The surgery clinic

Today Mum went to the surgical clinic to speak to four specialists: a surgeon, an anaesthetist, a pharmacist and a Nurse. Daniel and I were there for moral support, to ask questions and because we had nothing better to do at the time :)

Each of the four were considering different aspects of the surgery scheduled for tomorrow and were also there for any questions Mum or the family had. Here is a summary of the consultations:

Nurse- The nurse dealt with the administrative aspects of the surgery, including fasting before, what to wear, what not to wear etc. They also addressed how Mum would cope at home after surgery and said Mum will only be discharged when she can mobilise appropriately (can safely live in her apartment). Although Mum will be in substantially better shape than she is now, there will be recovery time where some domestic tasks which may pose a hurdle to Mum (cooking goes without saying but this is not related to her condition). The nurse was surprised that Mum has not been assessed after her first hospitalisation last month. After this consultation, Mum, Daniel and I decided we would talk to the hospital social worker early about domestic assistance and we would make it clear that Mum will not consent to a discharge without being appropriately assessed with the right level of domestic care in place.

The nurse was very caring and another excellent example of the Qld heath system (for all the flaws reported in the media, there a some amazing people working the system keeping it running for the benefit of the patients).

Anaesthetist: The anaesthetist is in charge of keeping mum under anaesthetic while in surgery as well as managing her pain post-op. He advised that the surgery will be close to her lungs which will necessitate a double barrel chest tube (so each lung can be independently fed oxygen and can independently collapsed to allow the surgeons better access to the site of the surgery). Apart from that, he explained that he will knock Mum out before the surgery and keep her out of it the whole time and that is what we wanted to hear from him.

He also walked through Mum's post-op pain management. Mum will be brought out of general anaesthetic heavily medicated so when she wakes up she will be comfortable. After a surgery like this, the two options that have been considered for Mum's case are an epidural and a Patient Controlled Analgesia morphine drip (PCA). The epidural has been ruled out due to the risk of haemorrhaging around the site of the needle. This leaves Mum with a morphine vending machine with a limitless supply of tokens. She will have a button that she can press to administer morphine when she feels pain. It will deny a dose where it exceeds safe levels but Mum has clearly been told to be aggressive with this. At the slightest hint of pain, Mum is to tap that PCA. If she does not, the pain may take over and it can be hard to bring it under control again.

Mum was not the best at calling for pain relief in her first few weeks of the disease so she is going to need to concentrate on this. If you speak to her over the next week or two, please do ask her how her pain is going (please do) as this reminder really helps. Remember, with the pain medication she is on, there is a level of intoxication that impairs her thinking (her pain meds are very, very strong) so these prompts are very beneficial.

He also considered the risks associated with Mum's blood thinning medication. He was satisfied that the risks were manageable but Mum made it clear her eyesight was very important to her and this was to be taken into account in treating her (i.e. get her back on the blood thinning medication ASAP as this significantly lowers the risk of Mum popping a blood vessel in the eye). They are expect to use frozen platelets during the surgery to reverse the effects of the blood thinning medication. They will conduct a blood test tomorrow morning (the day of the surgery) to work out her blood viscosity (INR) to make a decision on how exactly to treat it during the surgery.

At this point it is worth mentioning Mum's GM. His name is Stuart and when Mum was at an appointment with him on Wednesday, after finding out Mum's INR, he called the PA Surgeon right then to advise of Mum's VERY high INR (meaning low blood viscosity and high bleeding risk). Not only was his action great for Mum's piece of mind, but also was Dr Laherty's response. He said they would counteract this effect with frozen platelets and vitamin K. This quick response was very comforting indicating that he knew what he was taking about and also can think on his feet. Mum has been very lucky in the medical professionals she has been dealing with (with her personal GP being no exception).

Pharmacist: This was a straightforward. She looked at all of the medication that Mum is currently on and considered if it was going to impact the surgery or pose a risk. She found that Mum can keep taking her current medications without a problem (with exception of the blood thinning medication which she ceases on Monday night). This is good news as this consultation is usually about 2 weeks before surgery so this could have posed a risk of postponement as it was only the day before surgery (remember, Mum is being rushed through due to the risk of melanoma and therefore the need to remove the bone legion as quickly as possible).

Surgeon (neurologist): This was the money consultation. Although we had received a substantial amount of information at the consultations so far, this one was with the team who were in the drivers seat. He was a confident man with a sense of humour and it really worked well to provide us with confidence and also put us at ease (it was not the inappropriate humour that one would expect if he was a Young- which is a little disappointing).

He reinforced the information provided by the anaesthetist about Mum's blood thinning medication which is good. Neither are concerned about the risks because they are manageable. This was something I was worried about before but I really believe it is not a risk of concern after these consultations.

The operation will take a few hours but in total, Mum will be in pre-op, the operation and post op for about half a day. After this, she will be in recovery. If it does not go as planned, she may be in intensive care but this is a very low risk. So tomorrow Mum checks in at admissions at 10am and they take her to surgical care in prep for the operation. They also take blood to test her INR (blood viscosity) so they have the most up to date information to decide on how to deal with her higher bleeding risks.

So we can expect Mum to be out of surgical care and on the ward in the late afternoon or evening on Friday. From there, the focus will be on pain management (and Mum was advised that the aim is for her to wake up in a state of comfort through effective pain medication, basically a chemically induced Saturday night in the Valley). The next day (Saturday) Mum is expected to be out of bed and walking (although I cannot see this being a problem as Mum will be fighting for a nicotine fix well before this point). She will also have a fluid drain in her side for 24-48 hours.

Overall, the day was long but very comforting. We are under no illusion that this is not a significant surgery but from the consultations, it would seem that all parties have the risks mapped out and planned and Mum is in good hands. We are now at the point of crossing everything to bolster the medical team in any way possible- every bit counts.