays before they went into her cubicle and of course drew the curtains around. But although we couldn’t see, we could all hear and imagine everything that was happening within. The girl doctor from the night before was part of the team - still wearing the same clothes - looking even more exhausted. But the first one to speak was a male doctor. He said to Emily, “I’m afraid we have some bad news for you. We have had the results of your x-rays and the tests of the contents of your stomach and blood tests, and you need to have an operation, and if you don’t you won’t be getting better.”

Emily said, “I don’t want to have an operation.”

“It is your choice completely, but I must make clear to you that we found that you have a hole in your intestine, and that if it is not operated on and we do a colostomy, you will not get better.”

“I don’t want a colostomy.”

He said, “I’m sorry this sounds very brutal, but if you don’t have an operation you will die. If you do have it, there's every chance that you will be able to go back to your normal life, and when you are better, we can reverse the colostomy. But it is your choice. We can’t force you to have an operation if you don’t want one, but if you don’t have one, you will die. I’ll give you five minutes to think about it,” and then he went out of the ward.

Then the girl doctor spoke to her, “Emily,” she said, “only you can make this decision. Not the doctor, not your family, not me. It is for you to decide. But a colostomy is not such a bad thing. The
Queen Mother had one. I’ll bet you didn’t know that and look how well she coped. And you would have a special nurse to help you with the bags, and lots of people have them and go on with ordinary lives. You have been living independently, and have a reasonably good quality of life. I know when you came in here two weeks ago, it was for a different problem completely, to do with your asthma, and when we were looking into the cause of your stomach pain, we have now found out that you have this hole in your intestine and that is a very serious thing and needs immediate treatment. I will phone your daughters to come and talk to you about it, but remember it is your choice.”

Emily said, sobbing now, “I don’t want a colostomy.” 

The doctor added, "Well, I’ll come to see you again later. They will get the surgery all ready for you in case you change your mind because if it's going to be done, it has to be done as soon as possible.” And then she left.

It wasn’t long before the two daughters came in. One was about 30 and was plumpish and quite quiet. The other was younger and had a small baby. The girls had no hesitation at all in trying to influence their mother’s decision. From the moment they arrived they said over and over. “You have always been so strong, and you have such courage. You can do this. You were so scared it was cancer, and it isn’t - it's something that can be treated. The doctors here are so good and they will very soon have you back to normal." On and on it went until eventually their mother’s resistance was broken down, and when the young male doctor returned, she said, “I trust you and know you will take care of me.” And he assured her over and over that they would take very good care of her and that she had made the right decision.

In the meantime, things were going on in the rest of the ward too. My doctor came in at 8 and told me that the x-rays were normal - so no operation. And that he would arrange a scan hopefully for that day or the next, and after the scan I could eat, and if the scan wasn’t till the next day, I could have clear fluids.

At 8.30 or so, somewhat later than planned, they came to take Freda down for her operation. She had been pre-medicated so was more or less asleep as the trolley went by my bed. She was back by 11.30 and put on a drip and they monitored her fairly frequently for the first few hours.

The shift had changed again at 8 and this new lot of nurses were very pleasant, but the head nurse was rather unwilling to bend the rules at all. When I got the message that my scan was
scheduled for 10 the next day, I said the doctor had told me I could have fluids, but she wouldn’t believe me and wouldn’t allow me to take the aspirin I felt I needed so badly due to my constant
headache. And she put up another six hour’s worth of drip.

In the meantime, the lady next to me, Hilda was also waiting for her operation, but she was far down in the schedule, and hadn’t been given a time except that it was in the afternoon. She was very
nervous about it, never having had an operation or even been in hospital before. She was 82, a widow of 12 years, with four children - but all living far away. Her problem was a bleeding bladder - and she had come into the hospital on Sunday, for a transfusion - as she had been very anaemic.  So she
also had a very long day of waiting, and in the end it turned out to no avail - because her surgery place was given to Emily, and Emily’s operation took a long time. At 6 p.m. they told Hilda the surgery was cancelled and they would have to rebook it on Sunday or Tuesday next week. She was very upset - but had little choice but to agree.

It was about 2 when they wheeled Emily off to the theatre. Her daughters who had been with her all morning were positive and cheerful the whole time - but they were rather tearful as they kissed
her before she went off. “See you in a little while when you will be much better. Remember to keep your courage and be strong.”

After they had taken her down, I was chatting to Hilda. “I was very upset at the way they bullied her into having that operation,” she said, “Both the doctors and her daughters really forced her to have
it. She didn’t want it.” She said when her mother had been very ill, a surgeon and a medical doctor had stood at the foot of her bed and argued about the next course of her treatment. The surgeon said that he could deal with whatever her problem had been, and she said, no doubt he would have done a beautiful mechanical job. But the medical doctor knew her mother couldn’t cope with the after effects of the surgery - and so he felt it was wrong to put her through it all.

I thought about how I had been considered for the same diagnosis as Emily had been given - perforated bowel. I wondered if they had given me her choice to make (and if I had been her age and in her physical condition) what I would have decided. And I think I would have decided for the surgery - not really so much for the reasons that her daughters gave her. They might have believed what they were saying about her quality of life and getting back to normal again, but I was pretty sure that Emily would never be normal again. But the surgery was the only chance available - maybe her odds were 99 to 1 against - but she had a chance and therefore she had hope. And it also gave her
relief from pain.

When they brought Emily back into the ward at 6 p.m., her daughters were with her but they were both crying. She was breathing regularly, but was asleep or unconscious. It was amazing how much smaller she looked with many fewer tubes in her, and her abdomen was much less distended. The nurses came and did their usual checks. I walked by her about 9 and her eyes were open, but I don’t think she could really see. She gave no sign of recognition when I smiled at her. I heard the nurses say that her urine output had not increased in the last hour, and it was very concentrated and dark red. Hilda whispered to me, “I think she's dying.”

Freda was feeling pretty well by now, and we had a new occupant in the bottom bed on the other side, Dorothy - who wanted nothing more than to chat non stop. We all had her life history in a very short time. She was in for a biopsy. She had had cancer a few years back and she was having a lot of pain now, so they were investigating to see if it was recurring. She said the pain was so bad she dreaded going to bed at night as it was much worse when she was lying down. And the other day she had had two bottles of stout with her tablets and had managed four hours of sleep on the trot. But she was worried about forming a drinking habit, so didn’t want to do that every night.

We really didn’t see much of the men in our ward as they had their own toilets and bathrooms at the other end. But one time we were very aware of one man - most likely the little Chinese man who was closest to the connecting doors. The young girl doctor was with him - doing something - and we heard him yelp with pain - and it got noisier and noisier and he yelped  for about a minute non stop and for about three times. I thought he was being prodded in a very sore abdomen - and that he
either was much sorer than I was, or much less stoic. Anyway, before long our lady doctor came in and she was laughing. “I wasn’t beating him, honestly,” she said to us all. “He started making
the noise when he first saw the needle - and it got worse and worse as the needle came closer. But I was only taking some blood, honestly.”

I asked if I could have a sleeping tablet, since I was now allowed to have fluids - and was given one. I took it at 11, and was drowsy within minutes, and when I was next conscious of anything, it was 6 the next morning and I felt wonderfully refreshed. I looked across at Emily’s bed and the curtains were partially drawn around it. I got and walked across but when I looked the bed was empty and a nurse was cleaning the area. “Has she died?” I asked, and she nodded, “about 2.30.” I think we all knew she was going to die even before she went for the surgery, and certainly whenshe came back   - but I was nearly overcome with emotion. I didn’t know Emily or her family - I never spoke to any
of them, but I felt that they were a part of my life and that I was now sharing their loss. I had an overwhelming urge to write to the daughters and say how sorry I was about their mother. I wondered if that was a stupid thing to do, so I asked a nurse and she seemed to think it was a lovely idea. She said she couldn’t give me their address, but if I wrote a letter, she would address it and post it
for me. So I did that, and gave her change to buy a stamp for it. It was an awkward letter to write and they no doubt were very confused at getting it - but I was so worried that those girls who were much
the same age as my sister and I were when our mother died, would feel they had done the wrong thing in pressuring their mother into the surgery. They had said so convincingly that if she had the surgery she would be okay. So in my letter I told them that all of us in the ward couldn’t help but become aware of the situation with their mother - and that I felt that she had made the right decision. And that if I had had to make the same one, I would have chosen as she did. I said that it should be a little consolation for them to know her last 12 hours were pain free and that when she went to sleep under the anaesthetic her thoughts were very positive and that she knew how she was surrounded by their love. Maybe it was a stupid thing to do. But my compulsion to do so was really quite overwhelming, I did it, so there was no point in regretting it.

About 9 my doctor and a colleague came on rounds, and told me that if the scan which I was due to have at 10 was negative as he was sure it would be, I would be free to go home, and that I could eat properly again. Then he noticed me writing (this story in long hand took 26 pages) and asked what I was writing.

“I’m writing about what happens in C3” I said.

“Oh that must be very boring, “he said.

“Oh, no,” I said, “it's like being in a soap opera. It is very dramatic.”

“I wish I could write things like that,” he said.

“Don’t worry, I won’t publish it,” I said, grinning, and he smiled, “Oh, I wouldn’t be worried if you did,” he said.

My scan-driver arrived with my wheelchair just before 10, and I was wheeled to another x-ray department. The person doing the scan told me he had been told to look for pancreatitis. When I showed an interest in what he was seeing, he had me turn slightly to see in his screen and he showed me each of my organs as he examined it and identified the major blood vessels and so on. Then I told him the only area of real pain was the central portion by my naval, and he showed me that on the screen and said there was nothing abnormal to see, but, he admitted, this form of scan is the least efficient form for the intestines. “It is very good for the major organs,” he said, “but because of the density and complexity of the intestinal system it really is not very good for diagnosing anything in the intestines. A far better system is the CT scan and if your pain continues, they may well send you again for one of those. You are American, aren’t you?”

I agreed I was.

“In America they would almost always do a CT scan as the first method of diagnosis, but I think, rather cynically that that may because it is the more expensive form. It would cost £1000 for a CT scan while an ultra sound costs about £400.”
Anyway, the scan and the chat were now over, and I was wheeled back to my ward, where I lost no time in letting the nurses know that I was now allowed not only water, but food if I wanted it. I hoped my doctor had actually written that in his notes. They checked and he had, and I gratefully drank my tea when it came around, and quite enjoyed my lunch an hour later.

My doctor came to see me once more. He told me what I already knew - that the scan was normal. Then he told me he would see me in six weeks as an outpatient, but that if I had any pain of a similar nature in the meantime to come in. He said he couldn’t put a name to my problem. He was baffled by it, but he said that often was the case with intestinal pain and it would go down on the record as severe abdominal pain of unknown aetiology.

So my dramatic stay on ward C3 was now over, but to me it was quite an experience. I felt I had learned something about life and death and human nature. I had had my faith in the much maligned National Health Service renewed. I had been treated with great concern and loving care and the system, apart for the obvious shortage of doctors, had appeared to be very efficiently run. I had the
reassurance of having had a very complete physical and I appeared to be very healthy indeed - except for the odd unidentifiable pain here and there.

P.S.  A few weeks later, I had a letter from the daughters of Emily, thanking me for my note and hoping that had now recovered from my pain.