Making decisions about knee replacement as an older person with multiple conditions

Because I had to go then for a medical into the [hospital], and then I had to go to all through like blood pressure, ECG and so forth and asking me different questions.

Then I went to see the consultant and he said, “Oh yeah, we’ll give you; we’d better give you half a knee,” and he said that “Oh beginning of September.” And I said, “Great.”

Anyhow the beginning of September come and I had to go back up again, and it wasn’t for the operation it was to see another nurse to ask me questions about the operation.

No, no, they were okay. I mean it seems a lot of palaver when you’re thinking about  - well if the consultant said, “Yeah I’ll put you in,”

And then, before that date comes, I’ve got to go and see a special nurse about diabetes and so forth.

But still that’s the way it went and that’s the way it happened.

I’ve got a friend who lives here at [retirement development] and she has had hip operations done at, oh, I won’t mention the name of the hospital, at another hospital a little further away but with a much shorter waiting list than the one that I was on the list for.

So I got in touch with them and, you know, did the necessary things like getting a copy of the original referral and all that, of that kind of thing for them. And I had a very, what I call a whirlwind appointment there where a lot of things were done all in one day - like I saw the consultant, then he sent me for a whole lot of X-rays.

Went back to see him for a second time, and then after talking and deciding that, yes it was appropriate for me to go on their list, so to speak, then I also had a - I don’t know whether to call it, well I’ll call it a, like a separate appointment - with two nurses, who did just about everything you can think of, like ECG, all the basic things like height and weight and so on, blood tests, well everything really that you can think of that would take place for a pre-admission appointment.

So, you know it was quite a, quite a full day. And beforehand you’re given a whole lot of forms and things to fill in and they hadn’t had time to get them to me in the post, so in between all these different going here, going there and everywhere I was trying to fill in the forms as they moved me from like one area to another to another. I had to pick up everything like coat, scarf, gloves, and all these papers and the clipboard thing to try and move on and go on with it somewhere else. So, it was quite a whirlwind - I would, that’s how I describe it.

However, you know anywhere else I feel, or some other places that might have been up to four appointments. So, you know, two times, the twice seeing the consultant, the X-rays, and then the pre-admission appointment, that could all have been separate appointments. So, you know I think it was very good.

The only thing that didn’t happen on the day, unfortunately - and I don’t know whether it was an oversight or what - was seeing the anaesthetist. So, we did have to go up again for another day to see her. That was all fine.

But you know it was a shame because that was like not a very long or detailed appointment and you know, it probably could’ve or should’ve been included in that first day. Especially you know going quite a distance and coming back. So that’s the only sort of downside of, so far.

Anyway, in the meantime I hadn’t been feeling great, and I had been to the doctor about several things, and it had been decided after me having - or rather after the doctor using the stethoscope and so on - my area where I had the mitral valve repair in 2016 -  it was decided that I should have an echocardiogram.

Now, you could say that was unfortunate, because what it meant was that the hospital, - the new hospital - then wanted to wait for that to happen. And of course that gradually was moving towards the Christmas period.

Trying to get some idea of how long that was going to be for an NHS appointment for that, and then when it seemed it was going to be almost as long as the time I’d been on for my knee - which by now was a year.

So I went through my insurance and got an appointment through [private hospital]. That sounds alright, except as I say it was coming up to the Christmas and New Year period so you know nothing happened terribly quickly.

But I have now had it, the result of that has gone off to the new hospital, I have spoken to them and checked that it was sent direct to them by email - as I had asked.

And the young woman I spoke to said yes, she went straight into her email and there it was and she said, “I’ll print it off straightaway and I’ll take it straight down to the anaesthetist.”

So that’s where I am now. I don’t know what they’re thinking about the result, and therefore you know whether they’re going ahead with the admission.

The anaesthetist did ring me up - I think I told you, the anaesthetist rang me up before I went for surgery because what was interesting was they told me I had an enlarged heart, and getting cardiac appointments at the [hospital] here, you can be 12 months waiting for an appointment.

But they’re so busy, and the anaesthetist rang me up and said, “It said on your notes you had an enlarged heart.” I said, “Yes,” so she said, “Well, I can’t see it on the X-ray.”  I said, “Oh well, I don't know, I don’t even know what I’d be looking at,” so, I don’t know what’s going on.

So, they sent me to the fast triage thing at one of the Nightingale [temporary hospital set up in pandemic] things, and I had a scan done on my heart there.

I think they’d kind of discussed before I went in, they knew my history, but when I went, there’s a whole day that you go for like pre-op discussions and I saw about eight different people and things were ticked off.

But the last person I saw was the one that made the decision about the anaesthetic, and all the rest of it. And the anaesthetist I had was incredible - he went through the pain relief, 'cause I’m allergic to morphine, and he went through the anaesthetic, 'cause I can be quite, I get quite affected by anaesthetic. He went through that he would anaesthetise the around the knee, and not put so much anaesthetic actually in my body. Which, which was, you know I was so pleased with.

And he had worked out quite a - it looked complicated to me the pain relief - but he said he would get the hospital to tabulise it; you know have it in boxes and colour coded, which ones to take when. So, he’d really, really thought it through. And I was so appreciative of, of that because I know that the anaesthetic is, well one of the most dangerous things with an operation. So it was that, I mean I was just so impressed by him.

Well, they checked absolutely everything with my health, it was incredibly thorough. And the last guy I saw read all of my medical notes and I’ve donated my body to medical science and he asked me about that. And all sorts of things.

They really went into it in depth, so I was, you know, there was obviously time in-between sort of waiting, but I was very impressed. They were very thorough.

Well, a bit apprehensive obviously because of all the contraindications they say to you. You know you think, ‘Well, yeah, let’s hope nothing goes wrong.’

But on the whole, I mean once having made the decision to go ahead with the operation, really, you've got to remain fairly positive about it and think, you know, this is going to be fine, nothing’s going to happen.

As long as I came through the operation all right, no, I didn't think-, have any worries.

I was-, I knew I was in good hands and, yeah, that I trusted people to look after me, – and they did.

I had leaflets, and then the staff, I could ask them about it, the nursing staff.

Yes, no, I had what I needed. And lots of leaflets about aftercare, and what to do and what not to do. No, no, I wouldn’t-, and I was given all the information I needed.

In the end, you know, it’s always a bit daunting when someone says you have to sign a consent form, and you know think, ‘oh, I hope I'm going to come through this.’ But then that’s natural with any operation, isn’t it?

And once you get to the day, you just go with it.

So, then when I went for my assessment.  They did take-, they were quite… about two and three hours, something like that.

And then my consultant said that your health and condition will be discussed by an anaesthetist. But that didn’t happen, you see.  Well what-, look I understand, they do on a daily basis and they must do hundreds in a week, you know? They do all these all the time, and sometimes we think that you are some-, your condition is something special, but I understand it’s not.

So yeah, they did the ECG and so forth and, well, what they did, they’ve got staff who are trained to do this kind of assessment, not so much the doctors, I think doctors they sit-, I believe that initially they sit in the room, at the control centre, and then they send people out to get information and do all the tests and everything like that.

So-, the lady who saw me, she was a pharmacist, she said, “I’m pharmacy, but I’ve been trained to do the assessment,” you know assistant to the doctors, anaesthetists and so forth?

And, yes, so I didn’t see the anaesthetist, which my consultant said that I will be, you know, because of my heart condition. So I didn’t see it, but the paperwork they gave was excellent, I read the paperwork and everything, so that working.

And the paperwork said that if you’ve got any concerns, to phone. And then I did phone, it was an answerphone, but somebody actually answered it, I said, “Look, I’m a bit concerned I’ve got-, expecting you-, you are doing the assessment and then I’ve not had any feedback to say everything’s fine.

It was a nur-  I think it was a nursing staff and he said-, “Look-”, he was quite nice, so I can’t complain about that. He did say, “Yeah, everything-, everything must be fine,” he said, “but I will check,” you know.

But what was - in the following week I had to go in for my blood test the week before the operation, but I got his name, so when I went on a Friday, I asked for him and then he came to talk to me and I said, “Look, you do this and this, is everything okay, and I’ve not got any feedback,” and so forth.

He said, “I can’t tell you everything,” he said, “but generally, [chuckles] no news is good news,” [chuckles] Which means that it will be quite-, because they said they will find some-, speak to my consultant-, heart consultant about some results and all that sort of thing, you see? And they say they were going to obtain it from my local hospital, and now that the pain resolves or-, or what if they’re happy with it.

So that’s the only bit of-, which-, you know, I didn’t get the kind of assurance that-,  But as I say, I understand, you know, that they deal with-, I mean especially a knee operation, it’s mostly people who are over 60, 70, so they’re all older people with underlying conditions, you know?

Not all of them, but well, probably half of them, people have got underlying conditions, so they deal with this sort of thing. But because you feel-, you-, [chuckles] that I will look at you, but they haven’t, you know? So I-, in the back of mind say, look the whole point of the assessment is for them to make sure there is nothing, you know, is going happen, and that they are taking all the precautions.

So, I didn’t see anaesthetist and I didn’t get the, technically an assurance, that’s all, that’s my one little criticism.