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.
Godspelled 