The Reluctant Patient. Part Two.
Waking up from the sedation took a long time. My first awareness was a continuous beeping noise that became annoying quickly, Then I was aware of someone moving around the bed.
My most recent memory was the black rubber mask on my face and the sweet smelling gas getting stronger on each breath and it's effects, making me buzz and tingle, trying to keep my eyes open but failing. The anaesthetic was too powerful to resist. It just flooded my head till I lost conscious and drifted off into warm deep dark sleep.
I found being anaesthetized with gas quite pleasant, strange but I would volunteer to be slipped off to sleep by mask anytime. The bit where the gas wins and you slip into the darkness was usually accompanied by feeling really good and very excited. At that stage I can no longer actually smell the anaesthetic laced gas, it just flows in and out of my lungs, pushing me closer to sleep.
A soft female voice asked if I was awake. Nearly, I croaked, my mouth and throat were dry. When I tried to move I became aware that I was strapped down. Lie still, one of the Doctors will be along shortly to see if you are well enough to go home. The Nurse said.
The Doctor was beaten by the Anaesthetist who had put me too sleep. Hello, how did you sleep, she asked. I don't remember, I have just woke up, I replied honestly. That is good, no strange dreams? She asked. No. I replied. That's good too, did you enjoy the mask induction? She asked. Yes. I replied quietly, feeling bit embarrassed that I enjoyed it. It's ok, some people don't mind breathing gas, others hate it and get on far better with a quick injection of Propafol or Thiopentithal to send them off. She explained.
I personally don't mind the rubber mask and Nitrous Oxide / Fluothane mix to put me under, it only takes about one minute if you take nice long deep breaths. She said.
I smiled in agreement. Did you get all tingly and buzzy as the gas put you out? She asked . Yes, I was trying to keep my eyes open, but the gas made them so tired and sleepy. Nobody can resist the powerful anaesthetic, just as well really as we would struggle to operate on them if they didn't go to sleep. Fluothane puts you deeply asleep, quickly, so it's ideal as a induction anaesthetic and it has a pleasant smell, well until it gets strong enough to put you under, by then you are not in a position to argue, are you? She said. No, not really I agreed.
As long as you were happy with your gas induction, when we were training at medical college we use to practice mask inductions on each other. My favourite anaesthetic was Fluothane, it was quick and easy with 50% Nitrous Oxide added at the start, four or five breaths then add the Fluothane gently increasing the strength, around 2% Fluothane will send most people under nicely . She explained.
How long can you keep someone asleep for? I asked. As long as they are healthy and tolerate the anesthetic eight hours is easy enough with careful monitoring and a few other drugs added. She replied.
I tried to imagine what being under anaesthetic for eight hours would feel like. You would not know you had been under that long, you would just go to sleep and wake up feeling that you had just gone under a few minutes ago, except you might not want to wake up as quickly as a short anaesthetic. She explained.
The Anaesthetist excused herself as the Doctor had arrived and left me with him. How are you doing now? He asked. I'm not sure, I have only just woken up and I'm still strapped down. I replied. I can see that, let's release you carefully then we can see how your neck is doing. The Doctor said.
The straps were loosened and the Doctor supported my head with his hands as I tried to get into a sitting position. Suddenly my head went very dizzy and I started to panic because I thought I was going to fall.
It's ok just take your time, I've got you. Dizzy, I gasped. Don't worry it will soon pass, just take few moments for you head to adjust, you have been lying down in the same position. The doctor said .
Being sat up, getting disoriented and the sudden flow of urine downwards in my bladder, I began wetting myself, I tried to stem the flow but couldn't, it just sort of dribbled out till I was empty.
Ohhh noo. I gasped. What? The doctor asked. Looking quite confused. I have just wet myself I stammered. That's ok, you are in a nappy, no harm done. He said. How does your neck feel, does it still hurt? He asked.
I was not sure, he was still supporting my head. Gradually he relaxed his grip and I gently moved my head, my neck still felt a bit stiff but most of the pain had gone.
I guess that is a lot better. The doctor asked. It is still stiff. I replied. It will be for a while, you have to be careful and not bash it around or jerk it with sudden movements till it has completely healed. The doctor said.
I think you can go home later. The doctor said. Why did I pee myself, I asked. I don't normally, I added. Probably because your bladder was full from the sedation drip and you suddenly sat upright, I wouldn't worry about it you will soon get back to normal The doctor assured.
Right, we will let you go home, so we will ask the nurses to get you ready to go home. The doctor said.
When the Doctor left one of the nurses returned and said I have telephoned your Mother and she is bringing some clothes in for you around two O'clock. I have wet this nappy. I said shyly. That's ok, that is why you are wearing one. The Nurse said. I shall get you a fresh one and change you now. She added.
She returned with a fresh nappy and white vinyl pants, also some white nappy cream also a bowl of warm water a flannel and a towel. I was soon stripped, washed, dried, creamed and a shaped cloth nappy was applied then the pull on pants were placed over the bulky nappy. I think we might give you a few of those nappies and pants to take home, just in case you have a few accidents, especially at night. The nurse said. I have only had one accident. I said defensively. Only one you know of, you have been changed three times overnight and again now The Nurse said.
I didn't know that and wondered if it was the sedation that caused me to wet, perhaps even soil the nappies.
The vinyl pants must have been new as they had a pleasant new vinyl smell that took me right back to when I wore nappies at night for accidents while being potty trained.
I also remembered being allowed to wear nappies while out in the car and shopping with Mum. I also used to wear my overnight nappy till it was soaked or dinnertime on the weekends. Mum never chastised me for using the nappies, she said they needed washed anyway so wetting them was allowed.
I was collected by Mum in the car, Mum was surprised to see the big bag with six nappies and a box of twenty vinyl pants sized to suit the nappies. Mum asked about this, how long was I to use them, the answer was till I was reliably dry at night.
This turned out to be four nights, with Mum insisting I continued to wear them for a whole week, including over the weekend.
There was a couple of appointments to change the covering on my chin. These were quite painful as they were truly well stuck to my skin.
Things soon got back to normal and life went on normally till my next dental check up. My Dentist noticed that my two front teeth were moving slightly in my gums. Some tests were conducted and the verdict was these two teeth were dead and would get looser till they fell out.
I got referred to the Dental Hospital in town. They done more tests and X-Rays to confirm what the dentist had already said. Unfortunately they could not confirm that the second teeth would grow through later or if they were damaged too.
The Dental Hospital were all set to inject my gums and pull the teeth same day. I objected to this and asked if my own dentist could remove them on their next gas day. The Dental Hospital only done General Anaesthetics for young children or whole mouth clearances, and these were referred to the local Hospital.
I went to my own Dentist and he said I would need to go into hospital to get the teeth removed under General Anesthesia.
I argued that I had been anaesthetised several times at the practice for teeth removal and fillings. The dentist said that he would be happy for me to come on a gas day and he would remove the two teeth, but he was under pressure to reduce the patients having General Anaesthesia due to the cost of having an Anesthetist attend every week.
What eventually happened was I got an appointment back at the local hospital to get the teeth removed under general anaesthesia the following Tuesday.
I was not very pleased to be losing my two front lower teeth and would have to wait a few years to see if my second teeth would be ok and there was a possibility that they might either not grow in or they could be damaged too.
Tuesday came around quick enough. Mum was the responsabil adult, she would sign the anaesthetic consent form. The fasting instructions came with the appointment letter.
We were directed to the children's ward and I was to get undressed, have a large thick shaped nappy with velcro tabs, with a folded soaker inside. I began to wonder how long I was going to be asleep.
When I was in bed I got my blood pressure checked, I was taken out of the bed again to be weighed, then returned to the bed. Then I had a visitor, another young female Anaesthetist. She introduced herself as Liz and said that she would do my anaesthetic today. Liz had been reading my medical notes and said that she noticed I had several general anesthetics, how were you with those? She asked. Ok, I said. Liz looked at me as if she wanted more than that. How would you like your anaesthetic started? She asked. The same as all the others, breathe some gas from a mask till I'm asleep. Would you not prefer a little squirt of something in your catheter port to put you under? She asked. No, I like breathing myself under from a black rubber mask. I said. Ok, I will see you along at the pre-op room shortly, you are first this morning.
She checked my weight and blood pressure the said, See you in ten minutes.
I was still not happy about losing my two front bottom teeth, but didn't mind that I was having General Anaeathesia started with a mask induction.
One of the nurses came back and placed a cannula in the back of my left hand the taped it down, then she fitted a set of monitoring tabs to my upper body then connected a set of leads to the tabs.
There you go, all ready to go. The nurse said. No sooner had she said that than two Porters arrived to take me to the operating theatres. It only took a couple of minutes to get to a double yellow door that said pre-op 2.
As soon as the door swung open I could smell anaesthetic. The room was quite long but very narrow, at the top end there was a large anaesthetic trolley with four large cylinders two blue nitrous oxide hanging on one side and two black oxygen cylinders with white tops on the other.
Liz the Anaesthetist was standing waiting beside the machine. When the bed stopped rolling Liz pumped the bed up in the air. Liz selected a small sized black rubber mask and handed it to me, Try that on your face, she asked. I had almost forgotten how tight those rubber masks were inside and how strongly they smelled of rubber.
The soft rubber cuff molded itself to my face and nose, it had a strong rubber smell with a slight taint of anaesthetic. The mask was twisted onto the shiny elbow making a squeaking noise as it went on. The black corrugated hose was quite long and lead back to the gas outlet on the machine, another shorter corrugated hose hanging on the machine with a small black rubber rebreathing bag on the end.
Are you ready? Liz said. Yes, I replied. I will start you off with some oxygen to begin with, then add some nitrous oxide to make you relaxed and maybe a bit giddy, after a few breaths I will add the proper anaesthetic that will quickly put you to sleep.
Ok, I replied. Liz wheeled the big anaesthetic machine round so I could see the flowmeters and the vaporizer. She opened the Oxygen flowmeter and the little red bobbin climbed up the scale to the number 6. The black rubber mask began to blow quietly still hanging on the hook.
Liz picked the mask up and said, You can hold this on your face for now, just breathe normally for now. As I placed the mask on my face Liz hit the oxygen flush button, it made a whooshing sound and the black rubber bag filled and became fat and round.
Can you lean forward for me. Liz asked. She removed the pillow behind me and placed a little roll pillow in it's place. Can you wiggle up the bed towards me she asked. Liz then helped me lie back down and positioned the little pillow under my neck. Do you like the smell of rubber? Liz asked. It's better when it is mixed with nitrous oxide, I replied. Ohh, I can fix that, Liz said.
She adjusted the flowmeters till two little red bobbin now danced and spun at 3 liters per minute on the scales. That should sweeten it up a bit, just continue taking those full easy breaths for me. Liz said.
I could taste the Nitrous Oxide as I breathed, it made a sort of tickling sensation at the back of my throat, it felt like I was going to cough. This was until my head suddenly went dizzy, Nitrous Oxide is fast acting, not powerful enough to make you unconscious, but it still makes you feel all floaty and giddy. It is also an ideal carrier for the anaesthetic vapour. When it is introduced things start to happen quickly.
First you feel tingles in your hands and feet. The tingles get stronger, travelling up your limbs. My head sometimes begins to buzz as the anaesthetic gets stronger. Other times I get an all over frizzly feeling. This can become quite alarming, but if you have experienced it before you keep taking long deep breaths and the anaesthetic quickly puts you under, you are never exactly sure when this happens, you just slip into the warm darkness.
I like the smell of Fluothane, it is sweet and enticing to breathe and soon gets strong and heavy, but it works very quickly.
I was under for 45 minutes while a Dental Surgeon carefully cut my gums so the teeth came out without causing too much gum damage.
I woke up in recovery, in Hospital they have someone watching you, but usually the leave you to wake up by yourself rather than being shaken awake at the Dentist's.
My tongue soon found the massive feeling gap where my teeth had been and the soft squishy holes.
I had to wait nearly three years, with regular dental check ups and X-Rays to see if my adult teeth were still healthy or would they have to be extracted too. I was fortunate the they were fine and grew in naturally, I did need my two back lower first teeth extracted to allow my molars to grow in.
These were done in hospital again and I got general anesthesia again. I was told that I would be put under with an injection in the back of my hand.
When the Anaesthetist came to see me I asked for gas from a mask. She advised me that they used different anaesthetics now and although it was safer I might find it less pleasant. I asked if it would still put me under. Yes, of course it will, you might find it rather quicker. She said.
Are you scared of needles? She asked. No, I just prefer breathing myself to sleep. I replied. You will still get a Canula in the back of your hand for other drugs, but I can give you gas from a mask till you slip off to sleep. She said. You might not like the smell of Isofluraine, but it's only smelly for a couple of breaths, then you won't be able to smell it, just feel it's effects. She said.
I was taken in my bed along to the Pre-op room. The Anaesthetist was waiting for me and I was soon wired up for monitoring by a nurse and a Butterfly Port was fitted to the back of my hand.
My pillow was removed and a little roll pillow was place under my neck, tilting my head back, opening my airway up.
A bloody pressure cuff was fitted to my arm it ran an inflation then deflation and the figures noted, also a little clamp with the red light that measured blood oxygen.
Right, I'm ready, are you? She asked. Yes, ready. I replied. The big anaesthetic machine was wheeled forwards so I could see it. The Anaesthetist set the flowmeters so four liters per minute of Oxygen and two liters of nitrous oxide was flowing. A soft blowing noise was now comming from the black rubber mask, with a big squishy soft rubber cuff.
The mask was lifted and placed just clear of my face, I could feel the gas blowing at me. The mask was gently placed on my face and the mask and plastic hoses had a strong smell like a new plastic beach ball.
Just breathe normally for me. The Anesthetist said. After a few breaths she adjusted the machine to increase the nitrous oxide.
I was not counting the breaths, just trying to concentrate on the feelings. Suddenly a sweet ethereal smell flooded the mask, the first breath made my chest warm and fuzzy, this fuzzyness quickly spread to my head. The next breath was even stronger and my head buzzed loudly and I knew my conscious was slipping away fast. The next breath rushed into my lungs assisted by the Anaesthetist squeezing the green rebreathing bag. I fell forwards into the mask, as if it had just vacuumed me up. I spun off into the warm darkness and time stopped.
I woke up much later minus my two lower back teeth and that horrid bloody taste.
I have a few more anaesthetic experiences, but they were all done the modern way. A syringe full of white Propafol, otherwise knows as the milk of amnesia. Nowhere near as much of an adventure as the old gas through a mask routine.
