Decolonisation and the Wind of Change, or From : to ; in the Time of Covid

By Tina Moskal

"Once I had a colon but now I have a semi-colon" - a friend’s father’.

The hospital which has just relieved me of half my gut gave us patients a journal to fill in during our stay. This was to record physical progress along with personal joy and angst. All of my angst became fixated on a pair of linked banalities: agonising constipation and cruel wind.

Here I offer the experience to those who have the stomach for it: a slice of life in the time of Covid. My first suspicions coincided with the beginning of lock-down, so I held back from 'bothering the doctor', but new symptoms led me to get a diagnosis. Then things took off with impressive momentum.

The breathlessness I felt just before Christmas last year turned out to stem from anaemia, which in turn led to suspicions of a digestive tract tumour. Given my decades of gut-friendly diet, I couldn’t imagine this would be a primary: it must surely have seeded all over the place. I started to accept with grace my God-given three score and ten. So when surgeon Shaban told me I had an isolated colon cancer, he may have been startled when I said rapturously “Is that all?”.

Straight away, half a dozen preliminary procedures are booked before the surgery date in two weeks’ time - not easy under Covid. We live on the coast 40 km east of Edinburgh. To qualify me for a 'green' (Covid-safe) as opposed to 'amber' (Covid-iffy) hospital ward, our whole household has to shield pre-op, so our usual train and bus are not an option. Husband Vince insists on driving me back and forth. Unfortunately for him, extraneous bodies are not welcome in the hospital; no nearby friends can be legally visited, nor cinemas, theatres, bookshops, even cafés. So, Vince spends a lot of time palely loitering in parks and looking for loos (though surgeon Shaban, on hearing of this, began at once trading with colleagues and rescheduled three of these visits into one). During these appointments I, of course, experienced more social life than I have over the whole of 2020. So much for shielding…

Finally, the day of the op… I can’t say “dawns”, since we have to leave before five of a February morning in order to arrive for seven: double travel time because the Beast from the East is ravaging our coastal roads. We set out over fresh-fallen snow which completely obliterates road markings and verges – not to mention yesterday’s ice – and the horizontal blizzard in our headlights draws a dazzling curtain across the windscreen. Somehow, we fumble through to street-lit Edinburgh where, on a short gentle slope up from Princes Street, our horse refuses the fence, wheels spinning sadly on the slush…

Nevertheless, with exactly one minute to spare, we skid to a halt at the hospital door. Vince turns around to retrace his tyre-marks into a hesitant dawn, and I enter the operating suite on time, to scattered applause. A nurse immediately sends my perishable foods off to the ward fridge, and stashes my luggage in a corner. I climb onto the gurney and they wheel me in to get gutted.

By way of conversation as we wait, I ask how long the op will last. They startle me with “Four hours” and, had I died on the operating table, my last words would have been recordable as “F*ck me!”

After the Covid-complicated slew of out-patient appointments leading up to admission, once we check in to our wards, we in Green Zone are hardly aware of new restrictions. Traditional protocol against sitting on or in other patients’ beds or chairs is tightened and, of course, no visitors are allowed. These being the usual bearers of gifts, grapes and clean undies, we had been advised to bring in ample clothing, and favourite foods.

The staff wear masks at all times, but one is, of course, used to the image of masked medics. Patients are only required to mask up and sanitise when we leave our own ward rooms. We are free to visit the hospital shops or the cafés for a decent take-away espresso, and to wander the in-patient buildings, except for the designated Amber areas. We were Covid-tested three days prior to admission, and at intervals thereafter, by an apologetic wandering adolescent with cotton buds.

Our post-operative journals are for personal navel-gazing, yes, but primarily to furnish data on appetite, energy, mobility and the passage of wind and stool. The wind question is especially crucial in Colorectal: during gut surgery, the patient is pumped full-to-bursting with air, in order to provide good firm tubing to work on. Presumably this air penetrates beyond your previous day’s meals and gets trapped. You’re encouraged to expel most of this wind before expecting your traumatised colon to process solids again. Thus, alongside the time-honoured “Have your bowels moved today?”, the staff enquire tirelessly, “Have you passed wind today?”, rejoicing with those who have. Until wind has passed and bowel movement begun, they’re reluctant to let you home. What with inactivity and the need for opiates to control pain, constipation can follow any operation; but with colorectal surgery there is a complication: oral laxatives are strictly off-limits. They work by causing spasms of the bowel, which could tear the new stitching apart and lead to all sorts of leaky problems. Nor are doctors keen on approaching too soon from the other end.

For some reason I fall full foul of these complications. My journal entries begin here:

Day 2. Today far worse than Day 1! No longer dopey enough to ignore wind and wound pain, head- and musculoskeletal ache, bone-dryness. Sudden midnight flit from High Dependency to open ward meant no sleep –– due to previous excess, along with all manner of sleeping sounds and everyone’s bleeping things, randomly erupting on hair-trigger.

On the bright side, I was able to add to the general cacophony by starting to pass wind. Over the day, wind power carried discreetly on. By this second evening, I can just about sit up and turn over in bed. Once on my feet, I’m fine.

Day 3. But it’s there! I can feel it from outside, but it won’t budge! Dry, hard, large as an infant’s skull! I am fully dilated; it’s crowning, but I can’t birth it. Midwife, please tell me Push/Don’t push. What to do? I tried going for a long evening lope along yawning empty corridors. Suddenly, the dam threatened to burst there and then, and I dived into a providential loo. But when I sat down, ‘twas not even hot air. And now the old wind-type pain has returned, more localised.

Day 4. Yesterday’s woes continue. I feel like a beached body bag around a barbed-wire-in-concrete colon. A pessary inserted at noon forged but a narrow passage through to… more caverns of wind. Spent the day doing T’ai Chi and yoga, trying to squeeze out… matter, air, anything. I feel hard-done-by; the initial recovery pains seemed fair enough, but this turn-up for the books came out of left field.

Now I cannot pee either! The entire area has merged into one agonised, undifferentiated super-sphincter which doesn’t know where to turn. My bladder hanging grimly on to the gallons of water I have been trying to slacken my bowels with, mercifully relieved by the night nurses with a temporary (I hope) catheter.

Day 5. Double pessary today. No go. The pain is excruciating. The ward doctor assures me that all will come to pass in the fullness… I disagree. I need a pickaxe. I adopt crouching postures reminiscent once more of labour; kindly nurses commiserate. Then the feisty one says she’ll go and “Kick doctors’ ass” and, blimey, turns up with a prize in the form of the lovely Shaban (my surgeon), who actually investigates, and proceeds to excavate my interior by (gloved) hand! Pain, yes pain, but productive, and the certainty that this is what was needed … though I’d envisaged something more mechanical… but hey, fingers before forks. As poor Shaban could only reach in up to his wrist, he left me with a silky enema for penetrating beyond, and I am promised more tomorrow.

Day 6. Felt great, first thing. Long and peaceful pacing in the Recovery Walkway with insides again blocked, but more pliable, ready to respond to the promised enema. But where was said unguent? By late morning, getting more rigid by the minute, I was told there had to be 24 hrs between treatments. That would mean, by the time 6pm came round, I would be hard back where I’d started. Kind, sensible souls finally consented to give it to me after lunch, and lo! I have managed to pass a modest first stool, stony as a petrified porcupine, but all my own work.

This relief has left me with, yes, much thanks, but the remaining petrification starting a little farther up; not so much a lump of concrete, more a stalagmite, stone dagger or needle of Dolomite, on which I am impaled like Edward the Second. One must walk very upright to avoid puncture, yet walk one must, in the hopes of grinding it down. By the end of tonight’s trudge through the corridors, groaning like a ghost, I have dislodged enough crumbs to be able to lie still sans pain, and so sleep, sans offending opiates.

Day 7. More stone chippings dislodged throughout the night have me lying more comfy. Another enema and some Slippery Elm pills delivered by Vince have done the final trick (Vince just happens to be up in Edinburgh for HIS skin cancer excision).

I guess I could have gone home today, if push came to shove, but feel safe here where there’s no panic. Rapid serious action when necessary, as with Pam opposite, but panic is not what you (nurses) lay on us patients. Just your patience, and your willingness to succour us in our whines or whims.

Day 8. …I had my quarrels with some bits of timing, and one of treatment, but these were heard, and ironed out. You have a wonderful balance of heart and head: touchy-feely and science-of-steely. Thank you.

Ten days later, I am now confirmed cancer free, and leaping like a goat.