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Hemicolectomy

Dr Lucy Free has undergone several bouts of major surgery over the past 20 years and believes NHS standards have plummeted

I've had six operations realted to my hemicolectomy over the past 20 years. Each one has meant being in hospital for about a week and while the experience has been intrinsically unpleasant, it has given me a good insight into the state of the NHS and reminded me what it is like to be a patient.

I hardly remember the original operation now. I was a trainee GP at the time and had always been healthy. So I knew something was up when I went off my food. My GP agreed with the diagnosis of appendicitis and off I went to hospital.

I was happy for the duty registrar to operate – after all, they do far more appendicectomies than consultants do. Except that it wasn't an appendix and he was forced into his first hemicolectomy.

Seven years later I started to get abdominal pains. I had no idea why, except that it was intermittently extraordinarily painful and I felt ill. Bloods, endoscopy, ultrasound and X-rays were all normal and sometimes I felt quite well.

I began to wonder if I just had an irritable bowel or some psychosomatic disorder. I pestered the poor consultant – who I knew – to pursue my ethereal symptoms, which was a bit awkward given that everything else seemed normal.

Paradoxically it was an enormous relief when, finally, a barium enema showed an anastamotic stricture and an enormous blind loop. The second resection was complicated by a strangulated incisional hernia – the scar getting longer and longer and my functional bowel getting shorter and shorter with each operation.

Things 'downstairs' have never been quite the same. I have had several more obstructions and three more laparotomies to sort out the matted tangle of spaghetti that remains. I dread the thought of another barium enema, the most undignified procedure – I can't imagine why people want colonic irrigation – and still have a painful heel from a bedsore after an epidural. These things matter as a patient.

It's difficult being a doctor and a patient. You're given a private room and left alone apart from the twice-weekly ward rounds. The role of an ill person can be embraced or denied. I switched off and waited to get better.

It was never a secret that I was a doctor but I didn't advertise it either. It could be intimidating for carers who I noticed were either super-careful or studiously casual so it was very common to be left alone. At least I was spared the indignity of students.

The boredom is incredibly difficult to cope with when you're used to being a busy GP. You can

very quickly have too much daytime TV, books are too demanding and magazines too insubstantial, and uncannily full of recipes when you're nil by mouth.

Plastic mattress covers crackle when you turn over and make you sweat, spells of inactivity

and hospital food affect your bowels and your brains. The rhythms of the hospital lead to insomnia and indigestion.

You also find out who your friends are. Hospital visiting involves effort: finding and paying for parking, taking in a gift, finding something to talk about. As a patient you feel obliged to entertain visitors, which can be a real struggle when you're tired and it's hardly as if you can ask them to leave.

Real friends understand all this and make visits short and frequent – and don't bring potted plants. Real friends take your nightie home to be washed, look after the dog and bring in tasty home-made snacks, though sometimes I couldn't eat these because of the peculiar diet I had to follow.

NHS standards have plummeted with no matrons to keep on top of things. Cleaners are slack and nurses are too busy being academics to do real nursing. You don't like to keep ringing your bell but it can take a while to get attention.

I am lucky. My condition is not terminal and there are a lot of people far worse off. It has been interesting to watch the advancement of surgeons and the deterioration in nursing care.

Lucy Free is a portfolio GP in West Sussex

What I have learnt from my experience

lBeing a doctor and a patient is doubly difficult. Don't be afraid to act like a patient – ask questions, accept advice.

lOnce you have undergone major surgery, things are never quite the same again – although time is a great healer. Doctors should nevertheless be confident in encouraging rehabilitation.

lBowels are embarrassing so talk to patients in simple language. Use the word 'poo' and don't giggle when you say it.

lDoctors need clues, not red herrings. But trivial things can be important to patients, so do listen.

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