In and out of the rehab clinic

Big Mistakes

Monday November 21^st

Everything hurt.

I think I had overdone it – all my marching up and down the corridor – and this morning, every muscle in my leg and back was complaining. Today I had to pack, and I had not realised just how much of putting things in a suitcase involves twisting, turning, bending and stretching. I fought bravely on, in the belief that this was the right thing to do and that I would gradually loosen up, but everything hurt.

When they wheeled me off to the ambulance I was again back with the sense of helplessness – I could do nothing for myself. I was strapped in the back of a glorified van with obscured windows, unable to see more than a glimpse of the world outside- and I recognised none of it. When I had arrived, 10 days previously it had been mild and sunny; today was bitter and wintry. I was disoriented. It was a short run to reach the clinic and it was exhausting…this whole sense of being held hostage on unknown terms combined with the sense of bruising and muscular strain. Maybe now I would be coddled and nurtured.

They unloaded me after the short drive to Trevi and wheeled me in. The first impact was the view through a doorway to my right, an explicit Torture Chamber. All I could see was a vast hall equipped with racks, benches, wall-bars, weights, pulleys and incongruously colourful giant beach-balls. A coven of what appeared to be Women’s Institute committee members were huddled around a table engaged in a strange ritual. They were cutting up pieces of felt and ribbon and stitching them into extremely unattractive Christmas decorations. I came over all Jack Nicholson.

Surely it can’t be this bad – but we were only just starting.

The room had two beds and shared a bathroom with a similar room adjacent. It was quiet, as everyone was at their morning exercises. All my comfortable, home-making things – the computer, the headset, the Kindle and so forth were packed into the two suitcases so I rested, but soon became restless. After 20 minutes or so I stumbled out of bed and started to put away some of the bits and pieces to make space for unpacking the suitcases. I had just hung up my jacket when a nurse appeared at the door, arms akimbo. Her comments were along the lines of:

‘Well, Mr Harvey, what do you think you’re doing? Out of bed, barefoot, no walking frame and no crutches….! Get back in bed this instant!’

I climbed back sheepishly, upon which the nurse pulled up the sides of the hospital cot, leaving me completely trapped and imprisoned in my bed with a urine bottle should I need it, and a call button should I need anything else. She then wagged her finger and told me not to try anything like that again…and marched off.

I was completely held prisoner for most of the rest of the day while a selection of other officers and wardens interviewed me about my medical history and criminal record.

At four in the afternoon, two orderlies arrived to unpack my stuff. This process is undoubtedly one of the greatest insults to personal dignity as clothing and undergarments are held up, surveyed and commented on, together with all the other peripherals that comprise one’s packaged, travelling identity. Then came the next lecture: If I wanted to get out of bed for anything, I was to use the call button to summon someone with my wheelchair; I would only be allowed to move around on crutches later, as and when they thought my body was safely adjusted and coordinated.

Is that quite clear?

Yes, Miss.

So, will you be cooperative from now on?

Yes, Miss.

Right, you may join the other inmates for the evening meal in the dining room; Maria will fetch your wheelchair. What do you say?

Thank-you Miss.  

And so it was that I was wheeled away and wheeled back, locked in my bed where I escaped to the internet on my computer and the story of Lord Sugar and the precocious teenagers on Young Apprentice.

Parrots and other birds

Tuesday November 22^nd

The early-morning nurse asked for my parrot. Even if I had been wide awake, I would have been confused, but as it was, awakening in the bars of my cage in a still-unfamiliar room, I was totally speechless. And then she pointed at my side table, and I realised that the silhouetted profile of a parrot would be identical to the silhouetted profile of the urine bottle. So there’s new Italian language vocabulary that’s not in the average teach-yourself book. I asked for my wheelchair so I could go to the bathroom, clean up and shave. When it was brought I sat patiently, doing just as I was told, waiting for the patient from the adjacent room to vacate the bathroom.

When I heard the door open and close, I wheeled myself through and luxuriated with the tingle of toothpaste and the stimulus of hot, soapy water. After a few blissful minutes, I felt ready to face the challenge of the physiotherapy programme as I spun the wheelchair neatly round, climbed out and sat at the table where I had set up my computer. The nurse appeared again, and she was still not happy.

What do we do before we get in or out of the wheelchair?

Put the brakes on, Miss.

Yes, Bob, we put the brakes on, don’t we? And we don’t go to the bathroom alone until we are physically stable and competent, OK?

No Miss, I mean Yes, Miss.

Bathrooms are dangerous places and you might slip and have a fall, and then what would you do, and what would we do, Mr Bob?

Is that a rhetorical question, Miss?

I was determined not to let them get me down, and after my weak tea and dry biscuits I rang the bell for nurse to put my shoes on and help me into my wheelchair so that I could spin on down to the exercise room for my first session of physiotherapy.

The coven were in full session and had added gold ribbon and tinsel to their ingredients. They cackled away, mass-producing bows, stars and hearts. I wished I’d brought the Kindle, not realising that the physiotherapy would be in individual sessions, so all I could do was sit and wait. It was a couple of hours later when my turn finally came and one of the extensive team of nubile wenches introduced herself: My name’s Francesca and I’ll be your therapist during your stay with us here in Trevi. Rather like an American diner: My name’s Bonnie and I’ll be your server for this evening. Except that it sounds more alluring in Italian.

She led me over to a bench the size of a double bed, told me to lie down and stretch out and then climbed up next to me. I started to forgive the Kommandant. Then Francesca started to massage the thigh muscles surrounding my wound. The sensation was exquisite, I could feel all the tension floating out of my legs, and across my lower back. She worked on my calf muscles then lifted up my legs and had me stretch, raise, bend, lower. It was initially difficult, but as the hour progressed, my whole lower body started to regain some sort of sense of cohesion.  

She paused for a moment and then took a decision and had me stand with my crutches, then told me to walk across the room. I felt a wonderful sense of OK – now I’ll show you!  …and I stepped out confidently. Francesca called out to a colleague to look at me, and I knew that what they had said at Foligno was right – I had made a very rapid early recovery and with a bit of effort and application I could be a star pupil and stop having the warders tell me off for being too ambitious. When I returned to my room I was glowing with a sense of achievement and looking forward to the afternoon therapy session after lunch and the rest period.

Just before three I asked a nurse to supervise me into my wheelchair, and then I spun off and settled myself in the corridor outside the exercise room with the Kindle. I was enjoying the opportunity that my incarceration created to lose myself in a wide variety of reading and was getting to grips with a thriller set in modern Moscow. It wasn’t long before the girls arrived, passed me my crutches and told me to walk across the room. I was super-confident this time. I walked steadily and smoothly, then carefully manoeuvred a 180 degree turn to meet their alarmed stare. But it wasn’t my ambulatory expertise that had mesmerised them; it was the pool of blood by my feet.

Emergency Repairs

They hurried me back to my bed and within minutes a flurry of nurses and doctors appeared and together rapidly agreed that they would patch me up and put me in an ambulance back to Foligno. Foligno created the problem, let Foligno fix it.

So it was that I sat in the ambulance wheelchair in my exercise clothes, wrapped in a blanket. I was clutching the Kindle for two reasons: I couldn’t face the boredom of all the waiting around that hospitals always entail and secondly, I was dying to learn the next developments of the story in which I was totally engrossed. As the ambulance sped away, I was once again overwhelmed with that sense of being totally out of control and only partly conscious of what was going on around me.

As they took me back to the Orthopaedic ward at Foligno hospital there was much banter with the staff. I told them I’d come back because I didn’t like the food in Trevi, which caused great amusement. A doctor and nurse took me into a treatment room and they spent what felt like a painful hour reopening and cleaning my operation wound. Apparently there was a hematoma – a build up of blood and liquid underneath where it has started to heal over. They bandaged me up again and that’s when they told me I’d be staying overnight, and possibly for a day or two more.

An hour later a suitcase arrived with my phones and computer, three shirts and two pairs of underpants. No trousers. The tracksuit bottoms that I’d been wearing were drenched in blood, so once they’d wheeled me through to a bed, I draped these over a radiator to dry out – I couldn’t live in underpants knowing that relatives and assorted crows would be in and out, day and night.

Finally, I crawled into bed, wondering what the doctors would all agree in the morning.

Slowing down

Wednesday  November 23^rd

I decided, as soon as I awoke, to do everything I could to avoid being “hospitalised.” In my mind I was no longer a patient, I was now a resident at the physiotherapy clinic in Trevi, temporarily in Foligno hospital for a quick-fix to a minor problem. I didn’t want to get back into all the trauma and transfusion of being poked and probed by nurses and orderlies. I wanted to maintain a sense of transition beyond that and being well-on-the-way-to-full-recovery. I wanted out: I wanted to get back to Trevi, the Torture Chamber and all those lovely young therapists.

I removed the itchy tee-shirt I’d been wearing in the exercise room and pulled a clean shirt and underpants out of the suitcase; I took the track-suit bottoms off the radiator and satisfied myself that the bloodstains had dried into invisibility and pulled on my seductively comfortable fleece slippers.

While my fellow residents were still sleeping, I rearranged the room, commandeering the table and moving it against the wall and under the window beside my bed. The view of the road and car-park were all part of the psychological context of not really being in hospital. Then I wired everything up: the computer plugged into the mains, the mobile-phone chargers both hooked up and the dongle connected up to test the internet access. My pillow now became a cushion for the hard chair and I was as happy as could be expected while I waited for the poke and probe teams to start their rounds.

First the vampires took 4 or 5 blood samples (once they’ve got a good flow they seem to want to fill a whole row of little bottles.) Then it was heart-rate and blood pressure, which were both excellent.  Later the sweet trolley arrived and the anti-biotics, anti-coagulants and whatever were checked, dispensed and logged. Finally, well into mid-morning, the three musketeers arrived, comprising Leonardo, my surgeon, with his boss and the human tailor who had sorted out the wound the previous evening. Together they inspected, clucked and tutted and Leonardo gave me a scrawled prescription for a special a waist-high orthopaedic stocking which is designed to protect against deep vein thrombosis. That didn’t sound too arduous, until he told me I’d have to wear it for at least a month. Ah well! It gives a whole new meaning to Christmas Stocking. With pleading eyes I asked whether I still had to stay in hospital, and they gave their unanimous verdict that they would keep me at least one more night. Understandable, I suppose; they didn’t want to be the laughing stock of the Trevi crowd if I started leaking again.

And so I started an extremely boring and disorienting day. I read till an inedible lunch arrived- sticky, over-cooked pasta followed by their speciality of meat-loaf disguised as cat food, or vice-versa. In the afternoon I listened to the BBC Radio Four podcasts I’d downloaded, Play of the Week, Saturday Live, Thinking Allowed and the Now Show. The isolation brought with it waves of depression, made all the more poignant by the constant flow of visitors and overnight campers who arrived to surround the other beds. The brain rejects logic in such situation and wallows in emotional weakness – looking back later, in hindsight, it’s all easy to analyse and dismiss: it just gets difficult to handle at the time.

Dinner was more appetising, though that’s a rather strong adjective to use, and in the course of the evening I finished my book, let Laurie Taylor provoke me with ideas on moral issues, and chuckled at Richard Coles’ guests on Saturday Live. I stretched out on the bed, itching from too much wriggling from attempts to find comfort in a bed that needed to be six inches longer, and finally dozed off, determined that this should be my last night in the hospital, if that could, please, dear God, be possible.

Escaping back to Rehab

Thursday  November 24^th

I put my marker down: I dressed and packed. Not without talking first with the various medics who checked me out on their early-morning rounds and verified that all was well with the way the wound was healing. I confirmed that my partner was coming at midday and would then purchase the special support stocking so that I would have everything needed to make the move back to Trevi. They confirmed that I could then make the transfer by ambulance. Sorted!

Sadly, nothing in Italy is that simple.

As soon as Fi and Gerry arrived they went off to purchase the stocking from the shop on the ground floor, but returned promptly with a list of the measurements they needed. I rang for a nurse to help with the measurements – to make sure we didn’t mix up ankles and knees on the list, but the nurse didn’t want the responsibility and sent for someone “official.” Another medic arrived and was meticulous in determining the essential statistics so that after another 20 minutes I was all set to go and asked for the administration to book transport, while Fi and Gerry grabbed some lunch

Another 20 minutes and the nurse returned to tell me that transport would not be available until next morning. I was sitting there packed and ready to roll, so I told them I could arrange my own transport (by having Fi and Gerry drive the 10 miles to Trevi.) The nurse said I’d need a discharge letter and went off to arrange it.

Another 20 minutes and Fi and Gerry came back and I explained the situation. Fi went to arrange a wheelchair, and in the confusion I thought she picked up the discharge note and she thought I had it, but in any case I was on my way down in the wheelchair, hugely relieved to be moving to a positive environment.

Another 20 minutes and I was belted into the front seat of our car with my luggage and longing to put the hospital behind me and get on with the recuperation and rehabilitation programme.

Another 20 minutes and we were driving round in circles around Trevi, as Tom-Tom tried to send us down disused, dead-end farm tracks. We switched off Tom-Tom and headed for signs pointing to  Centro, sometimes the old ways are the simplest.

One final 20 minutes and I was in my room, happy and content, and Fi and Gerry (- many, many thanks, guys,) were driving off, up over the mountains homewards.

At least 4 specialist medics (I lost count) came and wagged a finger at me with lectures about not putting strain on my wound, always getting someone to help me stand and not trying to dress myself. I kept an attentive expression and nodded gravely. The truth is that Foligno hospital never told me anything – they just assumed I’d be OK and when I did try walking up and down, they applauded my efforts. I never broke the rules before, and I love the structured programme that Trevi enforces. Tomorrow I’ll be back in the routine… and relishing every minute on the way to regaining full physical independence.

Pain, Punishment and Progress

Friday  November 25^th

Next morning, there were fresh checks on my bandages and more stern words of warning about the importance of doing exactly as I am told, and I was finally back into the clinic’s rehabilitation programme. I waited patiently outside the exercise room till Francesca summoned me to wheel myself through, then I climbed up onto the massage table and stretched out.

Her fingers started to knead and manipulate my bruised and strained muscles. The sensation was truly exquisite. It was a strange combination of pain and pleasure. Sometimes I was almost reduced to tears, and at other times I thought I would stop breathing.  After the massage, she started on the exercises, forcing me to push against resistance, or raise a leg that simply seemed immobile, or leverage my back up off the bench with my feet raised up high and balanced on a giant, inflated exercise ball. Each exercise was repeated ten, twenty times, then a pause to catch my breath before twisting into another improbable position and discovering more, new, previously unused muscles.

Finally, I swung off the bench and was handed my crutches and given marching orders: slow, steady, straight back, even paces, don’t stoop, not too fast….Bravo!

There was another session in the afternoon with further exercises that looked so simple, but were totally frustrating when my legs simply would not do what they were told. But I knew there was progress, and when I went to bed, I found that for the first time in 2 weeks I could lie on my side without every muscle in my thigh and hip screaming out in protest.

The message at the clinic is still the same. Rest: don’t try to do everything at once. The challenge is that all I want to do is get back to normal as fast as possible – and this gentle process is not an easy one to accept. Still, if I can just overcome the guilt around being out action then I’m sure I’ll get there in the end.

Orthopaedics in Italy

Introduction

Autumn 2008

The benign doctor in the consulting room in Tunbridge Wells smiled: ‘You’re getting old, Bob! It’s a touch of sciatica!’

I’d developed a slight limp and stairs were starting to be a bit of an exercise, especially when I was carrying the shopping back to my apartment. Then there was the back-ache and the tendency to put my weight onto one leg when I was standing around. Sometimes it was very painful and I started to have physiotherapy, which made things a little more comfortable. The local NHS trust was broad-minded and when physio didn’t resolve the matter they sent me for acupuncture, and in my long search for comfort I also tried deep massage and – of course – the good old idea of exercise. Everything helped to some extent, but nothing resolved the discomfort.

After several months I bullied the doctor into getting me an appointment with the orthopaedic specialist, but by the time it was all fixed up with the joint replacement centre in nearby Crowborough, we’d already started the move to Italy. Thus it was that I flew back to UK in the winter of 2009/10 for a series of consultations, X-rays and scans. This time the evidence was clear; the cartilage of my left hip joint was worn, and I would eventually need a replacement. In the meantime, I could just keep on with anti-inflammatory capsules and pain-killers. On reflection it was a business decision to delay the expense of the operation for a year or so; there was always the possibility I might die in the interim, in which case the NHS would have saved the cost of a major operation. From a personal point of view, all it did was prolong the painful condition.

I returned to Italy and established my Italian domicile so that I could register with the Italian health services. Once this was done, my affable local GP sent me off for X-rays and – in common with the British specialist – he decided I could struggle on for a year or two. Like any self-respecting professional, he changed the medication to assert his authority, but the principle was the same: anti-inflammatory capsules and pain-killers together with something to stop the anti-inflammatories upsetting my stomach.

Through 2010 I gradually became less mobile and early this year I persuaded the local GP to refer me to the specialist and see if I could get “on the list.” The suave, debonair Italian surgeon took one look at the X-rays and smiled across his Adriatic tan and designer stubble. ‘Yes, we’ll put you on the list; there’s no cartilage left, it must be quite painful.’ They took my phone number and promised to call as soon as they could fit me in.

Nothing happened for six months, and then the surgeon’s secretary called me in September and told me he was now based over the mountains, 100km away in Foligno; would I mind coming there for the operation, and would next Tuesday be OK?

Shock! Yes, I would be happy to drive to Foligno but not next week, because I now had a hectic diary with my son’s wedding in October and a Public Speaking Masterclass to run on November 1^st. But anytime after that…

The communication lines went down again, and despite several attempts to make contact we heard nothing. Then, when I was actually on my flight back from UK to Italy after running the November Masterclass, they called to ask me to come in the following week. No, not for tests or X-rays; this would be for the operation.

With Fi planning crucial business meetings in London that following week, I reverted to lone-traveller mode. Rather than have her lose a day being a taxi service I would hop on the train to Foligno, treat myself to the local Umbrian cuisine at a recommended local hotel and then check into the hospital at the appointed time the following morning.

I unpacked, then, after the weekend, I repacked.

On the Train

Wednesday November 9^th

Tolentino station would fit perfectly into the Italian equivalent of any 11-year old’s “Hornby 00” layout. “Hornby double-O” was probably the most popular model train set and if there is a station in the range of continental accessories, then Tolentino would be the model.

A single track comes in, bifurcates to run alongside two ground-level platforms, then departs to west and east as a single track once again. Back in UK, the line from Devon down to Saint Ives used to be single track, with a physical “token” that the driver or his mate grabbed off a pole at one end and then deposited on a hook at the other end. The token was the size and shape of an unstrung tennis racket, so the driver could loop his arm into the ring and pull it from its pole without needing to stop. The eastbound and westbound trains alternated and this token would be used to unlock the points for the train that would be travelling in the opposite direction. It’s a no-nonsense, effective and beautifully simple solution to running on single track lines.

Ferrovia Italiana’s single track control is probably automated – I’ve not seen the driver reach out to take the token, but the track itself is most likely much as it was when it was constructed. Hefty oak sleepers are in-filled with rocks that are uniformly the size of cricket balls, and the train rattles along with a reassuring sway. The label on the window announces “E pericoloso sporgersi” [-it’s dangerous to lean out] just as the label did 50 years ago when I unscrewed one and added to my multi-lingual collection of “Gentlemen lift the seat,” “No Smoking” and my prized treasure “Do not flush while the train is standing in the station” – black on silver aluminium in English, French, German and Greek.

Even in the cities, many continental railway platforms are at ground level, so you literally climb up into the carriage. Not a problem 50 years ago when I criss-crossed Europe with my student rail-card, but more of a challenge with a hip that gives me a decided limp, and a suitcase that is not so much heavy as simply awkward.

This train-line seems to survive on school kids. Just as the clock was ticking towards 13.36 at Tolentino, the carriage was invaded by teenagers, all chattering, joking and jibing. They were headed two stops up the line to San Severino which presumably lacks the educational facilities that Tolentino offers. There’s always a game of slamming the door between the seating area and the standing area beside the exit. This is generally associated with horseplay and flirting, involving a group of girls in the end block of seats and a group of guys in the standing area. Nobody seems to tire of the game, accompanied by much joshing and jostling as the train pulls in to the station where they all tumble out with much shouting and jeering.

 Halfway from Tolentino to Fabriano the train reaches Matelica, famed for its white wine, a Verdicchio that rivals (and, in my opinion, bests) the more renowned Verdicchio of its rival town, Jesi near to Ancona. The vineyards stretch up the slopes and the winemakers are out between the vines, checking sugar levels and deciding when to pick. I love this journey on up through the mountains to Fabriano, where the track meets the main line that runs from Ancona on the Adriatic to Rome and the Mediterranean. The scenery is spell-binding; a constant panorama of mountains covered with thick forests and valleys planted with olive trees, maize and vegetable gardens.

At Fabriano I catch the train headed towards Rome and alight at Foligno where I am staying at a small hotel (thanks, Trip-Advisor!) so that I can be at the hospital for 8am.

HARVEY Robertjohn

Thursday November 10^th

Somehow or other, the description of my wonderful meal in Foligno and the scathing attack on the ethics of local taxi-drivers all got lost, so consequently my description of this day starts with my arrival at the hospital…

I negotiated my way through the hospital bureaucracy registering myself the way they like to call me HARVEY, Robertjohn and was eventually ushered into my room, sharing with a man roughly my own age. The 2^nd floor is dedicated to Orthopaedics and Urology and judging by the complex pipes and tubes that surround his bed, I gather he’s here for the latter.

I had an ECG and several blood tests; I had a chat with my surgeon and I had various X-rays. The pleasant surprise was when the surgeon asked if I was willing to have 2-3 weeks residential physiotherapy after my operation. No cost, and the likelihood of a much more speedy recovery.

How could I refuse? It’s an excuse for another blog.

11 - 11 - 11 - 11 - 2011

Friday November 11^th

They woke me at 6 for injections, then at 7 for more blood tests, then at 8 to shave my thighs, then... it went on and on as the clock moved on towards 11 o’clock.

 What, me? - Superstitious! Nonetheless, it was around 11.11 on the 11th day of the 11th month of the 11th year of the millennium that they wheeled me off to the operating wing. I was trolleyed across to a giant serving hatch in the wall, then my bed was cranked up and a wide conveyor belt pulled me through the hole and onto the operating bed. The operating wing of this ultra-modern hospital is literally physically isolated, almost quarantined and looked more like part of a set from a James Bond Goldfinger command centre rather than a room in a hospital. 

More pretty, bright nurses, more conversations, more tests, more interrogation and then I signed my consent to the risk of this operation on a rather large person. One of the nurses wiped my lower back with alcohol and then slipped an injection needle into my spine. Oh Heavens Alive! - They were going to chop my leg up while I was under only a local (they called it regional) anaesthetic. Happily, they put a curtain across so that I couldn't see what was going on, but that didn't prevent the shock of seeing sundry staff splashed all over with blood -  my blood. Even the spotlight over the operating table had flecks of scarlet blood on it. At least there was a discreet curtain at neck height so that I could not watch what was happening below my waistline.

Suddenly, the sound coming through the curtain was deafening BANG! CRASH! They were hammering – not tapping – the prosthetic joint into position. I shuddered with each hammer-blow trying not to imagine what it would feel like without the numbing drug.

Later, the surgeon confided that it was the largest (62mm diameter) prosthetic he had ever fitted. All this stuff about 11-11-11-11-11 isn’t mere hocus-pocus. As son Toby said last night, his children will have a bionic grandfather The biggest surprise was that as the anaesthetic wore off, I no longer had the sensation of the painful joint connection that has grown steadily worse over the past two years. I am, of course, still bed-ridden but I feel much livelier.

The night-time was weird. I lay flat on my back with a tangle of tubes hanging over me, dispensing saline, morphine and paracetamol; while other tubes were draining away waste fluids and blood. I don’t tend to sleep calmly and woke around 3 in the morning, having knocked out most of the tubes and with the left side of the bed scarlet. A nurse appeared and cleared everything up, but no sooner had she left than I reached too far and once again and sent more blood spraying over the clean sheets. I’ll try and behave better, now that it’s Saturday

Groggy and Bilious

Saturday November 12^th

It’s a strange mix of feelings.  I’m confined to bed at the moment, so my bum gets itchy. The bandage is soaked through, but they’re not going to change it till the medics have seen me. There’s a drip in my right hand which makes it difficult to master the keyboard, and finally – I can’t consume a dry rusk without bringing straight back up.

So I write this little self-indulgence, play the odd game of patience and read.

And sleep.

And that’s about all for the moment…!

I managed to knock two more needles and pipes out of my arm in the course of the day  but all this hardware should be unplugged tomorrow (I hope) and maybe I’ll be allowed to walk and start my physiotherapy. Right now I am feeling mentally very lively, with just a bit of pain from bruising but it could be that I am just high on morphine. It does feel a bit like prison, but I guess I’m just impatient. I am so tempted to swing my legs round and stand up, but I suppose I should wait till tomorrow morning, and if I do that I’ll probably pull the tubes out again.

Thankfully, there’s no television in the room and I’ve downloaded plenty of Radio 4 podcasts, and there’s plenty to read having borrowed Fi’s Kindle. So, on that note… I’ll return to reading Soul Mountain.

Stiff legs and embarrassing indignity

Sunday November 13^th

For the last 4 months I’ve had high blood pressure. My local doctor banned salt, coffee, tea and most other simple pleasures; he also gave me pills to lower my blood pressure and these had limited effect. Of course, blood pressure is something they check daily in hospitals and when they double-checked the readings yesterday and today, it was steady at 115 over 70 which means that I am super-fit. The obvious answer is that if I am to maintain perfect health, I need to spend more time in bed, being waited on hand and foot. Regrettably, that’s not likely to go down very well at home.

But you never do get two doctors to agree, do you? My specialist in Tunbridge Wells insisted I should take Testosterone permanently, since my blood analysis showed a zero count (something to do with radio-therapy 25 years ago.) Daily applications of testosterone gel quickly sorted things out – I had more energy and it was easier to control my weight. However, the family doctor in Caldarola seems to put testosterone supplements on a par with cocaine, and gesticulates angrily when I raise the matter. Once I get my mobility back I’ll track down testosterone on the internet – I am fed up with the lack of energy.

They keep promising that they’ll take all my tubes out today: what a relief that will be! I am beginning to wonder just how stiff I’ll be when I get up – and I had half the answer when I tried to lie on my back and bend my knees this morning. The sensation of serious bruising is severe, and I keep thinking back to the way they took a hammer to the prosthetic to get it to fit. That, and the whine of the electric saw, will haunt me for years to come.

I suppose I am still on a morphine high and should prepare for a tedious cold turkey when that particular medication ends. This empty waiting is depressing and I find myself too impatient just to sit and read like a good boy. I’ll play patience on the computer for a while and try and magic up a medic on unplugging duty.

The unplugging medic didn’t arrive until 4pm, but before then, my sister arrived from Rome at midday and we had a pleasant couple of hours shooting the breeze. She brought grapes and digestive biscuits as well as a little bag with the things you don’t get in an Italian hospital – cutlery, paper napkins and towels. She shared my lunch and then, when I was nodding off and couldn’t keep my eyes open any longer, she went off to do some sight-seeing. She called me from the station before taking the train back to Rome having had a wonderful couple of hours exploring Foligno, discovering piazzas and palaces, and an artisan food market where she bought honey and cheese, and tasted mead.

I feel a wonderful liberating sense of relief now that most of the tubes, drains and catheters have been removed. There’s just a saline drip remaining, and that doesn’t get in the way of my keyboarding. Tomorrow I’ll be allowed to get out of bed. But I do have a confession to make: I could not face the indignity of my giant nappy a second time and when everything was quiet earlier this afternoon, I carried my drain bottles in a carrier bag and very, very gently made my way to the loo. Yes… rash, I know, but it felt SO GOOD!

I won’t try it again until they say I’m allowed out of bed, I promise I’ll be a good boy now.

Wot – no trousers?

Monday November 14^th

I slept restlessly. I dozed off at 9 in the evening, so that by the wee small hours I was wide-awake. The morphine had finished Sunday afternoon, so I’m sure that some of my condition was withdrawal.

I was getting very uncomfortable, sweating and grubby in bed, and it was a luxury to have a nurse give me a bed-bath this morning, then replacing the sheets all around me.  They still won’t let me wear trousers – just the pyjama top. My theory is that it’s a feminist revolt designed to humiliate men. Well, it works and all the men clutch the fronts of their dressing-gowns sheepishly as they walk up and down the corridor

 It was good to feel relatively clean but better still when, after a bit of negotiation, they gave me a Heath-Robinson monstrosity of a kind of Zimmer frame with wheels and bicycle brakes and pads that fit under the armpits. Now I can make my way independently to the bathroom. No more nappies!

I had all the thrill of my first blood transfusion today as my haemoglobin (that word does sound like a Danish Dwarf, doesn’t it?) count was down as the result of the blood I lost in the operation. I’ve not had one before, and I was terrified to watch an air bubble work its way down the tube into my vein. I never did any science or biology at school but I had this belief that an air-bubble in the blood stream would kill a patient…..?

Well, that was a couple of hours ago, so I suppose that’s just an old wives’ tale.

Then along came my surgeon. Like all his underlings, he treats me as a special case – a Super-Sized Englishman who seems to have an indomitable positive attitude. He explained that his Italian male patients are all wimps, so I raised and lowered my leg and wiggled my hip joint, to the amazement of him and his assistant. Once more he recounted that he had never inserted such a chunky prosthetic. I can believe him – I heard the hammering!

He is keeping me in hospital at least until Friday and then they’ll take me by ambulance to nearby Trevi – about 10km away. This is a rehabilitation clinic and they will keep me in for 3 weeks at the end of which they claim I will be walking normally – without crutches or sticks. Well, that’s what he said. It has always amazed me the way that footballers and rugby players suffer crippling injuries but are back playing in just a few weeks. I suppose this is the answer, intensive physiotherapy and structured exercise.

So, all in all, a positive day, though it’s going to be pretty boring for the rest of the week. The dumpy unshaven Italian who has been sharing my room checked out today, to be replaced by another, similar dumpy Italian. The care is excellent even though the food is hospital – sadly.

I think I should enjoy my hibernation and prepare for Yuletide.

Sawdust and Syrup

Tuesday November 15^th

I do not know how anyone can start the day with these tiny biscottate – dry rusks that crumble into sawdust. I admire the technical expertise that goes into their manufacture; it takes a clever process to create such perfectly formed slices with even colouring from slightly brown at the edges to a pale gold in the centre. But the lack of flavour is unbelievable, and they disintegrate into dust and crumbs when you bite into them.

That’s the choice at breakfast, served with a plastic pot of very sugary jam that is either yellow (apricot) plum (blue) or red (cherry.) The beverages are sweet lemon tea or roasted-barley “coffee.” Not a very nurturing way to start the day, especially when one wakes un-refreshed after a long night, drifting in and out of dream-filled slumber till the first nurse comes for blood samples at 05.30. There are more medical checks every half-hour or so, then the orderly arrives to strip the bed and I need to decide whether to stay in bed or move to the table and chair.

Later, someone came to check on the mobility of my joints, but the physiotherapy won’t start till they move me to the rehabilitation centre; right now they just want my wounds to heal and my strength to build up again.

And this is incredibly boring.

But my life in Italy is never boring, and the phone rings. A UK production company is stuck on developing a theme for an annual conference for 3,000 employees – or maybe 5 x regional conferences each for 600. What can I dream up that will confront their corporate employee cynicism?

·        Well actually, I’m in hospital recovering from major surgery…

·        I’ll send you some stuff…

·        I don’t have web access…

·        Let me just run this by you…

·        Call me back, the medics are back to do more tests

·        Do you remember that concept you did for the insurance company?

·        Well, suppose we took this approach….?

…and I’m hooked because they offer me the two things I can never refuse – money and flattery.

The rest of the day is taken up with text messaging and topping up phone credit and trying to think up new zingy ideas. The phone keeps ringing and gradually the project takes shape. I just don’t believe that I am master-minding ideas for a quarter-million plus budget, propped up in a hospital bed in my underpants and pyjama jacket. It was so nice just curling up with Radio 4 podcasts, but it’s even nicer to be wanted – for money!

Sweat, Grease and Drips

Wednesday November 16^th

I lay down feeling sweaty and sticky last night and by the morning I couldn’t stand sleeping with myself. I wheeled myself into the bathroom and greeted the stranger in the mirror. To my pleasant surprise I discovered I was much more stable on my feet, and I managed to give myself a once-over with a hand-towel soaked in hot water and lots of liquid soap. By the time I’d shaved and combed my hair I felt much more human.

Most of the morning was spent working on the conference proposal ideas, with text messages interspersed with phone calls, and it was great to be back in the – remunerated – buzz again.  Lunch was an improvement on last night’s dinner – a meat-loaf which might well have been cat food, but I still find I am eating only about half of what they put on the plate. As the noise level rose with the arrival of more dumpy little ladies to sit at the bedsides of their suffering spouses, I settled in to a couple of hours of personal writing and reading.

The test regime continues, starting with blood samples at 05.30, then continuing with temperature checks, medication and blood-pressure during the day. My blood-count is still low, and they are watching it closely; they also want to do some more X-rays to check it’s all settling down well.  They said the surgeon would be talking about the physiotherapy centre, but that didn’t happen either, so my day pootled along.

 I’ll just get even more used to being waited on and looked after. It grows on you. The beauty of it all is that if I start to feel any pain from the healing wound when I’m trying to get to sleep, I click the bedside buzzer and they hook up a Paracetamol drip to my arm and the pain evaporates in minutes. But, as I found out next morning, there is a downside.

Urgent Attacks

Thursday November 17^th

When I was suffering in the night they brought me a second drip – not Paracetamol, and I dozed peacefully. It seemed to settle me down, but regrettably the constant cocktail of antibiotics and palliatives comes with their particular mix of side-effects. At 05.15 it was time for the daily blood-test, and as the nurse probed to find a vein, I felt my stomach rumbling and bubbling. All the simple basics of day-to-day life become a challenge when you lose control of your mobility and panic sets in. No sooner had the nurse departed than I swung round out of bed and limped to the loo as fast as I could make it. But I’m on that Zimmer contraption –I can’t move quickly and it becomes a desperate race to maintain my dignity. It is all just too humiliating.

I skip breakfast [wisely] and stick to plain water, propped up on the bed, reading a wonderful book until two flirty young nurses wheel me off supine on my bed, to have my new hip x-rayed. The earlier medication makes me light-headed so I decide to make a joke of it and stretch out on my trolley with hands crossed on my chest in the manner of a medieval knight on a cathedral tombstone. The humour is not lost on the girls who break into fits of giggles.

I’d not long been back in my room when Gerry and Debbie stagger into the room with a large suitcase. We sort through the selection of clothes and I decide against half of them… I wonder whether someone thinks the Physiotherapy Centre is a sort of State-funded Champneys. On the other hand, I am now blessed with a thick towel, my favourite tea-mug and the Italian language course that I had promised myself I would tackle in my isolation. In any case, it’s better to have the opportunity of choosing from a broad selection of clothes and stuff than miss something vital, and it is wonderful to have slippers on my feet. Having visitors means having the help of someone who can nip downstairs to buy me a couple of bottles of water as well as the crutches that are compulsory for the next few weeks.

We chat for half-an-hour and they take away the dirty laundry and the excess wardrobe, then I slip back into the routine.

Leonardo the surgeon comes by with a broad grin on his face. He has seen the X-rays and is thrilled with his handiwork. I say I would love to see them, so he pulls out his Android phone and scrolls through the pictures in the manner of a proud father boasting about his new child. I have to admit that even to a layman, the picture is impressive. He takes the crutches and adjusts them to the maximum height, then coaches me in walking with both crutches synchronised, and keeping my feet squarely facing ahead.

Finally, he bids me farewell as he will be working at a different hospital on Friday, and by the time he returns to Foligno, I should be in the Centre in Trevi. I take his mobile number and promise to phone in a month once I have had new X-rays taken, to fix a follow-up appointment.

He smiles broadly, and as he leaves I feel my stomach rumbling and bubbling. I seize my crutches and manipulate my route with my new-found dexterity.

Clunk-Click, Every Trip

Friday November 18^th

Nights are never comfortable. It’s only possible to sleep flat on my back and that only works for me after Burgundy and Brandy; normally, I like to curl up on my right-hand side, and then I hardly move all night. Last night was typically restless, the stomach-churning persists but at least there are no more early-morning blood-tests so I got to sleep through to 06.30.

I still have a wound-dressing the size of an exercise book, so there’s still no chance of a shower, but a mop-down and a wet-shave brings me to life. Now all I have to do is to wait for a doctor to tell me what is happening today. It all seems to be very ad hoc in Italy. Last-minute appointments are the norm (I had 6 days notice with a phone-call to come in for my operation.) This morning, here at the hospital, a medic marched into my room and gave the man in the next bed a document of some sort. The patient immediately leapt out of bed. His time had come; in the space of five minutes he had dressed, packed up, phoned someone to pick him up and was out of the door. Now I have the room to myself, I haul the blinds up in the windows so that the room is really bright, claim the table as my desk and relax.

Keen to develop my mobility skills, I take my crutches and stride out, up and down the corridor. The two physio-nurses give me big smiles and encouragement, then the sister comes out and talks to me while the physios fine-tune the adjustment on the crutches. Sister tells me it’s all settled for Monday morning; I should pack up after breakfast and then the ambulance will take me to Trevi. There is a spring in my step as I march back to my room. The crutches clatter – “clunk-click: every trip.”

I rearranged the room, set up my language studio with my headphones and Italian course and learned some verb endings. Another stroll before lunch, then I decided to read another chapter of the book, and I stretched out on the bed.

It must have been an hour later that I was assailed by 3 girls dismantling my office – which meant undoing all my rewiring of phone chargers and computer transformers. Before I could say “…haven’t we met somewhere before…?” my bed was being raced down the corridor to stand watch on a loudly snoring patient in a room two doors down. When I move in somewhere I do truly occupy it, and while one girl was hanging up shirts another ran two and fro with toiletries, pens, odd socks and paper napkins. I think we’re straight now, so I’ll get back to my book.

Full-scale nightmares

Saturday November 19^th

It was Friday evening, and the man in the next bed was attended to by a small crow.

If you’ve been anywhere near the Mediterranean, you’ll’ know what I mean: a stooping little-old-lady who moves around constantly, fussing here and there, waddling and swaying from left to right like a crow on a ploughed field. Well, that’s his wife – I presume – and she twitters constantly in his ear. As far as I can make out, he’s just had his hip done and he lies in bed and moans, mumbles and mutters. Maybe I was just lucky, because I cannot relate to the discomfort he seems to be going through.  And it goes on and on. Moan, moan: twitter, twitter. Visiting hours end but that’s not going to deter the crow who pushes two chairs together and settles in for the night. Now there’s more moan, moan: more twitter, twitter, and it’s just enough to stop me dropping off.

When he does finally drift into a morphine-induced sleep and when she is settled into her makeshift bed, my personal nightmare starts. I become haunted by every negative interpretation of everything that has ever gone on in my life. Logical equations with depressing conclusions float convincingly around in my head and things that have been said in any aspect of my life – professional, social and personal – are reinterpreted to undermine me further and further. Hospitalisation destroys any sense of personal identity in the course of institutionalisation, so there is nothing I can tell myself to counter the total sense of loss and deprivation. The hours crawl by and nothing alleviates the sense of despair. Daylight brings no sense of relief; it’s just another countdown to another day, another blood-test, another cramp in the coccyx from trying to sit up in a bed that’s just a few inches too short for comfort, another day of watching the crow in her vigil.

My sister Maggy did warn me about post-operative mood swings, (she had her hip done in February.) She has also told me that even just one dosage of morphine stays in the system for months. Even so, I’d not expected anything this violent. There is, of course, only one answer, and that is to sit it out until the mind refocuses and the extent of the self-delusion becomes clearly apparent. But I also acknowledge that the haunting interpretation has a degree of validity… maybe my nightmare scenario is the reality; maybe I must stop kidding myself. Maybe my world really is falling apart.

Cue International Rescue theme music: Thunderbirds are go…!

Maggy called and must have been on the phone to me for the best part of an hour. She dispensed lots of care and lots of tough love, forcing me to re-examine many of my judgements and conclusions. I didn’t accept it all, because she didn’t have all of it totally correct, but most of what she said was pretty much spot-on. Then it was Jane Plimsoll on the phone – ever wise and gentle – and then Digby came through with the sort of filial love which always blows the clouds from the sky.

I was drugged; I was over-reacting; I am OK. Same message as the last pages of my Kerala blog earlier this year.

Do I believe it yet? Now there’s the rub.

New Dawn

Sunday November 20^th

Things change. No matter how many times we experience it in life, we never cease to be surprised when things change and life moves on. Every year, summer fades into autumn and months later winter breaks into spring. Yesterday morning I was in a very black place but when I went to bed last night I was no longer haunted by demons. I was enveloped in a pleasing sense of security and I knew I would drift into a peaceful sleep.

Which I did; only to be woken just as I was slipping deeper and deeper. The lights went on and roused me from my slumbers. The man in the next bed was surrounded by staff. His wound was giving him a deal of pain following his operation. They sorted him out rapidly – that’s the beauty of administering pain-killers through a drip – but it was some time before I could get comfortable again and sleep.

I started this morning determined to get clean and fresh. A total shower was out of the question as my hip is still partly padded by a large wound dressing, but I reckoned I could strip off and at least get my hair properly shampooed. By the time I’d shaved I felt transformed and once I’d dressed I decided to attempt a rather longer walk around the corridors to see how it felt and whether I believed I was making any progress.

As with the black moods, it’s all about little changes that gradually create big transformations. Each step makes a difference and though I could feel the bruising around my hip, I could also feel improvement as I paced out the full length of the building and back again. It was tiring, but I’ll try to do it a couple of times more before I am transferred, tomorrow to the Rehabilitation Clinic tomorrow morning.

After a week in Rehab (Wow - a true celeb!) I'll post again.