So, I was recently admitted to the Royal Victoria Infirmary (RVI) – a hospital under the Newcastle Upon Tyne Hospitals NHS Foundation Trust – for a final surgery on my thumb and it made me think and realise all the different elements you need when being admitted to hospital. And that they don’t have in evolve around packing a toothbrush and chargers for your phone!
Why I was admitted…
Unfortunately,
I broke my wrist in November 2019, and apparently that injury can lead to what
happened with my thumb on Boxing Day (December 26th) 2019. I was
using my thumbs to try to wiggle the cork of a bottle of Prosecco loose when
all of a sudden, I couldn’t move my right thumb (you can read my first post
about the injury here)!
It wasn’t as though it was sore, and I couldn’t move it because it’d hurt, I just genuinely couldn’t move it. It was so frustrating because I could feel my brain telling my thumb to lift up, but it just hung there, powerless, limp and lifeless. It was definitely one of those things where you don’t appreciate what you’ve got until it’s gone! I really hadn’t recognised just how important my thumb was to my general movement and ability to do things until I couldn’t use it.
I
instantly knew I needed to go to hospital and so I went with my Mum to my local
Minor Injuries. The Nurse Practitioner examined my thumb and predicted that it
wasn’t broken or dislocated but agreed to do an x-ray anyway. I was convinced
she’d be proven wrong and was shocked when she returned with the results and
diagnosed me with a frozen muscle/joint and recommended my Mum encourage me to
put it in warm water and to slowly try to start moving it. And I just wanted to
say that water would make no difference – it wasn’t going to move because
something was wrong with it. After showing me the x-ray in an obvious attempt
to placate me, my Mum and I went home and I was left feeling terrible for
‘spoiling’ Boxing Day, but Mum obviously reassured me that wasn’t the case at
all.
When
my thumb still wouldn’t lift upwards a few days later, I decided to take a
chance and went to Accident and Emergency (A&E) at the RVI. Booking in at
reception I was worried that I’d either be laughed at for attending for the
sake of a thumb or told to just go along with the Minor Injuries advice of warm
water. So, when the Nurse Practitioner called me through and his first words on
seeing my thumb were: “something’s wrong with that!” – I felt so validated and
relieved that a professional could finally agree with me and felt hopeful that
in doing so, it heightened my chance of actually receiving treatment for it and
the chance of it recovering.
After
another x-ray the Plastic Surgeon was called and explained that I’d either tore
a ligament which would take months to heal or I had torn a tendon which would
need surgery. Either way, he gave me an appointment to attend the outpatient
Plastic Surgery department the following day.
After
a quick examination the Surgeon determined that my Extensor Pollicis Longus
(EPL) tendon has torn and that I needed surgery that day to ensure I didn’t
lose the function of my thumb! Honestly, I was obviously upset and scared at
the prospect of surgery, but I was also very angry that the injury had been
misdiagnosed (I talked a bit about this, and the impact my physical health was
having on my mental health here).
I
thought that after that surgery, that would be the end of it but the tendon
repair tore and within a month I was faced with the prospect of more surgery
(which I blogged about here). My Surgeon was hesitant to
go in and do another, bigger surgery so early on and recommended that I try to
adjust to the loss of mobility over the next few months and then re-assess
whether it’s still worth operating on. Honestly? I was a bit put-out because a
lot of my Surgeon’s recommendations were off the back of other patients with
the same (to a certain degree) injury and that made me worry that she wasn’t
grasping just how much it was affecting me and just how desperate I was to have
the surgery.
Then,
unfortunately, my mental health deteriorated and after two surgeries to repair
my radial nerve after severing it during self-harm, my Surgeon decided that she
wouldn’t do the tendon repair until there’d been no instances of self-harm for
six months. She explained that her reasoning for this was her being concerned
that she might operate and then me basically ‘ruin’ her work! At the time it
was really frustrating because I thought that getting the mobility back would
actually support my mental health and encourage safer thoughts which were the
direct opposite of those around self-harming. Looking back though, and now
being at almost 300 days self-harm free, I can totally understand and
appreciate her way of thinking.
So,
when I had an appointment with my Surgeon not too long ago, I actually felt
really proud to tell her how long I hadn’t self-harmed for and was really
grateful that she kept to her word. She did an examination to check the
mobility and asked me a few questions about how it was impacting my life and
the things I’ve had to learn to do differently because of my thumb. She agreed
to add me to the wait list for the surgery which she explained would be a
tendon transfer.
My
understanding of that, until right up to my last examination with her on the
day of my surgery, was that we have one tendon in each finger except your index
finger and thumb (where you have two in each!) and so the surgery would mean
replacing one of my torn tendons in my thumb with one tendon from the index
finger. Honestly? I feel like it just screams pain! Like, just to hear that
process sounds painful. And when I’ve been asked by friends and family what the
surgery would be, they’ve all either wrinkled their faces with disgust or
widened their eyes with the amazement of the things medical professionals can
do these days!
On
the day of my surgery, my Surgeon explained the actual procedure a bit more and
it turned out I hadn’t exactly understood it very well. Now, whilst my surgeon
hasn’t told me every incision and stitch etc step by step, this link seemed to
be the most accurate to what I was told: https://www.assh.org/handcare/condition/tendon-transfer-surgery
Why it’s ok if packing your bag is
important…
Whilst
the title of this blog post and the theme of it, is that a hospital admission
isn’t only about preparing an overnight bag; I won’t deny the importance of
ensuring you have the practical things packed.
I’ve
talked a lot before on I’m NOT Disordered about being labelled materialistic
and superficial – particularly when it comes to my passion for makeup,
handbags, shoes, and my reliance on technology! Over the years – mostly due to
undergoing Dialectical Behaviour Therapy (DBT) – I’ve learnt a lot about
recognising and respecting the coping strategies others find helpful in
managing their mental health difficulties. It’s left me believing that if I
find doing my makeup soothing and helpful in deterring thoughts of self-harm or
suicidal ideations then that should be appreciated by myself and by others. It
shouldn’t be used as a judgement tool to decide that I ‘mustn’t have been that
suicidal’ for something like that to have helped me.
So, I’ve made a few little images of favourite items to take on a hospital admission (apologies that some of these may not be appropriate for everyone!):
Overnight
Bags:
RSD Barrel
Bag: £70
White
Monogrammed Suitcase: £75
Black
RI Barrel Bag: £45
Beige Weekend Duffel Bag: £55 (MY ACTUAL BAG)
Wash
Bags:
Guess
Cosmetics Bag: £16
Fenella
Smith Cosmetic Bag: £9.99
Skinny
Dip Lemon Makeup Bag: £7.99
DKNY Cosmetics Bag: £12.99
Essential
Items for Your Wash Bag:
LED
Travel Mirror: £27.99
Makeup
Brush Set: £11.99
Ted
Baker Mini Set: £15.50
Travel
Toothbrush & Toothpaste Set: £7
Travel Hairbrush: £4.99
Other
Essentials:
Fluffy
Bed Socks: £13.99
5
in 1 Plug: £16.99
iPad
Keyboard Case: £28.99
Everything
Disordered by Aimee Wilson: £18
Mindfulness
Book: £2.65
Why planning the transport around my
admission helped…
The
practical part isn’t all about packing a bag though either; it can also be
about transport to or from the hospital. I decided not to get the bus there for
two reasons:
1. It would’ve meant getting up
earlier than I really needed to
2. I’d just had coronavirus
swabs and was worried after testing negative for them, a trip on the bus might
turn any more positive!
So,
one of my very lovely and kind best friend’s; Georgie, took me to hospital and
then obviously having had the surgery I really didn’t feel up to getting a bus
home, so she picked me up, waited with me until my discharge papers were ready,
and took me home.
Having
that plan and preparation for something that might seem so simple and
insignificant was actually really helpful in lowering my stress levels. I think
a large part of that stems from the fact that throughout this whole… ordeal(!)
I’ve felt that things have been so out of my control. I mean from everything
like the actual injury to the recovery time! And as someone who has struggled a
lot with control, this has been challenging on my mental health too.
Why I had to prepare for trauma triggers…
In
that loss of control around the injury, I think that a big difficulty was that
I have become so used to being responsible for something being ‘wrong’ with my
body. For years, I have been the one to have inflicted pain on my body and so I
very easily came to the mindset that no matter when the aftermath of the
injury, I knew I was to blame for it. And this way of thinking stems right back
to the abuse and the realisation that my abuser might neither take
responsibility for what he did to me nor suffer any real consequences for his
actions. So, I’ve found that blaming myself and having me be responsible for
what happens to me, is a much more straightforward feeling than any frustration
or anger I’ve experienced when another person isn’t accepting any
responsibility.
Through
DBT, I learnt a lot about blame and responsibility – particularly around the
abuse. I learned that whilst it might seem easier to blame yourself, it
isn’t healthy. Rather than do it as a coping mechanism, you really need to
learn how to cope safely with any feelings toward the person who is responsible.
But how do you cope when there really isn’t anyone responsible?
In
considering the abuse and relating it back to my tendon injury and the surgery,
I also think that I’ve struggled with coming to terms with the fact that I hadn’t
wanted the pain (in both the abuse and the tendon). It wasn’t as though I was
struggling with my mental health and it was providing me with so many reasons
to inflict pain on myself and to self-harm in some way.
Over
the years of self-harm, I’ve experienced a lot of instances where I’ve caused
some sort of pain to my body but have found myself still suffering the
consequences of that even when I no longer wanted the pain. This was particularly
true for the occasions when I self-harmed to a degree that I severed the
branches of my radial nerve because I had to have surgery days later. I
remember crying when the Plastic Surgeon said I needed the operation and that whether
I had surgery or not, the damage may be permanent.
It
was frustrating but being the ‘glass-half-full’ type of person that I am, I
managed to put a positive spin on things and started to view that frustration
as motivation to fight thoughts and feelings around self-harm. When that
mindset would creep in, I reminded myself that I’ll have to live with the
consequences of whatever I do as a bid to get through that one moment I’m struggling
with. It helped that the Crisis Team taught me not to regret these things if I have
been able to learn from them.
In coming
to terms with all those difficult reminders and the connections to self-harm
etc, another trigger I worried about was that I was being admitted to the same
ward I’d been on when hospitalised for self-harm. In fact, the last time I’d
been on that ward, I hallucinated and self-harmed in the bathroom and was put
under strict observations of having a member of staff sat with me through my
entire admission. So, of course going back there stirred up some anxiety and
worry in me…
Finding bravery from DBT…
Coping
with the anxiety and panic around the possibility of being triggered regarding
my surgery and the injury in general, wasn’t the only reason why I needed
bravery for my hospital admission. But I mostly found bravery in using my pros
and cons exercise from the Distress Tolerance module of DBT. Typically, this
exercise is used in making a decision so that it enables you the opportunity to
sit down and really think about all the benefits and consequences to your
decision. It’s sort of an attempt to really avoid any emotional and impulsive
thoughts and feelings in making the decision. So initially I used the exercise
to make the decision as to whether or not to even go ahead with surgery; but in
questioning my bravery, I found that reading the pros to my decision actually
really supported me in maintaining a level of courage. It really helped to
motivate me in recognising that I had some very important reasons to be brave
and to see this surgery – and the admission – through.
I’m
definitely someone who benefits from having things written down in front of me
and so creating the pros, cons, and middle ground graphic really helped to make
all these reasons actually real and meaningful. It felt as though now they were
solid and embedded in my mind so that if I found myself questioning my bravery
again, I would have some ammunition to fight those worries and doubts.
As
it turned out, it wasn’t just about triggering and upsetting memories of
previous hospital admissions that challenged my bravery. There was also the
very obviously blunt fact that I would be going under a general anaesthetic to
have surgery that might not work! I mean, going into the anaesthetic room to be
confronted by three anaesthetists, a nurse, and a ton of medical equipment; my
first words were “oh God!” And when they tried to reassure me, I told them that
everything looked so intimidating. Having those ‘pros’ of getting the surgery
though, willed me to get up onto the ‘bed’ and lie still while they prodded me
with needles to administer the anaesthetic.
After
surgery, I was also faced with needing courage to manage the pain I was in. Of
course, I had expected pain – I mean, it was surgery(!) and they were transferring
some tendons so of course it was going to hurt afterwards! But even knowing you’ll
be in pain from something, you can’t really have an exact and accurate expectation
on just how much pain there’ll be and just how well (or unwell!) it’ll be
controlled with painkillers.
Unfortunately,
I’ve been on painkillers for quite a long time since the tendon first got injured,
so the amount of medication they could give me after surgery wasn’t as
beneficial as it might have been for someone who has only ever taken paracetamol!
However, my mental health being as stable as it is, I was able to find bravery
in understanding and accepting that this pain wouldn’t last forever – no matter
how persistent it may seem.
My recovery plan…
Currently,
I have an appointment next week to have my dressing/cast changed – at the
moment the only solid, cast part of my dressing is down the underside of my arm
from the elbow and then around my thumb. Across the top of my arm and over my
knuckles is all soft dressing. So, at the appointment they’ll be doing a wound
check of the incisions, and then putting on a ‘full cast’ which will stay on for
three or four weeks.
At the
end of June, I see my surgeon for the cast to come off entirely, to have her do
an examination, and then have an assessment with the Physiotherapists to
determine how intense my physio needs to be. To be honest, when I was deciding whether
or not to have surgery, I really didn’t put much consideration into the idea needing
rehabilitation after it. And I definitely didn’t think about a particular issue
I’d need physio for because my surgeon didn’t tell me about it until after the
surgery! She said that because the tendons were transferred, some people find
it difficult to coordinate their thumb and forefinger in that sometimes when
they intend to give a thumbs up, their forefinger will lift! So, physio will be
about re-routing my mind in accordance with the new positions of the tendons.
Longer
term, my surgeon has said that the expectations are that I have better mobility
in so far as lifting my thumb, and that there’s ultimately little to no pain.
All the practical essentials for your recovery…
Peony
and Suede Candle: £3.50
(similar)
In-Ear
Headphones: £14.99
Harry
Potter Box Set by J K Rowling: £34.12
(similar)
Sleep
Eye Mask: £3.33
Kindle:
£69.99