The surgery took 6 hours, which is quick for a DIEP reconstruction. At 3.20pm Mr A phoned Nick and told him his colleagues were just finishing up and that the operation had been a success and the patient had not died. He told Nick to wait until 8pm to see me on the ward as I’d be kept in recovery until a specialist nurse was on duty.
I have no recollection of recovery or being moved onto Lynher Ward. I’d been very anxious about going back to Lynher Ward after my experiences some 18 months earlier following the mastectomy. I need not have worried because I was in a side room next to the nurses station and the care I had was exemplary. There was no demand for the application of power red lipstick this time, no demands for anything other than a drink which is why I needed the sports bottle with integral straw.
The reason I was in a side room on my own was because I was considered to be a high dependency patient who needed 15 minute observations of the new breast and general observations too for the first 12 hours. I was nursed by a wonderful woman who wore a maroon coloured uniform, was a band 6 so the equivalent of a Sister, had decades of experience and as well as being a nurse she was also a clinical educator and so taught students and less experienced nurses on the ward. Sister D was amazing as she was so reassuring, she explained everything she was doing including lifting the dressing on the new boob where there was a 4cm diameter circle of skin from my tummy which will eventually be a new nipple. For the reconstruction to work the plumbing in of the deep inferior epigastric perforators had to ensure that there was a good blood flow. This was measured by pressing on the new tummy-nipple for a count of 5 and then counting to see how long the capillaries refilled. As long as this was no more than a count of 2 things were going well. The side room was very hot, not least as I was placed under a bair hugger. This is a blanket which has warm air forced through it to help keep the new breast alive and keep the blood pumping. I was attached to a the bed in a variety of ways – oxygen tube looped around my ears and chin to deliver O2 into my nose, catheter to measure fluid output, saline drip to measure fluid input (to keep the veins perfused and open), 4 drains from my chest, underarm and two from my lower abdomen and patient controlled analgesia pump which with a press of a button gave a shot of fentanyl to remove any pain. I also was attached to a heart monitor via a finger and had a blood pressure cuff around my arm which was blown up at 15 minute intervals. My blood pressure was much lower than usual at 100/40 probably as a result of lying flat for so many hours. My resting heart rate was about 58 which I didn’t think was too bad.
Sister D stayed with me throughout the night, nursed me, with the health care assistant helped me up the bed by gently rolling me one way, then the other to put a blue nylon slippy sheet under me and hauling me up the bed. Sister D wiped my face with wet wipes, encouraged me to drink lots of water, chatted away about families and gardens, plumped the pillows under my head and under my knees, checked the drains, changed the catheter bag as with the saline drip and all the water I was drinking the output was great – this meant my kidneys were working well and if they were perfused there was a good chance the flow to the new boob was as well. It was so hot under the bair hugger. I couldn’t move much and couldn’t really see what state the “assault” had left me in as I hadn’t looked down to my new tummy. Sister D was very keen that I pressed the pain relief button before any form of movement and made me as comfortable as humanly possible all through the night. It was still a hard night but between Sister D and the oncall Plastics team doctors who dropped into to check the colour of the boob I was well looked after.
In the morning Sister D brought in a cardboard basin filled with soapy water and hibiscrub, she then washed me, checked that no bed sores were developing and that allowed me to see that my tummy area was a mess of dressings. There was a large dressing with a flap in to check the boob, a dressing over the V shaped incision under my arm and black stitches holding the drain in place. Over the centre of my tummy was a dressing to hold another drain in place, one over my new tummy button (the original stalk of my tummy button was saved but a new incision was made for it), there were a variety of dressings from my left to right hip which is where my tummy had been stretched and stitched together and then two drains below this with dressings on. I looked a bit of a mess and was boiling hot with the bair hugger going full tilt. With the use of the blue slippy sheet Sister D and the a HCA from Northern Ireland changed the sheets, put me in a new gown and added a “gamgee” which is a thick, warm surgical dressing to stop any drafts getting in at the new boob. I had been washed, checked, she even brushed my hair and then I was ready for handover and morning rounds. Before rounds there was a friendly face – Nick arrived at 7.30am complete with breakfast – dairy free yoghurt, blueberries and a little granola and orange juice. I couldn’t face any of it as the act of trying to sit up made me feel giddy and sick.
Lynher Ward has the highest turn over of patients in Derriford as it is a surgical ward which caters for urology, plastics, ear, nose and throat (ENT), breast patients. Each faculty of specialism has it’s own team of consultants, senior and junior doctors – they hunt patients in packs armed with sets of notes and ernest expressions. They are accompanied by a senior nurse who explains how the patient has been cared for and is supposed to have various results at the tips of the their fingers (usually they are in the notes). My first visitor was the young South African who came in and checked the boob, he was then followed by a team who spoke to Sister D and asked me how I was doing. The answer was okay considering. Sister D was off duty and was going home to have a good sleep. She had been wonderful and would be back to nurse me that night. The long night was over.
Day one loomed. New nurse, new boob, new me. No cannonball.