Cancer surgery in the age of Covid

One year ago today I had bowel cancer surgery.

As I explained in a previous post, just before Christmas 2019 the oncologist and surgical teams decided to stop my drugs therapy and undertake surgery. I’d been diagnosed mid 2017 with advanced bowel cancer that had metastasised into my liver and pelvic bone. For two and a half years I’d had fortnightly infusions of a targeted drug called Cetuximab plus chemotherapy. This had unexpectedly and miraculously affected the tumours sufficiently to make them operable.

In January 2020, the drugs treatment was ended and after four weeks recovering from the chemo I had a colonsocopy. The tumour in my bowel was injected with a dye to make it easier for the surgeon to recognise it when the big day came. The surgeon performing the colonoscopy was confident that my procedure would be key-hole surgery.

After a couple of weeks waiting, on February 14th, Michael and I went for an appointment with the consultant colo-rectal surgeon at our local hospital to discuss the risks of surgery and the probable likely outcomes.

The consultant explained that the surgery would be key-hole and that there was a possibility of a temporary ileostomy (aka a bag) which would be reversed after about a year. Otherwise there were all the usual caveats but overall every reason to proceed.

A this stage, no cases of Covid 19 had been identified in UK although News bulletins were reporting the situation in Wuhan.

A couple of weeks passed and I was informed of a date for the surgery and that there was a change of plan and I’d been allocated to a different surgeon.

On March 5th we went back to the hospital to meet the “new” surgeon. He confirmed the previous discussion and when we asked if this Covid virus would affect the situation, he thought not. On March 5th, 50 new cases of coronavirus were recorded in the UK.

I’ve got the numbers for the daily new Covid19 cases from the UK Government website. There was no mass testing at the time so the early data is based, as far as I recall, on hospital admissions and doesn’t remotely record the number of individuals who were actually infected with the coronavirus.

On March 9th we had an appointment with the consultant at our regional hospital’s hepatobiliary department to discuss my liver re-section which would be performed about three months after the bowel surgery. He explained that once I’d recovered from the bowel surgery I would need an MRI scan and they’d go from there. Meanwhile we sat in a crowded waiting room and walked through an extremely busy and bustling super-large hospital. The new cases of Covid19 that day were 147.

On March 12th I went to our local hospital for pre-operative assessments, form filling and to collect a bag of preparations to take to prepare my body for the surgery and to aid recovery. I met the specialist nurse who dealt with ileostomy patients and she talked me through what I’d need to do if I did get “a bag”. And she gave me a training kit to use at home to practice in case of that eventuality. I waited in the pharmacy and the blood tests department as well as the assessment ward. The hospital was crowded and very busy. New Covid19 cases that day were 481.

On March 16th I had a phone call from the hospital asking me to report to a different ward on the day of my operation as a re-organisation was underway to accommodate Covid 19 patients. The number of new cases on March 16th was 611.

The next day we had to return to the hospital for a final blood sample to be taken. New cases of Covid19, 769.

Early in the morning of March 18th we arrived at the hospital for my admission. We went to the designated ward and said goodbye. By now the hospital had announced that visiting hours would be limited to one hour each evening with only one visitor for each patient. Michael and I decided that it would be safer if he stayed away until I was discharged. We would communicate via video call and minimise the risk of him bringing the virus into the hospital with him. This was a very hard decision but looking back, it was the right one.

After Michael had gone I sat in a waiting area for a few minutes and was measured up for Norah Batty surgical stockings. Then it was time to talk with a member of the anaesthetics team. We were well into completing her form when the door opened and one of her colleagues said, “He’s self-isolating. He’s not coming in today.” At which point they both left the room and I sat there wondering what was going on.

Some minutes later the door opened again and a person wearing scrubs introduced himself. He explained that the surgeon I was expecting to perform my operation was self-isolating as a member of his household was unwell and had developed a cough and a temperature. This new surgeon would step into the breach, the only thing was he didn’t do key-hole. My operation would be open-surgery and he explained the ramifications of that. To say this was a shock would be the understatement of the year! I asked what were my options. Either go ahead today or wait and see what happened. Well, that wasn’t much of a choice so I decided to go ahead and hope for the best.

I knew I’d made the right decision when, after we’d completed the formalities, the surgeon asked if I would like him to phone my husband when I was in recovery. I thanked him and said yes please. “What’s his name and phone number?” he asked, writing both on the leg of his scrubs as I replied. And he did do just that. Which was fantastic in the circumstances.

I went back to the waiting area, changed into the hospital gown and was escorted to the anaesthetics preparation area. After a few uncomfortable “sharp scratches” and a rather lovely hazy feeling the next thing I knew was waking up in the recovery room and it was all over.

On March 18th there were 998 new cases of Covid19.

I stayed in hospital for a few days and gradually began to recover. I was discharged on March 23rd with a large incision down the middle of my tummy held together by 28 metal staples. The surgeon had removed about six inches of my bowel, the remains of the tumour, twelve lymph nodes and all surrounding tissue. Early results from tests was that all tissue was cancer free.

When Michael came to collect me in the late afternoon, the hospital was deserted. There was plenty of car parking space and the roads were virtually empty of traffic.

Lockdown had begun.

New Covid19 cases recorded on March 23rd: 2327.

It’s a complete mystery why I didn’t catch Covid19 whilst in hospital. Precautions were minimal although nursing staff had received PPE training a couple of days before I was discharged. The PPE they’d been given consisted of a paper mask and a flimsy plastic apron. But it wasn’t available in sufficient quantity yet to start using it. Some people were adhering to social distancing and avoiding handshakes. But the day before I was discharged was Mother’s Day. And every visitor had hugged their mum several times during the hour.

What a difference a year makes!

Lockdown 1 – Lockdown 2 – Lockdown 3. PPE scandals; useless contact tracing apps; useless test and trace systems; eat out to help out; hands, face, space. Hundreds of thousands of coronavirus cases and over 125,000 tragic fatalities. And the vaccine. The hope in the darkness.

Me? I had my clips removed at the GP surgery ten days after arriving home from the hospital. I swallowed a lot of painkillers and depended greatly on my dear husband, Michael, to look after me for several weeks. I was identified as clinically vulnerable because of the drugs I’d had for such a long time and was placed on the shielding list. My daily exercise was round and round the garden listening to music on my Sony Walkman. My huge gratitude towards our wonderful NHS continued every day. And eighty two days after my bowel surgery I was admitted back into hospital for a liver re-section. I’ll tell you about that chapter of cancer surgery in the age of Covid another day!

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Image credit Image by vargazs from Pixabay