Brians Diary

I had no idea how big the urology department was in the RUH (Bath). I guessed about half a dozen but actually there are 51 if the picture is anything to go by. PS  I have avoided making the names readable.

I considered myself fairly well prepared and alert in life in general but what gets me all confused are two things, the first is novelty – in other words something I have not experienced before, and secondly just good old-fashioned anxiety about how it will go and how much pain I will feel and so on.

Another symptom of anxiety is that I do not read the paperwork enough – don’t ask me why. Also at the hospital when I come out of a clinical office I lose my sense of direction and find myself wandering all over the place. I feel like a twit but that’s how anxiety affects me.

THE day itself

I caught an earlier bus to Bath for an 11.50 appointment and was glad I did because I had time to settle. I attended the so-called One Stop Haematuria clinic. This is about anything which includes blood in the urine of which I’ve had one or two examples over the last few months. The amounts were very small, I would say to err on the generous side 1cc but the doctor took notice of it as perhaps an early warning of something else.

I then presented myself to the urology outpatients and was promptly sent for an ultrasound scan – which I was asked to do prior to coming but did not read the appointment letter fully. They ‘ultra soundeded’ my front, right side and left side. This took about seven minutes and was good humored and chatty. Every time they pressed down on my skin it made me want to go for a wee but for some reason the scan required a full bladder so I had to hold on.

Incidentally , A healthy adult bladder can hold between 400–500 milliliters (cc) of urine before it’s considered full. However, people usually feel the need to urinate when their bladder is holding around 200–300 ml.

I then went upstairs to wait my turn for the procedure. I was asked to give a urine sample and then bought it back to the reception desk, completely missing the notice outside the toilet  asking us to put our samples in a basket. Probably even if the notice consisted of flashing lights I wouldn’t have seen it but I tend to have tunnel vision under these cases for reasons given above.

There were quite a large number of people in the waiting room and what I did not appreciate was that they were all there for different reasons in other words there were lines or queues for various conditions of which my procedure was only one of many.

Preparation for the procedure.

Before I knew it there were two or three of us left and a very nice chap called Kevin, a male nurse with an avuncular attitude,  took me to a corridor and explained the procedure.

He is one of these people gifted with instant empathy and this combined with his professionalism was really a source of comfort and support, not that I thought I needed support but in the event I did need some hand holding both metaphorically and physically it’s that you don’t know what is going to happen. I told him that if he could talk to me whilst the operation was going on this would be a good distraction.

It was during this chat that I confessed that they were going to be the subject of today’s diary. They thought it was just an ordinary private diary but I said no I do publish it on the internet and yes I do publish every day. There’s got them intrigued and they wanted to see it. So this, US Election Day, Fireworks Day, my goodness what a day.

I was led into a small cubby hole room where I had to take off over everything below the waist and put on a gown, one of those that you can put on frontwards and backwards. I normally do it the wrong way but who cares.

The procedure itself

I was led into the operating room itself where there were three people, four including myself. There was a lovely touch. In the ceiling there was an image of cherry blossom. There was the consultant, Amina from Nigeria, Shak (sorry if I’ve spelt your name wrong) who was an assistant and Kevin who came in with me. I am used to developing instant rapport with people so as Kevin was similarly inclined we got on very well from the word go.  I’ve told him that it would help me in cases of pain if I could hold his hand and he was agreeable saying, ‘hold it as tight as you like’.

Meanwhile the consultant was reading my notes from my doctor (at least this aspect of the NHS works well)  who told me what she was going to do. First of all she will put some numbing fluid in my urethra which is basically the tube formed by the penis until it gets up to the bladder and the prostate gland. My goodness was this numbing fluid strong and potent!  I cannot say it was painful. The best analogy I can think of is being given strong curry but it did not hurt as such.  Then before I knew it she had put the thin tube consisting of a telescope and light, and I think there’s a little grabber that can get samples if needed.

Before I was aware of it the procedure was almost over.  The consultant asked me if I wanted to see what the camera saw on a screen and I declined. I’m a bit like this with injections. During the session there was much light-hearted gossip mostly initiated by me, I said to the consultant that I got through things easier if people told jokes and she said that she was not very good at jokes but Shak probably was. Shak did not say much but his presence certainly filled the room and I thought that he was a caring and concerned soul who may be looking for his next role in the system – who knows.

The Value of a second opinion

The  consultant was not sure about one small feature on the imagery so she called in Mr Green who was another of the consultants and he advised a return visit in a couple of months. There is no question that senior people emit a certain air of authority which gives confidence, he certainly had this in my case. Anyway, I got up off the operating table and there was some blood on the sheet, a spot about the same as a two pence coin or 10 cents if you’re reading this in America.

This reminds me to address the very important contact of getting a second opinion. You can be under an illusion and very sure of your self at the same time. I find this very frequently in websites which have not been testing, and advertisements which are often too complicated for their own good. . Also we all have blind spots and it’s very easy to miss something because in the previous let us say year of cases, no adverse outcomes happened so in a way you are lulled into a sense of security. This is why the operating consultant called in a senior colleague. It is not a sign of weakness to do such things.

Shyness about the body

On another topic, I think it’s part of the English culture not to expose ourselves never mind our private parts to people other than our spouses or partners .  In this case the atmosphere was totally professional and objective and I realized that the penis and indeed the vagina is just another part of the body which has its own functions, a bit like a mouth or teeth or limb so what is the big deal . I suppose some of the more senior people would be a bit embarrassed but I think this is a learned insecurity rather than an intrinsic habit on our parts.

I was warned there would be some blood as indeed there was when I first passed urine about half an hour afterwards. Blood has the habit of looking worse than it is in terms of volume. The second time I passed urine a couple of hours later there was some blood but more diluted and this was more or less in line with what I had been told to expect. The consultant told me to drink at least three litres of water per day, far above my normal level of consumption, but I’m sure she has her reasons.

Post operative service

A few minutes later, after I had got dressed, Kevin met me outside with the technical report, a copy of which was going to be sent to my doctor. He said that if you get any significant pain call your doctor and get some antibiotics. I gave my opinion that this sounds partly redundant because in older times when the method was not so advanced as it is now, infection was probably more common but now the advice was given to me just as a precaution and with  this he seemed to agree.

My usual wander round the hospital

When I first arrived at the hospital I found that the main restaurant was closed ‘for a few days’. This was one of the reasons for fixing my slot near lunchtime so I was disappointed.  No reason was given which made me a bit suspicious. I’ve took my time looking around the corridors at the excellent art exhibition which has hundreds of works in and so far as I know anyone who wants to visit the hospital can come in and look around because there is no one checking you in. A third of the sale price of the artworks goes to maintaining facilities at the hospital so it is a worthy cause.