Archive for October, 2021|Monthly archive page

Living with hernias

I am going to open up – literally – a new thread on this blog. It is going to be about health, or perhaps more precisely, ageing and health. It has been prompted by the discovery of two 3cm long hernias after an ultra-sound scan, conducted by a wonderful NHS ultra-sound practitioner who intuitively found hernias, despite looking for something completely different and, apparently, unrelated. I will come back to the apparently in a subsequent post.

The NHS – the National Health Service – to any non-British readers, does not repair inguinal hernias as a matter of course. The position seems to be, if one can adjust behaviour such that the condition can be lived-with, then invasive surgery is unnecessary and/or ill-advised. But living with hernias requires quite a radical – and in some cases embarrassing – adjustment. The embarrassing is having to ask for help all of the time. Yesterday, for example, I was in a shop with a full shopping basket. I had to ask for help to raise it to the counter. Essentially, though, anything that requires heavy lifting has to go. That is pretty radical in my life.

At the time of writing, I was anticipating to be recovering from surgery. Indeed it was three weeks ago today that I went for a Covid-19 PCR test, to be followed by isolation so as to limit the spread of the disease on checking into the hospital on the morning of 15 September 2021. A call the night before from the nursing sister on the ward that was to receive me, confirmed that I was expected the following day. And when I got there at 0745, my name was on a big whiteboard adjacent to the ward – for want of a better phrase – control room/desk.

I was first visited by a nurse who recorded my blood pressure and temperature. She went through the paperwork and assisted with putting some compression socks onto my feet. I was then visited by a surgeon who drew on my body the arrows pointing to the hernias and, presumably, incision points. He went through my consent form. There was something slightly wrong with it, so a change was made and I counter-signed it. He told me that they do not like doing two hernias in one go, but it was left like that. We talked about the nature of “keyhole” surgery in the context of hernias. My understanding developed a little here. In order to do the keyhole surgery, gas has to be pumped into the body to lift tissue to provide surgical access. “You will be sore”, he said.

Next up was the anaesthetist. She went through the paperwork and advised me of the effects of the anaesthetic. I could expect to feel nauseous. I was then visited by another surgeon. For reasons which are now a little blurred, she indicated that she was not the person who could do the surgery that I had now agreed to. She had to find a colleague who was possibly not on duty. I was asked to wait about 30 minutes or so.

In the end it was about 60 minutes before a third surgeon arrived. She was the right surgeon and she was not dressed for surgery. She and her colleagues had obviously been talking about my case. The third surgeon pulled no punches. She told me that had I gone through her clinic, I would not have got this far. She was not satisfied that I understood fully the risks associated with the surgery. Before she would perform it, that risk was going to be spelled out again.

The risk of failure is 5 per cent. I was aware of that, and was prepared to take the risk in order to fix my hernias. The risk is not just 5 per cent of failure. If the procedure, involving the insertion of meshes, fails, it does not just not work. Failure does not leave a patient back where they started. It leaves the patient in a far worse place than just living with the inconvenience of not being able to lift a basket of shopping. It has to be reversed. The process of failure is not nice. Those meshes are rejected, they become infected. Reversal can take as long as five years; that is not just inconvenient, it is also five years of debilitating pain.

The surgeon looked at her watch and said “we still have time to do it. Why not phone your wife and have a chat with her? I will come back in half-an-hour.” When she returned, I had already put my clothes back on. The operation was cancelled. We revisit in a year. This blog entry, then, is part of a process by which I am coming to terms with not having had the surgery, and the physical and mental challenges that decision generated.

Three weeks on, I do not know whether I made the right decision or not. Whilst 5 per cent is high, 95 per cent is higher. But human bodies are such that no one can predict who will be in the 5 per cent, and who the 95 per cent. And if I was the 5 per cent, my professional life would be trashed. I am just about to publish a book, as some readers know, about business strategy and climate change. I have written the book to make my contribution to positive change in the context of my own university teaching, and that of others who will adopt the book. That would go by the wayside, for sure. Five years is a big chunk of life when one is in their late 50s. The surgery can be done later, and it can be done sooner if the pain becomes intolerable.

Every day, the decision is revisited in my head.