Before going into hospital I scoured the internet for information on what would happen after surgery. Some aspects were very much out of my control so I did everything I could with the things that I could control, to maximise the chances of reaching the desired outcome. I had, in my eyes, the best surgeon in the country – someone with outstanding skill and who genuinely had my best interests at heart. So I was totally confident that the surgical side of things couldn’t be any better. I was as fit as I could be at that point, had planned my pre and post op pain management with my pain doctor to try to reduce the chances of long-term pain and I’d read everything I could find about amputation to try to be as clued up as possible.
Following surgery I was in hospital for a week. Like most things, this is different for everyone and is affected by a variety of factors including pain, complications, healing, home situation, preference of the surgeon etc. The choices upon discharge from hospital were home, or into an Amputee Rehabilitation Unit (ARU) and this would depend on bed availability and personal preference. I was very keen to go into the ARU because I knew it would speed up the rehab process dramatically, but would have been fine either way.
Waking up post-op is always a bit of a blur. I don’t mind having a general anaesthetic at all which is lucky, I guess, having had quite a few in my time. You go to sleep, you wake up, it’s all done. Lovely! Some people do strange things when coming round from a general anaesthetic and, embarrassingly, I am one of them. My awful habit is thinking that it’s hilarious to hold my breath so my oxygen sats drop below 90 and the machine starts beeping. This isn’t funny and isn’t a good idea at all – you need oxygen. I know I’m doing it but I can’t stop myself. I now tell the anaesthetist prior to surgery and make sure someone in recovery tells me to stop being silly and to keep breathing when I wake up, then it’s all good.
I also have a very vivid memory of waking up after frame had been put on, with lots of broken bones and metal rods in my leg and having extreme pain for hours, or so it seemed, before the pain was under control. Since then, I often wake up from surgery thinking that I’m in agony, no matter what my level of pain. One time I’d had a nerve block that had worked perfectly, but the anaesthetist didn’t bother to discuss this with me beforehand so I didn’t know I was having it. I woke up thinking I was in a lot of pain, when actually I couldn’t feel a thing. As “more morphine than I’ve ever given to someone your size” wasn’t touching the pain, they called the anaesthetist to see me who then informed us all that I’d had a nerve block. Quickly, the pain subsided and he was right, the nerve block had worked and so well, in fact, that I had to stay in hospital longer than expected because it took so long to wear off. Who knows exactly what was going on in my brain, but I believe that if I’d been told I was having the nerve block, those few hours may well have been a lot more pleasant. This was entirely down to poor communication and, here, it led to me having a big quantity of totally unnecessary drugs. He probably assumed that it would have been fine – give the injection and she won’t be in pain. But assuming isn’t good enough and this is a clear example of how medicine is an art, not a science. There was so much more to that situation than just giving an injection. I’m sorry in advance if I go on about that kind of thing but as a medical student and doctor to be (and healthcare professional in general), what I have learnt from some of these experiences is too valuable not to share for others to learn from too.
However, this time it was completely different. I woke up and felt great. Epidural was working, so no pain at all and I felt a real sense of calmness. It was finally all over. I had an absolutely lovely trainee midwife monitoring me in recovery and we chatted away (/I told her my whole life story, sorry). Then, somehow, the tube on my epidural got pulled and knocked out. The pain started to kick in quite quickly and I asked for it to be put back in. They wanted me to try with the drugs instead for a while, but I didn’t want that at all. I did for half an hour and by this point was vomiting every few minutes and feeling the complete opposite of how I felt initially. A little argument later with the messenger (“Well you get that anaesthetist and tell her to come and tell me to my face that I can’t have it.” This was the same consultant anaesthetist that I’d point-blank refused to do a pregnancy test for before surgery. “I did one at my pre-op appointment.” “We need another,” “No.” “You’ve got to do it. Nurse, go and get one for her.” “No. I’m not doing it, you’ll have to physically make me.” She gave in eventually… ) and they took me back in and replaced the epidural. Every now and again my stubbornness is a little uncalled for (refusing to pee in a pot, but to be fair I had been royally messed around by this point and was very angry), but most of the time I really do know my body and what is right for me.
Recovery and theatres can be really scary places. There are so many people around you and so much going on, but you are entirely on your own. All these people are doing things to you and you just lie there, helpless, disoriented and I had just had my foot cut off. But I felt so genuinely loved and cared for in those few hours. It’s different on the ward where I’ve always got friends and family around and I’m constantly in contact with people on my phone, but in recovery, at your most vulnerable, it’s just you and that recovery nurse. This one was great, but then I started throwing up violently due to the drugs given when the epidural came out. Then, she was outstanding. She didn’t just pass me a sick bowl, but she comforted me, held my hair back out of my face, held my head and put an arm around me as I threw up. I’m not a big fan of anyone helping me, even when in that kind of state, but she gave me exactly what I needed and she treated me with such extraordinary compassion and love during that couple of hours. From that very first step of this journey, I knew that I wasn’t alone.
All of the other staff on the ward were fantastic too and I’m incredibly grateful to them for putting up with me breaching visiting hours, leaving the ward for afternoons, undoing then redoing the epidural myself when I’d been warned not to when getting changed because I didn’t want to ask for help etc. I could reel off a long list of times when others went the extra mile and I can’t think of one moment when I wasn’t treated with total dignity and respect, but that is the moment that really stands out.
On my arrival to the ward I was greeted by the lady in the bed opposite telling me that she’d just had to move beds from the other end of the bay and that I was lucky being down this end with her. When I asked why she had to move, she replied, “I went for that lady down there, tried to punch her.” Hmm, I thought, lucky me being near you then. As it turned out, she was the better of the two to be next to and there were a few more incidents over the week, but no one got hurt – they just provided me some very good stories and kept my visitors entertained with updates on the latest ward developments.
The day after surgery they got me sorted with a wheelchair and I quickly learnt to unplug my epidural machine from the wall and wheel off, escaping the Big Brother-esque drama of the seven spirited 65+ yr old ladies in the bay. The next week flew by because I was kept busy by a packed social schedule of friends and family visiting. Having medical student friends on site was pretty handy too, but a bit awkward when a medical student I didn’t know wanted to take my history and I was “busy” chatting to a friend. I told her she could come back and take my history in an hour.
The care I received from my surgeon’s team was on a completely different level to any I’d had before. I saw a member of the team every day without fail and every single member of the team was on the same page, right down to the FY1. For the first time ever, I felt genuinely cared for by the whole team. When I asked how the operation had gone, the registrar grinned and told me that it was an absolute masterclass in a below knee amputation. To say I was relieved is an understatement. When the bandaging was taken down and wound checked a few days later, they said they’d never seen it looking so good. For the first time in a long time, things seemed to be going my way.
I wasn’t given prophylactic antibiotics and asked why, having previously had them for pretty much every other operation and clearly there was as big a risk of infection here as there was in any other surgery I’d had. My surgeon told me that I simply didn’t need them. He was absolutely right, of course, and I didn’t have any kind of infection at any point. I know I go on about him a lot, but it’s because he is truly one of the most amazing people I have ever, ever met.
On day six in the Big Brother ward a single room became available so I moved, and at this point I decided that the epidural needed to come out – it had become more of a hindrance than a help because there was always some kind of problem with it, dragging it around had got a bit annoying and I wanted to start getting on with a bit more physio. So it was taken out, I vomited for a few hours whilst the big doses of morphine hit me and then slept like a log. Peace at last. We had a call saying that there was a bed for me in the inpatient rehab centre the next day so I was transferred over, excited but nervous, not knowing what to expect at all. Then the hard work began.