Bobby

 

Robert James was a perfectly normal seven year old boy, about to go up from infants to junior school, sometimes good, sometimes in trouble. Well, not completely normal because he wet the bed at night and sometimes himself during the day. He tried his best not to, and woke up several times a night to go to the toilet, but then he'd get so tired by morning that he wouldn't wake in time and his bed would be wet again. His mum and dad were very understanding so his bed had a plastic cover over the mattress, the duvet and the pillows as well as an absorbent pad under the bottom sheet to soak up the worse of it. The stay-dry absorbent under sheet went into the wash and usually managed to keep him somewhat drier than he would have been in just a wet bed.

 

His parents had taken him to the family doctor on several occasions, but the elderly doctor just told them he'd grow out of it. That summer the doctor retired and young lady doctor took his place. Bob's mum and dad decided to take him to her to see if she could do anything. Bobby's mother said that she'd take him as soon as she could get an appointment for him. On arrival in her consulting room, the doctor asked them both to sit down while his mum told her about the number of times he went at night and how occasionally he wet himself and that he occasionally had 'accidents' during the day. The doctor said, “Hmm! This doesn't sound like a simple childhood 'growing up' problem. I suspect there's more to it than that. Let's have a look at you, Bobby. Would you get your shoes and shorts off and get onto the couch for me. I need to poke and prod you a bit, but I'm sure you know I'm trying to help!” She gave Bobby a beaming smile which put him at easy, so he smiled back and obeyed her instructions. The doctor picked up an incontinence pad with green plastic backing to place under Bobby and picked up another smaller pad with yellow plastic backing. She asked Bobby to raise his hips while she placed the larger pad under him and then said, “I'm going to pull down your briefs, Bobby. Don't be embarrassed, but I need to push you quite hard. Tell me if it really hurts, won't you?” She had put on a pair of rubber gloves and pulled down his briefs over his ankles and handed them to his mother. She placed the pad between his legs. “Bobby, this is really important. Please try not to wet yourself when I examine you, but, if you can't help it, I don't mind, but I really need to know how well you can hold back. OK, pet?” Bobby said that he understood. She pressed his abdomen and asked whether he felt like he would soon need to go to the toilet. He admitted that his bladder was no quite full and, as she pressed, a stream of urine flooded into the pad between his legs. Bobby blushed a beetroot red, “I'm sorry, doctor, I really was trying to hold it back.” “I know you were, Bobby. I could feel your muscles were tensed up with the effort. As I said, I'm not cross. She carried on examining him until she put one hand in the small of his back and another just below his ribs to feel his kidneys. Bobby cried out with pain as she did it and cried again when she did the same on the other side. “How long have you had pain there, Bobby?” the doctor asked, kindly. “For as long as I can remember, doctor. I tried telling the old doctor, but he didn't listen to me.” “Well now, that's all past. I certainly will listen to you! Do you mind if I talk to your mother about you, but please interrupt if you don't understand what I'm saying to her. I really need to explain to mum as there are some decisions she needs to make today. OK, love?” Bobby said that it was all right by him. He was really surprised as he'd never been spoken to on equal terms like that by the old doctor.

 

“Mrs. James, I am very worried about Bobby. There are a number of problems I can find just by examining him as I have done. You said you didn't punish him for wetting and I'm really glad about that – it's certainly not his fault. He has a very small and mal-formed bladder.” Bobby piped up, “What does that mean, doctor?” She turned to him and smiled, “Well done, Bobby. Many boys your age wouldn't have asked. It means your bladder is the wrong shape.” Turning again to mum, she continued, “He also has very enlarged swollen kidneys which suggests back pressure from his bladder up to his kidneys.” Turning to Bobby, she explained, “That means that the urine you make in your kidneys isn't getting out properly, making your kidneys swell up a bit.” Bobby nodded to show that he understood her. “I suggest that he goes to hospital for tests to see what can be done for him.” “How soon do you think that would be, doctor? How bad is the waiting list?” mum asked. “Oh no! I'm going to send him today, with your permission! I think it's that urgent.” Bobby's mum started to cry, “We kept bringing him as we were worried. Will he be all right? We should have insisted that something was done.” “Don't blame yourself,” the doctor reassured her, “It certainly wasn't your fault. Shall I phone now?” “Please,” Bobby's mum replied. The doctor picked up the phone and ran the children's urology consultant at the local acute hospital. She carefully explained her concerns and was pleased to be told that Bobby would be found a bed immediately. She picked up her pen to write a short letter to the consultant, sealing it in an envelope when she'd finished. “If you take Bobby home and get some night clothes for him, and a few toys, as well as his wash things, you can take him straight to the Paediatric Urology ward: they're expecting you. Please give them this letter. Now then, Bobby, we can't let you go like that. Let's get you sorted.” The doctor put on another pair of rubber gloves and picked up a patient wipe. Removing the wet pad, she wiped Bobby carefully where he had got wet. Fortunately the adult sized pad she'd put between his legs had soaked up most of it. She then fetched a child sized disposable nappy. “Bobby, you can't help having accidents. It's not your fault, but the nurses in hospital will want you to be in nappies so you don't have accidents at the hospital. It doesn't mean that you're a baby: it just means that you are a very poorly boy.” With that, she held out the nappy. It was white plastic with four tapes and cartoon characters across the front where the tapes would go. With obvious skill of long practice, she raised Bobby's legs, slid the nappy under him and pulled the tapes around to fasten it snugly in place. “Bobby, if you need to 'go', use your nappy. The nurses will expect you to arrive wet and will probably change you into a rather more absorbent hospital nappy. Bobby looked as if he was about to cry. The doctor cuddled him to her, “You poor pet. We'll get you sorted somehow, I promise!”

 

Bobby's mum took him home in the family car and quickly packed using the list which the doctor gave her as she left the consulting room. Bobby was in a daze: everything was happening so fast. He got back into the car as his mother belted him in. They set out together to the hospital, neither saying anything to the other as they were both trying not to burst into tears. His mother parked the car at the hospital, 'paid and displayed' her parking permit and, taking Bobby's hand in her right and his case in her left, they set off for the paediatric urology ward, following the signs pointing them in the right direction.

 

At the door of the ward, Mrs. James had to ring the bell and state who she was using the intercom before a nursing auxiliary came to the door to unlock it to let them in. The door was secured to prevent children from escaping and to protect them from abduction. The auxiliary led them in, taking the letter from Mrs. James' hand and showing them to a bed in the ward. It was an open ward with a play room at the end with the sound of happy children playing. One of the nurses came over to Bobby and pulled the curtains around his bed. “Bobby, I expect you may need a nappy change by now. I'd like to put you in a clean dry nappy and gown to make it easier for the doctor to examine you. You'll be having some of your tests later today, so you may as well stay in the gown. If you could stay with Bobby, please, Mrs. James, the doctor will need you to sign a consent form for one of the procedures. I'll go to get the nappy trolley and sort you out. Oh yes, you're far from the only one here who is in nappies, so don't worry about that! Would you put on the gown for me while I get the rest of the equipment?”

 

Bobby's mum helped him remove his clothes and put the gown on so the opening was at the back with the tie-tapes. Bobby noticed that the gown had 'Hospital Property' as the pattern in four different colours. He sat on the side of the bed and waited for the nurse. She came back in a few moments with a trolley and also an electric sphygmomanometer and thermometer. She put the thermometer in Bobby's ear to check his temperature, then placed the blood pressure cuff around his arm, explaining that it would pump up and squash his arm to measure his blood pressure. A pulse oximeter on his finger recorded blood oxygen saturation as well as his pulse rate. The nurse wrote it all down on his chart which was already prepared to his mother's surprise. The nurse noted this and remarked, “Oh yes, we started to get everything ready with tests booked and so on as soon as we knew Bobby was coming in.” After this, she pulled on a pair of rubber gloves and took a changing mat off the trolley. This was the one with a lower pad between three sides in a babyish nursery print. She placed it under Bobby as she asked him to raise his hips. The wet nappy was removed and Bobby was cleaned up with a couple of wipes. The nurse dried him, then rubbed silicone cream into his nappy area before reaching onto the trolley and removing three terry towelling nappies. Mrs. James expressed her surprise. “I thought you'd be using disposables!” “We did,” replied the nurse, “but we switched back to the reusable nappies as they are cheaper for the hospital in the long term and better for the environment as there is less waste.” She folded the nappies into three and bent back a section to make a thick pad over Bobby's penis. She put a nappy liner over the appropriate place on the nappy. Bobby noticed that, although most of the nappies were boiled clean and white, there were yellow stains from frequent wetting which the boiling process hadn't removed as well as orange stains where the nappies had been soiled by many children before him. With the skill of long practice, the nurse pulled the doubled over triple thickness between Bobby's legs and, pulling up the sides around his hips, pinned them in place with four white tipped safety nappy pins. She picked a pair of clear plastic pants off the trolley and worked them over Bobby's ankles and up his legs and bottom, making sure that all of the nappy was tucked inside the plastic pants. The plastic pants ballooned round Bobby's hips, but cut into his thighs and waist to ensure that they didn't leak.

 

When she'd finished, she removed the changing mat from under him and helped him into bed. At that moment the consultant arrived to repeat some of the prodding which the family doctor had done. The consultant smiled at Bobby, “We'll do our best to get you well as soon as possible.” Bobby liked her smile and immediately felt that he could trust her. “You've been a good boy to let me poke you like that. We're going to starve you, I'm afraid as we need to have you empty for some tests later. First you'll have some blood taken and then you'll go down to X-ray for an X-ray of your tummy, then to Ultrasound to let them look at your bladder and kidneys another way. When you're in X-ray, I want you to drink a bottle of water that nurse will give you to take with you so your bladder is full, if possible when you have your ultrasound scan. It won't hurt, I promise, but please try not to use your nappy after you've had your X-ray.” Bobby promised that he'd try. “Good boy! Apart from that, I positively order you to wet your nappies as much as you can. I don't want you trying to hold back as I don't want more pressure on your kidneys. Is that understood? You will be in trouble if you don't wet in your nappies!” Bobby promised her that he would keep wetting his nappies as often as he could. Secretly he was surprised at this as he'd always been encouraged to try to be dry until now.

 

In a very short while he was taken down to X-ray where a full abdominal plate was taken and then after drinking the water from the baby bottle the nurse had filled for him, he was taken to ultrasound for a scan of his kidneys and bladder. The lady was right as it wasn't painful: if anything, it tickled a bit as the probe was rubbed over his tummy where the doctor had pushed his nappy down a bit to get to his bladder region with the probe. Afterwards, the doctor doing the ultrasound pulled his nappy back up, followed by his plastic pants and said that he could let it out now. Bobby was so pleased. His kidneys hurt as well as his bladder from the effort of holding it in for the doctor. That night his mum kissed him and had to go home. He got to speak to the boys on either side of him and learnt, to his delight, that they were wearing nappies and plastic pants too, so he was in good company. He asked the elder boy what happened if he wanted to 'do his number twos'. The boy told him that he could either ask a nurse who would take his nappies off or he could use his nappies and let the nurse know that he needed changing. The boy told Bobby that the nurses preferred those in nappies to use them full time and they'd be changed as needed. “But I can't do that!” exclaimed Bobby. A nurse was passing and asked what the matter was. Bobby asked her about toileting. She laughed and assured him that his nappies could hold more than just urine and that it was quite in order for him to soil them. She did tell him when the scheduled changes were and advised that he'd be more comfortable if he filled his nappies just before a change. “I don't know that I could go in my nappies, like that,” he said to her. “If you have any problems, we can give you something to make it easier. The doctor wants you to stay in nappies as much as possible. You were told to drink plenty weren't you?” Bobby wasn't sure whether he had or not and said so. “I'll settle the other children down and then come back and give you a drink. How about that?” Bobby agreed that he'd like that, so she pulled the curtains around his bed while the nurses settled all the children for the night. In a short while, the nurse came back to Bobby wearing her white plastic disposable apron and carrying a large baby bottle full of orange juice with a rubber teat on the end. She pulled down the cot side from his bed and lifted Bobby onto her lap. She cuddled him and rocked him gently as she gave him the bottle. Bobby thought that he was just like a big baby, but found her cuddles and rocking very soothing – so much so that he fell asleep in her arms and was lifted onto the bed gently by another nurse.

 

The next day he had an excreting urogram and a micturating urogram. The first one he had his nappy removed, then a board strapped across his tummy followed by an injection or radio-opaque dye. The were balloons or something underneath the board and these were blown up so that his tummy was squashed by the balloons. Bobby had explained to him that it would squash the tubes from his kidneys to his bladder so that his kidneys would fill with the dye. When they had taken X-rays of that, the balloons were deflated and the board removed so they could film the dye passing down Bobby's ureters to his bladder. He was asked to empty his bladder and then came back to have one last picture taken to see how much was left in his bladder when he tried to empty it fully.

 

The micturating urogram wasn't very pleasant. His nappy was removed (fortunately dry as he'd just had a change in the ward before each procedure. The doctor swabbed his nappy area with antiseptic, then with the help of a nurse who held his penis, squirted lubricant gel into his penis. This was followed by a catheter and a pressure monitor. The doctor explained everything to Bobby as he did it, even warning him that inserting the catheter might hurt – he was right – it did. After this, the doctor inserted a pressure probe wrapped in a rubber finger cott in Bobby's back passage. His bladder was filled until it hurt with radio-opaque fluid and the catheter was removed. All the time X-rays were being taken. Bobby was asked to stand sideways to the X-ray scanner as he emptied his bladder. He was so embarrassed to stand there emptying his bladder into the funnel while that staff watched and videoed the pictures from the X-ray scanner. The doctor told Bobby he'd done well and there were just two more things to be done. He told Bobby to take a big breath and pulled the pressure sensor from his bladder – that really hurt! Finally he removed the pressure sensor from his back passage and the nurse put his nappies and plastic see through pants back on him. She lent over and whispered, “You've been great! You didn't make a fuss at all. Good lad!” Bobby felt proud he'd pleased the staff – he'd tried not to make a face when it hurt him.

 

The next day, Bobby, his mum and the consultant met around Bobby's bed. Bobby was very hungry and thirsty as the nurses had put a 'Do not feed Bobby' notice over his bed, saying that he might have something done later after the consultant had seen his mum and him. Bobby was in bed and the two adults were sitting on chairs facing him. To his surprise, the consultant spoke to Bobby, not his mum. “Bobby, you have a number of problems which need sorting urgently. Your bladder is too small and is deformed – that means it's the wrong shape and doesn't empty properly either. That means that the urine can't come out of your kidneys properly which hurts you and makes your kidneys swell There are operations to cure this, but they are better done when you're fully grown. There are a choice of operations and new ones are being produced all the time. If we do nothing, your kidneys will die and you'll be very, very ill. What we must do at all costs is protect your kidneys. Do you understand that?” Bobby told her that he did. “Right then. There are several things we can do to make your urine drain properly. One is to put a special catheter into your bladder. You had a catheter put in for your micturating urogram, but it wouldn't be painful like that probably was. You would have one all the time with a bag strapped to your leg to collect your urine. The second possibility is what is called a suprapubic catheter. We'd put you to sleep and make a little hole in your tummy into your bladder and the catheter would go through there, again with a special bag.” Bobby's mum interrupted at that point. “I can hear a 'but' in your voice, doctor. What are the problems?” “Well, Bobby, your kidneys are a severe risk if you got an infection and the catheters are likely to cause you to have infections. We still need to keep your bladder drained but in a way in which you won't keep getting infections. Putting tubes into you allows the germs a way to get in. There is another way which should stop your kidneys being damaged, but I'm not sure if you'll like it.” “I won't know if you don't tell me,” Bobby said boldly! The doctor laughed, “Well, you get straight to the point and no mistake! That's good. What I would suggest doing is inserting a special valve in the neck of your bladder which will stay there until you are old enough to choose which surgery you want and also your body will not have problems as you'll have stopped growing. This valve is a one way valve which lets urine out but not back again.” “That sounds all right, “ said Bobby, “What's the problem?” “You'd leak urine constantly and need to either wear what we call an external catheter which won't cause infections, but isn't suitable for a boy of your age, or you'd have to be in nappies all the time.” Bobby thought about this as the doctor signed to his mother to let him make the running on this. “Wearing nappies isn't as bad as I thought it would be. I can live with that, I think. How would I get on at school, though. Wouldn't the other boys tease me and call me a baby? I couldn't stand that.” “It wouldn't be a problem. There's a special school for boys and girls with physical problems who are otherwise normal. It's got very good results (for mum's reassurance) and you wouldn't be teased because all the other boys and girls would have some sort of problem too.” Bobby turned to his mum, “I don't want my kidneys damaged and I'd like them to stop hurting. If you're all right, I think I should let the doctor do that. What do you think?” His mum replied, “If it's the best solution and you're happy to wear nappies, I'll sign the consent form.” The consultant immediately handed over the form which his mum signed after the consultant explained all the ins and outs of the procedure. With that form signed, she turned to Bobby and said, “The nurses will get you ready. We'll do it as soon as you're ready for theatre. You'll be asleep for this so it won't hurt. And you can be back here for lunchtime ready for something to eat!”

 

They left Bobby in the care of a nurse who took him to the bathroom. He was given the chance to use the toilet, then she put him in the bath and proceeded to wash him thoroughly from head to foot. She'd put on white rubber Wellington boots and a neck to ankle length plastic apron which she'd put on to keep her uniform dry. She washed his hair and rinsed it off with jugs of water from the sink. When she was satisfied that he was clean, she dried him on her lap in a big white fluffy towel. John thought that was marvellous! She put him in a disposable nappy for theatre, giving him the choice of design on the front. He chose the 'Harry Potter' ones with Harry waving his magic wand. The rest of the nappies were thick padding with leg cuffs and noisy white plastic outer covering. He then had a theatre gown and a paper 'shower cap' type hat put on his head to keep his hair out of the way. She picked him up and cuddled him to her as she carried him back to his bed which had been freshly made ready for his trip to theatre. As soon as he was in bed, she and another nurse wheeled him down to theatre. Bobby hadn't had time to be apprehensive – everything was happening so fast! Mum came out of the ward office to join them and held Bobby's hand. When they reached the waiting area, Bobby's mum was asked if she would carry him, which she did, as they made their way to the anaesthetic room. Bobby's mum was asked to sit down, and cuddle Bobby for them. The operating department assistant put some monitoring electrodes on Bobby's chest, a pulse oximeter on one finger and a sphygmomanometer cuff around one arm, explaining what she was doing and why to the little boy. The anaesthetist held out a green clear plastic mask with a soft green silicone rubber inflated rim attached to a white corrugated polythene hose with a blue inner hose leading over the anaesthetic machine. “Bobby, I want you to hold that mask over your nose and mouth and to take big breaths. See this green bag here? I want you to try to blow it up for me. You'll smell something like apples. That's my special gas which will help you off to sleep and, in a few minutes, you'll wake up and it will all be over! When you're asleep, I'll give you a little injection so that you won't feel anything for a while below your waist so there won't be any pain or discomfort.” He handed Bobby the mask which was hissing from oxygen being piped through it. Bobby held the mask over his nose and mouth as he'd been brought up to be an obedient buy. He tried taking big breaths and giggled into the mask as the bag inflated and deflated. As he was doing this the anaesthetist turned on the sevoflurane so that Bobby drifted quietly and uneventfully into unconsciousness. As his hand dropped away, an ODA lifted Bobby from his mother and he was placed on the trolley in the anaesthetic room. The mask was held over his nose and mouth with his head tipped back by the anaesthetist who massaged the bag to force the unconscious Bobby to breath more anaesthetic to take him down deeper. His mother was asked to go back tot he ward to wait for him. When she'd gone, the anaesthetist popped a child sized laryngeal mask airway down the lad's throat and reconnected the anaesthetic tubing to the LMA. A quick listen with his stethoscope confirmed all was well. With Bobby's veins dilated by the anaesthetic, the anaesthetist inserted a cannula into one of Bobby's veins. He preferred to do this once the child was unconscious as they tolerated it better that way. Bobby was rolled onto his side for the caudal block injection which would provide pain relief for him post operatively. His coccyx was swabbed with antiseptic, then the anaesthetist felt for the right place between the bones. He inserted the needle then moved the syringe so the needle pointed towards Bobby's head and pushed it into the caudal space, He injected the bupivacaine local anaesthetic, removed the syringe and Bobby was wheeled into theatre.

 

In the theatre his legs were put in the lithotomy stirrups to allow the consultant access to his penis. He was swabbed with aqueous antiseptic by and ODA who then draped surgical sheets around him leaving just his small manhood exposed. The consultant asked a nurse to grasp his penis for her as she squirted sterile lubricant from a special syringe into his penis and urethra. Her registrar placed some gel on Bobby's abdomen and held an ultrasound sensor over his bladder. The consultant took the inducer from its sterile packet and gently, to avoid damage to his urethra, inserted the inducer into his penis. She felt the resistance as she reached his prostate and the sudden ease of introduction once she'd passed the prostate and was into the bladder itself. “You're there,” her registrar told her. The consultant pressed the plunger on the inducer to its stop. This allowed the barbed hooks on the stent and valve to pop out all around like the petals of a flower. She then pulled back on the inducer which brought the hooks into place around Bobby's bladder outlet. She continues to pull as the hooks embedded themselves in place, holding the valve so securely that it would take open bladder surgery to remove them. She continued to pull as the inducer came away, leaving Bobby's bladder sphincter muscle held open by the valve. When the inducer had come out of his urethra, there were two thick nylon threads emerging as well. The consultant grasped these with a pair of Spencer-Wells forceps and tugged hard. This was to make sure that the hooks were well in place. She removed the forceps and pulled on just one of the threads which turned out to be just a single thread looped inside the valve. The thread came away leaving the valve in place and Bobby completely incontinent of urine. His legs were taken down from the stirrups and the ODA placed a thick layer of nappies on him and a pair of new clear plastic pants for his new life as a constant wetter.

 

Bobby soon woke in Recovery and was allowed a sip of water. He had a drip of saline up to keep him hydrated and to run plenty through his kidneys to allow the gel and any blood to be washed from his bladder into his nappy. Bobby was taken back to the ward where his mum hugged him, crying. Bobby didn't understand why she was crying until much later in life when he had children of his own and realised what an anxious time it was for parents when their children were in theatre. “Mummy, I can't feel anything below my waist,” Bobby said to his mother. “You're not supposed to, dear,” she replied, “You were given an injection to make you numb so there wouldn't be any pain.” “Oh yes,” Bobby replied, “I remember now. The man who put me to sleep said he was going to do that!” Soon Bobby was drinking from a baby bottle as he was still lying down. In a while he was allowed to sit up and eat some lunch. The nurses, who had been checking him regularly since his return from theatre, decided that he was fine and didn't need checking again. Later, Bobby started giggling. “What is it?” Bobby's mum asked him. “My bottom is all tingly! It feels really funny.” “The anaesthetic must be wearing off,” his mother said. Soon his legs got 'pins and needles' too. Eventually he had normal feeling restored. He could feel the dribble out of his penis into his nappy for the first time. It dribbled almost all the time and he supposed he'd get used to that over time.

 

The next morning, the drip was removed and he had yet another nappy change into new nappies and new plastic pants to go home in. Mum came in with some jogging bottoms to cover up his nappies and took him home. There were some changes. In place of his usual bed was a new hospital style bed, on permanent loan from the health authority, with a plastic covered mattress exactly like the one he'd had in hospital. “I haven't made your bed, yet, Bobby. I thought you'd like to see it. If you leak, don't worry because the mattress is the same as the one you had in hospital and wipes clean.” Bobby also noticed the changing table beside the bed with its plastic padded top and raised sides to stop him rolling off. Underneath was a shelf with piles of nappies and packets of new plastic pants. “The hospital delivered all this, this morning before I came to collect you. We're all ready to look after you!”

 

During the rest of the summer, they fell into a routine. He'd be woken up, wet in his nappies, and he'd be taken to the bathroom where he would have his nappies removed and sat on the toilet. He'd be allowed some privacy to 'perform', then he'd be placed in the bath and mum would wash and dry him. Wrapped in a towel, she'd carry him back to the changing table where he'd be well creamed with silicone cream to protect his skin and a thick layer of nappies put on. His dad had bought some Protex rubber pants for him which were moulded in one piece. There were no elastics to cut into his legs and waist as the yellow-brown semitransparent plastic pants were moulded in one piece with legs which came partly down his thighs. Bobby liked these, especially at bedtime as they were very comfortable over his thick night time nappies. They'd also bought him some children's print plastic pants which he loved wearing around the house with just his tee shirt. He was wet all the time as the valve did its job of keeping his bladder empty to avoid back pressure on his kidneys.

 

Come the start of September, it was time for Bobby to start at his new school. His mum got him ready that morning with his favourite pair of printed plastic pants with Harry Potter on them. “Won't I need to take nappies with me?” Bobby asked. His mum explained that most of the children at the school had no control over their bladders or bowels, so the school had nurses to change the children and to look after their medical needs, as well as good supply of nappies and plastic pants. She did give him a bag with his name on with spare clothes in case of leaks. Not long afterwards a minibus with tail-lift drew up outside and Bobby's mum led Bobby out to it. There were several children already in the minibus, strapped into their wheelchairs which in turn were strapped to the floor of the bus. The driver sat Bobby down and strapped him in. Bobby was the last to be picked up so they set off for the school. The other children were keen to ask Bobby who he was and why he was joining them at their school. He sat next to a girl of his age called Sarah. They both took a liking to each other and Sarah said to him, “I bet we'll be sitting together as there's an empty desk next to me1” After about half an hour's drive into the country, they pulled up the long driveway to the school. Bobby was impressed. It was a single story new building set in lovely parkland. He expressed his delight to his fellow passengers. “It's lovely, isn't it?” Sarah said. “We're all very happy here and we hope you'll be too!”

 

The minibus pulled up at the ramp to the main entrance where it was met by two smiling young nurses who greeted the other children by name and helped the driver unload the wheelchairs. Only one child needed pushing, the others having electric chairs or could propel them themselves. Bobby felt a little bit left out as he was the stranger. Suddenly he felt his seatbelt being undone and turned to see one of the nurses smiling at him as he unbuckled him. “You must be Bobby!” We have heard about you from the hospital. I'm Susan and the other nurse is Jane. You'll soon get to know everyone. Come with me.” She took Bobby's case in one hand and Bobby's hand in the other and led him out of the minibus into the school. She took him first to her room which she shared with the other nurses to show him where he was to come to be changed if he needed any extra changes. “We'll come to ask you to come for a change on a schedule to keep you as comfortable as possible. We'll keep your spare clothes here and, as you can see, we have changing tables, showers and baths so we can look after you properly!” Bobby looked at the room with its separate large cubicles with the changing tables and sinks, as well as the bath with electric hoist and a couple of showers. Bobby was impressed. She then took his hand and led him to the classroom. At the door, she said to the other children, “This is Bobby who is joining you all from today. Please make him feel welcome!” All the class chorused, “Hello, Bobby, welcome!” bobby was led to his seat which was, as she thought, beside Sarah. The teacher came in and took the register to start the day's session. The teacher said to the class, “OK, it's time to vote again. I'd better explain for Bobby's benefit. Everyone here is a 'wetter' and is in nappies. We don't have anyone with a catheter, so shorts and skirts are basically just something in the way of being changed and comfortable. We have a vote at the start of each year to see if you want to wear your shorts and skirts or just your plastic pants and nappies. OK class, how many for plastic pants? How many for shorts or skirts? OK then, plastic pants it is. (Bobby had watched the others and voted with them so as not to be the odd one out) Bobby, the nurses will take your shorts off at your first change and then put them back on just before you go home.”

 

At various times during the day, children were fetched by the nurses to be changed. Bobby took his turn. When he came back he could see Sarah staring at his plastic pants. “Wow! Those are really cool!” she said. Bobby blushed as he wasn't quite used to having his plastic pants stared at like that. As Bobby was the only one not in a wheelchair, he fetched and carried for the other children. Being changed was fun as the nurses who looked after his class, were really kind. The nurse came in a white plastic apron and rubber gloves to lead him to the nursing area. What did surprise him was the first nappy change when the nurse removed his shorts and tee shirt, then lifted him onto the changing table which, to his surprise, had a shower attachment to hose off the nappy area and drainage underneath. He laid there naked, but the room was very warm so it didn't matter. The nurse commented on the dribble of urine out of his penis. “We know about your valve, Bobby, and the reasons for it. We'll be nagging you to keep drinking to keep your kidneys working properly and give them chance to recover!” Bobby was surprised when she picked up a thermometer, dipped it in some lubricant and parted his legs before she popped the thermometer into his back passage. She held the thermometer in place, twisting it as she timed the thermometer. Bobby had never had his temperature taken that way before. Susan explained, “We check every child every morning as some of our children are very frail and we try to avoid a sick child bringing infection into school. She removed the thermometer, checked it, washed it and put it in disinfectant ready for later use. She wrote the result down on a chart and then took Bobby's pulse. She picked up the shower attachment. “We wash your nappy area every time and cream you with the same cream your mum uses before we put you in clean nappies.” Bobby loved the attention and the way she dried him with a soft white fluffy towel before creaming him. She took a thick pile of terry towelling nappies and folded them before placing them under Bobby and pulling them tight around him, pinning them in place with his pins at waist and hips. She wiped the plastic pants out with an antiseptic wipe before putting them back on him. “We only change your plastic pants it they're soiled. I gather you control your bowels. If you need to use the toilet, let one of us know and we'll take your nappy off for you to let you use one of the bedpans as we don't have normal toilets for the pupils!” She showed Bobby one of the green plastic bedpans with a rim not unlike a toilet seat. When she checked, Bobby agreed that he could control his motions.

 

Bobby really liked the school as the other children were fun and the lessons were challenging, more so than he'd been used to at his other school. All went well until one day when Sarah soiled herself in a very smelly way. Bobby commented, “Co! What a stink!” Sarah blushed deep red and looked as if she were about to cry. The whole class went silent. Bobby suddenly realised his mistake. He started to apologise to Sarah, but she wheeled her chair away and headed off to the nursing area. Sarah came back very red around her eyes from being changed. Bobby tried to apologise again, but she ignored him. The rest of the day, the other children had as little as possible to do with him and the nurses weren't their friendly cheerful selves. When he got home that night, he blurted it all out to his mum and how sorry he was. His mum said, “With your wet nappies, you might smell at time, you know. You were put there so no-one would bully you for wearing nappies and you've been a bully yourself.” Bobby kept saying how thoughtless he'd been and how sorry he was. His mother asked him if he'd be as thoughtless again and cuddled him as Bobby burst into tears. Later that evening, the family went out to Burger King where he was given a double helping of onion rings along with his burger and Coke. [The sulphur containing chemicals in the onion family contribute to foul smelling stool]

 

The next morning he was left to stay in bed asleep longer. His mother hurried him and didn't let him use the toilet before school. “You can always go at school,” she said to him when he complained. His mother put an extra thick layer of nappies on him that morning and clear plastic pants. “Can't I have some printed ones, mum,” he asked. “Not this morning, dear,” came the reply. Just before the bus was due, his mother brought a small glass covered in condensation with a spoon in it as well as a larger glass of orange juice. She stirred the smaller glass and brought it over to Bobby. She held his nose and told him to swallow it quickly. As soon as he'd done that, she thrust the other glass at him as he retched at the oily taste. “Drink that quickly!” he did so and then she gave him a peppermint to take away the taste. “What was that, mum?” he asked. “You'll find out later,” his mother said.

 

As soon as he arrived at school, one of the nurses took him to check his temperature. Leaving his shorts off, he was escorted back to the classroom. Everyone stared at his clear plastic pants, already showing the yellow stain where his urine was constantly leaking out, keeping him wet. During the morning, his stomach started churning and he needed to use the toilet urgently. He went to the nurse who sent him back to the classroom. “Bobby, your mother was asked to give you some laxatives. Today, you're not going to be allowed to use the bedpan to pass your motions into. You'll stay in your nappies. Now go back to your class!” Bobby went back with a heavy heart. A little while later, his bowels erupted into his nappies. His nappies were pinned on tightly so the loose runny stool spread out all over his bottom and up his front. The brown stains were clearly visible through the clear plastic pants. Bobby was bright enough to realise what had been done to him. He saw Sarah looking at the stain across the front of his nappy. His bowels erupted again and the foulest smell possible escaped from his nappies and plastic pants. Sarah commented in a loud voice, “Co! What a stink!” Bobby burst into tears as he was so sorry for his thoughtlessness the previous day. The teacher said, “You'll stay in your dirty nappies until after lunchtime to remind you that others can't help soiling themselves as you have done today.” Sarah reached over from her wheelchair and pulled him to her, cuddling him to her, “I forgive you, Bobby. We're still friends aren't we?” Bobby never made an inappropriate comment again. He was sad when he had to leave the special school to go to an ordinary school where the school nurse changed him as needed and he was allowed to miss games and PE to avoid being bullied. Nappies were his way of life and he kept putting off going back to the hospital to have further surgery.