Bog 9: The Quest for an Operating Room

Notes from my 2012 diary

6 June. I received a supportive text message on behalf of the nursing staff in the breast unit. Nurses are fantastically kind human beings. My training and work experience as a surgeon have all been in the UK. I have always found nurses in the NHS to be friendly, very kind, hard-working, dedicated and pleasure to work with. They are the ones who make the NHS one of the best healthcare systems in the world.

8 June. Another miserable day with severe pain (8 out of 10 on the pain scale). I am feeling very low because of the pain and the fact that I have been unable to go back to work.

I received an email reply from my surgeon. Here is some of what he said (italicised) in his email (Bold words for the reader to comment on):

I had assumed that the problem had been sorted out, either spontaneously or as a result of the block.

Have to say that I wouldn’t have taken you back to theatre so soon, given my long experience of the operation and its aftercare, …”

I don’t have an excuse for not contacting you after your last text except to say that in general no news from patients who have had problems is generally good news.”

Seeking help from Libyan doctors:

Soon after the start of the Libyan revolution on the 17th February 2011, I set-up a database to help facilitate and coordinate the relief efforts inside and outside Libya (for example, in the refugee camps in the Tunisian desert). More than 2,400 Libyan professionals from all over the world enrolled in my database. When I became ill, I emailed all the pain management specialists in my database, seeking their advice and help. Many replied, and they were very supportive. I would like to take this opportunity to say, thank you all. I very much appreciate your kindness.

10 June. My surgeon text messaged offering me a clinic review, but it was too late. I had already contacted a legal firm.

11 June. Very soon after I got up from bed, my pain shot up to 8 out of 10. Constant aching pain, along with stinging and razor-sharp pain in the inner aspect of my left groin. Also, penetrating (dagger-like) pain through the middle of my left groin, which took my breath away and gave me a sickly feeling. Worst of all was the left testicular pain.

I received a phone call from the surgical manager at my hospital. He was very supportive and reassured me that my job was not at risk and, if needed, I could take as long as I need until I am fit to work again. He also kindly asked me, “is there anything I can do to help you.” Thank you so much for your kindness.

12 June. Occupational health review outcome: “Not fit to return to work in any capacity. Not certain when will be fit. Review in 4 – 6 weeks.”

14 June. The British Hernia Surgeon emailed the Danish Professor asking if he could help me and letting him know that I am willing to travel to Denmark.

16 June. A very kind text message from two work colleagues (a surgeon and radiologist): “Hi Adel, we feel very sorry about your post procedure complication. Ironic that this happened to a meticulous and caring surgeon like you. If there is someone up there!! better give an explanation for the situation you are in at the moment!! Work goes on don’t worry at all, take care and hope you get well soon.”

18 June. The British Hernia Centre surgeon called me to inform me that the Danish Professor of surgery would see me during his forthcoming visit to London. He reassured me that this professor is, “amazing guy and he is the top guy in the world on this”.

Following this phone call, I emailed the professor:

20 June. My GP prescribed Versatis Medicated Plasters. After a long period of use, I did not find them useful at all.

25 June. The Danish professor contacted me via email, and he followed up that by phone call. He told me, after I explained the facts to him, that my surgeon should have taken me straight back to the operating room and released the trapped nerve as soon as I informed my surgeon of my acute severe pain. He also told me that when he operates on me, he will need to remove my mesh along with three nerves from my left groin. He said that he wouldn’t be able to do it in Denmark and will have to come to London to do my operation at the British Hernia Centre. At the end of the phone call, we agreed on the time and place of our first meeting at a hotel in London.

29 June. My surgeon sent his response to my complaint addressing the issues raised, including inappropriate surgical technique and lack of follow up. His response made me even more upset as it sounded like he was blaming me.

In his letter, he quoted two publications about acute pain following inguinal hernia repair. Here (and in the future) he fails to acknowledge the vital fact that my pain was severe neuropathic (nerve pain), and therefore what he quoted was irrelevant to my case.

He said, and I quote, “I am not aware of any reference in the literature to the practice of immediate re-exploration for the management of post-operative pain following hernia repair.”

In my future blogs, I shall reveal the references which he was not aware of.  These many references are not from obscure medical journals or old textbooks. They are from the most famous and up-to-date Hernia Surgery Textbooks, journals, international hernia surgery guidelines, etc. 

Every senior general surgeon I have spoken to has told me (in private) that my surgeon should have re-operated on me and released or excised the trapped nerve. One even quoted two of his private patients who developed acute nerve pain after inguinal hernia repair. He re-operated on them immediately, and both were completely cured of their nerve pain. 

2 July. My pain is very debilitating, making me very depressed and on the verge of crying.

5 July. Accompanied by my wife, we took the train to London to meet the Danish professor.

The professor told us that he has operated on 55 cases like mine, and he quoted an 80% success rate. I asked him about any possible risks or complications. He said there was only one case of testicular ischaemia (lack of blood supply), and that was after the fourth operation on the same groin. He also said that he was about to publish a paper about these cases.

He then added that in delayed presentations like mine, he would wait six months after the original operation before he would operate. He said that he has recently turned down two similar cases to mine and that he only accepted to operate on me because I came through his friend the British Hernia Centre surgeon.

9 July. My occupation health consultant called me for an update.

On this day, I requested my medical records from the private hospital where I had my operation. The Manager sent them to me by post two days later.

I received an email from the professor:

11 July. The British Hernia Surgeon emailed to tell us that the British Hernia Center has declined to grant operating privileges to the professor. This was because he is not registered with the GMC (General Medical Council) and therefore, does not have a license to practice in the UK. He also has not held a substantive NHS post. Consequently, he would not meet the CQC (Care Quality Commission) standards.

I replied asking the professor if he could re-explore the option of operating on me in Denmark.

15 July. As the professor was having difficulty finding a place to operate on me, I contacted my hospital to see if they could offer him operating privileges. They never replied!

16 July. Very good news from the professor!

30 July. The British Hernia surgeon wrote to the professor expressing his wish to attend my operation. He also wanted to see him examine patients and asked if he was still seeing patients on a regular basis.

6 August. The professor emailed me to confirm that the operation date will be on the 22nd of August. He said that it will be performed in the department of gastroenterology and that the chief of that department (a professor of surgery) will be assisting him during the operation. 

I booked a flight and a hotel for myself and my family.

7 August. One of the two medico-legal lawyers I have been in touch with regarding my case has requested that I pay £1,500 for medico-legal reports, plus £50 for her to get my medical records from the private hospital, and another £50 for her to get my medical reports from my GP along with other fees. So, I declined her service!

9 August. Paid for the cost of my treatment in Denmark via bank transfer.

10 August. Text message from the nursing staff at my hospital: “Dear Adel, how are you? The place just is not the same without you here with us. Take care

This was followed by another kind text message: ” Dear Adel, you know we all wish you well and will pray for a successful operation and recovery. With love

13 August. A very kind female consultant radiologist text messaged me: “How are you? Missing U and want to hear you have improved. Did you have the surgery? I wish you all the best.”

15 August. I was unable to sleep until 8 am and then managed to sleep for two hours only.

Last two days, the pain was not bad, but today it came back with a vengeance.

At 12 noon I went back to bed and stayed in bed until 5 pm. Had a very upsetting dream and woke up in tears!

17 August.

Surgical manager at my hospital: “Hi Mr Rateme, hows things? Hope you are feeling a little better and not still in pain. Thinking of you. Best wishes

Me: Hi, I am due to have an operation in Denmark. Pray for me!

Surgical manager: “I hope it goes well, you are in my prayers. If there’s anything I can’t do please let me know.

😂 Obviously, he meant “I can do.”

In my next blog, I will tell you about the operation I had in Copenhagen, Denmark.

About the Author

Dr Adel H. Rateme
Retired Consultant General Surgeon and Oncoplastic Breast Surgeon

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