Pre-Assessment – What did they do to me?

When in their training do nurses get taught the same lie?  Considering that the nurse doing my pre-assessment was a Kiwi, it is obviously a lie of international proportions.  I don’t like needles. At all.  However, every nurse who has ever taken blood from me has always said, ‘You’ll feel a slight scratch’. Since when could having a needle jabbed into you ever have been likened to a ‘scratch’.  At this point I am usually staring fixedly at the far junction of two walls and the ceiling, muscles clenched, just waiting for the pain.

I was duly offered the National Joint Registry consent form to complete, and remarked that I ought to sign it as it was me, I continued, modestly, who wrote it.  I don’t want to take the Mystery Shopper thing too far, after all.  I was not, however, given, an NJR Patient Information Leaflet and it was not until I was sitting on the couch waiting to be swabbed that I noticed one on the wall next to me.  It was an old one and very out of date.  Much tutting from me, ignored by the nurse, so I will need to speak to the member of the team responsible for this region and make sure that they have up to date information. Swabbing, however, was not something that I had been warned about and I was a bit concerned when a fresh pair of latex gloves went on and some rather large cotton buds appeared. The gloves were dark blue.  I remember them very clearly. Concern turned to alarm when I was invited to drop my trousers.  Two tips when attending pre-assessment: firstly, ensure that you have blown your nose thoroughly; secondly, ensure that you are well scrubbed ‘down there’ and that the state of repair and/or design of you undergarments are not likely to cause embarrassment when viewed by a stranger. Fortunately, Monday is shower day and I suffered no embarrassments.  Mind you, at the same hospital last year, in front of the Consultant and a nurse, I removed my left shoe to be greeted by the sight of my big toe peeking at me through a large hole in my sock.  I saw a knowing expression pass between the Consultant and the nurse, and I hurried to reassure them that, whilst my salary didn’t provide me with enough money to afford both a mortgage and new socks, I was on the company medical insurance scheme and that they would get paid handsomely for what they were about to do to me.  Inevitably, it involved needles.  Three of them, each getting successively bigger.

Back to pre-assessment.  We spent rather a lot of time going through the form that I had completed but had failed to post back to them.  They only gave me two weeks. What can a man do in the time?  It took me a long time to fill in or, being strictly truthful, it took me a long time to fill in one box: ‘Your Weight’.  Despite what the Unfeeling One thinks, I am not totally unobservant and I have noticed a few pounds going onto my otherwise svelte frame. It took me ten days to pluck up enough courage to get onto the scales, only to discover that the battery had gone flat in the 6 months since I last climbed on.  Obviously the scales in the hospital reckoned I was heaver than did my own scales (holding my breath and trying to stand on tip toe did not help) and my BMI was duly calculated.  Not as bad as I feared but still enough to contribute to that ever climbing curve, produced by one of my colleagues, that shows the increasing BMI of total knee replacement patients.  I do need to lose weight, if for no other reason than it will give my new knee a better chance.  At least I know where to start.  As I got off the scales at home, the Unfeeling One, who had been watching closely, muttered one word: ‘Beer’.

I also discussed anaesthetics with the nurse and it was a very short discussion:

‘Mr Kneedyman, have you considered what type of anaesthetic you want?’

‘Yes.  The sort where I sleep a lot and have absolutely no idea of what is being done to me’.

Who on earth wants to know what is going on? I don’t want to hear the muttered ‘Ooops’, followed by a lengthy, collective silence.  My mum was awake throughout both her hip replacements but, obviously, the ‘sterner stuff’ gene didn’t get passed on.  I shan’t be having a pre-med either.  I had one many years ago, just prior to the first time my left knee was hacked into. The nurse came in and I lay there, in my happy state, and watched him shave my right leg. Ten minutes later, the surgeon, with entourage, swept in and confidently drew a big black arrow pointing up to my shaven right knee, topping it with an even bolder and more confident ‘L’: ‘Don’t want to chop up the wrong knee, do we Old Boy? Hey? Hah, Hah!’  Fortunately one of the entourage piped up, ‘Colonel. I think that’s the wrong knee’.  I, woozily, had just assumed that as he was the surgeon he knew something I didn’t.  A fresh razor was produced along with another board marker (red this time) and my left knee was duly marked up.  A green marker was used to cross out all the writing on my right knee. The ink was there long after the hair had grown back.  No, no more pre-med for me.

So, in summary,  do make sure that you are offered the NJR Consent Form and Patient Information Leaflet: the Registry can’t do it’s job of improving patient outcomes and patient safety without your details.  Do complete and return the questionnaire before going to your pre-assessment clinic:  it saves busy people some time.  You will have a lot of information thrown at you and it may become overwhelming.  Ask questions and ensure that you are given enough time to consider your choices.

I shall now compare experiences with Hippychick’s blog  and see what differences there are for hip and knee patients after their operation. Will get back to you tomorrow. Kneedyman.