Today I had my pre-assessment appointment in Exeter, prior to my upcoming parastomal hernia repair operation. The original date for the operation, Thurs. 28th April, has been cancelled and my operation postponed, with so far no new date forthcoming, but today’s appointment went ahead as planned.
The first part of the appointment was with a health care assistant who took bloods, blood pressure, temperature, finger prick test for blood sugars, and ECG. I was also weighed and measured. I was then taken into the appointment proper, with a specialist nurse.
Very early on in the consultation she realised that Mr. Daniels had not given her all the information needed – all he had said was “parastomal hernia repair” with no mention of the tummy tuck. She had assumed this would be a day case. I showed her the letter I had had, with his answers to all my questions, and she then realised that this was major surgery and she would have to reassess how to conduct the consultation. (Here we go again, I thought – another breakdown in communication in this hospital! I’ve had my fill of them…) As a result of this, I required further bloods to be taken and had to go back with the health care assistant to be pricked again with the needle (she was very good at it and it was almost, but not quite, as painless as the first time). By this time the hospital blood collection had taken place, but they were able to take the sample to the nephrology department which had a later collection time, so all was well.
I returned to the consulting room and we continued with the appointment. The nurse took my medical and surgical history. I asked whether the copy letter from the anaesthetist who conducted my 2018 pre-assessment had reached its way into my notes. She said they don’t have “notes” as such any longer – it’s all on the computer. This is presumably their much-trumpeted “state of the art computer system” in which I have good reason to have little faith, given my previous experience with this hospital losing me in their system, continual breakdowns in communication, etc. The letter was not there, despite the fact I had asked Mr. Daniels’ secretary to make sure it was appended.
The nurse asked if she could keep the copy of the letter which I had brought with me, and I was happy to oblige. She said she would scan it and attach it to my records. She instructed me to bring another hard copy of it to hand to the anaesthetist on the day of my operation. The main point at issue is whether or not they will permit me to have a PICC line installed, to avoid all the problems I have had in the past with cannulae tissuing over as a result of vascular damage caused by my chemotherapy back in 2015. She read aloud as she typed on her computer, “PICC line advisable” so that looks hopeful at least! I told her of the very disappointing and irritating experiences I had had with the hospital since my referral back in 2018, for which she apologised – I said I had come to the conclusion that I need to check absolutely everything because I couldn’t rely on any information being properly transmitted between departments. I have never had any of these problems at Torbay.
She read the letter I had received from Mr. Daniels, answering all my questions. Much of this information was new to her. I am very surprised that Mr. Daniels gave her such scanty information that she was under the impression that this was a relatively minor procedure and not major surgery. She was also surprised about his reference to my having an epidural which was total news to her. I am very glad I took that letter in for her to see. It should surely be up to the professionals to make sure information is sent where it should go, and that this should not be left up to the patient…
We discussed my ME and my difficulties with sitting out of bed for the length of time required by the nurses on the ward, and the problem I had at Torbay with one nurse, until I informed one of the junior doctors on the ward, who obviously had a word with her and things were easier after that. I shall definitely be having foot pumps to aid circulation. I explained that my fatigue is going to be worse than normal post-operatively, because of my ME, and that I cannot sit comfortably on a hospital chair but will need my wheelchair. She noted this in her report. She also noted my request that anyone due to handle my wheelchair in my absence (i.e. taking it to the ward ready for me after my operation) must consult with me first, because someone once broke the control switch for the power-assist system by pulling on it, believing it to be the brake. I do not want my wheelchair damaged by people who don’t understand how it works.
We discussed any allergies etc. that I had, and I said I wasn’t sure if it could be classed as an allergy as such, but I’d been given cyclizine for nausea on one occasion when I was in hospital, and was hallucinating out of my skull, with all the nurses appearing to have beards! This amused her greatly, and she made a note to avoid cyclizine!
She asked if I had any religious or dietary requirements. I told her I was a Christian, and also enjoyed a whole-food plant-based diet which for their purposes could probably just be classed as “vegan.” She noted this.
Asking about the pre-op energy drinks, she produced two bottles of these for me to take away with me, with instructions when to drink them. I had asked Mr. Daniels if I had to have them and he said it was recommended. I had mentioned that they were horrible – really gloopy and full of sugar. However, this time around, they appear to be clear fluids rather than a thick milkshake consistency, and “lemon” flavoured – the nurse agreed they would probably taste horrible even so! Anyway, I am happy to take them as part of the enhanced recovery programme as they do help produce a better outcome.
I told her that Mr. Daniels had advised me to stop my rivaroxaban (anticoagulant medication) 5 days before surgery, but she said they had their own protocol, and I should stop them 72 hours before, i.e. 3 days. She said this was the decision of the anaesthetics department rather than the surgeon’s. I am to bring them in with me, along with my exemestane, and they would advise me when I should resume the rivaroxaban after the operation had taken place.
They will send me a PCR test kit which I can do myself, and then deliver it to the clinic they advise. This will save me having to go to Newton Abbot for it. I would in any case much prefer to conduct this test myself as it is pretty unpleasant. This will take place 72 hours before my admission and I will have to self-isolate until I go into hospital. If it is positive, my surgery will be delayed by about 7 weeks. I also have to advise them if I get Covid in the meantime, or any other illness, and if I am suffering from any kind of infection on the due date, I must inform them, as I cannot be admitted with vomiting and diarrhoea or a cold, etc. (Normal stuff really.)
In conclusion she said she had all the information she needed, and she considered me fit for surgery. Let’s hope all the information gets to the right people and there are no further mix-ups. She sent me home with a brief print-out summary of the appointment, and said that more detailed information would be sent in a letter once a date had been set for surgery.
Alogether, as far as this specialist nurse was concerned at least, it was an efficient consultation, and I feel more confident now that all my questions have been answered or at least are in the process of being dealt with, on the understanding, or course, that their famed “state of the art” system doesn’t fail yet again!
