1st Liver Cancer Operation Experience
I) Introduction
Before I had my operation, I surfed the web for news about liver cancer. Practically every liver cancer patient died within a year or two. I also consulted about my cancer operation and was told that in the scale of operation, appendicitis is at one end, open heart surgery in the middle and liver cancer operation the other extreme. It is not a simple case but with good surgeon it will be not much of a problem. What is more important is post operation care. I must Not get pneumonia. That is the killer in most cases. Don't be worried about cold and cough germs in the air but do not come in close contact with people who have cold and cough. I was to tell the doctor everything that I do not feel good about. Don't be shy or try to take it, when I am at the ICU. What I can do to help myself is to not to pamper myself but to force myself to walk and to breathe deeply. I would feel like being run over by a truck.
II) Brief notes on my stay in SGH'S hospital (11 April 99 to 23 April 99)
1) Day 1 (Sunday 11/4/99 my day start from 7am to next day 7am)
Admitted to SGH for liver cancer operation. Given enema to clear my bowel. Went to toilet often. Slept well in the night.
2) Day 2 (Monday)
There were 5 operations for the Liver Surgeon that day but two of the patients opted out. I was scheduled for the afternoon operation. Went to the operation theater at 2pm. Was wheeled down late and the Anesthetist scolded the people who wheeled me down. But another wheeler answered back that they were also working. This is Not too good. The Anesthetist was angry but he did a fast and good job for me by inserting an Epidural needle at my back, intravenous catheters on my throat and my hand. Was taken in to the operation theatre at 2.30pm. Was operated on from then to 7pm. There were some complicated sections to remove. Sections 6, 7 and 1B of my liver were removed. Taken to the ICU ward. I slept well and did not feel a thing that night.
Day 3 (Tuesday)
Was transferred to HDA (high dependency area). Was put next to the windows but it was too hot for me as I had fever. Asked to be moved away from the window. At 12 midnight I felt pain and call the doctor he increased my morphine dosage from 5 ml to 7 ml/hour. Slept till 3am. Could not stand the pain, called the doctor again and he further increased my morphine to 10 ml.Slept till 5am.
Day 4 (Wednesday)
Felt extremely painful in the morning. Called the doctor but no one came until they took out my Epidural at noon. Then a new Anesthetist installed a pump for me to control my pain. It was set at 12ml/hour.If I try to pump more than 1ml in 5 minutes, it did not work until after 5 minutes. The limit was set at 1 ml for every 5 minutes. Doctor advised not to be afraid to pump if I felt pain. I would not be over dosed and there is no danger of complication.
Because there was a crisis, in that a lorry has overturned and 15 people were seriously injured, every one of us was transferred to another section of the HDA. The place was so cramped that one could virtually touch the other patient feet, if not for the corridor. There were two old men, one in front of me the other on my left. The one in front made so much noise by pulling his catheter out every time his hands were untied in the night. He just wanted attention. The other whined most of the time. I could not sleep the whole night through because of them. I was totally knocked out. My head was groggy and I could not connect. I felt very sick and totally exhausted. I asked to be transferred out the next morning. I could not stand another night without sleep and I knew that I would be in a very bad shape if not transferred out from these two patients. The Liver Surgeon saw me in the morning and I told him that I did not sleep the whole night because of the two patients' noise. He promised to take me out in the evening.
Day 5 (Thursday)
At around 2pm I saw the ward doctor and told him that I wanted to be certain that there was a bed for me when I would be transferred in the evening. I asked him to check and report back to me. He felt insulted by me telling him to report back. I made a mistake by saying "report", when I meant to "inform" me after he had checked. He told me they are professional here in the hospital and I told him I just wanted to be sure. He told the Sister and a nurse was sent to tell me that there was no class A1 bed available and that I had to upgrade to class A1 Plus bed. I thought that this meant that I would have to pay for everything in my hospital stay at expatriate prices. Very much more than A1 class. I was desperate to move out and since I have to have some sleep that night I agreed. I knew that if I did not move out I would really be in a very bad shape. The nurse came back and asked me to sign that I wanted to upgrade. I told her that she could go ahead and upgrade me but if they wanted me to sign then I have to put in my reasons why. I told her to check. The Sister came with her staff and told me I have to sign otherwise they could not transfer me. I told her that I will sign but I have to put my reasons why. She said I cannot and I told her that was not reasonable. I told her that the Liver Surgeon promised me in the morning that I would be transferred out. I told her I didn't mind to be put in class B ward and then transfer to class A1 bed the next day as I have to be transferred out so that I can sleep that night. She said that in that case I will be given a bed if the Liver Surgeon said that I can be transferred out. I thanked her and said that was fair. Suddenly, she changed her mind and told me that even if the Liver Surgeon agreed to transfer me out there was no class A1 bed available as she has checked with the Business Administration, so I still have to sign to upgrade to A1 Plus. I was physically and emotionally exhausted. I felt so shotted up, robbed, mugged, bushwhacked that I suddenly burst out crying. I was in so much trauma and pain that I felt that I was dying. The Sister did not know what to do and she went out and told the Business Administrator. The next minute I was given my bill to top up. The Business Administration person came and saw me and wanted me to sign. I told her that this is stupid and unreasonable as I am still in the hospital and I cannot run away. I was so emotionally traumatized that I did not stop crying. She felt bad and promised me that I will be charged class A1 fee but I would be upgraded for the night to class A1 Plus. I thanked her. She went out and lectured the nurse about post surgery trauma. The irony was that she turned the table round and blamed the nurses for not treating me properly!!!! She caused it in the first place. She wanted to make sure that there was no bad debt in the hospital and that was what she did. Make sure the patient sign and after that the patient cannot say that he did not know. This is a crazy policy for any business--No bad debt at any cost. The rest of the action will follow automatically after that faulty policy decision. I can see it all. It is not their faults. It is the implementation of a faulty policy. Every one from the doctor, to the nurses, Sister and the Business Administrator have to protect themselves and in protecting themselves there will be gaps in between for patients to fall in. The doctor sees that his job is done the moment he informed the Sister, the Sister sees her job as done the moment she checked with Business Arbitrator that there was no bed and asked that I sign to upgrade and the Business Administrator makes sure that the patient sign for any change. Policy dictates actions but the hospital policy must always be to look after the patient first not to make sure that there is no bad debt at all. Any business will have some bad debt and once one accepts that then there is room for the staff to use their initiative to suit the circumstance.
I was still crying when the Liver Surgeon came around 6pm and asked why and I could only briefly tell him that they could not find me a bed. He told me not to worry. He will see to it that I get a bed so that I can sleep properly. I thanked him and he came back to tell me that only class A1 Plus was available. I told him ok. A moment later the Sister came and told me that they have found me a class A1 bed in ward 58. Leng came and accompanied me to ward 58 and I was able to sleep that night.
Day 6 (Friday)
In the morning I was attended by a nurse, who had cough and cold and she coughed in my face. I made a request that no one who has a cold or cough should attend to me as I just had a major liver operation and was vulnerable to pneumonia. This note was put into my file.
Leng rang me from home and we had a good chat and she understood why I was so emotionally upset. In the night I found that whenever the throat disturbed me, I started to cough and in the process the spasm occurred. Once the spasm started, it was terrible for me. I would be in tremendous pain.
The pain killer pump was working so well that I was hallucinating. I was lying in a room with vaulted ceiling and dead reeds hanging down from the ceiling. I also saw grotesque figures floating around whenever I close my eyes. The moment my eyes were opened I saw myself in my hospital bed.
Day 7 (Saturday)
Leng was called down in the morning to the Business Administrator to pay up the same top-up bill. She blew up on them and told them off. The Manager has to come out of his office and heard her out burst at the clerk. He apologized for their insensitivity and wanted to come up my room to apologies to me. Leng told him not to upset me.
In the middle of the night I had the same spasm. It always started with an irritation on the throat, then coughing, and then spasm and fever. This time round it was so bad that every time I had spasm I felt that some one is pressing down my chest and that I couldn't breathe. Called the doctor and he give me a sleeping pill (Dormicum) to put me to sleep with the oxygen on my nose. Meanwhile, Leng was so worried that she paced the floor from 12am to 4am and raise high heaven with the nurses that she wanted to call the Registrar or the Liver Surgeon. The nurses told her that no one would come on the weekend. Anyway the ward doctor had attended to me already. She prayed.
Day 8 (Sunday)
The Liver Surgeon came on the Sunday morning and ordered that all my tube to my stomach, the blood drain tube and all the intravenous catheters be removed. He also said that if there was no more fever I could go home on Tuesday morning. I felt good the whole day and was looking forward to going home. Unfortunately, in the middle of the night I cough and got spasm and fever.
Day 9 Monday)
The same nurse who had cold and cough came into my room and told her colleges that she had two days off for influenza.
I felt good for the whole day but in the middle of the night I had fever and they got me to stay the night.
Day 10 (Tuesday)
The same nurse who had influenza still attended to me.
The day I was supposed to go back home but in the night from 12am to 4am I was having very high fever. It usually started with some irritation on the throat, then I coughed and then I got spasm and high fever of over 400C. In the morning the Liver Surgeon came and ordered all the tests to find out the source of the fever. I had blood count, liver function tests, urine tests, ECG, x-ray and CT Scan.
Around 7-8pm an assistant surgeon was sent by the Liver Surgeon to assure me that I did not have abscess in my liver and that the liver was all clear. He told me that I had lung infection and that was the source of my fever. They put me on intravenous catheter and pumped in antibiotics like Gentamycin, Ciprobay and Flagel one after the other to stabilise the fever. That night I was able to prevent my cough after the advice from my relative(see below for details).What I noticed was that the moment the throat irritation came and if I breathed hard and deep I was able to prevent the cough from coming and thereafter the spasm from taking place. Most of the time I was able to do that.
Day 11 (Wednesday)
In the morning I felt good. The Ward Sister came to see Leng and I and we told her about the nurse who has influenza is still attending to me. She said that all the patients are post operative cases in the ward. We told her that she had to prioritise, For a lot of cases it does not matter that the nurses are having influenza but for serious cases like mine it will have serious consequences if I get pneumonia. She agreed and she put a note in my file that no one who has cough or cold should hand me my thermometer, food, straw, urinal, etc and they are not to enter my room.
At around 4pm a Lung Specialist came to see me. I told her what I could do to prevent my spasm. She listened and advised me to continue deep breathing. She told me that I had a minor pneumonia. I asked her what is pneumonia and she said it was a lung infection. She also told me that she would recommend that my intravenous catheter be taken out and that I be given oral medicine. I slept reasonably well in the night.
Day 12 (Thursday)
I told Leng that my body felt that I was given too much medicine. I told the doctor in the morning that the Lung Specialist has recommended that the intravenous catheter be taken out. The doctor checked with the Liver Surgeon and in the afternoon my intravenous catheter was taken out and I was given only Ciprobay. Since I was able to prevent the cough I felt good and slept well.
Day 13 (Friday 23/4/99)
The Liver Surgeon saw me in the morning and I asked him when can I go back home. He said that it can be this morning or the next day as they would like to monitor me for another day. Leng agreed. I felt good and did not want to stay another day so I convinced Leng to go and talk to the Liver Surgeon to release me that morning. The nurses and doctor told Leng they could not contact the Liver Surgeon. I told her to try the Sister of the ward. The Sister came in much later and I was able to convince her that I am well. She rang the Liver Surgeon and I was discharged at around 12.30pm.
.
III) The Movie experience
Lying in the hospital, I saw the movie "The Preacher's Wife "[the last part only] and it touched me very emotionally. I have seen the picture before and it did not mean much to me then, but this time round, I was moved by it. Tears came to my eyes and I was choked up. What was it that touched me? Why was I so affected by the movie? I didn't know but I felt that there were messages for me. What were the messages? They are:
1) God is love
2) God will give me hope but
3) I must believe and
4) I can make a difference.
God sent every one of us here to do different types of work. It can be a doctor, driver, a clergy, an engineer, an investment banker, etc. In order for us to individually grow, we must, in addition to our work, do the following:
1) treat the person we come in contact with as an individual person, NOT as a mass of people or as a digit.
2) We must see the person's potential, NOT what he/she was before. Because if you see a person as what he/she was we condemn him/her to the past and he/she can never improve. We are to see a person as what he is now and see the POTENTIAL and the best that he can be.
3) we are then to LOVE him eg respect, and kindness and
4) we are to give him HOPE
In practical terms, it means that every person can make a difference to his/her spouse, his/her children, his/her grand-children, his/her relatives and all the people he/she comes in contact with.
But first things first. I was in tremendous pain on Tuesday the 20/4/99. I had high fever. I had to undergo all the tests ordered by the Liver Surgeon---blood tests, liver function tests, blood count, ECG, x-rays, and CT Scan. The pain was so terrible, I felt extremely sick. My back was in enormous pain. In between my skin and bones I felt so painful it was unbearable. The constant pain was getting to me and I felt as though I was dying. I don't know how to describe the feeling. It just was so bad that I could not think. Suddenly I remembered the movie. To get the hope from God I must believe. Do I believe? Do I have faith in Him? Can I be absolutely certain that God will keep His Word? Do I waver like the waves in the sea, tossing here and there? One minute I believe, the next minute I don't? If I am like that who am I to blame? What was I to do? Psychologically, I can take two steps---negative or positive. Which do I choose? Since I was in such a terrible shape, I decided to take the positive step. I have nothing to lose. I started to believe and to take His Words as they appeared to me. "Ask and you will receive...For everyone who asks will receive." (Matthew 7:7-8 Today's English Version) "When you pray and ask for something, believe that you have received it, and you will be given whatever you ask for."(Mark 11:24 Today's English Version) “He gave us His Son--will He not also freely give us all things?” (Romans 8:32) I asked God to relieve my pain and I believed that somehow or other he will send a thought, a person, an angel to help me. I was much relieved but I was still in constant pain.
Early in the morning I asked Leng to check with our relative as to what I could do. The relative rang and spoke to Leng and me. I asked him what could I do to help in relieving my pain and fever. He said they had to find the source of my fever before they can treat me. He told me that I paid good money so let the doctors do their job. I told him there must be something I can do. I told him that I notice that it was usually around 12am or 2am that I started to feel the big pain. It will start with a little irritation in my throat, then I start to cough and then I have the spasm and tremendous pain. He explained that what has happened was that I did not move in the middle of the night, fluid then collected in my lung, where the liver was removed. Once fluid collects, bacteria start to multiply very quickly and the fever rises and I have a spasm. I can help myself by taking long deep breaths. Then, the fluid will not collect in my lungs. I did that, and I remembered a surgeon telling me to take deep breaths too and to walk. I did walk but I forgot to take deep breaths as it was painful to breathe deeply when in pain.
That night at around 12am the same irritation in the throat started to happen but I notice that if I take deep short breaths even then I am able to somehow stop the cough and the spasm from coming. I did that for 4 hours until I was totally exhausted. I asked God to help me to get to sleep, as I was far too tired. I had a fretful sleep that night but I did not have much spasm. The relative helped to explain to me in a language that I understand as to what was happening.
Lying in the hospital, all I see are CNN, Asia news, and occasionally movies. I see the Kosovo refugees, the Timorese refugees and the senseless killing of innocent high school children and I wonder why? Is there a God out there to help? How can God allow that to happen to innocent victims? I have no answer but I get the message that I can make the difference and that the innocent victim could be me. What I like then is for individuals to treat me with kindness and respect and to give the time to listen to me. I then want them to give me hope by cheering me on. Life must go on and there is a better future out there for me to look forward to. Every individual who wants to grow spiritually and emotionally, must give the time and a listening ear and to give hope to cheer the innocent victim. That is how God is helping, through us individuals.
The other movie which I saw "Touched by Angels" tells us that God does things in His time, not our time and for our overall good.
IV) Lessons learnt from this surgical experience
1) God is love. Where love is God is. God is the greatest Carer and the greatest Giver.
2) Individual belief is extremely important to benefit from God's promises.
3) For us to grow as a human being, we must treat people as an individual person not as a mass of people or as a unit
4) Early detection brings enormous benefit.
5) Even with inadequate preparation the benefits are always there.
6) Policy dictates how bureaucracy works.
7) A loving home is the best place for speedy recovery after an operation. The moment a person in not on drip he should go home to recover. One day home earlier is like one week stay for recovery in the hospital.
8) I found that flossing my teeth and brushing my teeth and upper lips after every meal helped me to eat my meal without any difficulty.
(The above was written on 28 April 99, 5 days after I was discharged on 23 April 99.)
Post Operation Experience
I was re-admitted to SGH on 4 May 99 because I was having low-grade fever of 37.2 to 38.20C. I had 5 days of fever. When my relative heard about it she told me to ring the Liver surgeon up immediately. She told me not to wait any longer as it could cause me to be admitted under emergency condition. Precaution is better than crisis situation. I was lucky to get the Liver surgeon on Monday the 3rd as he was in the operating theatre performing operation. He told me to see him the next day or see his staff that evening. When I saw the surgeon the next day the first thing he suspected was that I may have fluid in my lung and abscess in my liver. He sent me for an x-ray and found that the x-ray showed only a little fluid in my lung although when he listened to my chest he felt that there was fluid in my lung. I had to do one test after another. Three days later when they did a CT Scan on my liver they found abscess, which they put a needle in to drain the next day. Meanwhile, the surgeon asked an Infection Specialist to check on my condition. She listened to my chest and found that I had fluid in my lung and that it may have to be drained as well. She also changed my medicine to Vancomycin instead of Cyprobay, She said that 90% of the time the infection is due to common bugs instead of something unusual. The moment I took the Vancomycin my fever went down to normal for two and a half days. I felt good and I asked whether I could do away with the panadol. I was taken out of the panadol for only half a day and my temperature shot up again. Meanwhile more x-rays were taken to see whether I had fluid in my lung. The Infection Specialist came again and listened to my chest and said that the fluid may have to be drained. Every morning the Medical Officer listened to my chest and commented that there were still fluids in my lung. The Senior Registrar came while I was at the toilet and he looked at the x-rays and said that since it indicated just a little fluid it was best that they do not drain my lung. He did not listen to my lung and he based his decision on the x-rays. Meanwhile my fever was going up and down. The surgeon said it was very strange as my white blood count showed that it was normal. Normally if one has an infection the white blood count will go up. They took further x-ray and found that the liver drainage has moved so they waited for a day or two to take further x-ray that all my liver abscess was drained. They removed the tube for my liver abscess on Wednesday the 12th but my fever was still high. The surgeon said they have to drain my lung even if it was just a little fluid. They could not get me to drain my lung the next day as there was no slot for me. They put a needle to drain my lung but initially could not find any fluid, but when they actually found a spot the fluid gushed out like a tap. They have to open the area bigger and put a half-inch tube to drain the fluid. Some 500-600ml was drained out. The nurse did not fix my bag properly and some 200-300ml was spilled on to my bed. The moment the fluid was drained from my lung my fever went to normal. I asked, how was it that they could not detect the fluid from the x-rays. One of the MO bluffed me by saying that the fluid has to be about 500ml before they can see it in the x-ray. The next day I asked the surgeon the same question and he told me that the fluid has flooded the whole of my lung and there was no distinctive mark to show the fluid. The Senior Registrar made the wrong decision by not listening to my chest and not listening to his MO and the Infection Specialist. He made his decision based on “inaccurate” x-ray data. His mistake was not counter-checking to make sure that his decision is correct. I had to pay for the mistake by suffering
Every day the nurses took measurement of the fluid that was draining from my lung. They recorded that it was 200ml for one day another 175 ml another day, 150ml and so on. They recorded that the amount of fluid in my lung was 1000 ml. I had noted that the drained fluid was at 700ml after the second day and this was confirmed by one of the MO. It remained at the same level throughout. It showed the 700mls mark, so I did not understand how the nurse took their measurements until one night I asked them how did they measure the fluid. I was shocked when they told me that they have to flatten the fluid to measure the increase in the fluid in my bag. I told them that different nurses will flatten the bag at different pressure and the measurement will then be inaccurate. The nurses told me that was how they always do it and they believe its the right way. The next day I told the doctors that the daily measurement of the fluid that was drained out was inaccurate. It took me quite a while to convince them that the measurement was inaccurate and they were basing their decision on inaccurate data. One cold, aloof Registrar said since there was a dispute on the measurement they will get the doctor to do it from then on and they will take further x-ray to see the next day. I already had my x-ray on Sunday and this further x-ray was on Tuesday. On Wednesday morning at about 5am I woke up feeling mad and angry. I told myself that I wanted to go back that morning no matter what. I was just fed up to my teeth. I was on continuous intravenous drip all this 15 days and it felt terrible. The intravenous catheter could only last 2-3 days and the doctor had to find another vein to put new catheter for the antibiotics for me. All my veins in my two hands were all shot up. The morning drip took 3-4 hours to complete as they have to drip 3 antibiotics-Vancomycine, Gentamycin, and Metronidazole. The afternoon and mid-night drip took 2-3 hours to complete as they gave me only Vancomycin and Metronidazole and depending on the state of my veins. Some of the veins were so swollen that it took much longer to complete.
The more understanding Registrar came on the Wednesday the 19th morning and I asked whether I can go back that morning. He said that the record showed that there was 175ml of fluid more that night. I told him there was no measurement and it had stayed at 700ml. He took a look at the Sunday x-ray and the Tuesday x-ray and said there was marked improvement and I can go back that morning after they take out my tube. The MO came in to confirm that there was no fluid that night and it had stayed at 700ml. Two doctors came around 11am to remove the tube but found that they could not find the thread that tied the tube. They asked me to lie on my left side and they left me in this position for half an hour, with an open tube sticking out of my right chest at the back of my body. Leng went to look for the missing doctors and not finding them told the Sister of the ward, who came and clamped the tube close with a piece of gauze and paged the doctors. The two doctors managed to find another doctor who came and cut the tube and cut the thread but found it hard to remove the tube. He said that since I am not his patient he is not covered by insurance otherwise he would just yank the tube out. They called another doctor [fourth] in and he said that the thread was cut wrongly. He managed to cut the remaining thread properly and he took out my tube without me feeling a thing. What a difference with a person who knows.
This time round I felt really bad and it was worse than the first stay for the operation. I was made to pay for wrong decisions based on inaccurate data. I stayed for thirteen days the first time, I stayed for sixteen days the second time. If the decision is critical the doctors should have counter-checked their data. Great doctors would have done that automatically.
In my projects I have systemized a procedure to make sure that any critical decision that I have to make, I make doubly sure that my data, facts, information are accurate. I always counter check them. Why? because the data, facts or information could be :
Coloured
Inaccurate
Tainted
Assumed
Partial
Since I came back, I am having fever. Every time it hit 380C I take two Panadol. I had fever on the night of 19th. On 20th at 4pm I had 38.10C. On 21st I had 38.00C at 4am, 38.50C at 1pm and 38.00C at 7.30pm. On 22nd I had 38.20C at 3pm. Fortunately for me, I consulted a surgeon who told me that I must expect my fever to go up and down but anything below 38.60C or 101.50F I should not worry too much. I am keeping a very close watch over my temperature. I do not want to stay in the hospital again.
(The post operation experience was written on 22 May 99, 3 days after I was discharged.)