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Tessa Richards: Postoperative posting

15 Sep, 08 | by BMJ

Tessa RichardsSarah Palin may have raised the profile of female politicians, but I’m lifting my glass to the girls who saw me through surgery last week. I did spot the odd male among the panoply of health professionals who looked after me, but they were thin on the ground. From the consultant surgeon and anaesthetist to the kindly soul who sang as she emptied rubbish sacks, mine was a female dominated “hospital episode” and none the worse for it.

Being a patient is always a salutary experience. I had forgotten about the solidarity between occupants of adjacent beds; and the need to accommodate all manner of sights, sounds, sentiments – and suffering. The pre-operative moments of farce, when a large black arrow is drawn on the “effected” side and you struggle to maintain your dignity in a unisex surgical gown with missing strings.

Less predictably, I was struck by how well the ward was run and the notable esprit de corps, despite the high dependency of the patients. On previous admissions I had been struck by a sense of poor morale and signs of turf wars between doctors and nurses. Both are deeply worrying for patients, not least when the different camps push rather different messages and issue different instructions.

Remarking on the good atmosphere my staff nurse confirmed this. “This is a really good unit to work on,” she said. Relations between doctors and nurses were very good, she underlined, and she clearly valued the fact that the medical team were so receptive to ideas nurses put forward about improving the service.

As a closet sceptic about the feminisation of the medical workforce I have to confess that the advantages of a shared universe had passed me by. Meeting my trainer clad consultant wheeling her 10 month old baby along a hospital corridor got me thinking. Who better to understand the 360 degree demands being put on the nurse just back from 10 months’ maternity leave?

Another thought was whether we can we do better at managing postoperative pain? Patient controlled analgesia via intravenous pumps is clearly tremendous when it works, but it does not work for everyone. I was as violently sick on my intravenous fentanyl as I have previously been on intravenous morphine. One or two of my fellow patients appeared to be in much the same boat. One gets through the shortlived ghastliness of course, but is it inevitable?

I’m also left wondering whether we take informed consent to extremes. In cases where the operative risk is low and surgery is routine, as it was for me this time round, it was no big deal to be told that I had a one in six hundred chance of not surviving my operation … But when patients are very ill and the risks of surgery very high (as was the case for me in 2004) I was jolly glad to be spared the grim truth. My husband knew, as relatives clearly must, but is it not enough for the patient to know that the operation will be extremely challenging? Most, I suspect, will already know, or sense when the stakes are high. Those who want the odds spelt out will surely ask for them? I have to confess, this time round, to being rather taken aback at how stridently the bottom line was presented to one fellow patient.

But the main thought my hospital stay has provoked is how simply wonderful it is to be well. And when you are not, just how much difference good cheer and skilled support makes. I have just had both in spades from the staff on my NHS ward, and I can’t thank them enough.

Tessa Richards, 15 September 2008

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  • Hugh Ip

    Dear Tessa,

    Thank you for your thoughtful post. I wish you a speedy recovery.

    Kind regards,
    Hugh

  • Anne Savage

    I was delighted to learn of Tessa’s recovery from her latest op. I had intended to wish her well beforehand but, as always, something intervened.

    I wonder if her hospital was the Whittington? I once, when a patient there, said to my nurse ‘You know I like this ward. You all get on so well’. I well remember her reply. I love this hospital’ she said ‘I’ve tried several times to leave but always came back.’

  • Seye Abimbola

    Dear Tessa,

    I wish you strength and the quickest recovery possible. Some times, all a patient needs might be that “good cheer and skilled support” and of course, a grateful heart like yours.

    Seye

  • http://BJM tom

    Congratulations. You have just had a cost effective encounter. Over here in the US these are rare.
    Careful analysis of the VP contender you mentioned does not suggest that she will be part of any reforming of our out of control healthcare system in the US. It is hard to know if either candidate is up to it. Although you may have some long waits with the NHS, we bankrupt people, and I say that as a cancer doctor nauseated by the whole system. Good luck to you!

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