Before the drama commences, just a quick note as to how I came to be on C3 which is the surgical urology ward at our local hospital. One Saturday afternoon, I was walking upstairs, when I suddenly had an acute attack of the most tremendous pain that I could imagine for no apparent reason. Hospitals ask you to grade your pain from 1-10. This was a 10, and even childbirth had to be downgraded to a 9 in comparison.  The doctor was called, and he gave me morphine,  but since it was a bank holiday weekend, he said to wait and see how I was by the following Tuesday, and if I still had pain to go to my GP. The pain gradually subsided to about a 7, but was still there on Tuesday.  When my doctor examined me, she said since the pain was still very severe  I ought to be seen by a surgeon at the hospital.  I was admitted to ward C3. feeling a bit of a fraud as I was so much better, yet relieved that I was being investigated just in case there was something seriously wrong that wasn't apparent. I settled in and then waited.

Let me tell you a bit about my companions in the room. In the next bed to me there was a tiny little old lady with snow white hair called Hilda. Then on the end was Freda, also elderly (I was the youngest by at least 20 years) due for bladder surgery in the morning, and she kept getting instructions about what the routine would be for her. She was first on the list so would be taken to surgery about 7.30. She was very concerned because the gown she was going to have to wear was open in the back, and she was told she couldn't wear panties. However, the nurses said they would get her some paper ones that could then be cut off her before her operation. Then came Emily, a very sick lady with tubes all over the place, who I originally took for being very old, but now I doubt if she was over 65 and finally, a woman called Eleanor who was recovering from surgery I think - and had a neck brace on all the time.

It wasn't long after the evening change of shift that the drama which is the reason for this story started, and it centred around Emily. She was on oxygen and was groaning all the time from pain. She had a catheter from which they took samples every hour, and they now came and told her they had to put down a nasogastric tube to suck out the contents of her stomach. They told her it would relieve the pressure on her stomach and make her more comfortable. She was not happy about having to swallow while this tube was passed down her nose and into her stomach, but the cheerful and pleasant and very efficient nurse managed it with a minimum of fuss. I still had seen no doctor, but every so often someone would report that she was still on her way.   It was now about 15 to 11, and Emily suddenly started making a fuss, wanting her "usual tablet." But she of course had this tube down her nose into her stomach - and an IV was running, there was no way they were going to give her the usual night time tablet. She became more and more agitated - and as it turned out the tablet was "for her fits" and she was very worried about what would happen if she didn't have one. The nurse tried very hard to tell her that it wouldn't matter and that she could not have anything that would go into her stomach at the moment. But since she continued to worry and fuss about it, the nurse agreed to have the doctor come and talk to her about it. And before long, the doctor herself finally arrived. She said hello to me, but said she would deal with Emily first. The doctor was young, and she had long, rather dank, auburn straight hair. She was wearing a black short sleeved front-buttoning sweater and tight beige stretch pants and black boots. She took some blood from Emily's arm, and then tried to explain to her why she couldn't have an oral medication. Emily said, "But the consultant said I had to take the tablets every night and if I don't I will have a fit and I will die." Doctor said, "Lots of people have fits and they don't die. You won't have a fit, Emily, and you won't die." But Emily persisted and was becoming quite hysterical about it. The doctor, who had been sitting beside her holding her hand now said very loudly and firmly, "Look at me Emily. I am the Doctor. I am telling you, you will not have a fit. You are very ill, and if you do have a fit it will be from that, not from not having your tablet. And there is no way I can give you a tablet now."

But although the doctor then left her and came to me, she was still worried and upset, so after a few minutes with me, the doctor excused herself and went and told the nurse to give Emily a morphine injection to help her settle down. Now the doctor came back to me, but with her mind still very much on Emily. "Why didn't you just tell her you would put it into her IV solution," I asked.  "That would be totally unethical. I couldn't do that." 

But now the poor tired doctor turned her attention to me. She took a history of this episode, and while she was doing that tried to insert a shunt into my left wrist for the IV which I would be given later. But she had 3 failures before she tried on the other wrist and had 2 failures -I'm sure it was the inefficiency and tiredness of the doctor at fault rather than the needles not being right - and for some reason my veins were not at all cooperative. All her attempts were very painful - and I could understand people dreading her coming to take their blood. She took a break from that, and using another needle in my right arm, managed to get 2 larger samples into tubes. I asked what the blood was for and she said one for a white blood count to see if I had an infection and the other for bilirubin - because she thought from my history that I might have a bile duct blockage. Then she prodded my abdomen starting gently and then more firmly, watching the strength of my reaction to her probing. One area, more or less around the naval was the most sensitive and I certainly did gasp with pain on several occasions. Then she dug deeply into my abdomen and very quickly drew her hand out and the pain was enormous. "That," she said, "is called the rebound test, and the question is whether it hurt more when I probed you, or when I withdrew my hand suddenly." No doubt about the answer to that question. She did it a few more times in various places, but that one central area was certainly the most sensitive. "Well," she said, "You are a real puzzle. You are not at all typical of anything. You don't have all the symptoms of stomach flu or food poisoning, which was the most likely cause of your problems. You have pain in the region of the gall bladder, although that is not your worst spot - but the worrying thing is your rebound reaction - because how you reacted was typical of someone with peritonitis. I'm not saying you have that," she quickly went on "because you don't have the other symptoms like a very rigid abdomen which typically go with that. I will order some x-rays, but I think you need to be seen by the senior house doctor." I asked what the x-rays were for. There would be a chest x-ray-to see the diaphragm area mostly to see if there were any signs of air escaping into the peritoneum, and the abdominal x-ray was to see if there were any holes or unusual bulges. As she was going off she said, "I don't think you are lying about the pain." I said, "No, I am not lying." So off she went, and I tried to get a bit of rest.

The next doctor, a young Greek man in a white coat came about 15 minutes later and did all the same tests as she had, and asked the same questions. The only new thing he did was to ask me to breathe in his face. "Yuck" he said, "when did you last brush your teeth?" "About 4 o'clock" I said.  "Your breath is awful." I was very offended but he said he wasn't meaning to be rude but one of the diagnostic tests for abdominal problems was that the patient usually had fetid breath, and I certainly did. But he also came to the same conclusion - that he didn't know what was wrong with me. So he said he would have to ask the senior surgeon to come and see me when he got out of the emergency surgery he was doing.

About 2 a.m. this most important and very confident older doctor came.  He came still dressed in his surgery blue clothes and again I knew he had had a long day. But it was up to him to make the decision about whether I needed emergency surgery that night - and I knew that it was not a clear cut case. He also went through the history with me, and did the abdominal palpitations - but he was not convinced that I had a real problem. As he finished the exam he said, "I am sure you will not be having surgery tonight unless the x-rays tell a very different story." But he seemed quite confident in a way his junior colleagues had not been, and I think he doubted the intensity of my pain reactions. In fact once he said to me that he thought I was very sensitive to pain. I forgot to mention that while the first doctor was pummeling me, the little nurse slipped in beside me and held my hand. It wasn't necessary, but was a very nice comforting gesture all the same.

So the next step then was getting a porter to take me in a wheelchair down to the x-ray department.  I was wrapped up in a blanket, and a nurse went along. She wheeled me into the main x-ray room, and put the plate behind my back while I was still in the wheelchair for the chest x-ray. Then I was helped onto the bed while the overhead machine was brought in for the abdominal one. I was returned to the ward, helped back into bed, and connected up to my IV fluid which was saline and glucose and would take 6 hours to finish.

I got no sleep at all. There were lights on (because Emily needed an hourly blood pressure reading) and the nurses with spare time used the area directly across from me as a sort of rest area, so you could hear their soft voices all the time. And there were lots of people snoring in varying degrees of loudness. Emily made a lot of noise too - with groaning and snoring and the sound of her oxygen all combined.

But about 7, the real drama started.
One medical team came on rounds and when they came to Emily's bed, they spent quite a time discussing together and looking at x-rays before they went into her cubicle and of course drew the curtains around. But although we couldn't see, we could all hear and imagine everything that was happening within. The girl doctor from the night before was part of the team - still wearing the same clothes - looking even more exhausted. But the first one to speak was a male doctor. He said to Emily, "I'm afraid we have some bad news for you. We have had the results of your x-rays and the tests of the contents of your stomach and blood tests, and you are going to need to have an operation, and if you don't you won't be getting better." Emily said, "I don't want to have an operation." He said, "It is your choice completely, but I must make clear to you that we found that you have a hole in your intestine, and that if it is not operated on and we do a colostomy, you will not get better." Emily said, "I don't want a colostomy." He said, "I'm sorry this sounds very brutal, but if you don't have an operation you will die. If you do have it, there is every chance that you will be able to go back to your normal life, and when you are better, we can reverse the colostomy. But it is your choice. We can't force you to have an operation if you don't have one, but if you don't have one, you will die. I'll give you 5 minutes to think about it," and then he went out of the ward.

Then the girl doctor spoke to her, "Emily," she said, "only you can make this decision. Not the doctor, not your family, not me. It is for you to decide. But a colostomy is not such a bad thing. The Queen Mother has one. I'll bet you didn't know that and look how well she copes. And you would have a special nurse to help you with the bags, and lots of people have them and go on with ordinary lives. You have been living independently, and have a reasonably good quality of life. I know when you came in here 2 weeks ago, it was for a different problem completely, to do with your asthma, and when we were looking into the cause of your stomach pain, we have now found out that you have this hole in your intestine and that is a very serious thing and needs immediate treatment. I will call your daughters to come and talk to you about it, but remember it is your choice." Emily said, sobbing now, "I don't want a colostomy."  The doctor added, "Well, I'll come to see you again later. They will get the surgery all ready for you in case you change your mind because if it is going to be done, it has to be done as soon as possible." And then she left.

It wasn't long before the 2 daughters came in. One was about 30 and was plumpish and quite quiet. The other was younger and was married with a small baby.  The girls had no hesitation at all in trying to influence their mother's decision. From the moment they arrived they said over and over. "You have always been so strong, and you have always had such courage. You can do this. You were so scared it was cancer, and it isn't - it's something that can be treated. The doctors here are so good and they will very soon have you back to normal." On and on it went until eventually their mother's resistance was broken down, and when the young male doctor returned, she said, "I trust you and know you will take care of me." And he assured her over and over that they would take very good care of her and that she had made the right decision.

In the meantime, things were going on in the rest of the ward too. My doctor came in at 8 and told me that the x-rays were normal - so no operation. And that he would arrange a scan hopefully for that day or the next.

In the meantime, the lady next to me, Hilda was also waiting for her operation, but she was far down in the schedule, and hadn't been given a time except that it was in the afternoon. She was very nervous about it, never having had an operation or even been in hospital before. She was 82, a widow of 12 years, with 4 children - but all living far away. Her problem was a bleeding bladder - and she had come into the hospital on Sunday, for a transfusion - as she had been very anaemic due to the loss of blood in her urine. So she also had a very long day of waiting, and in the end it turned out to no avail - because her surgery place was given to Emily, and Emily's operation took a long time. At 6 p.m. they told Hilda the surgery was cancelled and they would have to rebook it on Sunday or Tuesday next week. She was very upset - but had little choice but to agree.

It was about 2 when they wheeled Emily off to the theatre. Her daughters who had been with her all morning were positive and cheerful the whole time - but they were rather tearful as they kissed her before she went off. "See you in a little while when you will be much better. Remember to keep your courage and be strong."

After they had taken her down, I was chatting to Hilda. "I was very upset at the way they bullied her into having that operation, "she said, "Both the doctors and her daughters really forced her to have it. She didn't want it." She said when her mother had been very ill, a surgeon and a medical doctor had stood at the foot of her bed and argued about the next course of her treatment. The surgeon said that he could deal with whatever her problem had been, and she said, no doubt he would have done a beautiful mechanical job. But the medical doctor knew her mother couldn't cope with the after effects of the surgery - and so he felt it was wrong to put her through it all.

I thought about how I had been considered for the same diagnosis as Emily had been given - perforated bowel. I wondered if they had given me her choice to make (and if I had been her age and in her physical condition) what I would have decided. And I think I would have decided for the surgery- not really so much for the reasons that her daughters gave her. They might have believed what they were saying about her quality of life and getting back to normal again, but I was pretty sure that Emily would never be normal again. But the surgery was the only chance available - maybe her odds were 99 to 1 against - but she had a chance and therefore she had hope. And it also gave her relief from pain.

When they brought Emily back into the ward at 6 p.m., her daughters were with her but they were both crying. She was breathing regularly, but was asleep or unconscious. It was amazing how much smaller she looked with many fewer tubes in her, and her abdomen was much less distended. The nurses came and did their usual checks. I walked by her about 9 and her eyes were open, but I don't think she could really see. She gave no sign of recognition when I smiled at her. I heard the nurses say that her urine output had not increased in the last hour, and it was very concentrated and dark red. Hilda whispered to me, "I think she is dying."

We really didn't see much of the men in our ward as they had their own toilets and bathrooms at the other end. But one time we were very aware of one man - most likely the little Chinese man who was closest to the connecting doors. The young girl doctor was with him - doing something - and we heard him yelp with pain - and it got noisier and noisier and happened for about a minute and for about 3 times. I thought he was being prodded in a very sore abdomen - and that he either was much sorer than I was, or much less stoic. Anyway, before long our lady doctor came in and she was laughing. "I wasn't beating him, honestly," she said to us all. "He started making the noise when he first saw the needle - and it got worse and worse as the needle came closer. But I was only taking some blood, honestly."

 I asked if I could have a sleeping tablet, since I was now allowed to have fluids - and was given one. I took it at 11, and was wonderfully drowsy within minutes, and when I was next conscious of anything, it was 6 the next morning  and I felt wonderfully refreshed. I looked across at Emily's bed and the curtains were partially drawn around it. I got and walked across but when I looked the bed was empty and a nurse was cleaning the area. "Has she died?" I asked, and she nodded, "about 2.30." I think we all knew she was going to die even before she went for the surgery, and certainly when she came back from the surgery - but I was nearly overcome with emotion. I didn't know Emily or her family - I never spoke to any of them, but I felt that they were a part of my life and that I was now sharing their loss. I had an overwhelming urge to write to the daughters and say how sorry I was about their mother. I wondered if that was a stupid thing to do, so I asked a nurse and she seemed to think it was a lovely idea. She said she couldn't give me their address, but if I wrote a letter, she would address it and post it for me. So I did that, and gave her change to buy a stamp for it. It was an awkward letter to write and they no doubt were very confused at getting it - but I was so worried that those girls who were much the same age as my sister  and I were when our mother died, would feel they had done the wrong thing in pressuring their mother into the surgery. They had said so convincingly that if she had the surgery she would be okay. So in my letter I told them that all of us in the ward couldn't help but become aware of the situation with their mother - and that I felt that she had made the right decision. And that if I had had to make the same one, I would have chosen as she did. I said that it should be a little consolation for them to know her last 12 hours were pain free and that when she went to sleep under the anaesthetic her thoughts were very positive and that she knew how she was surrounded by their love. Maybe it was a stupid thing to do. But my compulsion to do so was really quite overwhelming, I did it, so there is no point in regretting it.

About 9 my doctor and a colleague came on rounds, and told me that if the scan which I was due to have at 10 was negative as he was sure it would be, I would be free to go home, and that I could eat properly again. Then he noticed me writing (this story in long hand took 26 pages) and asked what I was writing. "I'm writing about what happens in C3" I said. "Oh that must be very boring, "he said. "Oh, no," I said, "it's like being in a soap opera. It is very dramatic." "I wish I could write things like that," he said. "Don't worry, I won't publish it," I said, grinning, and he smiled, "Oh, I wouldn't be worried if you did," he said.

My scan-driver arrived with my wheelchair just before 10, and I was wheeled to another x-ray department. The person doing the scan  told me he had been told to look for pancreatitis.  When I showed an interest in what he was seeing, he had me turn slightly to see in his screen and he showed me each of my organs as he examined it and identified the major blood vessels and so on. Then I told him the only area of real pain was the central portion by my naval, and he showed me that on the screen and said there was nothing abnormal to see, but, he admitted, this form of scan is the least efficient form for the intestines. "It is very good for the major organs," he said, "but because of the density and complexity of the intestinal system it really is not very good for diagnosing anything in the intestines. A far better system is the CT scan and if your pain continues, they may well send you again for one of those. You are American, aren't you?" I agreed I was. "In America they would almost always do a CT scan as the first method of diagnosis, but I think, rather cynically that that may because it is the more expensive form. It would cost £1000 for a CT scan while an ultra sound costs about £400." Anyway, the scan and the chat were now over, and I was wheeled back to my ward, where I lost no time in letting the nurses know that I was now allowed not only water, but food if I wanted it. I hoped my doctor had actually written that in his notes. They checked and he had, and I gratefully drank my tea when it came around, and quite enjoyed my lunch an hour later.

My doctor came to see me once more. He told me what I already knew - that the scan was normal. Then he told me he would see me in 6 weeks as an outpatient, but that if I had any pain of a similar nature in the meantime to come in. He said he couldn't put a name to my problem.  He was baffled by it, but he said that often was the case with intestinal pain and it would go down on the record as severe abdominal pain of unknown aetiology.

So my dramatic stay on ward C3 was now over, but to me it was quite an experience. I felt I had learned something about life and death and human nature. I had had my faith in the much maligned National Health Service renewed. I had been treated with great concern and loving care and the system, apart for the obvious shortage of doctors, had appeared to be very efficiently run. I had the reassurance of having had a very complete physical and I appeared to be very healthy indeed - except for the odd unidentifiable pain here and there.

P.S.  A few weeks later, I had a letter from the daughters of Emily, thanking me for my note and hoping that had now recovered from my pain.