"My gall bladder and how I lost it"

My gallbladder – a personal account

Why this account?

I decided to write this account of how my gallbladder came to be removed after the searches I performed seemed to reveal far more horror stories than “Happily ever after” ones. I guess it’s only human nature that people who consider they have a good case to moan about should do so, and that people whose cases clanked quietly through the system just shut up and get on with living. I thought I would try to redress the balance.

About us

First, a little background information. I am 65 and retired two years early to coincide with a move from Buckinghamshire to east Hampshire in order to be nearer to our daughter and her family. I have always enjoyed good health, and an overnight stay in hospital in 2007, following ear surgery, was my first such since 1967. My wife and I have been married since the dawn of civilisation, and we celebrate our ruby wedding next year. She is disabled by rheumatoid arthritis and has considerably more experience than I of hospitals, having had two joints replaced and a few other bone repairs.

How it all started

My story started in the middle of August, 2009. One Friday morning I noticed my urine was rather darker than usual. In view of the season I thought I had maybe let myself get a bit dehydrated, so resolved to drink more in compensation. Later in the day I went to my weekly Pétanque session, but a backache developed and I did not play for long. In the evening a pain developed immediately below my breastbone. It was constant, dull but powerful. I tried a couple of doses of Gaviscon but to no avail, and finally I rang the doctors’ deputising service.

A doctor called me back in about 20 minutes. After listening to my list of symptoms she declared “In view of your age and sex I am sending an ambulance.” I have been a first aider for some years, and the pain did not match the criteria for a heart attack, but by now it was getting me down, so I put a few essentials into a flight bag and waited for the ambulance.

We live in a village, eight miles from the nearest (not very large) town. The ambulance turned up in about 15 minutes. I was conducted aboard and immediately wired up to a multi-purpose cardiac device which appeared to be an electrocardiograph and defibrillator combined. The ECG produced was good, so no worries about the heart. The paramedic did several more tests and inserted a cannula into the back of my hand before we started off for the Royal Surrey County Hospital at Guildford. I remember little of the journey, as by now I was breathing gas and air and the pain was dulled. The small boy which resides inside every middle-aged man would love to know if “blues and twos” were used. I do not recall any sound, but judging from our progress up the A3, including through the notorious Hindhead roadworks, something must have been suggesting to other road users that they should move over, for one abiding memory was observing, through a small tinted-glass window, a constant stream of overtaken vehicles.

Friday night in A&E

We arrived at the Royal Surrey at 10.20 pm. I was wheeled into A&E, and the paramedic took the multi-purpose cardiac device, which obviously worked with its own battery, off to show the triage nurse. Five minutes later I was lying on a trolley in an A&E cubicle. First, another ECG. Next a series of blood tests and X-rays before, after about two hours, I was ‘seen’. The seeing was done by the A&E doctor, who pronounced his opinion that I had suffered an obstruction of the bile duct, no doubt from a gallstone. Before being taken to a ward for the night I was wheeled to the surgical assessment unit, next door to A&E, where (as soon as he had finished his latest operation) the duty surgeon came to see me. He expressed his agreement with the opinion of his medical colleague, and cleared the way for me to spend the rest of the night on a bed which, after my A&E trolley, felt the epitome of luxury and comfort.

This was my first contact with A&E on my own account since, I believe, 1960, when the cut hand resulting from contact with a model aero engine propeller was rapidly stitched up. I was hugely impressed with everything I saw of the department. It all appeared spotlessly clean, and the staff were superb. I came into contact with staff from at least three continents and I know not how many nationalities, and every one of them dealt with me in a totally professional, friendly manner. Two things remain in my memory: in the adjoining cubicle was a very old gentleman who had quite forgotten why he was there or who had brought him. The patience of the staff trying to tease bits of information from him was beyond praise. And an overheard telephone call (I cannot call it a conversation, all I heard was very one-sided): “Sir, your son is here, he is 14 years old and very drunk. He is not fit to go home alone and he certainly cannot stay here. You will please come and collect him”. (The time was around midnight.) I am reminded of a few lines of Kipling’s:

Yet, patient, faithful, firm, persistent, just

Towards all that gross, indifferent, facile dust,

The angels laboured to discharge their trust

By the next morning the pain had subsided. Presumably the blocking gallstone had moved on to pastures new. Around mid-day I was seen by the duty consultant, a general surgeon who specialised in laparoscopy. He offered me another day in hospital, but for home reasons I preferred to get away. He ordered further tests – gastroscopy and ultrasound – before deciding on a course of action.

 

Further tests

A few days after returning home I suffered a high temperature and the most amazing night sweat. My GP was called and diagnosed cholangitis, an infection in the bile duct. It responded quickly to some industrial-strength antibiotics, but was exciting while it lasted! It certainly stiffened my resolve to get rid of the gallbladder as soon as I could, as did learning that Andy Warhol died of a gallbladder-based infection.

Now came a period of waiting. The first test turned out to be an ultrasound scan of my abdomen. This proved to be the only occasion on which the practitioner was not communicative. He seemed anxious to ensure that I could see nothing of the scan results. In the end I asked him directly if there were gallstones; I assumed the resultant grunt to mean “Yes”.

Three days later, on 21 September, I went for endoscopy. My wife has had a couple of these procedures and finds them distressing, so she suggested I elect for a sedative. In retrospect this was not a good decision: it meant a £30 taxi ride to the hospital and collection by a ‘responsible adult’. As things turned out the sedative was a waste of time and effort. The practitioner was very thorough in numbing my throat, then he administered the sedative and set to work. I was compos mentis all through the procedure which I did not find too unpleasant. Only afterwards was a little light shed on things. Sitting in the patients’ room (television, free coffee and sandwiches) I got into conversation with my neighbour, a very slightly-built man. He told me he had slept throughout the procedure, having received 10 ml of the sedative. On looking at my notes it became apparent that to sedate me, weighing probably a stone more than my new acquaintance, I was given just 2 ml! It would seem to me that the thoroughness of the throat deadening was the key to an easy procedure. Anyway, the gastroscopy turned up no ‘nasties’ beyond a mild inflammation of the duodenum. All clients of the procedure are now given a test for the presence of helicobacter pylori, the precursor to stomach ulcers, and that result was fortunately negative.

During the next six weeks I tried on two occasions to contact the consultant’s secretary, in an attempt to find when my follow-up appointment would be. On both occasions I left voicemail messages, but neither call was returned. I was beginning to wonder if I had run up against an age barrier, but with hindsight I think it was just simple incompetence, the only instance of it I experienced in the whole of my gallbladder saga. In desperation (I was keen to get a resolution by Christmas if possible – I could visualise a malevolent gallstone deciding to disrupt Christmas day!) I rang my GP surgery and asked if they could chase things up. They had more success and spoke to the secretary. The follow-up appointment was set for 19 November.

 

I arrived at Guildford bright and early for my 8.30 appointment. By 9 am I was giving a blood sample, having agreed to the proposed laparoscopic cholecystectomy. By 9.30 I was being pre-surgery assessed. The staff nurse carrying out this task was superb: patient and thorough with a good sense of humour. All pre-op patients are tested for MRSA. A positive result, the information leaflet assured me, did not mean that surgery would be cancelled, but special care (a private room perhaps, or last of the day’s operating list) would be taken to minimize the chances of cross infection. By 10.15 I was tucking into a light breakfast in the staff/visitors’ restaurant.

On 25 November came a telephone call from a lady in the admissions department: would I be available for surgery on 23rd December? I actually cried off that day, as I had an audiology appointment at Basingstoke. (I am hard of hearing, or as my wife would say, deaf as a post.) The following day she called again: how about 4th December? I jumped at that appointment, and spent the next week jumping around equipping the house for an expected week of car-free convalescence.

Surgery at last

I presented myself at the SSSU (short-stay surgery unit) by 7.30 am on the 4th. By 8 I was lying on my bed in a gown, having my details checked. By 8.30 I had seen the anaesthetist. By 9 I was drifting off to sleep – such a change from my 1967 operation, when sleep came unpleasantly like becoming paralysingly drunk in about half a second. By 10.30 I was in recovery, by 11 I was in the ward drinking a welcome cup of tea and talking to the surgeon. The gallbladder was thickened and inflamed, and I was better off without it. Thirty minutes later I was dressed and eating a light lunch. My daughter once again obliged, and I was home by 3.30.

Aftermath

I make no apology in going into detail here. Knowledge is strength, and forewarned is forearmed. The NHS information leaflet tends to gloss over anything its writers consider at all unpleasant, but life isn’t like that. I hope the points I make here will be of use to a future patient.

The hospital supplied some Co-Codamol tablets, a high-strength painkiller, sufficient for four days. The first evening was not very pleasant: the left-over gas which had not been purged from the abdomen tends to collect around the shoulders, and no amount of rubbing does any good. I had provided myself with a couple of tubes of Trebor extra-strong mints. Just how they work I do not know, but at least they take one’s mind off it! Walking about seemed to help, too. The drug administered to dry the mouth was very effective, and for most of Friday my mouth felt like the inside of a sandpaper factory. But the mints helped. Going to bed was a trial, as the diaphragm and stomach muscles were decidedly out of sorts, and punished me for flopping down on the bed by making it feel as if I were breaking in two! I finally got comfortable, but only on my back. I did not get much (or any) sleep.

From Saturday onwards was just steady positive progress. By Wednesday I was free of pain everywhere except directly over the highest incision. I celebrated by taking my dog for a walk, the first time (by me) since Thursday. Later that day we went shopping. I was careful to ensure that the bags were only very lightly filled. The old advice - back straight, lift with your knees, hold the load close to your body - is useful here.

Aftercare

What aftercare? In my experience there isn’t any. The old leaflet I had been given referred to a morning-after visit from the district nurse, and a follow-up appointment at hospital, but they are long gone. The incisions are closed and sealed with adhesive which can be washed after a few days, though I intend to keep mine dry for ten. This method has at least the advantage of making the entry of germs very difficult, but infection can, of course, start up internally. Following my mega-temperature episode in the Summer I bought an accurate, reliable digital thermometer. I recorded my temperature twice daily for a few days before the operation, and of course carried on afterwards. There is no simpler and quicker way of spotting an infection than temperature rise. More than 1 degC. rise means an immediate call to the doctor. Antibiotics can then knock it over quickly.

The only other point I want to mention here is bowels (did someone say ugh?) Disturbed eating patterns, plus heavy-duty painkillers, can result in constipation at a time when lots of straining in the lavatory is very unpleasant. A call to our friendly pharmacist confirmed I could ‘borrow’ some of my wife’s Lactulose solution. It is actually palatable! And about six hours after taking a dose I was relieved that normal service was resumed and the problem was behind me. The other point, of course, involves the very opposite. Without the gallbladder to provide a ‘boost’ in bile availability, a fatty meal can escape being fully digested. While this can have advantages for those (including me) who find it a trial to maintain their chosen weight, the sudden arrival of a lot of fatty food at the body’s back door can result in diarrhoea. I started to reduce my intake of fatty food at the time of the Summer crisis, but after the surgery, as I did not wish to end up depriving myself of some well-liked dishes, I decided to follow the modern trend and keep a Blog. No, not one of them, this one is a bog log! It simply allows me to co-relate any sudden outputs with what was previously input. So far (eight days post-op) I have had no problems in this regard.

Finally

I wrote this for fun. If any pre-surgery patients find any of it of interest I shall be delighted.

December 2009