As I write I am sat in the shade of a tree, not a beautiful oak with lush green grass and a cool, temperate climate but somewhere else. The tree is a short stumpy fig, planted in a parched open space within a stones throw of a bypass roundabout and a playground. Roads go West to Santa Ponsa, East to Palma and the other exit delivers the occasional car to the school grounds and temporary village that is the 2017 Traditional Tattoo and World culture Festival. The gates are not open yet so I have time to collect my thoughts. To say that it has been a crazy year would be an understatement and my time in Mallorca is a very welcome break from the day-to-day and one I am extremely grateful for.
This year started with me still awaiting an operation that I thought would stop my UTIs. Last summer we had cautiously waited till the time was right, putting inconvenience above healing. Summer sunshine, children’s laughter and a trip to Asturias helped distract me. October’s Ironman (which I am very proud to say my wife won her age group) and November’s trip to Morocco all helped distract me from the continual presence of Urinary Tract Infections. As the cold winter weather moved in however a feeling of stagnation developed. The need for change but the inability to achieve it haunted me. Christmas came and a New Year triggered a brief period of optimism. Complaint letters were sent. Dates were promised, only to be postponed again the next week. Eventually though it became apparent that February 13th was going to be the day.
My wife drove us to Glangwili, both of us nervous about the operation I was expecting, a diverticulectomy. We understood that the procedure would involve an incision across the abdomen that would allow the surgeon to access and remove my bladder diverticulum. I was anxious about the operation and the healing. We arrived on time and were ushered into an empty day room. We sat waiting till another gentleman in jogging bottoms arrived. We talked about medical matters. I explained my diverticulectomy, he, the various complications associated with his TURP (Trans Urethral Resection of the Prostate; a procedure that involves the core of the prostate being removed in a variety of ways and is a very common operation amongst men over the age of 60). I had heard about this procedure and this man’s experiences only reinforced my fear.
As time went by and more patients arrived nurses started to call names and people were ushered away one by one.
“Patrick Boothman”- My wife and I were greeted by a nurse and taken into a side room where we were met by my consultant and another who had travelled up from London. The visiting doctor introduced himself and then very quickly started talking about operating on my prostate! I was shocked and stunned for a while before i realised they were talking about the dreaded TURP. I interrupted and told him to slow down.
“What about the diverticulum?”
“You need a TURP”
“Where is the evidence?” I countered
He then thumbed through my extensive notes in an attempt to find something , but whatever he found it did not look too convincing to me. He then settled the situation by declaring that without the TURP the success of any diverticulectomy would be minimal. I had to make a decision wether to proceed or not.
“It is important that you make this decision without stress or duress”.
I know nothing about NHS protocol but I bet changing the operation on the day is a bit of a no-no. We had to choose between going home and waiting till we were given another date (another 6 months?), go down the private route or getting it done today without harbouring any negative emotions. We asked for details about possible complications with the operation and went away to talk through our options.
I needed an operation that day. I had been waiting too long and needed some progress. The complications could possibly include i) erectile disfunction; which would be extremely unlikely in a man of my age and could be “cured” with pills. ii) incontinence; should the surgeon damage the neck of the bladder this could result in me wearing nappies for the rest of my life. iii)damage to the urethra; which could cause scar tissue to narrow the tube and create further complications and finally iv) retrograde ejaculation. The main function of the prostate is to direct sperm out of the penis upon ejaculation. With the centre of my prostate removed this would not be possible so sperm would instead enter my bladder leaving me high and dry! Fortunately I have already had a vasectomy so the infertility issue was not one that needed to be considered. What concerned me most was my loss of visible ejaculation. Since my teenage years I have seen that sticky fluid as evidence that I was vital and important. That physically and visually exciting splash of gism would no longer be a part of my, or our, life. Quite a lot to get your head around. After tears and hugs I relinquished any issues I may have had, submitted, got changed into the NHS robes and waited.
Simplified slightly a TURP involves a small loop being inserted into the penis and passed into the prostate. The loop is then manipulated so as to chip away the core of the prostate. The first thing that was needed was some comfort management (anaesthetics). i had elected for a spinal and as the anaesthetist made his calculations and positioned his needle I realised that this was going to happen and there was no stopping. I felt the needle in my spine and gradually felt the oozy slow liquid drip down the various pathways to my legs. Like in a dream I felt my legs slowly filling with lead. A lead so heavy I could not move but at the same time made my legs feel weightless. Once the fluid had reached my abdomen I lay down and anxiously watched the ceiling move as I was wheeled into the the theatre.
Once in position the team introduced themselves and one particularly perky chappy asked if I would like to watch the proceedings on a VDU. I felt that was something I did not need to see and declined politely. A green, fabric screen was quickly assembled infront of me to obstruct my vision. I could feel some sort of movement and was surprised to see my legs being raised in front of me without feeling their weight. A small tent was erected around my less than private parts and something started happening. I could feel pulling, tugging and forces at work but no pain. My mind drifted and as I shifted in and out of awareness. Looking for distraction I focussed on the shadows reflected on the large polished surfaces of the over head lamp. The angles of light and dark seemed to be moving in time with the tugs and pulls. I tried hard to make sense of the movements. A further uncomfortable push and I made out what I calculated to be an arm. My mind now assembled the pieces. If that was an elbow moving then it must be attached to a body. I found the shoulder then the head. Following the line of the back I found another moving shape. Another tug, that must be the other arm. The jolts and the movements now made sense and from the distorted reflection quickly realised the shape I was observing was the back of the surgeons head with his arms moving backwards and forwards between my raised legs….I quickly moved my eyes elsewhere.
After what seemed like an hour I was congratulated and with a scurry of activity all tools, equipment, screens, smocks, gloves and masks were removed and I was once again wheeled away. For a short time I felt relieved but after a brief spell under observation I was wheeled back onto the ward and began to feel stiff, tired and uncomfortable. An indwelling catheter was quickly draining the contents of my bladder, a bright red mixture of blood, water and clotted matter.
I had been told that it might be necessary to have the indwelling catheter remain in place for 10 days after the operation but its presence still upset me. On day 11 I passed my trial without catheter and was greatly relieved but knew I could last long without intermittently self catheterising. The idea of inserting a catheter into my tender body seemed backwards. Over the next two weeks the bleeding and clots became less and less. Then one morning I woke, passed water and immediately recognised the symptoms of another UTI so rudely announced by the foul stench of my urine. Back to normal?