Pre Op - Wednesday

The team on Cheselden ward would later confirm that Wednesday December 11th was their busiest day of the year.

If there was a rule for minimum distance between beds on a ward, like there is a rule for gaps between seat rows on airplanes, then I’m sure Cheselden would be contravening that rule on that day. Likewise if there was a rule for minimum hours of sleep full rest for the surgeons in between 12 hour shifts in theatre, as there is for pilots after 9 hours of flight, then I don’t think they would be compliant either. I remember thinking that if Lowry had painted a scene of a hospital ward; he might have chosen this vision of dense humanity laid out on a grey backdrop. It wasn’t chaos per se, as the nurse in charge, marked out by the red piping on her grey uniform, somehow just about kept everybody and everything in check. And by 6.30pm, when there still wasn’t a bed available for me, and when my Surgeon, the ‘Prof’ strode past us in the corridor in his scrubs looking burned out, responding to my query with the palm of his huge hand, clarifying: “Not now, I’ve just come out of theatre, we’ll speak tomorrow Sophie “.

Well, on the day before my operation, the omens didn’t feel good.

I played back the texts in my head, like the one that my boss had sent that morning:

“Good Luck, I’ve just got a feeling that everything is going to go really well.”

My only saving grace was when the Prof also raised his giant hand to the Jewish looking Doctor when he motioned to go for a pint and he responded: “Not tonight mate, I’m knackered!”

“Thank God!” I muttered to Alex, aware that it was Christmas party season.

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Hospitals evoke different memories for different people. For me, when I enter a hospital, I think of Christmas day.

Christmas day for the Evans kids growing up meant digging into our stockings in a race to grab the chocolate coins and tangerine, before dressing neatly and bundling into Dad’s brown Allegro to be driven to the Royal Liverpool hospital in town, known simply to Scousers as ‘The Royal’.

After a row about who was old enough to get out of singing Away in A Manger at the hospital chapel (As the youngest, I never was), we’d stare out of the windows, watching excited kids in new Liverpool and Everton strips ride their spanking new bikes, or scooters of skateboards, or whatever the craze was that year. We’d always argue about why we were the only kids in Liverpool who had to wait until after lunch to open our presents (nearly 5pm); but for some reason we never dared question why we were obliged to shake the hands of every one of Dad’s patients, on 3 different wards, on 3 different floors, on Christmas morning.

It wouldn’t happen now. I mean I don’t think you would be allowed to get the Consultant’s children to dispense a shot of Sherry to elderly patients at 10am, much less get those same kids to guess the age of each patient. Jo and I would guess the age in our heads, and then take off 5 to 10 years before saying it out loud. Matt wouldn’t take any years off, and so more often than not, he would end up offending the patient.

“Well she did look like he was 81” Matt would say.

“Yeah, dirrr, but you don’t say that in case she’s not that old. That’s rude!” Jo would say knowingly, admonishing her little brother.

And if a patient raised their hand to turn down the shot of 40% proof alcohol, we’d join Dad in shaking our heads in disappointment. “Come on it’s Christmas day; it will do you some good, are you sure?” Dad would say.

It was an induction into hospital wards really – the sterile smells, the tubes, the kidney shaped dishes, the wee sacks, “that’s a catheter Sophie!”; the tilting beds, the transparent plastic cups, the green curtains, the high backed chairs, the stairwells and long endless corridors with double doors, oh, and all the old people looking ill as they waited for visiting hours.

The doctors tried to discharge as many patients as possible ahead of Christmas, so I was never struck by a sense of overcrowding, not like it hit me at St Georges on Wednesday morning some thirty years later. The one similarity was that it always took Dad ages to find a space in the car park at The Royal even though he had a staff badge.

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Arriving at St Georges on Wednesday morning, Alex and Harriet would spend a good 45 minutes tailing people in the hope of poaching their space, whilst I raced ahead on foot. I would find Sam at the ward reception, stooping behind the classy SHO – Cordelia, who couldn’t have been more incongruous on this old school ward in her high heals and height of fashion outfit.

Sam thankfully had located my notes, and led me straight to the lab down the corridor whilst I estimated that I was 30 to 40 years younger than anyone else on the ward.

“Right, you need a couple of tests in the vascular lab first. When that’s finished, come back to reception and find me so we can get you ready for your CT scan which will be in the building next door.”

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I’d actually managed some sleep on Tuesday night, which I hadn’t expected, and I put it down to going to bed smiling: Earlier, as Alex and I were sitting down for dinner, and conversation had eluded us, my iPhone alerted me to an incoming email. It was from my colleague – the lovely Susannah Wood who is Marketing Director at Solarcentury - the brilliant Company that I've worked for over the last 10 years. The short email linked me to a video on YouTube entitled:

“A song for Sophie”.

So we fetched the iPad and propped it up in between our two plates to watch together. We saw in turn: the Chairman; the CEO; some clever editing, and most of my favourite colleagues staring back at the screen and mouthing the words to “You’ll never walk alone”. I’d rarely managed to get all of these people in a room together for an important meeting, because their diaries were always too busy. Yet here they were on YouTube, finding time for me, letting me know in an incredibly creative way, that they were thinking of me at a time I felt so distant on maternity leave. And it really made us both laugh and smile. That video banished the awkwardness from our last supper together at home, and would also make my wider family smile as they went to bed too: “You must be very well thought of Sophie!” my mum had said on the phone that night.

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I was relaxed and had some sleep under my belt when I called Cheselden ward on Wednesday morning to confirm they had a bed for me and that I should arrive at 2pm.

“Yes, absolutely, see you then”, someone had replied.

Thank goodness! I’d thought, I’m not sure what I’d have done if they couldn’t locate my name on a list.

I'd just confirmed to my parents that all was going to schedule as they set off from Liverpool to visit me, when a woman called Sam called to explain that it was crazy on the ward and they didn’t actually have a bed for me after all. She suggested getting a good night’s sleep at home, fasting from midnight and coming in at 7.30am on Thursday ahead of the surgery a few hours later.

“Buttttttt” I said. Buying some time to work out what my but was

“BUT.......what about all the scans that the Surgeon said I needed to have the day before?”

There was some checking on the other end of the line.

“What do you think you need?” Sam asked.

"Well the surgeon mentioned having another ultrasound and CT and some checks on my brain or something?"

“OK, the Duplex! “Right, well come in at 3pm then”

“Well are you sure?” I asked, I mean I think that’s what the surgeon mentioned, but presumably you have some notes?”

“Yes, I’m sure we’ll find them, see you at 3!” She responded, trying to hang up, but I interjected:

“So the surgery’s definitely still on for tomorrow?”

“Yep, you’re down to go in third into theatre, probably not until the afternoon.”

“THIRD!?...But the surgeon said the operation will take about 10 hours, surely I’d be scheduled first thing?”

“Err no, well, they might bring it forward, but it says you’re third here. I imagine 10 hours is worst case, it might not be that long. See you at 3!”

And she was gone.

I hung up and puffed my cheeks out, looking up at Alex as I relayed the message to him, frustrated, worried. I mean in my working world, I prefer to tackle all the hardest problems in the morning, when my brain is at its most alert, especially if I want to start and finish something in one go. I save up all the easy tasks and reactive working for about 3pm, when my concentration is wavering. So it worried me to think that I was third in line, for Prof Thompson’s ‘big one’, my big one come to that - recalling him saying -

“The operation might take ~ 10 hours. Well I’d say I’d do about one of these operations every 1 to 2 years, 10 in my career maybe, it’s incredibly rare!”

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The lab technician seemed quite young but she was clearly very competent. I lay on a bed, a bit like a Dentist’s chair, as she probed up and down the right side of my neck with the ultrasound equipment, taking various measurements. When she appeared to be finishing, I asked her what measurement she had recorded for the aneurysm diameter.

“2.2cm” she said.

“That’s interesting” I replied. “That’s very similar to the size the Neuro lab had returned in January, but my CT scan had it at 3.5cm in July. So I wasn’t sure which technique was more accurate, or whether the aneurysm had grown dramatically after pregnancy?"

She clearly explained the reason for the difference – the Ultrasound could only measure the lump in one plane across the neck, but the CT scan could measure the diameter in multi dimensional planes, and hence in terms of an accurate measurement for the largest diameter, unfortunately the CT scan was the reliable source. Given the cap for a ‘giant’ aneurysm range was defined as 2.5cm, this later measurement had been quite a shock.

“What are you doing next?” I asked as she pulled out more equipment.

Do you want the technical explanation?” She asked.

“Yes please, I like understanding the technicalities” I replied.

“Right, well I’m going to put these probes onto your temples and push quite hard. What we’re trying to do is to see whether we can get a signal through your skull to measure the flow of blood around your brain. Some peoples’ skulls are too thick and so this might not work, but if it’s not too thick, then we’ll be able to track the readings in theatre."

“So how do you use that info?” I queried

She explained that there was a circular network of blood vessels that provided blood to the brain as a back- up supply, in case one of the main arteries became blocked. This network, known apparently as ‘The Circle of Willis’ sounded like the equivalent of the thin tyre you have in the boot of your car, in case you get a puncture - Most of the time it will do the job if you drive a bit slower, but it’s just a temporary fix and you should get it changed as soon as you make it to a repair centre. Actually as the lab technician explained it, it sounded a little less reliable than the tyre in your boot, and that’s why they wanted to get some information about it in theatre if they could.

“So will you be in theatre tomorrow during my operation?”

I gathered that she would be, and her role would be to provide timely information to the Prof, once he had clamped my internal Carotid artery (ICA) down. Basically, she would be indicating how much time the surgeon had once he’d stopped the blood flow to the right side of my brain, to the effect of:

'Err, there’s not much flow, you need to hurry up NOW!', or

'Right take your time, we’ve got a nice steady flow here, the brain is being well fed, I’ll let you know if that changes'.

The Prof had kicked up quite a lot of fuss about having this instrumentation available to him in theatre with my health insurance company, as they had challenged why the operation had to take place at St Georges, and not one of their pre- approved private hospitals. So I was very relieved to hear that I had a nice thin skull, and the flow readings were loud and clear.

After the lab, I caught up with Alex and Harriet in the visitors room, before finding myself in the medicine store room where Cordelia the SHO volunteered to quickly put a cannula into my favoured vein (inside right elbow) so that the radiologist could later pump dye into my vascular network for the CT scan. As she concentrated, one of the Doctors came in and out with his hands on his head. “aghhhhhhh” he said, before spotting me there.

Sam’s instructions took me along one white corridor after another, punctuated by sets of large glass double doors. The scene of busy hospital workers and lost visitors in front of me went past my eyeline as if flicking between fast forward and pause, like Peter Gabriel’s Sledge Hammer video.

Recently, I’d been to a number of London hospitals, and each time I’d been struck by the corporate sponsored freshly painted corridors and brightly coloured framed prints adorning the walls, which I imagine, just subtly acted to lift the spirits of patients, staff and visitors alike.

Not so St James Wing at St George’s.

Weaving my way towards the CT unit, I noticed that nothing had been done with this building to lift the spirits at all.

I finally made it to a door covered in radioactive warning stickers, and realised that I was in the right place.

“Hi, I’ve come from Cheselden Ward for a CT scan, Sophie Orme?”

I was pleasantly surprised to find that Brenda the receptionist had my details and ushered me through to the waiting room. I soon realised that Brenda was a one woman band, performing the roles of receptionist, patient prep, radiologist, and patient supervision through various states of undress and dress afterwards (most of whom needed help). I was once again quite shocked by the intensity of people’s role in the NHS.

“They told us to prepare for the busiest winter” Brenda had told me ahead of my scan. “But It’s been like this since August! I don't think I'll make it to Christmas!”

She explained the scan procedure and told me to expect the nasty iron taste in my mouth once the dye was injected, and the intensive heat sensation, including the feeling that I’d wet myself, but the assurance that I wouldn’t. I knew all this from my previous scan, but I appreciated the warning. It is a horrible sensation actually – the heat! The sense that you are on fire, and that every droplet in your body is about to boil over; but I knew this time that it would be over very quickly, much like scanning your food items at a supermarket checkout. In contrast to the MRI, it held no fear or anxiety for me.

After the scan was finished, I returned to the ward, determined to drink pint after pint of water so that my kidneys could process all the dye in my system before the fasting deadline kicked in.

Back at Cheselden, I found that Harriet was beginning to query the quality of the playdate she’d been brought on. She had her Daddy, and a sick looking elderly man for company, together with a blaring quiz show from the large TV opposite, it was hosted by Alexander Armstrong - the guy who had been sitting at the table next to us at a recent wedding. Alex had gathered that the poor old man was just getting to the end of a second day in the waiting room as he waited for a spare bed. His daughter would pick him up at the end of her working day and bring him back again tomorrow to try out his luck once more.

I took Harriet on a tour of the ward, introducing her to the staff, hoping to endear them further to me, and trying to get a smile out of line of patient beds. “I’ll come over in 10 minutes”, one of the doctors motioned to us:

“Right, we’ve got everything we need from you today. I’ve just been told that we’ve got a discharge coming up, and if you want it, they should be able to get a bed ready for you at some point tonight. But if you live nearby, I’d get a good night sleep at home if I were you, and come back first thing, it’s pretty noisy here.”

“Thanks”, I said, but I’d like to take the bed if that's ok”

The Doctor and Alex both looked at me, slightly perplexed by my decision.

I turned back to Alex and said “I’ve said my goodbyes now, I can’t face going through them again. I just want some solitude”

Alex understood, and realising the limitations of the visitor waiting room, he dropped me off at The Crooked Billet on Wimbledon Common to have dinner with my parents and my brother Matt who had intended to visit me in hospital post work. There I had sat letting the hectic Evans conversation fly past me, too tired to engage. My only contribution was to ask the waitress to put more logs on the fire which nobody else seemed bothered about. When I went to the toilet I realised I was shivering involuntarily, which probably had more to do with the needle and procedures I’d had that afternoon, rather than the draft coming from the window. I called Alex to ask him to come and pick me up. I was done. I wanted to go back to hospital now and I couldn’t force any more food down.

The night shift had brought some quiet and order to Cheselden Ward on our return, and either it was my private patient status or the gods that were finally shining on me. For not only was a bed available when we got back at 10pm, but it is was a bed in a private side room, which we hadn’t realised existed earlier, complete with an en suite and a large window from which I could see a London rooftop nightscape. I blue tacked 3 large photos on the wall at the end of my bed, and unpacked my stuff, before Alex wrapped me up in a goodnight kiss. As my head hit the pillow with my Bridget Jones Audiobook ringing in my earphones, I didn’t expect to find any sleep at all. But I must have dropped off for a few hours at least because I had a 9 chapter gap in the book when I woke up at 3am.

Those three hours or so would be the last proper sleep I would get until Saturday night. And when Professor Thompson came to speak to me at 7.30am the next morning to reiterate the two groups of risks and to introduce some previously unmentioned ones. I wasn’t unnerved this time and I knew I was ready for the operation. I felt completely calm and at peace.

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