Reflections on St George Hospital

Major surgery starts early in the morning, allowing the full day for the procedure. The night before, the patient anticipates the dawn. Remarkably, in my case, I slept well, waking just before the the alarm at 5-45 am. We reported in to the Day Surgery Unit at 6-30 am, to await the surgeon's visit, before my being taken into theatre. It was 8 am before he appeared, having just completed his morning ward rounds. With a few words of encouragement he left. It was to be several days before I saw him again. Miang, Mary and I exchanged a few words, and then I was wheeled to the anesthetic room, once again meeting the astrophysicist turned anesthetist, who had briefed me the day before. He removed my wedding ring, slipped a cannula into a vein in my hand, and I was gone.

In what seemed an instant, I was emerging into strange consciousness, though I was later to discover that over 24 hours had elapsed. Miang, Mary and Tom were standing beside my bed in the Intensive Care Unit, though I was unable to speak to them, because of a ventilator tube passing through my mouth. I needed to tell them something and moved my hands to indicate the action of writing. They passed me a pen and a notebook. The words I wrote were incoherent, but what I wanted to express was a memory of physical distress while young women had endlessly chatted in a sort of teenage patois, oblivious to my condition. This was the beginning of several days of morphine-induced impressions, vaguely connected with human activity or conversation within earshot, all vivid and mostly bizarre.

The periods of consciousness were initially short, perhaps only minutes, but of course, I was the least reliable witness. After another 24 hours, my ventilator tube removed, I was moved to the High Dependency Unit, where a male nurse seemed to wish to engage me in deep discussions about my scientific work, or New Zealand's social liberalism, none of which I particularly welcomed, but to which I offered polite and hopefully good-natured replies, in the least number of words possible. I was later rescued by an orderly who shifted me to a regular ward, where the nurse to patient ratio was sufficiently high to make such in depth interrogations unlikely.

Over the next days, my plumbing was gradually removed so that by the time a week had elapsed, I was able to eat, I had a functioning bowel, I was walking the ward corridors, and my self-controlled morphine line had ben removed. This clever device, known as a PCA (patient controlled analgesia), allows the patient to press a button to obtain a shot of morphine, the pump then being deactivated for 5 minutes, before a repeat is possible. This delay ensures that the drug has a sufficient sedative effect that any attempt to overdose will be preceded by the patient falling asleep by about the fourth or fifth dose . Prior to the PCA removal my sleep had been accompanied by vivid, and often very unwelcome, dreams. Even in my semi-conscious state my brain would interpret voices in the corridor in a dream-like slightly paranoid sense that these conversations involved me, or people who knew me, strange recollections of people from my distant past, here in ward 3E, St George Hospital.

On disconnection, a sense of normality returned, and my physical progress continued apace. In a bed across from me was a comrade who had has his operation two days before me. He could not hold down food and was in distress much of the time. My rapid progress was good fortune, but probably little comfort to him. I left the hospital on day 13, and for the next week visited this comrade each day. To my enormous relief, at the end of that period he suddenly improved, was able to eat food and to move about a bit.

My son tells me that a high pain threshold is helpful to surgical recovery, allowing the patient to more rapidly reduce the pain-killing drugs, with their unhelpful side effects, and to mobilize earlier, to be able to get up and walk about, again assisting the recovery process. I have something to add to that. For me, it is the horror of hospital meals, no matter how nourishing, no matter how well presented, the dread of the relentless delivery of that tray, at a time prescribed by the meals service, drives a determination to escape.

And so I have emerged, from yet another hospital experience, entertained by the distinct personalities of the medical staff, treated to extraordinary care and kindness, and throughout, uplifted by my family and friends. During my last two days in hospital, Miang, Catherine and I made plans for a summer holiday at a rented bach on the Kapiti Coast. It was an unfamiliar and most pleasant experience, to be planning for the future, albeit only a couple of months ahead. A year that had begun with a sense of closing, completing and coming to terms with the immediate term, was ending with a new lease of life. There would be next year, possibly another, and maybe further good years ahead.

Surgery is a remarkable profession in which procedures beyond the imaginative possibilities of most of us, bring about transformative change. My son, himself a surgeon, had advised me of this radical peritonectomy possibility back in April, a treatment of which my New Zealand oncological advisors were largely unaware. Yet I have much reason to thank my oncologists. They had treated me with a cocktail which significantly reduced my cancer burden, buying crucial time, time which had enabled me to organise the Sydney surgery.

For Professor David Morris and his team, I have nothing but admiration and respect. I would like to see other New Zealanders with peritoneal metastasis have the same opportunity that I have been given. That's one more plan for the future. I am going home with immense optimism.