Month: December 2014

My Prostate Operation Was Cancelled – After 3 + hours of waiting.

Well, it’s taken me a while to get my thoughts together after what turned out to be a really stressful morning. Truth be told, I had probably been stressing for quite a few days but had not realised……
As I said in my previous post, we had been requested to arrive thirty minutes earlier than the 07:00 originally planned. This was, supposedly, so that I could have my pre-operation meet with the surgeon and anaesthetist. So my wife and I dutifully presented ourselves at 06:30 in Theatre Admissions and were, almost immediately, shown through to a consultation room.
A nurse arrived, wrote out a luggage tag for my small holdall, and attached a fancier version to my wrist. So far all was moving along quite nicely. Next she started taking / checking my details and very soon I began to wonder what the point of the pre-operation assessment was since all the questions were repeats of Wednesday afternoons interrogation. My doubts further increased when she informed me that she didn’t have my blood details nor my ECG results both of which were part of the Wednesday session.

Already somewhat stressed, in anticipation of the forthcoming procedure, I was beginning to get a little terse. Not just that, but I was also beginning to wonder if they knew what I was in for. A thought that was reinforced a few minutes later when I was invited to get changed. Some of you will remember from my previous visit, for the template biopsy, that I had been given a gown which was way too small and couldn’t be secured. In an attempt to prevent the same indignity I asked for a larger gown. Yet again I was offered a small size. It was obvious that it wouldn’t even fit across my shoulders, let alone do up at the back. Almost grudgingly I was offered a “bariatric” gown. I muttered “whatever that is ” under my breath. Obviously not under enough, as I was informed “oh they are huge !!! “.
As she handed me my bell tent I was asked “what is it you are having done? ” I replied “my Prostate!! “. “Then you should take everything off!!” she informed me.

With that I was left to change. The gown had enough room in it to hold a small disco but at least I could fasten it up. And, best of all, my new dressing gown was of sufficient length to reach the lovely sage green pressure stockings I was sporting. This new vision of sartorial loveliness was finished off by my new suede moccasin style slippers. Now, properly attired, I returned to sit with my wife in the consultation room.

There then ensued a, seemingly, long wait. In truth it was probably only minutes but eventually the anaesthetist arrived and after he had confirmed my details, and repeated many of the questions from Wednesday afternoon, and from earlier this very morning, he ran through what the order of play would be.

For the first time the duration of the operation was mentioned. I had been under the impression that this was to be a two hour procedure. Nope, this was to be four to five hours in duration. Suddenly the first penny, of a whole bag full, dropped and the true magnitude of this operation began to sink in. Five hours!!! He also mentioned that it was possible that the robotic basis of the operation could switch to full open surgery should any problems arise. This had always lurked at the back of my mind and, to be honest, that is where I kept it filed. That is, until the session with the surgeon.

Fast forward a few minutes….

Mr. Wilkinson talked us through the operation and thoroughly explained risks. How little I knew. Over the last couple of years I have reviewed the implications of having this operation and thought that I was pretty well versed. Trouble is, I had been focusing on the post operative time frame. I had not paid too much attention to the detail of the surgery itself.

He, Mr Wilkinson, listed the various risks involved with a radical prostatectomy, starting with how difficult it was going to be to find the little sucker. Especially given the route taken during keyhole surgery, in through the abdomen then turn due south and head for the pelvic zone.

Add to that the fact that the robot has fixed length (but short) arms. I know some folks who are like that when it comes to buying their round in the pub. Next up was the proximity of the prostate to my bladder which introduces a risk of damage over and above the urinary incontinence which is to be expected. Moving swiftly on, next on the list is the proximity to the bowel.

New news here was that the prostate could be stuck to the bowel and that this could have been caused by, if not caused by then exacerbated by, the biopsies I had as part of the original diagnosis and active surveillance regime. At no time was it ever explained to me that the biopsies, TRUS or Template, could have negative impact on future surgery. Apparently during the prostate operation they mighty have to peel the bowel away from the prostate. The biopsies could contribute to any adhesion between the bowel wall and my prostate and the act of separation could cause damage that would have to be repaired. If such damage occurred it would require a colostomy to allow the repair to heal. Obviously, once the repair was healed there would have to be another operation to undo the colostomy. My four to six weeks recovery period suddenly looked to be extending with the possibility of the further surgery and recovery period.

Continuing on with the inherent risks of this surgery, let’s not forget that during the procedure I would be tilted head down by approximately 30 degrees. This would cause my innards to slop towards my head, thereby putting pressure on my heart and lungs. Apparently this is a negative thing.

The coup de grace was  the underlying small print of robotic surgery, if they ran into any difficulties, i.e. the Da Vinci machines short arms couldn’t reach, they would revert to the good old fashioned procedure and open me up from stem to stern.

Bottom line for me was that, due to my 18.5 stone (259lb) weight, the risk factors were double the norm.

This operation, and the potential ramifications, was taking on mammoth proportions. And now, the anxiety I was already feeling, was ratcheting up to whole new levels. I really was beginning to feel that I was making a big mistake. But, despite my misgivings I still signed the consent forms.

You may well ask “Why?” Why proceed when I was obviously having doubts.

I can offer no sensible answer. Guilt, Fear, Not wanting to let anyone / everyone / myself down.

After Mr Wilkinson left, my wife said “I fully expected you to refuse to sign that “.

Her statement just added to my anxiety and it was at this point that the anaesthetist returned to ask if I would agree to an epidural. As there was the possibility of my robotic surgery converting to full open surgery he thought it might be a good idea to give me an epidural to help with the pain management.

It was then that I experienced what I can only describe as a “crisis “. It wasn’t that I was crying, there was no wailing and gnashing of teeth, just that my mind was in total turmoil. I was in a flat spin. I really don’t know if I was coherent but I do think I was borderline having a panic attack. I couldn’t answer him. I tried to explain that I was seriously thinking that I shouldn’t go ahead with the surgery. He sat there patiently until I regained my self control and eventually I informed him that he should go ahead with the epidural.

So I was still going ahead. I think that I probably convinced myself that it was normal to have doubts and that I was probably magnifying the issues out of all proportion.

At around 09:00, my wife, took herself off to work and I went to sit with the other surgical victims where I waited for nearly an hour. During this time I was brought a cup of tablets, my antibiotics, anti vomiting, anti anti everything etc etc. And a small cup of water to wash them all down. This was the only drink I had since 05:30. The nurse that delivered them said something that I didn’t quite catch but when I asked she apologised for the long wait and informed me that there was meeting underway to discuss if my operation was to proceed as there was an issue regarding availability of a bed for me after my operation.

Around 10:00 Mr Wilkinson arrived and took me off to a consultation room. He explained that my operation had been delayed due to the beds issue. That he and the other consultant, Mr Solomon, had decided at around 09:30 that the operation was a no go. At around 10:00 the management had given permission for the operation to proceed but by then this was considered to be way too late. The operating list for Friday was morning only, such a late start would mean changing members of the surgical team mid operation and a probable finish time around 17:00. Adding to the risks previously outlined and putting the surgical team under the clock, more so than they would normally be. All in all, not good for the patient, Me! And not good for them.

To say that I was relieved would be an understatement. I had a long chat with Mr Wilkinson about my earlier “crisis” and whether surgery was the right option for me. The net of this was that the reschedule of my operation would be deferred until after Christmas.

To be quite honest,my wife and I are taking this time to rethink if this is the right way to go. Right now it doesn’t seem that surgery is for me.

I think, fate was on my side, that this operation was never meant to be.