9 June 13

	With the exception of proven cancer or life-threatening hemorrhage, 	hysterectomy as treatment for female disorders has far less merit than the 	compounds, elixirs and nostrums nineteenth century ladies furtively passed 	from hand to hand on the back steps. It deserves equal obsolescence.
	When To Say No To Surgery by R G Schneider, M.D.

The day that had been proposed as the second date for the Independent Professional Review was warm and sunny. I woke about 5 am but did not get up until 7 am, when a nurse came with a stack of material, which included a theatre gown, 2 blankets and the canvas for a stretcher, and I went for a shower.
In 1971 Seropian and Reynolds found that shaving increased the chance of developing a wound infection, while using a hair removing cream did not. The cut would go through my pubic hair area so I had, on Sunday afternoon, used the depilatory cream I had brought with me to remove the offending hairs. As Cruse and Foord had found that showering with an antiseptic detergent before operation had also been associated with a reduced wound infection rate I showered with a cheap, antibacterial face wash.
The increased incidence of wound infection with shaving was confirmed by Cruse and Foord in their 1973 study of 23,649 surgical wounds, but 20 years later women having operations like vaginal hysterectomies, which leave no abdominal wound at all, are still shaved even though hair removal is only justified where it physically interferes with wound stitching. Viney found that not only is shaving still the standard method of hair removal but it is still done many hours before surgery, which further increases infection rates. Perhaps this is because not only is using creams messier, and more expensive, but as antibiotics now seem to be routinely used to prevent infections developing the use of creams, rather than razors, may make little significant difference to present day infection rates.
I decided to take every measure possible to avoid infections and if nothing else I'm sure that I felt psychologically better for making the effort. And hair that has been removed by depilatory cream grows back less prickly and uncomfortable than shaved hair.
The theatre gown kept slipping down my shoulders but at least it tied down the side and was not embarrassingly open at the back, as I had heard many were. When I sat on the bed one of the nurses told me that the anaesthetist insisted on his patients getting two blankets as he liked them to be kept warm, to get the blood flowing. So I got under the covers.
At 7.30 a nurse came in with the premedication - 3 small tablets, one yellow and 2 white. When I had seen the anaesthetist at his clinic he had said that I should have a sedative - temazepam - and he wouldn't be very happy with an unsedated patient. But I had read that at least some of the caesarean mothers are not sedated and I was intensely interested in what was going on. However I did feel quite alarmed at the thought of being sliced open and I would not be able to control the effects of panic on my circulatory system, which would be monitored by the anaesthetist. I felt sure that there would be a fuss if I refused outright to take the sedative so I would either have to take it or pretend to do so - and the nurse appeared to be watching.
I had no objection to a muscle relaxant, which was what I was told the yellow tablet was, so I took that first. Then I compromised and swallowed one of the sedatives, while dropping the other into the operating gown. Much later I remembered that an epidural produces the best muscle relaxation this side of death, so why would a muscle relaxant be necessary? 
Half an hour later the anaesthetist came. Since an epidural is said to give excellent post operative pain relief I elected to remain on it after the operation.
Monaghan wrote that he preferred to use epidural and spinal analgesia for radical surgery as there is reduced blood loss, less oozing during the operation and fewer harmful anaesthetic effects. Epidurals also produce extremely relaxed musculature and makes the gut contact, keeping it away from the pelvic organs. Because the gut is not paralysed, as in general anaesthesia, you don't get a feeling of bloating or wind afterwards, there's no sore throat because you don't have tubes pushed down it and few of the feelings of nausea which a general anaesthetic frequently produce. Many women are frightened of not waking up after an anaesthetic, not a problem if you're going to be awake anyway. And you need have no fear of the rare event of recovering consciousness and feeling the agony of surgery while being unable to speak and tell anybody. An epidural can have definite advantages from the patient's point of view.
At the 52nd Annual meeting of Canadian Anaesthetists Society it was noted that although local anaesthesia is highly effective with fewer side effects, less bleeding, nausea and vomiting, and a faster recovery time than general anaesthesia it was underused. The reasons for its underuse seemed to be that most patients do not want to know what is happening and the medical profession does not want them to know what is happening.

At 8.20 a porter brought the big, high trolley. However I couldn't just get out of bed and onto the trolley, it had to be brought into the room, displacing the bed and cubicle to get in, and docked next to the bed. Poles were then slide down the loops in the stretcher canvas and I was lifted over, the sides snapped into place and then we were off. At the ward entrance a nurse checked off my name band and operation type and asked me to confirm my signature on the consent form. Then we went down in the lift for authorised use only and along the corridor to the theatre block entrance. I had passed this several times on my way to the general office and thought it looked most unspectacular. One of the theatre staff was talking about her recent holiday in Spain. It seemed strange to think that this place was a familiar work place for some people. Here I was moved across to a theatre trolley and checked in, both my identity band and the consent form being again verified. The theatre block was an old brick building, with the bare brick walls painted a deep cream colour.
We went into a crowded, narrow room with stacks of breathing tubes around. The anaesthetist had an associate with him. First a nurse put a drip into my left arm. Then I had to sit up with my feet on the edge of a chair besides the trolley, fold my arms across my belly and bend forward slightly. The epidural tube was inserted. It was painless but was an odd feeling that reminded me somewhat of the pushing sensation you get when you have a tooth filled. The tubing was taped up my back and three discs were stuck on my chest for the heart monitor. I lay down again. The room seemed small and busy. Dr Dunn visited briefly. The anaesthetist had said that I would be sent off to the recovery room while the epidural took effect but I remained in the prep room and it didn't seem much later that he tested the analgesic effect first by sprinkling on cold fluid and then by a pin prick. 
And so to theatre.
With its painted bricks and large windows it reminded me of an old Victorian school hall. It was not what I expected. It all looked somehow rather low tech. The operating table seemed very narrow, which I suppose it has to be to allow the surgeon and his assistant easy access to the parts other professionals can't reach.
A mechanical device scooped me off the trolley and put me on the table. A urinary catheter was put in and some strange things put around my calves to squeeze them and keep the blood moving round. From the waist down I was completely dead and couldn't feel, or move, a thing. A low bar was fitted across the table at waist height and draped with green material. I lost sight of my lower body. Behind my head, to the left I was aware of a bank of instruments, the cardiac monitor and the anaesthetic machinery I suppose but I didn't get a good view of the room layout and I felt tired and lethargic, possibly due to the temazepam.
I turned on the Walkman I had brought with me and listened to the sounds of whales, the sea, too many seagull, and subliminals telling me that I was at peace, balanced and harmonious. Well at times like this a girl needs all the harmony she can get. I had read of the use of Walkmans to calm patients in a Medline extract and thought it seemed a good idea as not only would it give me something to listen to but I believed that if I was occupied the theatre staff would feel more at ease. And I wouldn't like to upset anybody who was rummaging around in my vitals.
There were two circular banks of lights over the operating table and one of the bulbs in the bank over my lower half had a dead bulb. The reflection on its surface was very indistinct and appeared largely red. I never felt a thing as I was cut open, or stitched up but I did feel some pressure effects as my internal organs were moved around. Just sensations of pulling and pushing, as my womb was pulled out and the gut was packed out of the way. When the growth had been removed the low screen was briefly removed and I had a glimpse of my womb oversewn with quite large dark stitches, rather pale in colour and further up my body than I thought in would be. Then one of the theatre staff showed me the fibroid in a dish. It looked lumpier than I thought it would be and not that big. Finally Dr Brisk sewed me up behind the restored wall and I was pushed off to recover. I was halfway through the second side of my tape.
As far as I came make out from the medical notes I went into surgery at 9.25 and came out at 10.10. I was rather disappointed in the very brief theatre notes, which gave few details about the operation and did not say whether the ovaries and appendix had been inspected for damage. Nor did it say whether any other fibroids were present. There was also no mention made of adhesions although the pathology report stated that the fibroid showed evidence of them. It was, however, remarked that in spite of the Zoladex, the use of Bonneys clamp to stop blood flow to the womb and infiltration with pitressin, which also helps to cut down bleeding, the womb was still very vascular at operation. The estimated blood loss was 600 mls, a bit more than one blood donation. It took no longer to take out the fibroid and patch up the gap than it would have done to remove the entire womb.
I would really have liked a video of the event. I have heard that videotaping is becoming quite common in the US, where they no doubt form the ultimate weapon against the tenacious guest.
Dr Dunn wrote to my ex-GP telling her that I had had my myomectomy and that, "The procedure was technically uncomplicated."

The recovery room was large with big, curtained bays. I was in one by the entrance and could see a clock for the first time. I was feeling very cold and was covered with blankets and then with a metallic sheet. The epidural tubing was connected to a machine which regulated the rate at which the anaesthetic, bupivacaine, was dribbled into my spine.
The medical record noted that I was put in Flowtron boots, which squeeze the legs to prevent blood pooling and forming clots, and at 10.30 I was given a unit of blood. At 10.45 I passed two huge clots and was trickling blood. Dr Dunn was informed but was scrubbed up at the table. At 11.05 the anaesthetist came to see me and another unit of blood was transfused. I was still bleeding at 11.25 but had fortunately stopped by 11.45 and was sent back to the ward soon afterwards. I just felt tired and cold and kept nodding off and knew nothing of what was going on.
Most hysterectomies take one hour from leaving the ward to coming back to coming back to it. I had been off the ward for three and a half hours, half of that time in the recovery room. Setting up the epidural drip had occupied some of that time but I think I stayed in recovery because of the blood loss and couldn't be sent back until the bleeding had stopped.
I have immense admiration for the 32 patients of Fayez and Dempsey who had fibroids with a mass greater than a 16 week pregnancy removed through a vertical cut, and yet who went home within 24 hours of surgery, with no blood transfusions, or drips, or drains necessary.
Back on the ward I had an intravenous drip on my left, the epidural drip machine on my right, a urinary catheter, a wound drain and Flowtron boots on my feet. This kept me pretty well confined to bed and I dozed through much of the next 24 hours, still dead from the waist down. I found it uncomfortable being unable to move, or even feel half of my body and found it difficult to settle. If I lay flat on my back my spine started to ache so I went I went from one side to the other but could not move position unaided. And each time I turned over the urine bag had to swap sides too.
I had concentrated on what surgery I was going to have and had given little thought to recovery afterwards. Somehow I had expected to be sitting up in bed with feeling restored to my legs during the post operative epidural anaesthesia. I found the continuing complete numbness in my lower body extremely disabling. From shivering with cold I went to hot flushes and was given glasses of iced water, which I had to drink through a straw since I couldn't even sit up. I drank fairly frequently. There was nothing else I could do. However the medical profession is keen on observing kidney function and they seemed to be pleased to have large volumes of urine produced, so it is very likely a good idea to drink as much as possible. It probably also helps to flush out drugs and toxins.
Sometime in the afternoon the jolly senior registrar, who I had never seen before, came in, joking about sleeping the sleep of the wicked. During the evening I asked for the telephone and telephoned Nan, the chronically depressed sister I lived with. She was miserable and managed to disconnect me. I was rather miffed at the time but while I had been the focus of a great deal of medical attention all day my sister had been having quite the opposite experience.

On Saturday the 11 June Nan had taken her extremely sore throat, aching muscles, headache and feeling of malaise to her doctor, who practised at the local centre where my ex GP, Dr Craft-Tort, was the senior partner. She came back with antibiotics and painkillers, but felt no better on Sunday and after I had left for St Mary's she called out the doctor on duty, who was none other than Dr Craft-Tort. He said that she had quinsy, that is abscessed tonsils. He knew before he saw her that she had quinsy from the sound of her voice on the telephone. He said that she should go to hospital and have the abscess lanced but she was worried about the effect it would have on her six year old daughter to have both the people she lived with desert her in rapid succession. Craft-Tort gave her stronger painkillers and Nan waited for the antibiotic to take effect, while our father stayed to take care of her girl. That night she vomited the water which was the only thing she had taken all day.
The next morning, two days after taking antibiotics, the swelling was no better and she was unable even to swallow water, so at 9.30 on Monday 13 June, while I was being cut into at St Marys, she telephoned the health centre. Her own doctor was on holiday and Craft-Tort was not in. She told Dr Malady about her quinsy and how she felt worse. Dr Malady said she should think about going in to hospital and phone her back. When Nan phoned an hour later she was told that the doctor was "busy". Another hour and a half later the doctor had gone out on rounds. At 2 pm there were no doctors at all in the health centre.
At 2.15 Father took Nan to Helton hospital's Minor Injuries Unit. As quinsy is infectious she was isolated by a nursing female Nan described as "a bolshie cow", who said that if she was ill she should have stayed at home and let her doctor handle her ailment. As she only had tonsillitis she was ignored for another hour and a half, by which time she had had enough and went home.
When she got back her uncle, who had been looking after her girl, said that Dr Craft-Tort had telephoned and apologised about her treatment by the practice.
This I found totally unbelievable.
When I phoned after 7 pm she was just not interested. She had been talking to our nursing sister who told her that their quinsy patients were always admitted to hospital and given an intravenous, antibiotic drip to stop them dehydrating. And the abscess is lanced, as if it bursts it may cause blood poisoning. Not the best of news for any depressive. That night she was hallucinating. Father phoned the doctor. Doctor Savage refused to come out.
First thing Tuesday morning Father phoned again and was told the doctor would be there about lunch time. At 1.30 he phoned again. By the time the doctor arrived at 2.30 the antibiotics had finally had some effect and the swelling was beginning to go down.

Meanwhile back at St Marys my pulse and blood pressure were checked every hour all Monday night and into Tuesday. During Tuesday morning I began to feel the toes of my right foot. I also started to feel pain, not in my belly but in my chest, which felt as though I had been kicked in the ribs. This was presumably pain referred from my outraged pelvis. The epidural drip was increased and the ache subsided. A large, black nursing auxiliary came with a student to wash my "hands and face", which turned out to include a good deal more besides. I felt much more alert afterwards, especially as the feeling had started to come back to my legs, particularly the right one. I became aware of the Flowtron boots inflating, squeezing my legs and then delating. It began to feel uncomfortable and sweaty and I was very glad when the sister came, shortly after noon, and removed both the boots and the epidural drip, after giving me some tablets to take over pain relief.
Free of one of my attachments I could now get out of bed and sat in an armchair during the afternoon, going through a stack of women's magazines which the ward sister had brought down for me. After a couple of hours I felt daring enough to move to the washbasin, about six feet away, and clean my teeth, pushing the dripstand and urine bag along. A small step for woman but a long shuffle for patientkind.
A few hours later I got into bed and the senior registrar and Dr Brisk looked in on me. I did have other fibroids, I was told, at least one as big as a fifty pence piece and possibly other seedling growths. And my womb cavity had been entered during the operation. This was not advisable in a young woman as a cut through the entire womb thickness weakens it and would mean that if she became pregnant (and most women don't even get a myomectomy unless they want children) she would possibly have to have a caesarean section. In my case, however, it was probably to the good since it meant that any bleeding from the fibroid shell would drain through my vagina instead of emptying into the body cavity.
Later a woman came to the door and asked if I was having tea. I wasn't sure if I should be eating or whether a meal had been ordered for me so I said no, though being endowed with the appetite of a moderately voracious vulture, I would probably have eaten anything I was given. But as my teaching sister, her boyfriend and my niece, Tina, came visiting after 7 pm, bearing fruit and biscuits I pigged out then. Nan stayed at home with her infectious quinsy but she was feeling better and had dressed Tina in a fancy pink frock and crimped her hair. Tina liked the large cupboards - so big, she said, she could sleep in the top one and move her rabbits into the bottom one.
I resumed the program of B,C and E vitamins recommended by Stephen Fulder. I later found that another patient was also taking vitamin C to help her recovery. Many doctors are scornful of vitamin therapy but even the establishment now uses vitamin C and I noticed that it was present in the drugs trolley.
When the last of the intravenous antibiotics had dripped through, just before midnight, the drip was removed. The blood vessel above the drip insertion felt hard and was tender for more than a week afterwards.

On Wednesday morning I tottered down to the dayroom for breakfast and the urine catheter was removed soon afterwards. If I walked for longer than a few minutes I got a prickly, stabbing pain near the drain site so I went back to bed and tried to sleep.
The drain came out of the cut near its right hand edge and was taped to my right thigh. I put a little comfrey oil along the left side of the cut which was loosely covered by a dressing. The wound looked neat with no sign of infection and was closed with ten stitches of a dark blue synthetic material, using a mattress stitch which catches together the skin each side of the cut, pushing the cut edges together and making a fold of skin between the end loops of the stitch. The upper edge of the cut was rather red, probably because the top flap would have been stretched to open up the slit and allow easy access to the body cavity. I later measured it as 22 cms long. Fayez and Dempsey wrote that their myomectomy incision was between 8 and 10 cms wide, but most of their patients had much smaller lumps to be removed and it might have been rather difficult to get a womb containing a 10.5 cm fibroid out of a 10 cm cut, though a cut can be stretched a bit. As their patients were very probably private they would have looked with great displeasure at anything bigger than the smallest possible cut. Also as fertility experts Fayez and Dempsey may have been so experienced that they found it easy to work even with very limited access. A book written for British patients gave the usual cut length as from 15 to 20 cms long.
In spite of the fact that it heals stronger and is associated with fewer wound problems Monaghan condescendingly declares that the most important value of the low horizontal incision is cosmetic. He thinks that for many women this cut maintains an illusion that their abdomen is apparently untouched by the surgeon's knife. I still cannot regard my 9 inch slash as illusionary.
During Wednesday afternoon Dr Dunn came and inspected the wound and seemed satisfied with it. I had refused painkillers but when the ache in the ribs returned along with aching shoulders I was very glad to have them again.

I spent Thursday morning doing a jigsaw in the dayroom and about 11 am one of the nurses removed the drain. This did not hurt but it produced a strange sensation as the tubing slid out from under my skin. I had finished with the magazines and as I felt so well I went out for a walk, looking for a newspaper. I never wear slippers so I had comfortable slip-on sandals on my feet and instead of a dressing gown had brought a woollen wrap, which completely covered my nightdress so I did not look an obvious patient. The ground floor shop did not sell papers so I went along the covered walkways to the Royal, where there was a Menzies, and snack shop and, by the entrance, a restaurant and a Citizen's advice shop, due to close down soon for lack of funds.
I was still getting small, prickling pains from the wound on walking about so the drain had not been responsible for them. I think that because there was a skin fold between the stitches body movements produced a pull on the stitches and this was what caused the little twinges. However pressing lightly on the wound surface stopped the pull on the stitches and the twinges.
Dr Dunn came round in the afternoon and agreed that I could go home after the stitches were removed on Saturday morning. I must have spoken to him on least half a dozen occasions yet I felt that the amount of communication had been minimal. Advertisements for office staff always seem to insist that it is essential for candidates to be fluent communicators. It is important that the girl dealing with your invoice should be clear and understanding but these characteristics are not thought important in the man who cuts open your body or doses it with dangerous drugs.
The dayrooms were stuffed full of all sorts of leaflets about women's health, especially contraception, and the staff had more notes on the operations they did, like hysterectomy, myomectomy and IVF. I didn't see a single sheet on health insurance and only one small leaflet was a drug company production.
There were three new patients in the dayroom for tea, one of whom had come over 100 miles. Another patient had been told that Dr Dunn's patients recovered well because he was a quick worker, so they did not stay long under the anaesthetic. And when I had seen him on the ward he did not have a retinue of students and assistants, which seemed strange for a teaching hospital. However as it was June perhaps they were all doing their exams and I was just fortunate in having surgery during a student free period.
A couple of the patients said how marvellous and considerate their consultant, a cancer specialist, was. Other women said that they had come to get done whatever it was the surgeon had decided to do. They didn't want to be consulted about what treatment they should have. They didn't even want be informed about what was wrong. 
As Collier remarks in The Health Conspiracy, "I suspect that the majority of people may always seek to decline any responsibility for their own medical welfare... this behaviour gives many arrogant doctors an excuse to label many of their patients as ignorant and to justify their failure to communicate".
I found it singularly depressing to think that women who wouldn't take a man's advice on the colour of their lipstick left total responsibility for the type of treatment doled out to their female organs to a person who had none. The future of their reproductive system was of less importance than their cosmetic appearance. This is probably one reason why the removal of a breast, which is only a milk producing gland, appears to produce more trauma than the removal of the female organs, which have much more important functions and effects.
Another reason is the western association of the breast with sex. A reader of Woman magazine wrote on breast implants, "A woman's breasts are important to her sexuality. If she sees fit to improve her quality of life, confidence, appearance and sexuality, that's her choice."
Take away a woman's baby nourishing gland and you damage her sexuality. Take away the organs which define her sexual identity and she's told that she's better off without such cancer producing areas!

On Friday morning my hair felt rather greasy so I went shopping. I had only been on the ward for six days but already it felt strange being outside, walking on a pavement. The shops were only round the corner and I had passed them many times on my way to outpatient appointments. As I crossed the busy main street I was overtaken by an old woman with a walking stick - a new, and rather alarming, experience for me.
There is something exhilarating about spending money - even when you only get a bottle of shampoo, a book of stamps and a postcard. Then I had to st down and rest on a conveniently situated bench before making the trek back.
At the hospital I was surprised to find that although I am not normally a very sweaty person perspiration was trickling down my sides. I didn't feel tired but the trip to the shops must have been a bigger strain than I thought. I left the lift at the first floor, which was where the pathology department was situated. I hadn't got a good look at the lump and I wanted to know all about it. As the lab would no doubt be closed the next day, being Saturday, if I was going to get a better look at my growth I would have to do something now. The lab door had a code lock and a bellpush. I pressed the bell button and while I waited for a response a man arrived and told me that the bell didn't work and the door wasn't locked. I went in and told a woman in the office why I had come. She went to see the pathologist and I sat down and waited. I think they were probably surprised. I don't think many patients come looking for their severed bits but I have worked and studied in quite a few labs and feel completely at home in them.
In a windowless storeroom my fibroid resided in a plastic tub, pickled in formalin. I was well acquainted with this preservative, having spent many hours pouring over formalin soaked dogfish and rats during Zoology A level dissection. It stinks, makes your eyes smart and dissolves the fat out of your fingers.
Some of the mass had been cut into slices and the pathologist put a piece onto a paper towel for me to see. It looked like a thick chunk of cooked chicken roll and from its structure I could finally make sense of the conflicting ultrasound reports. It was mainly composed of the swirls of muscle cells, characteristic of fibroids, with a band of fibrous material running down the right-hand side and across the bottom. Small circles of muscle tissue could be seen on the outside edge of the fibrous bands, but in the upper left was a large, densely muscular area. This would be the denser area noted by the professor and I was impressed by his clinical skill in detecting it. Extensive degeneration but no calcification had been noticed. I later read in Gynaecological Radiology by G H Whitehouse that, "calcification occurs in fibroids following necrosis in pregnancy or is secondary to postmenopausal degeneration. Finkle et al found only 5 instances of calcified fibroids on radiographs of over 4,000 adult women, 4 in women over 50." So it would seem that fibroid calcification is unusual in premenstrual women.
The lump itself had always felt like one solitary mass to me and its internal structure showed how it could have been mistaken for multiple masses. As I had suspected when Dr Rimmer had measured the lump she had measured the whole fibroid but the radiographer had measured only the denser patch and had assumed that the muscle swirls and degenerated tissue outside of this area belonged to other fibroids.
The pathology report stated that the fibroid measured 10.5 x 9.0 x 8.0 cms and weighed 530 grams. I was a bit disappointed that its volume was not measured. Calculated from its size it should have been about 400 ccs, which would mean that its density was about 1.3, pretty heavy as you would expect from something made mainly from muscle tissue. Assuming that Dr Rimmer's measurements were accurate the fibroid's volume had decreased from about 1200 ccs. It had therefore shrunk to a mere third of its original size.
The pathologist wrote that most of the lump was covered in serosa, the thin skin that covers the womb. Like an inverse iceberg it seems that 90% of the growth was outside the womb, a huge swelling on the top of an otherwise normal organ with the lower 1 cm or so impacted through the wall and into the womb cavity. It could be said that it was a mainly subseral fibroid with an intramural and submucosal section. So it was a subseral/intramural/submucosal fibroid. This demonstrates the problems you can have with any system of classification. Dr Dunn must have run a scalpel around the junction of the mass with the womb and then pulled the fibroid out, or rather off the top of the womb, leaving a cavity perhaps 6 cms long and 1 cm deep, probably bleeding quite profusely. While he stitched the gap together blood must have been oozing into the womb cavity, forming the 2 huge clots that I later passed in the recovery room.
I would have liked to have had a longer, closer look at the lump section - in fact I'd have liked to examine it under a low power microscope - but the pathologist didn't even seem to want me to touch it and I felt that I was probably preventing the staff from getting on with their work so I went back to the ward.
Next morning my sister telephoned soon after my stitches were taken out and before 11 am I was on my way home.

Aftermath

I had been given a sicknote for the week that I was in hospital and before I left the hospital I got another note for a further 4 weeks. As I had no GP, and the hospital was unwilling to give me any more notes, 5 weeks after surgery I was again registered as unemployed and fit for work. The average time taken for a hysterectomy victim to recover enough to return to work is about 9 weeks but after the operation described by the majority of medical authors as having more morbidity than hysterectomy I was, officially at least, recovered in just over half that time. I never realised before what a stranglehold the GP has on the provision of medical care. You can't be sick if you have no GP. You can't get a prescription drug. You can't see a specialist. And you can't be dead or, no matter how big your belly, pregnant without an official certificate.
The wound was a swollen ridge, which gradually went down over the following weeks. After the first couple of weeks I noticed that each side of the pubic mound the flesh was sunken in below the cut and I worried about whether the body wall was going to heal up evenly. However this effect seems to have been due to the less traumatized flesh below the cut healing faster. As the tissues above the cut lost their swollen appearance so they stopped bulging so much above the wound. At the end of the day the wound tended to ache and felt like something was grasping my belly tissues, rather like wearing tight clothes. Over the weeks it ached less and the feeling of tightness faded but it still felt a bit tight months after surgery.
A T.V program in the series Under the Sun told the story of Bai, a Chinese woman sterilized for having more than two children. Although brought into theatre on a trolley, she was dressed in her everyday clothes. On the 
operating table her trousers were pulled down, she was wiped over with antiseptic and tied down to the table. There was no anaesthetist and Bai apparently had only a local anaesthetic, presumably a spinal, which wore off before the end of the operation, when she was helped off the table and up a flight of stairs to a bare camp bed, where she could rest for 24 hours before walking home.
Western women sure have it easy.
The vaginal bleeding that had stopped in the recovery room started up again late on Wednesday night, 2 days after surgery. It persisted for nearly 4 weeks, at first a bright red, light flow, which as it decreased in amount to mere spotting turned a dark reddish brown colour. Nearly 7 weeks after the operation I started bleeding in earnest. My periods had returned.
Although my menstrual cycles returned immediately to their normal length they were disturbed for months afterwards as I bled slightly for upto two weeks. The amount and length of excess bleeding decreased over the following five cycles until I bled only for the usual 5 days. I found that I was still losing about 300 mls of menses a month; less than the 400 - 600 mls I used to lose but still in the menorrhagic range, though nothing I couldn't easily cope with. 
During the year following the discovery of my lump I lost 3 stones in weight, and went down to 8 stones, my weight in the January of 1994. I was surprised to find that when weighed in St Mary's on the day before surgery I was half a stone heavier and before Xmas I was up to 10 stones, at which I stuck.  My family tends to be over the medically agreed ideal weight and I believe that it was only stress which kept my weight down. When it was decided, in March, to remove the mass I started to put on weight and have finished up at my more normal, if not medically desirable, size.
Before I left the hospital I posted a request for my medical records in the internal mail but in all it took 3 attempts before I got all the records I wanted and as the hospital insisted on sending the records by registered post the 3 invoices totalled over £8. Ain't bureaucracy wonderful?