Oddly, I looked forward to the day. It was partly the thought of being “made whole,” partly it being a different day from the normal, and partly a chance to experience the NHS doing what it does well.
I don’t think I’m a masochist, but I did like the idea of the scalpel slicing through my skin and my flabby body entering a catabolic phase. Plus I liked the surgeon. He knew I’d once been the editor of The BMJ, and said, “I think it will be better for you and us if you’re asleep.” I agreed. As I left the outpatient appointment, I said: “I look forward to being under your knife.” “We look forward to cutting you open,” he responded. All very reassuring.
I arrived in the surgical lounge at St Thomas’s Hospital at 7.15 am, having admired the full moon beside Big Ben and remembered Wordsworth’s great poem. I saw the surgeon just after 7.30 am and was the first on the list. I then saw a nurse, the junior anaesthetist, the anaesthetic nurse, the consultant anaesthetist, and then the theatre nurse. All asked me about consent, allergies, and what operation I was having. They wanted as well to see the arrow pointing to my right inguinal hernia, a sizeable beast. I know the evidence for the value of checklists, and I thoroughly approved.
I put on my paper pants, gown, and stockings, and then was led through to the frantically busy theatre area where they have 12 operating theatres. The consultant anaesthetist was ready, and we chatted as he put in my drip and did his thing. He said how much he enjoyed working at St Thomas’s: good people who are always willing to listen to ideas for improvement. I reflected how I’d come across staff from Ireland, the Philippines, South Asia, Eastern Europe, and the West Indies. I don’t know who is going to look after us ageing Londoners if the anti-immigration zealots have their way.
Next I knew it was just after 10 am and I was in the recovery area, feeling fine. I had mild pain, but nothing severe. I didn’t feel at all sick. The recovery nurse was from Limerick in Ireland, where my grandmother was born. She gave me some water. I talked about how I’d just been reading a book in which a man had an amputation at the beginning of the 19th century, and how he had to be filled full of rum and have six men hold him down.
I told the same story to the anaesthetist, who said how assistants often lost their thumbs then because the surgeons had to operate so fast—and inadvertently sliced off the thumbs of their assistants. I saw both the consultant surgeon and consultant anaesthetist within a few minutes of waking. I mentioned to the anaesthetist, in response to a comment he made about how easy it had been, the famous phrase that “anaesthesia is 99% dead easy, 1% easy dead.” To my amazement, he’d never heard it and said he’d use it in his teaching.
The mildly unsatisfactory parts of my experience were the least important parts. I could have left the recovery room at 10.30 am, but they couldn’t get a porter. Eventually, at about 11.15 am, the ward sister wheeled me down to the recovery lounge. Then there was no telephone signal in the recovery lounge, and the WiFi didn’t work. They said I couldn’t leave the area as I still had a cannula in my hand, but I wanted to ring my wife. So a nurse accompanied me to the corridor.
I was home by just after 1 pm feeling fine, and I ate my delayed breakfast of porridge, fresh grapefruit juice, and two (rather than my usual one) slices of toast. It was all especially yummy. The rest of the afternoon I spent in bed: emailing friends; reading a complete chapter of the biography of George Eliot and an insightful article from Grayson Perry arguing that white, middle aged, middle class, heterosexual men running the world is bad both for them (us) and everybody; listening to Lynda Bellingham’s beautiful interview on why she is stopping chemotherapy for her metastasised colon cancer to enjoy Christmas and then die; together with thunder and rain in the window; and drinking tea and eating cake. I can enjoy such an afternoon with a clear conscience because of my operation. I, remarkably to me, have no pain or nausea. Plus everybody is being very nice to me, including some who are usually keen observers of my many, persistently unrepaired faults.
It wasn’t like this 25 years ago when I had my left inguinal hernia repaired. I was kept in overnight as was usual in those days. And I was in the women’s ward as there was no bed in the men’s ward. I slept much of the afternoon, stupidly declined a shot of morphine in the evening, and then woke up with pain in the night. I was reluctant to get the doctor out of his or her bed to prescribe something but eventually had to. Those were the days before checklists, protocols, and pathways. Even further back, in the 1970s, my father had two hernias repaired at once and was in hospital for two weeks. “Productivity” has certainly improved in some parts of the NHS.
Truly, there is much to be said for the sick role, particularly if you feel entirely well. So if you’re a bit down or stressed, I recommend some minor surgery to lift your mood . . .
Richard Smith was the editor of The BMJ until 2004. He is now chair of the board of trustees of icddr,b [formerly International Centre for Diarrhoeal Disease Research, Bangladesh], and chair of the board of Patients Know Best. He is also a trustee of C3 Collaborating for Health.
Competing interests: Nothing further to declare.