“It was bloody awful actually!” I replied, now sitting up in a steep backed armchair, my head drooped.
I felt tired, desperately tired.
It was 9.30am on Friday 13th of December, 16 hours after the operation.
Most of the wires were still linked to the large monitor above and behind me. To my relief, the new day nurse had just taken out 2 of the 3 intravenous cannula’s in my arms. Heather’s shift had started at 7am, and since then she’d been busily caring, sorting, organising, and feeding me. The first thing she had done was to remove the catheter, which I had been lobbying for since 5am with the previous nurse. As soon as it was out, I felt a sense of control and dignity return. But I hadn’t yet put the night fully behind me. Not yet.
Like yesterday, Alex looked like one of those black and white prints with a red London bus splash of colour across. He wore his bright pink Gaza Italia racing jersey which contrasted with his grey pallor and black cycling leggings. He looked shattered and concerned. I’ve only recently pieced together his appearance that morning, with what he had encountered on his walk to my room. Of course he was tired from looking after the kids and still anxious about how I was coping after the operation, but there had been something else that had rattled him - When the lift had opened to take him down to ICU, a young nurse had stepped out, sobbing into her hands. As Alex continued his journey to my room, he grasped the news that a child had not made it through the night, and an elderly patient in the room next to me remained critical. “I couldn’t feel my own relief either”, Alex later told me. “A hospital is just so wracked with emotions.”
I had no appreciation of what or who lay beyond the four walls of my room. I could only focus on my own survival, of getting through the night. My curiosity was limited to understanding why it took my nurse 25 minutes to respond to the call button each time I buzzed it. On one occasion it took 42 minutes. Every time I pressed the buzzer for help, the repetitive bleeping would soon be joined by the louder bleeps of the monitor, which was set off each time that my blood pressure went above a maximum target. Funnily enough, this would happen every time I cursed the nurse’s slow response, and the reverberating noise pounded the fragility of my head, like the January storm waves that would soon break up the old harbour wall at Portreath, (our little Cornish village). I quickly came to realise that it was a hopeless viscous circle, and that the nurse was probably thinking that I’d soon learn not to hit the buzzer again. I wondered if there was a parallel with sleep training Harriet - each time I guiltily leave her for a few minutes of crying, I hear my mum’s advice ‘She won’t remember Sophie’. Maybe the nurse had a Gina Ford style manual ‘the contented patient’ which instructed her to wait before running to the buzzer. Either that or she was deaf, or simply beyond apathy. Only this situation wasn’t about getting a baby into a routine, it should have been intensive care!
“I must be intolerant to morphine, Al, like my Mum. I’ve never been so sick! And the nurse must have been distracted by something. I don’t know why she didn’t come when I buzzed. The fucking bed kept moving – it’s like a lilo, filling with air every few minutes, I felt so travel sick. I just wanted to sleep through it, but I couldn’t – I managed to drift off once, and the last time I looked at the clock it was 2am, so when I woke up again, I crossed my fingers, thinking and praying that it was at least 5, but when I saw the clock, and it was just ten past 2. I couldn’t believe it - 10 bloody minutes of respite, it was a killer. And that was it; all night.... Aghhhhhhh.... I couldn’t take my eyes of the clock for a second. The first time I threw up, it wasn’t too bad; I caught it all in a kidney dish and felt a bit better afterwards. I didn’t understand where all the liquid came from, because I’d only managed small sips, but Heather just explained they were probably pumping fluids into my veins to bring my blood pressure down. When I begged the nurse not to give me morphine again. I literally pleaded with her - any pain relief but morphine, I said. I tried to spit it out after she’d given me a vile to drink and I tasted it at the back of my throat, but it was too late, I’d already swallowed most of it. She said the anti- sickness drip would work this time, but it didn’t. I knew it wouldn’t. Waves and waves of nausea came over me until I filled up the kidney dish again, but there was more to come and I just threw up all over myself. And still she didn’t come. I just lay there tasting the morphine in my throat and lying there saturated in my own sick for half an hour. 30 minutes Al! She tutted under her breath when she came in and saw the mess I’d made, sizing up the task of disconnecting and then reconnecting all the wires to change my gown; and then...
“Was it harder than Himal?” Alex sensibly interrupted.
I brought my lips together to answer, but paused and took a few moments - I wanted to do both experiences justice before I answered.
****************************************
In 2008, my friend Ali and I decided to go in search of an intrepid adventure. I was married and living in Madrid at the time, and Ali was single and living in Balham in London. The idea started with a random opening of the Lonely Planet country by country guide, and ended with the successful climb of Mardi Himal, a peak of 5588m. (I later worked out that it was a few meters higher than Alex had reached when he had trekked to a ridge above Everest Base Camp the year before). Satiated by the accomplishment on my return, I would tell Alex that I was finally ready to start trying for children.
The final altitude itself is by no means remarkable, the challenge I reflected later was that we climbed and descended the mountain far too quickly, with minimal time to acclimatise.
Mardi Himal at the time was a lesser- known peak in the Annapurna range, which we’d chosen based on our desire to conquer a summit that required minimal climb experience and if possible, we didn't want to see anybody else on route. Thanks to ‘Major Ramm’, a retired Ghurkha in Kathmandu whom Ali had tracked down via an army friend in London, Himal fitted this bill perfectly, and apart from the beautiful village people we encountered on day 1,the only other person we would see on our trek was an elderly goat herder at ~ 3600m. As our plan started to take shape, Ali’s friends Laura and Andy decided to join us.
So in October 2008, we started our trek in Ghachok as four, with a mere entourage of 18 Sherpas (or porters as they liked to be called) to carry an embarrassing amount of kit to our last camp at 4600m and back again. One poor porter had the uncomfortable responsibility of carrying an impossibly heavy black metal toilet seat. At each camp he would set it up on a base of 3 crossed sticks and dig a latrine below. As I crouched above the seat, at high camp, on the night before our final ascent, I dwelt on how bonkers it was that (a) we had a toilet seat, and (b) it was huge, heavy and made out of metal, so it would always be too cold to sit down on.
By now we were down to three, as Andy had decided to return from base camp on the previous evening, due to his fear about a shoulder injury recurring, and generally feeling low in the cold and the wet. At that stage, we had been trekking through swirling blizzards, which we were reliant on to scrape up for drinking water, since all the high streams had dried up following no rains for the last 6 weeks.
As I hovered above the toilet seat, my knees were exposed to the blizzard outside, with the blue sheeting of the make shift toilet tent flapping against my arms. It was about -15 degrees C, and the blizzard was horizontal. At 11pm, I had just made my second sprint across to the toilet, somewhat unsuccessfully after taking too long to zip up the sleeping tent properly to ensure I didn't freeze Ali who was sleeping inside. Well-travelled, I was familiar with these gripes in my stomach, but I didn’t know if my body’s need to empty itself was due to the altitude, my nerves after climb equipment training (at 4600m the night before; Kathmandu might have been more sensible when we’d arrived); or due to drinking the water that we’d melted from grotty snow that we scooped up with our bare hands after doing our best to sift out dirt.
The cause didn’t really matter, the point was that when I decided through gritted teeth to join the ascent when we all got up at 2am, I took the partial decision on no sleep, an emptied stomach, a cocktail of Immodium and Norfloxacin and fuelled only by a cup of tea, a spoon of peanut butter and half of a poor man’s digestive biscuit. I also had to strap my water bottle within one thin thermal layer from my skin to use my body heat to melt it, as it had frozen and I knew that rehydrating would be critical. The decision was helped when I managed to wake up Goran - the other guide and persuade him to join us to the bottom of the ice climb, so that he could guide me back if I couldn’t go on. That was the clincher, as I couldn’t handle the idea of ruining the ascent for the others.
When we set off, I was completely wired, and focused on copying every foot placement of Karma – our amazing mountain climbing guide. I could feel my pulse thumping through my temples as I maintained pace, terrified of tripping over in the darkness. I turned everything into a positive - my empty stomach distracted from the discomfort of wearing the specialist climbing boots that were too small, I told myself that the exertion of each step served to melt the ice pack around my body, and the total concentration of watching Karma’s boots helped me block out the sheer drops on either side. So when I arrived at the spot where we needed to attach the crampons and rope on the climbing gear, I had lost all awareness of Ali and Laura’s progress.
Karma and I turned back, horrified to see Ali lying on her stomach - straddling a ridge, with Laura behind her trying to coax her into continuing. The aptly named Karma quickly danced back along the ridge to them, impervious to the effects of the 5,000m altitude, whilst I took my first sips of ice melt.
The sun far below us, was just beginning to cast light on the sacred peak of Machapuchare (the fishtail), the mythical mountain face which had towered above us throughout our climb and now seemed within touching distance. We’d seen the iconic fishtail shape from the air when we’d flown past it on our flight from Kathmandu to Pokhara. Machapuchare is one of the few places on earth that has never been touched by man, and it served to draw me in that morning, like a magnet. I felt imbued by the spirituality of the place, uplifted beyond the weakness of my mortal body, and completely exhilarated by the challenge of making it to the summit of Mardi Himal.
‘It’s 9am’, I said. ‘People will just be arriving at work now!’
I was completely hyper at the top, and felt delirious with the sense of extraordinary achievement, complete fulfillment, and humbled by the beauty of it all. The blanket of bubbling clouds below us was starting to dissolve into wispy balls of cotton wool, giving way to majestic snow-capped mountain ranges. We took our time to drink in every detail around us, whilst Karma pointed to 3 of Annapurna's nearby 8,000m peaks that he had climbed, before speaking dreamily about one day travelling to the Alps to climb there. Having been completely awestruck by the Himalayas, it sounded odd to our ears to hear this incredible Nepalise mountaineer talk about how he revered the great climbs in our European back garden, ahead of a quest to climb Everest. Except for one photo cue, Ali remained on her hands and knees throughout our 10 minutes at the top, too fearful to stand up on the highest rock whilst we weren't 'roped on'.
So at 8.55am on October 31st, 2008, we were the first and potentially only group to make it to the peak of Mardi Himal that year. Would anything ever compete with this dizzy high again?
But it was getting down again that was the real challenge.
Abseiling down one rock face in the Mendips on a work development course 15 years earlier, was not quite adequate preparation for abseiling down an ice face wearing crampons in the Himalayas at ~ 5600m. And if there had been anything at all left in my stomach, I expect it might have come out as I hung back over the first vertical drop, with my crampons skidding against the rock like a dog on ice skates. I found out that when you really don’t have a choice, when the rest have gone ahead and when nobody is watching, somehow you just find a way, even if it isn’t pretty. The problem was that I would use up the last drops of adrenaline during that abseil, and shatter my arms with the tension of trying to hold my body weight by clinging onto the rope as I lowered myself, rather than relaxing my grip and trusting in gravity and the process.
When we made it back to camp at about 10:40am, we found that the tents and porters had disappeared. All that remained was Karma's anxious girlfriend and Goran (the not very good guide) who’d returned at the base of the climb, and was now sitting down waiting to explain the change in plan: The porters were tired of melting the dirty snow to drink, and wanted to get down quicker to a level where the streams were still flowing.
“OK” I said, using my climbing stick to keep me upright. How much further?
“Just a few hours” he said
We all turned to Karma and asked him to find out how far it really was.
“Maybe 8 to 9 hours if we keep to the same pace” he replied after conferring."
The picture above captures my face (far right) moments after hearing Karma’s honest assessment. Behind us, the peak to the right is Machupacare, and Mardi Himal is just poking above the cloud to the left. At that stage, I didn’t feel I had anything left to give and I still couldn’t stomach any food without now, vomiting it back up again.
So the ten hours (we didn't quite keep pace) that followed were my breaking time on Mardi Himal, and the passage of time that I was trying to compare with my night in ICU. After making it the crest of our mountain, then all the way back down to camp on no sustenance at all, I found out that there was still at least 9 hours of hard walking on difficult ankle breaking terrain to go. As I stumbled forward, my mind seemed to fold in on itself, losing all awareness of the people around me. Throughout, I trailed at the back, head dipped down listening to tunes from my yellow 1980’s headphones; I lost the horizon, only daring to look at the ground a foot or two in front like a Himalayan yak. Karma diligently followed right behind me, deployed to try and catch me each time I fell, which I did regularly towards the end. I’m still not sure if I tripped over or blacked out on each occasion.
I remember clearly reaching a plateau at around 5pm with the light fading. We were on a section that could almost be described as a path. The guides agreed we could rest for 5 minutes, and so I sat down and looked out at the vastness around me, sipping from my camel water pack which I’d recently added a couple of outdated purple diarolite sachets of salts too. It tasted mildly better than the bile that kept coming into my mouth.
When the guides were ready to go again, I called them back:
“Sorry, I can’t go on another step. That’s me done for the day I’m afraid. No more!”
“We have to!” Ali knelt down to talk to me: “Come on you can do it. We’re almost there Soph, we’re all hurting.”
“No I really can’t” I replied. Either the sherpas need to come back and set up camp right here, or someone needs to call for a helicopter to take me off this damn mountain.”
Ali and Laura laughed, nervously.
“I’m serious, when Alex trekked to Everest base camp, the travel company arranged for a helicopter to take one of the team down because she was too ill to go on. You need to ask them to call for one for me, I can’t make it down”.
Ali laughed more naturally this time. "Soph, this isn’t Exodus, this is Major Ramm’s adventures. I doubt the guides’ satellite phones even work!"
At least they humoured me and spoke to the guides, before Laura came back and sat down next to me. “Take this!” Laura said. "It’s my last boiled sweet, it won’t make you sick. It will get you down to there", she pointed, "one of them is going to run down ahead and ask the porters to wait for us, and send some back to carry you.”
Hmm, that’s not really the same as a Helicopter, I reflected.
The sweet was red, raspberry flavoured, and I made it last a good twenty minutes. Laura was right, it didn’t make me sick and it did get me down to a point where two porters had scrambled up to meet me. They took it in turns to pick me up and sling me backwards over one of their shoulders like a sack of potatoes. There my body jangled against the Porter’s bony shoulder as he jumped down rocky steps in a stumbling fashion. It was a much more effective tactic than the sweet, and got me back on my feet very quickly, repelled by the body odour, sickened further by all the jolting, and realising the indignity of not making it down on my own two feet. I pretty much jogged down after that, even with the light beginning to fail.
It had been dark for a few hours by the time we arrived at camp. A meal of lentil dahl had been prepared, and as we sat down, Ali placed an elbow on the makeshift table and rested her head in her hand, her whole body quivering as she started to cry in relief. I recorded a video diary in my own tent that night, trying inadequately to describe how hard the last 19 hours of climbing, abseiling and trekking had been for me. ‘I can’t imagine I will ever do anything as hard as that again in my life!’ I said to the camera lens.
Two days later, we were relaxing in Pokhara restored to full health, I rowed my great climbing companions across the stunning lake. It was the spot where I officially announced my retirement from mountaineering, and where Ali and Laura began plotting a climb of Mont Blanc.
************************************
“Yes!” I finally replied to Alex.
“Last night was worse! …..There just wasn’t anything to lift me”.
I thought of how I couldn’t seem to cope with lying there passively feeling sick, dry mouthed, terrified to move my neck, my headache engulfing me. Himal was physically harder, but the beauty of it all was so inspiring, it warmed my soul, so that when I felt so close to the edge, something otherworldly seem to propel me onwards. Whereas in ICU, I just couldn’t get beyond the four white walls, or the slow ticking of the clock and I couldn’t tap into my emotional toolbox or cut my mind on happier places. All I wanted was for the nurse to remove stuff: I wanted her to take out the warthog like oxygen tubes that went up into my injured nose and irritated my inflamed left nostril; to take out the 3 lines of tubes in my veins that caused a hideous sensation in my finger- tips, each time they flushed them clean before pumping me with something; to take away the large plastic bottle filled with stale maroon deoxygenated blood which rolled side to side on my chest, the catheter line that kept snagging and confusing me, the clip that measured saturation on my left finger, restraining me each time I tried in vain to reach the water jug, after the nurse had accidently knocked the table away as she left the room; and the maze of wires which were everywhere. I wanted her to turn off the unnecessary bed motion designed to help blood circulation in elderly patients, to bring me some entertainment like a radio, or talk to me, or give me a drug to knock me out and not make me sick. I just wanted some help through the night actually! Laura wasn’t there to offer me a boiled sweet, nor Ali to tell me there was no helicopter.
Yes! Thursday night in ICU was definitely worse.
***********************************
Sitting upright with Alex, it was a new day at last, and Heather was already talking about a return to the ward, I was able to comprehend that perhaps I didn’t have brain damage after all. It must have been the physical shock that would continue to numb my emotions until the kids visited on Sunday afternoon.
Soon after my parents and Alex had left the night before, just a few hours after surgery, the shock revealed itself in the form of tremors that started with a crescendo of teeth chattering and ended with my legs shaking violently on the bed. The night nurse had shown her technical competence by wrapping me up in a sort of canvas blanket that she then inflated by attaching it to an electric pump, filling the tubes in the blanket with hot air. My teeth chattering and shaking successfully abated soon afterwards, but unfortunately the nurse left the room, and ten minutes later when she finally returned I was streaming with sweat, thinking that I was going to suffocate. It made it a tough call to motion towards the blanket a few hours later, when my trembling got out of control again. I begged her to stay this time.
It wasn’t until the nurse had got a clean gown onto me, and was reconnecting the last of the wires that I sensed a little of her cold detachment melt away: Ever since putting on the blue surgical gown after my shower on Thursday morning, I’d been preoccupied with the placement of two breast pads underneath. I’d stopped breast feeding Harriet completely one month earlier, but the taps were not completely shut, and whatever the surgeons might be privy to when they performed their operation, I didn’t want them distracted by 2 damp circles.
“How old’s the baby?” the nurse asked in a West African accent, still concentrating on unravelling some wires.
“6 months now” I replied. “A little girl – Harriet” I said.
It wasn’t exactly a conversation, but shortly after her next disappearance, she returned bringing with her some gauze and white tape for me to use as a substitute for the sick saturated pads.
“Thank you so much, I really appreciate this” I said as our hands met.
“You’re welcome!" She drawled. "Now, you’ll need to get some food inside you. I’ll go get you a yoghurt or something.”
The tension in the room seemed to lift a little after that, and although the nurse didn’t actually get round to bringing me any food before her shift ended an hour or so after, I felt calmer and hopeful that a new day was not so far away.
Professor Thompson came through the doors shortly after Heather’s shift begun, and just after she had removed the catheter. The first time the doors swung open with his entourage in toe, it was pretty embarrassing. I sat up in my chair, poised to be grateful, to remember the big picture and not mention the small insignificant details from the night. Only as soon as he stepped inside the room, he turned away and put his big surgeon’s hand up, motioning for the group to follow him back outside again. Looking around, I spotted the arm chair next to me, and realised that I was still sitting on the commode. SHIT!! For all intensive- purposes the commode looked and felt like an arm chair, only it wasn’t. At least my knees were covered up by the gown.
So when he returned I cringed even more when he apologised for coming by the first time without first checking with the nurse.
“No I was ready, I mean I wasn’t actually doing.. I forgot it was a ……anyway”
If not sad, or happy or gloriously relieved, at least I could feel embarrassment, I thought.
“How was your night?” he asked.
“Yeah – erm, OK, well I didn’t get on with the morphine, but it was OK really, it was fine. Thank you, Thank you so much……”
“Good to hear. Your readings all seem fine, so with any luck, they should be able to get you back to the ward later today”.
“Oh thank you, thank you so much Professor, for everything, I mean everything seems to work...”
“Yes it went very well. Everything that could have gone right, did! I’ll see you back on the ward tomorrow morning, take care!” and the doors swung closed again, as they rightly turned towards their more critical patients.
That short dialogue was probably why Alex got an earful when he arrived a couple of hours later, because I mustn’t have had the strength to hold back a second time. I kind of regret unloading my honest account to him, but it led to him following up with Heather to find out the name of the night nurse, and in turn she sensed there had been something wrong and urged us to feedback to her manager.
“No, no, it’s fine, it was just one night, I’m sure I’ll get over it quite quickly, I just want to move on, I don’t want to say anything, I know you all have such difficult jobs here, and you’ve been completely amazing, and my parents said the nurse yesterday was fantastic too…. Maybe I’ll write a letter in a few weeks.”
“No Soph” Alex interjected “it will be much better if you feedback in person now, otherwise you’ll dwell on it. I don’t want any anger lingering and a cloud hanging over you - Heather’s right, I think she should get her manager here this morning, I don’t like what you told me, it’s not OK. It’s not OK for the next patient.”
So I nodded reluctantly, and shortly afterwards Heather brought the ICU manager to sit down and hear my account. I have to say, he couldn’t have been more professional in the way he listened, asked follow up questions, thanked me for the information and offered the most sincere of apologies, assuring us that he would deal with it. I in turn tried to emphasize my hugely positive experience with the other nurses on ICU, the surgical team, the ward and the overall St Georges experience that I would be eternally grateful for.
“Will you be coming back here to ICU for your next surgery?...Because if you are coming back to St Georges, you should ask for me, or the other shift manager and we will make sure you have impeccable care here in ICU.”
“Sorry, what surgery are you talking about. I…..?..”
“Oh, I was just reading your notes, and read about the prolactinoma in your pituitary gland, I just didn’t want last night to put you off having surgery here in St Georges, and well I hope it hasn’t, and if you were to choose us again then…”
“No, no" I said, "I mean I haven’t thought about that yet, It might not even come down to surgery, well I hope it doesn't, it's just too soon to..."
Christ, this isn’t a Mr and Mrs Smith hotel, I thought. Can’t fault the guy for his customer service, but what a time to try and sign me up for some kind of ICU loyalty scheme!
Later, after Heather had removed almost every tube and wire that she could, and I’d stood up on my own steam to walk down the corridor to the toilet and back, she came in to tell us that she’d spoken to the ward, and that they would prepare the same private side room for me to return to that afternoon. At that moment, the idea of returning to my side room on Cheselden ward sounded about as fabulous as the Copacabana Hotel did on route to Brazil for our honeymoon. And I think that was the first time I broke into some sort of smile after surgery.
“I can’t believe you!” Heather said looking first at me, and then Alex. It’s funny but you don’t look anything like the patient I expected when I read your notes and your surgical disclaimer form. I mean, most people in intensive care don’t just stand up and walk off to the toilet by themselves – you seem…so young and well - Before I came into your room this morning, I was reading your form, and I’ve never seen anything written so bluntly about your need for surgery – there in black and white…. You’ve probably seen all the pages of surgical risks that you’d signed, but I presume you didn’t see what Professor Thompson wrote on the form on the back?”
Alex and I both looked first at each other and then back to her inquisitively. “Oh yes?” Alex said.
“On the last page it reads ‘What are the risks of non - surgical intervention?’
Just to the right, Professor Thompson has written in black ink ……..‘DEATH’
Then he’s asked what the probability is of that risk, and he’d written…. ‘100%’.
It’s the first time I’ve ever seen that written down so starkly.”
So however much the physical shock had numbed my senses, and whatever feelings I couldn’t yet express or draw on, I looked back at Alex after she'd spoken, and we both knew that I was incredibly lucky indeed.
******************************************
Links to video's of the team at the summit of Mardi Himal, and of Laura beginning her abseil down are here:
http://youtu.be/sbxy4pPJ4HM
http://youtu.be/3l1MtZrJdZc
You should also be able to navigate to them from my Google + profile, or searching for 'Sophie Orme' in YouTube.
After note
I deliberated hard about including the negative account of the night in ICU, because I am so indepted to the amazing cast of medical staff at St Georges, together with the GP, and radiology staff that came beforehand. I truly have them to thank for my life. With only one brief exception, I experienced fantastic care throughout. In all walks of life, and professions we come across the occasional bad apple, and I’m pretty sure the manager had plans to sieve this one out, so I hope I don’t in anyway unsettle anybody who might require subsequent medical treatment who is reading this blog. It was also very difficult for me to cast my mind back to that night, because I really had put all the detail to bed as soon as the wonderful Heather put me back together again and pushed me back to the ward. I have indulgently interwoven the story of Mardi Himal to help motivate me to write this, as that was a very special place to return to in my mind. I guess the judgement call I made in writing this post is to stay true to the honest and open narrative that I have used so far.
I plan to write one more post in this series titled ‘post op’ in the next fortnight to conclude. Thanks for getting this far.
