Saving Face

Let me tell you about our latest visit to Barts, in preparation for my operation next week.

Catherine and I went along on Friday afternoon, to meet a Speech and Language Therapist and Manny, the MacMillan Nurse. Those of you who have been following my blog will know that I've been highly impressed by the NHS staff we've encountered, but I'm afraid that the woman from Speech & Language Therapy was just rubbish. I'm not saying she's incompetent or incapable, but her interpersonal skills were non-existent.

She started off by going straight for the worst case scenario, which in this instance is that my pharyngeal wall is so profoundly damaged during surgery that I lose the ability to swallow, and spend a lifetime being fed by tube. She then became remarkably coy and evasive, seeming reluctant to even consider the possibility of a full recovery.

It's not that we can't take bad news - we're getting quite good at that - but we do also want a realistic assessment of the likelihood of various outcomes. This woman only wanted to talk of the nightmare situation, and seemed shocked that we were shocked. It also became apparent that she hadn't properly familiarised herself with my personal condition. At the end of a thoroughly uncomfortable and unsatisfactory conversation, she grudgingly admitted that I have "a very good chance of rehabilitating the swallow".

I must get over my antipathy towards this woman, particularly as she is going to be responsible for putting me through my paces after the operation to get me swallowing again, but I'm still seething two days later. One final point: I don't know what they teach you at Speech & Language Therapy School, but I'm willing to bet that it isn't to respond to all of your patient's questions with a nervous giggle, which was the intensely irritating mannerism she displayed on Friday.

Fortunately, our meeting with Manny was more positive, although it did involve going through all the gory details of the operation, which I will summarise now. Those of a sensitive disposition may want to jump towards the football and music stuff at the end of the blog.

The technical name for my op is mandibulotomy with radical neck dissection, tonsil resection, temporary tracheostomy, forearm free-flap reconstruction and dental extractions. Impressive, heh? Apparently the suffix -otomy means to cut or separate, so a mandibulotomy means cutting / separating the mandible, or lower jaw bone. A quick google search takes you to the Cambridge Journals web site, which states: "mandibulotomy provides excellent exposure for oral and oropharyngeal tumours, with low complication rate".

So anyway, what is this all going to involve? After the madibulotomy my chin will be joined back together with sutures, but the neck dissection will involve clips. I think this means that the scarring on the chin will be relatively neat and tidy, while the neck might look a bit more heroic. I'll have a drain from the neck lymph nodes. Before leaving hospital, I will be asked to drink a glass of water containing blue dye, to make sure the neck has healed: a niagra of blue fluid pouring from my neck is the tell-tale sign that all is not right.

The tracheostomy will shut me up for a while, but should be removed after 4 - 7 days, leaving me with a nice hole in the neck, or a stoma, as we medical experts like to say.

The forearm free flap reconstruction is a microvascular reconstruction, involving taking a piece of skin from my arm and fitting it to the back of my throat. Just to clarify, the word "flap" does not suggest that I'm going to have a piece of loose skin wiggling about at the back of my throat. Apparently, in this context "flap" describes the movement of tissue from one site on the body to another. This brings with it the possibility of fistulas or tracks (technical jargon for holes, I think). The medics therefore have to monitor the healing process very closely, with oral examinations every thirty minutes for the first 24 hours. Manny says I might find this a bit tiresome, and I suspect she's not wrong.

I'm told that this is all going to be a "bit uncomfortable" (thinly disguised medical code for "agony"). I will have a PCA (Patient Controlled Analgesia), which allows me to pump morphine into my veins, without the risk of overdose.

I will have a cannula in my groin for a drip, and a urinary catheter for the first 2-3 days. So with a RIG in my stomach, a drip in my groin, a wee-catheter, the PCA, tracheostomy and the lymh-node sump, I'll be a veritable spaghetti-junction of tubes.

All v. scary, but I'm feeling remarkably calm at the moment. Ask again how I'm feeling this time next week.

And while we're talking of unpleasant experiences, did you see the football last night? We watched it with our neighbours, and Geoff - a West Ham fan - vainly tried to use the unpredictability of the new ball as an excuse for Robert Green's catastrophe. It wasn't the ball: it was the crap goalie. Some of you may know that I have played in goal, and I'm no stranger to the odd cock-up. After a howler like that, I would face merciless teasing for seasons to come, but in Steven "Dirty Red Kopite" Gerrard's post-match interview, he said you can't blame the goalkeeper. Yes you can, because it was his fault!

I was amazed that the general view of the pundits after the game was that England didn't play too badly. Excuse me? This was the USA, with a Watford reject at the heart of their defence! I didn't think that anybody distinguished himself, and there were several performances that were well below par.

As for Capello, who has until now seemed faultless: will he regret the decisions to take injury prone Ledley King and Jamie "The Snail" Carragher? Why play Milner (who I really rate) if he's been ill all week, only to substitute him after 30 minutes. And all this stuff about Heskey being a great foil for Rooney: I'm afraid that a return of 7 goals in 60 internationals is simply not good enough. You just knew that when he was one-on-one with Tim Howard there was no way he was going to score. It's all too familiar, and gets me almost as worked up as dealing with the Speech & Language Therapist.

A couple of blogs ago, Susie suggested some songs for the Some-Chicken-Some-Neck compilation, so here's the top ten songs of determination and defiance, starting with her suggestions.

1. I Will Survive - Gloria Gaynor
2. Always Look On The Bright Side Of Life - Month Python
3. We Shall Not Be Moved - recorded by loads of people, but my favourite is Mavis Staples
4. We Shall Overcome - Bruce Springsteen (yes, I know that others did it before him)
5. Ain't No Stopping Us Now - McFadden & Whitehead
6. Keep On The Sunny Side - The Carter Family
7. Life Is A Song Worth Singing - Teddy Pendergrass
8. My Life Is Good - Randy Newman
9. Be Thankful For What You've Got - William DeVaughan
10. Ac-Cent-Tchu-Ate The Positive - Johnny Mercer

I shall be away for a few days, having the RIG fitted in my stomach. Compared to the mandibulotomy, this is a relatively minor operation, and I'm expecting to be back on Tuesday. If Catherine gets time, and feels so inclined, she may post an update.

Smile, smile, smile.

R