Hysterectomy: A nurse goes undercover.

Published : January 25, 2016

"As a nurse, I’d seen hundreds of bare bottoms over the years, the backs of operation gowns being renowned for their reluctance to meet. Now I was a patient, preparing for a hysterectomy, and no one was going to see my bare bottom. Or so I’d thought. What had happened? How had I got into such a tangle?"

by: Lisa Mulligan

The night nurse, tired at the end of her shift, was clearly wondering the same thing as she deftly untied the triple knot that had so eluded my fumbling fingers. She pulled up my pretty paper hospital pants too.

It was the sleeping tablets that had done it, of course. I had welcomed the two on offer the night before and was actually, if truth be known, still untangling Hugh Jackman from his operation gown. The nurse gave me my ‘pre-med’; more tablets that would make me ‘nice and relaxed’ before the operation. I smiled at the blood pressure machine. I thanked the picture on the wall. I was very relaxed.

Five minutes later I was under the covers. My mission had begun. In the interests of health journalism, and the women of Western Australia, I was about to undergo a hysterectomy so I could accurately report how it really feels from the patient’s point of view; from the frontline, as it were. Or perhaps the bottom line. Oh, and it would be good to see the back of the endometriosis that had plagued me my whole life…

As hysterectomy is the most common type of elective surgery for women, I hope a light-hearted look at what to expect may provide potential patients with some extra reassurance. I fully acknowledge that women with more serious conditions simply have no choice and it is certainly not my intention to trivialise this major operation.

Although I had nursed plenty of women through their hysterectomies, I still found it difficult to imagine how I would cope myself. My main fear was how much pain I would suffer. I was also a little emotional in the days leading up to the surgery. My teenage son comforted me as I shed a few tears, slapping me on the back consolingly as he declared, ‘It’s alright, Mum, it’s done its job!’

The first hysterectomy was performed in the second century A.D. by Soranus of Ephesus. It may have been comforting for the patient to know that her surgeon had a sore bottom too!

Flourish Fact:

Hysterectomy is the surgical removal of the uterus.
Reasons for hysterectomy: Uterine fibroids, heavy menstrual bleeding, endometriosis/adenomyosis, uterine prolapse, cancer and severe post-partum haemorrhage.

Types of Hysterectomy

Western Australia has one of the highest rates of hysterectomy in the world and there are several different types.

Sub-total or Partial Hysterectomy: This involves the removal of the fallopian tubes and the upper two-thirds of the uterus only, preserving the cervix.
Hysterectomy with Conservation of Ovaries: Uterus, cervix and fallopian tubes are removed, while preserving the ovaries.
Hysterectomy plus Oophorectomy: Involves removal of uterus, cervix, fallopian tubes and one or both ovaries.
Radical Hysterectomy: Same as above, plus removal of nearby lymph nodes and the upper portion of the vagina. Done in the treatment of some gynaecologic cancer cases.

Methods of Hysterectomy

The method chosen will depend on the reason for the hysterectomy, the woman’s medical history and the doctor’s skills and preferences.

Abdominal: Incision made in abdomen, may be vertical or a ‘bikini line’ cut.
Advantages: Lower incidence of damage to urinary tract.
Disadvantages: More pain, lengthier stay in hospital and longer recovery time.
Vaginal: Incision made in upper portion of vagina and uterus is removed through here.
Advantages: Less pain, shorter hospital stay and recovery time and absence of visible scar.
Disadvantages: Increased risk of damage to urinary tract.
Laparoscopic: Part of the hysterectomy is performed laparoscopically, that is, through three or four small incisions in the abdomen.
Advantages: Shorter hospitalisation and recovery time than for abdominal hysterectomy.
Disadvantages: Possible longer operating time, higher costs and increased risk of damage to urinary tract.

Dr Bruce Thyer, an eminent Perth gynaecologist, points out, “Thirty years ago there was a preponderance of abdominal hysterectomies. These days the balance has swung quite definitely towards vaginal hysterectomy, if the option is possible. More recently, laparoscopic hysterectomies have started to make inroads into those areas where formerly people would have been subject to abdominal hysterectomies.”

Dr Thyer also remarks that new treatments have been developed for several conditions, resulting in a marked decrease in the rate of hysterectomies over the past 30 years. “When it comes to utero-vaginal prolapse, for example, the traditional way of approaching it was to do a vaginal hysterectomy in conjunction with a vaginal repair, but that’s changing rapidly so that there is much less need to take the uterus out. There are great advantages to just leaving the uterus there and incorporating it as part of the whole repair process,” he adds.

My uterus was certainly positioning itself for a prolapse, but nowhere near as pointedly as that of the patient who informed me, “It’s been coming out to say hello to me every morning, but I don’t want to meet it!”

It is important to take plenty of time to make the decision to have a hysterectomy and be aware of the risks and complications that can occur. “I think it’s a very wise thing to do to make sure people don’t take that step until they’re really convinced that that’s what’s required. I think if people have this connection with the rational process, they find it easier to come to terms with it emotionally,” Dr Thyer advises.

There may be no need to head straight for the operating theatre at the first sign of trouble, but Dr. Thyer concedes; “You find some people will literally stand in the doorway and they’ll say, ‘I want the operation’. They’re not interested in anything else, it’s so cut and dry for them. The way in which their uterus is behaving is getting in their road and affecting their enjoyment of life.”

Speaking of enjoyment, let me tell you about ‘the shave’! As I was to have a vaginal hysterectomy I underwent the full, shall we say, epilatory experience. I would recommend the DIY approach prior to admission (using clippers, not a disposable razor!) unless you want the nurse doing it as you discuss the most recent episode of Desperate Housewives. One of my patients, in her eagerness to avoid such a scenario, decided to wax the area the night before, but developed a severe skin reaction and had to postpone her operation.

I must tell you about the ‘lion’s wee’ too. By this I mean the bowel prep I had to drink the day before my op. Three glasses of it. Yummy! Now I’m sorry, but this is not compulsory for all hysterectomies. I know, I know; you feel cheated. But only those of us fortunate enough to have clumps of endometrial tissue lurking throughout our pelvic cavities are permitted to sip from the revered chalice of colonic irrigation. And yes…it works. Very well.

So I’ve had my shave and tasty bowel prep and am fast asleep, waiting for my operation. Everything is under control at home; there are meals in the freezer and children’s lifts have been arranged. My purple furry dressing gown lies snoozing on the chair beside me. My new slippers wait patiently in the cupboard…hang on a minute…I’m the one waiting patiently. Where are they? Why are they taking so long?

There are three nurses standing at the end of the bed, laughing at me. Maybe it was a mistake to have my surgery done at the hospital where I work, they are clearly doing very little to speed up proceedings.

“You’re back on the ward now, Lisa. Have you got any pain?” Pain? What’s she talking about? Why would I have any pain when I haven’t even had my hysterectomy yet?

“Look, Sophie,” I hiss at the smiling nurse (whom I had previously considered a friend), “Are they being to go much longer?” Sophie is laughing at me.

Now someone is squeezing my legs! What is going on? Really, this is too much. I try to turn over, away from the laughing nurses, but I seem to be wrapped up in tubes, and a cat is sitting on my face. Oops, it’s an oxygen mask.

I get it; I’ve had my hysterectomy. And you know the best thing about it? I have no pain. If any does come I have the PCA button in my hot little hand, all ready to press.

Flourish Fact:

PCA: This stands for ‘patient controlled analgesia’ and is a drug delivery system whereby the patient is able to deliver his/her own intermittent intravenous analgesia. The standard PCA device is a computerised syringe pump that delivers a pre-set amount of pain-relieving medication to a patient at the press of a button.
Calf Compression Devices: These comprise of inflatable cuffs wrapped around the patient’s calves following surgery. Attached to a small machine that sits on the end of the bed, they are programmed to alternately squeeze each leg in order to promote blood circulation and thereby assist in the prevention of deep venous thrombosis.

Sophie is taking my blood pressure now. She explains that I have two drains (one vaginal, one abdominal), a catheter, a drip and a PCA. She comes in regularly to check my vital signs (blood pressure, pulse etc), and I have a bell close by if I need to call her. I feel very comfortable and safe, and spend the rest of the day dozing on and off. Whenever I am awake I take deep breaths, do leg exercises and press my PCA if I need to. I take sips of water, and even manage a little food at teatime.

The next morning, one of my drains is removed, as well as my PCA. I am helped to have a nice hot shower that feels wonderful. My nurse regularly asks me about my pain to ensure I am receiving adequate analgesia. As you know, I had been worried about the pain side of things but, compared to the excruciating pain I had suffered with endometriosis, my post-op pain is no problem. By the way, if your doctor prescribes anti-inflammatory suppositories, don’t be shy. Take them, as they provide wonderful extra pain relief.

I feel a little nauseated that afternoon but some intra-venous medication soon alleviates it. Later on that evening I feel sick again, really yucky this time. The night nurse recommends some ginger ale and it settles my tummy beautifully. Remember that one too! My ‘under-cover’ mission has been worth it for that precious piece of information alone!

My catheter, the other drain and the drip are removed the following day and I feel good. I go for gentle walks up and down the ward and pop in to say hello to a patient I had nursed the previous week, who gets a surprise when he sees his nurse wearing pink pyjamas! I am well enough to go home just three days after my operation.

I had six weeks off work, the first two of which were spent lying or lounging about the house as per Dr. Thyer’s instructions! I found this easy enough as I was very tired. My family and friends were marvellous, and the time passed quickly.

Researching this article, I have spoken to many women who have had the operation. Without exception, they have proclaimed, “It’s the best thing I’ve ever done!” The bottom line is: the only mystery about hysterectomy is why we take so long to decide to have one!

Bottomnote: Not long ago, a friend of mine telephoned her mother in Ireland to discuss her older sister, who’s a mother of eight.

“Oh, Mammy”, she said. “Poor Eileen. Isn’t it awful she has to have a hysterectomy?”

To which her mother swiftly replied, “Not at all! She sure put it to great use while she had it!”

For more information on hysterectomies, you can contact the Midwife and Menopause Support Group at King Edward Memorial Hospital on 08 9340 1535 or freecall 1800 629 799 for country callers.

Suggested websites:

www.womhealth.org.au/conditions-and-treatments/hysterectomy-fact-sheet

hystersisters.com

happyhysterectomy.com

Dr. Bruce Thyer, interview, April 2nd, 2007.