Friday, September 04, 2009

Did I promise to blog about hernias? Oh my!

Once upon a wartime, an army had a problem. Their soldiers were getting hernias... which I suppose is not too surprising considering the amount of heavy kit that soldiers have to carry around, not to mention the heavy lifting, the stretching, the yomping.

This story, however, is not about the Falklands war.

The army wanted its fighting men to get back into good shape as soon as possible, with the most reliable prognosis. (In those days, women didn't do battle.) Research was done, and... to cut a long and painful story short... the Shouldice method was perfected.

You may have noticed that this blog is personal, and not about the Craft of Writing at all. Nevertheless, (as Malcolm Muggeridge used to say on Mastermind) "I've started, so I will finish."

The Shouldice method does not darn or patch. It uses no mesh, just fine, cold, steel wire to stitch together layers of muscle and tissue. We're told that all that stitching will not beep in airports or in popular chain stores. We'll see.

The Shouldice Hospital does hernias and nothing else. It seems to do a roaring trade. I'm not sure I ought to say that! Every day, thirty people with hernias are admitted (after sanitizing their hands thoroughly before being allowed to enter the building, and then being interviewed, inspected by an admitting doctor, and thoroughly tested to make sure that a hernia is their only health issue.)

Hernias come from all over the world, not necessarily for their first repair, but almost always for the last repair for that particular weak area. For one hernia, it's four nights in the Shouldice, for two or more, it's six nights (they like patients to have a good day's break between surgeries).

Admission is between ten thirty and noon, and a patient's driver must stay... in case the patient isn't healthy enough for surgery (I assume). Then, they go to the room they share with one other patient. I infer that older patients get the bed nearer the en suite bathroom, so they don't have so far to go in the night.

Meals are served (by waitresses) in the dining room in the walk-out basement, except for on surgery day, when the patients are brought a tray in their rooms.

There's pool (the game), mini golf, an unremarkable pond in the grounds, artificial waterfalls in the gently rolling landscape, shuffle board (tremendous fun!), a wi fi hot spot, tables with magazines, cards, etc in the spacious and luxuriously appointed common rooms, also tv in the common rooms, lots of phones (but not in the room...) Every effort is made --almost every incentive given-- to encourage patients to walk, move, climb stairs, sit on chairs and benches of different elevations and degrees of softness.

It's really like a country club!

The last meal is around six at night. Those who are going to surgery early the next morning have to shower the night before. (The showers at Shouldice are not well-conceived and it is all too easy to flash or moon a surprised visitor emerging from an elevator. Use of the elevators is not encouraged.) They are given a sleeping pill, which generally does not work terribly well because almost everyone is nervous. At least the patients are all going through the same thing!

Nevertheless, they say that every hernia surgery experience is a bit different. Not every gentleman will discover that he has post operative rings of colour (like a coral snake) in parts adjacent to the operative area.

Soon after five am, the fasting first batch are shaved for surgery (with ruthless efficiency). Then they go down... in the elevator. (Wearing surgery outfits). There are five operating theatres, so presumably, six batches of five patients pass through each day. They are not permitted to take false teeth, glasses, or other accoutrements, so younger patients have to help those with less good eyesight to find their beds (marked with name tags with names written small). It's a bit like musical chairs, except there is a bed for everyone. Then, after the patients are given a pill or a shot (according to their individual surgeon's preference) to relax the patient, each bed is wheeled off to a separate surgery.

For now, I will pass over the surgery.

Afterwards, the patients are returned sitting, in wheelchairs, are helped to change into their pajamas, and then sleep for at least four hours. They must remain recumbent for those four hours, and use a bedpan or bottle if necessary. After that, they may attempt to sit up, but must sit for twenty minutes before attempting to stand, and if dizzy must lie down for another hour before trying again.

Once awake, they are encouraged to drink lots of juice and water. Not only does this help to flush out the anaesthetic, and the vitamin C promotes healing, but it eventually provides an incentive to get up and talk ones first walk.

Tylenol is available. Moving does hurt (a lot), although it is going to hurt more on the following day when the anaesthetics have worn off. Patients spend the rest of the day easing themselves off their beds, and shuffling around the corridors and common areas. Visiting hours are 2pm to 4pm (great timing for helping with the first bottle, the first sips of juice, and the first sit-up) and from 7pm to 9pm.

That evening (the first after surgery), we sat at a dining-sized table, and played Pelmanism (or Concentration) to exercise the mind.

The third day (second after surgery) the patients are treated to gentle communal exercise classes at 11am, later half the clamps are removed from their incision, and they all compare notes. The fourth day (third after surgery) is much the same. The rest of the clamps are removed and patients and their visitors admire and feel the firm, banana-like shape of the swelling.

Discharge is early, between 9am and 10 am the following morning, after a doctor has visited, inspected, and answered any lingering questions. Patients may drive themselves home if they wish to do so and feel up to it. (Some choose longer routes on roads known to be free of pot holes.) Swelling and discomfort lessen over the next week, but will remain to some degree for a month or more.

1 comment:

Pat Cochran said...

Rather regimented, it seems, and well organized! Not at all like
the procedure when I was a nursing

Pat Cochran