Being ill abroad - Part 6 - endgame!

***GRAPHIC IMAGE ALERT*** There are some images of the wound post-surgery that may affect those of a sensitive nature. 

When I was in hospital for the biopsy I found out that things worked very differently in Peru. I kept being asked who my "familiar" (Spanish for relative) was, and I assumed they were just asking about next of kin - but it was much more than that. A relative has to be on call to run errands, collect meds, and so on - and many stay at the hospital all day in case they are needed! Twice a day the nurses/doctors check if you need more supplies and give this to the familiar to collect from the pharmacy (which could entail going into the centre of Trujillo)! I explained that I had no family in Peru, and was told that normally there are volunteers who can do these for patients, but due to the pandemic the volunteers could no longer enter the hospital, and the social workers (who had in fact collected things for me the previous stay) couldn't for long stays. In my case, too, as a foreigner who had to pay for everything, collecting meds from the pharmacy entailed going there with the prescription, getting it digitised, then going to the cashier (not at the same location) to pay, and then returning to the pharmacy to collect the items - if some were unavailable the relative also had to go out of the hospital to find the items elsewhere, and this was twice a day! The relative also is not allowed to come into the ward and see the patient due to Covid restrictions!

I was at a bit of a loss what to do, but a friend (from my volunteering days) told me she would be happy to do this for me - and then spent much of the next 9 days outside the ward waiting to be called upon by the ward staff! It was way more than I expected, and I realised I had a guardian angel - Carmen!

Carmen - my guardian angel. This is how you had to cover up - double mask and face shield - to enter the hospital grounds!

She assured me that she didn't mind, and had some friends among the support staff, so was visiting them as well, but what she did for me was above and beyond what I expected from a friend, as opposed to a relative! Prior to admission I had to pay for one night's stay plus a selection of medical "supplies", but after admission the first "familiar" collected prescription arrived, and this included the surgical supplies required for the operation - and included things like scalpels, gowns for theatre staff, anaesthetic, and so on! It also included 3 units of blood, which might be needed if there were problems during surgery requiring a transfusion! Since I had no-one to call on for this I had to pay for 3 units to be on standby, which were not needed and took me three weeks post-discharge to get refunded for!

While I was in hospital the nurses came round every 4 hours to take "stats" and this included pricking my finger for blood sugar testing (I only do it once a day at home), and although I had my own testing kit, though had to ask Carmen to buy me some more test strips as I hadn't anticipated the 6-a-day tests, they preferred to use a hypodermic needle to "prick" the finger rather than the test kit lancets - the problem with this is the lancet controls the depth, while using a needle they were pushing it in much deeper, and it hurt like hell! My fingers were bruised from this, and they were very reluctant to use my test pricker!

One of the surgery team came to speak to me prior to the procedure, to ensure I understood the risks involved, and warned me that worst case scenario (well, second worst case as death is always a risk with major surgery!) was that I could also lose my right arm. They already knew that the scapula (shoulderblade) would have to be removed, but if the tumour had attached to my humerus (upper arm) as well, they would have to remove that too, and also there was a possibility that the skin covering Chip was too badly damaged so I would need a skin graft, taken from my stomach, to replace that. As with everything else I accepted this with good humour - what else could I do? Whatever transpired I had to live with, as I could not carry on without getting the surgery.

December 8, 2020 - 4 weeks before surgery

The day, Tuesday, of the surgery arrived and I was prepped in the ward - with my shoulder and stomach (in case they needed to take the skin graft) shaved - and then taken down to the operating theatre.

In the operating theatre before surgery.

The next thing I was aware of was coming round in recovery, and I recall I was "growling" as my throat was so dry. They wouldn't give me anything to drink, but after a while allowed me to suck on a small gauze square, which did nothing to allay my raging thirst, though eventually they did give me a tiny beaker of water. My first action was to try and wiggle the fingers on my right hand, and, with some relief, discovered I still had the use of them, meaning I still had my right arm as well. My stomach was exposed, so no skin taken for a skin graft, and a while later the English-speaking surgeon appeared to tell me all had gone very well. They had removed over 7kgs of tissue, including 5.23 kgs of tumour, which had been sent for pathology!

Surprisingly I felt no pain at all in the following days and weeks and even until today, 18 months on, which was because they had removed or killed off the nerve endings, which do not appear to have regenerated. It was quite bizarre to have them change dressings and clean the wound, and not be able to feel a thing - except for the rip of the plaster which extended beyond the immediate surgery site! In the following days I was repeatedly being asked if I required additional pain relief, but since I could feel nothing (even though I was half expecting at any moment for the sensation to return!) I declined, leading them to nickname me "El ruso" - The Russian (presumably they consider Russians to be tough as nails!). I had my phone with me - they gave all my valuables to Carmen for safekeeping as I went into surgery - so managed to update my daughter (and Facebook) after my return to the ward.

I remained in hospital for a further 6 days before being discharged and the only thing of note was that the canula they inserted in my groin - in case I had needed the transfusion - started leaking, leaving me with a huge bruise on the back of my left thigh, and a colourless liquid staining my clothing and the bed. They had left it in "just in case", but that almost caused a further complication!

Carmen helped me leave the hospital and return to my flat in Huanchaco and I could never have coped those first days without her help. She did my shopping, though at my bidding just chopped vegetables and fruit for me, so I could try and cook, and discovered that I could manage that myself. For the next 3 months she came round at least twice a day to change the dressing on my shoulder, at times breaking curfew to do so.

This was taken on April 14, 2021. We asked a doctor to come and check the dressing, and Carmen took this once the hospital provided dressing was removed. 8 days after surgery and everything was healing brilliantly, apart from a small opening where the two incisions met. The drains are clearly visible under the wound.

I am a fiercely independent person, and was very conscious of the amount of Carmen's time I was taking up, so tried to get her to cut that back. She had a family of her own - grown up - and also worked part-time for a charity, and did some other private work, so I tried to do my own shopping (initially ordering in heavier things I could not carry from the shops), but I still needed her to change the dressings, so still needed quite a bit of help.

On April 30, 2021, I had an appointment at the hospital to see if the stitches and drain could be removed, so Carmen came along - ostensibly to translate if needed (my Spanish was adequate!), but also as she wanted to see how it was done.

April 30 - before the stitches were removed. The dark area where the incisions met was necrotic tissue (scab) and the surgeon decided to remove this.

Left edge of the wound - healing extremely well

Bottom of the vertical incision, and the drain holes - all appeared to be healing very well

Where the two incisions met - the horizontal and vertical incisions - there was some evidence of necrotic tissue, scabbing, so the surgeon decided to excise that with a scalpel (could not feel a thing, thankfully) revealing a large opening in the wound.

Although this looks pretty horrible it was not infected, but it did provide an alternative drain for excess fluids.

The surgeon showed Carmen how to dress this wound, and prescribed medication to use, and this was required twice-daily until I left for the UK in July - and still had not fully closed! The biggest issue here was that this "hole" now became the drain for any fluids, and as well as the dressing it had to be covered with absorbent material - and adult incontinence pads proved to be the most successful at this.

May 15, looking much better, but still closing very slowly

I was having regular follow-up appointments at the hospital as well as Carmen's ministrations, and was even referred to a plastic surgeon to see if he could do anything about closing the wound, though he said he would have to cut the original scar open to get enough skin to close the wound, and if they were intending to do any reconstruction of the shoulder he felt it better to wait for this. As it turned out on my final hospital appointment in June the traumatologist (lead surgeon) admitted that they could do no more for me in Peru, and advised me to return to the UK (the borders were finally open for international travel) to continue treatment.

I will cover the preparations for departure in another post, but I finally arrived in the UK on July 2, 2021, and entered the quarantine hotel (also to be covered later!), but despite twice-weekly dressing changes after I arrived at my daughter's on July 13, it took until September for the wound to finally close completely - the medication used here in the UK was much more effective at actively closing the wound.

September 7 - wound finally closed, and scars looking very healthy

Surgery had been performed 2 years and one month after I first discovered Chip, and the wound finally closed 5 months after surgery. Quite an adventure, but I remained positive throughout - many have been surprised by my attitude, but I just felt I had no choice - I had to keep going, and I had to find a way to cope. Yes, my life has changed - I am right-handed and can no longer use my right arm, though can use the hand - but I am managing quite well, and realise that I am fortunate in that millions of people are in much worse predicaments than I am. It was difficult getting initial treatment due to my blood sugar levels, and then the Covid pandemic shutting everything down, but once I was able to see a doctor in Peru in September 2020 things started to move reasonably quickly, and I am pleased with the outcome - and the specialists here in the UK were very impressed with the treatment I received in Peru. Total cost of all the treatment, including the diabetes control, which was essential in getting the surgery performed, was around £4000, with over £2500 of that being directly attributable to medical costs regarding Chip. That does not, however, include the taxi fares for the innumerable trips to the hospital, or for tests elsewhere, which probably raise the total by at least £500!