Revision and excision - a nip/tuck tale.

PREP - OP

You'd think that 50+ trips to the hospital in one year would desensitise me to the experience - but no.  Even as we search for a parking space my heart begins to race and waves of sickness rush over me.  That doesn't stop me advancing so my body tries palpitations instead.  When it realises I'm still heading towards those airport-style revolving doors I break out in a sweat and feel lethargic, completely exhausted.  I'll perk up once that has passed, it's just one of the many little tricks my subconscious employs to avoid the hospital 'experience.'

Even before my operation came around I'd had a couple of meltdowns.  The biggest one took place when I received my paperwork.  I merrily tore into the envelope, anticipating my 'minor' operation appointment.  I scanned the fat pack of instructions and my heart sank.  Let's be more specific; it plunged to the floor and smashed on the tiles.  The reams of paper covered preparation for my operation, including my general anesthetic and tracheal tube.  It was a bigger procedure than I had thought.  I was horrified.  The pre-assessment date was 3 days away and I couldn't make it and I had to have the operation asap, before the weather got any hotter.  I was STRESSED.

I managed to rearrange and attend the pre-assessment clinic where they swabbed me for MRSA and told me to visit the hospital pharmacy to purchase my antibacterial wash.  I needed to use it for 5 days prior to the operation, including washing my hair.  Then we moved onto my operation...

Me, accusingly : 'I thought I was only having a local so I'm quite surprised that I'm now having ANOTHER general anesthetic.'

Nurse, falteringly : 'Yes, um, hold on, um, yes it says local here.  You're having a local.'

Me, irritated : 'Well it says on my paperwork that I'm having a general and this other weird thing....'

Nurse, brightly : 'Oh don't worry about that.  Whoever sent this has sent you the wrong paperwork.  You're definitely having a local.  Look it says here, 40 minutes. In and out. That's good isn't it?'

It wasn't her fault.  So I pasted on a smile, grabbed my coffee and made my way out into the real world, where people check paperwork before they send it.

PRE-OP

When we arrived at the hospital I was fairly calm.  I'd chattered inanely to my Mum the whole way there for distraction.  I was ready, although hungry, as breakfast was at 7.15am and there was no food allowed until it was over.  The appointment was at 12.30 and I whispered comfortingly to myself the phrase I had bravely told everyone else, 'it's minor.  It's nothing.  In and out.  In and out.'

I attempted to sign in to the 'quick-check-in' which was anything but.  And failed.  So we followed the letter's instructions and went to the Day Surgery Outpatients.

'Oh, you're not here.  You need to go to St. Andrew's Burns Unit.'


St Andrew's Burns Unit, 'Oh, you're not here.  You need to go to Day Surgery.  What?  You've been there?  Let me call around.  Ok, you're in Theatre Admission.  It's third floor, B133.  Just get in that lift there and you're there.'


Lift, third floor.... no B133, only A103.  Wandered around. 'B133 is another part of the hospital....miles away.....'  Went to A103,  'TADS,' just in case.  Thankfully, I was expected here.  But by this time, my cool at been lost, somewhere at ground floor.

'You need to take a seat.  Once checked in, you go on a list.  Anytime between 12.30 and 19.30.' 


It was midday.  I'd arrived thinking 12.30 was my appointment!  I hadn't eaten since 7am and I could be waiting until 19.30?  Over 12 hours?  Luckily it wasn't busy today and by 14.30 I was bundled up in hospital gowns, extensive questionnaires completed and ready to be lead into surgery.  In and out.....in and out......

DURING OP


As I laid upon the narrow gurney they stretched my right arm out upon a table ready for disinfecting with pink stuff and covered my body in a green operating sheet. I had the impression that the surgeon was presented with just an arm, easy to forget it was attached to a person as I was entirely covered up.  Then came the needles.  At least 10, deep, slicing, anesthetic needles in the sensitive, new skin of my graft.  By the 5th needle my knees were literally knocking together under the green sheet and my eyes were swimming in tears.  Instructed to 'breathe', I cried as silently as possible through the pain.  At intervals the surgeon pressed a pin in me and asked if I could feel it.  Mostly I couldn't.  Twice though, I felt something intensely sharp and cried out.  More needles.

'Can you try to stop shaking?'  They asked, as though I was doing it on purpose.

Finally, everywhere, numb.  I expected to feel nothing at all.  Surprisingly, local  anesthetic works by taking the pain away but not the sensation.  I could feel the scalpel slicing through my skin, tugging and pulling at it's fibres.  At one point I could feel him lifting skin away, literally peeling it from me.  Then the stitches, the needle dragging and jerking through.

Once the 2 areas had been excised (removed by cutting) and 1 revised (Z-plasty, a technique where a Z-shap is made in tissue to improve the function and cosmetic appearance of a scar. Triangular flaps are raised on the opposite sides of two ends and then reversed creating a 'Z'.)   it was time for the steroid injections.

It took an hour and a half.  Not quite in/out.  More in - time passes slllooowwwllllyyy - before finally, mercifully, out.

POST OP

I was in recovery, regaining my composure.  The nurse got my notes from the surgeon and completed the 'recovery' box.  I noticed she had written under the box indicating 'calm any anxiety from patient/explain procedures,' that I had 'no anxiety displayed.'  Despite sitting silently in a wheelchair, border-line bursting into tears (again) and feeling like I had fractured inside, I was deemed 'not anxious.'  This was because I wasn't screaming, crying, wailing, etc.  It really annoys me that in this world, if you're not Little Miss Drama Queen, everyone assumes you're fine.  I can't believe that I have to dissolve in sobs in order to 'prove' that I've just endured a traumatic experience.  This goes for the whole burn/graft/recovery scenario.  Just because I haven't cried at every occasion, got clinically depressed or behaved irrationally people assume I am an iron woman.  Actually, I just think my emotions are my own business and I'd rather not have to 'prove' how horrific this has been.

Seething tearfully, I slathered toast with butter and jam and put away some coffee, got dressed rapidly and waited to be sent home as soon as I could.  The Nurse found some amusement in my desperation to leave.

Finally, I was dismissed with extra bandages and instructions to come back in a week for a check-up, a couple of weeks for physio to check the scars aren't contracting (this AGAIN??? I thought I'd got past this worrying issue) and 6 weeks to Burns Outpatients.  Other instructions included:

1. Don't lift or twist.  (Can't get my own seatbelt on, dress myself properly etc etc.)
2. Don't get arm bandages wet.  (So no showers for a week then.)
3. Wear compression vest.  (OUCH.)
4. Come back immediately if there are any signs of infection.  (The symptoms are quite revolting.)

I can see the site underneath the bandages, where the line of blood curves against the white plaster.  It's about 2 inches long by one inch wide on the bottom of the graft. The part between my arm and underarm seems only about 1 inch in diameter, a circular wound.  Luckily, there isn't much discomfort, unless I move. Which I have discovered is difficult not to do!

Although I've had much worse done, it's still hard to accept the consequences of an operation.  Not being able to move properly, dress, shower or exercise is irritating and something I never wanted to have again; it brings back terrible memories of being incapacitated last year.  Equally, I am back with the 'unknown.'  Hopefully it will look fabulous - for skin grafts - once healed.  But the uncomfortable truth is that skin is unpredictable.

There is a lot of discomfort but not much pain unless I move too vigorously.  Humans take both comfort and easy movement for granted.  When you are uncomfortable for long periods of time (compression vests, injuries) it drives you slightly mad.  You can't sleep properly, you fidget and you just can't concentrate on the task in hand.  I can't wait to be comfortable in my own skin again.  If the stitches pull then boy, do I know about it!  I guess at least I won't have to cook/wash up/food shop for a week or so......every cloud!

So, here's to next week's big reveal....it had better be worth it!  I'll let you know...