A hospital timeline

Given that I have had more visits to hospital than Jimmy Savile I consider it something of a specialist subject. Thought not in the same way as Jimmy did. I thought, having previously outlined the various types of people you find in hospitals, the drugs you may be offered and how a day in an Indian hospital looks it might be useful to readers to offer some guidance as to the timeline of an entire hospital stay after surgery. Using my first-hand experience I can put to (sick)bed misconceptions and allay/create fears. Of course this is only my personal experience and your mileage will absolutely vary but I hope it can be of use for anyone considering going under the knife.
This can be considered a follow-up to my widely popular 2011 tragi-docu-comic series 'I fell from a moving train'.
Previous entries include -

• The Doors
• A Hospital Taxonomy
• Knock, Knock
• A Meander of Thoughts
• Included with this post a voucher for reclaiming 2 minutes of your life (5 if you`re a slow reader)
• A whitepaper on healthcare reform
• Tick followed tock followed tick followed tock
• Pills, pills, pills
• 1 year return to base warranty

Day 0

You have discussed the medical issue at length with your specialist consultant (you do have a specialist consultant don't you?) and agreed a surgical procedure that will alleviate it. Thank the consultant, leave the hospital and put the matter far from your mind as nothing is going to happen for a very long time.

Day 1 (never mind that Day 0 was at least 365 days ago)

Morning

You have discussed the issue at length with your charming partner (you do have a charming partner don't you?) and agreed they will support your every need and whim pre and post surgery. Thank the partner, attend the hospital at 7AM on the day instructed and find somewhere to check in. Note that this may be behind a locked door with no-one around. If you are the first person on the surgery list for the day then, great, you are currently the most important person in the house. If not have a seat and open a copy of Take a Break from 2017. The morning of surgery will feel a little like it is your birthday. Everyone here knows your name and is very concerned for your wellbeing. Ensuring you have a good time is paramount for them. Side note here - even though it feels like it is your birthday everyone will have forgotten the date so be prepared to remind them. Your gifts will include a second-hand gown, a bracelet and a pair of jolly red socks such as I imagine Santa wearing around the house. You'll also need to slip into a pair of the most uncomfortable knickers you'll ever find. The only person I can imagine them fitting is one of the Teletubbies. They are also, inexplicably, translucent. Your normal clothes will now be confiscated giving the occasion the slight air of a stag do. A nurse will then ask you about your name, medical history, allergies etc.. If you can't remember any of these details then they usually have a handy computer screen you can read from on which it is all noted. If there isn't a screen then answering 'no' to all their questions usually gets you a pass mark and onto the next stage. Your consultant should have rolled into the hospital by 8AM all casual like it's just a job and not the most important day of their life and your birthday. They will sit down and talk you through the pre-agreed procedure. Now is a great time not to ask any further questions. Alternatively they may do what is known in the medical world as 'busking it' and suggest a different operation. If this alternate operation sounds more exciting then just go for it! Once the operation is agreed the Consultant will disappear off to change into scrubs and you will have to sign some paperwork saying you agree to have the operation. This is an important step because you didn't really listen to all the details when the consultant was talking and that is the hospital's fault if this goes to court. Sign the paperwork but reassure the nurse that you won't sue no matter what happens because that would be rather impolite and very American. You'll meet a variety of doctors at this point. A greater number than you would think you need in fact but since this is the NHS you aren't paying per doctor so the more the merrier I say! The anaesthesiologist will have the most complicated title to spell and will be the most interested. They will ask you a lot of the same questions that the nurse did earlier but this time without the answers so try and remember what you said. Your name and date of birth can be found on your bracelet if you struggle. Get these final questions right and they'll hook you up to the gas, ask you to count to ten (bit late to check numeracy but hey) and then it's good night morning.

Afternoon

You will come around in another room from the one you passed out in feeling very unusual and with pain in a place you're never had it before. Again, slight airs of a stag do. If you can gather any of your senses then you can play the fun game 'How did the operation go?'
Some clues include -

• Bandages: are they in the right place? If so a good sign they operated on the correct part of your body
• Limbs: are they in the right place? If so a good sign they didn't remove anything they shouldn't have
• Concerned faces: are there lots of them? If so a good sign that there was a colossal fuck-up and the hospital is worried about getting sued despite your earlier disclaimer

Generally though you will have an exceedingly pleasant nurse on-hand to reassure you that all is well and that you are "going to feel a bit funny for a while". This is true. They may also give you a shot of morphine which is strong recommendation of mine from their menu. Note though that Fentanyl is 100 times stronger than morphine and is the premier choice in this category, thousands of homeless people can't be wrong. If they ask how much pain you are in on a scale of 1 to 10 then 7 is a good number to choose that usually ensures morphine but prevents panic. You'll hang out in this room for a while before being wheeled in your bed up to your room. Sometimes longer than a while as you will need a Porter to do the job and they appear to be all but extinct these days. Being wheeled around in bed is very agreeable way to travel. I think that my work days would start on a more positive note if that was how I commuted. At this point you will see your charming partner and they will look concerned no matter how successful the operation was. If they do not look concerned then they were hoping to be able to sue the hospital for clinical negligence and manslaughter. You have now entered the world of post-operative care and will, depending on the sort of operation you had, experience wildly varying levels of investment in your comfort. The rest of the day will be spent in a cheery state of bafflement at the mechanics of your new environment as the nurses continue to top up the drugs. Your partner will leave you at 8PM in the tenderly cold embrace of the nursing team with whom you will shortly become familiar. Good night.

Day 2

Morning

You'll wake with a clear head. Too clear. The powerful drugs that staved off pain yesterday and hopefully got you through the night in a pleasant haze are now going to get scarcer. After your first observation (obs) of the day - blood pressure, temperature and oxygen level you'll be given some paracetamol and/or ibuprofen. Now I know what you're thinking - "those are for civilians". And you're right. You'll also be thinking "where's my fentanyl?" and "the UK is so rubbish we can't even have opioid epidemics". Right again. But on the lookout though as they will sometimes refer to drugs by their more sciency names, for example codeine may be called dihydrocodeine. Codeine is a step up from paracetamol so say yes if they mention it. A side effect is constipation - this will be useful later. Be wary of saying yes to anything sciency though, laculose is laxative and you do not want that. This is a good opportunity to refer you to my previously published whitepaper on healthcare reform. It's full of lauded ideas but, alas, still unimplemented by the NHS after 15 years. Since this is the situation in which we find ourselves take your Calpol and bide your time. Also, always say thank you when on the ward. To everyone. Politeness will distinguish you from others on the ward and pissing off the nurses will ensure misery. Next breakfast will arrive. It may well be cold toast and colder butter but anything more exciting will kill you dead at this stage of recovery. It'll come with a liquid they refer to as 'coffee' but the only person who wouldn't disagree with that description is the guy in the room next door to you that is in a coma. Breakfast finished, your room will now have coalesced into solid shapes around you and everything will be out of reach. I am assuming you are bed-bound (since that is my main area of experience) so here your real trials begin. Hospital rooms are still setup on the basis that the patient is in a vegetative state or that the only movement required is to avoid bedsores and all nutrition is from a drip bag. I wonder if the seven dwarves took it in turn to roll Snow-white or did it need all of them at once? Raw-dog your stay if you want an Insta-worthy challenge but I can't recommend. The bed itself will be handy enough with motorised sections you can move up and down to position yourself comfortably. If that is sufficient entertainment for your stay then great but otherwise you'll be wanting distractions. And somewhere to keep them when not in use. There may be a bedside cabinet but that will be behind you, the chair will be taken up by your charming partner at some point and the floor is out of reach so your storage solutions are limited indeed. I like to think of myself at this stage of the stay as being like a bear in one of those zoos that make them work for the things they want, gets them to solve simple puzzles for example. Given time you will be able to reorganise the room to a more ergonomic form. If you have a long enough stay then be ambitious, be like that guy in Spain who built a cathedral by himself. As a piece of serious advice I would council you to begin breaking down ordinarily simple tasks into a series of sub-tasks. This will increase the likelihood of completing them successfully and safely and decrease the likelihood of losing your mind. By all means talk yourself through the steps and offer congratulations on their completion. Method > Madness. A heads up here, come the evening you'll want to make sure the big light is turned off and your bedside spotlight is inverted to make a serviceable uplighter and create what little ambience is possible. So make sure that bedside light is in reach. A decent view from your window is to be preferred - Sydney Opera House perhaps or The Hanging Gardens of Babylon, herds of wildebeests, that sort of thing.

Afternoon

Lunch will be delivered. It will be whatever you 'chose' from the jumbled menu that was shouted at you from the door earlier in the day. To order I generally repeat the words I recognise and hope for the best. That is not wise and I would council you to hope for the worst. You will not be disappointed. The food in hospital is not trying to kill you but neither is it trying particularly hard to keep you alive. Vegetables sound like a healthy addition to the meal of a convalescing patient so you order them. The damage those vegetables will do to your soul will outweigh any good they do to your body. It takes real commitment to make food as stodgy as what you'll be served and it slips down as easily as concrete. It is a cruel irony that the worst part of the food process is yet to come though because if it hasn't already happened it is probably about to. I refer to certain bodily functions and will address them numerically.

Number 1

The nurses will have been taking your blood pressure, finding it low and encouraging you to drink water to remedy this. If you have maintained a seal until now it is about to break. Once it is does for the rest of your stay in hospital more fluid will come out than you put in. Modern science has no explanation for this. Being bed-bound and without a catheter (if you do then piss away, try not to think about how they got it in or will get it out) you'll need help. You'll be given what is called a pigeon (in Ireland anyway). This is not, as you may suspect, an actual pigeon for emotional support. Though they would be very much easier to source than puppies or donkeys, pigeons are selfish, distant creatures unsuited to the task. They are also prone to the sort of catastrophising that doesn't make for a good bedside manner. No, a pigeon is a oddly shaped bottle which you position between your legs while lying on the bed and attempt to aim your urine into. You will urinate into the bottle, onto the bottle, onto the bed and onto yourself 75% of the time. 25% of the time you will just urinate onto the bottle, the bed and yourself. The experience will reinforce just how poorly humans perform standing up tasks while sitting down. The pigeon will also always have less capacity than what is in your bladder, I strongly advise against trying to switch to another mid-stream. The pigeons, when full, can be placed carefully onto the floor though it takes almost no effort to generate the sort of wave motion inside the bottle that kids go crazy for in a waterpark thus spilling it. Full ones will be changed by nurses if you ring your bell though I have always favoured the Howard Hughes approach of amassing a collection of full bottles. Great minds think alike.

Number 2

Urine is a trifle compared to this (n.b. don't order the trifle for dinner). W. B. Yeats wrote of this problem in his poem 'The Second Coming' thus -

The darkness drops again; but now I know,
That twenty centuries of stony sleep
Were vexed to nightmare by a rocking cradle,
And what rough beast, its hour come round at last,
Slouches towards Bethlehem to be born?

The anaesthesiologist may have warned you yesterday that the drugs they would administer would cause constipation. What they didn't stress was what a blessing this was, a blessing that would not last forever. You might have felt that rough beast stirring already but, with fortitude, have resisted the urge. But you can resist no longer and the hour has come round. Being bed-bound will, once again, be a disability but now with a terrifying ignominy. You will never feel more reduced to a helpless childlike state than now but this can be averted if you follow the steps I lay out here. If you haven't seen a physiotherapist yet (you won't have, they're rarer than porters) then you're not allowed out of bed. The nurses, once alerted to your imminent delivery, will bring a bedpan. Do not entertain the idea for a second. I tried it once and, with my best friend guarding the door with the alacrity of a dead dog, I suffered a peak of humiliation from which I have never descended. Neither has the testicle I sat on during the manoeuvre. Refuse the bedpan with a firmness similar to the stool now begging for release from your bowels. If needs be threaten to hold on until you explode in a shower of arse-splattering mayhem. The nurses will doubt your sincerity but will be reluctant to put it to the test. After dismissing the bedpan then option B will hopefully be offered - a commode. This is a potty that has been attached to a child's high chair. It better resembles a normal toilet and is far superior to option A. The disadvantages are that once the nurses and/or your charming partner have helped you up onto the seat like some decrepit old African dictator you'll be expected to do your business in the middle of the room. Like some decrepit old African dictator. You'll need to clean yourself with extreme deftness given the shallow bowl of the commode or you begin to resemble a toddler in their early days of potty training. Once this is done you'll need to summon the nurses again to get you back off your stinking throne. I once did all this while other nursing staff flitted in and out of the room, their professional oblivion was impeccable but part of me died inside. The nurses then wheel the commode away and, I trust, burn it. Option C is the best and so the most difficult to secure. If you have a room then you will have a toilet. A normal, porcelain thing in a little room that will suddenly seem like a gleaming Eden. A cupboard of dreams. Or the aforementioned Bethlehem. So near and yet so far. To get the nurses to assist in your journey and fulfil the destiny of the stodgy food they've been bringing you then a combination of charm, threats and reason will be needed.

• You've already offered to shit yourself to death - reiterate
• You've already given the impression of how distressed you'd be to defecate around others - emphasise
• You now need to now convince them that the major operation you've had is little impediment to your movement despite only having one functioning leg (again I only reference personal experience)

Suggest that the commode be used as a kind of wheelchair to get you to the toilet that you can them seamlessly hop onto. Better yet have them find one of the commodes that fits over the top of the normal toilet so no transference is needed, they will vastly prefer this. If they raise concerns about your low blood pressure and fainting due to movement (bodily not bowel) then have them retest you. Holding your breath while they do the test should raise it nicely. Once you are positioned on the seat and the door is closed and you are alone as God intended then wait just a second, quietly contemplate your achievement and, well, Rudyard Kipling said it best -

If you can force your heart and nerve and sinew
To serve your turn long after they are gone,
And so hold on when there is nothing in you
Except the Will which says to them: ‘Hold on!’

If you can fill the unforgiving minute
With sixty seconds’ worth of distance run –
Yours is the Earth and everything that’s in it,
And – which is more – you’ll be a Man my son!

Your work for the day is done. Good night.

Day 3

Morning

You won't wake this morning. Not because of some fatal complication in the night, you're in the clear for that sort of thing now. You won't wake because you didn't sleep. Without drugs and the ability to flip over into a more comfortable position sleep will be in fits and starts but mostly stops. Machines will whir away nearby, their daytime silence becoming a night time chorus line. The white noise is broken by bleeps and clicks and the faint sound of someone, somewhere screaming. Your birthday was two days ago though chum, it's back to keeping you alive rather than happy. The first of your daily observations will be at about 6:30AM, the time varies as it carefully coordinated to be just as you are finally nodding off to sleep. You'll have met about fifteen nurses by now between the day and night shifts and will be starting to mentally sort them into a matrix based on the simple measurements of how good they appear to be at their job (competence) and how pleasant they are while doing it (pleasantness). Plot these two measurements and you can find out how likely it is that you will suffer at their hands.

You really only need be concerned about the low-competence / low-pleasantness nurses and particularly at night when there are less staff on the ward. They will eventually respond to your bedside buzzer but will be primarily interested in turning off the alert at the wall and getting back to whatever they were doing. You can momentarily delay them by saying things like "I haven't had any antibiotics today" or "all the blood is coming out of my body" but they will treat these as statements rather than questions even if your voice does go up at the end. Once they have shuffled off to haunt the darkened corridors your only real choices are death or persistence. Not always an easy choice as one hates to be a nag but I do recommend persistence. Eventually they will pass on the information to someone who cares. If you wish to do a quick assessment of a new nurse then the matrix score can be gleaned by estimating the force with which they slam your door,

• Low = so softly you barely hear it
• High = causes you minor fractures

Breakfast will come, eggs benedict it will still not be. A piece of advice I would give you here is to abandon the 'coffee' if you haven't already and choose the tea. Along with regularly recording your blood pressure, temperature and oxygen level the nurses will also, more subtly, be keeping track of other things. Things such as regularity of bowel movements, when you last washed yourself and tea. If you haven't had a cup of tea since the operation then the nursing staff will be very concerned by now. Tea's properties to heal both mental and physical ailments are widely known and entirely anecdotal. It will greatly put everyone's mind at ease if you drink the tea. By day 3 life in the hospital should have settled into a kind of rhythm. Breakfast, lunch and dinner. Observations. Antibiotics. Painkillers. Doctors. All of these come around on their cycles. But while you ought to be able to set your watch by them that isn't always the case and here is where you can become the 12th man of the medical team. In any relationship communication is the key and you are surrounded by and part of myriad relationships on the ward. Like the second law of thermodynamics which states -

In every energy transfer, some amount of energy is lost in a form that is unusable

At every shift change some information is always lost. It could be benign, like the fact that you asked for some paracetamol for mild pain. But it could be significant like you are in significant pain and the doctors have prescribed no morphine. Handover notes are only as good as the scribe and the reader. There are few staff and many cracks and you will fall into one if you stay long enough. Understand when you should get what. Remember whom you asked to provide something and whom they were supposed to ask. Ask, ask, ask. It is an unfortunate but unavoidable fact of the healthcare system that he shouts loudest lives longest.

Afternoon

Your mind will drift unoccupied by the petty necessities of modern life. There is nowhere to go and nothing you need to do. If you are of the right sort this unstructured time is the greatest gift you can ever get. We all have far, far too little of it in our lives. In fact from childhood these days we are taught to fill time to the brim and beyond. And if it all feels to much then we aren't trying hard enough. To have time to think, to philosophise! The best advise I could give you to find this time is to sustain a major injury 15 years ago that has no obvious surgical remedy and instead offers the chance to have numerous interventions over the succeeding none of which will fix the problem entirely. I have racked up five hospital stays from this one alone and, with a little creative thinking, there should be more to come. So I sit here thinking of the world and my world. My world reduced to what I can see and experience from this fixed position. And I think of it in the context of Plato's cave.

The allegory of the cave is by the Greek philosopher Plato and in it he describes people who have spent their entire lives chained by their necks and ankles in front of an inner wall with a view of the empty outer wall of the cave. They observe the shadows projected onto the outer wall by objects carried behind the inner wall by people who are invisible to the chained 'prisoners' and who walk along the inner wall with a fire behind them, creating the shadows on the inner wall in front of the prisoners. The 'sign bearers' pronounce the names of the objects, the sounds of which are reflected near the shadows and are understood by the prisoners as if they were coming from the shadows themselves. Only the shadows and sounds are the prisoners' reality, which are not accurate representations of the real world. The shadows represent distorted and blurred copies of reality we can perceive through our senses, while the objects under the Sun represent the true forms of objects that we can only perceive through reason.

Room 16
Now, what I mean by this is not that I have been chained to a wall in a cave by the NHS. Firstly things are not that bad and secondly good-quality chains are expensive. Rather, that to be stuck in one room behind a door that is only open for brief periods each day begins to distort your experience of the world. When the door opens you can see out onto a corridor that presumably you travelled along to get to the room but you have no recollection of this. People come into view from the left and the right within the narrow aperture of the door but you do not know where they have come from or are going to. Is the nurses station just beyond your room or far down the corridor? Where's the kitchen? You can hear the sounds the patient in the room next door makes but what does he look like? Young or old? What's his malady? The mind inevitably fills in all these gaps but it's little more than conjecture. The desire takes hold to know what is around that corner. You begin to yearn for a world that is just a fraction larger.

The allegory then supposes that the prisoners are released. A freed prisoner would look around and see the fire. The light would hurt his eyes and make it difficult for him to see the objects casting the shadows. If he were told that what he is seeing is real instead of the other version of reality he sees on the wall, he would not believe it. In his pain the freed prisoner would turn away and run back to what he is accustomed to (that is, the shadows of the carried objects). The light would hurt his eyes, and he would escape by turning away to the things which he was able to look at, and these he would believe to be clearer than what was being shown to him. Then suppose that someone should drag him by force out into the light of the sun. The prisoner would be angry and in pain when the radiant light of the sun overwhelms his eyes and blinds him. Slowly, his eyes adjust to the light of the sun. Eventually, he is able to look at the stars and moon at night until finally he can look upon the sun itself and is able to reason about it and what it is.

Somerset Ward, St. Thomas' Hospital
I doubt I will be dragged out of this room because, again, while there is always a shortage of beds things are still not that bad. The time though will come when you are ready to go home. This day will calculated using the formula below -
(day when you desperately want to go home) + 1 day
As mentioned you'll be waiting on tail-end charlie in the form of the physiotherapist. Given that they are very much the P.E teachers of the medical world it is a wonder they don't get between patients with more speed. Nonetheless they will eventually turn up, find you not to be a decrepit old African dictator, be incredulous that you've used crutches before and then give you the all clear. One time they went the extra mile and made me climb up and down stairs which I did but not without popping open the stitches on the large wound I had on my thigh. It rather undid the good work of their surgical colleagues I thought. And so now out into your world of sensory conjecture that is the ward. Nothing is quite where you thought it would be. The guy in the room next door is a frail old man and you feel guilty for wishing he'd die in his sleep to stop the loud coughing. The corridor continues and the world begins to opens up.

The free prisoner would think that the world outside the cave was superior to the world he experienced in the cave and attempt to share this with the prisoners remaining in the cave attempting to bring them onto the journey he had just endured. The returning prisoner, whose eyes have become accustomed to the sunlight, would be blind when he re-entered the cave, just as he was when he was first exposed to the sun. The prisoners who remained, according to the dialogue, would infer from the returning man's blindness that the journey out of the cave had harmed him and that they should not undertake a similar journey. The prisoners, if they were able, would therefore reach out and kill anyone who attempted to drag them out of the cave.

The World
You step out into the wider world beyond the hospital doors and blink in the brightness. People go about their day under a unseasonal December sun and you are chilled to your bones. The cave is full and people are fighting like hell to stay there.

Day 4

Morning

Wait...you're still here? Repeat day 3 until they release you.