Neil’s Complications

 

Neil lay in bed reflecting on how things can change one’s life in just a few short seconds and how he had no inkling of what was to happen when he got up for school that morning that terrible day.

 

It had started out like any other. His mother had called for him to get up, so he’d climbed out of bed, gone to the bathroom and showered, then back to his bedroom to put his school clothes on ready to join mum and dad at the breakfast table. It had all seemed so normal as he finished his breakfast, kissed his mum goodbye, then walked out with dad for him to catch the bus to work while he walked to school, meeting up with his friend Stephen. Neil was thirteen years old, attending the local comprehensive school. His way to school involved crossing the busy high street, but he was always careful and used the pedestrian crossing to cross the single carriageway road. He'd pressed the button and waited for the 'Green Man' to be displayed, then started to cross in the approved manner. His friend, Stephen, saw the four-wheel drive vehicle bearing down on them. It was one of the BMW SUVs with bull bars, although those had been outlawed for good safety reasons so the driver had fitted them illegally. He shouted a warning, which caused Neil to half turn to face the on-coming vehicle which hit him across his thighs with a badge on the bull bars hitting Neil's abdomen. He was knocked flying in the air, landing on the pavement where, perhaps mercifully in the short term, he lost consciousness.

 

When he awoke, he was being cared for by ambulance staff, one a female paramedic and a male technician. The male technician was holding a bag of fluid connected by tubing to a cannula in Neil's left hand. He had one of the pale green transparent oxygen masks over his face – the type with a metal insert to fit it over the nose and an elastic strap to hold it in place. He was lying with his legs in splints on a metal 'scoop' stretcher. He tried to lift his head to see his legs and body, but the pain forced him to lower his head with a moan. His abdomen hurt and burned inside with both legs feeling, correctly as it turned out, that he'd had them both snapped in two. The female paramedic bent over and said to him, “We'll give you something for the pain now you're awake. I'll give you an injection of Nubain which is a pain killer and you can also have the entonox to breath which should help too.” She gently removed the oxygen mask, easing the elastic over the back of Neil's head and handed him a black rubber mask with an inflatable rim. “You'll need to hold it tightly to your nose and mouth and take deep breaths. If you don't get a good seal, the gas won't come.” Neil held it to his face, smelling the strong rubbery smell of the mask and the sweet after-smell of the nitrous oxide. He took a breath, but nothing seemed to happen. The paramedic pushed the mask more firmly to his face, “Try again!” This time he heard the click of the demand valve as it opened and smelt the sweet smell of the nitrous oxide mixed with oxygen. When he breathed out, he could hear the metallic click as the demand valve closed and the exhalation valve opened. He breathed in and out, feeling the gas begin to make him feel dizzy and disorientated, helped, no doubt, by the injection of Nubain which the paramedic was putting though his iv. tubing. The blue entonox cylinder was given to Stephen to hold and a by-stander took the IV bag as the ambulance crew lifted Neil on the 'scoop' onto a normal stretcher, then wheeled him into the ambulance which had lowerable rear wheels and a drop down ramp. Neil made good use of the entonox as he was wheeled into the vehicle. He hurt despite the pain-relieving drugs, continuing to suck hard on the entonox, with the paramedic, feeling sorry for the poor lad, helping him to hold it in place, against all the rules, so that he would continue to get the pain relief. She was glad he couldn't see that his trousers were wet with bloody urine, guessing, correctly, that his bladder had been damaged by the impact.

 

At the hospital, Neil had several X-rays before he was taken to the CT scanner. There an anaesthetist asked him some questions about when he had last eaten, whether he had any allergies or if he had any crowns, caps or plates. She then passed Neil a black rubber mask like the one he had used in the ambulance and asked him to take deep breaths of the oxygen for three minutes to saturate his blood with oxygen. While Neil was doing this, the anaesthetist explained that, as he'd recently eaten and had abdominal injuries anyway, he would have to have someone squeezing his throat while the anaesthetist put him to sleep to stop him regurgitating his breakfast. She told Neil that he was to be put to sleep for the scan and then kept asleep while they sorted out his problems and set his broken legs. An assistant then pressed on Neil's throat to compress his oesophagus while the anaesthetist injected thiopentone, followed by sux to paralyse him. She quickly inserted the laryngoscope down his throat, visualised his vocal cords and popped the ETT down through the cords into his windpipe. She then inflated the cuff after checking the insertion distance and connected the ETT to the anaesthetic machine and ventilator which would breathy for Neil when he was paralysed. She checked the tube was in the correct place by listening to his breath sounds with her stethoscope. Having made sure that all was well, she injected a longer lasting non-depolarising muscle relaxant to keep Neil in a state of paralysis until his surgery was over. Just before he was placed in the scanner, a nurse came over with a unit of blood as the matching from the sample taken in A&E had been done and Neil was in shock from blood loss.

 

From the scanner he was taken into theatre where a laparotomy was performed. The surgeon cut Neil from just below his diaphragm to his crotch to allow for a thorough check of his abdominal organs. Fortunately his intestines were intact, but the object on the bull bars which had hit his abdomen had caused his bladder to rupture, tearing the sphincter muscle which controls continence at the bladder outlet. A urinary catheter was passed up Neil's urethra into his bladder which was opened up as an assistant used a suction to remove the urine from the abdominal cavity and another ran fluid in to prevent the intestines from drying up and to help to wash out every trace of urine. As well as blood, saline and glucose, Neil was receiving heavy doses of antibiotic to cut down the risk of post operative infection. The rubber hoses twitched as the ventilator's bellows rose and fell, keeping Neil alive. Meanwhile a further team of surgeons was working on Neil's legs. Pins were placed through holes drilled in his lower leg bones and his legs were bandaged, ready for traction to be applied to move the femurs, as both were broken just in one place, on each leg. The orthopaedic surgeons had decided that it would be better for Neil in the long term to have his legs in traction rather than pinned as he was still growing. It would mean a longer stay in hospital, but they considered that it was worth it for him. His abdominal cavity was cleaned and his bladder stitched back together. The catheter had been changed for the largest one three way one which could be inserted through Neil's urethra to allow his bladder to be continuously irrigated to wash out any blood clots which formed inside his bladder.

Neil woke in intensive care with tubes seemingly everywhere. There was the catheter into his bladder with the irrigation bottle hung high washing blood out into the drainage bag, a wound drain sewn into his abdomen, a central line carrying fluids and antibiotics as well as a cannula in his back connected to an infusion to provide an epidural for pain relief. The nurse explained all this to him, saying that he shouldn't be able to feel anything below his waist. Neil was able to confirm that, thankfully, he was in no pain. His legs were attached to a frame which was fixed to the bed. There was a pin through the tibia in each of his lower legs and these pins were suspended from the top of the frame. His hips were off the mattress as his weight was taken by the pins through his lower legs so that his weight provided traction on the femurs. His legs were bandaged from just below the top of his thigh to his ankles so that his body was lying flat with his legs sticking up at right angles suspended from the frame often called the 'gallows'. A pillowcase had been draped over his crotch to provide some dignity for him. After five days during which time the pain relief medication via the epidural was cut right back, he was transferred to a children's orthopaedic ward. There the nurses cared for Neil, washing him, feeding him and, because it was easier for him as he was lying down and his abdominal incision made it painful to try to curl up from his waist, he was given drinks by bottle. Neil never complained so he had become a favourite of the nurses. Instead of getting him to hold the bottle for himself, the nurses enjoyed giving it to him, sitting by his bed and holding the bottle. His clips in his abdomen were removed as his wound had healed that clean healing which happens with young people. In addition, the epidural was removed so that full feeling returned to Neil's legs.

 

One morning the consultant on his rounds decided that it was time for his catheter to be removed. One of the nurses came to do it, deflating the balloon inside Neil's bladder with a syringe, and then gently pulling the catheter out as she instructed Neil to take a deep breath. It was sore at first and the nurse said that he would be given plenty to drink to flush through his 'plumbing'. She placed an incontinence pad, one of the shaped ones with green plastic backing, a soft cover to the absorbent layer and elasticated sides so that it curled snugly around him, over his penis and then the pillowcase. Later when she came back to give Neil a bottle, she checked on the pad and found it was wet. She watched and saw that urine was just dribbling out of Neil's penis all the time. She bleeped the consultant to tell him that his fears were justified. He came back to see Neil again and asked him if he could hold back his urine. Neil replied that he was, wasn't he? The consultant told him that he had been leaking constantly and that the pad had been soaking it up. The consultant explained that he had been expecting this because of the damage, which had happened to Neil's bladder sphincter muscle. Neil said, “Does that mean I'll have to wear nappies all the time?” The consultant replied, “There are operations which could help you, but for the moment I think we need to get your legs healed up and then you really need to be a bit older before you decide which of the several options you want to try. There are no guarantees for any of them, so you'll have to decide which one you want to try first. For the moment, I'm recommending that the nurses put you in cloth nappies and plastic pants to keep the bed dry and you fairly comfortable.

 

After the consultant had gone, the nurse went to get a bowl of water, towel, nappies and side poppered plastic pants as, of course, with his legs in the 'gallows' pants couldn't be slid over his legs. She washed his nappy area clean and dried him with the towel. She explained, “Neil, the accident damaged the muscles which stop urine leaking from your bladder. The muscles tore and the surgeon tired his best to sew them back together. He didn't expect it to work as the muscles were very badly torn so the scar tissue stops the muscles closing properly. In addition, he thought there might be nerve damage, too. We are moving over to real nappies instead of disposable ones as they are environmentally more friendly as well as being cheaper in the long term for the hospital. I'm going to put cream on you to stop you getting nappy rash, then I'll put the nappies on you. She had placed another disposable pad there to soak up the urine, which was trickling out of Neil's penis constantly and creamed around carefully. She took four large nappies and folded them into three, then brought the front back to make a really thick pad for between Neil's legs and crotch to place the absorbency where it could do most good. The nappies were soft and white terry towelling, although there were permanent stains from previous use, which even the hospital laundry couldn't remove. As Neil's buttocks were off the bed anyway because of the 'gallows', she was able to slide the pile of nappies under him and, removing the pad, brought the eightfold layer up between his legs. She brought the sides round, securing them in place with four white tipped safety pins. The plastic pants were clear with poppers down each side. The back of the pants was slid under the nappies and the front brought up and over between Neil's legs. She started at the bottom on each side and did the poppers up. The pants were tight at waist and thighs, but were enormous, ballooning out to hold the thick layer of nappies. It was a good job that his legs were hanging well apart in the 'gallows' as the thickness of nappies would have forced them apart anyway. “I know I've just been started on proper solid food,” Neil said, “but how do I go to the toilet 'properly'?” The nurse smiled, “I presume you mean to pass stool? We'll change you nappies on schedule after each meal and before you go to bed at night. If you can, pass your stool into your nappy just before you're due a change. You would have found passing stool difficult anyway in the 'gallows'. That's why younger children would have been in nappies in the 'gallows' anyway. You almost certainly will be a bit constipated at first and may be all the time you're like that because you're having to 'go' uphill. If you are 'bunged up', let us know as you're written up on your drug card for various drugs to help you go to the toilet. We'll use them as necessary, but we do expect a bowel movement each day, or we'll resort to the other methods!”

Neil could feel his nappies gradually becoming wet even though he was unaware of the urine actually leaking from him. It was not an unpleasant feeling and he guessed that he was somehow remembering the safety of being a baby with no responsibilities and no need to use the toilet. That, coupled with being fed when the nurses put a large plastic bib around his neck to keep him clean and fed him bottles of water, milk and orange juice allowed him to revert to being a dependent baby. He wasn't really allowed to do anything for himself. He was washed, changed and fed all by the lovely nurses who cared for him so kindly. He had been eating solids for three days when one of the nurses at the morning nappy change after breakfast, after she had washed him and put the clean nappies under his buttocks, lubricated her rubber gloved finger and, after telling Neil what she was going to do, inserted it into his back passage. She wriggled her finger about and, after the initial shock of being violated like that, Neil found it strangely pleasant, especially when she brushed the tip of her finger against his prostate causing him to have an erection. “You're pretty solid up there, Neil. We need to shift that lot inside you and I suspect you're beginning to feel uncomfortable down there.” Neil sheepishly agreed that he was, but that he hadn't wanted to fuss about it. “Bless you, Neil, you're a good boy. I'm just going to get something to try to help you.” With that, she exited through the curtains, which were always drawn around his bed when his personal needs were being attended to and came back a few moments later with a cardboard box. Inside the box was a bottle with a nozzle on it. “This is a Fleet phosphate enema, Neil. I shall put the tube into your bottom and squeeze the bottle. You'll feel some cold liquid going into your bottom and I want you to hold it there as long as possible. I'll put your nappies back on you and you can go into your nappies. I'll come back soon to see how you got on and to change you into some clean ones to make you more comfortable.” With that, she pulled the cap off the nozzle and inserted the pre-lubricated tip into his back passage. She squeezed the bottle gently, injecting all 118 ml of the phosphate solution into his back passage. She removed the bottle quickly and pinned Neil's nappies back around him, making sure that the fit was snug around thighs and waist, then pulled up the plastic pants, snapping the poppers closed. “Try to hold back as long as you can so it will have a chance to clean you out. You'll be much more comfortable once you've been emptied.”

 

Neil felt the phosphate solution starting to work inside him. He found it difficult to clench his buttocks to hold back the enema due to the thickness of nappy between his legs. After 10 minutes, the enema won the battle and he released it into his nappy. He didn't feel as if he passed any stool and the nurse, when she came back 20 minutes after administering the enema to Neil confirmed that he'd basically just returned the enema. “I held on for 10 minutes,” Neil told her. “I shall speak to sister. I think more effective measures are called for! I'll leave you in your nappies and change you once we've cleared that blockage.” The nurse left and came back a few minutes later pushing a drip stand with a clear plastic bag filled with soapy water with a long plastic tube attached and a nozzle at the end. “I cadged this from the X-ray department. It's a barium enema set with a special nozzle to help you to hold it. The bag is filled with hot soapy water which will both soften your stool and help you get rid of it.” She lubricated Neil's anus again with a gloved finger covered in gel, having first smeared some over the plastic enema nozzle. She gently inserted the nozzle into Neil's back passage and, when the balloon part had passed his anal sphincter, squeezed the special bellows to inflate the balloon inside Neil. He felt the balloon inflate which made him feel as if he needed to empty his bowels, but the balloon was well fixed and wouldn't shift. The nurse released the clamp and the hot soapy water slowly began to flow into Neil's colon. Soon Neil could see that his abdomen was distended from the amount of soapy water inside him. He was desperate to pass the enema, but the inflated nozzle held it back as the soap softened the stool inside him. After ten minutes, the nurse released the balloon, swiftly removed the nozzle, pinned up his nappies and fastened the plastic pants before Neil let go and the softened stool and hot soapy water added to the urine already in his nappies as it continued to trickle from him. The nurse had put plenty of thickness around him and it was just as well as the nappies were filled with the soapy discharge. Neil had thought that it would feel disgusting to do that in his nappies but was surprised that the warm mess felt quite pleasant. The nurse placed a pad under him and a fracture bedpan as she removed the saturated and heavily soiled nappies and plastic pants, washed him clean and reapplied clean nappies and plastic pants. She smiled at Neil, “I think you enjoyed that!” “I did. It was different and I like being cared for. Is that wrong?” The nurse laughed, “No, Neil, it's not wrong. We like looking after you!”

 

That night, Neil was given a dose of lactulose and two ducolax tablets to ensure that he didn't become constipated again. The next morning he woke with the urgent need to pass stool. He remembered the nurse had said that it was all right to do that in his nappy if he needed to, so relaxed and let it all out. After breakfast, the nurse came to change him. “Gosh, you passed a lot again,” she said, as she placed her rubber-gloved hand against the pile of stool in his nappy, which had formed between his legs. She grinned at him as she pushed a little harder, squashing it between his anal cleft and forcing it up between his legs and around his penis. “It's much softer today, isn't it?” Neil had to agree with her. She had pulled the curtains and had brought the equipment to wash and dry him before applying a clean layer of nappies. He was plastered, but loved the way she gently washed him clean, dried him and then creamed him. The lactulose caused him chronic wind – a side effect of that laxative in some people. Neil was glad to have the nappies on as they muffled the sound of his passing wind.

 

A few days later, the radiographer came to X-ray his femurs. She placed a lead apron over Neil's genitals to prevent radiation damage and clipped the plate to the gallows, taking the picture there and then in the ward. When she came back, she told him that the plate had come out well and that his legs looked mended, although the doctor would have to confirm that for him. Later one of the nurses came back with a wicked grin on her face. “You're to have your legs taken down tomorrow and you'll have the pins removed from your legs in theatre tomorrow morning, so I'm afraid no breakfast and nothing to drink after 6 o'clock. You're a bit constipated, aren't you? You could really do with another enema?” Neil laughed, “Oh yes, definitely!” She winked at him and went to get the equipment. Just like before, she first removed his nappy and plastic pants, then she lubricated Neil's anus with a gloved finger covered in gel, having first smeared some over the plastic enema nozzle. She gently inserted the nozzle into Neil's back passage and, when the balloon part had passed his anal sphincter, squeezed the special bellows to inflate the balloon inside Neil. This time Neil got even more soapy water inside him so his tummy was really swollen with all the hot soapy water inside him. This time, she turned his plastic pants back to front and just did up one popper at the thighs so that what had been the front of the pants hung down like a curtain between his legs. She placed a bedpan under him, telling him that the pants would direct the flow into the bedpan. Neil was rather disappointed, as he'd hoped to release it into his nappy again. The nozzle was removed and Neil allowed to void the enema. It still felt great as he emptied himself, but he missed it filling his nappy. He was washed after the pants were removed and the enema nozzle reinserted after the bag had been filled with just hot water. Again he was filled up, but this time, to his delight, really thick nappies were put on him with plastic pants normally. “Hold it as long as you can, and I'll be back in half an hour so, so to change you.”

 

It turned out to be more like an hour and Neil loved the warmth and feeling of the wet nappies surrounding his hips. He was washed, dried and creamed again before another thick layer of nappies was applied. The next morning he was taken down to theatre on his bed. He had been washed and put in a thick set of nappies and plastic pants over. A paper cap had been put over his head to keep his hair out of the way. In the anaesthetic room, the anaesthetist smiled and welcomed him. “Neil, I'm just going to breathe you to sleep with a gas called sevoflurane which smells of apples. It's pleasant to breathe and you'll soon be asleep. Once you're asleep, you'll be wheeled into theatre on your bed, your legs will be lowered and the bandages removed. The pins and the sides of your legs will be painted with antiseptic, then the surgeon will pull the pins out. It actually doesn't hurt and, if you were an adult, you'd just get them pulled out without anaesthetic, but I guess you'd rather be asleep?” “You bet!” came Neil's emphatic reply. “I won't put a tube down your throat on anything like that today as I'll be waking you up as soon as the pins are out. The nurses will put bandages on where the pins were and you'll be awake before you know it!” The anaesthetist picked up the mask, “Will you hold it or do you want my assistant to hold it?” “Your assistant can hold it for me, please,” Neil requested. “When I start the gas, I'll tell you and you'll smell the apples smell. Would you take deep breaths for me and try to blow up my gas here?” The anaesthetist showed Neil the green rubber reservoir bag connected to the machine. The assistant took the mask with its green silicone rubber air filled rim and the concentric polythene tubes leading to the anaesthetic machine, the gas supply tube being smaller and coloured blue with the outer tube being clear to carry the gas back to the machine. The assistant said, “This is just oxygen, Neil.” With that he held the mask tightly to Neil's face, covering his nose and mouth. Neil could hear the gas hissing through the tubing and found it quite hard to breathe out against the flow. He could smell a chemical smell in the mask from anaesthetic vapours which had permeated it with other patients. The anaesthetists said, “Deep breaths now, please Neil,” as he turned on the vaporiser to release the anaesthetic vapours. At first Neil couldn't smell anything different, then the gas reached him. It did smell of apples as he remembered to take the deep breaths with the reservoir bag inflating and deflating beside him just in his eye line. He felt weak and tired as he rapidly fell into unconsciousness. Waking up but a short time later in recovery, there were no 'gallows' on his bed and his legs were down on the bed for the first time in weeks.

Back in the ward, he was soon allowed to sit up and drink from a glass. He was secretly disappointed as he'd come to love the nurses giving him his drinks from a baby bottle and feeding him, but he hid his disappointment, agreeing politely with the nurses that he was glad to be able to do things for himself again. He was taken down regularly to physiotherapy to basically learn how to walk again as his muscles were so wasted from lack of use. There was one other major change, which he approved of. His plastic pants were now pull on and, instead of being clear, were in attractive coloured prints on blue or green plastic (he'd said “No!” quire firmly when one of the nurses had, jokingly suggested putting him in pink plastic pants.) He wore a tee shirt and just his plastic pants around the ward and didn't mind when some of the other boys and girls stared at his plastic pants. He wasn't the only one wearing them, so didn't mind at all. When he went to Physio, he had a gown put over the top of him to cover him up in the corridors, but did his exercises in just nappies, plastic pants and tee shirt. The physiotherapists would sometimes comment if he had a particularly attractive pair of pants on that day. One pair had fierce fire breathing dragons printed on the blue plastic: those were his favourites!

One day he was told that he could go home as he was now walking much better. He was sad to leave those kind nurses and his friend on the ward. He wore a pair of tracksuit bottoms to cover his nappies as he was wheeled to the entrance by one of the nurse. His 'good byes' had been quite emotional and tearful. At home, his mother showed him his new bed with waterproof mattress just like he'd had in hospital, as well as a Neil-sized changing mat to slip on the bed when he needed changing. His mother changed him regularly, secretly enjoying looking after her son in this way. She'd always wanted another child but problems during Neil's birth had meant that Neil was an only child and he'd always be so. She loved the chance to 'baby' him a bit, wondering whether he'd let her sit him on her lap and give him a bottle to drink from. One day Neil found the bottles his mother had bought in the hope that she could 'baby' him some more. “Mum, let's use these. They're no use in the cupboard!” Neil's mum grabbed one, filled it with juice and sat on the settee. Neil sat on her lap and she cuddled him to her as she gave him the juice. Neil thought it was heaven! One morning he'd been a bit constipated, although not as bad as he'd been in the hospital. He was surprised and delighted when his mum put a plastic apron on, laid him across her lap and pulled down the dragon print plastic pants which she'd bought for him and his nappies, then inserted the nozzle of a Fleet phosphate enema into his bottom and squeezed. She pulled his nappies back up, went to wash her hands and brought back a baby bottle. She sat Neil on her lap and gave him the bottle to drink from. During his drinking, his bowels emptied into the nappy. Yes, he was a very lucky boy to have such a loving mother and to be wearing plastic pants with dragon print and especially his wet nappies!