The last meeting before anyone has the operation is the compulsory ‘Pre-prostatectomy preparation clinic’. This is where the hospital team tell you what will happen during and immediately after the operation. This meeting should occur two weeks before the operation. It is so important that if you fail to attend this meeting you cannot have the operation. I managed to get the date of the appointment mixed up with another so when I realised and got to the hospital it was too late to join so I had to attend the next seminar which just happened to be the day before my operation.
Now this would either be a very good thing or a bad thing. It would be a good thing if there was anything particularly gory about what was to come as I would only have a day to brood on it. On the other hand, it would be a bad thing if there were any decisions that needed to be made and I needed time to make them. Basically I attended the meeting not knowing if I going to be OK or thoroughly stuffed.
There were about twenty couples in attendance of all sizes, colours and age groups and even two couples from Gibraltar. I am not sure if I was the youngest as there was one single guy who seemed to be in his forties. We had introductions from some old boys that had also undergone the surgery previously and were now volunteers. We met the different teams that would be looking after us in the future – the nurses, consultants, the continence team and the aptly named ‘erectile rehabilitation team’. We were given a presentation which covered eating a healthy diet, foods we should be avoiding (basically if it looked good or tasted nice it was out), pelvic floor exercises, the catheter and ordering equipment and supplies. Also in attendance were a number of other research teams asking for help.
We were given a run down on what is going to happen on the day. Firstly, there would be the million times you would have to confirm your name and date of birth to basically anyone and everyone that crosses your path. You would be introduced separately to the surgeon and the anaesthetist. Then it’s a short journey to the theatre. The last thing you are likely to remember is when the cannula (the needle and value thingy) goes in. The surgery itself takes two to three hours and then its off to the recovery ward.
The main part of the operation, apart from removing the prostate is reconnecting the urethra and preserving the two sets of nerves. There are two sets of nerves either side of the prostate, think of your open hands around a football, which the surgeon has to delicately cut away from the prostate. These nerves are what controls the King’s hydraulics. The aim in every operation is to preserve both sets but this will depend on how damaged the prostate is. The urethra is cut and the prostate is removed. Removing the prostate also removes one of the two valves that retains your urine. This is the function the pelvic floor muscle must replace and hence the pelvic floor exercises. The urethra is re-attached, and the catheter is inserted to give time for this new joint to heal. That is essentially the operation but the running order may be different.
During the operation the catheter would be fitted and possibly a Robinsons drain, which is a container used to siphon off any excess fluid that your body might generate during the operation. Once alert and awake you would then be wheeled off to one of the main wards. On the ward you may be attached to an IV drip and they will manage your pain. This is the bit that had me frozen in mid bagel bite. Pain was going to be managed with paracetamol. Paracetamol? My eyes widened. We are having major surgery and they are going to throw headache tablets at us. Not the proper hard stuff that you hear about where people are trying to distil cough syrup and the like to get at it. My bagel by now had lost all taste. Not impressed. Just to round that bit off you will not be allowed to eat until the following day.
While recovering we will become very ‘windy’ apparently. Not the normal anti-social stuff that makes you look around on the bus with a slapped face for the culprit but during the operation they move the odd organ or two and create room by blasting your stomach with carbon dioxide. This will bloat your stomach and you expel the air over the next week. To prevent blood clotting you will have to inject yourself daily with a blood thinner for twenty eight days. These injections needed to be either in your triceps or the fat in your thighs. You will need to drink at least two litres of water daily and for your efforts you may become constipated. Driving, heavy lifting and strenuous exercise are also out for the next four weeks as the entry points for the keyhole surgery heal. The catheter would be removed anytime from five to twenty one days afterwards. The surgery removes one of the valves that controls the flow of urine. To compensate for this you will have to preform pelvic floor exercises for the rest of your life. We were then shown how the catheter works, how we look after it and how it connects to the ‘mothership’ at night.
All cheery encouraging stuff then.
Then six weeks after the operation you have the ‘final’ blood test. This test should indicate that you have an undetectable PSA count which means you are cancer free.
Then it’s onto the incontinence and hydraulic work but that’s another class.
In conclusion then, I wasn’t stuffed as I feared I could have been. Other than a few points it was good not to have to dwell more than a few hours on anything.
The next morning myself and Annette arrived early at the hospital. Like the wise old squirrel storing away his nuts (excuse the pun), I had made good work of the food curfew last night where I had polished off everything in the fridge and freezer remotely good looking, tasty or edible all with five whole minutes to spare of the curfew. I had created enough new blubber to last a day or to without food. There were only a few people waiting when we arrived but half an hour later when the doors opened to the ward that had grown to nearly a full corridor. After confirming my name and date of birth I was given the paper underwear and gown. I put them on and added my secret weapon – my green monster slippers. If I was going down today I would be known as the dude in the slippers.
There are some things in life you definitely want to be first for and others you don’t. Like back in the day you wanted to be first to kiss that hot stranger at midnight on new year’s eve in Trafalgar Square or the bowl of cake mix when your mum has just finished making a cake or at an event when you have been given insider information that the food is going to run out. On the flipside there are certain things you don’t want to be first for like the new buggy computer operating system that’s just been released, or you are at an event and you don’t like how the cooked chicken waved at you, a clinical trial for a new drug and of course a major operation. Even history will back me up. Those old Tarzan films when the bad guy ran off first into the quicksand did he ever make it past the first commercial? Or what about in that action film when they are walking through that corridor or room – that first dude is always bullet bait.
Now purely generalising I thought if the surgeon had an argument with the misses the night before it would have worn off by the second or third operation. Had they gone out for a few pints the night before they would have consumed enough coffee by the second or third operation to be buzzing and alert. Preposterous?, outrageous? Maybe even libellous? Yes to all three but not intentionally or maliciously – look when you are about to become sushi all manner of thoughts go through your head. I was about to have a major operation so I found some comfort in it. Anyway there were so many people here I knew I wasn’t first so I was happy.
Armed with a couple of books I walked happily into the waiting room, where the nurse had told me to wait. My only care in the world now being that I could secure a good seat where I would not be bothered by some nervous soul wanting to have a chit chat beforehand. I was prepared for such an eventuality with a fictitious story about an out of control killer surgical robot incident – only I might forget to add the fictitious part. I was well prepared. In the waiting room there is a queue for people to confirm their name and date of birth – just in case it has changed in the last ten minutes since someone last asked you. I waited patiently in my airy and fetching paper attire and green slippers to confirm mine. I gave the nurse my name and date of birth while nervously watching all the good seats starting to go. He pressed a couple of keys, smiled at the screen and then said,
“Ah you are the first operation this morning”, he announced.
NO, THERE MUST BE SOMEONE BEFORE ME IN THE QUEUE. YOU NEED TO BRING THEM BACK.
I thought he was joking. I thought he was just taking the mick. I was waiting for him to start laughing but he didn’t. I wanted to tell him that there must be others who have been waiting longer and I was happy to wait. Maybe he could call someone who was sitting at home on standby. I couldn’t see it but I felt a lot of the colour draining from my face. Maybe it was that guy with his daughter or young side chick that I had seen earlier was meant to be first. Flipping liberties if you ask me.
The nurse led us back to one of the small rooms. I confirmed my name and date of birth once again and he took my height and weight. He then took my blood pressure. He looked at the result and said it was a little high. Yeah, figure that one out I thought. He left and said the doctor would be in next. Dr C came in about five minutes later. He laughed at my green slippers. I confirmed my name and date of birth. He said he would do all he could to keep the two nerves intact. He took Annette’s number and said he would call her after the surgery. He said bye to us both and then was off. About ten minutes later the anaesthetist was next in the office. I confirmed my name and date of birth and she asked about allergies and if I had eaten and ticked and scribbled as I answered away. She was an attractive and very classy woman in a nice designer dress. She ran through the procedure, all good. Annette is in the clothing industry so we had a side chat afterwards about her designer dress. As you do.
My porter had arrived now to take me down to surgery. I said my goodbyes to Annette, none of that long and lingering teary rubbish like in the movies and off I went.
We took the trolley lift down in silence. What we needed was divine intervention by virtue of the lift getting stuck and pushing me back up that operating list but it never happened. I even looked at the control panel for a delay button but of course not to be. We went down to the basement and through a number of doors and snaked around a few corridors. It was very quiet and spartan down there, with only a few staff walking about. My slippers got some laughs from some nurses as one pointed and nudged another as we went past. Then through the last set of double doors and we were there.
We entered the large room, this was much more like it. This was the type of operating room to get geeky about. To the left were the two consoles that the doctors would work from and to the right of the room there it was, cue the music – the Da Vinci machine. The multi-million keyhole surgery robot machine. Think of a large silver and white spider with four, plastic covered, legs drawn up into its body that’s the Da Vinci. Then think of a shish kebab, that would be little me in a short while with those legs stuck inside my abdomen.
The classy anaesthetist greeted me again and asked me to climb up on the table. I confirmed for the last time my name and date of birth. She asked me how I felt and I gave her a genuine “I’m good” and I complimented her on her dress. Always good to compliment the anaesthetist, much better than discovering that was the person you had a heated argument with in Nando’s the other day. She smiled and said it was just a bit frustrating as she only got to wear her classy clothes to work for a little while as she was always in scrubs. We both smiled. She positioned me on the bed and put the cannula in the back of my hand and she was saying something about putting a drip in my back. That’s all I can remember.
We were on.