Thursday, August 4, 2011

The Surgical Team and the Operation

My operation was done under a spinal anesthetic, so that I was completely conscious during the whole procedure. They inject a numbing injection to the spine first and then inject the anesthetic into a three places in the spine with a long needle. I was not too crazy about that! I had gone through a similar operation before so it was not a surprise.

During the course of the operation, there was a technician who was giving a running commentary top the surgeons about the positioning of the various procedures. He was using x-ray technology to guide them in their work and was an integral part of the team.

The automatic blood pressure monitoring system in that operating theater failed during my operation, so the doctors had to use the old fashioned manual ones, until another automatic one was brought from an adjoining operating theater and settled that problem. It was a little panic stations at first, as it is not easy to check the blood pressure every few minutes manually while under surgery.

The two main surgeons who performed the surgery, Dr Pubudu and Dr Dhammika were the ones who had performed the surgery last time on me. It was interesting that one of them suddenly came up with questions about my life, that he knew and said he had been reading my blogs!! Dr Banagala, was the overall consulting Orthopedic Surgeon, who was handling the case and was reviewing the work done by his HOs or House Officers.

The surgery took a while due to some adjustments that has to be made to the original plate implants as some nuts had to be removed and tightened etc. and then the tissue in the area of the joint had to be removed for the bone graft to be inserted. So it was not easy to reach all the areas to remove the tissue that had formed in the past six months instead of the bone tissue which would have formed if it fused. The cut nearer my waist to take bone near the hip for the graft had to be stitched up soon after the bone fragments were removed, as otherwise the anesthetic would have worn off. as it starts wearing off from the waist down.

A cousin who is an Anesthesiologist was also in the operating theater, and she knew the consultant anesthetist at the operation. I was not taken into the operating theater immediately so I was waiting for another surgery to finish. When mine started late, and went on for a long time, the number of staff in the theater also seemed to diminish, much like them going to lunch while the operation was going on, like hang on I am still cut up, where are you guys off to? Anyway I guess the surgeons were so confident of their tasks, even the consultant sneaked off giving final instructions on exactly what procedures to do, knowing he could rely on his team!

After the operation, I was waiting a while to be taken back to the room, and then the next team for the afternoon surgeries were getting ready with their roster. It is amazing how busy these operating theaters must be in the National Hospital. Once I got to the room, there was no one to greet me and as I did not have my mobile phone was unable to tell my family that I was OK and back in the room, in case they were wondering why it took so long.

Later another member of the surgical team dropped into meet me and have a chat about Polonnaruwa, which he may have heard from the other doctors. He said he single-handedly got funds for a rural hospital in Pulasthigama and had it all done up during the time he was in charge including the land around with fruit crops. He had been in Polonnaruwa for about 8 years, and is now specializing in Orthopedics and not had time to go back to see how things are at the hospital.

It would be nice to go with him one day soon to see his handiwork which he is very proud of. I asked his name at the time and now completely forgotten!! Another doc in the team, Dr Duminda came to have a chat about his interest in the outdoors as he has a place near Sinharaja and would like to have more time to go birdwatching. He likes the colorful ones there, and I told him I see more of the raptors in my area, the big Owls, Hawks and Eagles. He must also have gotten word about my background and wanted to share some of his experiences. It is so nice to find some common ground with people who lead such different lives.

I am due to be released in a few minutes, when one of the surgical team came earlier, we chatted about the fact that some of the instrumentation is overused and needs replacement. Apparently some are used 5 times as much as the recommended usage, due to the shortage of the stuff, presumably due to the costs for the health service. I can imagine that some of these tools of the surgeons cost over Rs1m each. So I asked the doc to give me the full details when I come to the clinic in two weeks so I can ask my contacts if they could help out with funding one that was used in my operation, which would have helped me if it had not been so worn out!

Thanks guys for all the effort and assistance in my case, and would love one day to host you all in my little forest hideout in Ratmale, when I finally am able to finish it and spend some quality time there. So please contact me. (

Wednesday, August 3, 2011

My experience at the National Hospital

At the time of my accident I was in an ordinary ward starting with the overcrowded, accident wards, however this time round as I could chose the date I was admitted the Doctor gave a note for me to be admitted to a Class I paying ward.

Once the admission formalities were completed on Monday, July 25th I was admitted after 1pm, and was told due to the preparation times etc, that I would not get any food till after 1pm the next day. It is part of the bureaucracy on their part!

The room in on the 5th floor of the Bandaranayake building, and overlooks the new Central Hospital and various Colombo landmarks. There is a very wide balcony, the widest I have seen anywhere in Sri Lanka, wide enough to put a bed lengthwise. The attached bathroom is also very big, clean and basic, but fully tiled.

The room has the high hospital bed with two pillows, but the head or foot cannot be independently raised as some of the beds of the regular wards are. A desk and chair, and two more chairs along with a clothes cupboard, a dressing table,a bed side table and a clothes horse. There is plenty of fluorescent lighting and the two plug points hold square plugs. There is a speed controlled fan that gives enough power. Due to the elevation, there are no mosquitoes, and it is very breezy as the sea breeze comes all the way here, and I sleep with all the windows and doors open.

The regular service schedule is as follows. A nurse usually comes at 4.30 am to check the temperature. They are just impeccably turned out in their kits, with not a hair out of place throughout their shift. The morning coffee is brought at 5 am and at 6 am morning breakfast is served along with tea, in a large tray, (wooden) and a plastic cover to prevent flies. This morning there was green gram for breakfast.

At 7 am someone comes offering hot water either for the flask or for washing one's face, then at 8 a person comes to sweep the room and on alternate days to also mop the room. The bath room is cleaned daily by another person at around 9am. The nurses come around 8 about 5 of them to discuss each patient's particular treatment and drug schedules. The doctors assigned to the patients come later with a nurse who takes down any instructions. Then the instructions like cleaning my wound is done very professionally by two nurses with disposable face masks and gloves just for that activity.

Another team of two come every other day to change all the sheets and pillow cases! even I do not change them this frequently. There are male hospital orderlies whose task is to take patients to x ray surgery or similar function, clean them up if necessary and prepare them for surgery, like in my case the whole area where the operation was performed had to be shaved and cleaned with antiseptics.

At around 10, coffee is served and then a tray of lunch is at noon. We have already had a few days of yellow rice, and fish or chicken curry along with other vegetables, and dessert is either a yoghurt, or fruit salad or a slice of papaya. Then afternoon tea is served around 3pm, with either biscuits, or a cheese and crackers and today it was a savory sandwich.

Dinner is served around 6pm, and it was a soup, followed by boiled vegetables of cabbage, beans, carrots and potato with a piece of chicken in a gravy, along with two thick slices of white bread. the cold jelly comes about an hour later so one can eat it as is then!

The nurses come during the day with the various medicines relevant to each patient, and after dinner a final review of last medicines to sleep and after meals, and in my case the antibiotics, and pain killers to take before bed time. There is no TV and I go to sleep around 8.30pm.

The general visiting hours are 6am to 7, noon to 1pm and 5 to 6. Surprise surprise I have no visitors during visiting hours and they all seem to come at the other times!!

I have a 24 hour attendant who is a retired hospital employee who is in the room all the time except when he goes to get his food, and I have the luxury of sending him at 6 am to get me all the newspapers to read for the day! If one does not have a family member with the patient, then one is recommended.

The attendant is paid Rs1,200 for the day and room charges including food is Rs1,750. The strong Augmentin 1.2m injections at operation and thereafter we have to buy, and the follow up Augmentin 625g antibiotic course is also bought by us, but all other medications including the Walteren for the swelling and pain is supplied.

The surgery and related doctors' visits and x rays as well as the daily physiotherapy is NO CHARGE

When a visitor told me about appalling service at a 5 star hotel, where the servers were quite clueless in how to serve, I told them, that in comparison, I received 7 star service in the largest State Hospital complex in the world!

Please note that the non paying wards usually offer three rice and curry meals a day with red rice, whilst we are offered one white rice lunch as well as the less healthy white bread in the morning and evenings.

I read somewhere that the Colombo Hospitals are overstaffed, and the rural ones are understaffed with doctors as well as all the ancillary workers. Surprise surprise!

I am about to leave the National Hospital

It is Wednesday the 3rd of August, and it was last Wednesday that I had my rather complicated 'bone graft operation". This operation took about 4 hours and was longer and more painful than the one fixing my leg with with pins in February as reported earlier. I will not go into the details as I don't know much, but they took the graft bone fragments from my right hip area, and implanted them in the area of the joint that had hitherto not fused, a "non union" situation.

I found out that in about 10% of cases like mine the bones don't fuse, necessitating this second operation. I am told it went as well as it could and that it should work out, though the time frame is a little vague owing to my personal circumstances, age and ability to absorb and fuse. Until the bones fuse I will not be permitted to put any weight on my right leg, and so I am in for a long period of physiotherapy and rehabilitation.

I am still in a little pain, reduced by pain killers, but my leg is extremely stiff and painful to move, but move I must to get as much movement as possible with the help of the physio, to speed up the recovery.

I was told I will be discharged tomorrow. Where to may I ask?