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Prelude - an explanatory background
I give some relatively detailed background information here, not as a personal indulgence but to inform and assist other people with such anus problems as I had, which latter often tend to cause a lot of suffering, typically with people feeling that they are alone with the problem and that it is too awful to contemplate any sort of surgery to resolve issues on that delicate and indeed taboo part of the body (i.e. even when surgery actually is needed, which for many conditions it is not) - and also to allay fears that the aftermath of such surgery would necessarily be horrendously painful.
I had 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.
* Through careful observation through hard personal experience, I have come to the conclusion that the real underlying cause of that overtightness was and is, for me and indeed for at least the vast majority of affected people, a particular type of interference from the garbage (aka 'dark force', 'forces of darkness'). Unfortunately, true to pattern, the medical profession has put the jargon label 'stenosis' on that over-tightness of the anus, as a sort of fig leaf to distract attention away from any notion that there might actually be an underlying non-physical cause. So, the medical profession is intractably unable to 'get to the bottom' (sic) of this issue (as indeed is the case with virtually all physical problems that people experience - i.e., apart from actual injuries and infections). The generally recognised medical 'solution' is to cut part of the anal sphincter muscle - though thankfully nobody suggested that 'solution' to me.
On my Self-Realization site I present a collection of methods by which one can progressively clear oneself of garbage interferences of all sorts (and indeed pretty well all other underlying non-physical causes of people's physical problems), thus progressively clearing that anus over-tightness as well as bringing about major positive change in all areas of one's life.
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 had got an abscess there, and they both independently told me that it was not 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.
* In medical jargon a fistula is an abnormal channel connecting two organs or parts of the body, or one internal part of the body to the exterior. In the case of an anal fistula, it is a channel that connects a point in the lower rectum or anal canal itself to an outside opening beside the anus. Thus some anal fistulas can be regularly discharging small quantities of faeces and soiling one's underpants (the more widely recognised fistula manifestation, which was not the case with me).
On the other hand, as I was to learn during my briefing for the operation recounted here, the internal hole can be very small, so that recognisable faecal material would not pass through the fistula, but there would still be a constant 'drip feed' of infection, so that periodic discharges of pus alternating with a rather watery or mucoid tissue debris plus blood, due to the natural attempts to heal, would be issuing from the external opening of the fistula. This was exactly what was happening for me.
I'm still mystified, though, as to why the discharge from the infection was forcing its way through healthy tissue to an opening outside the anus rather than simply emptying back into the anal canal through the infection route - surely the latter would be the line of least resistance, and is what, say, an infection caused by something entering through broken or punctured skin would generally do.
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 (aka 'dark force', 'forces of darkness')), 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, the doctor seemed to be (reasonably) interested in the haemorrhoids and referring me for them to be 'done', but somehow did not really pay much attention to the 'abscess' issue, even though at that time I said rather apprehensively that I thought that that needed attention too.
* Imagine that your anus is a fresh open wound that has just been firmly rubbed with very coarse sandpaper, or, especially after bowel movements, has a resident razor blade, scalpel or piece of broken glass in it, actively moving about to cut open the anus wall. That is what it felt like! But the pain would periodically come and later completely disappear in a sort of pattern that exactly matched the sort of periodicity and circumstantial correlations of strong garbage attacks with emotional trauma material that I had experienced previously, and also, for me actually to press on the anus, and indeed move my hand about a bit while doing so, did not increase the pain at all and indeed tended to slightly lessen the subjective impression of the severe pain, so it was clear that the pain was not reflecting a genuinely painful condition there. The actual physical pain there was actually just a mild soreness, which for most of the time would pass completely unnoticed.
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.
* Banding of haemorrhoids is a simple and quick procedure that is done on an outpatient basis, with no anaesthetic required. An anuscope sort of device containing a little camera is inserted into the anus, and each haemorrhoid in turn is quite precisely grabbed and a little rubber band automatically put over it by means of a spring-loaded action, to fit tightly around its base. The banded haemorrhoids then, deprived of their blood supply, wither away and drop off over the next couple of weeks or so.
That is the theory anyway, but it appears to be pretty common for the banding not to work, so that other removal options then need to be considered.
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 had not been mentioned in the referral letter, but then she did a quick visual and finger examination and said that 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 would not 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 would 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 was not 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 would 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 was not 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 would 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 that 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 had always had difficulties over peeing, and so was most thankful that this was a very short stay and so almost certainly I would not 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 was not 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 that 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 had 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, was not 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'.
* Presumably the very term 'patient' reflected the fact of one having to exercise so much patience during all one's waits in the hospital!
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 was not strong / 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 was not the easy matter that I had 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 had not fully emptied myself of that load. Also, that time I did not manage to pee.
After that I could not pee anyway, and so had a gradually building bladder discomfort. At least I had not drunk anything since 1.0 p.m.; otherwise I would 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. I was given a blue gown to wear instead of my clothes, and was wheeled 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 did not have really apart from whether my rather full bladder would be a problem - which he laughingly said would not 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 had 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 would 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 would be out soon after breakfast.
I was also greatly surprised. Just as I had seemingly instantly lost consciousness, I had 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 had 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 would even be thinking that the operation had probably not been done yet.
...Well, er, in retrospect I can reasonably say that, apart from allowing a few extra hours as a matter of sensible prudence, it would have saved me a whole lot of trouble if I had indeed just walked out early without so much as a 'by your leave' - i.e., if I had somehow been able to avoid excessive conflict with those hospital staff who were still assuming that they (and not I) were in charge of me!
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 did not 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 did not 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 cannot 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 did not 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 was not really bothered by all the obstacles to getting a good night's sleep, because I was not really expecting much sleep this particular night anyway, and the following night I would be back at home, where I would 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 us 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 is 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 is eaten. It simply does not give the body the foundation of a reasonably balanced and substantial meal to provide a nutritional foundation for the day. It is 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 unharmonious, 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 was not that bothered because I would soon be home and then I would 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, so all she had 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 would not need replacing. So, in other words, I would 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, I was told 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 had 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 my discharge from the hospital.
One thing a bit remiss about the information I was given by CP's registrar was a suggestion that I might want to use some sort of pads to prevent soiling of my underpants by the actually quite smelly discharging and 'weeping' from the opened-up fistula, which would be bound to continue until a late stage in its healing. It is not that what I was told was wrong, but it was just greatly lacking. What does the average man know about really appropriate absorbent pads that can be used in his underpants without them getting shifted out of place by his walking movements?
Because I was given no recommendations of specific solutions, I was left to improvise with paper towels - really not satisfactory at all! I found that a 'book' configuration of three paper towels folded in half worked sort-of okay, though I'm sure that if I had been doing a lot of walking they would have moved out of position much more readily. I would change them after each bowel movement.
I was particularly scrupulous about this because I had not brought with me a change of clothing at all (including underpants) - though at least I would soon be home and then I could look out for some better solution.
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 was not drinking much despite my throat feeling dry, as I did not 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 would 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 could not 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 would 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!"...
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 had 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 M, the very busy-looking charge nurse on duty that day, to find out when somebody was going to come to me to organize my discharge. He then told me what I should have been told at the outset. That is, that I would be discharged after - and only after - I had 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 could not 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 would not be enough for me just to pee and report the fact; I would have to show proof that I had 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 M, 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 had 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.
* Something had to be wrong about that accusation. Even though I had spoken to the nurse in a stressed manner, it was not as though I had said anything at her, nor asked nor demanded of her that she do anything, nor indeed said anything 'negative'. I had simply said three times "I'm thinking of discharging myself!". What could be disrespectful or demeaning about that?
This has all the hallmarks of M's strong authoritarian pattern having at once quite purposefully distorted her presumably quite innocent report of what I had just been saying into something that he could use as ammunition to strongly smack me down as part of a strategy to assert himself strongly over me.
Indeed, it is pretty standard behaviour of individuals who have very strong authoritarian patterns that they will put upon the target person an accusation of a particular adverse behaviour that is actually none other than that of the person with the authoritarian pattern. And so, M accuses me of speaking disrespectfully and demeaningly to a nurse while he is actually speaking disrespectfully and demeaningly to me - very much so!
I did not seek to argue with M about that clearly false accusation, because I could see the authoritarian pattern at work and I knew that whatever I said would be 'wrong' and he would be 'right'. Indeed, but for the fact that there appeared to be no-one else for me to be dealing with at that time, I would have given him a very wide berth.
Also, another point about this was that any even half decent member of caring staff would ignore the odd stroppy thing that a 'patient' might come out with (except, of course, in the odd situation where a patient is behaving really abusively or threateningly), and would concentrate on keeping his/her own house in order by speaking in a courteous and friendly manner to the 'patient'. That would encourage 'patients' to speak similarly to them. So, really it was a complete non-issue as to whether I had really said anything untoward to that nurse who came to check my blood pressure; the fact was that by even making that accusation at all in that situation, even if it had been true, M was already acting in a most unprofessional and authoritarian way.
About my desire to self-discharge, unfortunately I had not done my homework over this, because it had never occurred to me that I would ever have cause to do such a thing, so I felt to be on weak ground here - which of course M 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 would be completely on your own, and there would be NO WAY that we would 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 had 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.
Every time I said that this pee-before-discharge stipulation was insane and not possible for me to comply with, M uttered the same justification for it, which subsequently various other staff also came out with. Allegedly, this requirement was because, even though the operations on people here in this particular ward were not on people's 'waterworks', until a patient had peed properly after an operation it was not possible to be sure that the operation had not in some manner caused 'waterworks' problems - and therefore in order to be sure that the hospital had discharged (sic) its responsibilities fully to the patient it had to lay down this requirement so that the patient would not be coming back to them later on, perhaps with a serious problem.
Very significantly, there had been NO requirement upon me that I have a good bowel movement, and indeed show the proof of it, before I could be discharged - even though I had just had an operation on my anus, not my 'waterworks'. That suggests strongly straight-away that the peeing requirement was there for some bureaucratic, not medical, reason and really was not necessary at all. Clearly, if it was not necessary to show proof of full bowel / anus function before discharge from the hospital, it also was not necessary to do similarly for one's peeing ability.
This rang a bell for me, because I had heard on news programmes and the You and Yours consumer affairs programme on BBC Radio 4 over the last few years that the Government had put a very controversial pressure upon hospitals, by which they were being quite severely penalized financially for each patient who was readmitted with a significant problem within a certain period after an operation. It had been reported that this was causing hospitals to hold onto many patients for inordinately long times, so very considerably reducing the number of new patients who could be admitted. Clearly my own situation was an example of this mindless bureaucratic stupidity.
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 could not 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 could not 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!
M 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 that it would not be enough to satisfy the requirement. Eventually I returned and told M 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'.
* Actually in retrospect it is easy to see how misinformation arose here. A much reduced urine flow with rather a burning feeling can indeed be a symptom of obstruction caused by an enlarged prostate, BUT, on this occasion I had so recently had a catheter forced up my urethra, and it had been quite painful as it was pushed through the section that passed through my (somewhat enlarged) prostate. There would thus have already been some degree of tissue trauma there, so of course I would at that stage have experienced a burning sensation and probably increased obstruction, regardless of any enlarged prostate or 'shy bladder' considerations!
Also - and I have no means to be sure that this is correct - my own inner inquiry results using energy testing pointed to a good bit of the prostate's obstruction of the urine flow as NOT being genuine. By that I mean that a good part of the obstruction was not being caused simply by the prostate's basic size but by a particular interference from the garbage (aka 'dark force', 'forces of darkness'), which was also causing constriction of my bladder sphincter and anus. The point here is that the prostate is a highly muscular structure and the garbage can interfere with it to make parts of it contract slightly in a way that increases pressure upon the urethra and convinces people that they need a prostate operation.
So, did I explain that to M? -- You have to be joking! If he was so scathing to me about the widely recognised 'emotional tension' phenomenon of shy bladder syndrome, clearly he would all but blow a fuse if I gave mention of 'garbage' / 'dark force' interferences causing any part of my problem - and indeed he might conceivably even have sought to get me shunted into psychiatric hospital, where theoretically my detention could have been legitimized (though actually I have particular good reason to think that in such an event the local psychiatric hospital staff would have seen no grounds for 'sectioning' me and would have either refused my admittance in the first place or promptly discharged me)!
So, M 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 M 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 M looked suspiciously to be deliberately avoiding me (by looking particularly preoccupied and busy), maybe in order to give me a hard time with my bladder.
Eventually I called out to M 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 did not 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, M 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 shall not bother to repeat what I had 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 would 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 would have had to pay for those, but the meals there are remarkably inexpensive and so really the cost would not 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 was not 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 would 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 was not 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.
* I use this expression here with artistic licence, as part of an expression of my exasperation. No, of course it was not a hell-hole, at least in the sense that people would usually mean, though I explain further below how in quite an important sense it was becoming the 'set' of what was for me the beginnings of a subtle sort of 'hell' experience caused by the bureaucracy angle on the proceedings.
"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 would 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 would 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 had made on Tuesday, which 'threat' had elicited such a severe and unprofessional response from M.
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 had come to the hospital without any change of clothing, including underwear, because I had 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 would 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! 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 was not something to get greatly concerned about, at least at this stage.
* Actually, in retrospect from over a year later, after having discussed that mess and its significance with a very experienced district nurse who assisted me with my catheterization following my 2011 operation, I'm less sure as to what extent that was really true.
The point is, prior to the catheter being inserted, a liberal quantity of a lubricant jelly containing a little local anaesthetic is forced into the urethra to lubricate the catheter, and, once the catheter is in place, the surplus of that stuff gradually oozes out again. However, the greenish yellow colour on this occasion did very much suggest some amount of pus, even if it was actually much bulked out with oozed catheter lubricant.
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 had had one in a catheterization in 2004, so I was not 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 M 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.
Actually, this whole Kafkaesque experience had very much an astral realm quality about it, with there seemingly being nobody in the slightest interested in my presence there and the fact that I was blocking a precious bed from use by needy patients. I had mentioned the situation to various of the nurses who attended to me with such formalities as routine blood pressure checking, and they had all just shrugged their shoulders and looked as though some annoying little fly had just flitted across their field of view and disappeared. They were all doing their jobs but appeared to have no comprehension of such issues as a need to ensure that an individual's actual needs are met and that beds are freed up as soon as possible for further patients. I appreciate that these nurses were really good people, but within this mind-numbing bureaucracy they could not help being remarkably like the impersonal puppet-people that you would get in an astral realm replica of the hospital.
I noted how the consultant proctologist and her entourage did not seem fazed in the slightest by the fact that I was still there, occupying a bed unnecessarily - 'bed blocking' - and so denying really needy patients a bed. It was very much as though they were astral realm replicas of the respective real people, just acting and speaking in ways that the programming of the particular astral realm dictated, but without the full range and variety of normal human responsiveness. Surely, if they had been functioning even half properly, they had have been outraged that a patient of theirs was being treated like that, and that a precious bed was being denied to other patients on just a bureaucratic technicality!
This 'astral realm likeness' aspect made my whole experience here in Lyme Ward beyond early Tuesday all the more unsettling and stressful for me, for I was working hard to cultivate groundedness of my awareness, and my being in a scenario that looked and felt like a very noxious sort of astral realm was not in the slightest helping. There was a definite nightmare quality about all this - but the 'nightmare' being of a more insidious type than the up-front terror type, and one that not many people would have sufficient depth of awareness to recognise for what it was. Really, not so much nightmare, as a particular 'flavour' of night hell.
* Actually it was a particular tedium because of my lack of anything really to occupy me. Yes, there was the bedside TV / entertainment console, but there was nothing in that to interest me in the slightest. I have never had a TV, and, for me, watching TV is a sort of psychological torture. Neither did I care in the slightest for having tinny sounds delivered to me from the headphones on the console. Nor was there anything there that particularly interested me to read. Also, I had no visitors to break the monotony, though at least I did have the odd friendly exchanges of greetings with the odd visitors who had come to see other patients in the ward. And the nurses and other staff were pretty well all too busy for me to have any friendly chats with them.
So, it was all an unscheduled extended 'meditation' experience for me, in which I would take turns at slowly pacing up and down in this bay of the ward and sitting on my bedside chair and occasionally having a recline on my bed. I was being (a) patient indeed!
Interestingly, C, 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 would not 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 had 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 would 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 could not have supplied a double amount like that to many more people. I had 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 could not 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 C 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 had not seen before. There was something about her that seemed to identify her as 'nurse', but she was not 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 could not 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".
* I say 'dratted' not in any disrespect for the consultant, who had done such a good job for me (as far as I could tell), but to reflect my growing sense of being taunted by those visitations, which always seemed to bear potential for the consultant or, particularly, her registrar to 'wake up' and actually get something done about my situation. There was something weird and disembodied about their keeping coming back to me in the ward, seemingly without recognising that anything was untoward. It reminded me of some of the paintings of Salvador Dalí, in which there would be the most horrendously scary objects or apparitions in a nightmarish-looking landscape, and within that landscape would be the odd very normal looking people wandering about in a most untroubled manner and apparently seeing nothing of that as untoward at all.
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 had 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 would 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 did not make sense anyway, because it was looking as though I would have to keep the catheter in place till such time as my prostate was 'done', so in reality the issue would not be about my peeing in the hospital but about getting me some more appropriate pee bags for use at home, because I could not 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 did not 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 would not 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 had 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 would 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 had come to the hospital on Monday morning, and said that something now simply had to 'give', for this could not 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 said, "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 M, the matron then lightened her tone and said, not to worry, and to hang on just for the moment, for she would see right now what could be done about this. She also remarked that she had not been here to do anything about this before because she had been away the last two days.
After a little wait, the ward doctor came over to me and told me they had made inquiries and found that the urologists were very busy operating, but one of them would come to me as soon as they had finished. He could not 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 did not 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 was not confident that I would 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 would need to do if I went into retention again would be to go to Accident & Emergency or the NHS Walk-in Centre, and I would be taken care of as appropriate. So actually it looked to be worth taking a chance on this.*
* Actually, as I rather suspected at the time, with all the internal injury and infection caused by Tuesday's two catheterizations, this was really risky, because a third catheterization, if it had proved necessary, would have been virtually certainly a major problem for me, with a lot of further tissue injury, much infection and pain, and with infection most likely being pushed up into the bladder and also getting into my prostate.
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 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 did not agree with them all. Perhaps in any case by this time she had 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 am doing this against medical advice.
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 had been in less of a hurry I would have crossed that line out and substituted:
I understand that I am doing this against the politically based advice of medical staff.
Or actually a still better one would be:
I understand that I am doing this on the basis of the best medical advice available to me - my own.
That is indeed what I would 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 is ultimately responsible for myself, and no medical worker nor organization has any business to try to take over that responsibility.
* Er, well, except that, on further consideration I see no earthly reason to bother myself about signing any such disclaimer anyway. Requiring one to do so was and is itself a completely unnecessary hoop that the hospital bureaucracy had set up for the likes of me to jump through, to drum home the implication that in discharging oneself, even with full knowledge and understanding of one's situation and physical state and one's readiness for going home, one is doing something (at best) not quite right. No, once I'm really clear that I'm genuinely ready to go home, then it would be just a matter of picking up my things and briefly bidding my friendly farewells and thanks to the staff, and farewells also to any patients on the ward who I got to know, and to express my good wishes to them all - and, simply, to go home.
To "But, just a moment, Mr Goddard, you can't just do that" there is a very simple response, to be delivered with a much savoured friendly smile: "Actually, not true. -- How do I know that? -- Simple: I am doing just that - therefore I can do it!". As it is not a psychiatric hospital, the Law in the UK does not support any attempt by staff to physically stop a patient simply leaving. If the hospital staff are not happy with my doing that, that is a prompt for them to at last start asking themselves why the eff they are treating patients as non-humans (i.e. without any sense of their own intrinsic dignity and freedom and plain good sense) in the first place.
The only catch about that would be if I needed to be supplied with specific medication, dressings etc by the hospital before going. They would be very unlikely indeed to arrange such things for me without a formal 'discharge' process. At least, for small operations like the July 2010 one that would not be an issue for me.
Anyway, I had 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, 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 would 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 was not 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 was not 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 had 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 (not 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 had 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 could not 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 did I not receive any specific advice to use such eminently suitable pads from anyone at the hospital? Indeed, why was the hospital not supplying patients who had 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 had 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 had consistently refused all offers of painkillers, with no sense of stoicism about that at all. I shall not 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 from day to 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.
* This was much more than the slight soreness and tenderness that I experienced following catheter removal on occasions in 2005 and 2006, and was verging on what one could call 'severe'.
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 did not 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 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 would not 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 would not 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 did not 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 had had an hour or so before the initial heavy bleed. For that I was not messing around with my anus(!), but possibly certain muscular contractions might have disturbed something. I would not 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 did not 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 might well have the latter condition to some extent, the fact of profuse bleeding while my anal canal was closed indicates that the blood could not 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 seem to have 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 did not 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 to actually 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 is unlikely that the solo sex session actually had anything to do with the bleed, because I had not 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 completed, 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 was not 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 severe 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 energy 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 could not 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 (aka
'dark force', 'forces of darkness'). That was the first attack of that sort of
strength that I had 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
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 'M', he was clearly showing a very strong authoritarian pattern and some pretty extreme unawareness and insensitivity towards me as a patient, and it is 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 would say that no hospital medical / nursing staff who do not 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 M, I would 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 had 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 would 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.
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 is 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 is '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 is generally 'understood' that it is 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 to actually 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 would not 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 are 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 is not 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 is 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 is deemed important to know that all clients can pee fully before they are discharged, what is 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, do not 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 have had a good pee is sufficient, and requiring proof is demeaning and authoritarian, serving no genuinely helpful purpose. It is the client's responsibility, NOT YOURS, to ensure that they give you correct information about that (i.e., if indeed it is genuinely needed). If for some reason a client gives you wrong information, that is 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 is important that all staff draw their personal and 'institutional' responsibility boundaries intelligently - which they are not doing at the moment.
As I have already intimated, that peeing requirement is clearly NOT NEEDED anyway, despite all the supposed justifications for it that were given to me! Let us now expand on why that is 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 conceivably have gone awry as a result of the particular clients' operations, with the potential to cause them problems. So, if it was not important to get clear indications that all 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 have had 'waterworks' surgery of some kind (including prostate surgery) there is 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 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 is difficult for you to pee in the hospital environment, we would 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 is the client's responsibility, not the hospital's, so it is nothing for hospital staff to get worrying themselves about.
Do not 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 is 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 is 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 would say it is not, and doing that is part of treating the clients like cattle rather than individual people. To target such tests to where they are 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 are doing, and how you can target that work just to those for whom it is 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 should not 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 did not 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 was not, 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 has been made clear that they are medically ready to go home and they are 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 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 would not 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 is not 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 is not necessarily against genuine medical advice. The disclaimer line could read something like "I am taking full responsibility for this action, whether or not I am 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 am doing this against medical advice", while the other would say "I am taking full responsibility for myself and I understand that I am 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 is 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 is 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 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 are at home. For example, if they have 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, is not 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 do not 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), and 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 is not really on because they are 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 is 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 is true that Lyme Ward did have what was referred to as "the Day Room", but it was pretty clear to me that this was not 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 is a little perverse that those patients then do not 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 reorganization, as I understand to have happened in some hospitals elsewhere in the country. It is bizarre that hospital staff and visitors can get inexpensive (presumably subsidized) meals that, although not all what I would call 100% 'healthy eating', are nonetheless pretty good, while, just along the corridor patients in the wards are served up such travesties of meals.
The 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.
"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 are 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 would not at all be so petty and mean-minded as to seek to make problems for a 'patient' who had spoken out about shortcomings in the system, and indeed who had done so in a positive and constructive way. Yes, of course it is 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 is conceivable does not mean that it is a practical likelihood*. After all, it is not as though I have 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 would not be accepting any bullshit, and even he would know that he would have to tread very carefully with me if I were not to submit a further complaint about his behaviour.
* For example, it is thoroughly conceivable that I shall get struck by a meteorite straight out of a clear sky - but it would be extremely unhelpful to go regarding that as a real practical likelihood. So, I get on with life on the quite reasonable assumption that I'm not about to be splatted by a meteorite anytime soon, no matter what I do! Thus one thing I would not be doing would be to stay cowering, crouched under my dining table for evermore just because it was conceivable that I might some day get splatted by a meteorite (or indeed struck by lightning). Indeed, even if I chose to waste my life in that way it would be pretty pointless, because if a particular meteorite really did have my name written on it (figuratively speaking), unless it were very small it could smash through the roof and indeed the table, and might well smash much or all of the building into a crater in the ground. So, that 'protective' strategy would not really be much of a protection at all!
Cowering under that table, unfortunately, is effectively what the vast majority of people are doing through not speaking out about the very wrong things that are going on in the National Health Service hospitals bureaucracy. So it all goes on and on the same old way, because nobody dares to hold its problems up to the light and speak out for the hospitals to 'get their house in order'.
And surely the hospital staff would really be much happier in a better functioning system, where they were expected to use their own good sense, discernment and innate flexibility to enable them to provide uniquely appropriate responses to individual clients and their particular situations. Having to unquestioningly follow routines and bureaucratically sourced rules instead of having the space and the encouragement to use one's own intelligence and think for oneself is not a happy state for an employee anywhere.
I would 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.
There is 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 is 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 would 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 would 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 would be discharging myself (at the appropriate time with regard to genuine medical considerations), because I did not 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 would 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 would 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 would already be relaxing and would not 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 would 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.
As part of the latter ongoing policy, 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 did not have much confidence that any really effective action would result. I well understood that I would 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 have 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 would 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 did not 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 is not 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 us remove the 'cattle' status and indeed the 'patient' label from the (human) clients who come into hospital!
The hospital's response to my complaint
I eventually received the following acknowledgement, dated 23rd July 2010 (though I received it a good week later):
I am writing to acknowledge and thank you for your letter dated 19 July 2010, in which you express concern regarding your experiences on Lyme Ward following a recent procedure
I was sorry to learn of your concerns and, on behalf of the Trust, I would like to apologise for any distress and anxiety which may have been caused.
I am grateful to you for bringing this matter to our attention, and please be assured we take feedback on our services very seriously. To this end your letter has now been passed to the relevant staff for investigation and once we have received their comments we will be in touch with you again.
I do hope that we will be able to achieve a satisfactory resolution to your concerns.
(signed on behalf of RP, Patient Services Department)
Note how, even at this stage, my complaint (actual direct physical observations plus statements as to what needed changing) had got twisted round into "your concerns", with a rather patronizing reference to "any distress and anxiety which may have been caused", and rounded off with "I do hope that we will be able to achieve a satisfactory resolution to your concerns". So, straight-away, there was a clear indication that the so-called complaints procedure was going to prove to be nothing more than a bureaucratic stonewalling / whitewashing exercise - a display of diplomatic dishonesty to put a fig leaf over inconvenient truths, attempting to 'allay concerns' rather than to recognise a complaint for what it was and to act upon it to put things right.
On 18th September 2010 I posted a reminder letter as I was still waiting for the promised response. The reply to that, dated 23rd September and actually received on 29th September, apologized for the delay in their getting towards a position in which they could give me a full response, and assured me that they would contact me on or before 4th October with an update.
On 7th October I received a quite long letter, dated 1st October, from Angela Peddie, the Chief Executive herself (at least it was signed by her). Although it is too long and couched in waffly diplomatic language for me to quote here in full in addition to my commentary on it, at least you get an idea of her response from my following commentary.
Basically the response was just the sort of thing that I had thought to be most likely. Overall, she was speaking not as a genuine human being with an intelligent mind (as I assume she would be, personally), but just as an official figurehead and mouthpiece of the hospital bureaucracy.
In her letter, generally speaking, just like a stonewalling politician with complete contempt for those who call his / her Party's policies into question, Peddie dishonestly* sidestepped each of the points I had raised in my original letter and instead went to some length to state the official position, NOT on the exact points I had raised, but on substituted general points related to the specifics that I had raised, and getting the odd things garbled along the way - so, despite the superficial politeness of her letter, there was a distinct subtext of "Up yours, dirty paws - you can like it or lump it, like everyone else!".* I use this word deliberately here, because I am not a 'diplomat' except where that would serve a genuinely beneficial purpose, and my task here is straight speaking. I am not saying that Angela Peddie, the actual person bearing the 'Chief Executive' label, is a dishonest person in her everyday life (of course I could not know about that), but I am saying that in her role as Chief Executive she is being dishonest - that dishonesty being an institutional dishonesty that she is going along with and repeating to awkward cusses like me who write in with genuine complaints that reflect unfavourably upon the hospital bureaucracy and point to radical changes that need making.
Although she acknowledged with lukewarm thanks that I had referred her and the relevant members of staff to the much fuller information on this web page, it was abundantly clear that neither she nor any of the other staff members had read this page, at least to any material extent - particularly as NONE of the many additional points raised here, that were not in my original letter of complaint, were mentioned at all in the response letter.
She even sought to deny to me that I had had the very significant damage and infection in my urethra resulting from the catheterizations - based on the fact that it was not in my medical records, and a certain amount of post-catheterization discomfort is normal. It was not in my medical records, of course, because, as must already be clear from the above account of my experiences, (a) those ward staff who I did mention the infection to summarily dismissed it as nothing important (albeit worth my monitoring for more adverse developments), without ever having looked at anything other than the pee bag, and without knowing anything about my urethra condition after my self-discharge, and (b) I managed that issue myself, for I did not want any more medical interventions for that issue if they could possibly be avoided, seeing that they would have only exacerbated the problem.
She also stonewalled completely over the unprofessional behaviour of the charge nurse M, and was "very sorry" that my perception of him was other than of his being extremely professional in his manner with patients - and, most 'conveniently', she did not refer at all to my reporting that M had told me a pack of lies about what would be my situation if I discharged myself - surely a disciplinary matter! She went on to imply that it had been absolutely fine that I was kept in for those extra, unscheduled days, and indeed potentially indefinitely, until some urologist too busy with other things finally finds a moment to see me - perhaps weeks or months later, for all I know! - and that in discharging myself I had done something ill considered and not quite right*.* As is made pretty clear from my account given on this web page, there was indeed something not quite right about my self discharge - its timing! The best time for me to have self-discharged would have been as soon as I learnt that I was being required to have a full pee before discharge - in other words, on the afternoon following the operation! I could then have resumed peeing normally back at home, and without all the urethra damage that was caused in the event by the two catheterizations.
I had held on longer only because I had not been sure enough of my own ground at that point about self discharge and so had let myself be bullshitted by M into staying put on the ward!
She completely garbled one aspect of my complaint regarding M, as follows:
There was no intention to suggest that you were blocking a bed by remaining on the ward unnecessarily; the overriding concern was to ensure that you were safely discharged from the ward with no clinical problems.
Absolutely bonkers! In reality there was an intention to suggest that I was unnecessarily bed blocking - but that intention was MY OWN! As you would have read from my account further above, it was a major part of my complaint, that I was forced by the hospital bureaucracy into bed blocking unnecessarily, and had to resort to self discharge in order to minimize the clinical problems that I went home with (as well as to be able to get on with my life and indeed to put an end to that shamefully unnecessary bed blocking)! Sure, nobody else at the hospital said that I was bed-blocking; it was I myself who was saying it - awkward old cuss that I am! Indeed, in her letter Peddie appears to be implying that I had claimed that M had accused me of bed-blocking, or had at least said something to make me feel that I was. Why could this confounded Peddie woman not even read my letter properly and respond properly to what I had actually written, both in the letter and on this web page, to which the letter sought to refer her (evidently in vain)??!
As to the matter of wanting to be sure that I was "safely discharged with no clinical problems", that simply repeats exactly the institutional confusion and dishonesty that was at the core of the substance of my complaint. I have already explained on this page just why "ensuring that the patient is safely discharged with no clinical problems" could not at all be the genuine reason for insisting that a patient cannot be discharged until (s)he has peed fully (and shown proof of it) - all the more so when the particular patient cannot pee in the hospital for a purely non-medical reason (i.e.,shy bladder syndrome). But of course there is no sign that Peddie nor indeed any of the other relevant members of staff had read this page to any material extent, so they would not have known, nor wanted to know, what I had to say on that matter.
One particular claim she made about M to try to justify his unacceptable behaviour was that he was simply "following instructions from the ward doctors to try to persuade [me] to stay on the ward". That was clearly untrue (i.e., a blatant lie), because there was no issue about my possibly self discharging and thus there supposedly being a need to try to persuade me to stay on the ward, until M had already behaved in that unprofessional manner towards me when I said I was thinking of self discharging. So he could not have had any of the purported instructions from the ward doctor (singular, actually!) until after his initial most untoward responses to my raising the issue of self discharge. So, sorry, Chief Executive, but your attempt at a cover-up of M's unacceptable behaviour simply doesn’t hold water, and simply besmirches your own reputation!
And of course if he had been instructed by the ward doctor to behave to me in the unprofessional way towards me that he did, then there would be still more of a problem because that would have meant that there had been a collusion between doctor and M in that unprofessional behaviour, and clear cause for a proper disciplinary inquiry concerning the behaviour of both of them. But I'm pretty sure that that was not the case, and that here I had caught Peddie with her knickers down, so to speak, telling me a lie to try and cover up M's unprofessional behaviour. Whether the lie was hers or M's, of course I have no means to know.
With regard to the hospital meals, Peddie had this to say:...you make a number of comments about the standard of hospital food. It is very evident from your letter that the meals provided were not similar to those you would have eaten at home and I am sorry for any additional upset of disappointment which was caused as a result. ...
It just happens that in my complaint letter I did NOT at all make any comparison with what I would have eaten at home, and neither did I say anything about 'upset' or 'disappointment'. I simply referred to the totally inadequate quantity and quality of the food supplied. So, my real complaint, which pointed to real action that needed to be taken to change things for the better, had been transformed into something more like a petty little whinge from a spoilt little brat, so that she could then patronizingly pat me on the head ('There, there, now just run along like a good little boy!') instead of paying proper attention to my actual complaint.
At certain points in her letter Peddie sort-of 'apologized', but actually there was not one word of apology for anything that had in fact been wrong about the service or the ways certain staff members behaved towards me. She was simply expressing 'apology' or 'being sorry' that I had felt that this or that had been wrong during my hospitalization and had experienced "anxiety" and "distress" from certain aspects of it. From my perspective, that was not a genuine apology at all but more like a diplomatically expressed patronizing insult! If she was going to express apology at all, why the eff could she not apologize for their actually having got some things wrong??!
Also, her response letter referred repeatedly in a mealy-mouthed manner to the "concerns" that I had purportedly expressed to her about my experience, and not to my factual observations, nor to my constructive suggestions and requests for clear and indeed radical changes. For the record, I did NOT express concerns at all in that letter, any more than I have done on this web page. What I did was directly and honestly to report certain factual observations of mine and point out certain things that needed changing. It is pretty obvious why that simple reality had been distorted by their 'complaints' procedure into a perception of my just "expressing concerns". If a person just "expresses concerns", then the authorities can write back with some old flannel to supposedly 'reassure' the person or 'allay his / her concerns'. The idiots! That is NOT what submitting an actual complaint is for!
There were, however, the odd glimmers of possibly positive details in her letter - though it was all couched in very non-committal terms that carefully avoided acknowledging that anything had really been amiss or anyone had actually done anything wrong, or that anything would definitely be changed. I think they were all really just 'old flannel' that was given to me in a lame attempt to keep me quiet, rather than as any genuine indication that material positive changes would follow on from my complaint.
She did say that my comments about M's behaviour toward me had been discussed with him. While that looks to have been just part of a whitewashing operation (sic), it is sort-of conceivable that M actually got a certain degree of 'encouragement' to behave differently in future - and might indeed have got some sort of mild caution about his having given gross misinformation to a patient about self discharge, and in making that false and indeed completely gratuitous accusation of my supposedly having spoken badly to a nurse. If he had been taken to task at all about those misdemeanours, no doubt the authorities would not publicly admit that such misdemeanours had happened, and so Peddie would thus have given me such a bland statement about it.
In any event, even if the reality was no more than his having been made aware that I had complained about his behaviour towards me, and there had been some sort of internal "gentlemen's agreement" to gloss the matter over without any sort of reprimand or criticism towards him, he would at least know that he needed to go very carefully in any future dealings with me, whether or not anyone had suggested as much to him.
- She stated:
"The surgical team have noted your comments about being able to relax at home and I will be asking them to consider whether other, similar patients may be allowed home a little earlier, in order to minimise their stress, with a request that they keep in close contact with the ward."
Again she avoided referring to the exact point that I had raised - about some people, including myself, having shy bladder syndrome, and the need specifically to waive or remove the idiotic pee-before-discharge requirement - but at least, if that statement of hers is anything more than a politician's promise (i.e., an effing lie), theoretically some positive change could come of that - though somehow I doubt whether such change would go much further than the relevant staff knowing to be very careful about me if / when they have to deal with me again.
She stated that, in view of my comments about the hospital food, she was arranging for a copy of my letter of complaint to be passed to their Catering Manager "for his information". Brilliant! I can just see them all running around now to change their hospital meals to a reasonable standard, like that of the meals available at the already mentioned Oasis restaurant! - Well, except that it would require a whole ongoing daily flow of such complaints to get that brontosaurian bureaucracy to even consider changing anything significant in their hospital meals system. No, I do not see this as anything more than a diplomatic "I have 'taken note' of what you say [and have filed it in our waste bin]".
I simply do not have the time priority to go into this in greater detail or escalate the matter now. I sent back a letter to the Chief Executive to make it clear to her that I do not accept her response as even remotely satisfactory, despite the odd points that might just possibly point to something positive, and that it has compounded rather than allayed my 'concerns' (as she patronizingly and demeaningly describes the points - NOT "concerns" - enumerated in my complaint). I now have pretty well no confidence whatsoever in the Chief Executive and the hospital complaints policy / procedure overall, and clearly, in the event of any further causes for complaint arising for me in future hospitalizations, any actual complaints that I submit would undoubtedly similarly be diplomatically stonewalled. On the basis of my own experiences, the claims that the hospital authorities make, that they value patient feedback to help them 'get things right', appear to be just cosmetic LIES.
I could take the matter further, of course. In particular there is a Health Service Ombudsman. However, the amount of my own time and energy resources taken in doing that simply would not be worthwhile in this particular case, in view of my other time priorities. If I had sustained more major, and visible, harm, and particularly, if it were of a nature that it would stand up for a significant compensation claim, then of course I would take it further.
However, this page remains here, to be an ongoing embarrassment and irritant to the Kafkaesque hospital bureaucracy, and I shall update it as appropriate and report here further untoward experiences, should they occur.
Eventually, on 29th November 2010, I got my apparently final response to my reply to the Peddie's useless response to my complaint (it was dated 23rd November). This is what she had to say:
...I am sorry to hear that you are unhappy with my letter to you of 1 October 2010.I have looked at the details on your website and a further review of your file has been undertaken. However, I have to advise that I do not believe I can helpfully provide you with any further information to resolve your concerns. Therefore I consider the local resolution stage of our investigation to be complete.
So, supposedly she actually deigned to "look at" the details on this website - but whether she properly read this whole page is quite another matter! It hardly sounds as though she did. Even if she did read it all with her eyes, she clearly did so with a closed mind and no intent at all to actually take on board my observations and the important points that I have raised from them.
Note again how she refers to resolving my concerns, NOT to resolving the issues raised in my complaint! I still have not had a single word of apology for what they got wrong, nor any clear indication that they would seek to put right the various things that I found to be amiss. In other words, once again a complete stonewalling couched in diplomatic waffle language.
She goes on to give details of how to contact the Health Service Ombudsman if I wish to take the matter further. That is all very well, but she would well know that my doing that would be a time consuming process that would not really be justified against my other time priorities in the light of the harm that I sustained not really being of a level for which I would be inclined to make a compensation claim.
This underlines what I had written above, about the hospital complaints service having nothing more than a political, cosmetic function, to whitewash over anything that draws attention to failings in the hospital service - and the Chief Executive functioning as a puppet and mouthpiece of the hospital bureaucracy, not as a genuine human being who would seek to get things put right.
Thus, the bottom line to me from the hospital service was none other than:
...And of course, my own bottom line regarding the whole RD&E hospital setup is that it needs a thorough clean-up of its bureaucracy, including its complaints procedure, replacing all its dishonesty with honesty and genuine concern to get things right with each 'patient' - and that process would undoubtedly need to include the sacking of Angela Peddie as Chief Executive, for she is clearly not fit for any genuine purpose, at least possibly until after some quite radical retraining.
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!
* I gave them the kudos of bearing a name because they made virtually all my farts that would otherwise have been silent into real 'party piece' ones that sounded as though I were having a five-star 'accident' in my pants and announcing it far and wide! And, with my rather inefficient digestion, that meant rather a lot of said party pieces!
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.
* This involves dilation of the anus under general anaesthetic and inserting a Doppler probe, which uses ultrasound to identify blood vessels that are supplying the particular haemorrhoids, and then inserting a stitch to tie off each of those blood vessels, so, supposedly, causing the particular haemorrhoids to wither away. The stitches are supposed to be in an area of the anal canal which is relatively devoid of pain nerves, so that at least potentially this is a relatively painless operation apart from the anus dilation, and thus should cause no more post-operative pain than I experienced for my fistula operation in 2010.
The first postponement of my operation was because I had 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 would have to have somebody to accompany me back home from the hospital after the operation and to stay in my flat overnight with me - both of which I could not 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 would 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 have related much further above.
In the event the 23rd August appointment did not 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 departure 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 indicated that they understood that there was an issue about my 'shy bladder' and that I would 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 would 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 would 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 that 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 would 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 did not 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 could not pee again. Fortunately I had 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 was not 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 that I had 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 would have to wait some hours before going home, to allow the anaesthetic effects to wear off sufficiently. My own energy 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 would 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 energy testing supported that option at the time.
Presently the consultant proctologist and the doctor who had been working with her on my operation came to see me and report on what they had found and done. They had 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 had been a problem after my operation last year, and did not 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 could not recommend such action and we would need to discuss it first when she saw me later on, though she did understand that we did not 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 had 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 would not budge. That all felt rather like a pressure to pass faeces, and my system was completely unwilling to allow me to pee until I had passed the actually more or less nonexistent faeces that it was 'detecting'. In other words I had got into a sort of Catch 22 internal deadlock in which I could not 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)!
As it was coming up towards my earliest sensible time to go home, and indeed my energy testing was indicating that I was already okay to do so, I was getting a bit restless, because the consultant proctologist had not 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 had previously dealt with me came to me and said that she had now come to organize my self discharge! Yes, she actually had not 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 was not exactly right, but was not 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 had dealt with me, and I was off, somewhat amazed at everyone's helpfulness in the hospital this time and the almost complete lack of resistance I had 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.
* This appears superficially to be quite a contrast from my return home after the previous operation, when my bowel immediately relaxed and I then had a good bowel movement and the pee immediately followed. However, by then I had already had some 2½ extra days for my system to settle down and the anal soreness to subside a fair bit before I went home. Quite possibly, if on that occasion I had returned home right away without all the bureaucratic shenanigans I would have had exactly the same problem that I had this time, and so would have had to have been briefly catheterized back at home.
I was as good as my word to the consultant proctologist - I phoned Dart ward at the hospital. After all, she had 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 really 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 would 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 had 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 had 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 did not 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 very 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 would 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 had 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.
* Indeed, because it looks as though they may not have Flip-Flo taps at the hospital, because they seem to be addicted to having male patients with 'waterworks' problems 'brought to heel' and made to feel that there is something really wrong with them by being attached by a long tube to an unwieldly and distinctly unsightly pee bag, next time I have an in-patient appointment at the hospital I shall have an advance word at my doctor's practice, for I'm sure they would be very happy to give me a Flip-Flo or two to take with me to the hospital. Then, if I did have to be catheterized I could be fully mobile and even have meals at the Oasis restaurant instead of those pitiful travesties of meals on the ward.
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.
* I do really rather despair of non-specialist doctors generally, for they have a really poor track record with me, both for diagnoses and advice - notwithstanding some of them being particularly nice people who I enjoy meeting. At least my actually registered doctor (not the one mentioned above) has tended to score a bit higher in that respect, primarily through not being so categorical with diagnoses and opinions in the first place, and her listening better to what I am saying, and seeking to work out in proper consultation with me the best solutions to issues that I raise.
However, I was not 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 would 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 could not 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 is 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 was not going to lose an opportunity to point out to the hospital the particular areas that I had noticed needed improving, but clearly it would be a waste of my time to communicate further with the RD&E's Chief Executive, who had 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 had experienced during my brief hospitalization, then adding the bit of feedback about the inappropriate, and I would say unprofessional, response that I had had from the ward receptionist when I had 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 e-mail 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 do note that once home the advice and response to your phone call was not 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
I promptly e-mailed 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 had sought to 'go straight to the top' then because I had seen the issues I had raised as being ones of hospital-wide importance - which indeed they were, and so I had not given direct feedback to the matron or senior matron at Lyme Ward. Clearly that was an unfortunate omission of mine, and it is now clear as to what is the general best direction 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 am fairly sure that 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 cannot go back in time now to actually verify that the consultant had said that to me and I had not 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 did not raise the matter of my recalcitrant haemorrhoid(s) with anyone, and just waited for an appointment letter.
* This is a particularly succinct example - i.e., a genuine recording of one of my farts with that little flabby thing vibrating in my anus. (I had no plans to record any farts of mine, but this was a serendipitous one that got into another recording of mine, so I clipped it out and, well, here it is for you to 'enjoy'!)
Finally, in mid-April 2012 I thought an appointment was long overdue and I had 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 had 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 organized for me by a nurse) without waiting to discuss my self discharge intention with the consultant first as she had 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 cannot say that I relished, in view of the likely severe post-operative pain. I would 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 is 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 have not 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 that would be the one that had been seeming to me to be a haemorrhoid. She said that they would 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 energy 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 would 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 that 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 is 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 energy 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, would not 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 would 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...