How I became a hospital bed blocker

Prelude — an explanatory background

I'd had a long history of periodic anal fissures (all of them being torture!), which had a tendency to become chronic and extremely difficult to heal, thanks particularly to an ongoing chronic over-tightness of my anus*, which was almost certainly the primary direct cause of the fissures in the first place. The last occurrence of a very long-lasting and really torturing fissure was in 2004, though since then my anus generally remained over-tight and could still become quite sore at times. Then in late 2007 there came out of the blue the beginning of a fluctuating weird abscess-like manifestation next to my anus.

When that strange infection manifestation first started making an observable small skin swelling I showed it successively to two doctors at my GP's surgery, telling them that I was pretty sure I'd got an abscess there, and they both independently told me that it wasn't an abscess, one saying it was an aggravated haemorrhoid and the other saying it was 'just a skin tag'.

I was sure that they were both wrong and that it was an abscess or other infection manifestation of some sort, and, sure enough, within a matter of days it broke open and discharged some pus. It would seem to go away and the skin to heal, and then it would come back again, always in the same position, and with what felt like a turgid column or channel coming up from within to the external swelling or opening.

On two occasions when it came up while the skin was well healed, pressure built up so that it caused great pain and needed lancing (then delivering sumptuous offerings of pus), but otherwise it was either completely painless or was just a little sore when more active. Still no doctor recognised it as an abscess, but nobody mentioned the dreaded word 'fistula'*, even though I myself suggested that it looked as though a fistula was trying to form. It was as though none of the doctors I saw knew what an anal fistula was — haemorrhoids, fissures (just about) and skin tags representing the limit of their knowledge of anus pathology.

At the very beginning of 2010 I had a devilishly severe phase of chronic anus constriction (caused by a particular type of attack from the garbage), together with the garbage projecting very troublesome phantom pain* onto the anus and thus giving me quite a rough time, and because of the sustained involuntary clenching and all the resultant straining to pass faeces, my haemorrhoids became overly big and prominent and tended to get a bit torn during the difficult bowel movements (thus with decorative spatterings of bright red blood in the WC), so I went to my doctor to get referred for the haemorrhoids to be removed.

By this time the strange 'abscess' phenomenon had a permanent small opening at the tip of a seemingly permanent little protuberance, which was at the tip of that internal turgid column or channel, which now was flush against the wall of the outermost part of the anal canal. In line with the established pattern, my doctor seemed to be (reasonably) interested in the haemorrhoids and referring me for them to be 'done', but somehow didn't really pay much attention to the 'abscess' issue, even though at that time I said rather apprehensively that I thought that needed attention too.

Consequently, in February 2010 I had an out-patient appointment at the Royal Devon & Exeter (RD&E) Wonford hospital, during which four haemorrhoids were 'banded'* as a preliminary stab at resolving my anus issues, and then in April of that year at my follow-up appointment the consultant proctologist herself showed up (it had been some junior doctor who I saw the first time). I told her there seemed still to be at least one large haemorrhoid remaining, and she talked of options for dealing with that, and we agreed on a surgical option (haemorrhoidal artery ligation) that would involve a single day general anaesthetic job. She was extremely reassuring about it and made it all sound a most approachable and untroublesome option.

As she was about to leave the room I pointed out that we still had unfinished business because we still had to address my 'abscess' issue. She was surprised, as it hadn't been mentioned in the referral letter — I really do despair of the GPs I've had to deal with! —, but then she did a quick visual and finger examination and said this really needed doing before any haemorrhoids, which could be done in a subsequent operation after full healing from the first operation, and the latter looked most likely to be a relatively simple and quick job to resolve, looking as though it were very superficial, so that it could most likely just be 'laid open' in the operation, without needing packing (with medicated gauze), and it could be left to heal naturally then.

She also remarked that it was quite possible that the first operation would in any case cause the haemorrhoids to go away, so that a second operation wouldn't necessarily be required. Again she made it all sound easy, straightforward and non-intimidating, and agreed to get that operation arranged. There was something very reassuring about her and her 'energy', and I felt a great confidence in her, and for the first time actually was now looking forward to having the operation(s). Yes, seriously!

The operation was finally scheduled for Monday 12th July; I'd have the operation in the evening and come out after breakfast the following day. The pre-op consultation with a nurse was the week before, so some basic tests were already done, and I had been briefed as to broadly what to expect and what the various requirements were with regard to when it was and wasn't okay to eat or drink before and after the operation.

On the day before the operation — Sunday 11th July — I prepared myself in characteristically grand style by having a major hike — hitch-hiking very early to Exmouth and then walking on the coast path to Seaton — a very strenuous walk of some 21 miles and over 1100 metres of ascent (not bad for a nearly 68-year-old!). This felt to be a really joyful celebration of the morrow's operation — in beautiful contrast with the morbid dread with which I had been viewing any such operation prospect until so very recently. Once I was back in Exeter I had a quite large and healthy evening meal out, knowing it would be my last 'real' meal till I was back from the operation.

Admission on the Monday was given as at 10.30 a.m., the operation itself being scheduled for round about 8.30 in the evening.

My unedifying narrative

Zero day arrives!

I rarely sleep all that well after one of my major hikes, and this occasion was no exception. I got up at my normal time — 5.20 a.m. — but was feeling still fairly sleep deprived. I got breakfast, but had been told that breakfast, if taken, should be eaten not after 7.0 a.m., and should be a 'light' breakfast, avoiding 'milky' things, and best without fruit, and with the odd other restrictions.

That meant missing out my usual bowl of chopped fruit and yoghurt, and the second part of my breakfast being reduced to just my usual two doorstep slices of fresh wholemeal bread, with butter but without my usual slices of feta cheese and boiled eggs, but at least with my usual herbal tea. My breakfast was finished at 6.0 a.m., and I was to eat nothing more till after the operation, when I would be able to eat normally again. However, I'd be allowed to drink 'clear liquids' (which for me was really just water) up till 1.0 p.m.

Following my 'minimized' breakfast I had my regular post-breakfast hour of self-healing / self-actualization practices, followed by a final hour catching up on the computer, and then after getting my 'overnight bag' together, I set out to walk the 1½ miles to the hospital, dressed in shorts and T-shirt (sandals for footwear), with no additional clothing apart from a precautionary dressing gown, as it was fine and quite warm and expected to remain so for my return the following day.

At Lyme Ward, where I was due, the nurse welcomed me and told me my bed wasn't ready yet, and it would be about an hour before they could take me in, so I could wait in the Day Room (actually labelled 'Waiting Area') or go on walkabout till then. After a little walkabout I plonked myself in the 'Day Room' and waited.

…and waited — that initial hour having long passed.

Eventually the consultant's registrar came in to see me, and told me some more details about the schedule and the operation. He explained that my bed in the ward was still being occupied by somebody else, so I'd have a bit longer to wait yet, but it would all be okay. His description of the prospective operation indicated a clear expectation that there would be no actual abscess to open out and pack, but simply a fistula, and very likely a relatively superficial one — though the exact situation could be established only during the operation. If it was relatively superficial like that, then it might well be workable also to 'band' any obvious remaining haemorrhoids in the same session. Something about this was put on the consent form, which I then signed.

One thing he confirmed for me was that the consultant herself (i.e., rather than some unidentified general surgeon) would be doing the operation. This was greatly reassuring, for, as already mentioned, I felt a great confidence in her, and felt sure it would all be straightforward and nothing untoward would happen with her at the helm.

I took care to keep myself reasonably 'watered' up to the 1.0 p.m. deadline, though without overdoing it — making the odd visit to a seemingly not very busy toilet across the main corridor for emptying my bladder. In previous hospitalizations I'd always had difficulties over peeing, and so was most thankful that this was a very short stay and so almost certainly I wouldn't go into full-blooded 'retention' requiring catheterization, as had happened during two previous hospitalizations some years previously. I still had the 'shy bladder syndrome' (not being able to pee when people are around or are waiting for one to pee), so, despite all my best efforts with my self-actualization methods, this was still an issue that I needed to be mindful of while in the hospital, even though it wasn't at a level that was limiting or indeed disruptive for my life generally in the way that it can be for some people.

It must have been about 5.0 p.m. when I was finally told my bed was ready and I was led into the ward — bay B, with 6 beds (all male). One of the first steps in preparation was to take off my socks and put on unpleasant special long elastic stocking things, which were supposed to reduce the risk of getting blood clots in one's legs. I had further waiting here, and my gradual crescendo of anticipatory nervousness was affecting my 'waterworks', so I presently needed to use one of the two patients' toilets on the ward. In this situation I found it more difficult to 'go', though I did manage.

The anaesthetist came and had a chat with me, to explain what would happen when I was taken out 'to Theatre' that evening. He was a really nice, positive and reassuring guy, and I felt very happy that he was to be my anaesthetist.

The waiting went on and on. I'd forgotten how much in-patient hospitalization could involve seemingly interminable waits.* The staff generally seemed to have no conception that perhaps hours on end, even for the smallest of matters, wasn't an acceptable general waiting duration for 'patients' — which no doubt had a lot to do with their being called 'patients' and not simply 'people' or 'clients'.

Eventually, when maybe the first patient on the consultant's Evening List was already being 'done', a nurse came and gave me the requisite phosphate enema. It was uncomfortable, and sent a brief searing pain through my fistula (even though it had been delivered into my anus and supposedly not into the fistula) — though thankfully that pain wasn't strong or persistent enough to be a significant issue. After a minute or two of my lying on my bed, my bowel started to make very uncomfortable contractions and, as instructed, I went to the toilet to have the inevitable empty-out. However, this wasn't the easy matter that I'd expected, because my anus was by then pretty tightly constricted, so instead of a great relieving torrent letting forth into the bowl, it all squirted out in laborious little bits and pieces as I did my best to force it out, and it thus took me quite a long time, still with a feeling that perhaps I hadn't fully emptied myself of that load. Also, that time I didn't manage to pee.

After that I couldn't pee anyway, and so had a gradually building bladder discomfort. At least I hadn't drunk anything since 1.0 p.m.; otherwise I'd have had more of a problem.

Zero hour arrives!

It must have been about 8.15 p.m. when finally my turn came up. My nervousness was increasing, even though I was in many ways still quite at peace about what was happening, and very confident about it — and I was just beginning to get a bit trembly, also my bladder feeling increasingly uncomfortable. They gave me a blue gown to wear instead of my clothes, and wheeled me on my bed to the anaesthetics room, attired in that most unprepossessing of gowns.

The friendly and quite jolly-mannered anaesthetist explained what he was going to do, and invited any questions, which I didn't have really apart from whether my rather full bladder would be a problem — which he laughingly said wouldn't be a problem at all. By that time I was shaking quite a bit, and the anaesthetist assured me that that was a perfectly normal response to this situation.

He then put a canula into a vein in the back of my left hand, for a drip and also for administering, first, some Tramadol painkiller and then the anaesthetic. I wondered what 'going under' experience I would have. Previous general anaesthetics that I'd had — all in my childhood / teens — had been gas ones, and the experience of losing consciousness, although bearable, had been an unpleasant and anxious one.

This occasion was different however. One moment I was looking up at the anaesthetist and wondering what I'd experience, and then suddenly I was lying on my bed in Recovery, knowing that it was all done, and a slight wiggle of my buttocks confirmed that there was a new, albeit slight, soreness there between them. Wow! It's done! At last!, I immediately and spontaneously exclaimed in an intense joyful excitement. And I really was feeling overjoyed. Undoubtedly I'd be out soon after breakfast.

I was also greatly surprised. Just as I'd seemingly instantly lost consciousness, I'd also had a seemingly instant switch on of my full cognitive perceptions and mental function, with no sense of a 'coming to' process. Upon that abrupt awakening I seemed to be instantly aware of who I was, where I was and approximately when it was, and was able at once to remember all my experiences right up to when my consciousness had switched off — and I seemed to have full alertness with no obvious muzzy, woosy or dopey feelings.

Most likely I could quite safely have got up and walked home right then!* This was in marked contrast with the various gas anaesthetizations that I'd had in my childhood and teens (two in hospital and two in dental surgery), when I had suffered a transient memory loss and confusion upon coming to, so that I'd even be thinking that the operation had probably not been done yet.

Night after Zero Day…

Anyway, first things first. I was soon wheeled on my bed back to the ward, the time then being about 11.15 p.m. if I remember correctly. It was then to be 'just' a matter of trying to get some sleep.

Although I was in a quite sleep-deprived state after the previous night, this didn't prove easy, for not only did I at this point have my all too familiar 'overactive mind' state that could easily lose me much of a night's sleep even if I were at home and not thinking of anything in particular, but also here there were all the various physical distractions. Although the anus pain was still only a dull aching soreness and nothing to write home about, I didn't know how much stronger it might become over this night and the next day or two. For this reason I did accept a bedtime offer of a couple of paracetamol caplets as a precaution, though I guessed that they were probably not really necessary.

The bed was pretty awful for getting a really good spine alignment, especially as the two pillows supplied were the wrong thickness for me — one of them being too low and two of them being too high, even with my making as much dent as possible in them — and that did matter because of my clapped-out spine, which needed a lot of attention to good alignment in order not to start getting various pains.

Also, there were all the disturbances of the ward — people moving in their beds, and the odd snorings and burps (some sounding as though the relevant person were about to vomit), hiccups, groans and sighs, and the constant sound of a fan. And of course I still had that dratted canula in the back of my left hand, with the drip tube attached, which obviously I had to be very careful about. Sometime in the middle of the night I sought to go for a pee. That meant having to be very careful with that drip tube, and cautiously wheel the drip bag stand with me to the toilet.

I can't really remember now, but I rather think that I did more or less manage to pee then, though it would have been difficult because of the dull pain in my anus, which was a distraction because the slightest strain to encourage pee to start or to flow caused a sympathetic contraction of the anus, with a consequent transient increase in its post-op soreness, which in turn made me feel as though I had some pressure for a bowel movement, which actually I didn't have at that stage because of my fasting for the operation and of course that phosphate enema shortly before it. — And in my everyday life I found it very difficult to pee if I felt to have pressure for a bowel movement, my system wanting to get the bowel contents eliminated first before my pee would flow.

Anyway, I wasn't really bothered by all the obstacles to getting a good night's sleep, because I wasn't really expecting much sleep this particular night anyway, and the following night I'd be back at home, where I'd be much more undisturbed and relaxed, and would be able to get catching up on the sleep. — And of course I was still feeling really joyful about the operation having apparently gone so smoothly and my soon being back at home with all that firmly behind me.

Eventually, after gradually increasing light through the windows for a seemingly interminable time, nurse activity in the ward reception area just outside this bay increased, the Reception lights were turned on, and presently a sort of toasty smell and the rattling of cups and plates on a trolley indicated that breakfast was on the way.

Now, let's bear in mind that, after an operation, people in general, if they have no particular problems about eating food at that point, need reasonably well-sized meals including a reasonably high proportion of high protein food to help promote healing of their operation wound(s). And what did breakfast here consist of? — A cup of tea or coffee, some rather overdone white or 'brown' toast (thin slices yanked from standard wrapped sliced loaves) — it was regarded as normal and thus most acceptable to take just one or two of those — with just enough butter (those tiny foil-wrapped pats of butter) to spread on them, and tiny dobs of marmalade (or, I think, some other equally non-nutritious alternative) that one had to extricate from little plastic 'bubble' containers that were extremely difficult to get into, and…

And what? — Eggs? Cheese? Meat of some kind? Fruit (I mean real fruit — marmalade doesn't count!)? Anything actually nutritious to balance up with the toast? Not on your furdlemucking nelly (i.e., the expletive of course minus the 'urdlem' bit)! In any case, plain bread would have been much healthier than toast, which, unless extremely lightly done, contains various potential carcinogens (all the more so when it's heavily toasted and indeed partly burnt like what was being served up to us here in this hospital).

Okay, many would seek to justify what was presented as 'breakfast', claiming that it was simply a 'Continental breakfast'. But that begs the question as to whether a so-called Continental breakfast itself is actually a healthy one — especially for people who are needing additional dietary support in their physical healing process. Indeed, my own clear understanding is that for general purposes that type of minimalistic breakfast is unhealthy wherever in the world it's eaten.

It simply doesn't give the body the foundation of a reasonably balanced and substantial meal to provide a nutritional foundation for the day. It's also unhealthy psychologically because it somewhat weakens one's grounding and helps cultivate a certain lack of aware respect for one's body, and that, being inharmonious, is weakening in a general sort of way for one's non-physical aspects and overall mental and emotional well-being.

Anyway, although ravenous and still feeling starved after that almost non-breakfast (bearing in mind that my last meal had been a reduced breakfast the previous day, so I was famished), I wasn't that bothered because I'd soon be home and then I'd feed myself properly.

Ready now for my discharge from hospital…

So it came that I was waiting, sitting on the chair beside my bed, all eager for the consultant proctologist's ward round so that I could hear what had been done in my anus and whether there were any remaining problems to be addressed — and of course to get the okay then for my immediate discharge, assuming that I had no further issues that necessitated my staying in any longer.

Well on in the morning, after the seemingly mandatory couple of hours' wait, around came CP the consultant herself with her registrar and another assistant of some sort, and I learnt that my fistula had been just as CP had originally thought most likely — a very superficial one with no associated abscess. Its inner opening had been just a little pinhole in the anus lining, and no part of it had involved the sphincter muscle, so all she'd done was to cut the whole fistula channel open and pack it with a little medicated gauze, which, she said, would come out at the first bowel movement and wouldn't need replacing.

So, in other words, I'd have no need after all for the expected daily visits to my doctor's practice to have a nurse repack the wound. Indeed, about future hiking, they told me that it would be good for me to get out hiking again just as soon as possible — not at all the sort of thing I'd read about this condition (i.e., post-op) in various books and web pages! Great! — And somebody would shortly come to me and arrange with me for my discharge from the hospital.

So, I had the canula removed from my hand, and I myself removed those ghastly elastic stocking things and put on my own socks once more, and sat there by my bed, waiting in joyful anticipation — well, and waiting…

I was getting increasingly fidgety, for I tried a few times to pee, and was unable to do so, and really wanted to get back home pretty quickly and make myself comfortable at last. Because of this I wasn't drinking much despite my throat feeling dry, as I didn't want to end up with my bladder so full that I went into full retention.

Past midday, a smell of stale reheated cooked potatoes and then a rattling of plates on a trolley indicated that the ward lunches had arrived. Surely there was no point in my bothering about that, for I'd be off so shortly and would be able to feed myself properly then. But my indications 'from within' were that it would be advisable to partake of the 'lunch' that was indeed offered to me. This 'lunch' affair was remarkably like one of those minimal airline 'meals', but with the difference that this was much more basic and less tasty / appetizing.

The potatoes had clearly been cooked on a previous day and subsequently reheated. Also, their weird broken-up inner texture was highly suggestive of their actually having been frozen at some time between being cooked and being finally reheated. The meal was so minimal and so lacking in decently cooked fresh vegetables that it couldn't possibly give anyone proper nutritional support for their physical healing process, let alone being healthily active (and thus further promoting the patient's healing).

Anyway, although my 'insides' felt again frustrated and let down by that travesty of a 'meal', I consoled myself with the thought that at least I'd be having a proper evening meal at home or maybe out at Herbie's, a particular favourite restaurant of mine.

 

All you have to do is go to the toilet and pee!…

Shy bladder syndrome just a figment of one's imagination — indeed!

About that time I got wind of something that gave me a flush of unease. Another patient in the ward, who was due for discharge this day, with pee bottle in hand, said something about his now going to the toilet to pee, because it was required of him that he provide proof that he'd done a full pee before he could be discharged.

Could it be that I was being kept waiting so long because such a requirement applied to me too, only the supposedly responsible person had omitted to tell me about that requirement? — I got up and asked Mark, the very busy-looking charge nurse on duty that day, to find out when somebody was going to come to me to organise my discharge. He then told me what I should have been told at the outset. That is, that I'd be discharged after — and only after — I'd had a full pee and provided the proof (i.e., a reasonably filled pee bottle). Ouch!

In dismay, I explained that that was an insane and impossible requirement to put on me because I simply couldn't pee in this hospital environment and needed to go home very soon indeed now in order to get peeing again. Nonsense! was his immediate severely abrupt response; Of course you can pee. It's a normal biological function. All you have to do is go to the toilet and pee!.

In rapidly increasing dismay, I tried to explain about this actually quite common emotional tension related issue, which has been given the medical jargon name of 'paruresis'. Severely, as though he were a schoolteacher of the worst kind telling off a malingering schoolboy, he reprimanded me, telling me that there was absolutely no problem, apart from the problem that I was creating in my mind, and still all I needed to do was go to the toilet and pee — but, he emphasized severely, as though I might tell a lie, it wouldn't be enough for me just to pee and report the fact; I'd have to show proof that I'd done so.

I protested that his putting that requirement on me just compounded the problem by putting additional pressure on me and making it still more difficult to pee — to which he countered that that was rubbish, because I had all the time I wanted to pee, so there was no pressure upon me at all. I could remain there just as long as was required for me to pee — in other words, implicitly, for ever — as though I hadn't got better things to be doing with my life!

Really bewildered at this turn of events, I returned to my bedside chair, feeling like tearing my remaining hair out, not knowing what the eff I was to do about this.

Shortly, along came a youngish woman nurse to check my blood pressure. How are you feeling now?, she started. In response I voiced the thought that had just come to me: Well, actually I'm right now thinking of discharging myself!. I spontaneously repeated that a couple of times in a clearly stressed state, and she ran off to Mark, who then in an intimidatingly abrupt manner called me into an office for him to speak with me. In an abrupt and severe tone, again as though I was an errant youngster, he told me that I'd just upset one of my staff through talking to her in a disrespectful and demeaning manner*, and he wasn't going to have all my difficult behaviour on the ward. Peeing was a normal biological function and all I needed to do was go to the toilet and pee; there was no problem apart from the one I was creating now in my own mind.

About my desire to self-discharge, unfortunately I hadn't done my homework over this, because it had never occurred to me that I'd ever have cause to do such a thing, so I felt to be on weak ground here — which of course Mark exploited. Again very severely and with particular menace, he told me to think very carefully before choosing to discharge myself. If you do that, you'd be completely on your own, and there would be NO WAY that we'd help you with any problems that arose then!. He said this in not just a severe manner but with a quite ferociously menacing 'energy', clearly aimed at completely browbeating me into submission — an extremely unprofessional way to behave, even if what he was saying had been true.

Because I was unsure of my ground there, for the time being I felt obliged to accept that what he'd said to me might be true, and to hold off just for the moment from going ahead with the self-discharge idea. If it would really be too much of a problem for me if I did self-discharge, then clearly there had to be another way.

For this reason, this time I was still more insistent that he was demanding the impossible of me, and something would have to 'give' here, because there was no way I could remain here indefinitely just because I couldn't pee in the hospital and with this particular requirement upon me. In desperation I suggested that perhaps if I had a catheter briefly inserted just to empty my bladder, then with a more or less empty bladder I might be able to pee again.

Visibly really stressed himself, he did grudgingly agree to that, and, after a short wait, carried out that procedure. However, after that bladder emptying and my drinking some more water till my bladder started asking for emptying, I still couldn't pee, and so, very reluctantly, I sought him out again, and also spoke to the ward doctor about this. The ward doctor was actually a really nice man, albeit very busy and still working within the system, with its lunatic requirements upon patients. Although not in any severe terms, he did emphasize that I really did have to pee and provide proof of it before I could be discharged, and that there was no way round that. Not a very good advertisement for his credentials as a doctor!

Mark very grudgingly suggested, as supposed proof that there was no pressure upon me, that as a special concession I could go out of the ward to the toilets by the Oasis restaurant just down the main corridor, where it would be less busy, and spend half an hour or so there to do my pee. So, not being clear what else I could do, I traipsed down there with pee bottle, my bladder by then being uncomfortably full again.

In the event, feeling in a state of considerable stress, I did eventually manage to force a few dribbles out with a nasty burning feeling where my prostate was presumably constricting the urethra* — but I knew it wouldn't be enough to satisfy the requirement. Eventually I returned and told Mark that it looked as though my prostate was now stopping me, and that I was now effectively in full retention and would have to be catheterized again — this time with a 'permanent' catheter, maybe until my prostate had been 'done'.

So, Mark then agreed that he would shortly do that catheterization, and that then this particular department would be passing responsibility for my discharge to the urologists, so a group of urologists would come to see me, hopefully today or definitely tomorrow, and arrange for a urologist appointment to be made for me in the next week or so, and in the meantime would then discharge me according to their own expert discretion. No mention here of my own expert discretion (I being, after all, the #1 expert on myself and my own needs!), nor of my own basic free will!

Bloody hell — another overnight stay on the cards! I was shocked at any such prospect. Anyway, hopefully the urologists would soon come and this would all be sorted out. However, in the meantime I waited and waited, getting more and more fidgety as the pain of my bladder fullness increasingly grabbed my attention, coming to completely eclipse my anus soreness, which was now at its maximum, though in itself no great trouble.

I kept hanging around the reception area, seeking to catch the attention of Mark and indeed the ward doctor, because I was getting to feel desperate to get my bladder emptied by the agreed second catheterization. I could sense that both these individuals were getting very much on edge as a result of my coming wandering around in Reception like that, and Mark looked suspiciously to be deliberately avoiding me (by looking particularly preoccupied and busy), maybe even deliberately in order to give me a hard time with my bladder.

Eventually I called out to Mark that I was in considerable pain and something had got to be done quickly, and then he said, okay, he would come very shortly — and so I was kept waiting about another five minutes before he finally came and carried out the catheterization. About 1.5 litres went into the pee bag at that point.

As for the pee bag, this was a multi-day night bag with a very long tube and a tap at the bottom. It was fitted with a plastic handle so that one could carry it about in one's hand or hang it on any conveniently placed rail while sitting or lying, but what it didn't have was any means to attach it, say, to a leg, so before I was discharged this would have to be changed for a proper leg (day) bag, also with a supply of day and night bags issued to me.

Sometime later on, Mark came round the bay, giving each patient an injection into a thigh, with something to thin the blood to help avoid blood clots. I noted when he came round to me, how abrupt and demeaning was his verbal manner and body language — as though I were not a real human at all but just a head of 'cattle' being processed by a busy farmer.

I continued my wait, doing my best to be patient (sic), and so it came that I had the unenviable purgatory of enduring another hospital meal. I shan't bother to repeat what I've said about the lunch; exactly the same comments were applicable to this evening meal — an abomination — a National Health disgrace — well, apart from a baked potato, which, apart from being rather small, was at least 'real', and healthy as far as it went, and indeed I actually enjoy baked potatoes!

Really, I'd have much preferred to skip such meals in the ward and visit the Oasis restaurant just down the main corridor to have proper meals. Okay, I'd have had to pay for those, but the meals there are remarkably inexpensive and so really the cost wouldn't have been an issue. The only trouble was that that confounded pee bag was rendering me somewhat captive (almost like a ball and chain), for it wasn't designed for mobility.

Whenever I walked around I had to unhitch the bag from wherever I had got it hanging on its large plastic hooks and then carry it around in my hand using its crude and uncomfortable carrying handle. If I put it, say, in my shoulder-bag for while I was walking around, it would be too high, so that it would tend to empty back into my bladder — clearly a happening to avoid. Thus, as long as I had that pee bag rather than a proper leg bag it was really not practical to go to the Oasis as I'd really have liked to.

…And, sure enough, those urologists never came, and so I was stuck with another night in this hell-hole*, with little and greatly disturbed sleep, and an increasingly aching neck and back because the pillows were really unsuitable, and also the mattress wasn't firm enough to support any sort of good spinal alignment. Also I now had the pain of the catheter in my urethra — especially within my penis. As this was a second catheterization in one afternoon, there was now a fair bit of tissue trauma (aka injury) in there, and the slightest pull of the catheter in one direction or another tended to hurt quite a bit.

Tomorrow, and tomorrow, and… –∞ ?

With my sleep deprivation and my whole body's sense of its own malnutrition increasing, gradually Wednesday dawned upon the ward. At least I was thankful to have that really stressful Tuesday behind me, and presumably I'd soon be seen by those urologists at least today. Indeed, when CP and her entourage came on their morning ward round, her registrar assured me that there was nothing to worry about and I'd see the urologists today and get this all sorted out. But when he repeated that reassurance in the late afternoon ward round, its chronology had got amended to presumably today, with or at least definitely tomorrow appended.

WHAT? — By now I was seeing a clear pattern emerging in all this. These people actually had no idea at all of when or even if those confounded urologists were ever going to come, nor indeed whether anything really helpful would come of it if they did, and were just saying those things to keep me strung along, waiting and waiting, instead of anything actually happening, or — worst of all! — my actually carrying out the implicit 'threat' that I'd made on Tuesday, which 'threat' had elicited such a severe and unprofessional response from Mark.

When I was repeating my case to the ward round group, and indeed anyone else now, I emphasized additionally the already mentioned fact that I'd come to the hospital without any change of clothing, including underwear, because I'd been expecting to be out on Tuesday. I particularly emphasized this because it was clear that nobody at all was thinking of my basic human dignity and desire to keep myself clean and wholesome — and I had nobody to visit me and bring further supplies of anything.

Yes, there was a shower on the ward, but after a shower I'd have to put on the same increasingly smelly clothes, for which also there appeared to be no washing / drying facility. For this reason particularly I took a lot of care to ensure that the paper towels in my underpants were in place and changed reasonably frequently.

The additional padding that I had in my underpants to avoid soiling from any discharge coming out of my catheterized willie had done its job handsomely this day, for when I eventually looked at that pad I saw to my amazement what looked like a whole mass of 'green Gilbert' snorted out from a sumptuous sinus infection — and, to the best of my knowledge I had not ejaculated — not that my ejaculate had ever looked like that before! So evidently yesterday's catheterizations had caused a very considerable urethra infection.*

However, the good sign was that all that purulent stuff so soon after the catheterizations meant that my body was clearing that infection very actively, and so this would actually be nothing to get greatly concerned about, at least at this stage.

I did actually mention that infection at some stage, I think at one of the ward rounds, and probably to the odd nurse who came to check on my state — but it was brushed aside as just a normal happening when one has a catheter, and no cause for action unless it continues developing over some further days or I got other possibly related symptoms such as feeling generally unwell or, particularly, feverish, or if the pee delivering into my pee bag started coming out cloudy. Actually I already understood that such infections were pretty normal, and I'd had one in a catheterization in 2004, so I wasn't really expecting any action over the current infection, and definitely wanted to avoid taking antibiotic unless it was really necessary.

At least, one thing that made Wednesday less stressful for me was that Mark was nowhere to be seen. However, the tedium of waiting and waiting for hour after hour* and having it very gradually dawning that one is very likely to be staying there yet another night, and that this could go on theoretically Tomorrow, and tomorrow, and… even for the rest of one's life, was something more awful than I could ever describe. It was really like being trapped in an astral realm that was an astral replica of something out of Franz Kafka's novel The Castle.

Interestingly, Chris, a really nice and aware patient on the other side of this bay, spontaneously remarked on that very resemblance between my situation and the mind-numbing and cheerless scenario of labyrinthine dehumanized bureaucracy depicted in Kafka's The Castle. He also remarked, with a great generosity of heart, that he really felt for me because, he thought, my situation was much more stressful than his, because at least he knew he was ill and needed to be there at that time. I was really touched by his generosity in saying that, because he himself appeared to be having quite a rough time, being in the early stages of recovery from an operation to remove a cancerous part of his intestine. I certainly wouldn't have wanted to be in his shoes with all that!

One amazing plus point that did raise my spirits a bit was that I was now starting to get bowel movements again, following my having resumed eating yesterday (albeit minimally). Inevitably, in view of the small meals, these bowel movements were small, but what was so amazing to me was that they were NOT painful! In the past when I'd had anal fissures bowel movements and the few minutes following them had been the most exquisite torture, feeling as though I had shitted a razor blade and had another merrily sitting in my anus, cutting slits in it to continue the torture. Yet here I had this gaping surgical wound in my anus, and each bowel movement was failing to cause me more than just slight peaks in the general soreness 'down there' corresponding with any contractions of the anus, but nothing that I'd really call pain, let alone troublesome pain. Wow!

Well, those confounded urologists never turned up. And of course that also meant that this was another day of significant malnutrition as I sought to endure the abominations that were presented as hospital meals. At least, at breakfast I stepped out of line and asked if I could have four whole-round slices of (brown) toast — even though it was decidedly overdone and indeed partly burnt, and thus distinctly unhealthy! This was freely given, though the meals woman was certainly surprised, apparently regarding this as decidedly odd, and I got the impression that she couldn't have supplied a double amount like that to many more people.

I'd also noticed that on the menu choice forms that we had to fill in for the next day, there was a box you could circle to get LARGE portions — Alleluia! — Well, except that when I got the meals with the supposedly larger portions, I really couldn't recognise them as being any larger at all! Just perhaps the roast pork would have been just one wafer-thin slice in a standard portion instead of the two such slices that I got, but otherwise, as they say, Plus ça change!.

…And of course my clothes were just a bit more smelly than the day before…

That evening, the patient Chris was having a particularly rough time, which made me feel a bit more stressed, and then a new patient, R, was wheeled in, who looked as though he too had had some bit of his intestine removed, and he was put next to me. Very late evening, and R had a massive dark green vomit all over himself, and two nurses were attending to him for much of the night, making it a very disturbing night for me, with still less sleep than the previous night. This was also not helped by the urethritis and the catheter chafing in my penis becoming increasingly painful.

Dawn seemed to take forever to lead on to breakfast time. It was now Thursday, with my clothes one further increment more smelly, and I seemed to be still no further forward, and now I no longer had any particular confidence that the situation would resolve, at least in the way that was being promised. That dratted* ward round of CP the consultant proctologist and her entourage came round in due course, but this time they were accompanied by a woman who I hadn't seen before.

There was something about her that seemed to identify her as 'nurse', but she wasn't wearing the standard blue uniform of standard nurses — actually wearing a black top and having about her an air of some sort of authority, while still having a warm and very pleasant manner. When the group came round to me, I remarked pointedly that this was now my third day of needless bed blocking here all because of a needless bureaucratic stipulation about my having to pee in the hospital, which I couldn't do because of a non-medical reason.

I described it as a Kafkaesque situation, and that woman immediately gave the knowing sort of nod that indicated she understood what I was talking about and what I meant by 'Kafkaesque'. She said at once in a sympathetic tone something like Oh dear, well I'll see what I can do about this.

Also, CP's registrar assured me that a urologist would pretty definitely see me today and get this matter resolved — but then he added something to the effect that presumably even after the catheter had been removed, the urologist would still require me to pee in the hospital before he would allow my discharge.

WHAT? — What the eff? — Could that really be — that I'd waited here all that time, and when finally seen by a urologist, who was supposed to resolve this matter for me pretty well there and then, I'd still be required to pee in the hospital before I could be discharged? — Plus ça change indeed!! What the effing hell was I supposed to do? Really to wait to be returned to square one? — And then what??

Actually that didn't make sense anyway, because it was looking as though I'd have to keep the catheter in place till such time as my prostate was 'done', so in reality the issue wouldn't be about my peeing in the hospital but about getting me some more appropriate pee bags for use at home, because I couldn't really go home with that night bag still attached. However, the prospect of that seemed pretty daunting in the light of the increasing painfulness of having that catheter in place at all.

Inwardly I was now restlessly and increasingly insistently telling myself within, that something had simply got to 'give' here, for this scenario clearly had the potential to go on indefinitely — theoretically even for the rest of my life! Absolutely, mind-numbingly, crazy! Well, maybe that 'woman in black' might be the answer. But the only thing was, had she really been meaning anything by those words, I'll see what I can do about this? And what authority did she have, anyway?

One sign that perhaps something really was beginning to 'move' was that a nurse or doctor came to me to take a blood sample from me for a PSA (prostate specific antigen) test to be carried out. The level of PSA in one's blood is supposed to be a fair indicator of the likelihood of one's having prostate cancer. However, this didn't raise my morale that much, because very likely the result of the test would be issued in a few days' time, and I suspected that the urologists who were supposed to be seeing me wouldn't bother to come to me till they had that result. Yes, this could actually lead to my being kept in at least tomorrow (Friday) too — AND then there was the weekend, and most likely no urologist would come to see me then anyway… Oh, kcuf! (i.e., backwards!)

Time dragged on and on, and presently — horror of horrors! — once again came the stomach-quivering 'aroma' of stale reheated potatoes and the sound of rattling plates on a trolley — surely enough to start instilling a Pavlovian 'preparation for vomit' response…

My heart was sinking with a feeling of inevitability about this. I was getting increasingly sure that no urologist was going to come to me today (and neither indeed was I now at all convinced that it would be any useful solution even if one did come) — and this looked more and more likely as the afternoon went on. However, at one point that black-topped woman came into this bay to speak with somebody, and in the course of what I overheard I learnt that she was the ward matron.

Matron! Wow, of course! I'd heard about all this 'matron' stuff a few years ago. Gone were the tyrannical hospital matrons who ruled with a rod of iron and who nobody would even dare say 'boo!' to. The modern concept of the hospital matron was quite different — a friendly conciliator who'd always be really approachable and available to sort out problems, giving the hospital a more human face. Right, now — let's have a word with the matron, then!

I thus explained to her more fully about the abomination of my being held there bed-blocking completely unnecessarily for (by then) three whole days, and without a change of clothes since I'd come to the hospital on Monday morning, and said that something now simply had to 'give', for this couldn't go on any longer, and I was now thinking of discharging myself. Yes, I had at last returned to saying, like Oliver Twist in Charles Dickens' novel of that name when he asked for more, the taboo thing that the whole system was evidently seeking to steer patients away from even though that would often (though of course not always) be their best option.

Her face darkened and she shook her head at my uttering that unthinkable taboo desire, darkly declaring I really can't recommend that you take that action. — To which I responded, Well, what else is there for me to do? Something's got to 'give' on this, because this crazy situation simply can't be allowed go on any longer — just look at that bed, already unnecessarily blocked from needy patients for three days!.

In contrast with Mark, the matron then lightened her tone and said, not to worry, and to hang on just for the moment, for she'd see right now what could be done about this. She also remarked that she'd not been here to do anything about this before because she'd been away the last two days.

After a little wait, the ward doctor came over to me and told me they'd made inquiries and found that the urologists were very busy operating, but one of them would come to me as soon as they'd finished. He couldn't tell me exactly what time that would be, but it should be a bit after 5.0 p.m.

Oh bloody hell! This sounded to me more like They said they've got more important things to do than see you, period! Anyway, increasingly fidgetily, I waited an extra hour, and as it came up to 5.30 p.m. I went over to Reception and caught the matron's attention, pointing out that still no urologist had turned up. To my welcome surprise, she didn't put up any obstacles at all, but at once said in a perfectly friendly and welcoming manner, Well, I assume that you want to discharge yourself now. Well, if you're going to do that, I'll have to remove that catheter first, because we can't let you out like that…

Actually that had been an issue that had been making me feel a bit trapped, because after Tuesday afternoon's stressful experience when trying to pee after the first, temporary, catheterization I wasn't at all confident that I'd be able to pee now without the catheter, even at home. But on the other hand, if that did turn out to be an issue, all I'd need to do if I went into retention again would be to go to Accident & Emergency or the NHS Walk-in Centre, and I'd be taken care of as appropriate. So actually it looked to be worth taking a chance on this.*

What was really nice this time was that the matron recognised that there would really be no problem in my going home at this stage, because I could then easily get whatever assistance was required in the event of a problem, and she was most reassuring and encouraging about my self-discharge intent. Clearly her initial rather disapproving signals about the idea of self discharge were not really reflecting her own personal attitude at all but reflected the 'front' that she was supposed to be putting on in support of the hospital's bureaucracy and its stipulations, even though she presumably didn't agree with them all.

Perhaps in any case by this time she'd gained more confidence in my own self-command and ability to look after myself. So, with no snottiness at all, nor any sense that I was doing anything wrong, she removed the catheter (Ouch!) and got me to sign the official self discharge disclaimer, which read something like:

I hereby am discharging myself from this hospital.

I understand that I'm doing this against medical advice.

Signed…

Because I was in a hurry to get out I just signed it without comment, but actually the second sentence was incorrect, and if I'd been in less of a hurry I'd have crossed that line out and substituted:

I understand that I'm doing this against the politically based advice of medical staff.

Or actually a still better one would be:

I understand that I'm doing this on the basis of the best medical advice available to me — my own.

That's indeed what I'd expect to write on the disclaimer* on any future occasion that I may self-discharge in response to any attempt to delay my discharge for any reason other than genuine medical reasons that I recognise as soundly based. The point here is that (a) medical advice itself can be wrong, and so should not be slavishly and unquestioningly followed, and (b) on this occasion the advice was NOT medical at all but was just an attempt to make me jump through a particular hoop to satisfy a bureaucratic stipulation, which was all tied up with hopelessly distorted notions of who was really responsible for a person's well-being.

I was actually self-discharging on the basis of extremely sound medical advice — from me myself! I myself am the one who is responsible overall for my well-being. Doctors and other medical staff are there to give assistance within their particular areas of expertise as delegated by me, but I myself am the one who's ultimately responsible for myself, and no medical worker nor organisation has any business to try to take over that responsibility.

Anyway, I'd signed the disclaimer, and the matron repeated her friendly reassurances that they would all still be there to help me in any way they could if needed at any time (what a difference from what the charge nurse Mark had told me!), and wished me well for a speedy recovery. When I said I was now going to order a taxi to get me home (it was raining; otherwise I'd have walked, and indeed would have really enjoyed doing so), she immediately offered to order one for me — which she did, bless her! Even that small friendly and helpful touch was greatly assisting the beginning of the unravelling and dissolution of the stress of this experience.

It was at about that point that a really well intentioned and unsuspecting nurse brought my evening meal. Thank you so much, I said, But I'm just discharging myself and am just picking up my bag to go now — thanks all the same!

You mean, you don't want the meal after all? — You could eat it before you go, she responded, looking me in the face first with some degree of astonishment and then with what looked like quite a bit of disappointment. Actually she made quite a sensible suggestion at that point — that even though I wasn't going to eat the meal, at least I could take the (minuscule) little pot of orange juice on that tray — at least that was something tolerably healthy as far as it went! Of course I wasn't going to hang on there to eat what was on that tray (apart from straight-away drinking the half gulp of that little pot of orange juice), for I couldn't wait to get out to a restaurant round the corner from my flat, to have a proper meal at last!

I had quite a wait in the rather cold and breezy main entrance vestibule while the rain sloshed across outside in the strong wind, I still being in just my shorts and nicely smelly T-shirt (also with whiffs of overripe underpants and in particular the delectable aroma from the discharge from my fistula wound), so I was getting cold by the time the taxi came — with the result that my bladder was filling.

During that short ride back to my flat I was somewhat shaking as the stress was beginning to unwind in earnest, and my bowel was 'getting active', so that immediately upon my return I had to go the to toilet for a good old-fashioned crap. Of all things, not only did I have my best 'Number Two' since the operation, but also I got an immediate and spontaneous flow of pee (albeit painful and with an 'obstructed' feel because of the urethra injury and infection)! Overjoyed, I immediately telephoned Lyme Ward and left a message for the matron to tell her that indeed I'd just had a good pee, so all really was okay!

Aftermath of the operation

The opened-up fistula was continuing to ooze a rather revolting peculiar smelling sort of reddish-brownish part-blood, part-goo stuff (neither pus nor faeces). Late afternoon on the day after my self discharge from hospital, during a search in a large branch of Boots the Chemist for feminine hygiene products at last I found my answer to what to do about that. Up to that point, since my return home I'd been using pads of kitchen tissue instead of the rough hospital paper towels, but these tended to move out of place when I walked about, and I couldn't sensibly go out on significant walks until I got this issue fixed.

My solution in the end was a particularly minimal version of a women's pantyliner with a self adhesive back — Tena Lady Ultra Mini with Aloe vera impregnation. These were particularly inexpensive. I guessed that these would continue to be needed until a very late stage in the healing of the wound. Now, why on earth didn't I receive any specific advice to use such eminently suitable pads from anyone at the hospital? Indeed, why wasn't the hospital supplying patients who'd had this particular sort of surgery with such pads during their stay in hospital and giving them a few to take home with them? — Absolutely crazy!

Over the first few days after the operation my anus soreness had decreased to a sort of steady very low level — really not an issue at all, though it was never all that much of an issue, having been strongest on the Tuesday after the operation, for then there'd been the pain from the forceful dilation of the anus, which would have had to have been done in order to carry out the operation. The actual operation wound apparently was intrinsically hardly worthy of the word 'painful', even on the day after the operation, when it was at its most sore!

Amazing after all my expectations! And, apart from a precautionary acceptance of the two paracetamol caplets on Monday night immediately following the operation, I'd consistently refused all offers of painkillers, with no sense of stoicism about that at all. I shan't be afraid at all of such operations in the future, should any indeed turn out to be necessary.

However, I got considerable pain* in my urethra and penis at times over the next several days after my return home, thanks to the catheterization while I was being wrongly kept in the hospital, though there was a steady decrease day by day, and infection discharge ceased after two days, so presumably then the infection was more or less cleared, but the tissue injuries caused by the catheters and indeed by the infection still had some healing to do, and thus the continuing painfulness at times, also causing my urine consistently to issue at an angle of about 40 degrees to the left, whereas previously that nuisance had happened only erratically.

Nonetheless, I was back to active walking, on the Saturday doing the 8-mile walk on flat terrain beside the River Exe and Exeter Ship Canal to Starcross, and, after that, resuming my regular 7-mile after-lunch walks down that way to the M5 motorway and back, with the intent to get on another of my full-length hikes on strenuous Cornish coast path again just as soon as the weather presented a suitable day.

In the event, that first suitable day was Sunday 25th July, when I hitch-hiked to Mousehole, walking the very hard-going 14+ miles to Land's End, then hitch-hiking back within the day. Amazingly, on that whole outing my anus didn't draw attention to itself at all — no matter whether I was walking, scrambling, or sitting on rocks, soft grass or indeed car seats during the hitch-hikes. Then, on a walk on 31st July, during a pee break (standing), for the first time since my getting out of the hospital my pee was issuing pretty well straight ahead and feeling almost unobstructed.

Also, a bit over a month after the operation, after a week of no obvious wound 'weepage' I discontinued using the pantyliner things, so evidently the healing had been going remarkably smoothly, apart from the little glitch mentioned below — though I doubt whether that was actually the official surgical wound, as I explain…

Just sent to scare my pants off…

Just over two weeks after the operation, in the middle of one night I got up for a pee (for which I always have to be sitting on the WC because my urine can tend to go out at an angle and end up on the floor otherwise), an alarming sudden completely painless heavy bleed from my anus commenced as I got up from my little sit on the bog. This was mystifying, for it was a rapid dripping of blood from an apparently fully closed anus, and without my having passed faeces nor attempted to do so, nor indeed having significantly strained at all.

The flow steadily reduced, and I applied pressure with pads of kitchen tissue to promote cessation of the bleeding. I eventually went to bed again with my underpants on (quite stretchy briefs) holding in place a kitchen tissue pad to absorb any further slight bleeding. The blood appeared to have the bright red colour that one would associate with haemorrhoids bleeding.

During the following day, really surprisingly, I got no obvious anal bleeding at all, even associated with my two bowel movements that day. I saw a doctor at my regular GP practice, and he said he could see two haemorrhoids, but they both looked normal and undisturbed, which he thought wouldn't have been the case if either of them had been bleeding — so he thought the bleeding must have come from the fistula wound (which, he said, appeared to be healing well).

However, I'm sure that even if something had pulled the fistula wound a bit more open again, it wouldn't have bled in that very profuse way, which was much more suggestive of haemorrhoids or at least some relatively major blood vessel getting ruptured.

Then again during the following night, when I sat on the WC for a pee a bit of blood dripped from my anus, though not nearly as much as the previous night. This didn't repeat on subsequent nights, however, but then instead I was aware of a slight discharge from my anus of small quantities of a slightly yellowish mucus, which seemed to be additional to the greatly dwindling 'weepings' from the fistula wound. This suggested to me some other damage in the more outer part of the anal canal, which was in the process of healing. Perhaps it had something to do with the inevitable anus trauma caused by the instrument that would have been used to dilate the anus for the operation.

Such a minor injury might possibly have got disturbed by a solo sex session that I'd had an hour or so before the initial heavy bleed. For that I wasn't messing around with my anus (Honestly! ), but possibly certain muscular contractions might have disturbed something. I wouldn't have got into sexual activity at that stage in the physical healing process, but my inner inquiry had indicated that it was advisable to have such a session once per three days briefly then to use the flushing effect of the ejaculations as a protection against any infection getting into my prostate after the urethritis. However, I didn't do that the following night, so I'm not aware of anything to have prompted that second bleed at that particular time.

A colorectal doctor at the hospital told me on the phone that he thought the bleeding was a symptom of my having diverticular disease, but, while I could conceivably have the latter condition to some extent, the fact of profuse bleeding while my anal canal was closed indicates that the blood couldn't have come from anywhere internal to the anal sphincter, and so it had to have some other, more superficial cause, and its timing indicated a very high likelihood indeed that it was in some way connected with the recent surgery, even though it was presumably not from the 'official' surgical wound itself. This is also underlined by the lack of any further bleeding during the following months.

Later on, through further retrospective inner inquiry about those bleeds, I've come to a tentative explanation for them, as follows:

The actual injury involved was neither the official surgical wound nor a rupture of one of the haemorrhoids themselves, but instead it was somewhere on the wall of the haemorrhoidal artery system (i.e., the blood vessels in the anal canal that are inclined to balloon out to produce what people recognise as haemorrhoids). As I had originally surmised, this injury had been a very normal little bit of 'collateral damage' caused by the anus dilation instrument that stretches the anus unnaturally wide-open to make the operation physically possible to carry out.

This injury had been something of a slight 'crush' injury, not a tear or rupture, and so didn't give rise to bleeding following the operation (and indeed most likely not during it either). However, there was one aspect of its healing process that made a very small area on that injured part of the artery wall become very friable as the damaged tissue was being progressively cleared out by the healing process.

The body is adapted to handling such healing situations in ways to avoid ruptures and life threatening bleeds, and what it was doing in this case was actually to hold back on particular aspects of the healing process during that critical phase while I was up and about, and to allow it to proceed only while I was in bed and more or less in 'sleep' mode, whether or not I was fully asleep. That would minimize the risk of a rupture and bleed during the 'clearance' part of the healing process.

My inner inquiry indicates that it's unlikely that the solo sex session had anything to do with the bleed, because I hadn't settled down to sleep at that stage, and so my body would have still been waiting to get to work on the tricky little bit of the healing process. The problem was simply my getting up later on for a pee break after my body had got to work on that process, it not being programmed to allow for unscheduled pee breaks!

So, the little healing patch on the haemorrhoidal artery wall had then become extremely weak, and just the pressure of the blood in that artery with me being upright and then sitting on the WC, with my slight 'straining' contractions to assist the start and particularly last bits of the pee flow, was enough to cause a tiny rupture to occur in the haemorrhoidal artery — and hence the big bleed.

The following night the same thing happened, but with the difference that the really critical bit of the healing process had then already occurred, so that a much smaller area of the artery wall was then disposed to break, and thus the bleed was less and it stopped more readily.

After that, the most critical part of that healing was complete, and the rest of the healing would have been more to do with filling in with new and healthy tissue rather than removing damaged tissue.

Some 'post-operative' comments

Actual harm that I sustained…

I should point out that I was significantly HARMED by being kept in for that extra time. Quite apart from three days being needlessly taken out of my useful life, stuck in that ward and thus denying others a bed, the main areas of harm were

• My not having an even half decent diet, nor even just sufficient quantity of food, so that I was actually both undernourished and malnourished during that time, thus hampering the healing of my operation wound. (I have the sort of metabolism that burns food up fast, so I do need larger quantities of food — especially carbohydrates — than the average person).

• The great degree of sleep deprivation through being on the ward with all its disturbances — which caused me physiological stress, hampering my immune system and making me considerably more emotionally stressable. That too was hampering my physical healing.

• I was caused accumulating emotional stress during those three days, despite my ability to very efficiently dissolve emotional stresses generally. I wasn't able to do very much to release all that stress without actually getting out of the situation that was causing it. That too was hampering my physical healing.

• I got really quite significant urethra trauma / injury from having not just one but two consecutive catheterizations on one day, and that led to a quite significant urethra infection, which caused me quite a lot of pain — not only with the catheter in, but also during the few days afterwards, while my body was then able to get healing all that.

  I was transiently on the verge of seeking medical assistance over that, but my own inner inquiry method that I call Helpfulness Testing indicated correctly that there was really no point in doing so because the infection was already on its way out fast, and the physical healing that still had to follow couldn't really be helped by any sort of medical intervention and so needed to be allowed to run its natural course, supported by a really good diet and plenty of healthy activity.

• Another sign of a quite serious weakening of my whole system caused by that situation was that on my first night at home I had a quite significant and potentially extremely frightening and harmful attack from the garbage. That was the first attack of that sort of strength that I'd had that year, and was enabled to occur because the garbage at that point was able to exploit the weakenings and ungrounding that had occurred for me during those three days of pointless bed blocking in the hospital.
  

  Fortunately I understood what was going on, and nowadays I have an excellent set of methods to use when I get such an attack at night, so, after taking particular measures I was apparently completely clear of that extremely menacing attack within an hour.

  N.B. I got no subsequent repeat attack, because once morning came I got back into my routine of my self-healing and self-actualization practices, and they, as well as my getting on with everyday life once more, were speedily restoring the grounding of my awareness and also restoring the strength of those aspects of my whole system (physical and non-physical) that had got weakened during my hospitalization.

That charge nurse

About that charge nurse Mark, he was clearly showing a very strong authoritarian pattern and some pretty extreme unawareness and insensitivity towards me as a patient, and it's hardly conceivable that all his abominable behaviour was just an unfortunate 'one off' affecting me only. In my view that man is a menace and would do much harm to the hospital's reputation through his abrupt, authoritarian and often demeaning manner and his lack of any concept of patients having real emotional and stress / tension issues that can get in the way of their being able to physically function in ways that are convenient to the hospital 'system'. You're just making up a problem in your mind is something that should NEVER be heard from any healthcare worker in this day and age.

Indeed, I'd say that no hospital medical / nursing staff who don't understand something about things like shy bladder syndrome can be fully effective in being supportive to patients, and they need some additional training. In the case of Mark, I'd say that he needs to be taken off the sort of work that he was doing when I was there, and given training in displaying a proper human, friendly and supportive attitude to patients, and to cut out his horribly abrupt manner, and NEVER to go putting upon patients or indeed any of his colleagues an I'm right and you're wrong trip as he repeatedly did with me.

He is particularly responsible for the ordeal that I went through, because he sought to intimidate me, not only by his manner but also by giving false information about what would happen if I self-discharged, and indeed by making a false and quite irrelevant accusation against me. If he'd been behaving properly and appropriately for his position, he would have at once either secured my immediate discharge or recommended that I actually do a self-discharge, making it clear that I was welcome to self-discharge if I was sure that that was really what I thought was best for me, and that they would still do all they reasonably could to assist if any problems arose.

I would right then have signed my disclaimer and I'd have been back at home sometime early that Tuesday afternoon, with no material harm done and only a few hours — not whole days — of my life wasted in faffing around at the hospital.

Whose responsibility is it anyway?

Not only the particular pee-before-discharge requirement, but indeed the very concept of a patient needing to or having to be discharged by the hospital rather than discharging himself, reflects a faulty understanding of people's responsibilities. Who is responsible overall for your well-being? — Doctors? Hospitals? — NO, YOU are! YOU yourself are, and nobody else!

Yes, as part of that you would need to use your good sense to delegate certain advisory tasks and 'medical jobs' to particular individuals who are, hopefully, experts in their respective fields, but none of them has any business to take over your ultimate responsibility for your own well-being, both physical and non-physical.

Unfortunately, probably as long as there have been doctors of any kind, personal status and power / control issues have tended to play themselves out in the relationship between doctor and client / 'patient', so that the doctor at least implicitly takes over some of the client's own personal responsibility, and helps cultivate a relatively disempowered mindset in the client, so as to reinforce the doctor's own sense of a certain superiority of his own personal and social status. As healthcare became institutionalized, so did the power / control agendas, and this is the situation we see today.

So, when we go into hospital it's tacitly assumed, at least by the system, that the hospital has taken over our own personal responsibility for our own well-being and indeed self determination, and seeks to have control over us to assert the sense of 'authority' and personal superiority of the doctors and other healthcare workers — this also being translated into a sort of 'programming' of the institutional mindset. It's 'justified' on the basis of various arguments about a doctor's or hospital's 'responsibility' towards the patient, but those arguments all obfuscate the issue of the patient's basic and intrinsic responsibility for himself and his own health.

Thus it's generally 'understood' that it's the hospital's job to discharge a patient, because the hospital has been posing as having taken over the patient's responsibility for understanding when he needs to go home.

The correct approach to patients leaving hospital would be to make it standard practice (albeit not mandatory) that a patient discharges himself. That would be so much more self-empowering and supportive of the healing process. Of course the patient would be given medical and practical advice that enables him to make a soundly based choice to discharge himself at a particular time, but nonetheless, it would be up to the patient's own good sense and self determination actually to make that choice.

There would need to be a provision, of course, to protect the hospital against people who sought to stay on without good reason; it would then make sense for the hospital to simply compulsorily discharge such patients. In an ideal world that wouldn't be necessary, but in the actual present day situation, some individuals are bound to seek to be unreasonable, and they would have to be dealt with summarily, before they could significantly block precious beds needed by other patients.

Some positive suggestions

For the ward staff and hospital Admin

• Adjust the whole working mindset to be thinking of the people who come in for treatment or advice as being clients or customers — NOT 'patients'. That would encourage a more aware and respectful outlook upon these people, and would be an excellent foundation for the necessary changes in how they're to be regarded and treated. At the moment, to a fair extent, 'patient' tends in practical terms to mean 'cattle' (though I'm all for better treatment of cattle too!).

• Have it clearly written into hospital staff guidelines and training, that the clients / customers are basically responsible for themselves and their own well-being, so that all staff understand that it isn't their business to seek to take over that responsibility, except in the specific area of the procedures for which the particular clients have come in (i.e., very temporarily delegating certain tasks and decisions to an expert in that particular field).

• As long as there exists a hospital bureaucracy that puts basically non-medical requirements upon clients, any such requirements should be applied in a sensible, flexible and considerate way. For example, even if it's deemed important to know that all clients can pee fully before they are discharged, what's the point of rigidly applying that requirement to somebody who simply cannot pee in the hospital environment? You make public fools of yourselves by doing that. In such a case, don't delay the person's return home, but, if necessary, telephone him / her at home later on to get confirmation that (s)he is peeing all right.

• In the case of any such peeing requirement, NEVER insist on proof of somebody having had a good pee; their word that they've had a good pee is sufficient, and requiring proof is demeaning and authoritarian, serving no genuinely helpful purpose. It's the client's responsibility, NOT YOURS, to ensure that they give you correct information about that (i.e., if indeed it's genuinely needed).

  If for some reason a client gives you wrong information, that's actually no problem for you, and, if it rebounds upon anyone it would rebound only on the client — and that needs to be seen as part of necessary learning for the client about the need for them to take proper responsibility for themselves. It's important that all staff draw their personal and 'institutional' responsibility boundaries intelligently — which they're not doing all that well at the moment.

• As I've already intimated, that peeing requirement is clearly NOT NEEDED anyway, despite all the supposed justifications for it that were given to me! Let's now expand on why that's the case.

  If that peeing requirement were really needed, then so too would be a requirement that every client have a good bowel movement and show proof of it (Poo!), and be able to demonstrate sufficiently full and regular breathing and having a full and healthy appetite, and be able to show proof of being able to see clearly (perhaps a vehicle number plate at the standard distance for driving tests?) and hear clearly and indeed have all sensory perceptions working fine, and their gall bladder fully functioning (a sample of their gall bladder secretions, perhaps?) and their thyroid functioning fully correctly, and their being able to secrete sufficient saliva and sufficient tear fluid, and have a fully healthy heart function and brain function… ^…∞

  Do you now see what I'm getting at? NONE of those other things was routinely being checked pre-discharge (i.e., for clients in general), and yet any of those and a whole multitude of other things could have gone awry as a result of the particular clients' operations, with the potential to cause them problems. So, if it wasn't important to get clear indications that any or all of those other body functions were pretty well completely fit for purpose before a client could be discharged, why on earth has the ability to pee to order in the hospital been singled out as supposedly so overridingly important for clients to demonstrate? The solution is just so simple — drop that whole absurd peeing requirement!

  Even for clients who've had 'waterworks' surgery of some kind (including prostate surgery) there's still no point in rigidly applying a pee-before discharge requirement, because some patients would still have shy bladder syndrome and be unable to pee in the hospital. I do understand, of course, that for such surgery there would be a wish to know that the patient is able to pee okay after the surgery.

  But even here the correct procedure is NOT to make peeing a strict condition of discharge, but simply to ask clients if possible please have a full pee before discharge and let us know that you've done it, or otherwise, if it's really difficult for you to pee in the hospital environment, we'd phone you at home in the day or two after discharge just for us to get confirmation that your 'waterworks' are functioning all right — and to inform the clients as to the options for assistance that are open to them if they do find they have any problems once they're at home.

  And even if a client fails altogether to provide that information (at least correctly), that really is the client's responsibility, not the hospital's, so it's nothing for hospital staff to get worrying themselves about (unless, of course, the particular client clearly had some degree of dementia).

• Don't allow the 'taking over' of a client after a procedure, nor delay his going home, in order for him to have investigations / treatments for other conditions that have come to light, unless it's a genuine emergency situation. In such situations the client should be advised that (s)he has the observed additional condition(s) and be recommended to make an early appointment with their own doctor, but still be promptly discharged.

  One can of course offer to arrange such a personal doctor appointment for the client, or indeed offer to transfer the client immediately to another department for investigation / treatment, BUT this should not be done without the client actually wanting that. Basically it's the client's own responsibility to arrange such things, and to choose his own timing for them.

• Is it really necessary to do routine tests such as blood pressure, heart rate and body temperature upon every client in the ward several times a day, regardless of what they came in for? I'd say it's not, and doing that is part of treating the clients like cattle rather than individual people. To target such tests to where they're actually needed would save a fair bit of staff time and reduce stress levels all round. For each client, every time, ask yourself Why am I doing this at this time for this particular person?.

  If the supposedly honest answer is something like This is what the system requires us to do or This is the way we do it here, then STOP and reconsider carefully what you're doing, and how you can target that work just to those for whom it's genuinely appropriate and necessary for their own well-being.

  Another example of this time-wasting and demeaning unnecessary monitoring that I experienced was the insistence that while I was catheterized I shouldn't simply go to the toilet to empty the pee bag, but instead I should have a nurse empty it each time into a bowl so that (s)he could measure and record the quantity. Not just once, but every time the bag needed emptying.

  This was totally useless work, because (a) it didn't show whether or how well I could pee, (b) the pee volumes that I passed meant nothing unless my liquid intake was being monitored too, which it wasn't, and (c) my 'waterworks' were not the reason for my being in hospital anyway. In short, the various nurses could instead have spent their time doing something actually useful (including even taking a little healthy pause for themselves)!

• Eliminate the current institutional taboo surrounding self discharge.
  Make it a part of ALL prior printed briefings for clients about their forthcoming procedures, that they are informed of their right to self-discharge if it's been made clear that they are medically ready to go home and they're being kept waiting unnecessarily for some sort of administratively based rather than genuine medical reason — both with a caution that if they intend to do that they need to be really sure that they really are medically ready to go home, and that they would have to take full responsibility for their doing so, and also with an assurance that their taking that action wouldn't in any way prejudice their relationship with hospital staff or any further necessary treatment at the hospital.

  Hospital staff need to be directed to use plain common sense about to what extent to support any particular client's intent to self-discharge. Clearly, if a client is seeking to do something silly and genuinely very likely harmful for him/herself through self-discharging, then it would make sense to do what one could to dissuade that client from doing so — though ultimately the hospital isn't a prison, and a foolish self-discharge against genuine medically based advice would be the client's responsibility and theirs alone.

  On the other hand, it would generally be easy to see where a client was actually medically ready to go home and whose discharge was being held up on some 'technical' point (i.e., bureaucratic requirement), and such clients should be actively encouraged to self-discharge in order to bypass such obstacles and thus free up their beds for other clients.

• Change the wording of the self discharge disclaimers, because self discharge isn't necessarily against genuine medical advice. The disclaimer line could read something like I'm taking full responsibility for this action, whether or not I'm going against medical advice.

  Or, perhaps better, there could be two alternative disclaimer lines on the form. One would say I am taking full responsibility for myself and recognise that I'm doing this against medical advice, while the other would say I am taking full responsibility for myself and I understand that I'm not materially going against medical advice. Those options would have checkboxes against them for the client to tick the option that is relevant to the particular self-discharge.

For doctors, consultants and their teams

• Theoretically it's easier for you to rise above any unhelpful bureaucratic issues and indeed inappropriate and authoritarian behaviour of ward staff affecting clients, so you have a particular responsibility to speak out when you see that clients are being treated as less than human — indeed like the old fashioned notion of 'patients'! If you know a client is ready to go home but is remaining in the ward, then question this, and insist on immediate facilitation of the client's imminent return home — i.e., unless the client himself has some specific genuine need to hang on a bit. Alternatively, indeed recommend self-discharge.

• Ensure that any currently unavoidable bureaucratic requirements upon clients are being applied in a sensible and flexible manner, to take account of individual client circumstances and sensitivities. No client should be required to do what's not possible for them to do, and particular anxiety and phobia issues that limit what clients can do must be recognised as a real problem for the affected clients and never dismissed as something they're perversely making up.

• Ensure that clients of yours are given precise details of any practical measures they need to take regarding healing of their surgical wounds once they're at home. For example, if they've had any sort of 'bottom' operation, advise precisely about the best sort of absorbent pads to use, both in their underwear and indeed, if appropriate, in their beds.

  Indeed, in the case of pads in underwear, ensure that ward staff actually supply such pads to use while in the hospital before discharge, and even give the client a few examples to start them off back at home. Just 'any old pads' is no good; they must be ones that stay in place in the person's own underwear when (s)he walks about. Women clients would presumably have some idea of this, but rarely men. Surely, having any of your clients left to improvise with paper towels from a ward toilet, as I had to, isn't what you ever intended!

A need for environmental improvements

• Thought needs to be put towards making available some sort of 'walkabout area' for patients who don't really need to remain lying or sitting all the time. As it was, for me the only really available space for much needed 'walkabout' was just the middle space in that particular bay of the ward, between the two ranks of beds. That was really insufficient (and more than two people doing that in the one bay would probably have been rather unworkable).

  Really it would have been much better for one's walking or pacing around to be a bit removed from the patients confined to their beds, who in some cases could find that rather unsettling. As things are, going on 'walkabout' in the corridors isn't really on because those corridors tend to be so busy, and I think patients on 'walkabout' there would be rather problematical in purely practical terms.

  Quite apart from minimizing the risk of blood clots, having as much 'walkabout' as one's system can reasonably take, as long as it's done sensibly, would actually promote rather than jeopardize the healing from most sorts of surgery. That was very much the case with my own anus surgery, where healing would have been very significantly hampered by long periods of physical inactivity, and especially sitting.

  It's true that Lyme Ward did have what was referred to as the Day Room, but it was pretty clear to me that this wasn't at all a proper patients' day room, nor really intended to be used as one, for it was actually signed on the door as Waiting area, and indeed it was being used as the waiting room for new arrivals before they could be taken to their bed in the ward. I think also visitors who came earlier than the official visiting times were able to wait there.

  Basically, the problem is that the hospital was never designed with thought of areas or facilities for patients to 'walkabout' and exercise themselves, so I appreciate that there may be little or nothing that can be done now about this issue for the extant wards. However, as I intimate in the note above, walking about is an important promoter of physical healing from a really early stage in the majority of cases, and so needs to be given a much higher priority than appears to be the case at the moment.

  This is tacitly acknowledged through the detailing of 'Physios' to visit various patients in the wards and do what they can to get those particular patients up on their feet and walking — but it's a little perverse that those patients then don't have anywhere really suitable to go on 'walkabout' of their own volition.

• Bedside chairs need to be of a different design. The hospital makes much of the risk of patients getting blood clots in their legs during their hospitalization — yet the bedside chairs, at least in Bay B in Lyme Ward, where I was, were actually well designed for maximizing one's risk of blood clots!

  The padding of the seat of this particular chair design was of such a nature and was so shaped that if I sat at all back from the front edge of the seat, the padding was pressing strongly on the underside of my thighs (and I have long legs, so the problem would presumably be still more acute for anyone with shorter legs). This was particularly marked if I put my bottom well back so that I could be using the chair's back for back support — presumably the way one is meant to sit on them.

  For this reason I considered it necessary for my own 'health and safety' not to spend much time sitting back on the chair, and indeed not to spend all that much time on it at all.

• As already recounted, the whole hospital meals system falls seriously short of giving a proper diet for anyone, let alone for hospital patients with their particular needs for supporting their physical healing. That needs a radical rethink and reorganisation, as I understand to have happened in some hospitals elsewhere in the country. It's bizarre that hospital staff and visitors can get inexpensive (presumably subsidized) meals that, although not all what I'd call 100% 'healthy eating', are nonetheless pretty good overall provided one chooses sensibly, while, just along the corridor patients in the wards are served up such travesties of meals.

  Those decent meals are supplied in the Oasis restaurant, which is housed in the hospital. I see the Oasis restaurant meals as being a good model of what needs to be made available to patients in the wards. At the moment we seem to have a sort of 'food apartheid' in the hospital, and this is quite unacceptable.

  Interestingly, in the neighbouring psychiatric units — Wonford House Hospital and The Cedars — the supplied meals, particularly the main meal (lunch), were quite reasonable considering that one wasn't exactly in the Ritz — the lunch in particular usually being of or approaching Oasis standard, though without the considerable choice that the Oasis offers each day.

Don't you think it's a bit risky speaking out about all this? Surely you're likely to be victimized when you're next in hospital?

That attitude, which is held at least to some extent by the vast majority of people, is a major part of the problem, and all such people are thus a major part of the 'guilty party'! They are unwittingly cultivating all the excesses of the bureaucracy about which they're so afraid to speak out.

All of life involves risk! How do you ever get positive change in a rotten system by keeping quiet because, your actually unfounded fear tells you, something troublesome might happen to you if you ever spoke out for the requisite change?

Quite apart from any other considerations, such an outlook is an unjustified slur on the hospital staff, who generally are great people doing an important and difficult job, and who wouldn't at all be so petty and mean-minded as to seek to make problems for a 'patient' who'd spoken out about shortcomings in the system, and indeed who'd done so in a positive and constructive way. Yes, of course it's conceivable that the odd member of staff might in some way seek to make things more difficult for me next time I'm 'in' again, BUT the fact that it's conceivable doesn't mean that it's a practical likelihood*.

After all, it's not as though I'd been anything other than positive in my relationship with the hospital staff — apart from quite necessarily retrospectively highlighting the particular charge nurse's completely unacceptable behaviour, about which something needed to be done. Indeed, theoretically he alone would be the one who potentially could cause a problem for me — but in reality there could be no significant problem, because I simply wouldn't be accepting any bullshit, and even he would know he'd have to tread very carefully with me if I were not to submit a further complaint about his behaviour.

I'd suggest also, that people who are carrying a belief (actually a covert illusory reality) that victimization is likely to occur in response to one's having spoken out, and that that would be a seriously bad thing that needs to be avoided at all costs, would unawarely tend to draw such behaviour from relevant hospital staff, whereas somebody who has no such belief and who approaches the whole situation positively and without fear-based imaginary scenarios would naturally tend to draw the best and most positive responses from those same hospital workers.

Do you really imagine that if that charge nurse Mark were working in a ward that I have to stay in during some future hospitalization, he would vengefully make things difficult for me? True, that's a theoretical possibility, but, seeing that I raised a constructive and articulate formal complaint, particularly about him (see further below), and apparently Management did have a discussion with him about that complaint, I rather think he would be very careful with me.

After all, he must have recognised, at least to some extent, that I'm a very determined individual who eventually saw through his bullshit and would simply make further complaints about him if he didn't play 'decent' with me. He'd surely most likely recognise that, aside from any further formal complaint of mine, I'd know my own ground much better on a future occasion, and would most likely tear him off a strip or two if he tried anything on me, as well as getting hold of the ward matron, of course, to report his behaviour there and then.

And finally, as I recount much further below, when I did go in for a further small backside operation, it was clearly in my notes that I was going to self-discharge if they required me to show a reasonably full pee bottle first. Not only were the nurses really lovely with me (Mark not tested, however, as it was a different ward), but a nurse proactively came to arrange my self-discharge before I even had cause to raise that issue. Reprisals, my haemorrhoidal arse!

Conclusion

There's a moderate possibility that I may need to have further surgery in my anus after the full healing of the July 2010 operation, to remove any significant remaining haemorrhoids. So, am I dreading such an experience after all I went through on the occasion related above?

Actually the answer's a definite 'no'! What really impressed me in July 2010 was what a minor disturbance for me the operation itself was, and how little post-operative pain resulted. All the actual problems that I relate above were bureaucracy-related ones that could hardly happen for me in the future, for the simple reason that I now 'know the ropes' (which also for one thing would make me much less apprehensive prior to the operation), and I now know my ground with regard to self-discharge.

While not meaning in any way to dictate to myself as to what I'd do on some specific future occasion, the general principle appears to be that, while doing all I reasonably could for friendly harmony with hospital staff at all levels, I'd ride roughshod through any attempt to delay or put conditions upon my going home, regardless of any pressure or threats directed at me by particular staff, and would make it known at the outset that I'd be discharging myself (at the appropriate time with regard to genuine medical considerations), because I didn't regard the hospital as having valid reason to assume such an authority over me.

Most likely, with any requirement upon me to provide evidence of my having had a proper pee first, on a point of principle I'd actually not even try to pee before my self discharge, and would simply go home first. Indeed, if the weather were dry so that I'd walk back rather than have to be looking out for a taxi, I might well take time to have a pee at the hospital (but in a public toilet, not one of the ward toilets) after my self discharge! Most likely it would work fine then, because I'd already be relaxing and wouldn't have any pressure upon me to pee; I could then be comfortable on my walk home, enjoying my little smirk all the more.

With the ability to completely avoid the sort of problems I encountered in July 2010, I can honestly look forward to any future such 'backside' operation as a good experience to come, though, as in my life generally, I'd treat any adversities that did arise as further valuable learning opportunities for all involved and would take whatever measures were practical to ensure that maximum constructive result came of any such adversities.

Yes, I did raise a formal complaint!

As part of my aforementioned policy of ongoing constructive engagement, I sent a written complaint regarding the July 2010 experience to the Chief Executive of the Royal Devon and Exeter NHS Foundation Trust (officially the first port of call for written complaints, particularly those of broad application, where resolution within the particular ward would be insufficient or inappropriate), though I didn't have much confidence that any really effective action would result. I well understood that I'd most likely be seen as just an odd individual who had stepped out of line and spoken up about what the hospital bureaucracy and its purported complaints system felt should really be quietly left in place.

Nonetheless, the issues that I've raised above are major and serious ones, and the National Health Service will remain rotten inside until such time as those issues are addressed and resolved, and clients (not 'patients'!) start being treated fully as real people with their own personal dignity and self command.

It was in my mind when I wrote my letter of complaint, that I'd be liable to receive an attempted justification of the pee-before-discharge requirement and any similar requirements upon patients before they can be discharged, on the basis that the hospital has to endeavour to protect itself from possible patient litigation, and thus has to do its utmost to ensure that each patient is in a good state before being discharged. I made a point in that letter to forestall such a claim: that if I had the money to do so, and I didn't have other, higher priorities with my time, I myself would right now be commencing legal action against the hospital to claim compensation for being wrongly kept in for three days and, in the process, being caused stress, pain and actual physical harm.

The fact is that if I have a prostate problem that would ultimately need attention, that would be a separate issue, and, except in some emergency situation, would require a separate sequence of consultations and, if appropriate, an operation — and it would be my own business and nobody else's as to when or indeed if I presented that for any sort of medical intervention.

Except in the case of a genuine emergency situation, it isn't the business of hospital staff to say, Oh, by the way, we're keeping you in because we've noticed that you have xyz wrong with you, and these too will have to be investigated and treated before we can discharge you. Let's remove the 'cattle' status and indeed the 'patient' label from the (human) clients who come into hospital!

Sequel — Return to zap the haemorrhoids

I had further outpatient clinic consultations at the hospital, which confirmed that the surgically opened-up fistula had healed and so was no longer an issue, and which also confirmed that I still had a couple of haemorrhoids — which I dubbed my Terrible Twins*. In a November 2010 clinic appointment a further attempt was made to 'band' those haemorrhoids. The following day there was something on the toilet tissue among some rather bloody mucus, that looked as though it could have been a haemorrhoid that had detached and come out, but it was quite apparent to me that I still had at least two healthy little haemorrhoids there, which had no intention whatsoever of keeling over at the sight of a mere doctor wielding a banding instrument!

At a follow-up clinic appointment in January 2011 the same doctor gave my anus a quick examination and then agreed to put me in for a haemorrhoidal artery ligation operation* (blessed with the acronym HALO). The operation date got put back twice, so that my eventual appointment for 23rd August looked like just another desert mirage that would evaporate as it came close.

The first postponement of my operation was because I'd been put in for a day case operation at the RD&E Heavitree Day Case Unit, and at the pre-op consultation the nurse was insistent that I'd have to have somebody to accompany me back home from the hospital after the operation and to stay in my flat overnight with me — neither of which I could arrange. So, that meant that they then cancelled my day case appointment and put me in for an appointment in the RD&E Wonford hospital, where I could be kept in overnight.

I emphasized at the time that because of my shy bladder issue I'd most likely need to self-discharge suitably late on the day of the operation regardless of having nobody to accompany or look after me, to avoid a repeat of the catheterization saga that I've related much further above.

In the event the 23rd August appointment didn't evaporate and indeed actually happened. There were minor differences about the practical arrangements, such as being admitted into Lowman ward, which was being used just as a sort of transit lounge, and after the operation I was put into Dart ward.

This was supposedly a morning appointment, and my admission time was given as 8.0 a.m. I actually got there about 7.30, so had a bit longer to wait. I was seen successively by the doctor who would be working with the consultant proctologist for my operation, then the anaesthetist, and eventually by the consultant proctologist herself. Both the latter and various nurses spontaneously indicated that they understood that there was an issue about my 'shy bladder' and that I'd be likely to choose to self-discharge — and I do have to say, they were all doing their very best to be accommodating about that.

Clearly my earlier representations (including at the pre-op consultation), and quite possibly my complaint following the previous operation, had made a positive mark. I was assured that, if I did choose to self discharge, they'd all do what they could to be of assistance as necessary. The consultant proctologist herself said to me that "

If you do self-discharge and then find you have a problem once you're at home, you must, must, must get in touch with us at once.

The doctor who'd be working with the consultant proctologist for my operation told me that I was just second on the particular list, BUT the first operation on the list was expected to take a long time, so it would be about lunchtime before my turn came. She explained that they were intending to approach my operation in exploratory fashion, with an open mind about exactly what they'd do.

Although the HALO procedure was regarded as the 'core' likelihood, they were open to the possibility of simply banding the haemorrhoids again, because the banding attempts in the clinic may have failed (as indeed I was suspecting) simply because the anuscope used didn't enable the operator to place the banding equipment precisely enough to get the bands on properly, whereas in the hospital operation my anus would be 'robustly' dilated by a special instrument so that the operator could see more precisely what she was doing. Indeed, they might even excise the odd small area.

About 9.0 a.m. I succeeded in having a pee, albeit with a little difficulty, but after that I couldn't pee again. Fortunately I'd been ready for that sort of problem, so had drunk only a small amount of water early that morning, before the 6.30 deadline beyond which one wasn't supposed to drink anything.

Late in the morning it was looking to me as though just possibly my phosphate enema had been overlooked, so I mentioned that to a nurse — and it looks as though it was just as well I'd raised that matter, for, upon looking through my notes, she said, yes, she'd better do that now.

By about 1.0 p.m. I was trembling a little and my bladder was beginning to feel uncomfortable.

They came for me just after 1.30 p.m. Again the anaesthetic experience was amazing. One moment I was facing the anaesthetist, and suddenly I was in Recovery — though this time with a much more pronounced pain in my backside than I had the previous time.

Clearly I'd have to wait some hours before going home, to allow the anaesthetic effects to wear off sufficiently. My own Helpfulness Testing consistently indicated 5 to 5½ hours from the time of administration of the anaesthetic. I mentioned this latter point when I talked of the possibility of self discharge with the odd nurse who came to deal with me. I did my best to reassure them that I had no intention of doing anything silly, and that I'd be continuing to monitor my own situation, and would opt to stay overnight (i.e., as the 'authorities' actually 'required' me to) if my own Helpfulness Testing supported that option at the time.

Presently the consultant proctologist and the doctor who'd been working with her on my operation came to see me and report on what they'd found and done. They'd gone ahead with the HALO procedure, and done this to three haemorrhoids — so evidently at some relatively recent stage my Terrible Twins had become my Terrible Triplets! The consultant also said that she would see me again later on that day, and we could discuss then about whether it would really be appropriate for me to self-discharge that day rather than stay on overnight.

She acknowledged that there'd been a problem after my operation last year, and didn't want to stand in my way if I really did have a need to get home to be able to pee. But, she emphasized, she couldn't recommend such action and we'd need to discuss it first when she saw me later on, though she did understand that we didn't all comfortably fit within the system's requirements, and she appreciated that I was emphasizing that I took full responsibility for my actions and saw myself rather than the hospital as ultimately responsible for my own well-being (so, in other words, the hospital actually had no genuine cause for worrying about legal come-backs from me if I got some relevant sort of problem once I'd gone home).

After an hour or two lying in Dart ward I gingerly got off the bed and started gently walking up and down that bay of the ward, to assist my system in re-co-ordinating and in clearing the anaesthetic effects — and also to eliminate any possibility of deep vein thrombosis through the stagnation that comes with being stuck in more or less one position. I was in considerable discomfort, for I had a quite strong dull ache sort of anus pain and a lot of trapped gas in my gut, and that wouldn't budge.

That all felt rather like a pressure to pass faeces, and my system was completely unwilling to allow me to pee until I'd passed the actually more or less nonexistent faeces that it was 'detecting'. In other words I'd got into a sort of Catch 22 internal deadlock in which I couldn't get rid of anything at all from my lower end. At least, presumably once I was home this would all sort out. Roll on 6.45 (or thereabouts)!

…It was coming up towards my earliest sensible time to go home, and indeed my Helpfulness Testing was indicating that I was already okay to do so. I was getting a bit restless, because the consultant proctologist hadn't turned up yet, and, just to keep things as harmonious as possible with her and the other staff there, I wanted to see her then so that we could come to an amicable agreement about my self discharge before I left.

In the event, however, something rather surprising happened. A bit before 7.0 p.m. one of the ward nurses who'd previously dealt with me came to me and said that she'd now come to organise my self discharge! — WTF?!!!

Yes, she actually hadn't waited for me to say I wanted to go home! She acknowledged that I was really required to stay overnight, but they understood that because of my particular circumstances I was going to self-discharge anyway, so they might as well make the process as smooth and trouble-free as possible. She took out the canula, which, up to that point, had still been stuck into a vein in the back of my right hand, and had me sign the inevitable disclaimer form — with different wording this time. It still wasn't exactly right, but wasn't completely wrong like the one I signed last year.

This time it was something like I understand that my doing this is against advice from our Medical Officer. Actually, considering that in this instance the consultant proctologist was presumably being referred to there as our Medical Officer, the signs were that in the light of my particular problem and her knowing that I was a responsible sort of person who took a lot of care about myself, she would have been unlikely to advise me to do other than to get home so I could pee!

Thus it was that I picked up my precautionary 'overnight' holdall bag and the nurse helpfully directed me to the phone on the reception counter (i.e., not the nuisance of a public pay-phone) so I could order a taxi. I then gave what quick thanks and kind words I could to the nurses around who'd dealt with me, and I was off, somewhat amazed at everyone's spontaneous helpfulness in the hospital this time and the almost complete lack of resistance I'd had this time to my intent to disregard the troublesome official requirements and 'get the hell out' once I regarded myself as ready to go.

I was thus back at home before 7.30 p.m., and could relax and at last let all that pee and gas out of my system.

— Well, er, except that the minutes and indeed hours passed and I simply couldn't! In increasing discomfort and indeed pain, I tried all sorts of ruses to encourage my system to let go, but the deadlock was consistent and showed no sign of relenting.* Eventually — about 8.45 — I went out for a quick evening meal, assuming that that would help me relax and encourage a bowel movement, which in turn would open the pee floodgate — but all to no avail. The garbage was attacking me with fear, so that I was trembling and my mouth was dry — and of course that was causing further filling of my bladder. This was getting to feel desperate.

I was as good as my word to the consultant proctologist — I phoned Dart ward at the hospital. After all, she'd told me that if I had any problem at all I must, must, must get in touch with them at once. Admittedly, really this was a daft direction to turn for this particular issue, because getting involved with the hospital again at that time was one of the last things I really needed, and all that was required was a catheterization to break this silly internal deadlock, and I'd be better off having this done at home by the out-of-hours doctor service.

The nurse or receptionist in Dart ward who answered me sounded abrasive and unsympathetic — presumably it was now a different shift and she'd not seen me there and didn't know me from Adam. You've gone home against our advice? — Then, sorry but we can't help you, she said in a very negative, telling-off sort of tone, as though I was a naughty little schoolboy who'd done something that he should be ashamed of. If you need assistance you'll just have to go to Accident and Emergency or call the Devon Doctors service (the latter being the name of the local out of hours doctor service).

What that suggests is that all the supportiveness towards me in my intention of self-discharging from the ward most likely didn't represent any overall change of approach to patients with shy bladder syndrome, who needed to get home to pee. Most likely the change was specific to particular hospital staff members' relationship with me, because it was in my medical notes then that I had a special need — and possibly my complaint last year may also have influenced their responses to me this time. Also, possibly some of them were even aware of this web page and wanted to limit the 'damage' to their reputation from last year's little saga reported further above, and get themselves a better 'press' this time round!

Anyway, from my perspective it was probably just as well not to get caught up with the hospital system again. So, actually with a bit of relief at not following that route after all, I called the Devon Doctors and eventually (around midnight by then) had a couple of really nice district nurses visit me to fit the requisite catheter. The remains of the night were peaceful for me, though I had little sleep, particularly as I had the distraction of having the catheter, which was attached to a night bag down on the floor.

The following day the anus pain was quite troublesome, even though not really what I'd call 'severe'. I was taking paracetamol to reduce it a bit. Probably it would have been better to have got a stronger painkiller such as Tramadol for that first full day after the operation. One plus point on that day was a visitation from a district nurse from my doctors' practice, with supplies for my catheter (in case of need to keep it in for a longer period) and, more importantly from my perspective, a relatively neat tap (described as a Flip-Flo) to fit directly on my catheter in place of the pee bag. I'd never known of such an option before, and would definitely ask for it in the event of future catheterizations.*

The short tube with tap actually fitted within my underpants, so I could go out shopping etc. in my regular (short) shorts with no pee bag in sight, and no risk of a pee bag coming loose from its straps and dropping down my leg and pulling hard on the catheter, and in bed I then no longer had a distracting tube connection to a night bag (which could get disconnected and result in a bed-wetting, as indeed did once happen to me in early 2005). It really was quite a liberation.

Late afternoon, I had a proper bowel motion at last — as distinct from the odd mucoid squitters that had issued with bits and pieces of gas earlier in the day. After that, proper farts and further bowel movements came, so clearly the internal deadlock was already finished, and all would be okay for an early removal of the catheter, which a district nurse from my own doctors' practice removed on the Friday.

Actually, the latter district nurse had discussed the matter with one of my doctors the previous evening, and, bizarrely, he had advised her, actually without any sound basis, that it would be best for me to keep the catheter in till the following Tuesday, after the August Bank Holiday Monday*. I was adamant to her, however, that the catheter did need to be taken out without further delay, because it was causing me an accumulation of injury in my urethra — which translated into increasingly painful chafing and increasing oozings of blood and purulent-looking discharge. Fortunately she was very nice about that and did remove the catheter then, to my great relief. After that I was able to pee once more.

However, I wasn't fully out of the woods even then, because although I no longer needed medical assistance, once more I was getting quite major interference from the garbage, which was causing my anus to be severely constricted and indeed in painful spasm for much of the time. When I attempted to pee, I'd get increased anus constriction and pressure to 'go', which would inhibit the ability to pee.

And when I sought to have a bowel movement, it would start with great difficulty and quite painfully (because of the anus constriction and phantom pain being applied to that region by the garbage) and then the constriction and painful spasm would increase further so that I couldn't even finish the bowel movement properly and still felt an urgency for a bowel movement — so, getting a pee started or sustained was extremely difficult. I often had to use the little trick of getting up from the WC and actually peeing into my wash-basin, which for some reason turned out to be much easier.

Unfortunately, all that anal constriction and the inevitable necessary increase of straining for bowel movements would have been encouraging further haemorrhoid development and could have undone some of the good work of the operation — and certainly, after more than a week after the operation, when washing my anal area I could still feel at least one juicy haemorrhoid still there poking out of the opening. Oh, shit!, as they say!

If, after a reasonable wait for full healing from the operation to occur, it really does turn out to be the case that the HALO operation has not reasonably fully resolved the haemorrhoids issue for me, then that would presumably mean another attempt at the same procedure sometime in the not far off future.

What I want to avoid if at all possible is haemorrhoidectomy (cutting the haemorrhoids out), because, although it's claimed to be generally more effective long-term, my online research has brought to light relatively consistent accounts of the prolonged excruciating post-operative pain over the following couple of weeks or so — virtually unbearable and greatly debilitating for a fair number of people despite their regularly taking strong painkillers that they were given for that.

What to do about that unhelpful ward receptionist?

As before, I wasn't going to lose an opportunity to point out to the hospital the particular areas that I'd noticed needed improving, but clearly it would be a waste of my time to communicate further with the RD&E's Chief Executive, who'd responded with a patronizing and indeed insulting whitewashing exercise. What I did about the matter this time was to go the RD&E hospitals website and find out who the ward matron was for Dart Ward. In the event I found that the ward had not only a matron but also a senior matron, and I chose to write (an actual letter) to the latter.

My letter was NOT a letter of complaint, but one of appreciation for all the helpfulness and efficiency of the staff that I'd experienced during my brief hospitalization, then adding the bit of feedback about the inappropriate, and I'd say unprofessional, response that I'd had from the ward receptionist when I'd phoned the ward after my return home.

I waited a long time and, by late October I was assuming that no response would be forthcoming — though I was already aware that communications between the hospital and patients tend to operate with huge delays. In the event, on 25th October I had a very nice email from the Senior Matron, and I quote it here in full to show how different this was from the patronizing rubbish that came from that horrible Chief Executive the previous time.

Dear Mr Goddard
 
Thank you for your recent letter.
I was pleased that your experience was a positive one, however I don'te that once home the advice and response to your phone call wasn't helpful to you.
I will share your experience with the team involved and contact you with any progress regards to 'who to call' if you have a problem and changes we have made.
Within the Trust we have started a group which is looking at 'patient experience' and how we can learn from feedback such as yours.
With best wishes

[signed]

I promptly emailed back to encourage her to draw the attention of the 'patient experience' group that she mentioned to the contents of this very page.

Now, that response from her points to my sad omission last time round. I'd sought to 'go straight to the top' then because I'd seen the issues I'd raised as being ones of hospital-wide importance — which indeed they were, and so I'd not given direct feedback to the matron or senior matron at Lyme Ward. Clearly that was an unfortunate omission of mine, and it's now clear as to what is the general best direction for me to send any feedback about my hospitalization experiences.

In the event she never did get back to me — but I was half expecting that anyway even assuming she had really been meaning to, because the nursing staff are all working under such pressure, and little things like little bits of patient feedback would inevitably tend to get buried and forgotten in the ongoing flurry of pressing demands upon one's attention from patients actually 'on ward'. I thus feel no ill will at all towards her for that omission, but just would like to think that some useful message from me, via her, did eventually get back to where it needed to go.

Try again (sigh!)!

Still having a pronounced flabby thing that I took to be a haemorrhoid sticking out of my anus and making every little fart sound extremely rude*, I waited ever so patiently for the follow-up outpatient consultation at the hospital in order to check on the results of the operation and see if any further work needed to be done. I'm fairly sure the consultant herself had said that they would wait a few months after the operation and then give me an appointment for such a consultation — though I can't go back in time now actually to verify that the consultant had said that to me and I hadn't just imagined it.

I am sure, though, that nobody at all indicated to me any need for me to take action myself to secure any required follow-up appointment. Anyway, it seemed to be only reasonable for there to be an automatic follow-up appointment after a few months, and so I didn't raise the matter of my recalcitrant haemorrhoid(s) with anyone, and just waited for an appointment letter.

Finally, in mid-April 2012 I thought an appointment was long overdue and I'd better phone the consultant's secretary and ask if possibly they had sent me an appointment letter and it had got lost in the post. It turned out then that, at least according to that secretary, they had not got me down for any follow-up appointment, and were considering my operation as successfully done, and that was the end of the matter as far as they were concerned until / unless I got myself referred to them again by my GP.

That really seemed very screwy to me, and left me wondering whether (a) this was part of a cost-cutting exercise to reduce their number of appointments, or/and (b) it was part of a new bureaucratic, and, one could say, cynical, 'target compliance' policy, to try to prematurely close as many cases as possible and record them as fully successfully completed, so that then when patients returned with their issues not properly resolved, they would come in as new cases and not sully the hospital's (actually falsified) record of successful treatments / operations.

Or of course (c) the slight possibility that they'd chosen not to make things easy for me personally to go back to them, as a mean and petty response to my having self-discharged (albeit that having been organised for me by a nurse) without waiting to discuss my self-discharge intention with the consultant first as she'd asked of me.

So, I had to make an appointment to see my GP in order to get re-referred for my persistent haemorrhoid(s) to be zapped one way or another. I could only guess that it would come down to haemorrhoidectomy, the prospect of which I can't say I relished, in view of the likely severe post-operative pain. I'd be so glad to get that whole business well behind me!

When I did see my doctor, she pointed out another quite possible motivation for the hospital not automatically arranging a follow-up appointment for me. Apparently the department gets paid something like twice as much by the Primary Care Trust for taking on new referrals as against follow-up appointments.

Anyway, whatever the actual reason for my having been messed around in this way, I guess the bottom line is that it's a bloody good idea to ensure that one is told clearly, before leaving hospital after surgery, whether there is to be a follow-up appointment, and approximately when, and then to be proactive in contacting the department's secretary to ensure that things haven't been quietly changed, and that the follow-up appointment is still in the pipeline.

Even then, that referral got no response, and after about three months I phoned my doctor's secretary to ask for this to be chased up — which indeed she said she would do right away. About a week after that I finally did get an appointment letter, giving 24th September — well over a year since my apparently (maybe partially) unsuccessful operation.

…Okay, so the appointment came, and it was with the consultant herself — and it was a really pleasant and friendly encounter. She had a quick look and feel around in my back end, and, to my surprise, told me that she actually saw no haemorrhoids at all, but just two skin tags. She reckoned that one of them looked as though it could be a 'left-over' from the previous zapping of an actual haemorrhoid, and I assume that would be the one that had been seeming to me to be a haemorrhoid. She said they'd be no problem in themselves, and there was no actual need to take any action against them unless I was bothered about them in some way.

However, and I really take my sun hat off to her for being so decent and respecting towards me, she said that if I really did want those both removed she would be perfectly happy to put me in for her to do it as soon as they could find an appointment slot for me. It would be like the other operations — basically a single-day general anaesthetic job.

She gave me a little interlude for Helpfulness Testing (at least she didn't actually say she thought I was nuts!), and my inner inquiry indications were for definitely going for it, particularly as I was then getting an indication that the presence of those small nuisances was actually somewhat weakening to some part of my non-physical aspects in a way that was a significant factor in my current rather bizarre foot pain issue — so, she said she'd put me in for the operation.

Following that consultation, however, I researched online about people's experience of having anal skin tags excised — and the general picture I got was that usually the post-operative pain was as severe, debilitating and extended (something like three weeks) as with the haemorrhoidectomy operation, and, what's more, there appeared to be a disconcertingly high incidence of the surgery actually causing new skin tags to form, thus more or less negating the point of the operation in the first place unless one had particularly troublesome skin tags to start with.

In the light of that, my Helpfulness Testing indicated a definite preference for not going ahead with the operation, at least unless I could get the consultant to agree to use an alternative method such as ligation (tying off) or a particular laser treatment — both of which methods appeared to get much more favourable reports with regard to post-operative pain and any tendency for new skin tags to form.

In the event it turned out that the particular consultant claims not to use any procedures other than cutting off for anal skin tags, so I asked to be taken off the list for the operation. I must say, it does seem a little bizarre, that the consultant, who seemed to be quite a bit flexible and open-minded in outlook, wouldn't consider less problematical alternatives to cutting, as she routinely does with haemorrhoids, but, as they say, There be none as quair as folk!.

— And thus, apparently, ends my little back-end saga, at least as far as I'd have cause to report here. The bottom line, then, is that my farts will presumably continue for the rest of my life to have a certain markedly 'picturesque' quality to their sound…