The Day of Surgery

Preamble – I apologise for the rambling nature of this blog post. I've tried to faithfully record my operation for two reasons; firstly, for my own record, before the details fade from my memory. Secondly, as I've mentioned earlier, while researching septoplasties, I didn't find many accounts of the process, and especially few relating to NHS health trusts in my area. If this does help anyone, then great. If it doesn't, I have my own record of my first ever in patient experience.

I haven't been sleeping well recently due to some ongoing back pain, and I don't tend to sleep at all before big events anyway, so I was never going to get a good eight hours. I went to bed around 9:30pm, and slept fitfully. My sleep app recorded me waking and falling asleep four times over the course of the night, before I eventually woke irrevocably at 5am. This wasn't such a bad thing; it was recommended I have a cup of water at 6am anyway, the last thing I could ingest as part of my fast before my anaesthetic. I lay in bed for a while until I had my water, and was then showered, dressed and out of the house by 6:30am. As you’re not allowed to drive after a general anaesthetic, I was taking the bus the couple of miles to Gartnavel. As I don't really trust buses, I wanted to leave plenty of wriggle room - unusually, I even packed my bag the night before, unprecedented levels of preparation for me. As a result, I arrived at hospital at 7am, a whole hour earlier than the time on my appointment letter. Thankfully, the surgical admission unit was already open for business, so I was able to get admitted straight away (I was the first day case patient to arrive.) I would meet a lot of nurses and doctors throughout the course of the day, and I can’t remember all their names, but they were all lovely and friendly and did their best to put me at ease, which isn't an easy task. I first saw Akua (I think), who checked my details. She wasn't aware that I'd had a pre-op assessment at another hospital, and seem frustrated the other hospital hadn't passed that information on when I told her. This meant she had to repeat everything that had been done at the pre-op – pulse and blood pressure readings, health questionnaire, height and weight (used by the anaesthetist to calculate how much anaesthesia you need.) She fastened an identity band on my wrist, and then returned me to the waiting area.

The next person I saw was the anaesthetist, who asked me many of the same questions I'd already been asked. I was reading the book ‘Adapt’ by Tim Harford, which describes how organisations become successful by learning from their mistakes; while I was in the waiting area in admission, I happened to read a passage which recounted the multiple security steps many organisations have in place, to try and catch cataclysmic failures before they happen. Clearly the NHS have a similar philosophy in place, where patients’ details are checked continuously to make sure they’re in the right place and having the right procedure carried out. Between 8 and 9am I met my surgeon for the first time. Mr. T is a pleasant Greek, and as he looked over my notes from the consultant that first examined me (Mr. B), he told me he didn't think that a deviated septum was my problem. Instead, he felt I had problems with the turbinates on the right side of my nose, but he'd carry out a closer inspection while I was under (‘Examination under Anaesthetic’,) and then proceed from there. I signed the consent form, and he told me he'd see me later. I had another short wait before I was invited to change into a gown (actually 2 gowns; one worn with the opening at the back, one with the opening at the front,) paper pants (far more comfortable than they sound), and a pair of foam foot-covering things I shall call ‘shlippers’. I'd brought my own slippers, but was told I couldn't wear them.

I then went through to another waiting area where a few other day case patients were waiting for a bed, and to be taken through to the anaesthetic room. Four of us were sitting in facing chairs, in matching gowns and wristbands anxiously awaiting our fates and it reminded me of the following scene from Hostel 2:

After a couple of hours (which I whiled away reading ‘What If?’ by Randall Munroe and filling in a questionnaire on nasal symptoms for Mr. T, it was my turn to get ready. A pleasant young doctor/nurse named Emma (I think) took me to my bed and got me ready, taking my outer gown and shlippers, covering me with blankets, and giving me a surgical cap to wear. She told me there was still a patient in theatre ahead of me, but she was getting me ready now to make things quicker when it was time to go. True to her word, she was back in ten minutes or so, and wheeled my bed the short distance to the anaesthetic room.

There, I was greeted by the male anaesthetist I'd met that morning, plus another female anaesthetist (I can’t remember either of their names.) They set about getting me ready, placing a cannula in the back of my left hand, to allow them to administer the anaesthetic, any other medication, and a drip. While the anaesthetist was pushing the needle into the back of my hand, ‘Emma’ patted my shoulder comfortingly. I'm okay with needles, being a regular blood/platelets donor, but I appreciated the gesture nevertheless. The team then fitted three sensors to my chest; one just below each collarbone, and one on the left side of my ribcage. Completing the electronic monitoring, they strapped a blood-pressure cuff around my right arm, and placed a blood-oxygen clip on my finger. The male anaesthetist emptied a syringe into my cannula, and told me I might become a bit woozy; I remember nothing after that. Not the cliché of counting back from 10, not feeling sleepy, nothing.

I came to in the recovery room, with no way of knowing how long I had been in the operating theatre for. I had a breathing mask over my mouth and nose, but I wasn't in too much pain, other than my right front upper tooth, and the back of my throat. Both are normal; the dental nerves run close to the nose, and the breathing tubes inserted during general anaesthetics often scrape the throat, apparently. I didn't, and haven’t experienced any nausea. The nurse at my side told me the surgeon had done a different procedure to what I'd gone in for, but I was perhaps still a little too out of it to comprehend her properly. I was on a drip, but she let me have a couple of cups of water, and some paracetamol, to help with the pain. After what felt like ten minutes in recovery, possibly longer, I was taken up to a ward to begin the observation phase.

Before your surgery, a nurse checks what your normal pulse and blood pressure (obs) is, as a baseline. Then, post-surgery, they check your readings every hour or so to make sure you're getting back to that baseline. Hospitals don’t discharge you until you've eaten, drank, and passed urine and your obs are what they should be.

I was wheeled into the observation ward at roughly quarter past one, and slid from the trolley onto the ward bed. The ward nurses measured my obs and checked in on me on a regular basis. Shortly, I had some toast, and a jug of water to drink from, and I amused myself by reading some more of my book and letting the world know I'd survived.  My surgeon appeared at half past three, and confirmed that he hadn't done a septoplasty. Instead, he had indeed felt that my turbinates were my problem, so he'd reduced these with a cauterising tool. He then gave me instructions to douche my nose with saline over the next few weeks.  A short while later, another lovely nurse (Mary, I think, a second year student around the same age as me) removed my cannula (how I can’t remember her name for certain when I was staring at her namebadge throughout that fairly painful process, I attribute to the anaesthesia), and brought me some orange juice, just in time for my sister and my niece to arrive to collect me. When you've had a general anaesthetic, hospitals mandate that you should be looked after by someone for 24 hours afterwards, and that you shouldn't do too much. My sister had volunteered to be my carer for the night, so I was free to go with my letter of discharge, my sick line, and my nasal douches.

In my sister’s house, I noted that my discharge letter was printed off by my surgeon at 12:12pm. The last time I looked at a clock in the surgery unit, the time was half-past elevenish. Allowing for ten minutes preparation, I think I must have spent around half an hour in theatre. I sent a message to my sister just after I arrived on the observation award, at 1:18pm. I don’t feel like I spent an hour in the recovery room...but assuming the clock on the computer that printed the letter is right, I think the approximate timeline of the day is as follows;

07:00 Arrive at hospital

07:10 Admitted

08:00 Speak to anaesthetist

08:30 Speak to surgeon

09:00 Change into gowns

09:30 Arrive in pre-surgery waiting

11:30 Prep for anaesthesia

11:40 Anaesthesia

11:42 EUA/Surgery

12:12 Recovery

13:18 Observation

16:30 Discharge

My discharge letter does show the full title of the procedure I had – Submucous Diathermy to Turbinate of Nose. Having spent the previous two months preparing and researching septoplasties, to undergo another procedure entirely has messed with my head a little. I've tried to read up a little on what this new procedure actually involves. The nose is apparently much bigger internally than that little flesh triangle that protrudes from our faces. There’s a lot of bone and cartilage in there; the first consultant I saw thought my chronic rhinitis was due to a deviated septum, which is a kink in the cartilage in the middle of your nose. However, there are sea-shell shaped (their Latin name is Nasal Concha) bone shelves in your nose, called turbinates. You have a pair of three, either side of the nose, and the largest can be similar in length to an index finger. The turbinates are covered with mucosal tissue, and effectively they act as a filter for air before it enters your lungs. Mr. T clearly thinks my rhinitis (runny & blocked nose, loss of sense of smell, sneezing) has been caused by turbinate hypertrophy, or swelling, in other words. Unlike septoplasty, there’s less information on the internet for submucous diathermy (other than its abbreviation being SMD), but it appears to involve using a cauterising tool to shrink the troublesome turbinate, while leaving the mucous membrane that sits atop it intact. I'm somewhat unclear as to whether this means shrinking the turbinate bone itself or the underside of the mucous lining atop it. While I thought that a septoplasty was a relatively minor operation, it appears that an SMD is even less complex, and since I came round from surgery, I haven’t experienced too much pain. I have however been taking paracetamol on a regular basis.

I have to confess to being incredibly anxious in the 10 days or so leading up to my procedure (I don’t think I can call it an operation with a straight face any more.) I said as much to the anaesthetist in the morning, hoping he might give me something to settle my nerves. He reassured me the process was quite low in risk; I was fairly accepting of the risk, but I'm just one of those people that gets nervous about things. Still, as I mentioned previously, the nurses and doctors were brilliant and fussed over me to an extent even I found acceptable. As far as my nose goes, it’ll probably be between 2 weeks to 2 months before I notice if there’s been any improvement. Guess I’ll just have to be…ah, I've already used that gag, haven’t I?