Adventures with a catheter

The title of my next book? A light-hearted, yet strangely deep and philosophically wise memoir of the experiences of a trainee urology nurse? Not quite…

This is the next instalment of my continuing health saga. In the last episode, I promised that ‘the next part of the adventure sounds so scary I haven’t even dared to google it’. Now read on, if you have the stomach for it…

The discharge summary after my TWOC just over a week ago was couched in a more breezily colloquial (yet also more coded) style than some of my consultant surgeon’s summaries have been.

Mr Price had a optical urethrotomy for bulbar urethral stricture on 15/05/19. He was discharged home with a urinary IDC in situ. Today, he presented to triage for a TWOC. He was otherwise well in himself. The IDC was removed with ease. He successfully passed the TWOC with 97mls PVR. We therefore discharged him home with safety netting advice which he acknowledged. Nil urology triage f/u needed.

Today’s scary part that I hadn’t even dared to google, because I really didn’t want to know too much about it beforehand, was innocuously advertised as an appointment at the ISC and Continence Clinic. That ISC is the sharp-toothed part: it stands for Intermittent Self Catheterization. The problem with urethral strictures, apparently, (whether bulbar or otherwise) is that the scarring can get worse again, causing the stricture to grow and cause renewed urinary retention. The way of preventing this, and keeping the urethra as open as possible, is to insert a catheter at regular intervals. Not to stay in, but just to remind that stricture not to grow.

We met K., the lovely nurse who was going to deliver this training. She produced three different types of catheter which she showed, described and demonstrated. It was a touch like speed dating, because she then popped the question, “Is there one of these that you feel particularly drawn to?” ‘None of the above’ was clearly not going to be an acceptable answer; but in fact there was one design which looked less unappealing, maybe I should even say more my style, than the other two.

Thereupon the next step was to actually try the thing out, watched with loving attention by K. and Alison (who was there to learn how it was done, in case I ever needed help or encouragement?) With reminders and a lot of that encouragement as we proceeded, I succeeded in catheterizing myself with the device I had been particularly drawn to. It is the weirdest of sensations, strange enough when it’s being done to you by someone else, but even stranger when you’re doing it to yourself. There was quite a lot of

“How far does it have to go in? Are we nearly there yet?”

“It has to go all the way into the bladder.”

“How will I know when it gets there?”

“You’ll know.”

Yes, you will, because when the end of the catheter arrives in the bladder, it immediately begins to drain urine, even if you’ve only just been to the toilet. It only took a few seconds to stop draining, since I had retained very little after the flow test that preceded all this. And then the catheter is removed. Slowly and gently. And this also is a weird sensation.

Much praise from K. (“You did really well.”) Much relief from me. I’ve always been a great fan of Lifelong Learning; but I never expected the syllabus to include this. But there is certainly a large amount of pride in doing something you could not have imagined doing, or even thought would be impossible.

K. tells me to do this impossible thing daily for the next fortnight, then every other day, then perhaps once or twice a week. Maybe ‘for the rest of my days’, as she put it. Or maybe it will only be when, or if, I sense the stricture is becoming a problem again. There’s a follow-up appointment in a few weeks’ time, which may shed more light.

They say that a huge percentage of NHS services are consumed by the over 65s. I’m beginning to have a much clearer understanding of what this means; and that I am one of those more frequent users. Thank God for the NHS.

O Land, Land, Land

Just started reading Kate Atkinson’s latest novel Transcription (just appeared in paperback — whee!) and I come across an epigraph which includes the translation of this Latin inscription in the foyer of Broadcasting House.

“This Temple of the Arts and Muses is dedicated to Almighty God by the first Governors of Broadcasting in the year 1931, Sir John Reith being Director-General. It is their prayer that good seed sown may bring forth a good harvest, that all things hostile to peace or purity may be banished from this house, and that the people, inclining their ear to whatsoever things are beautiful and honest and of good report, may tread the path of wisdom and uprightness.”

“…That the people, inclining their ear to whatsoever things are beautiful and honest and of good report, may tread the path of wisdom and uprightness…”

In the present car crash of British politics: the Brexit referendum, the implosion of the Tory party, the unfathomable triumph of the Brexit Party whose only policy is that they want to crash us out of the European Union even if it means leaving with no deal … I’m wondering if the first Governors of Broadcasting didn’t pray hard enough? Or, more likely, whether it’s ‘the people’ who have simply squandered their precious inheritance of honesty, good report, wisdom, uprightness and faith.

(The title of this post is from Jeremiah 22.29, the prophet’s lament over God’s people’s wilful deafness, refusing to hear and heed God’s message to them: “O land, land, land, hear the word of the Lord!”)

And so it goes on

The health — or rather ill-health — saga continues.

At the beginning of May we decided to go away for a few days, the first time we’ve had a ‘holiday’ kind of break since my operation in December. Just a little break for a change of scene and a bit of pampering with other people doing the catering for us… There were a couple of days when the weather was good enough to do a bit of walking, about as much as I could manage, or to go and visit a nearby National Trust property. The food was good, the room was comfortable, the setting was pleasant. So it was nice break. Except for the last night when I developed acute urinary retention, and was awake much of the night trying unsuccessfully to empty my bladder. If you’ve never had this experience, just take it from me that it’s a painful one.

Fortunately we weren’t too far from home; but even so, the drive home was painful. By the time we arrived, Urology wouldn’t agree to see me because I presented my situation wrongly, and they told me to contact my GP, but by that time it was too late to get an appointment. Instead the GP suggested I should phone 111 and contact the out-of-hours service. An interesting experience, where you’re faced with a barrage of questions obviously being read off the screen of some iDiagnosis app. My favourites included ‘Are there any blisters around the genital area?’ ‘Have you recently had sex with anyone who might have had an STD?’ and ‘Have you recently been suffering severe breathlessness?’ (I’ve since discovered this last can be a symptom of sepsis, so I’m glad I didn’t have it. Or, incidentally, any of the others.) The result was, I was given an appointment to see a clinician within about an hour, though it did involve a 15 mile drive to Bicester.

The doctor I saw had a feel of my abdomen and confirmed that I had a palpable bladder. Yes, I could have told him that. He catheterized me: the first size he tried to insert was too big, so he had to use a smaller 12-bore instead, which successfully drained about a litre of urine. He then prescribed tamsulosin to stretch the passage, and an antibiotic because he believed I had a urinary infection. (I was sceptical about this, having been on ciprofloxacin for about 8 weeks, but …) And sent me away for the weekend.

First thing on Monday morning I tried to contact my surgeon to tell him what had been going on; he phoned me back with an appointment for his clinic the following day. Which we attended, and he attempted to perform a cystoscopy but couldn’t insert it because of the narrowing of the urethra. This at least confirmed that this was the problem, so he admitted me as an urgent case to perform an urethrostomy.

Urethrostomy: (an endoscopic procedure typically performed under general anesthesia. A thin tube with a camera (endoscope) is inserted into the urethra to visualize the stricture. Then a tiny knife is passed through the endoscope to cut the stricture lengthwise and open the flow of urine. Wikipedia.)

No theatre time available that evening, so I had to wait till the following day, and in the mean time my bladder was full again. This time they didn’t want to insert another catheter, so they drained it by inserting a needle into the bladder through my abdominal wall. It sounds worse than it felt — though indeed, I wasn’t looking — and the worst thing was them pressing on my abdomen to get the urine to come out through the needle which was only the size of a hypodermic. It took a while, but it was ahuge relief, and kept me comfortable until the time of the procedure late the following morning.

It didn’t take long, which meant the general anaesthetic didn’t leave me as groggy as the last one I had on Christmas Eve. The stricture was cut, I was left with another catheter in place, but at least the choice this time of whether I wanted a leg bag, or a short tube with a tap on the end that I could drain at will, with the option of a larger night bag while I was asleep. I chose the second: the leg bag was really not something I wanted. Though the catheter with tap was also not a comfortable thing to have around, principally because it was in the tube where I’d recently had the knife.

One week on: catheter removed; TWOC satisfactorily passed — though this time the nurse tells me (which I didn’t want to hear) that success is only provisional in a sense, because the ‘trial’ continues through the following two or three days, when, if you have any recurring problems with retention, you need to contact Urology and be re-admitted. At least if it does happen again, I will know how to describe my condition in the right way and be able to insist on being admitted.

For the time being, it’s a huge relief to be catheter-free, able to pass urine more easily, and just feeling a lot better. Yesterday I had an appointment with the bone infection unit, where the consultant was pleased with what he heard about my improvement while taking the ciprofloxacin. The pain in the pelvis has more or less completely gone. I can walk again, though I could still benefit from some physiotherapy to build up the core strength I lost during the weeks I couldn’t walk. The antibiotic still has three more weeks to run, and he said I should take it to the end. He can’t give an unconditional promise, but he’s confident that that should ‘almost certainly’ clear the infection completely. He wasn’t planning to do another scan because at this stage it was unlikely to provide any helpful information. I should carry on with life when the course of antibiotics finishes, and contact them only if there’s any recurrence of symptoms. So I suppose that’s good news.

We’re not completely out of the woods yet, and the next part of the adventure sounds so scary I haven’t even dared to google it. (Watch this space.) But we may be getting nearer to being in sight of the end of it. Perhaps then I’ll be able to blog about something more cheerful than my pelvic regions and bladder.

A better resurrection

Since my last post accompanied by the image of Piero della Francesca’s painting of the Resurrection, when I said it was one of my favourite images of the Resurrection of Jesus, I’ve been thinking it over and over, and may have changed my mind…

There’s no doubt that the image powerfully represents the triumph of the Risen Lord. It also dares to portray the actual moment of Resurrection, and so is different from the great majority of images which portray the aftermath: the empty tomb, or the women or disciples first encountering their risen Lord.

I’ve since been reading John Dominic Crossan’s latest book, Resurrecting Easter: How the West lost and the East kept the original vision of Easter. It recounts a succession of pilgrimage visits to historic sites of the Western Roman and Eastern Orthodox churches, searching for evidence of the thesis that it was the East which retained the original vision of what the Resurrection meant. It’s an attractive book, lavishly illustrated with images taken by Crossan’s photographer wife Sarah Sexton Crossan.

Whereas Western art, when it shows the moment of Resurrection at all, emphasises the individual nature of Jesus rising from the dead, Eastern iconography came to focus on the universal aspect of Resurrection: that Jesus did not rise from death alone, but brought with him the whole of humanity, all who had “died in Adam”. This idea seems to have originated from the words in Matthew’s account of the crucifixion:

Jesus, when he had cried again with a loud voice, yielded up the ghost. And, behold, the veil of the temple was rent in twain from the top to the bottom; and the earth did quake, and the rocks rent; And the graves were opened; and many bodies of the saints which slept arose, And came out of the graves after his resurrection, and went into the holy city, and appeared unto many. (Matthew 27.50-53)

So, in this typical icon of the Anastasis or Resurrection, the risen Jesus is depicted with a cross-shaped halo, enclosed in an almond-shaped mandorla representing his luminous, risen glory. He stands astride the shattered gates of Hell, beneath which the chained figure of Hades or Satan lies crushed. With his two hands, Christ reaches out and grasps the hands of Adam and Eve, the first parents of the human race, and draws them out of their graves and into the light and glory of the Resurrection and of heaven. Behind Adam stand three other figures: King David, King Solomon (beardless) and John the Baptist. The figures behind Eve differ in different versions of this icon: here they seem to include Abel as a shepherd, and Moses. For a fuller description, see this post in the Orthodox Road blog.

After all, this Eastern icon tradition seems to me to present an image of a ‘better resurrection’. Not the ‘heaven and hell’ destiny that has so often been preached in Western Christianity, but a grand vision of a redemption that will embrace the whole human race, which believes with the Epistle to Titus that “the grace of God has appeared, bringing salvation to all”. (Titus 2.11 NRSV)

Do we believe in a big enough, and loving enough God, to accomplish this?