14th January, 2009

A visit to the surgeon to discuss my various herniations resulted in being seen first by a very nice, and new to me, registrar who knew all about me as he had studied my case history and had helped to write up the case notes with the previous registrar who had been hands on, so to speak at the time. My concern is whether or not the hole in the gauze cum false skin I have on my abdomen, through which the bowel is protruding or herniating, will get any bigger. I am assured that it will. Can anything be done about this ? Or should we be doing anything ? Or indeed should we leave it alone ? Yes, probably not and probably are the answers. The problem is that going back into the abdomen is fraught with difficulty. It all stems from the fact that according to the consultant and registrar I survived an un-survivable accident and that the surgery carried out on me was by and large trauma based, stop-gap work. This was not exactly how it was put but that was the essence of it. Isn't it always the case that you are told things in the consulting room which disappear from the mind the minute you come out ? I should know by now to concentrate more carefully on what is being said, or perhaps to take in a recorder. Mind you it is hard to absorb things when you are lying down. Anyway, the tissue inside me is still as hard as concrete. The consultant had hoped that it might have softened but it has not. Being so hard it is practically impossible to work with. Then there is the question of entering the abdomen without puncturing the bowel, almost certainly impossible to achieve, so one would be facing fistulas. Then there is the question of separating or peeling the bowel away from the layer of skin over the abdomen. Tricky. Putting a mesh over the herniation at the flare entry point was seen as possible as the skin is not attached to the bowel, although entry to this area would have to come from the front of the abdomen with all the attendant problems I have just described. So let's do nothing, see what happens and take things as they come. In the meantime a CT scan which has been booked will tell us more about the concrete tissue issue and the bowel. On the plus side small herniations tend to trap bowel and cause blockages which is problematic. Larger herniations do not. And I am in the larger camp. Then there is the question of the state of the skin which was grafted onto my abdomen. There is the possibility that this can break down in certain circumstances and that is less than handy. The consultant said "We will definitely be seeing you at some stage." Nothing will happen without them having as clear a picture of what is going on inside as possible and without the operation being absolutely imperative. Understanding that the hernia at the front of my abdomen will get bigger, as I suspected it would, is fine, I just hope it takes its time about it. I left the consulting room with the words “enjoy your life” ringing in my ears. Now this could have been meant in a “have a nice day” manner or it could have been more sinister. I am wondering if I should have a look at life and treat it in a rather more relaxed fashion than I do. After hospital I was hell bent on returning to normal life, to the rat race and the rut and providing for my family and picking up the cudgels of all the challenges I had been facing prior to the accident. To this end all the grand ideas about how we would change our lives, live in Italy or Cyprus, that we had nurtured while in hospital to try and see us through to the other side were thrown out of the window. Perhaps we should re-visit them ? Sally has always been of the view that “you can't take it with you”. I have always countered with “but you wouldn't want it to run out before you went”. So, perhaps a change is on the cards ? Fistulas are a pain and could mean a lengthy stay in hospital, I suspect but as and when any operation happens I will be fit, strong and well able to handle the tribulations unlike last time when I was half dead. We'll play it by ear then and take it one day at a time, said he slipping into the world of the cliche but I am sure that any operation will be some time off, well I hope so anyway.

Incidently Katie will be joining the world of the abbreviation when she starts with the Paramedics at the end of this month, beginning with ABC of course, Airway, Breathing, Circulation. There will be RTA's, DOA's, OD's CPR's, ECG's, Pulmofarcs, fibs, de-fibs and trachys to name but a few, or rather not to name but to initialise and acronymise...and then of course there is DEAD which stands for, er, well dead, actually.

Duncan