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Br J Gen Pract. 2007 October 1; 57(543): 846–847.
PMCID: PMC2151831

A patient's diary: episode 10 — post-operative check up

24 SEPTEMBER

This morning I went along to the surgery for my post-operative check up. It is just over 4 weeks since my unusually situated appendix was removed by Mr Cutler at the New Hospital. They treated me very well there, and probably saved my life. I was so fortunate to have a brilliant man like Mr Cutler available just when I needed him. The only problem is, being a busy man, much in demand, he had to rush away and did not have time to tell me about postoperative complications, several of which I had already begun to suspect. And after having someone's rubber-gloved fingers, however skilful and eminent, in your insides, in your very peritoneal cavity, you are bound to wonder: will things in there ever be the same again? Well they can't be, can they? No more appendix for one thing. Just a stump, like a little amputated limb.

They say you can do without it because it has no function but I wonder if that can be true. Surely everything is there for a purpose? Also I wanted to know when it would be safe to resume normal activities. The scar looks fairly firm but I wouldn't like to strain it prematurely and open up a great yawning gap through which … The very thought makes me feel a little nauseous so I shall not pursue it. And it is still a bit painful, particularly at the lower end where there seems to be a kind of pulsating swelling, although Hilda says it's probably just a trick of the light. Anyway, I thought I should get a professional opinion just to be sure.

My appointment was with Dr Sally Greengage, the registrar. Most people prefer the older doctors but I had selected her with good reason because, being freshly out of hospital, she is going to be much more au fait and up to speed with surgical problems. Well, let's face it, the others may know all about antibiotics and steroids, and so on, but it's many years since they saw any actual blood.

Norman wonders how he will manage without an appendix.

In the waiting room I found myself sitting next to old Harry Pocket who used to live next door to us, and somehow the conversation got around to operations. It seems that he has got to have a hernia done but he has decided to avoid the NHS waiting list and go private. Not that it will cost him a penny, he explained, because he and his wife have a joint policy with POSH (Private Operators Surgical Hospital) which will pay for the whole thing.

‘No waiting lists for me, Norman,’ he said, all very smug and pleased with himself. ‘Private room with plasma screen satellite television, five star catering and, most important of all, Mr Robert Cutler FRCS himself will do my operation personally.’

At this point I let it be known that I have had direct experience of Mr Cutler's prowess with the scalpel myself, on my own person, and all under the auspices of our still excellent National Health Service. I could see that Harry Pocket was quite impressed but was trying to conceal it with a show of nonchalance.

‘I dare say Cutler was in overall charge,’ he said, ‘but I expect the actual cutting and stitching was done by one of his junior assistants. Well, they have to learn their trade somehow. So why not practice on you?’ says he with a big grin on his silly face.

I was about to put him firmly in his place with a few salient facts about my relationship with Mr Cutler and his staff but the buzzer went and it was my turn to go into the consulting room.

Dr Sally Greengage greeted me warmly and expressed great sympathy when I told her about my emergency appendicectomy at the New Hospital. But when she looked through my records on the computer there was nothing there about it at all. Not even a letter from Mr Cutler. So I had to fill in some of the background for her myself. I explained, as tactfully as I could, how Dr Teacher had experienced some difficulty in reaching a correct diagnosis resulting in my eventual late night trip to Emergency.

I know that Dr Teacher is her mentor and she probably thinks he can do no wrong and I didn't want to dampen her youthful hero-worship. No doubt she will come to a more realistic assessment of his abilities in due course. And it was an unusual presentation, as I explained to her, sketching the anatomy on the back of an envelope. She found that very interesting. Then I asked if she wouldn't mind having a look at the scar to see if it was thoroughly secure? To tell the truth, I was just a bit uneasy after Harry's nonsense in case a junior surgeon had been allowed to do a bit of the stitching up and might not have tied a proper knot at the lower end. Dr Sally palpated the scar carefully. Nice hands she has, just a little bit cold. She concluded that they had done a first class job on me. There was no need to worry about anything coming undone. I got dressed again and took out my little notebook in which I had made a list of questions I wanted to ask.

‘I have just a few little points to go over’, I said, ‘if you have the time?’ She flashed a quick look at the clock on the wall and then said, yes, of course she had, in a very patient voice. So I went through the list: ‘How far can I walk? When can I drive the car? Is it all right to have a bath? Should I take extra laxatives?’ I don't know why it is, but somehow I always seem to leave the most difficult question to the end. I pored over the list and checked things off with my pencil. I think Dr Sally could sense that there was something else I wanted to say because there was an awkward pause in the conversation and she asked if I had something else on my mind. I took a deep breath and told her about my exercises. It might seem a bit ridiculous, I said to a youngster like yourself, for an old fellow like me to do exercises, but I do like to keep myself in shape so I do 20 minutes of aerobics every morning (well, until the operation anyway), and it puts quite a strain on the abdominals. Would it now be safe to resume them? She looked a bit puzzled but said it would be OK if I just did them gently to start with. Then she said she thought I had been going to ask her something about Mrs Gland. No, I said. Hilda isn't one for exercises. Running around after me is enough to keep her fit, I said. Dr Sally gave a rather musical peal of laughter and said that was all right then. Was there anything else I wanted to ask? By that time I had lost my place in the notebook and, not wanting to take up any more of her time, I thanked her and took my leave.

As I came out, the irrepressible Harry Pocket gave me a great wink and said, ‘you were a long time in there, old son. What's the matter, have they taken the wrong one out then?’ After which he laughed in his coarse vulgar way. Several people looked up from their magazines to see what the joke was. I just gave him one of my looks and turned on my heel without deigning to reply. He is beneath contempt. It was only on the way home that I remembered I had forgotten to ask Dr Sally about diet and whether one needs to take extra vitamins and trace elements to make up for the loss of digestive power of the appendix. So I popped into the health food shop and got a little selection just to be on the safe side.

Acknowledgments

We are grateful to John Salinsky for these extracts from Norman Gland's diary.


Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners