I know I haven't written for a while

 It's been slightly over a month since Geoff had his last operation. This time the main plastic surgeon was Dr Ottie van Zyl from Groote Schuur (a government hospital) with Doc Landau attending. He took veins from Geoff's calf, slapped them onto the side of his head, took the flap from his thigh and used skin from that same thigh as well. And what do you know, it seems to have been a success at last (fourth time lucky!) My son says it's because he operates in a government hospital, Geoff says it's because he's an Afrikaans guy! Whatever, Geoff is now off his crutches, he didn't need the wheelchair and is hobbling about. He is slowly recovering, and is his normal jokey self, just very very passive. Kate did a splendid job of looking after him from the Thursday (he was released from hospital on 30th September - niece Rachel fetched him - and I got home on the afternoon of 5th October) to the Tuesday while I was still away in Zanzibar.

Yesterday's operation seems to be successful

... but I'm not holding my breath. What's that definition of madness, something about doing the same thing over and over again and expecting a different result? But in all fairness both plastic surgeons looked happy and satisfied, nothing went wrong and when I was allowed to pop upstairs and see him for a few minutes he looked well and thanked me for staying (it was after eight pm - visiting hours because of Covid are from three to six only!) and so I was reassured he is lucid and on the road to recovery. It was exactly the same procedure as the last four times. The vein had to be replaced (so they took from his leg this time), but the artery was fine: the fake skull was supposed to be replaced (I'm assuming it was) and the 'flap' was taken from his thighs. So all in all, seems to have gone well.  

Curve ball

 I'm reeling a little with the latest news. Here's Dr Landau's latest WhatsApp: 

"Hi Hazel We've booked Geoff for Tuesday 14th, have to wait 6 weeks after covid as very high risk otherwise. I've motivated for medical aid to continue vac til then. "

So. It is what it is. I was quite agitated yesterday ... but thinking calmly and logically nothing will change for him really if I am here or if I am gone. Whether it's me or someone else staying here. Because of course my daughter-in-law's lovely gift to me (going to Zanzibar) starts on 25th September! So, what to do. 

First thing,  I asked my swimming friend Kate (who has no children or husband) how she would feel living here with Geoff and her dogs for ten days. She has agreed. So I have someone lined up. I did of course ask Geoff first if he would be comfortable with her sleeping here. Then, I have to get somebody in to wash him at least twice in the time I am away. Kate is comfortable with washing him, but even though he says he is, I'm not sure how that will work out. It may be easier if it is somebody who doesn't know him at all. I need somebody reliable to sleep here every night in case he falls in the night, and Kate fits the bill.  The other thing is, he does nothing. I mean, the only food he gets for himself is ice-cream from the freezer. He doesn't make coffee, he doesn't heat up any food, doesn't make any food. At all. The sum total of things he can do (or does do) is: he goes to bed and the loo by himself, he makes a fire, and he fetches ice-cream from the freezer. 

So as the person who lives here I: make breakfast, pack the dishwasher, collect and wash washing, hang it out, water the garden, clean the pool, do the garden, feed the animals, make lunch, make supper, buy groceries, bring wood in for the fire, make sure we have all the necessities milk toilet paper etc ... all of which I will have to ask Kate to take over. As she lives by herself, she already does everything, so this for her is not too much of an ask and she appreciates the fact that I will pay her to do it. She won't have to pay our accounts or pick up the girls or walk the dog. (My daughter will have the dog, and I will ask my nextdoor neighbour to feed the cat as Kate's dogs are not cat-friendly). I can't think of any other things I do offhand, but it's actually everything that a house-owner does. 

Just another setback

 Well, Geoff's pre-op covid test was positive. So no surgery for him on Monday. Luckily he had the first Pfizer vaccination 41 days ago, so he doesn't seem badly affected. His sense of smell has gone (as had mine for two days) and he has a cough and stuffy nose. More worrying though is his continued weakness. So on Friday (after surgical nurse Sister Anne warned me sternly to stay away from him - and before we knew he was covid-y by the way - Sister was just assuming that I was because I felt so ill) he tried to make his own coffee in the kitchen and fell down. This was after ten pm, so I did what she had suggested and called our security company. Two large masked men came in and got him to his feet. After they'd gone and he was getting into bed he fell again. This time he managed to get up by himself after I pushed the chair closer for him to lean on, and then during the night he fell over again (I didn't hear that time). In the morning he seemed much better but last night, dammit, he fell over again. I don't quite know how to strengthen him up other than by giving him more protein and a mug of Ensure every day. 

PS: I phoned Deep Blue (our security company) to let them know that unfortunately my husband has Covid and they should probably self-isolate for ten days - with apologies. 

Finally a date for the operation

Got a WhatsApp from Doc Landau today - must say he's a cheery sort! "Hi Hazel how’s Geoff’s leg? All healed? 🙈 " (I do like his emojis) Anyway, so this is the plan : Nil by mouth midnight Sunday, 6am admissions and after seeing a pic of his leg he writes: "Everything organized for Monday. Dr Hill will remove the plate and put a new one and Dr Ottie and I will take a flap from Geoff’s leg for cover" ... and a thumb's up after seeing this pic:

One step forward one step back

 Geoff made porridge for breakfast yesterday and seemed quite sprightly. So last night just when I was starting to relax - Geoff went to the loo three times that I heard and it was all fine and dandy - I heard his cupboard close quite hard. I listened for a bit, wondering what he was getting out of the cupboard - but nothing. So I went through to have a look. (We've been sleeping in separate rooms for a while now.) There he was on the floor. When I spoke to him he replied a bit incoherently (of course my mind sprang to a stroke straight away!) but after a bit and me giving a bit of a helping hand he sat up. He said he thought he must have fallen out of bed, and managed to stand up. On thinking it over, though, he thought maybe he fainted " ... because why would I have fallen out of bed? I never have." So I've been mulling over what he had to eat yesterday - probably too little protein? Porridge instead of the eggs I've been making him every morning? And I must buy some more Ensure.  

Zanzibar!

 Well, Geoff is slowly getting better and I have something huge to look forward to. My children Jeremy and Bettina have asked me along on a trip to Zanzibar! This is going to take place at the end of September. I will make all Geoff's meals and put them in the freezer (nearer the time of course) and am making enquiries about a carer for during this time. He doesn't want a carer of course, but. 

For example, today I particularly did not wake him up when I got back from the beach and he slept until eleven thirty am. He then made us both coffee, which was very nice. But again, what did he grab for himself for breakfast? Yoghurt. And I have been told he must have five small meals of protein (Sister Anne says things like chicken broth or any kind of soup with meat in it: he must eat the equivalent of three pieces of meat the size of my palm every day to keep his strength up). So I don't think yoghurt and ice-cream will cut it!  As for the long-awaited operation, no news yet. We are still experiencing a third wave of covid. And he is still having to carry that little machine with him wherever he goes. We walked the 600 metres to my son Michael's house last night so that he could watch the rugby. It's the first outing he has had since coming home. Michael brought him home (Springboks 17, Lions 22). It was a pleasure having the house to myself for the first time in weeks! 

Strengthening

 So good to see my husband getting stronger and stronger. He walked around two blocks yesterday and although he's fretting at having to carry the vacuum pack machine around with him he is coping extremely well. I'm proud of his progress!

Doctor visit

So today we went to see Dr Landau - who said he honestly does not want to risk putting Geoff in hospital where there are so many Covid patients at present (we are experiencing a third wave). He said were it a simple, straightforward operation that would only take a day he would go ahead, but he would rather wait for at least three weeks and hope that by then the wave will have subsided. We are both disappointed of course, but it does make sense. 

Confidence

 Confidence ... musing about confidence and how to boost someone else's. I drove the car to Park Island (roughly 2kms away) and Geoff said did I want him to fetch me. I said no, do you think you could drive? And he said: "No. No, I don't think so, because I've fainted without any warning. I'm just worried I'll faint."

 I didn't know what to say. I could have said, you're right, you could well faint. You'd better not drive anymore. That's what I wanted to say. But then I thought, Sister Anne said he fainted because he wasn't eating properly at the hospital. He's been eating well  now that he's back home, and even though he's felt a little wobbly every now and then he hasn't fainted again. On the other hand, I didn't want to say, of course you won't faint. So I just said nothing. But I was thinking about his confidence all the same. Yesterday he wanted to walk a little further than I would have liked. I was with him, and I got him to turn back after about 10 houses down the road. Later he walked to Windermere Road and back by himself. I particularly decided not to go with him, because I realised I actually sap his confidence by being next to him and having an opinion about how far he should walk. And I thought of Jeremy, and his letting Helen lean over to the fireman's pole and sliding down it, without him being within reach. He just said to her that he knew she could do it. Compared to me, wanting to put the walker in the car in case he needed it. I'm quite good at boosting Elspeth's confidence in her driving. I tell her she's a bloody good driver and not to worry. Why can't I do the same to Geoff? (I walked back from dropping the car at Park Island). 

Well, now we wait

 Right, so Geoff's wounds on his leg are healing nicely - Sister Anne says she probably only has to come to dress them one more time. (The donor sites on his thighs that got badly infected). The wound on his head is doing okay with the vacpack - but the operation is still considered an emergency, so in spite of the third wave of Covid infections Geoff should still be able to get a place in the ICU. So as soon as Dr Landau is back from holiday he should get booked in to theatre. And I guess I'd better book a Covid test three days before this time. 

A much nicer day!

 Shew, well today Geoff got up and made a fire! I'm so pleased! I was really worried yesterday because he slept the entire day. Dropped two cups of coffee from his nerveless fingers as he slept! (I was quite cross by the second one, by the way!) But today he is so much better I really feel quite upbeat. He's had five small meals - as Sister Anne, who comes in every three days to do his dressings suggested - instead of three biggish ones, and I gave him a sponge bath today as well. AND took him for his Covid vaccination - yippee!

Walker and Grabber

Well, I felt quite tearful today. It's not pleasant going out to buy your husband a walker. Frankly it's not. I couldn't find one with dead man's handles, so I got one with two wheels and two legs and no seat, instead. You have to lift the legs at the back to move along, and so it stops if you stop. I needed the handles in case he suddenly faints ... but this will do as well. I'm sorry it doesn't have a seat, but he can wear the vacpack handbag around his shoulders (Michael put a strap on it).  It's not as if he has to rest between walking from the lounge to the bedroom to the loo. Everything is pretty close. Anyway, as a fun thing I bought him a grabber as well. You can pick up your phone from across the table without having to get up. 

Home again, home again, jiggety-jig!

 So it looks like the Superbug has been vanquished, and I fetched Geoff from hospital this morning. At present he is sitting in the sun in the lounge, having had some of Bettina's Woollies soups for lunch. I was feeling so depressed earlier, mainly because yesterday he said I should maybe get him a walker with dead man's handles. But today I will go out and look for one ... even though today he thinks he probably won't need it. I would feel better if he had one to lean on in the night so that there's no more of that fainting going on! 

Dressings not done

Not a major rant, but I was annoyed to see Geoff's bandages hadn't been changed since Thursday. I was wearing blue gloves, so couldn't send a message (have to wear a yellow apron and blue gloves when I visit!),  but I got Geoff to ask Dr Landau to please sort it out. Which he did, promptly.  

Hideous Fairground Ride

 This is beginning to feel like a nightmare rollecoaster ride. You can't get off, you can't stop, you just have to keep hoping that it will be over soon. Yesterday started off well. My friend Kate arrived at 6am to help get Geoff into his car - he and I left the house at 6:25. We arrived in plenty of time at my son's house in Kenilworth for breakfast. His wife made lovely oats porridge and he ate before seven, because after that nil by mouth until the operation. This operation was going to be a success. Plastic surgeon Dr Landau called in a Dr du Toit from Grootte Schuur Hospital who was the very best, he said, and Doc Landau himself would be assisting. Now, we had a very narrow window for this operation. Dr du Toit was leaving for America soon after, and Dr Landau was taking well-deserved leave. So Geoff had to be squeezed in this day. He had to have an emergency covid test to make sure he could enter the hospital (all of us forgot about that) but it was fine, was negative. Then he waited until 1pm. At one o' clock, he was told the skin graft donor sites on his thighs have become infected. That was where the flap was to have been taken from. So they could not proceed. I went to see him in hospital and he was in the ICU in an isolation ward getting intravenous antibiotics because the bacteria (bacterium) was MRSA. Of course I googled it and saw it is the superbug that is usually hospital-acquired. I had no idea - hadn't heard of it before, but anyway, Geoff is in hospital and I'm washing all the stuff he touched on the hottest cycle on my machine. Well I hope it's all and that I haven't been busily spreading this bacteria to everyone around me. 

What a vac pack looks like

 

This is known as Negative-pressure wound therapy (NPWT), also known as a vacuum assisted closure (VAC). It is a therapeutic technique using a suction pump, tubing and a dressing to remove excess pus and promote healing in acute or chronic wounds. It is of course only a temporary measure, and I hope Geoff will have a fourth but this time successful operation soon. 

Home

Okay so today is a very good friend of mine's birthday, so I was in Somerset West when I get a messge from Geoff that he is being discharged from the hospital this morning and had to be out of the ward by 13:00 at the latest. I am so grateful I have children living in Cape Town! By the time I got home at just before half past twelve and had just pulled Geoff's car out of the driveway, Sarah sent a message to say she was nearly at the hospital and that she would bring him home. Apparently all three (Jeremy, Michael and Sarah) got to the hospital, Sarah signed all the papers and stuff, and Michael and she arrived back here. Mikey had to practically carry Geoff down the path, he was so weak. Shame, the other night Jeremy said he's like that guy in Monty Python and the Holy Grail, where the knight carries on fighting with no arms and no legs and he says it's but a scratch! But luckily he can get from the bed to the loo holding onto the furniture, the towel rail and the basin while carrying the vac pack bag with him. I can't see him managing to walk to the lounge for quite a while though.    

Well, soon

So this last operation failed as well. Dr Landau phoned to say now they are going to put a vac pack on his head, let him recuperate and recover in ICU for a few days, and then let him come home. Once he is home he will be able to walk around with a battery-thing attached to the vac pack, and will have to see a surgical nurse every three days to have dressings changed. Looking forward to having him home again.  6th June: no longer in ICU but in a private ward. Dressing to be changed while still in hospital on Tuesday ... and then maybe he can come home Wednesday. Will have to wait and see.

And another one

 just waiting to hear how it went. The operation started at four today and it is now ten o clock. So just after I wrote that I got a call from Dr Landau - he said they decided not to do another skin graft for at least a week. This piece of stomach has very small blood vessels.

Another operation

 Fuck what a roller coaster ride. Geoff has to have the second (and last chance) muscle taken out of his back, replacing the one that is there now. I am so sorry for him. So that's what is going to happen now either today or tomorrow. LATER: had a call from the surgeon and he says it went well, and that the new muscle is taking in blood properly and that he can deem it a success. He is going home to say some hail mary's he says. LATER STILL: he says he's not sure anymore. 

Update

 Well, the second operation went off okay ... there is a faint pulse in the muscle still, so possibly he won't lose the whole thing. It was a very bad night. He had to have a ventilator down his windpipe and thought he had had a stroke and had lost the power of speech. He was very agitated and tearful. I was allowed in for one minute at eleven am on Friday and the first words he said to me were: "I thought I'd had a stroke because I lost the power of speech." Well, that immediately told me that he had not become brain-damaged and that mentally he was fine! I was worried he would have lost oxygen because he had a lung infection as well. But Dr Hellig gave him an antibiotic. What I still didn't know was whether he could walk or not. But today, that is five days later, most of his drips and tubes have been removed. However, the plastic surgeon Dr Landau is still not satisfied and wants him to stay in ICU for at least another night. So that's seven days so far.

Sudden emergency

At about half past five this afternoon I get a call from the hospital, telling me Geoff has to go into theatre again. A haemotoma developed under the prosthetic bone (between the brain tissue and the fake bone) and four of the five doctors had to attend: Dr Kessow the anaesthetist, Dr Landau the plastic surgeon, Dr Hill the neurosurgeon and Dr Hellig the physician. The operation went off okay, except Dr Landau (who is quite young) was very upset and disappointed that this happened. So now he is ventilated and sedated, and possibly has an infection in his lung so has antibiotics as well. My poor, poor darling. And I was holding his hand, wondering if I was hurting him because it's all bruised from the veins being taken out. I wasn't sure if me being there for a while afterwards was stressing him out because visitors are tiring, or if I was comforting because he knows me so well and knows I love him. I think he found me a bit tiring the first night because he needed me to leave.  

Today's ten-hour operation only took nine hours and he seems well just very tired

 Well, Dr Aneet Kessow the anaesthetist phoned me to say the operation was successful, went smoothly and Geoff is recovering in ICU. I went to see him seeing a visitor is allowed (considering Covid 19 restrictions have been relaxed a bit), he slept most of the time but when he woke for a little while he was pleased to see me and said he felt fine just very very sleepy. 

Another operation May 2021

 Not sure how to begin with this. I suppose with Atul Gawande's 'Being Mortal'. For me, I know what I can cope with, and were I to contemplate having surgery which may leave me in a worse state, I would not. However. In Gawande's book, a woman asks her father how he feels about surgery that could leave him in a wheelchair. Well, says the father, as long as I can eat ice-cream and watch sport, I'll be okay. I'd rather choose life. 

Geoff chooses life, such as it is for him. So we go to Dr Landau at Kingsbury, and go and see what we can do about the debridement of his skull not working, and me still having to do a fresh dressing every day. (I would rather not, to be honest. Anyway, it has to be dealt with, it is necrotic tissue.) And Dr Landau says well, the radiation slowly but surely affects the bone. The effect it has, insidiously weakens the bone over years. In other words, having had radiation ten years ago (which I was amazed at, I thought it was fewer years), the bone is crumbling and dying, basically, well, that's how I understood it. So Dr Landau says we will do the following: I have a team. We have Dr Graham, your original plastic surgeon, the one who has referred you to me because the debridement didn't work. So he and I will head up this operation. We need the neurosurgeon, to check the brain. We need Dr Tunnicliffe, Senior Specialist Vascular surgeon, to check if his veins are sound enough for the op. We need Joscelyn Hellig, General Physician, to see if he is strong enough to endure a ten-and-a-half hour surgery. And of course we need to keep his oncologist in the loop. So we have had a round of attending appointments with all these doctors. I haven't accompanied Geoff to all of them, including having bloods done every now and then. Not that I absolutely don't want to go, but because of Covid, besides anything else, the hospital plea is please do not accompany the visiting patient if possible. 

Dr Landau explained, as clearly as possible, this is how the operation will proceed. We will remove a large part of the skull and expose the brain. Then one of the doctors (I've forgotten which - I think the neurosurgeon) makes a paste, which hardens into fake bone, and he places that over the brain, in effect making a new skull bone. This seems to be about the size of a cd. I'd guess. Maybe bigger. Then the plastic surgeons remove a muscle from Geoff's back. (Geoff asks, so is that muscle going spare? What does it actually do? Doc Landau says don't worry you won't miss it. (!) ) It has to be a muscle, not just a skin graft, because the flesh on top of the head needs blood so that it doesn't just decompose, and there is no more flesh on this wound, it has actually died. Then he will take a vein from Geoff's arm, and attach it to the carotid artery in his neck, and that will feed blood to the muscle on his head, which Doc Landau says (cheerfully) will look like you have a steak stuck on top of your head, but never mind, it will go down after a while. And then finally, he says, we will take some skin from your leg, and graft that on top of the muscle, and sew it all up. And bob's your uncle. A very cheery doctor. And he says he will love dealing with all this blood and guts. So that is the op. And that is what is awaiting Geoff in two weeks or so. (18th May is the date set for this huge operation, which will take ten and a half hours or so, and of course an anaesthetist will be in attendance too). I haven't said anything, but I do hope we will be able to pay for all this! I don't quite know how. But we'll just have to do it and then sort out the payments afterwards. Oh and of course, besides the bloods, he has to have a covid test three days before the op. 

Hair

 Well, I've been putting on a dressing a day since October last year. He had a debridement earlier this year - which was to make the bone granulate so that the plastic surgeon could put false skin on, but that hasn't happened yet. It does seem to be improving slightly. On another note, Geoff tried to trim his hair as usual, but couldn't reach the back anymore and he did look so like a fledgling that my heart broke. 

Inexorable downward drift

Dreadful to see this man, this lovely man with whom you have spent most of your life (well let me think: I was 19 when I started dating Geoff and am now 66 ... so yes: 45 years of my life IS most of it, I'd say!) becoming slower and weaker. There he was, how does Charles Aznavour put it: "... so young and gay,/A prince of love in every way!" .. that handsome boy with fierce eyebrows and a soft heart and here is now now, walking along slowly, bent, driving onto the pavement by mistake, me wondering, should I suggest I drive? It's heartbreakingly slow, so not a sudden stabbing hurt, just a snail-like sad dull ache, as you realise: "This isn't really going to improve, is it?"

Is it even possible for him to get strong, to get fit? No, stop it. Stop thinking of sparky 71-yr-olds who manage to run marathons and climb mountains. They have their good health. Geoff's is gone and that is it.