Appendix

I have been regaling the world with tales of my enclave of the Bagnall family for nigh on four years.  Many of these updates are planned; some are written out of necessity and are difficult because there were no major stories to base them around but there have also been a number of them that have been thrust upon me.  This is one of those.

Most of these updates have photos to illustrate the stories behind them.  A few have no photos.  This is one of those.

So what has happened to necessitate an emergency update prior to Éowyn’s birthday?

Our story begins in the early hours of Wednesday morning.  Lucinda had gone to bed feeling a little discomfort in her abdomen which we had put down to pregnancy grumbles, but at 0100 she woke me up saying that the pain was a little stronger and it felt like she needed to go to the loo.  We put it down to a virus that is going round and although she had a disturbed night thought it was nothing more.  I went to work the next day but kept in touch with her through the day to find out how she was feeling.  She didn’t seem to be getting better and she couldn’t get an appointment at our local doctor’s surgery so I left work early so that she could go to the walk-in clinic at our local hospital (Ashford) – it no longer has an Accident and Emergency department like many hospitals around the country, it used to but now it just has this walk-in clinic.

She was at the clinic for around 90 minutes before she was seen and they worried her: her symptoms seemed to indicate appendicitis and that she needed to go to the ‘local’ Accident and Emergency department at St Peter’s Hospital in Chertsey (the hospital where both of our children were born).  This is where living in the same village as your parents and brother comes in handy.  With Éowyn and Amélie in safe hands we headed around the M25 (in rush hour) to St Peter’s.

We reported in to reception and were quickly seen by the triage nurse.  Bloods were then taken and a cannula inserted in her hand and we were led to a bay to await a visit from the on duty doctor.  Appendicitis in pregnancy is not uncommon, and in fact appendectomies are the most common need for surgery in pregnant women, however appendicitis in pregnancy can be notoriously difficult to diagnose as, due the growing foetus, the appendix will have been pushed up and back from its usual position.  In addition not all of the usual symptoms (especially a fever) will be present.

The doctor we saw was excellent, she had a great bedside manner and quickly concluded that Lucinda did indeed have appendicitis and that she needed to be seen by the surgical team as soon as possible.  As you are probably aware appendicitis is the clinical term for inflammation of the appendix which, if left untreated, leads to appendiceal rupture (a burst or perforated appendix) which can lead to peritonitis, septicaemia and even death.  Obviously being pregnant complicates this somewhat.  A conservative estimate for the mortality rate of a healthy adult with a perforated appendix receiving treatment is about 0.5%, for a pregnant woman it is 8 times higher with 1 in 25 of patients dying and the prognosis for the unborn baby is worse with 1.5% dying in women with appendicitis and over 1 in 3 dying should the appendix burst.  Thankfully we were unaware of those odds at the time.

It is with those odds in mind that medical teams will err on the side of caution and always opt for the appendectomy.  It is far better to remove a healthy appendix than run the risks of the above, especially since the risks of the procedure are far lower than hoping that it can be tamed with antibiotics (which is only in the case of a ‘grumbling’ appendix).  Hence the removal rate of healthy appendices in pregnant women is higher than that in the population at large.

We were taken from the Accident and Emergency area to the Surgical Assessment Unit to await for the surgeons.  Unfortunately we had just missed the surgeon’s rounds and they were not expecting him to come back for several hours.  After waiting for several hours Lucinda and I decided that it was probably best for me to head home at relieve Lucinda’s dad of childcare duties and allow him to get some sleep.  Lucinda had her phone and strict instructions to call me when the surgeon came.  At 0200 the surgeon assessed Lucinda and basically told her to get ready for theatre.  She called me and was obviously very scared especially as there seemed to be a debate between the surgical team and the obstetrician team over who was in charge and what pain relief and medication she was allowed.  As many of you know when you are pregnant the only pain relief you can be given is paracetamol, nothing stronger and any medication given needs to be proven not to cause any issues to the unborn baby.  Not necessarily what you want to hear when you are pregnant, in pain and scared.

Needless to say I didn’t sleep very well and I am sure that the girls knew that something was up and they had a disturbed night too.  I got out of bed early and phoned the Surgical Assessment Unit.  They told me that Lucinda was now under Midwifery care and so to call the Joan Booker ward.  It took three attempts to get through to the Joan Booker ward to be told that they had no record of Lucinda and were just about to hang up on me when I became a little more assertive and before I really did get angry with their dismissive attitude they suggested that perhaps she might be on the Labour Ward.  I called the Labour Ward (thank Tim Berners-Lee for the internet!) and got through to a very helpful Midwife.  She went to check on Lucinda while I was on the phone and said that both Lucinda and our unborn son were in good health even if Lucinda was a little groggy.

Plan A then went into action.  Amélie was dropped off at Nanny and Granddad’s after which I took Éowyn to pre-school before taking supplies to the hospital.  Lucinda was a little groggy and in some discomfort but in good health and not in the pain that she was in the night before.  Obviously the Labour Ward has a high demand for immediate bed space and so we were temporarily moved into a delivery room to allow more immediate needs to take Lucinda’s space on the ward before she was to be moved to the Joan Booker ward.  In a quirk of fate the delivery room that we were moved to was the same delivery room that Amélie was born.

Before we were moved to the Joan Booker Ward the surgeon came to see Lucinda.  He seemed very pleased with her progress and was quite happy to discharge her from his care into that of the midwifery team.  He did confirm however that her appendix was extremely inflamed and close to rupture and because of its inflamed nature and the fact that in pregnant women the appendix will have moved he was unable to perform keyhole surgery and hence why she now has a 2 inch (5cm) scar.  Again in a quirk of fate she received her first operation scar thirty years to the day that I received mine (although mine is slightly more impressive: a 10 inch sternotomy scar from open heart surgery).

Before moving down to the Joan Booker ward we requested to listen to the bubba’s heart beat.  We knew that the midwife team were happy that all was OK in there, but we wanted physical reassurance of our own.  We were both relieved when a really strong heartbeat resonated through the room.

Lucinda got stronger throughout Thursday but was starting to feel the two nights of lost sleep, so I left her in the late afternoon and headed for Nanny and Granddad’s for a home-cooked meal and to see my little girls.  Again both the girls seemed to pick up on the fact that something was amiss and it took quite a while to settle Amélie before I could actually sit down and relax and eventually try and get some sleep of my own.

Friday morning started as Thursday: drop Amélie off at Nanny and Granddad’s, Éowyn at pre-school and then to St Peter’s.  Lucinda looked much better but was still feeling sore.  As anyone that has been in hospital would know it is not possible to get a good night’s sleep, especially when you are being woken every four hours to have your blood pressure and temperature taken and so it was for Lucinda.  It wasn’t long before we were given the news that we wanted, Lucinda had been discharged from the surgical team and the midwife team were happy to do the same and so it would not be too long before she could go home.  She also let us listen the bubba’s heartbeat once again and it was loud and proud.  By all accounts if a pregnant woman is to have appendicitis the best time to have it is in the second trimester.  In the first the foetus may not survive and in the third it can bring on contractions (indeed, one of the drugs Lucinda was given was an anti-contraction drug so that the surgery did not bring on labour).  Therefore Lucinda chose well to suffer appendicitis in her 17th week.

Just after lunch the duty midwife came with Lucinda’s notes and medication – Paracetamol for pain relief and Enoxaparin, a anticoagulant to thin the blood to prevent thrombosis.  The paracetamol was in the usual tablet form but the Enoxaparin is in a pre-filled disposable syringe and Lucinda has to give herself an subcutaneous injection once a day for the next five days, a small price to pay.

I have to praise the staff at St Peter’s and especially the midwifery team, they looked after Lucinda extremely well and the head midwife especially took an active role in Lucinda’s care.

So you will forgive the lack of photos and our elusiveness over the last couple of days but I think that the above is fair excuse and I thank my lucky stars that I still have my wife and unborn son even if Lucinda is making me honour the wedding vow ‘In sickness and in health‘.

Peace and Love

Baggie