The operation as I saw it.
Which wasn't more than about two seconds long it seemed to me.
As I walked into the operating theatre with the ward nurse I met my Consultant ENT Surgeon in the corridor. I have had many a chat with Consultant surgeons in corridors in the past, it seemed very natural to stop and speak. I shook his hand and asked him if he had had his lunch. He had and his hand was not shaking either! We wished each other well and I went into the anaesthetic room. A situation that was so frequent and regular for me over many years working in the hospital surgery environment. Only this time, I was the one asked to lay down on the trolley by a very young girl in training. She seemed only just out of school but then perhaps I looked like that once, a long time ago! I took the opportunity to show her how to speak to a deaf patient (I had had my only hearing aid and glasses taken back to the ward). We were alone at the time and she was a learner who had been asked to not leave me on my own. It was rather instinctive on my part, as I had done it so many times before on other subjects for new learners and I was a good example of the potential problems she would meet later in her career.
It is not easy to lip read without your glasses on, nor is the orientation helpful when you are flat on your back and not standing in front of someone as you usually would be to concentrate on their face. When the more senior assistant came in he needed no help in getting his questions answered by someone who couldn't hear. It may not have been BSL but his signs were clear and direct regarding when I had last eaten or had something to drink. His routine questions in a routine situation for him. I had decided in advance that I would be extra vigilant and test the way deaf patients are communicated with in hospital. This is one very nervous time when questions and answers are important. Informed consent means understanding what is happening to you and why. Being the centre of attention means several people acting at once and you may be suddenly grabbed where you weren't expecting it which distracts from what you were trying to concentrate on. Added to this is the situation were even hard of hearing people, who have got used to an increased level of hearing find themselves out of their depth without the hearing aid in place. It is probably best left in until the last moment but it is hard to remove someone else's aid from their ear. It is an orientation thing done by a wearer not a helper for most people. I knew what was going to happen but looked to see if due consideration was given for my lack of hearing. They were not to know that I knew what to expect.
The Consultant Anaesthetist approached me from the front and said who he was. I did not hear it but he was close enough to see that he was speaking directly to me. The details were not important it was the deed that mattered. Without my glasses on my peripheral vision was no use to me and only direct actions close in front of me could be seen. Any questions would be missed all together not just misunderstood, it is easy to just get on with it without asking. It takes time and persistence to get the understanding from someone not used to the words in common medical use. There may not be any simple alternatives to use. Many jobs have their jargon words not in common use in the world outside. After making life easier for the assistants, by raising my legs even before they had asked, when they were placing the leg DVT prevention apparatus on, it was the turn of the junior anaesthetist who had seen me first thing in the morning.
She put the needle into my hand exactly as I was expecting but I wanted to see how it was done to someone who could not hear the explanations. It is so routine to them that it is often done without thinking, even the information "a small scratch coming NOW" will not be heard and take someone by surprise if they didn't expect it because they did not hear the words of warning. With their face looking down at the hand, lip reading it is not possible, if your head is on a pillow the needle comes suddenly and unexpectedly unannounced. The reflex action from being pricked is to pull the hand away so if it is not securely held the needle can tear out of the vein. This is particularly awkward when the remaining choice of veins are even more difficult to find. I lifted my head and said it doesn't work that way for deaf people and she turned her head to look straight at me for the first time and smiled. A second lesson for the day, perhaps the next patient she has will benefit from it.
The Consultant Anaesthetist approached me from the front and said who he was. I did not hear it but he was close enough to see that he was speaking directly to me. The details were not important it was the deed that mattered. Without my glasses on my peripheral vision was no use to me and only direct actions close in front of me could be seen. Any questions would be missed all together not just misunderstood, it is easy to just get on with it without asking. It takes time and persistence to get the understanding from someone not used to the words in common medical use. There may not be any simple alternatives to use. Many jobs have their jargon words not in common use in the world outside. After making life easier for the assistants, by raising my legs even before they had asked, when they were placing the leg DVT prevention apparatus on, it was the turn of the junior anaesthetist who had seen me first thing in the morning.
She put the needle into my hand exactly as I was expecting but I wanted to see how it was done to someone who could not hear the explanations. It is so routine to them that it is often done without thinking, even the information "a small scratch coming NOW" will not be heard and take someone by surprise if they didn't expect it because they did not hear the words of warning. With their face looking down at the hand, lip reading it is not possible, if your head is on a pillow the needle comes suddenly and unexpectedly unannounced. The reflex action from being pricked is to pull the hand away so if it is not securely held the needle can tear out of the vein. This is particularly awkward when the remaining choice of veins are even more difficult to find. I lifted my head and said it doesn't work that way for deaf people and she turned her head to look straight at me for the first time and smiled. A second lesson for the day, perhaps the next patient she has will benefit from it.
When you have no hearing at all because your hearing aids are removed there is no environmental sound to guide you. No beeping monitors, no hearing approaching footsteps, discussions go on of which you are not aware and people suddenly coming into your vision unannounced. Take off the glasses and its all a blur as well, with things touching in unexpected places that are nowhere near your surgery site which is were you might reasonably expect it to be and all at different times. No warning came from anyone. It was all gentle and purposeful, positive action but to the nervous patient it was possibly in need of some initial direct explanation before the free for all began. This is a long way away from most peoples daily experiences.
She was all I could see in front of me and then the oxygen mask was held over my face. Not a surprise for me, it was expected, but it came silently and suddenly from above my head when I was concentrating elsewhere. I could not see then, nor hear and I was not aware of anyone else in the room but there must have been at least four people there somewhere. It was soft and comfortable with a gentle cool breeze on my face, I was waiting for this moment so that I could remember it and describe it all later.
She was all I could see in front of me and then the oxygen mask was held over my face. Not a surprise for me, it was expected, but it came silently and suddenly from above my head when I was concentrating elsewhere. I could not see then, nor hear and I was not aware of anyone else in the room but there must have been at least four people there somewhere. It was soft and comfortable with a gentle cool breeze on my face, I was waiting for this moment so that I could remember it and describe it all later.
Off I went into the Land of Nod and as soon as I felt warm and happily on my way I was suddenly being dragged by the hair through the concrete underworld of the utilities section of Gatwick Airport, amidst what looked like concrete blocks in shadows and contrasting corners with light patches. Then I was waking up being transported to my bed in the ward. Or that was my interpretation of how it felt to me! On reflection it must have been the exposed pipework of the hospital corridor ceiling as I passed under it on the way back, as my brain finally reached a state of memory long after the operation had finished. Even then it was still struggling to find a rational explanation for it and put two and two together to make five! It was like an unexplained bad dream and I didn't dare ask what they had given me to cause it.
Do hospital designers think of how ceilings affect patients who have a different view and perception of the architecture than that of the hospital staff?
Do hospital designers think of how ceilings affect patients who have a different view and perception of the architecture than that of the hospital staff?
Recovery.
On returning to the ward my head was bound in a large soft padded bandage. My left ear had been operated on and there was no pain and it felt reassuringly comfortable. I still had no hearing in either ear, of course, so the best approach to communication was with my pen and notebook. My mouth was very dry and no sound came out at first. The drying effect of the oxygen mask only made it worse. It doesn't surprise me that so many semiconscious patients want to rip the mask off their face when they first feel it. My throat had a dry lump in it which I had been warned about in advance and a jug of iced water was brought to get things lubricated again.
It was now 7pm, seven hours since I last had a drink and almost twenty four hours since I last ate. I was given a plate of fish and chips with baked beans. there was no saliva to chew with and I choked on food that just wouldn't go down. The solution was to dip the chips in my tea or put on lots of sauce and include grapes for extra moisture. The fish would have to wait for another day. Who needs cordon bleu hospital food at a time like this?
My neck was stiff and sore at the muscle behind my left ear as I stretched it turning my head to the left. To the right side was fine. After about three hours I got out of bed for the first time and went to the toilet. There was only a very slight wobble and I had no problem adjusting to it with none of the dizziness I was expecting. Being upright again and walking caused me immediate raging tinnitus but no seriously bad effects. It was important to be sure and steady first before setting out on this mission. The desire to go to the toilet is a strong impulse. Once learnt at an early age it becomes distressing when prevented in adulthood. It permeates the drowsy brain and makes you do this familiar thing half awake during the night. Feeling light headed and unsteady is a common problem from anaesthetics and in this case, the surgery as well. The procedure is to take your time. First sit up, then put your feet over the side of the bed, plant the feet flat on the floor. A pause before each part then stand up, check all is well and off I went, very surprised and delighted. I had soluble paracetamol (I couldn't swallow tablets) for a light frontal headache.
By four hours after returning from the operation the pain relief was wearing off, my jaw was mobile but stiff and my top teeth felt as though they had been pulled out. The joint on the left side of my jaw felt like it had been dislocated to give him a better view of my inner ear and then put back into place afterwards. It was not too extreme but there was nothing else to do but feel it and imagine why. The next dose of paracetamol quietened it down and the teeth felt secure again (they never were loose, of course, chewing was perfectly comfortable). It was the referred pain from the facial nerve and bruising from the surgery behind my ear.
I was now wide awake again but if this had been 4pm instead of 11pm I don't think I would have felt like going home. I think the physical effort of carrying suitcases with stairs and even a short walk to the railway station would have produced severe tinnitus and increased head ache. The effort would have been exhausting and probably catching me half way home in distress. Only a short car ride would have worked.
As it was I went nowhere and enjoyed a comfortable rest overnight with tea brought to me in bed in the morning to ease my still very dry mouth.
My neck was stiff and sore at the muscle behind my left ear as I stretched it turning my head to the left. To the right side was fine. After about three hours I got out of bed for the first time and went to the toilet. There was only a very slight wobble and I had no problem adjusting to it with none of the dizziness I was expecting. Being upright again and walking caused me immediate raging tinnitus but no seriously bad effects. It was important to be sure and steady first before setting out on this mission. The desire to go to the toilet is a strong impulse. Once learnt at an early age it becomes distressing when prevented in adulthood. It permeates the drowsy brain and makes you do this familiar thing half awake during the night. Feeling light headed and unsteady is a common problem from anaesthetics and in this case, the surgery as well. The procedure is to take your time. First sit up, then put your feet over the side of the bed, plant the feet flat on the floor. A pause before each part then stand up, check all is well and off I went, very surprised and delighted. I had soluble paracetamol (I couldn't swallow tablets) for a light frontal headache.
The night time.
By four hours after returning from the operation the pain relief was wearing off, my jaw was mobile but stiff and my top teeth felt as though they had been pulled out. The joint on the left side of my jaw felt like it had been dislocated to give him a better view of my inner ear and then put back into place afterwards. It was not too extreme but there was nothing else to do but feel it and imagine why. The next dose of paracetamol quietened it down and the teeth felt secure again (they never were loose, of course, chewing was perfectly comfortable). It was the referred pain from the facial nerve and bruising from the surgery behind my ear.
I was now wide awake again but if this had been 4pm instead of 11pm I don't think I would have felt like going home. I think the physical effort of carrying suitcases with stairs and even a short walk to the railway station would have produced severe tinnitus and increased head ache. The effort would have been exhausting and probably catching me half way home in distress. Only a short car ride would have worked.
As it was I went nowhere and enjoyed a comfortable rest overnight with tea brought to me in bed in the morning to ease my still very dry mouth.
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