The Surgeon

December

I remember my December appointment. I had read all about my diagnosis. Google and medical text books are great but cause many anxieties instead of a sense of relief. My recommendation? Don’t look up your diagnosis! I am worried about all the complications discussed at my first appointment and a facial nerve palsy (loss of function with a facial droop) is definitely my worst fear. I have come to terms with a unilateral deafness but am still worried that if I am operating in a surgical theatre, I may not be able to hear my scrub sister and assistants. Or the medical student on the right of me. I am told that musicians go back to work after this surgery so I need to see how I feel.

My husband and I go to the appointment and instantly feel at ease as we enter into the clinic room. It really does matter how the room is set up. It is light and there is no noise. I sit near my surgeon, close to him without the desk as an artificial barrier between us. He sets the scene and immediately talks about my worst fears. How does he know? He must do this every day but for me the discussion feels personal. He treats me like an individual and addresses each of my questions. He explains the rationale of his approach and tells me how he will try and minimise complications or manage them if they do happen. He has pre-empted many of my concerns and treats me like a patient but with an understanding that I am a colleague. Importantly, he does not assume I know everything and explains the rationale with diagrams. I love explaining diagnoses and treatments to my patients with the aid of diagrams and therefore find this a very comforting gesture. Later I remember the diagrams,  as they stay fresh in my mind, when I am explaining the discussion to my sister.

A nurse walks into the consultation and I feel uncomfortable, as I don’t know who she is. I reflect on how I feel and the fact that nurses walk in and out of my clinic every day. I try and introduce each one but at times this is difficult when you are explaining a difficult diagnosis. Maybe this illness will make me a better doctor as I learn to empathise even more on my patients’ feelings.

We negotiate a plan of action for my operation. I feel confident as I can make my own informed decision but know full well that I have been steered and guided into the right decision by the experience and words of the consultant surgeon.

January

I am still wearing my heels as I go for my final appointment to make the decision for surgery. I am determined to be in them until I stop working (so I feel I am in control!). It seems to have been a long time since the original diagnosis in October.

I go with my sister and close friend to this appointment.

My husband cannot attend as he is working hard to manage his patients within the NHS. Clinic cannot be cancelled as he has the pressures of the 2-week rule for breast cancers. To explain, this means that patients must see a breast surgeon (as to whether they have a breast cancer or not) within two weeks. I cannot imagine how these patients must feel, finding a lump and not knowing what it is and fearing the worst.  I am so lucky that my mass is benign and not malignant. This additional diagnosis would have brought a huge additional burden and conversation and I can only imagine the professionalism of the entire multidisciplinary team at this difficult time.

My surgeon is obviously running a busy clinic but this all becomes irrelevant once we walk through the clinic door. He concentrates on my case. We are introduced to the specialist nurse. I introduce my sister and my concerned friend. The surgeon explains my diagnosis and goes through the scan. He is just as comforting but his words are the terms that my companions can understand. And they are really helped by hearing the information from him and afterwards tell me that I am in safe hands. What do we say that develops those feelings in our patients? I am still thinking and that will be a future blog!

I agree I need surgery and have a pre-assessment that day. How efficient. It is 10.30am and I have my ECG straight away. We are asked to go for coffee until my designated time with the specialist nurse who will see me and explain what I can expect. She is on time and she is so patient. She goes through my history and tells me about the pre and post operative course. I need blood tests and a nasal aseptic. I will be admitted the day before surgery and will need to shower with a special shampoo and body wash. I should not wear deodorant on the day. Really?? I will not be able to wash my hair for several days and certainly will not be able to dye my hair. I will be in ITU initially and will be in for around 10 days. (Immediately I set myself a challenge to be out in 5!). I am given patient leaflets and a guide to the hospital. Have I read them yet? No but I will before surgery. I ask about pain and wonder why it seems so natural to ask my nursing colleague and not the surgeon. She gives me her number and tells me to phone, anytime. And I believe her.

I am then asked to go for lunch as the senior house officer will see me at 2pm. We find an M & S restaurant and sit down and have a meal. I cannot remember the last time I had an hour for lunch or a sit-down meal in a hospital. Normally  I either eat on the run or forget to eat. This seems normal to me and my colleagues but my companions do not understand my comment on this and state that this must be so unhealthy and that I should know better. The NHS is so pressured and the workload is high. We all strive to get important jobs done in a timely fashion but the list is endless and this is an impossible task. We all give freely but I can feel the goodwill slowly seeping out of the NHS as the NHS staff feel more and more unvalued. We need to consider how we role model to our colleagues. What we did in the old NHS may not be correct now.

We rush back at 2pm and are told that the SHO is covering for a rota gap and has had to cover the ward as well as the preoperative clinic so will be back as soon as he can. I understand completely as this is happening across the NHS. We sit down and wait patiently. Time passes and it is now after 3pm and I enquire whether he is still busy. And yes, he is as there are sick patients on the ward. Of course I could clerk myself but this would not acceptable but I am tempted. Should patients be allowed to clerk themselves if we gave them a proforma? I wonder….

It is now after 4pm and he is still busy.  Now I am getting frustrated despite the fact I work in the NHS. I can imagine the car parking ticket when we finally get out of here. It will be expensive but it will be cheaper than hospital parking in London. My poor patients who must go through this everyday and are still so understanding and sympathetic.

At 4.30pm he finally gets back to clinic. He looks exhausted and is apologetic. He doesn’t need to be. I know he has been busy. Lucky for him, I give a concise history. He professionally clerks me in 20 minutes. I cannot resist asking him about his training and career plans. He is dedicated to neurosurgery but wants to take an extra year to make sure that when he enters a training programme to be a Consultant Neurosurgeon, that he has made the right choice. His passion shines through in that short period of contact. And I know he will be a great asset and future consultant in the NHS.

Finally, I can now go home. I buy the pre-assessment team some chocolates. Everyone loves chocolates. And they deserve a big thank you.