Laparascopic Total Nephrectomy. The experience.

 

In  the autumn of 2023 I had a routine ultrasound scan which showed up, incidentally, a shadow on my left kidney.  Further CT scans of the kidney, followed by biopsy proved this to be a cancerous tumour at an early stage.
Its development was observed, on and off (sigh), over the next couple of years by the oncology team at the Royal Free London hospital (RFL) until August '26 they suddenly hit the panic button.

And then ...

Fri 28 Aug, just after 2pm,  I get a phone call from RFL Radiology.  Come in at 10am on Mon 31 for an MRI scan.  You what ?? 
It's a Bank Hol and 10 am is too early.  It takes me an hour and a half to get to RFL.  No breakfast and I'm gonna be trashed at that time of the day.  I email them asking if we can do a later appointment.  (reply an hour later. No.)

Half an hour later I get a pdf from Admissions telling me I'm gonna be admitted at 7.30am, 1 Sept.  There appears to be some unstated mad panic going on.   On top of which it's the same T&Cs as far as I'm concerned.  There's going to be no point going to bed on the Monday night.

Saturday I go down the library to print off the pdf so's I've got something in my hand when I turn up at Admissions.

Bleary and confused I show up for the MRI.  The radiographer admires my ability to breathe out and hold myself on the residual air long enough for her to get clear snaps.   Makes me think of the times I've seen people "winded" and the panic on their faces as they couldn't breathe at all.

Monday night I lay awake till all hours contemplating what I take to be my last night as a whole person.  I sleep for an interval of mebbe an hour, then I'm awake again.  And so on and so on.

I get to the RFL in good time to find a long queue at Admissions.  I don't actually get documented till 10 am.  smh

I get gowned up and me effects lockered.  I don't understand why the gowns are always open at the back when the access is going to be through the front.  But hey.

Then I'm shipped from the South Site to the North Site and await consultation with the surgeon.

She's brusque in her manner.  Do I know what's going to happen to me today ??  "I'm expecting you are going to chop out my left kidney."  She visibly flinches.  I dunno why putting it pithily in the vernacular so should be affecting.

There may be complications with the surgery.  I sign my consent to whatever it takes to get the job done.

She asks for a second consent, that my removed detritus may be used for education and research.  I say I'm good with education but concerned that I don't want my bits to be HeLa'd.  I have to explain to her about Henrietta Lacks, who died of cancer 75yrs ago, and whose cells are still bubbling away in test tubes.  The eternity cell.

She thinks that's marvellous, but I don' want none of thaat.  I come from a different school of philosophy.

She says you can't separate education from research and strikes out the request.

Things are frosting between us, and they weren't warm at the outset.  As she starts to leave, I ask her what does robotic surgery mean.  She snaps back "keyhole surgery".   I suspect if I'd asked her what does keyhole surgery mean, she'd have snapped "robotic surgery".

There's a hiatus.  Then a Pimply Faced Youth appears with a vaccination survey. 
"Have I had the winter flu jab ??"

"No".

"Did you have last winter's flu jab ??"
"No"

"Did you have the annual Covid boosters (23-26)??"
"No"

"The third and fourth boosters for Omicron etc ??"

"No"
"But you had the initial Covid 19 shot ??"

"No"

The PFY's eyes were like saucers at this point.

Then it was the turn of the anaesthetist.  Nicola.  She was a honey.  "How did you sleep last night ??"
"I didn't.  Whaddja expect ??"

"That's quite regular.  I'll give you a couple of hours sleep this afternoon."

Did I have any allergies ??
"I take it you mean penicillin principally, but no, I'm not allergic to anything except ....  in my dotage I've found I'm allergic to cod."
"Cod ??"

"Yes, strange isn't it.  A few years ago I saw cod in the supermarket and thought, that'd make a nice change.  Cooked it that evening and woke in the middle of the night in a terrible fever, soaked in sweat and the bedroom stinking of cod.  My sweat tasted of cod !!
Too strange.

Coupla months later, I saw some cod fishcakes and thought they'd have little enough cod in them to make a test.  I just cooked one and had a reaction.  Not too much but definite reaction.  So, no more cod for me."

"Any family history of diabetes ??"
"Only my adopted brother."

I think it was she who told me the sudden rush was because the lesion looked like it could push out blood clots through the renal vein and we didn't want that sorta thing going on.  She also said the surgeon hadn't had time to look at the MRI scan yet   smh.  I couldn't believe she was going to busk it, but discretion was the better part of valour at that mo.

She asked what I was expecting to have done and got the anticipated reply of radical, left kidney excision.  At which she produced a large marker and drew an "L" on my left forearm and then a large arrow pointing up in case anyone wanted to see the head of an ass.  She also drew a  line up the l.hand side of my torso.

She asked if I snored ??   Probably, but there's no one around to complain.  When I wake in the night I've a dry mouth so been breathing through it and prolly snoring.

She forewarned that she'd be putting a tube down my throat and, on waking, might feel soreness on account of it.  I've seen that tube and I'm not surprised.

And so, back to wait. .....

1 pm I'm trolleyed into theatre.  A large, bare walled, white room with one hell of a chill on it.  Honey is there with a colleague.  The acoustics make our voices so sibilant the bones in my ears rattle.  She tells me the surgeon has seen the snaps and it's all A ok for the go ahead.
I tell her I have one last request.  When she wakes me up, can she tell me first thing whether the procedure has gone to key hole plan or whether they've had to wade in wholesale.  "Yes.  Of course."

Honey endeavours to put a cannula in the back of my left hand while colleague puts an auto bp cuff on my right arm which breathes up and down as it checks my blood pressure.
Suddenly she exclaims "It's blown up !!" and we both stare at her.  She pulls out the needle and sticks it in another vein. 

I have oldster's hands,  sinews and veins and little by way of padding between them.  Leonardo coulda done his anatomical drawings from the backs of my hands in no time flat.

Honey again exclaims in exasperation "it's blown up" and tells me my veins make abrupt r.angle turns which foil her.  Really madam, we can complain about what I've done, which is my responsibility, but not about the way God made me.  Only how I've tried to maintain it.

A third attempt is successful and is followed up by another cannula upstream of the same area.

Her colleague meantime has dotted my torso all over with cardiogram points.  Screens and kit off to my right are showing waveforms.  She's strung me like a marionette and my heartbeat is beeping like in the movies.
It's time for me to lose consciousness and a kidney.

Honey wakes me in what must be Recovery.  She tells me the op took 3 hrs and that all went according to key hole plan. I'm left, moving in and out of consciousness.

There are curtains either side of the bed and an open one at my feet.  I'm on my back with my arms at my sides on top of the sheet.  My left arm is still cannula'd and my right is still cuffed.  Sometime I move my hand across the sheet and find there's a large patch beneath, over what must be the wound.
From the foot of the bed, there's floor space then a wall with a large clock facing me.  I wake on the hour, then doze 15 mins, wake, doze in a continuous 15 min cycle.

After nightfall the ward lights are dimmed and a nurse comes round closing the curtains.  I call out "can you leave that one so's I can see the clock".  She obliges.
In the course of the night, other wraiths come by and I have to repeat my call.  All oblige wordlessly.  I really appreciate this sympathy.  My 15 min cycle continues.

After dawn I'm disconnected and pushed down to a ward.  There I meet Amalia who tells me I'm now in her charge.  Am I in pain ??  "Oh yes".  She produces a large syringe and squirts a dose of linctus beneath my tongue.  It works.  I have a few more of those during the day and a couple of handfuls of pills too.

A nurse turns up.  She tells me she's come to remove my catheter.  My what ??  It dawns on me how I must've been kitted up since since I was knocked out.
"Take a deep breath and hold it."  I do and she wrenches the apparatus out in an action best described as a reverse whip.  It's a fraction of a second strike.  My deep breath comes out all at once as a pained gasp.  That tube is so long.  Through watering eyes I thank her for her experienced approach.

I resettle then breakfast arrives.  Some spoonfuls of porridge and a slice of toast and jam.  I take in where I am. A ward of four beds, three of which are occupied.  My near neighbour is an East Ender who's had a similar op, been there three days and had more than enough.  Most of his day is spent trying to talk them into discharging him and threatening to discharge himself.

He provides the most useful advice I got given.  Hold a pillow to your wound site.  It provides some ease.

I find there's no pad on my abdomen anymore.  That must've been taken off when they moved me out of recovery. I didn't notice.

Mid day I'm served soup, shepherd's pie and tea and a biscuit.  Knowing hosp meals are tiny, I'd brought a packed lunch to supplement this but that was with my clothes, phone etc, in a locker at the other end of the building.  Sheesh.

A bit after two in the afternoon, I'm told they'll take some blood samples and if they're ok I'll be discharged.  Sample lady takes one look at the cannulae hanging off my l.arm and opts to take the samples from my right.

Coupla hours later the surgeon appears with two confederates and tells me I'm good to go.  I thank her and ask if her companions are students or collea ....  "They're doctors" she snaps before I can finish my question, turns on her heel and sweeps out with them behind her.

I ask Amalia if we can do something about the cannulae still hanging off my l.hand and digging into my veins every now and then.  Yes.

The bag of my stuff is brought from its locker.  I find I can't do the zip up on my trousers as my waist is so swollen.  They did forewarn to bring loose fitting clothing but I hadn't realised they meant a sack with holes for my legs.

I ring my good chum Mert who'd volunteered to collect me when the moment arose.

I'm presented with a lucky bag, a week's worth of addictionable pain killers and a bumper box of laxatives, as a souvenir of my stay at RFL.  I barely wobble out into the Hampstead air when my lift arrives and takes me away from all that.  (6pm)

Mert gets me indoors.  Satisfies himself I'm suitably stocked and kitted up for the siege to come, and leaves me to it.  I take the tape measure and head to the bathroom to assess the damage. My waist is 40 inches instead of its native 33.  My belly is a barrel below my ribs. (I've got a couple of litres of CO2 separating my organs in there).  There's a 5 inch gash across my abdomen.  The back of my l.hand is blue.

That dot on the picture left, just below the scar, is my umbilicus.

I search out the baggiest trousers I've got, and my bracers cos there's no way I can do them up, so's I have some semblance of propriety around the place.  Then I neck down a prescription pain killer, eat the sandwiches in my lunch box and lie down, hugging a pillow for dear life.