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» » Daves Stay In Hospital « «
(This is loosely based on the author's own experiences)
Dave's friend, John, dropped him at the hospital entrance at about 5 o'clock after work and, with a cheery shout of, "Good Luck!", he drove away. Dave stood outside the hospital entrance and looked at the soot-stained red brick of the former workhouse. "Britain's National Health Service could certainly use some new buildings," thought Dave. He picked up his case and went through the entrance. He came to the main corridor which stretched into the distance to his left and right. Straight in front of him was a sign showing directions to the various wards and departments. Finding his ward on the sign, he followed the arrow down the corridor to the right and turned right again part way down the corridor and up the stairs to the ward.
Dave's ward, he realised was one of the modernised ones where new windows and other improvements had been grafted onto the old Victorian structure. The first time he'd ever been in hospital was a few months earlier when he'd had appendicitis. It was the same hospital, but last time he'd been in one of the 'nightingale' wards, so-called, he was told, because Florence Nightingale would have felt at home there. The ward was a long, high ceilinged room with beds on either side and toilets and bathroom at one end. He'd hated it as there were only three toilets for the thirty beds and there was often a queue. He'd been there in the main part of the ward until a couple of days after the operation when he'd been moved into a side-room (more of a cupboard, thought Dave) when the hospital discovered that he'd got MRSA infection.
His wound had been leaking serous fluid for weeks after his discharge and the district nurses had called every day to change his dressings. That, he mused, hadn't been too bad as some of the nurses were young and attractive. There was something about the nurse's uniform which seemed to set his pulse quickening somewhat. After the appendix operation, Dave had suffered from frequent diarrhoea which had had him running to the toilet both at work and at night. Occasionally, at night, he hadn't 'made it' in time and he was being admitted to hospital for investigations.
On arrival at the ward, clutching his suitcase in one hand and his admission letter in the other, Dave was greeted by the ward receptionist in a pink and white striped uniform. She held out her hand for the letter and said, "Dave, may I call you Dave? I'm afraid your bed isn't empty yet. The previous patient is waiting for his TTO's before he can be collected and go home. Would you take a seat , please?" "What are TTO's?" asked Dave. "Sorry," she laughed, it's hospital jargon for 'To Take Out' - that's the drugs and medicines for the patient to take home. We're waiting for his drugs to come from pharmacy."
As Dave sat by the ward office, he noticed a ward plan on the wall with his name down for Side Room Three. Half a Readers Digest magazine later, (one he hadn't read before, to his surprise) one of the staff nurses came to him. "I'm Karen, your named nurse. It's my special responsibility to look after you while you're a patient on this ward. Would you like to come with me?" Dave followed her to the side room. On the door was a green notice concerning infection control. Dave stopped to read it. Karen said, "You've had MRSA infection in the past, so we'll always nurse you in a side room. That notice reminds us all to take the special precautions when we treat you."
Dave looked round the room. To his left was a hospital bed, a table over the bed, a cabinet beside the bed, an arm chair and a cupboard. Straight ahead was a window which looked out onto the ward block opposite and to the right was a wash-hand basin, mirror, razor point and a chair. "Put your clothes in the cupboard, Dave, and put your pyjamas on. Your toilet is next door on the left as you go out of the door and it's saved for your use only. I'll be back in a few minutes with some medication and the paperwork."
Dave did as he was told and changed into his pyjamas, dressing gown and slippers. He sat in the arm chair and got out a book. Karen came back in, wearing rubber gloves and a disposable polythene apron. "All staff will have to wear this when we nurse you, but I expect that you remember all this from last time?" Dave confirmed that he did and then spent the next half hour going through the usual hospital admission questionnaire. He had his temperature taken by an old fashioned mercury-in-glass thermometer and his blood pressure taken by a mercury sphygmomanometer. Karen reminded him that these items, and the stethoscope, would stay in the room with Dave to prevent cross-infection. She then attached a wrist band to each of Dave's wrists with his name, age, ward and hospital number on. "I've got to do the MRSA screen again, Dave. You had that done last time you were here, didn't you?" Dave agreed that he had. Karen took four tubes with charcoal and swabs in them. She wrote Dave's details on each one, as well as the site from where the swab had been taken. Firstly she asked Dave to sit still whilst she took the nasal swab. She pulled the swab out of the tube and then wiped it around the inside of both of Dave's nostrils. Dave wanted to sneeze, but Karen had soon finished. Dave unbuttoned his pyjama jacket and Karen swabbed under each armpit with a new swab. She then said to Dave, "Stand with your legs a little apart and drop them!" Dave undid his pyjama trousers and let them fall to his ankles. Karen swabbed his anal cleft with another swab and then his peri-anal area between his scrotum and his anus. "All done, now, Dave, you can cover yourself up again!" "I'm going to get your medication now, Dave," she said to him.
On her return, carrying a large jug and a glass with a mark near the top, Karen explained, "You're going to have flexible colonoscopy tomorrow when you'll be given a drug to make you sleepy and a flexible tube will be passed up your back passage so that the doctor can look at your colon. We need to make sure that your colon is clear of stool, so we're going to give you a special laxative to make sure that your bowel is empty. You can drink clear fluids from now on, but you mustn't eat anything, nor have milky tea or coffee. Do you understand?" Dave said that he did.
"This is KleanPrep. You must drink a glass filled up to the mark every fifteen minutes. After a while, you'll need to go to the toilet and you'll produce a very watery stool. You'll then keep needing to go every few minutes until you're empty. I'm afraid that you've got four jugs to drink and you'll be going for several hours. This drink washes you through from top to bottom and it's one of the better ways of clearing you out, believe me." She held out the first glass to Dave and encouraged him to drink it straight down. It had a vanilla flavour and a slightly salty aftertaste. "Use your buzzer to call me if you have any problems. Otherwise, I'll be back in an hour with the next jug for you." With that, Karen left the room. Outside, Dave could hear her rip off the plastic apron and wash her hands thoroughly.
Dave had drunk three glasses of the KleanPrep and had walked over to the window. Suddenly he felt damp around the front of his pyjamas. He turned away from the window and parted the front of his dressing gown. To his horror, there was a large damp patch on the front of his pyjama bottoms. He had wet himself without realising! Dave buzzed for help. Anita, one of the 'brownies' came. "Could I see Karen, please," asked Dave. "I'll get her for you," Anita replied. (Sisters in some English hospitals wear dark blue dresses, staff nurses mid blue, student nurses pale blue and health care assistants wear brown. Male nurses have collar tabs of these colours as appropriate)
Karen came and Dave showed her the problem. "That's a side effect I've not come across before. KleanPrep can cause a runny nose, nausea and a bloated feeling, but that's the first time I've come across that 'nose' running!" Dave was acutely embarrassed and had turned bright red. Karen, noticing his discomfort, smiled at him and tried to reassure him, "Don't worry! We're here to help. Let me think, now. I know, I'll be back in a few minutes." As promised, Karen returned with Anita a few minutes later. Both were gloved up and wearing the white plastic aprons. Anita was carrying a bundle which she placed on the chair. She and Karen pulled back the counterpane on the bed and spread a plastic sheet from the bundle across the middle of the bed. A draw sheet followed with Karen explaining to Dave that this was to protect the bed. On top of the draw sheet was placed a large incontinence pad, with a green plastic backing. Anita held out a hospital gown to Dave and said, "Take off your top and put the gown on. Then take off your pyjama bottoms and we'll get them washed for you." Karen said for Dave to lie on his back on the bed. From the pile she took an adult incontinence all-in one nappy (diaper) and asked Dave to raise his bottom off the bed so that she could put the pants under him. "I'm not a baby to wear nappies," Dave protested strongly, blushing bright red again. Karen gave a gentle laugh, "Dave, many of our patients wear these for all sorts of reasons. You're leaking and obviously uncomfortable and this seems the best way to help you. I suggest that you stay on the bed and when the KleanPrep works, use your inco pants and buzz us to come to change you. I wasn't happy about your using the toilet next door anyway as past experience shows that you might not have got there in time! I suggested a bedpan for you in the room, but sister felt that you'd rather use the toilet. We normally wouldn't start KleanPrep this late in the evening as you'll probably be passing watery stools much of the night, but you wanted to come in after you'd finished work, rather than at midday, so don't blame us if that happens! At least you've got your nappy to use instead of having to get out of bed or using a bedpan." Anita and Karen expertly fastened Dave into the incontinence briefs, taping them firmly and ensuring that they fitted snugly around the legs and waist by careful probing with a rubber gloved finger. Karen adjusted the backrest so that Dave was sitting propped up in bed and then pulled the counterpane over him. She advised Dave to lie on his back and, with a "Buzz when you need us," from Karen, they left him.
Dave felt embarrassed both by the nappy and the hospital gown. It was open down the back and had tie tapes, but the nurses had only tied the top tape around the neck so that the gown would hang open all down the back. The armholes and neck were bound with pink tape and the gown was white and printed with multicoloured 'HOSPITAL PROPERTY' making a square pattern on the gown. Dave gave a little chuckle. Who the heck would want to steal a hospital gown anyway? He'd had a pink trimmed gown when he had his appendix out. He'd asked the nurses then and had been told that the gowns were trimmed in pink and blue for women and men accordingly. However, the hospital laundry didn't bother to send the appropriate colour to men's and women's wards, so patients got what they were given! The ward Dave was on was mixed sex and he at least felt glad that he was in a side room.
Dave drank the next three glasses of KleanPrep dutifully on each quarter hour. Karen was right, he did feel bloated and he was aware of an ever increasing damp patch on his inco pants. Indeed, the 'tale-tell' printing in the pants was blurring, showing that Dave was still leaking as Dave lifted the counterpane to look at his purple plastic covered nappy pants. Dave did not feel as if anything was happening when suddenly he felt an urge to pass stool. As he was sitting propped up in a bed, and not on the toilet, he squeezed the muscles of his back passage tight to try to control the urge. The pressure became even more insistent until, suddenly, he couldn't hold back any more. He felt the stool and fluid rushing out of him and into his nappy pants. He lifted the counterpane to see that his pants were now swollen by all the stool and fluid in them. As he looked, the urge came again and he was grateful that he hadn't got to try to get out of bed and rush to the toilet next door: he was sure that he wouldn't have made it in time. He relaxed and let his bowels empty again. The plastic covered nappy pants swelled even more as Dave felt the wet stools being pushed against his bottom. He thought that he'd be disgusted by the feeling but it brought back memories of childhood and he found the sensation strangely comforting. He decided that he'd better ring for a nurse before he started leaking. A few moments after he did so, Karen and Anita came into the room. Anita was carrying a blue plastic bedpan and the girls stripped the pants off and Anita placed them in a disposal bag, taking care not to spill the contents. Karen took a tub of incontinence wipes and started to clean Dave, wiping carefully around his privates. Dave found this erotic and Karen laughed as he showed his sexual arousal in the obvious way.
"Try using the bedpan, Dave, before we put another nappy on you. You are still drinking the KleanPrep, aren't you?" Dave proved that he was by pouring another glass and drinking it down. The bedpan was a blue plastic pan with a handle at the back. Anita asked Dave to hold himself up using his arms and legs whilst she slipped it under his bottom. Karen arranged the gown discretely around him to cover his modest and said, "We'll be back in a few minutes."
Dave tried really hard to pass some more as he didn't want to have to use the nappies more than he had to. He squeezed some urine into the pan, and a small amount of watery stool. He noticed that he was still leaking slightly from his penis and hurriedly rearranged his gown as Anita and Karen knocked and came back in. Karen told Dave to lie back and, before he had a chance to protest, took an inco wipe and wiped his bottom for him. Dave started to protest that he could manage for himself, but Karen hushed him and reminded him that, after all, it was her job to care for him. The bedpan was covered and placed to one side whilst the nurses re-diapered Dave.
During the course of the evening, Dave continued to drink the KleanPrep until all four litres had been drunk. At fairly regular intervals he passed increasingly watery stool into his nappy and was changed by the nurses. At 9 o'clock, Karen and Anita were replaced by Jane and Susan, of the night shift. They had been introduced to Dave at evening hand-over and his problems explained to them. Dave was beginning to get used to his nappy and was even beginning, to his surprise to quite like the feeling of a warm wet nappy around his bottom and private parts.
At 10.30, Jane came in with Susan. Jane removed Dave's nappy and asked him to lie on his left side with his knees tucked up. She squirted some KY Jelly on her gloved finger and, asking Dave to take a deep breath, inserted her finger into his anus and worked the finger around to ensure that it was well lubricated. Dave felt her press on his prostate gland and a little semen was squeezed from his penis. "I'm going to give you a small enema of diazepam. It's only 10 ml and its to relax you and help you to sleep. We're using an enema as the KleanPrep may stop sleeping tablets being absorbed properly. We'll then put a clean nappy on you and leave you. Buzz if you need anything overnight, won't you?" asked Jane. Jane took an enema which was a white plastic tube and a small bottle connected to it with flattened sides. She squeezed a small amount of KY Jelly onto the tip of the nozzle and inserted it into Dave's anus. When it was right in up to the bottle part, she squeezed the bottle and Dave both heard and felt the cold liquid and air squirt into his rectum. Dave was asked to roll onto his back whilst they put a thick clean disposable nappy on him. Dave asked for a bottle to pass urine into during the night. Susan laughed. "What do you want a bottle for? You've got your nappy!" With that, Dave was covered up, wished a good night's sleep and the girls pulled up the cot sides on the bed and left the room, turning the light out on their way out.
Dave soon started to feel drowsy as the diazepam did it's work. During the night, he work to the pressure from his bladder and realised that the seat of his nappy was already wet from passing watery stool. Dave relaxed and let the urine flow into his nappy and, with the comforting warmth spreading over his loins, went back to sleep.
At s-6 o'clock the next morning, Dave was woken by Jane and Susan. By now Dave's nappy was so soggy that it had leaked not the inco pad on the bed and his gown was wet. "Let's have all that wet stuff off," said Jane as she reached for the tie tape at Dave's neck. Dave started to protest, but was told that he was going to be washed by the nurses whether he liked it or not!
When Jane unfastened the tapes on his nappy and pulled the front down, she called Susan's attention to it. "Look, he's still been passing some stool. Dave, your specialist has requested that your bowel be a free from solid matter as possible, so we're going to have to give you and internal washout. Susan will remove the rest of the wet pads and cover you over whilst I'll go and get the equipment ready."
Dave was lying on a clean inco pad on the bed and covered decently with a sheet. Jane wheeled in a drip stand and then went back to wheel in a trolley piled high with equipment and covered with a towel. Susan explained what they were going to do. "We're going to put a three way urinary catheter into your rectum, Dave. One connection will be connected to a bag at the side of the bed so that we can collect the washout. We use a urine collection bag for that and the other connection will go to a container of water hung from the drip stand. We'll clip off the drain and fill you with water and then clip off the water and allow the fluid to drain into the bag. We'' repeat this until the fluid runs clear of solid matter. You must tell us when you feel full and before it becomes too uncomfortable." Jane asked Dave to roll onto his left side with his knees drawn up and his bottom near the edge of the bed. Susan arranged the sheet so that just his bare bottom was exposed to their ministrations. She lubricated her gloved finger with KY Jelly and inserted her finger into Dave's anus. Meanwhile Susan was connecting the catheter to the drainage bag at the side of the bed and the douche can which she had hung from the drip stand. Susan held out the tip of the catheter to Jane for her to coat the tip with lubricating jelly. Jane then took the catheter and inserted it into Dave's anus, guiding it in with her finger and inserting it as far as possible. Susan took a 20 ml syringe filled with water and used it to fill the catheter balloon. She repeated this three times. Jane asked Dave if he could feel the balloon inflating and he said that he could. Jane explained that the balloon was supposed to hold 30 ml, but would hold 60 ml comfortably for the length of the procedure. The balloon would stop the catheter from coming out and help Dave to hold the fluid in his rectum until the nurses were ready to drain it out. After she had filled the catheter balloon, she gently pulled on the catheter until no more would come out of Dave's anus. She explained to him that she was pulling the balloon up against his sphincter muscle to help to make a seal to prevent leakage.
Jane wiped the jelly from her finger whilst Susan closed the bottom clip and opened the clip from the douche can. The can was little higher than Dave. On noticing that the warm water was not flowing into Dave, Susan raised the can on the drip stand to increase the pressure. Some water went in, but then the flow stopped. She raised the drip stand again, but no more flowed in. She put her gloved hand on Dave's abdomen. "He's gone into spasm," she said. "What does that mean? asked Dave. Jane explained that some people, when they have an enema, find that the colon goes into muscular spasm so that the fluid won't go in. The way of dealing with this was either an injection of Buscopan, a smooth muscle relaxant to make the colon stop going into spasm, or to increase the pressure.
Susan left the room and Dave could hear her going through the usual cleansing procedures outside the door. Whilst Susan was away, Jane put her hand under the sheet covering Dave and started to massage his abdomen with circular motions to try to encourage his bowel to relax and let the enema fluid in. Susan came back in with a black rubber object in a kidney dish. She showed it to Dave. It had a ball in the middle, a nozzle at one end and a metal connector at the other. "This is a Higginson syringe, or ball syringe, Dave. We're lucky still to have one on this ward as they're considered very old-fashioned these days. It was used for enemas and the nurse pumps the fluid in by squeezing the bulb. There are valves to stop the fluid from flowing backwards." With this explanation, Susan unclipped the drain tube to let the small amount of fluid out of Dave's rectum. When it had stopped, she disconnected the tube from the douche can to the catheter and put the Higginson syringe between the tube and the catheter. She closed the clip to the drain and opened the clip from the douche can. She then became rhythmically and firmly to squeeze the bulb. Dave could feel the pulses of fluid flowing into his rectum and dilating his colon. He could also see the level of fluid in the translucent douche can falling by looking in the mirror over the washbasin. The feeling was slightly uncomfortable but also strangely pleasant. Dave was beginning to enjoy this until he suddenly felt very full. He could actually see his abdomen distended with the fluid and told the nurses that he felt full. Susan gave another couple of squeezes to the bulb for good measure and Dave thought that he would burst. She opened the clip to the drain and Dave felt the pressure ease as the fluid passed out of him into the drainage bag. Jane emptied the urine collection bag into a disposable bottle and commented, "There's still faecal debris there. You'd better do it again." Once more Dave was filled up with warm water and drained out. The second time, the drainage fluid was virtually clear. "Once more, for luck, Dave," said Susan.
This time, instead of unclipping the drainage tube, Jane took a syringe and asked Dave to squeeze his anus as tightly as possible. She deflated the balloon in the catheter but sucking the water from the balloon in three strokes of the syringe plunger. Then, placing her hand on his upper buttock and pushing it downwards to help to close off Dave's anal sphincter, she quickly pulled the catheter out, leaving Dave filled with about two litres of warm water. Susan reached onto the trolley and pulled what looked to Dave like a pile of rather soiled towels off the trolley. He was told to roll onto his back, still retaining the water enema, and to raise his buttocks off the bed. Susan slipped the 'towels' under him and Jane pulled them up between his legs and deftly pinned them in place. Dave suddenly realised that they were adult sized 'baby' nappies! When Dave showed his reaction by blushing bright red, Jane laughed. "Dave, we're been ordered to dispose of our old cloth nappies and rubber pants. So we're going to use a set on you today and tonight and then throw them away. From tomorrow onwards, it's disposable nappies only!" Jane then asked Dave to raise his feet as she slid a pair of shiny pink rubber pants over the thick bulk of the cloth nappies. He was then helped into another clean hospital gown. "Try to hold that enema as long as possible. The morning shift will come to change and wash you ready for your colonoscopy. Don't forget that you mustn't drink anything from now onwards. See you tonight!" With that, Jane and Susan left Dave feeling rather full, both from the enema and a rather quickly filling bladder.
When they had gone, Dave relaxed his bladder slightly to let a small stream of urine escape into his nappies. He could feel the warm wet sensation spreading over his abdomen and trickling down between his legs. He let some more go and continued until his bladder was empty. By now there was a warm wet patch over his abdomen, between his legs and spread across his back under him. Suddenly a small quantity of water escaped from his anus and he decided to let the water out slowly as he had done with the urine. Eventually no more would escape just by relaxing, so Dave drew his knees up and squeezed the last of the enema out by contracting his abdominal muscles. By now, the nappies were virtually soaked, but Dave decided that he liked the feeling. He put his hand between his legs and pulled the nappy closer to his private parts, enjoying the sensation of the wetness around there. The feeling made him think of his childhood and being cared for. To his surprise when he woke, he discovered that he'd gone to sleep like that and that the thumb of his other hand had ended up in his mouth.
There was a knock on the door and Carol, a staff nurse on the day shift came in with two student nurses, Sally and Emma. Carol told Dave that she was 'his' nurse that morning and did he mind whether the two student nurses helped her care for him? Dave agreed to their help. With that, Emma left the room and came back clutching towels, clean sheets, a clean gown, a yellow disposable pad and net briefs. Sally meanwhile was filling a bowl with warm water. "Sally and Emma are going to wash you and get you ready for your colonoscopy," said Carol.
Sally pulled the covers from the bed and placed them in a red plastic bag (red bags for potentially infected items) and removed Dave's gown. Between them, Sally and Emma pulled off the rubber pants and removed the soaking nappies, leaving Dave lying on the inco pad. The nappies were placed in another bag and the rubber pants were washed in the sink and wiped dry with a towel. Carol said to Dave, "We'll wash the nappies in the ward washer and bring them back. You might want them later!" Carol asked Dave to lift his buttocks and slipped a clean dry pad under him, and covered his privates with a towel. Sally and Emma started washing Dave from head downwards to his waist, towelling him briskly dry. They then washed his legs. Finally, to Dave's embarrassment, they very thoroughly washed and dried his buttocks, abdomen and between his legs. Emma asked Dave to stand and held out the net briefs for him to stand into. Sally positioned the disposable pad in the briefs as Emma pulled them up around Dave's waist. Finally the student nurses helped Dave into a clean gown. Carol asked to see Dave's wrist bands and checked the details with him.
There was a knock on the door and Carol opened it to find that the porter had come with the trolley to take Dave for his colonoscopy. The porter, wearing the usual rubber gloves and plastic apron, wheeled the trolley into the room. It had a thin black rubber covered mattress on it with an oxygen cylinder slung under the mattress with tubing and an oxygen mask attached. The mattress was covered with a sheet and there was a folded cellular blue blanket on the trolley. The porter wheeled it to the edge of the bed and invited Dave to transfer over. Dave did so, and the nurses covered him with the blanket, placed a pillow behind his head and adjusted the back support on the trolley until Dave was at a comfortable angle. Carol asked Emma to go with Dave to the Endoscopy Unit and to take his hospital notes.
In the lift on the way down to the main corridor, Emma asked Dave if he had had a colonoscopy before. Dave said that this was his first time. Emma said, "It's a pity that you're not having this in eighteen months' time. By then, the new Endoscopy Unit would be built. The present one is a little primitive. The porter wheeled Dave up the main corridor and turned right down a narrow passage and turned right at the end of that short corridor. The corridor was painted cream and looked decidedly old and the worse for wear. At the end of the short cross corridor, the porter turned left into the Endoscopy Unit. This was in an old annexe of the hospital. Emma handed Dave's notes over the sister at the desk at the entrance to the 'ward' and Dave was wheeled between two curtains. The ward was an old nightingale style ward with the bed replaced by the trolleys which backed up against the long walls and curtains to give some privacy to the patients. Dave noticed that there was an empty space either side of him. The sister came over to him and saw him noticing the gap. "You've probably guessed, Dave, the gap is just in case you're MRSA positive. Let me check some details with you." She checked his wrist bands again, asked when he'd last eaten or drunk anything, checked for false teeth, taped up his rings on his hands and asked about any allergies. She then told him that he was next and would only have to wait a short while.
Fifteen minutes later, she came back and wheeled his trolley into a room at the side of the ward. She then left the room, closing the door behind her. Two nurses were there. One of them introduced herself, "Hi, Dave. I'm Helen. I'm a nurse endoscopy practitioner and this is Sarah, my assistant. Would you transfer onto this special bed?" Dave did so when Sarah brought the trolley level with the bed.
Dave was asked to sign the consent form for the procedure and the risks were explained to him. He was told that there was a one in two hundred chance that the endoscope might puncture his colon and this would require surgery. He was to be given a sedative to help him to relax. He agreed to all this and signed the form.
Dave was asked to lie on his back and a pillow was placed under his neck so that his head was tilted backwards. Helen said, "The pillow is to help to keep your airway clear. Would you put your feet in the stirrups, please." Sarah had plugged two attachments onto the bed from which hung loops and, with the nurses' assistance, Dave put his feet in the loops so that his legs were spread apart with his knees bent. Helen and Sarah pulled his net pants up his legs so that his bottom was exposed and used the disposable pad to cover his privates. Helen pulled a lever at the side of the bed and the foot of the bed folded down so that Dave's bottom was hanging over the end of the bed. Sarah placed a cuff around Dave's left arm and switched the machine on. The cuff inflated and recorded Dave's blood pressure. "This will inflate every few minutes to check your blood pressure. Please put this on your finger. It's to monitor the oxygen levels in your blood and check your pulse Can you raise your head slightly so that I can untie the neck of your gown? Thank you. I'm going to stick three pads onto your chest. The wires connect to this machine here which will monitor your heartbeat. Unlike television, we don't have it beeping all the time!" Sarah pulled up a wheeled stool to the end of the bed near Dave's bottom. He presumed, correctly, that it was for Helen or Sarah to sit on whilst they fed the endoscope into him.
Helen placed a mask over Dave's face which hissed. It had a plastic reservoir bag which rested on his chest and inflated and deflated as he breathed. "It's only oxygen, Dave, to help you with your breathing whilst we do the procedure. She pulled on a pair of blue gloves over the latex gloves and Sarah did the same. "These gloves are extra tough for everyone's protection," she remarked. Helen then picked up the endoscopy and showed Dave how there was a light coming from the end and how the image came up on the television monitor. "I'll be recording the procedure on video tape so that your consultant can review my findings later. I'll also be taking biopsies which will be sent to the lab for analysis. Sarah, will you hold Dave's arm?"
Helen put down the endoscope and picked up a cannula. Sarah held Dave's right arm tightly whilst Helen tapped the veins in Dave's hand to make them stand out. Finding a good vein, she said, "Just a sharp scratch," and inserted the cannula into a vein. Sarah applied a transparent dressing around the cannula to hold it in place and then Helen removed the introducer needle and capped off the cannula. She then told Dave, "Lie back and take some deep breaths. I'm going to inject some midozalam into the cannula and you'll relax. You probably won't remember anything about this procedure and you'll probably only remember waking up in the ward afterwards." She picked up a syringe which was pre-filled and lying on a small trolley near Dave's head. She inserted the end of the syringe into the cannula port and slowly depressed the plunger. Dave felt the solution spreading up his arm and remembered no more.
He woke, feeling rather drowsy, as promised, in the endoscopy ward. He still had the oxygen mask over his face, but the net pants and nappy pad had been replaced over his bottom. Sister came and said, "Good, you're awake. I'll arrange for the porter to take you back to your ward and one of the nurses will come down with you. I can't tell you the results of the tests: your consultant will do that later, but I can tell you that you're going to have a barium enema later today and a motility test tomorrow." Before Dave could ask any questions, she'd gone to arrange his disposal. Dave glanced at the clock. Four hours had passed since he'd had the injection! His back passage felt sore and he supposed that it would do after having things poked up there. His mouth was really dry and he wanted a drink. He pressed the buzzer and a nurse came. "Please can I have a drink?" asked Dave. "Sorry, because of your barium enema later today, you can't have a drink, but I'll bring you a mouthwash."
She came back a few minutes later with a disposable kidney dish, beaker of pink fluid and pink sponges on sticks. She removed the oxygen mask and told Dave that he didn't need it anymore as his obs. were fine. Then she asked Dave to open his mouth and wiped around the inside with a sponge dipped in the pink liquid. She repeated this several times until all the sponges had been used. She then gave Dave the drink and asked him to swill his mouth out with it and spit it into the dish. He did this and, when she asked if that felt better, he readily agreed that it did.
A few minutes later, a porter came with Emma. Emma said to Dave, "It's all go for you today! I've been asked to go with you to X-ray as they're ready for you now. We expected that you'd be back on the ward first, but you slept for longer than we expected." Dave was wheeled back out of the ward, turning right into the short link corridor and up the slope to join the main corridor. The porter turned left, wheeling past Dave's ward's lift along the corridor, past the Assessment Unit, ICU and HDU, main entrance, theatres and Urology. Just past the Urology entrance the porter made a left turn down a slope and into inpatients' X-ray, the old part of X-ray. He wheeled Dave straight through and into the newish main X-ray department. Passing the reception desk, he came to the lifts and pushed Dave's trolley into the lift. They went up one floor and into the waiting area. Emma handed over Dave's notes to a radiographer and said, "See you back in the ward later, Dave." "Bring him in," the radiographer said to the porter.
Dave was amazed at the sight which met his eyes. He'd had x-rays before, but not on equipment like this. The table was much thicker than usual and there were two monitor screens on either side of the table. At the end of the table was a ledge covered with an inco pad. Hanging from a stand was a large bag of white fluid with a tube and pink rubber nozzle shaped rather like a certain part of the male anatomy! However, the holes were behind the tip, not a single hole in the end. There was a thinner tube attached to the nozzle with a blue plastic bulb attached. There was also a screw device like a blood pressure bulb. The x-ray head was a large box with screens hanging down from each side. In the room were two radiographers, the radiologist who introduced herself as the doctor, and a nurse. All four ladies were wearing blue plastic covered lead aprons as well as disposable aprons on top.
"Please climb on the table, Dave, so that your feet are towards the platform at the end," asked the doctor, "and lie on your left side with your knees drawn up. I'm going to put this tube (holding the offending pink nozzle) into your back passage and I'll fill it up with this fluid in the bag. It's barium sulphate which shows up on x-rays as the bowel doesn't show up on a normal x-ray otherwise. I'll be asking you to change position several times to try to get the barium right around your colon as far as your appendix. We'll then lower the bag below the bed to drain the barium out. This will leave a thin coating of the barium on the lining of the colon and I'll inflate you with air so that we can see all the walls of the colon. It's called double contrast fluoroscopy, by the way. The procedure is uncomfortable, but it shouldn't be painful. I'll be taking pictures using the monitors and video as well as conventional x-ray films."
Dave laid on the bed on his left side with his knees drawn up. "Take his pants off, nurse," instructed the doctor. The nurse pulled Dave's net pants from him and removed the yellow pad. "I'm just going to make an internal examination of your back passage, Dave, with my finger. I'm also going to put some lubricant to help me to insert the nozzle." Dave felt her finger press against his anus and penetrate him. He could feel the doctor pushing hard into him and running her finger around inside. He stiffened and 'came to attention' as she pressed hard against his prostate gland and a little semen was squeezed out. That's fine," said the Doctor, "No obstructions, so I'll start." She inserted the nozzle into Dave's rectum and the nurse taped the tubing firmly to his leg and around his bottom, explaining that that was to prevent the nozzle from coming out. The doctor requested Dave to lie on his back and she opened the nozzle to the bag of barium. Dave could feel it flowing into him and he had a griping pain.
One of the radiographers pulled the x-ray head over Dave. It covered him from mid chest to mid leg with the plastic lead filled shields hanging down either side and resting on his chest and legs. "Screen on, " said the doctor. "Oh dear, he's gone into spasm. Buscopan, please." One of the radiographers took Dave's hand and held it out with the cannula upwards. The doctor took the pre-filled syringe and inserted it into the cannula's port. She pressed the plunger hard and injected the liquid quickly into Dave. Almost immediately his vision went blurred and he couldn't focus. He shook his head to try to clear it. The radiologist laughed, "Don't worry. It'll soon pass. It's a side effect of buscopan." As she was saying this, Dave could both feel and see on the screen the barium fluid flowing into him. The doctor called for the 'screen off' and 'screen on' at various time as Dave was asked to roll on one side, then the other, with the nurse holding the tube going into his rectum to help to stop it coming out. Twice the whole machine was rotated through 90 degrees so that Dave was standing up on the platform. Eventually the doctor was satisfied and Dave was feeling very full from the enema and he could see that his abdomen was distended from all that fluid filling it. During the filling process on a couple of occasions, an x-ray film had been inserted into the table, everyone, except, of course, for Dave, retired behind the lead glass screen whilst conventional x-rays were taken.
The nurse unhooked the now nearly empty bag of barium from the stand and laid it on the floor. Dave immediately felt the pressure ease as the fluid flowed back into the bag. Again he was required to turn from side to side and stood on end so that the fluid would drain out. Dave breathed a sigh of relief, thinking that his ordeal was now over. "I'm now going to put the air in, Dave. This will be more uncomfortable and I need you to squeeze your buttocks together hard to try to stop the air escaping. If you do let any air out, I'm afraid that I'll have to put some more in." With this, she picked up the blue plastic bulb, clipped off the tube connecting to the barium bag, and started to squeeze the bulb rhythmically. Dave could feel the air inflating his colon and could see his abdomen distending. He had a great urge to pass wind, but he clamped down hard on his muscles to hold it in. Eventually the radiologist was happy and she told Dave to turn on both sides, his back and his front. During this, conventional and fluoroscopic x-rays were being taken. Dave was finally stood on his feet as the whole machine was rotated through 90 degrees. As this was done, Dave couldn't hold back any more. He passed wind and some barium fluid from his back passage with the most revolting wet bubbling noise he'd ever made. He turned a bright beetroot colour and started to apologise. The nurse, laughed, "Don't worry, Dave. We've heard and seen worse! You should see the mess when that happens when we're filling someone up with the barium! You've done well so far." The doctor patiently re-inflated Dave's colon and Dave tried even harder to hold back the air this time. The radiologist took the final x-rays and then the clip was released to the bag. The air which had been filling Dave rushed out into the bag which inflated with the air from Dave's colon.
"You can remove the tube now, nurse. Put his net pants and pad on as he's to have an enema in the ward." said the doctor, as the radiographers and doctor left to get ready for the next patient. The nurse removed the tape from the tube and gently pulled the tube out. She wiped Dave's bottom for him and helped him back into the pants and incontinence pad. "Normally, we'd let you use the toilet to get as much out as possible. Your stools would be white and hard for a few days. However, as you're to have more tests tomorrow and you can't have any barium still in you, you're going to be washed out again and given strong laxatives to help overnight." Dave was really looking forward to that, not!
The porter came for Dave with a wheelchair to take him back to the ward. When he arrived there in his side room, there were two drip stands. One had the douche can as for the enema in the morning and the other had a litre bag of i.v. Fluid containing normal saline. There was also a jug of water by the bed and the 'nil by mouth' notice had been removed. Carol came in as the porter wheeled Dave into the room. "Lie on the bed, please, Dave and I'll connect your drip up. It's to rehydrate you as you haven't been allowed to drink and enemas can be dehydrating, Dave did so and Carol took the end of the drip tubing and connected it to Dave's cannula, after removing the stopper. She then picked up a crepe bandage and covered Dave's hand with it, after having looped up the drip tubing securely to stop if from getting 'caught' as Dave moved around. She then started the drip running fairly quickly into Dave's vein. "That'll run through in about four hours and we'' put some more up later." Dave was then encouraged to drink as much water as he liked and emptied the jug!
Sally came in carrying tray of sandwiches and a mug of tea. "You can also eat now!" She said. We'll be back in half an hour to give you your enema to wash out the barium, but we thought you'd like something to eat first." Dave said that he was ravenous and he'd quite happily wait for half an hour before having another enema.
As promised, half an hour later, Carol, Emma and Sally arrived with a trolley laden with equipment. Sally connected the plastic tubing to the douche can and attached a three port catheter and drainage bag to the other end. Emma asked Dave to position himself on his left side on an inco pad in the usual position. Dave was getting used to this by now and laid down with his knees to his chest and his buttocks near the edge of the bed. Carol told Dave, "Sally and Emma are going to do this and I'm going to observe them." Sally filled the douche can with warm water and placed a bedpan on the bed. She opened the clip and ran some water into the bedpan from the catheter, expelling all the air. Emma lubricated her finger with KY Jelly and liberally lubricated Dave's rectum and anus, working her finger as far up as possible. Sally lubricated the catheter tip and passed it to Emma for her to insert. After Emma had inserted it, she held it for Sally to inject the water to inflate the balloon to hold the catheter in place. All the time, the two student nurses were explaining to Dave what they were doing. Sally took off her sticky top pair of rubber gloves and pulled on another pair on while Emma opened the clip and let the warm water fill Dave's colon. When the flow stopped, and Dave thought he'd burst, she opened the drain clip and the white water and barium flowed into the collection bag at the side of the bed, hung on a catheter stand. This was repeated until the water came out clear. "Once more, Dave, then we're done," said Emma. Dave was filled up again with nearly two litres of warm water and the catheter was removed. Dave was asked to sit on the bed pan and told that he could expel it immediately. The nurses left the room to give him time to do this. Fifteen minutes later, Emma came back and offered Dave some tissue to clean himself and removed the bed pan. "I'll leave you another bedpan in case you need to pass any more," she said to him.
Later that evening, Dave was given a cooked supper and he realised why the standard of food in NHS hospitals is so complained about. Still, he was hungry and ate it anyway. Later still, Alex, a night nurse, came in and said that she was 'his' nurse for the night. He'd see Karen, his 'named nurse' tomorrow morning due to shift rotations. She brought with her an iv bag containing glucose and potassium chloride and changed the old bag which had just run out. Alex had also brought in a glass of fruit juice with some oily globules floating in it. "To make sure your colon is clear for tomorrow, I'm afraid I've got a quick acting laxative for you. It's rather old fashioned, but you're being given it so that it will clear your system overnight. I'll hold your nose while you drink it straight down." This was done, but Dave gagged at the foul aftertaste which the castor oil produced. An hour later, Alex came back with a kidney dish and gave Dave another dose. She then handed him a glass of lemonade for him to drink. "Here, it'll help to take the taste away." Dave drank it down and noted a ginger aftertaste and a slight saltiness. "That's a glass of Fleet osmotic laxative. Together with the castor oil, it should ensure that you're really cleared out overnight. Roll on your left side and I'll give you another diazepam enema to help you to sleep." Alex took the enema off the kidney dish. She first lubricated her finger and inserted it in Dave's anus to check that it was clear and then she squeezed a small amount of KY Jelly onto the tip of the nozzle and inserted it into Dave's anus. When it was right in up to the bottle part, she squeezed the bottle and Dave both heard and felt the cold liquid and air squirt into his rectum. She took off the sticky top pair of rubber gloves and changed them. She opened the door and came in with a thick pile of terry towelling nappies and a pair of natural coloured latex rubber pants. These were a yellow brown colour and sort of see-through. She expertly put the nappies on Dave and pulled on the rubber pants. She checked that the towelling was completely inside the rubber pants with her finger around both legs and Dave's waist. She told him to use the nappies when he needed to pass stool and when he needed to pass urine. "You've been given the nappies as the diazepam will make you drowsy and, as you're in a side room, we don't want you getting out of bed and falling." With this, she pulled up the cot sides on the bed, switched out the light and bade Dave a cheerful, "Goodnight. Buzz if you need me." Dave had wondered why the nappies and, at least, that explanation made sense. He pulled back the covers and looked at his rubber cased abdomen and buttocks. He stroked the rubber thoughtfully. He decided that he was being to like wearing these. In fact, he liked it a lot.
He was soon asleep after a tiring day and the effects of the diazepam. In the middle of the night, he woke with a terrible griping pain in his abdomen. Suddenly he was maked to empty his bowels into his nappies. The pain didn't go away and this happened again and again. After a while, the pain eased and Dave could feel the warm wet mess around his buttocks. Suddenly the pains came back again and he was maked to pass a stream of liquid from the osmotic laxative. By now, there was no more stool left inside Dave, but the laxatives caused him to pass fluid again and again. He also had passed urine several times so that his nappies were really wet. At one point, Alex came in to change the iv bag and commented, "I gather that the laxatives have been working. Try to get back to sleep." "I can't sleep with this mess," Dave replied. "Try," said Alex, "I'm sure you will." She was right for he soon fell into a drugged sleep.
Dave woke early the next morning. He realised that he had gone back to sleep with the mess and wetness of his nappy. He put his hand down to the rubber pants and stroked them, enjoying the sensation of being cocooned in rubber and terry towelling. He felt comforted by it and, to his surprise, discovered that he wasn't looking forward to having them removed. He decided there and then that he'd take the nappies and pants home with him and they'd get used! He'd been supplied with disposable pads and all-in-one briefs through the district nursing service to help with his faecal leakage problems. He'd worn the all-in-one briefs at night, Tenaslips, in case he'd 'had an accident'. He thought about this and decided that he'd wear the terry towelling nappies and rubber pants instead and, if he 'had an accident', well, he'd sort himself out in the morning.
Next morning, Alex came in with another nurse. Together they stripped off the wet nappies and pants and Dave was subjected to another head to foot wash. The rubber pants were washed again and hung to dry. The pair of pink pants which had been washed and hung up were dry and were folded up and put in Dave's locker. The wet nappies from that day and the day before were taken away to be washed. "We'll bring these back for you when they're washed and dried, if you want them." Dave was told to change into his ordinary clothes as he was to be taken to the city's other main hospital for the motility test. He was left a bedpan and a bottle to use as needed. In a short while, he was brought a breakfast of orange juice, toast, marmalade and cereal, with a mug of tea. "At least they can't get this food wrong," he thought to himself. He rapidly changed his mind when he bit into the toast and found that it was both cold and soggy.
A porter came for him with a wheelchair. At the ward office, Dave was passed a sealed envelope containing his hospital record for him to take with him. "Don't forget to bring that back with you," the ward sister said. Dave was wheeled to the main entrance where he was met by an ambulance car. The driver took the envelope from him and held the door open for Dave to get into the front seat. On the way to the other hospital, Dave was questioned about his reason for being in hospital and why he was being transferred, albeit temporarily, to the other hospital.
Unlike the other hospital, this hospital was relatively new. It was an ugly concrete building of up to six stories in places. Dave was dropped at the main entrance and told to ask at the help desk for directions to the Motility Unit. Clutching his medical records in the envelope under his arm, and glad to be allowed to use his own feet for a change, Dave walked up tot he help desk and asked for directions. He was given a map with the route marked on it, and the lady explained the route to him. He went to the lifts and up to the fifth floor along what seemed miles of drab, poorly lit corridors. The main entrance was actually on the second floor as, like the other hospital and due to the lie of the land, there was a 'ground floor' and a 'lower ground floor'.
Dave followed the signs and his map and arrived at the door of the Motility Investigation Unit. The sign on the door requested that he knocked and waited on the chairs near the door to the unit. This he dutifully did and sat down to wait. At least there was a reasonable selection of magazines to look at. There were car magazines as well as the usual collection of women's magazines. After a while, the door opened and a lady walked out, followed by a nurse in a plastic apron. "Mr Bell, would you like to come in now?" she asked. Dave followed her in and handed over the envelope. She opened it and noted the yellow MRSA warning sticker on the front. "Would you go behind that screen and take all your clothes off. Put the gown on with the opening at the back and only tie the top tape, please. When you've done that, come and lie on the bed. I'll be preparing the equipment for you."
Dave changed and left his clothes folded neatly on the chair provided. This hospital gown had a completely different pattern in blue and grey on it and wasn't covered with the words 'HOSPITAL PROPERTY' all over it. Dave came out from behind the screen and saw a conventional hospital bed with a disposable paper sheet over it and an inco pad appropriately positioned.. The nurse, Clare according to her badge, was reading his notes. "I see that you prefer to be called 'Dave' rather than the more formal 'Mr Bell'. OK, Dave, I guess after reading your notes that you'll know what position I want you in first." Dave chuckled and rolled onto his left side, knees to his chest and buttocks near the edge of the bed. "Right first time!" laughed Clare. She put down his notes and went to a storage bin at the side of the room. From there she took a plastic gown with sleeves which she put on over her uniform and disposable plastic apron. "This is extra MRSA precautions, and, as you're the last person this morning, I'll be changing the bed after you." With that, she pulled on a pair of blue nitrile gloves over her latex gloves. "These are extra tough and help to prevent the gloves from tearing. I'm going to start with an internal examination."
Clare lubricated her finger and inserted it into Dave's back passage. She worked her finger round in the way in which Dave was beginning to get accustomed. He thought to himself that this hospital stay had consisted in quite a large part in female nurses shoving fingers or other things up his back passage. Quite a role reversal, he thought. Clare pronounced herself satisfied with her internal examination and informed Dave that she was going to insert a special catheter.
Over the next half hour, Clare did various things to Dave. They included inflating a balloon on the catheter and asking Dave when he felt it pushing against him so that he would want to pass stool. She also injected water into the catheter and the catheter measured pressures at various points in Dave's rectum. Dave was unsure of exactly what she was doing. He just answered her questions and rolled into various positions as required. Eventually, she announced that she'd finished. She removed the catheter from Dave and wiped him clean. He was then told to get dressed and to go to the transport room in the main entrance where he'd be taken back by car to the other hospital. Dave went to change. When he emerged from the screens, Clare handed him a sealed envelope with his records in. "I'll fax my report to your consultant later today."
Dave went down to the main entrance and found the transport room. He reported there and was asked to sit down. Shortly a driver called his name and took him back to the other hospital.
Back at the first hospital, Dave arrived back in time for lunch, such as it was. During the rest of the day, he was generally left alone by the nurses who only came in to take away his urinal or bedpan and to replace the said item with another. His supper came and then Susan came in to do his 'obs'. Because he was an infection risk, he had his 'own' sphygmomanometer, stethoscope and mercury-in-glass thermometer to record his obs. Normally, the nurses used electric sphygs and electronic in-the-ear thermometers. Susan said to Dave, "We haven't got any laxatives for you tonight, but would you like a nappy on overnight?" Dave's heart skipped a beat. Yes, he would! He causally agreed with Susan that it might be a good idea for him to wear a nappy, but neither of them were taken in by his casual response. Susan laughed, "I guessed you would, so I've got them outside!" She opened the door and picked up the bundle outside. Dave was, by now, lying on the bed in the appropriate position with his lower half uncovered. Susan expertly put several thicknesses of nappies on him, pinning them tightly around his waist and legs. Next came yet another pair of rubber pants. These were much thicker and were the red-orange colour of hospital sheeting. Susan handed Dave a gown to wear overnight to save his pyjamas in case he leaked, and gave Dave a large inco pad to put under him 'just in case', With a cheery, "See you in the morning!" Susan left him.
Dave put the gown on and placed the pad on the bed. He smiled to himself. After all, if he was going to wear a nappy overnight, he might as well make use of it! With that, he emptied his water jug by drinking ever last drop and refilled it for later in the night from the tap in his room. He turned the light off and laid down to sleep. In the middle of the night, he woke with the pressure that only a very full bladder can produce. He rolled onto his back in the middle of the inco pad and relaxed his muscles slightly. A small quantity of urine spread up over his abdomen and trickled down his sides. He relaxed some more and felt the warmth flooding over his abdomen and also down between his legs. He stopped to let the terry towelling of the nappy soak up the liquid and he could feel it soaking into the material behind his back. Gradually, stopping every now and again, he emptied his bladder and could feel the warm wet sensation of the nappy around his loins. He put his left hand between his legs and pulled the rubber pants and nappy tighter around his genitals. He put his right thumb in his mouth, rolled on his side and fell into a contented sleep. Twice more in the night he awoke to add to the dampness of his nappy.
In the morning, Dave awoke with the nappy cold and very wet, but he decided that he liked it. Susan came in and helped Dave to remove the wet nappy and pants. She washed the pants out for him and hung them to dry. "Another pair for your collection!" she said. She said to Dave that they were busy that morning and that he was to wash himself. Susan left the room, taking the wet nappies in a red plastic bag with her to wash in the ward's machine, and Dave did his ablutions as he had been told to. He changed into a pair of pyjamas and laid on top of the bed.
After breakfast, the registrar came to see him. "We've got the results of all your tests, Dave and we'd like to do one more. We'd like to do an endoscopic laparotomy under general anaesthetic this afternoon at the end of the session. We've had a patient not turn up, so you're lucky to get that slot this afternoon. If you agree, we'll put you to sleep and make a series of small cuts in your abdomen to insert various tubes and instruments. Then we'll put the endoscope in through a cut in your navel. We can inflate your abdomen internally by blowing carbon dioxide gas through one of the cuts so that we can see inside your abdomen. If you agree, please sign the consent form." Dave asked about risks. The registrar explained the normal risks with a general anaesthetic and also explained the danger of perforation a piece of bowel, but he was told that that was a very rare complication. Dave signed the form and was told that he would be seen by the anaesthetist later that morning. He could have a drink at 12 o'clock, but would be 'nil by mouth' from then onwards.
Half an hour later the anaesthetist came. She explained to Dave that he would be put to sleep by an injection of Propofol through his cannula in his hand and would have a tube down his throat to keep his airway clear. "I'll be using a pharyngeal mask tube which sits at the base of your throat. It means that I don't have to put a tube right down your throat so you shouldn't have a sore throat when you wake. I'll keep you asleep with a mixture of oxygen, nitrous oxide and isoflurane. You'll wake up in Recovery and, if you have any pain, ask one of the nurses. I see that you react badly to opiates from the last time you were here. Pethidine works, doesn't it, and you can take diclofenac?" Dave confirmed both drugs had been used in the past and were effective without the vomiting which other opiates like morphine had caused. "OK, Dave, I'll see you later in the anaesthetic room."
In the middle of the afternoon, Dave had had a head-to-foot wash from the nurses in his side room. His bed had been prepared and turned back for a post operative bed with a draw sheet and thin piece of polythene to protect the under sheet and he had his gown on. He was lying on top of the bed awaiting his transport to theatre when Karen came in pushing a trolley, with Emma and Sally accompanying her. "As you're having a laparotomy by endoscope, Dave, the pushing around in the abdomen sometimes presses on the bladder and your consultant has requested that you be catheterised in the ward rather than in theatre to reduce infection risk. I'm trained to insert urinary catheters, but it is your right to ask for a male nurse. If you are happy for me to do this, I'd like Emma and Sally to help me, if you don't mind." Dave said that he didn't mind and wondered what all the fuss was about. After all, they'd had their fingers up his bottom as far as they could get them and had washed his genitals on several occasions.
Karen asked Dave to lie on an inco pad on the bed on his back. She pulled on a pair of sterile rubber gloves over her non-sterile rubber gloves and asked Emma to open the catheterisation pack onto the trolley. Karen took the sterile filed and poked a hole in the middle of it with her gloved finger. She asked Dave to pull up his gown to his waist and for Emma to hold his penis for him whilst she placed the sterile field over it. She explained to the students and to Dave that this was to cover his pubic hair to cut down the risk of germs and infections. She asked Sally to don a pair of sterile gloves and to pour some sterile saline into the dish from the pack. She was then instructed to use the plastic tweezers and swabs to use the saline to wash from the tip of Dave's penis towards the base, using each swab once only. Sally was instructed then to use a swab to wash around the foreskin and finally to wash the very tip to try to remove as many germs as possible. Dave was by now very embarrassed as Emma still had a tight hold of him at the base of his penis under the sterile field. Karen picked up a pre-filled syringe of Instillagel. "This is a local anaesthetic, lubricant and antiseptic, Dave. I'm going to put this into your urethra, give the anaesthetic chance to work, then insert the catheter. You're had the catheters inserted before, although in your back passage, with the balloon to hold them in place. The catheter I shall be using today is a blue all-silicone one with only a 10 ml balloon. The catheter itself is 12 FG, or 4 mm in diameter." With this, she pulled the rubber bung off the tip of the syringe and squeezed a small blob of the clear jelly around and on the urethral opening. "You may find that this will sting a bit at first, but it'll soon become numb. That should be long enough." With that, Karen inserted the tip of the syringe into Dave's urethra and asked Sally to hold Dave's penis tightly around the tip of the syringe. She slowly injected the contents of the syringe, 11 ml in all, into Dave's urethra. Karen was right, it did sting at first. When all of the syringe was injected, Karen removed the syringe, asking Sally to hold the tip of Dave's penis tightly. "If you don't hold it, the Instillagel will leak out and won't have chance to work.
Dave laid there trying to image what he must look like. He tried to picture himself lying on his back with his gown around his waist with nurses holding his penis. He gave up as the pictures which he imagined were too embarrassing to even try to contemplate, he realised. After five minutes, Karen announced that the jelly must have done its stuff. Sally was asked to let go and jelly emerged from the tip of Dave's urethra. As it did so, Karen plunged the tip of the catheter, holding the rest of it in its sterile inner bag, and, using the bag, fed it into his urethra. She encountered resistance and told Dave to cough as the tip was about to pass the prostate gland and sphincter muscles at the bladder neck. Dave did so and experienced a sudden sharp pain as the catheter tip entered the bladder. Immediately urine started to flow from the funnel end of the catheter which Karen held over a disposable kidney dish. She asked Sally for the water syringe and, connecting it to the catheter's filling port, injected 10 ml of sterile water to fill the catheter balloon. She gently pulled on the shaft of the catheter to pull the balloon back against the bladder neck and asked Sally to connect the 2 litre drainage bag. Once that was connected, she ripped away the paper sterile field and wiped the excess jelly off the tip of Dave's penis with another gauze swab. "You can let go now, Emma," Karen said. "I'm glad about that! My hand was beginning to go numb!" Emma replied. Dave could have added that her hand was not the only thing beginning to go numb. "All done, now, Dave. You can cover yourself over again," said Karen. Sally had hung the drainage bag at the side of his bed on a white plastic coated hanger.
With that, the debris was placed in a bag attached to the side of the trolley and the nurses left Dave. Being catheterised was a strange feeling. As soon as he was alone, he pulled back the gown to have a look. The pale blue silicone tube was emerging from the tip of his penis and connected to a large bore clear plastic tube which led to the drainage bag which was starting to fill with his pale yellow urine. He felt his penis and could feel the hardness of the catheter running down the underside of his penis.
Emma came back a few minutes later holding a plastic tube with a nozzle on it. "I'm afraid you've got yet another enema, Dave. This one's a Fleet enema and should work in about five minutes or so. If possible, please try to hold it for fifteen minutes. Sorry. we forgot to give this to you earlier." Dave rolled onto his left side and assumed the usual position. Emma lubricated her finger from the tube of KY Jelly kept in Dave's room and inserted it as far as possible into Dave's anus. She then inserted the nozzle of the enema and squeezed the bottle until all of its contents were inside Dave. She put a bedpan beside him and told him to retain it as long as possible. After five minutes, Dave felt the pressure mounting inside him, but he was determined to hold on for as long as possible. Fifteen minutes came and he couldn't hold on any more. He rolled over and sat on the bedpan, thinking how awkward it was to actually sit on one in bed. He let go and his bowels emptied again and again. The Fleet enema had produced plenty of water stool and Dave was stuck on the bedpan for nearly an hour. Eventually he buzzed for assistance. Emma and Karen came in and Emma took away the bedpan. Karen washed Dave's bottom for him and gave him another clean gown to put on.
Shortly afterwards, Karen came in with the porter to take him to theatre. Dave was again invited to transfer onto the trolley and Karen covered him with a blanket. She placed a pillow under his head and raised the backrest to a comfortable angle. Karen picked up Dave's notes, x-rays and scans from the ward office and she, the porter and Dave set off to the lift. On the main corridor, they turned right, past the main entrance and up the corridor to the theatres. The porter pushed Dave's trolley up the slope to the theatres and right into the holding area. Dave's trolley was positioned well away from the other patients because of the infection risk. He was transferred from the porter's trolley onto the theatre trolley by sliding the top part from one to the other. The porter removed the trolley and with a 'Good luck", left them. Karen handed over to a theatre nurse who checked Dave's wristbands and asked his name and date of birth. Karen cross-checked with her as she fastened a label with Dave's name, hospital number and a bar-code to one of his wristbands. The label also had 'T6' on it. "That's theatre 6, Dave," said Karen. "I'll collect you later to take you back to the ward. Good luck and don't worry."
There was a television in the holding area for patients to watch while they were waiting. Unfortunately it was one of those terrible Australian soaps which Dave detested so much. Fortunately he was waiting only five minutes before two staff in theatre greens and masks came to his trolley. He was asked his name and date of birth again. This was checked off against his wristbands and the theatre ticket. "OK, Dave, we'll take you to theatre 6 now." On leaving the holding area to go to the theatre corridor, Dave's label was scanned by a bar-code reader. "You're cleared off against our computer system, Dave. It's to ensure that the right operation is done to the right patient in the correct theatre!"
Dave was wheeled into the anaesthetic room where the anaesthetist was waiting for him. The anaesthetist checked his wristbands and details yet again. He had e.c.g. leads placed on his chest, a blood pressure cuff around one upper arm and an oxygen saturation monitor on a finger. She put a black rubber face mask on his face, asking Dave to hold it over his nose and mouth. It was connected to the anaesthetic machine by clear and blue concentric convoluted polythene tubing and she told him that it was oxygen and for him to breathe deeply. Dave could smell the rubber and a taste of something else. He breathed deeply as he was told. The ODA looked at Dave's hands and wrists and, spotting he cannula, held the hand out to her. She picked up the first syringe and, flipping up the cannula port, injected it into him. "That was lignocaine so that the anaesthetic doesn't sting." She next injected another small syringe. That was fentanyl to stop pain." Finally, she picked up a much larger
syringe filled with white fluid and connected to the cannula port. This she injected much more slowly, watching Dave's face as she did so. Dave felt a tingling sensation up his arm, then absolutely nothing.
He woke up to the words, "Wake up, Dave. It's all over. You're in Recovery now." He opened his eyes and found that he had a green transparent plastic oxygen mask over his face. The nurse, in theatre greens beside him, asked him if he was comfortable. Dave was aware of pains in his abdomen and told her so. She produced a syringe and filled it from a phial. Pulling up the edge of his gown, she exposed his right thigh. "Wriggle your toes for me. Sharp scratch" and, with that, she buried the needle in Dave's thigh. She pulled back to check that she hadn't got a vein, then injected a large dose of pethidine into Dave's leg. It hurts, thought Dave, as he drifted back into a drugged sleep.
Dave awoke back on the ward in his side room. Karen was there with a trolley and said to him, "I'm going to remove your catheter and put you in net pants with a disposable pad in case you can't use the urinal in time. Please try to pass urine into the bottle and I'll be back later to see how you're getting on." Karen pulled back the bedclothes and lifted Dave's gown. She asked him to raise his hips whilst she placed an inco pad under him. She then took a syringe and inserted its tip into the catheter inflation point. She drew back on the syringe gently so that she would not collapse the thin inflation tube running up the length of the catheter. She checked that she had collected 10 ml and that there was no more fluid in the catheter balloon.. She disconnected the syringe and told Dave to cough several times. As he did so, she pulled the catheter out and Dave gasped as the deflated balloon passed through his prostate and urethra. She helped Dave to put on the net pants and positioned the pad in place for him. "Please drink plenty, Dave. You're on a fluid balance check, so I need to know what you've drunk. I've put your name on the urinals so that I can check how much you've drunk and how much you've passed." Karen then removed the used catheter and bag from the bed, the inco pad and, placing them in a disposable bag on the trolley, wheeled it all out of the room, with a final, "Don't forget to drink plenty!"
Dave did as he was told and had emptied the one litre jug in half an hour. He then started on his cans of drink which he'd brought in with him. He wondered whether it would hurt the first time when he passed urine after having a catheter in place for a while, but his bladder didn't seem to be filling at all. After a while, Dave felt as if he was damp between his legs and, looking down at the net pants, discovered that the pad was wet. The tale-tell printing had washed away with the urine. Dave buzzed and Karen came. "I've wet myself and I didn't realise I was doing it," Dave said anxiously. "Don't worry," said Karen. "I'll get the doctor to see you, but that's not uncommon after having a catheter."
About half an hour later, a lady doctor came in with Karen and Anita. Karen was wheeling a drip stand with a bag of fluid hanging from it with plastic tubing attached. Anita was pushing a trolley with equipment on it. "I'm Dr Shepherd, one of the urology doctors. I hear that you're passing urine without realising it and I want to do a simple test. Is that o.k.?" Dave agreed he was asked to lie on an inco pad, having removed the net pants and pad, with his knees up and his feet apart as near his bottom as possible. The doctor put on a pair of sterile gloves and went to the trolley. She said to Dave, "I'm going to pass a plastic catheter into your bladder and then I'll run water in and I want you to tell me when your bladder feels full. Whilst I'm running the water in, I want you to clench your muscles as hard as you can to stop any water leaking out." She took a long, thin packet from the trolley and ripped off the top. She asked Karen for the sterile water which she tipped into the packet. "This is a self-lubricating catheter, Dave. It doesn't need any gel into your penis as the catheter has a slippery coating which is activated by the water. That should be long enough." With that, she pulled the catheter from the packet and Karen held Dave's penis so that the doctor could insert the catheter. It slid in easily and, when it passed the prostate, a little urine trickled from the end. "Hold the funnel of the catheter for me, Karen," said the doctor. Whilst Karen held the catheter in one hand and Dave's penis in the other to stop the catheter from sliding out, the doctor connected the end of the tubing from the drip bag to the funnel. "Clench those muscles tightly now, Dave, please and look at the ceiling," she said, and opened the valve on the tubing.
Dave laid back and tried as hard as he could to stop the fluid from flowing out. To his surprise, he couldn't feel his bladder filling, even though the bag was emptying. "That's enough now," said the doctor. "I'm going to pull the catheter out gently." She did this and Dave sat up. The inco pad was soaking. "It looks like you've lost bladder sensation and control, so I'll ask Karen to put a suitable pad on you and we'll see you in the morning."
She left, and Karen asked Dave if he would like a disposable or terry towelling nappy with rubber pants. Dave selected the latter, so Karen asked Anita to fetch some. Anita came back with a pile of nappies and two pairs of rubber pants in black shiny rubber. "These are the last ones left, Karen," said Anita. "I'll put several on so that you won't need changing for a while. Still keep drinking and the night staff will change you before bed." Dave was carefully diapered with several thicknesses of nappies and the black rubber pants were pulled on over the top. Anita checked to make sure that all of the terry towelling was tucked inside the pants to prevent leaks.
Dave drank plenty as he'd been told and the night staff changed his nappies just before bed and again first thing in the morning. Dave really enjoyed the sensation of a wet nappy and the feel of the rubber pants between his thighs. Later the doctor who had done the endoscopy came along with two men in suits. "These gentlemen are from the hospital's administration department and legal department. There was an accident during your endoscopy when I severed the nerves to your bladder. I'm afraid that you're going to be incontinent of urine from now onwards. We will not contest a negligence claim for the damage which you've suffered." The legal chap spoke, "We suggest that you consult a solicitor to negotiate for you and we'll pay the bill." The other man spoke, "The hospital is terribly sorry for the mistake and the suffering and inconvenience which this will cause you in the future." The doctor said that he would arrange for the hospital's continence advisor to see Dave later that morning to discuss how he would cope with the problem and that the endoscopy had shown bowel problems which would not be treatable. Therefore the faecal incontinence was going to be a continuing problem. He also said that he felt that Dave would benefit from weekly enemas to be administered by the district nurse in Dave's own home and that he would arrange that with the Community Nursing Service.
Later that morning, a nurse came in and introduced herself as the hospital's continence advisor. She outlined the possible ways for dealing with the problem. "The first choice is an external catheter or sheath worn over your penis with a leg bag to collect the urine draining. Second choice would be a urinary catheter either through the penis or through a hole cut in the abdomen, suprapubically. The final option is some form of absorbent pads," Dave immediately jumped in at that point. "Since I'll still have the faecal incontinence, I may as well use the third method. She started to talk about disposables, but Dave said, "I'll use nappies and rubber pants and I'd like the hospital laundry to wash them for me since the hospital caused the problem." She tried to talk Dave out of this solution, but he was adamant.
When she left, he chuckled to himself. Not only was he to get compensation, but he would be wearing nappies and rubber pants for the rest of his life and getting regular enemas from nurses! Could life get any better?
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