Not only were Mr Hendersons blood tests and X-rays looking better, but he was looking better himself. The grey pallor had left his skin. His breathing was also less strained. Somehow experiencing the outside world had made a huge difference, where medicine had failed. Perhaps by being so close to all that life and energy, some of it seeped in.
It was amazing to watch Mr Henderson progress: moving from lying in bed, to sitting on the edge of his bed. Before long he was taking his first few tentative steps, soon upgrading from walking with a frame and two nurses to one nurse and a walking stick.
He took his walking stick with him on the day of his discharge.
While the team of doctors quietly congratulated themselves on a job well done, we knew that it was Colleen who had made the difference. She had taken a risk, one that could have turned out very differently. Though, when I look back now, I dont think Mr Henderson would ever have let us down. He would have stayed alive just to keep us out of trouble.
Helpless, but thats okay
Sometimes its possible to have the best of intentions, but get things wrong; in some cases, there is a very fine balance between doing just enough to help a patient, and doing too much.
It was particularly hard seeing Mr Belford in hospital he was such a physical, athletic sort of man, even in his eighties. You could tell he had spent a lifetime working outdoors his body was lean, hard and tanned. He had never smoked and never been much of a drinker. But even being such a fine physical specimen, I still thought he was far too old to have been standing on the back of a truck, unloading cattle.
Mr Belford was with us after one of the cows had become restless and had knocked him from the back of the truck, causing him to hit his head on the ground very hard. The knock had been so severe he had developed symptoms akin to having a stroke.
Ill get them to move, Mr Belford said, as he struggled to wiggle the fingers on his left arm.
Only 24 hours since his accident and the fingers were already looking like a set of claws.
I hope so, I replied there are no certainties when dealing with head injuries.
Mr Belford had difficulty moving his left leg as well, but thankfully his speech was okay and although he was unsteady on his feet, he was still able to walk with a stick. Mr Belford lived alone, had never married, and had always done everything for himself. Aged bachelors like Mr Belford are generally pretty strong willed, even argumentative.
Im not helpless, he said to me one morning, as I laid out his breakfast tray for him.
I had arranged extra-large eating utensils and made sure everything on the tray was in easy reach of his good hand.
Just doing my job, I replied, trying to make light of his comment.
That may be, he grumbled, but there are more sick than me in this place. Go take care of someone who needs some caring. I can take care of myself.
Having by then had numerous dealings with stroke patients, I wasnt upset by Mr Belfords words. I had learnt that anger is a natural reaction.
I left Mr Belford in peace but not without making sure he had his call bell within easy reach.
I felt I knew all there was to know about dealing with Mr Belfords situation. I was about to learn a simple, but important lesson.
Did you see that?
It was Mr Belfords ninth day with us, and small miracles had begun to happen.
I saw it, I replied, as I watched him slowly move his fingers.
The movement wasnt perfect, it was awkward and uncontrolled, but it was a great sign. His walk had also become steadier, although he would always be left with a slight limp and in need of a walking stick. He would never be able to climb on trucks or herd cattle again. Despite all the progress, things were going to be different now in Mr Belfords life; he could never be completely independent again.
Can I help you with that? I asked, as he began to button up his shirt.
His affected fingers werent nimble enough, so he was struggling with his good hand.
Im okay, he replied.
Are you sure? I asked again.
He was really struggling. I watched as it took him two minutes to do up one button.
Here, let me, I said, as I quickly stepped in.
Get ya hands off me, Mr Belford bellowed at me, as if I was one of his farm dogs.
I leapt back, stammering an apology, I only wanted to help.
Mr Belford stared at me in silence for a moment. The angry expression on his face began to fade.
I know you mean well, lad, he said.
Embarrassed, I felt my face redden.
But my life is different now. I cant do the big things I used to do only a couple of weeks ago.
His voice was hoarse. Hed always shown the tough, weathered old man-of-the-land exterior. This was a new side.
But the small things mean a lot now like making it to the toilet on time, doing up my shirt, cooking my own dinner. It may take for-bloody-ever, but its important.
Mr Belford was eventually sent to the rehabilitation unit, where he spent another three weeks. In that time, not only did he continue to do well physically, but everything was put in place to make sure that when he went home, he would be as independent as possible. Things like handrails being installed in the toilet and shower. A cleaner was arranged to help once a week, as well as a district nurse who would also be visiting him weekly. He was assessed to make sure he could cook his meals, and his neighbours were made aware of his situation and they promised to keep a close eye on him.
Thanks to Mr Belford, I started to think twice before rushing in to help right away. I learnt to be patient, and realised that the little things can mean a lot to a person, and make a big difference.
Golden years
During my time in Ward 13, the number of men I saw with prostate problems was extraordinary; it was almost as if they were an accepted part of ageing. Almost all of our urology patients were men needing some form of prostate treatment. (There were exceptions: the occasional female patient, who certainly wasnt there to have their prostate checked although it wouldnt have surprised me to find someone looking for it.)
Some things get better with age; other things can only be appreciated with age. I am quite a long way from my golden years, but the more I dealt with the elderly, the more I found myself wondering if I would eventually suffer some of the ills that often come with growing old and when. I started questioning whether my own water flow was as strong as it used to be. Id never previously worried about how far I could pee or how easily I could make the colourful blocks of deodorant sitting in the bottom of the urinal move.
And, if I was worrying then, imagine how the patients with actual diagnosed prostate problems felt.
Mr Riley was desperate when he was brought into the ward. He had never had a problem with his waterworks before, although he had noticed that he was peeing smaller and more frequent amounts lately. He thought he could solve the problem by drinking more and that is just what he did; he drank litre after litre of water. So, it was a bad time for his urethra to block off completely.
When we met him, Mr Riley was writhing on the bed in agony.
Please do something please oh please the pain is unbearable, he pleaded.
His looked to be a simple problem, hopefully easily fixed, so I didnt waste any time getting Dr King, the junior doctor, to see him.
I didnt want to palpate the bladder, especially as I could see it protruding up from his lower abdomen, so I left that part to the doctor
What the hell was that for!? I couldve told you its full.
Mr Riley nearly went through the roof as Dr King gently pushed on his lower abdomen. It wasnt really Dr Kings fault he was just doing what he had been trained to do: a complete and thorough assessment. He was a bit shaken, but he was new and probably hadnt seen someone in this much pain from a blocked urethra before.
Perhaps we could catheterise him now, I suggested.
The doctor readily agreed and we got started.
I dont have words to describe the look of relief that swept over Mr Rileys features as the catheter was inserted and the pressure finally released but Ill try anyway. Imagine spending a night out on the town drinking and waking up in the morning in urgent need of a pee. Now imagine that no matter how hard you tried, you could not pass a drop. Every minute, every hour the pressure keeps on building, the sensors in your bladder overloading with pressure, theyre screaming out at you to do something, but there is nothing you can do. Then suddenly
I cant believe it. Its no wonder I was in agony, Mr Riley said, as two litres of urine drained from his bladder.
You might think it impossible for a bladder to hold two litres of fluid, but what happens in cases like Mr Rileys is that over time the bladder slowly stretches and stretches. It took ten minutes to completely empty.
I cant believe it. Its no wonder I was in agony, Mr Riley said, as two litres of urine drained from his bladder.
You might think it impossible for a bladder to hold two litres of fluid, but what happens in cases like Mr Rileys is that over time the bladder slowly stretches and stretches. It took ten minutes to completely empty.
Mr Riley was now on the prostate surgery list; he was entering his prostatic golden years.
Unfortunately, the waiting list for urological surgery is often long and there are many older men sitting at home with a tube of their own because their plumbing has blocked up. Some of these men have spent longer than twelve months like this. Mr Riley didnt have private insurance and he now had to adapt to this new stage of his life.
It is unfortunate that we often have patients coming in to hospital because they have acquired an infection that has crept up this tubing and into their bladder, or patients whose catheters had blocked up because their urine was full of foul smelling lumps of dead tissue and bacteria. It seemed to me that more time and money was spent in the long run from these complications. And if anyone is going to get a complication it is most likely to be the elderly.
The veteran
Tom, Simon, Daryl and Joe were four patients who put a lot of trust in their urologist. At 75, Tom was the oldest of the men. He was a prostate veteran; this was going to be his second operation in three years. The rest of the men were virgins all in their sixties and about to have a trim.
Being four men in the same room, all about to have the same operation, enabled the men to share notes and generally have a laugh (albeit a nervous one) at the situation.