Earsham Ward Total Hip Replacement
Time: 8.30 a.m. 15th March 2005 Surgeon Mr. C. J. V. Mann
This document is not a criticism. It is not a complaint. It is merely a personal account of an operation which did not quite go to plan. As I am coming back for another hip replacement, I don’t want a repetition, or even to leave room for the risk of one. I am confident that, with a little adjustment, we can improve on this patient’s lot.
Pre-op anaesthetics and such.
Somewhere between 8.30 and 9.30 a.m., I was put in the sit up foetal position to receive an epidural. My first observation was that the anaesthetist had rather a lot of goes at poking around my vertebrae to find a suitable entry site- up to a dozen little arpeggios. It struck me, possibly wrongly, as behaviour not associated with confidence. However, when the needle went in, it was virtually a painless entry, with no discomfort. The drug was administered.
Within minutes my left leg was almost completely dead, while my right leg (the operation site) suffered only mild pins and needles down the whole of the inside leg and across the toes.
I related this to the auxiliary (or nurse?) facing me and helping keep position, and to the anaesthetist (No 1 or No 2) behind me. Both told me it would sort itself out. I.ve since been told that this would be simply remedied in theatre, by laying me flat, rolling me on my right side, and the drug would simply run from my left to right leg. If this was so, either it didn’t work, or they forgot to do it. Maybe five minutes later, I pointed out that the previous status was still quo, as it were, i.e. right leg mildly numbed down wrong side, wrong leg, dead as a dodo. Again I was assured that it would sort itself out. I believe the general anaesthetic was administered next, because-
Post op. recovery.
-my next recollection is of arriving back on the ward, while just regaining consciousness at 12 noon. By that you may understand that the operation was carried out under full and adequate ‘cover’ of a sort within an hour I was convinced that all was not right. The pain, which should have been diminishing, was increasing. The left leg continued to be a credit to the anaesthetists’ art, but the right leg was waking rapidly to the glories and passions of sensitivity and pain. I called a nurse, explained the situation, and she turned up the epidural. After a while (I must confess to having lost all sense of time), this whole ritual was repeated- ‘It’s hurting more!- I’ll turn up the epidural’, and again, which I believe brought the epidural up to maximum input.
I believe I was administered two more different painkillers, both in tablet form. My wife tells me that she arrived at 6 p.m. and at that time I told her that I had been given morphine. She asked a nurse if this was so. The nurse confirmed a doctor had sanctioned the same, and that I was now due for some more, which I had, and was pleased, at last, to be feeling some relief.
A short time later, while my wife was still there, Mr Mann visited me, along with his support band, and I believe the nurse who had collaborated in the morphine issue.
Mr Mann was not pleased! He was plainly dis-chuffed that I had been given morphine. The luckless roadie who had evidently sanctioned it was booked for a tongue-lashing with a curt ‘We’ll discuss this later.
Now I accept that this sort of disciplining matter is not my concern. But it happened at my bedside so I reckon that gives me the right to two pen’orth- well right or not, here it comes- It involved the deliverance of my body from acute, excruciating bloody pain- deliverance wot I had been asking for for several hours, and that nurse and that doctor gave it to me. I don’t know where Mr Mann was, or the anaesthetist, but I know where I was- on my back, whimpering with pain, and the nurse and the doctor were on bloody big white horses, killing the dragon who had spent a long afternoon trying to lunch off my arse!
Now, a word to the wise. There is no point in criticising success, no matter how ill-advised you may consider it. You only make yourself look peevish. If you must knock off Brownie points, far better to congratulate the lucky avoidance of an odds-on disaster, style-of-fing- dress it up- talk like a Dutch uncle.
Conclusion
So what do we learn from this little tale? Early in my account, you may remember the words-‘the operation was carried out under full and adequate anaesthetic cover, of a sort’, but that cover plainly did not involve the epidural which, though full and effective, was all in the wrong place- superfluous to requirements- as much use as the proverbial chocolate tea-pot.
It occurs I may be going too fast for those at the back. Well this is how it was told to me. The epidural is the big wellie. It kills the pain of the operation at a local level, almost like a local anaesthetic,, and goes on after the operation, to keep the body happy so it doesn’t bother the brain or the nerves with messages such as ‘Ouch!’ The general anaesthetic is just so you sleep through the op. without having to listen to all the cutting and sawing, and all the off-cuts going ‘Clunk!’ into the wings and limbs tub. That’s how it should happen.
In my case it didn’t did it? If the epidural couldn’t cope with the aftermath of residual pain, then it clearly can’t have the credit for killing the pain of the actual operation. The pain didn’t wake me, so it must have been absorbed by the general anaesthetic. So Mr Candyman (or Miss Candymaid in this case, I believe) when I come in for hip No.2, send the epidural to Maternity with my compliments, and I’ll just have a double general anaesthetic, with a dash of Angostura and a twist of orange- hold the ice. Mayhap you should make a note.
Well mes Braves, I think that’s all I have to say- for now.
How about you? Anything?
P.S. Now that wasn’t critical, was it? Or complaining. I told the nurses before I left, my only criticism is that the hospital is too far from the nearest beach. Otherwise, I’d be booking in for my holidays.
This went to the Registrar (copies for all concerned) and I received a prompt acknowledgement which confirmed that I was not registering a complaint, and assured me that a detailed response from all concerned would be forthcoming in due course. It would appear that, ten years on, the course is still due. At least the second hip was replaced without problems, and that is the response I really wanted.
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