I fucking hate needles!

Black Balls, Hallucinations on the Ceiling and Euthanasia — My Hospital Adventure!

TLDR: For the first time in my life I spent more than a day in hospital — a revelation

It all started in a quite innocuous manner. One Shorinji Kempo training session I decided to wear a knee support because I was getting twinges in my left knee, which is hardly surprising after 37 years of training and a couple of million kicks. Anyway, since I bought one in a sale that was too small, it was a bit tight. The next day I noticed a swelling above the knee to the inside of the left leg, which I assumed was an edema caused by the constriction of the support, and that it would go down after a while. However, I noticed that as I pushed it I could feel a pulse, which was strange because it was nowhere near the femoral artery. Maybe it was some weird vein related thing?

I waited for a few weeks, and for the most part it did reduce in size, but there was a consistent swelling and that pulse. So, having collected a number of injuries that needed some medical attention, or just review, I visited my GP, Dr Sara Hood. I started out with what I thought were the most urgent problems, which was a dislocated tendon in my ankle (I never realized you could dislocate tendons!) and a swelling on my knee, probably prepatellar bursitis (that knee support thing), and could she also take a look at this…

To which she replied that it was the most interesting case she had seen for some time, and would need to consult an expert on vascular problems at the local hospital. To cut that part of the story short, I had an appointment made within a week and was checked out by said expert, who immediately ordered a full body CT scan, which I got very rapidly after that.

From my point of view, there were two bad things associated with it. They both involved needles being stuck in me, one for blood tests and another to inject X-ray opaque contrast agent into me for the scan. I hate needles. The results arrived an hour or two later and I had a chat with some of the hospital consultants. The swelling above my knee was the femoral artery, and what was worse, I had an aneurysm in the aorta in the area of my stomach. The normally 2cm diameter aorta had ballooned to almost 8cm — if it popped I was going to die a rapid and painful death.

That was followed up by more fun news, which to sum up was that my whole arterial system was prone to different degrees of aneurysm, including both legs. Indeed, the bulge in my left knee area was due to the distended artery causing one or more blood clots that had effective sealed it.

About 4 years previously, I had noticed problems walking, with pain in the calf or foot — which I attributed to my ankle problem (plus the remnants of a partially ruptured Achilles). In typical fashion I exercised my way through it and the remaining blood vessels must have compensated to a large extent.

The aorta problem I must have also have had for years.
Amusing that in all that time I was training in Shorinji Kempo one good kick in the abdomen might have killed me. The symptom of a ruptured aorta is serious back pain, quite often mistaken for a kidney stone, which I have also had. It’s why I always carry codeine with me, so I would have taken some codeine and laid down and waited for the problem to disappear… Not a bad way to go, excluding the pain part that is. But more on that later. [Hey! — I killed Sensei with a single kick — cool!]
Yes, in other parts of the multiverse where I never wore a knee support I will be dropping like flies. My multiverse Tree of Life is being severely pruned even as I write.

The conclusion was that I needed stent grafts in both legs, the aorta and the arteries that connect the aorta to the femoral arteries. A stent is basically a tube made of PTFE and Nitinol memory metal that lines an artery, and I needed a pretty comprehensive set.

It was at that point I met the surgeon who would do the work, Mr Arindam Chaudhuri, who showed me an approximately 12cm length of the kind of tubing they were going to use. He asked me to guess the price, since I am an engineer. I said something along the lines of… “About £700 if I was getting it made up, but as all medically certified stuff comes with a huge premium, maybe £7000?”. Which he confirmed. So as I write I probably have around £30k+ of hardware keeping me alive.

I also checked out his CV, and it is rather impressive, as confirmed by a doctor friend of mine. It appears he had done quite innovative work in the field, so is not your average meat mechanic. Indeed, his CV is matched only by the modesty one comes to expect from surgeons who have worked long and hard to be called plain “Mister” instead of “Doctor”! Joking aside, I later asked him what he was doing in Bedford, when he could be treating fat rich Americans for vastly more $$$. Or, indeed, be working at far more prestigious hospitals than my local. His reply was that he preferred to treat the many rather than the few.

Within two weeks I was scheduled for two operations, the first to do both legs on 10 June 2016, and the second ten days later on 21 June 2016, to do the aorta and tributaries. The time between the first CT scan and the last operation was less than a month, so I assume they took my condition rather more seriously than I did. It’s rather hard to get worked up over a symptomless problem.

Why?

So, why had this happened to me? Well… genetics.
My father was Afrikaner and his side of the family has been in Africa for some 400 years. Small population, and plenty of inbreeding. Indeed, just about every Afrikaner is a cousin! (It’s worse than Norfolk…) The result being that I suffer from enormously high levels of cholesterol. So high, in fact, that I should really have died years, or even decades, ago it seems. The precise numbers for overall cholesterol was 13 (in UK units) and around 500 (in US units) — “normal” is about five times less. The only good news, from what I read on the Net is that it may well protect against things like diabetes and viral infections. I discovered all this about four years ago when I had a blood test to humor my doctor. Hence, I now take Simvastatin (along with CoQ10) and my cholesterol is now merely very high.

One surprising fact I discovered during a post-op consultation with Mr Chaudhuri is that I have virtually no arterial plaque at all.

So, How Do You Feel?

Normally I would skip over this bit as not being of interest (to me) but… how did I feel about the stark possibility of actually dying, and having my nose rubbed in my mortality with no warning or hint of anything wrong?

A bit annoyed, since dying would definitely put a dent in my Transhumanist ambition of not dying.

Actually dying does not worry me, not since I had a rather traumatic LSD trip a long time ago when I died endlessly. It kind of desensitized me to death. Certainly my own, but also that of other people (which may not be a good thing). The process of dying, on the other hand, is something else altogether, as is surviving with a major disability.

Then I started to think about all the arrangements I would have to make, rapidly, in the event of my later death. Apart from a Will, handing over my passwords to various accounts ranked highest. I did not bother with funeral arrangements! Fiona knows that my preferred arrangement is to be fed to the hyenas at London zoo, and maybe have my corpse dragged around a bit to make it more interesting for the animals. Oh… and no blubbering from her and the kids — it’s not as if dying is anything special. Anyone can do it, and all inevitably succeed eventually.

Operation One

10 June 2016 — I was supposed to turn up at 08:00 on the day, but arrived early. As usual, waited around for a bit and went through the paperwork (again), got changed into plastic underpants and scrubs, then waited some more. And some more. Until around 14:00. When I asked about why it was all taking so long I was told it concerned the availability of the recovery room which was privatized and run by an external company that did not coordinate well with the rest of the hospital.

Anyway, shortly afterward I was lying naked on the table under the X-ray machine with only a plastic sheet covering me. Or rather, most of me. The operation involved cutting a small slit (under local anesthetic) in both sides of my groin, then inserting something the size of a knitting needle into both femoral arteries before pushing long catheters deep inside them to the point where the stent grafts were needed. These were inserted piecemeal and guided through the catheters while I was being X-rayed via the fluoroscope. You can google the procedure of you are really interested.

All the while I was fully conscious (unfortunately).

The radiologist, Dr Ramita Dey, did most of the operation — I recall asking about her dosimeter badge which was film. The disadvantage of which is that you only find out you are dead when the film is developed later. Modern electronic ones sound an alarm if they pick up too much ionizing radiation in real time. I also mentioned something about their protective gear, which I called their “placebo aprons”, since they do not actually stop all the radiation but reduce it to an acceptable level.

Shortly after I got the anesthetic jabs to the left and right of my wedding tackle (slightly painful), followed by the incisions (painless). Then came the insertion of the knitting needle into the artery, after she said something along the lines of “This is going to sting”.

My witty riposte was: “Aaaaagh! — FUCK — that HURT!”. Then it happened again and I omitted the actual words the second time around.

Beyond that point it all went smoothly and I could see on the fluoroscope screen the stent grafts being built up. The only notable thing during the next three hours of boredom was when I felt warm liquid pouring between my legs. I casually asked whether that was my blood, and was told no. I suppose such little lies are told to keep the patients calm, but I certainly had not pissed myself and the later enormous blood stains told the truth. Not that I cared.

Later she and Mr Chaudhuri were closing up — pulling out the catheters and plugging the arteries. Unfortunately for me, the right femoral artery would not stop bleeding and to stop it Mr Chaudhuri pressed down on the wound with, literally, all his weight. I suspect he took over at this point simply because he was the heavier doctor. At one point he even asked whether the table could be lowered further so he could exert more pressure. I was grateful both that it could not be, and that he wasn’t a fat bastard or heavyweight Rugby player. The pain was immense, of the “balls in a vice” variety. Quite comparable to a kidney stone and about the most pain I had ever felt (including being kicked in the groin in a fight years previously). I was also required to lie still and let this happen, for obvious reasons.

The result was that my whole body was rigid with tension, and I was sweating like a pig both from the muscular response and the pain. I was seriously overheating and asked whether the plastic sheet could be taken off my body, but apparently not, for reasons of infection control. Then I asked one of the nurses (both Nigerians) to expose one of my legs and sponge me down with cold water, which she did, and it helped a lot.

At the same time the other nurse was regularly calling out my blood pressure, which had risen to 198/112 — pretty high and not something you want if you are bleeding out. Then Mr Chaudhuri said some more magic words along the lines of “Set the timer for 10 minutes” — which I assumed was the amount of time he was going to continue the pressure.

At that point I asked whether some morphine might be provided, to which he replied: “Now you’re asking!”. As someone else, who I didn’t see clearly, started to get it ready I requested the injection be in the arm rather than hand, to which Mr Chaudhuri casually commented: “We are beyond that now”, which I took to mean “Beggars can’t be choosers”. It was not high on my priority list right at that moment so I let it go and just hoped they would get on with it. Some eternity later, or a couple of minutes, the pain miraculously faded away and I relaxed. The bleeding eventually stopped and everyone started clearing up, while I lay with my hands behind my head talking with the nurses who were laughing at what I was saying, for some reason I couldn’t work out. Perhaps what I thought I was saying was not what they were hearing. Or maybe it was because I was lying there bollock naked. It’s all a bit hazy.

Then I got wheeled into recovery, which looked like a warehouse full of junk, before being moved onto a main ward.

Black Balls

The next 24 hours passed in a fairly drugged state, punctuated by back pain caused by the fact I was told to lie still on my back for 6 hours after the operation. Strangely it was worse than the groin pain from the operation, although the latter was in a considerably worse state than I imagined, as I discovered when I shuffled my way to the toilet the next day. Trying to take a piss was a monumental effort — everything across my groin area was black, bruised and swollen. Think a fat swollen worm poking out of a large black apple — or google “groin hematoma”, preferably while you are not eating. Almost all of this was due to the pressure needed to stop the bleeding which ruptured a number of internal blood vessels. I later took a selfie, but for reasons of good taste have not published it here. Just a little nostalgic memento.

A couple of days later I was discharged in a rather informal manner as Fiona arrived to pick me up from the hospital. I could barely walk and she said afterward that at that time, and during the night, my whole body was shaking. As I left I asked the staff whether I could have some painkillers to take with me — to which the answer was “No”. Which both I and a doctor friend of mine considered a somewhat appalling dereliction of care. So, I borrowed some from a friend and later called my own GP and asked whether she could prescribe some, which she did — codeine and oral morphine. That was pretty much my diet until the second operation on 21 June 2016 (Solstice).

Operation Two

This was the biggie, not that I experienced much of it since I was under general anesthetic (thank the gods!). There was potentially an option for an epidural where I would stay conscious for the whole procedure but I was definitely not prepared to tolerate that, especially since it came with a possibility of disability if there was bleeding into the spinal fluid. As I said to Mr Chaudhuri just before the operation, if there were two choices, one with a 10% chance of disability of one with a 50% chance of death, I would choose the 50% death every time.

His response was that it was a somewhat selfish attitude given that my death would impact those around me. Cynically I was also thinking that “Operation was a success, but patient failed” never looks good on ones CV. He also pointed out that he had to exert so much pressure during my last hospital adventure because if he had not I would have bled to death. As excuses go, it seemed plausible…

So, back on the table again in pre-op, which looked remarkably like a stock cupboard. Got the injection in the hand, was hooked up to various bits of tubing and waiting for the main event. The anesthetist then told me I was going to get a big intravenous injection of morphine, and I would feel “The Rush”. I was rather anticipating the “junkie experience” and when it came, well… It felt like a huge wave of heat passing through my body, and my vision defocused. I waited for the legendary euphoria to hit — and… nothing. I lay there seriously disappointed and was telling the anesthetist when he injected the knockout, presumably to save himself having to listen to a tedious rant on the failures of opiates to deliver the fun.

He mentioned that he normally asked his patients to count down from 100 - I just said I would hold my finger up. “Why?…” he muttered and then got it. When the finger dropped I was out.

Next thing I was waking up in recovery pain free and feeling rather good. It all went very well apparently, albeit taking 5 hours.

A few weeks later I mentioned this to Mr Chaudhuri and he was surprised that I got a morphine injection at all, and thought I must have misheard, or that it was possibly Fentanyl. However, I am pretty sure that it was morphine. I also wonder why it was given to me before the knockout rather than after — maybe just a fun bonus by the anesthetist?

My recovery from this operation was very rapid — I was back at work 10 days later, although I did have to take a day off when I stopped the morphine which I had been taking for a month. A touch of “Cold Turkey” manifesting as an upset stomach. Beyond that, no “cravings” or “addiction”. Just the opposite — thinking of taking it reminds me too much of bad times, although I find it does have a pleasant relaxing effect for a good night’s sleep.

All in all, I have taken a wide variety of opiates — codeine, pethedine, tramadol, fentanyl, hydrocodone and morphine. All of them work well on me as painkillers, but none I find in any way addictive or even especially pleasant. Seriously, it was harder giving up Coca Cola than morphine. Sugar is really addictive.

And a brief detour to explain the “Hallucinations on the Ceiling” bit. The nurses came round regularly offering a variety of painkillers, and I decided to try tramadol, which I had used once before for back pain. It was a serious mistake. I took some at 06:00, and unlike the codeine or oromorph it did not make me sleepy. Previously when taking it I had been at home in a reasonably stimulating environment, but lying in a hospital bed staring at the ceiling was an exercise in sensory deprivation. I began hallucinating. When I closed my eyes I saw parades of pictures flow by — for example, a dog sliding down a red carpet on a wave of milk. When I looked at the ceiling I saw words and mathematical equations forming and dissolving endlessly. This went on for 12 hours.

A couple of days later I had yet another CT scan, only notable for the fact they had to keep jabbing me with the needle because my blood pressure was so low because of medication during the operation. I calculated that I must have received a total dose approaching about 20 years normal background from all the X-rays. My Chernobyl holiday.

The next day my urinary catheter was taken out rather brusquely by a nurse, which surprisingly did not result in me pissing blood, although it felt like I ought to. Then I was discharged, this time with a doggy-bag of painkillers. I took the above pics on my last morning there.

Abandon All Dignity Ye Who Enter Here

And now to the bit that really worried me.

It was not my loss of dignity that upset me, because basically I don’t care. For example, I was too exhausted to bother with niceties like dressing in anything beyond the bloodstained scrubs of the operating theater. When I went to the toilet I just held them closed behind me with one hand, and if my arse was hanging out in front of other patients or visitors, too bad for them.

One of the consultants later came by with a band of medical students in tow, like a party of schoolkids at the zoo. When I was asked if I was OK I said “yes”, but was a bit worried about this… whereupon I threw my scrubs open and displayed my swollen black balls for their delight. I was told it would be OK in time, which a month or two later it was. I enjoyed the look on one or two faces…

It was the other men around me in the ward that horrified me. The man opposite crying because he had shit himself before the nurses could get to him. The old man on one side constantly complaining and calling for nurses who seldom came because they were tired of his trivial demands — yet who found time to sneer at others in vocal distress. Then there were the diabetes cases who were having toes, feet or legs amputated. One of them showed me a photo of his foot where most of the toes had rotted away and there was just a huge gaping hole. And other who looked like an inmate of Auschwitz with a weight under 40kg. When he took his shirt off the was just a skeleton, and anyone looking at him knew he had given up and was going to die.

Off in the distance a women shouting endlessly “I want to go out!”, allegedly because she wanted a smoke or a drink. The nurses would not let her drink until after a CT scan in case they needed to operate on her, yet on she went for hours. In fact, hospitals cannot hold you prisoner — you can just sign a waiver and walk out even if you are hours from death.

Then there was the time I woke up because the ward was filled with light and people. I asked the time and was told it was 02:30 — I had thought it the afternoon. Next day I realized someone in one of the beds opposite had probably died, but I couldn’t even be bothered to ask the nurses about it.

Some of the men to my left were discussing suicide, and I helpfully mentioned that you have to do it when you are healthy, because by the time you are in here stuffed full of tubes you are fucked. As I said it, the real horror of the lack of a euthanasia option struck me. It’s a peculiar sort of hell where there is no expense spared keeping you alive with no hope of recovery, whether in pain or drugged to insensibility and left to die of thirst (my mother’s fate when she died of cancer).

Through all this I was thinking “I am not like them, and never will be”. I have defined cutoff points where I will commit suicide if I pass those thresholds. Major disability, for example, of the “need a wheelchair” variety. Or mentally, if my intellectual ability drops to mere normal [The only cure for an average IQ is a bullet]. Arrogant? Yes.

My religion is Asatru — the old Viking religion. Back in those times the idealized death was one in heroic battle, and a “straw death” was shameful. And in my mind it still is shameful to hang on to every scrap of life no matter what the cost when one could, and should, end it on ones own terms fully compos mentis. Of course, this may not always be an option if one is struck down suddenly, but that is the only excuse.

And my final thoughts on my “Hospital Adventure” — the nurses.

In a word, brilliant. I would certainly not have the patience to do their job. It was they who made the difference between intolerable and bearable. I also learned not to abuse their goodwill by making unreasonable demands or being impolite.

I particularly liked the Nigerian nurses and their sense of humor — they seemed to radiate goodwill. I was talking to one of them a few weeks later about the operation, but she did not recognize me. Maybe if I dropped my trousers she would have remembered!

The NHS working perfectly