BAHA - Day 01 - Operation Day

My appointment to have the titanium implant of my new Bone Anchored Hearing Aid (BAHA) fitted meant arriving at the Freeman Road Hospital at 07:30 this morning to check in to the Day Treatment Centre (DTC). Arriving at the hospital the environment was clean and welcoming and it was nice to see that the corridors were clear and not filled with equipment which is often the case in many NHS organisations I have visited.

The tone of the day was pretty much set by two incidents before we even arrived at the centre. A hospital porter we met in the corridor at 07:20 greeted us with a cheery hello and a member of nursing staff, unprompted, asked us whether we were Ok or whether we needed directions. Some of my past and recent experiences of the NHS have left a great deal to be desired but here we were off to a good start. First impressions really do count and ours were good.

The staff in the DTC could not really have been more pleasant and helpful, we were greeted immediately and politely which is all that is required. I was impressed by the environment that we were asked to wait in which was clean, modern and nicely furnished with low tables and comfortable chairs and sofas, quite unlike many NHS waiting areas. There was a large flat screen TV on the wall for entertainment which was appreciated. As you can see below, a lot of thought had been given to these patient waiting facilities:

 One point I particularly noted was that a member of nursing staff regularly went into the waiting room to help particularly some of the older patients with their overnight bag which was nice to see and which was clearly appreciated.

I was called into the clinical area where pre-operative checks are done at 08:10 which was fine. I was soon in a hospital gown and was provided with a lockable locker for my gear. This system seemed to work well and is definitely better than an unsecured bedside locker. The area was occupied by men only which surprised me in a day case unit but which is clearly how things should be.

In this area I became aware of what was to be my only significant criticism of the service and arrangements. The trolleys and chairs that the patients were provided with were fine but they were separated only by curtains. There will be reasons for this but this is an unsuitable area for patients to be asked about their medical histories, allergies and to be asked to give informed consent to surgery as well as to ask any questions.

It is simply not possible to maintain privacy and confidentiality in these conditions. I sat in my "bay" and even though my hearing is poor I listened to what should be confidential discussions being held between doctors, nurses and patients, often in great detail. Under the current arrangements confidentiality is not maintained and it is quite impossible for other patients to avoid overhearing these discussions. It would be entirely possible in this situation to sit and listen to the medical details of a friend or neighbour who may well want them to be kept private, this is not acceptable.

During this time I was seen by the surgeon, Mr Johnson, the anaesthetist, and several members of the nursing staff all of whom were polite, professional and helpful, it was not possible to find fault, I couldn't have asked for better care. During the course of my discussion with Mr Johnson he indicated that if the wound heals well they may fit the sound processor NEXT THURSDAY! I was amazed, that's just 6 days after today's surgery and I was expecting it to be far longer than that based on the literature I had been given, things had clearly moved on.

Whilst I waited for my turn I had a nice chat with a guy in the next bay, Ray, who already had one BAHA fitted in his right ear and who was now having his left ear done because his hearing in that side had now deteriorated. He has been delighted with the outcome and couldn't speak highly enough of the device he has received and the outcome in terms of hearing improvement. This was music to my ears (well, the one that works at any rate) as it's good to hear these things face to face from someone who has actually been on the receiving end of the procedure. This all left me feeling very optimistic and I hope all goes well for the guy with his second BAHA.

My initial estimated operation time was 10:30 but I was finally collected at about 11:30. I was not at all concerned about this, as far as I am concerned day case surgery means that, it takes a day, not a couple of hours. Having something like this done as a day case is light years ahead of the previous long stays that people have had to go along with and it was a good opportunity to read a book and generally watch the world go by.

I was pleased and reassured by the number of times throughout this whole episode that my ID and details were checked and confirmed. These were not just cursory checks but proper detailed checks at every stage, everyone I met actually read my name band and checked the details with me. Some may feel this is overkill, I think it vital and it is very reassuring to feel that people are in control of what they are doing and who they are doing it to.

The theatre staff I encountered again could not have been more pleasant as was the porter and the member of nursing staff who took me down to the theatre. I did not feel that I was simply a number but was made to feel like a human being at a time when you do feel pretty vulnerable.

Once off to sleep the work of the day was done and I woke up in the recovery area at 13:00, about 15 minutes after I left theatre. I vaguely remember the tube being taken from my throat which was no big deal and I was very soon feeling wide awake with no residual nausea or dizziness. I was aware of the fact that something has "been done" behind my left ear but I was not in anything that could be described as pain, I was perfectly comfortable. So, the surgery itself seems to have lasted up to 40 minutes as far as I was able to piece together. I was in the recovery area for about 30 minutes chatting to again a very pleasant group of staff and I was back in the DTC at 13:35.

Soon after returning to the DTC the drip I had in was taken down and I was given a VERY welcome serving of toast, marmalade and coffee. Once I felt ready I was able to dress, I was given my instructions about the follow up appointment and a discharge summary to be delivered to my GP.

Whilst waiting to depart in the DTC I watched a member of staff carefully washing the couch covers with cleaning fluid and then all the linen was changed ready for the next people. It was nice to see that it wasn't just a case of changing the sheets, I just generally formed the impression that things were being done properly.

I actually left the DTC at 14:30, 7 hours after arriving. Given that I had:

1. Been admitted.
2. Been booked in and checked over.
3. Had things explained to me and given consent.
4. Been transported around.
5. Had a general anaesthetic.
6. Had an operation performed and an implant put in my skull.
7. Recovered from the anaesthetic.
8. Had toast and coffee.
9. Been checked over prior to discharge.

I think this is very impressive indeed.  The result of all this is shown below, quite a change from the "before" photographs.

In terms of pain it is now about 6 hours since the operation. I felt what I regard as minor discomfort for a few hours but nothing to be concerned about, I have taken no painkillers at all at this stage. If this changes I'll comment on this in a future post.

For now my summary would be that the whole experience has been a very positive one and all the staff I came into contact with were excellent. I felt well looked after and in safe hands at all times and as a patient that is what I really want. The only negatives about my experience were the privacy and confidentiality issue outlined above which I do feel needs to be addressed and there is of course the issue of the cost of car parking which I regard as nothing less than a means of extracting money from a captive market. The parking issue is obviously not a matter for the clinical staff but a management issue and an issue which many people will share my views on.