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Lung cancer - surgery

Only a small number of those diagnosed with lung cancer have tumours that are suitable for surgery. If a non-small cell lung cancer is small and has not spread it may be possible to operate and remove it. In small cell lung cancer the cancer has usually spread to other parts of the body before being diagnosed so surgery is rarely used. Here people discuss their experience of lobectomy (the removal of a lobe of the lung), pneumonectomy (removal of an entire lung), and extra-pleural pneumonectomy (removal of the lung, all the pleura, the diaphragm and the pericardium).

In some hospitals surgeons can perform a lobectomy using keyhole surgery, also known as video-assisted thoracoscopic surgery (VATS).

 

Doris recalled how she felt when she woke after video-assisted thoracoscopic surgery (VATS)....

Doris recalled how she felt when she woke after video-assisted thoracoscopic surgery (VATS)....

Age at interview: 80
Sex: Female
Age at diagnosis: 80
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So what was it like when you came round from the operation?
 
Well I don't remember much about it but I wasn't sick or anything. Didn't feel unwell at all. I was fine. And I didn't have any severe pain or anything. That was why it's alright, I couldn't get out of bed for the first day. They did help me to the toilet but that was, I only got out of bed once during the day but I didn't have any terrible pain or anything like that. No. It was quite alright.

 

 

Derick had video-assisted thoracoscopic surgery (VATS) during which doctors removed a lobe of his...

Derick had video-assisted thoracoscopic surgery (VATS) during which doctors removed a lobe of his...

Age at interview: 70
Sex: Male
Age at diagnosis: 69
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So we got to the point where, I was invited to have an operation, and what I was told was, they would take me down and do a VAT rigid operation, I did know at one point what VAT stood for, visual, something,
 
Video assisted...
 
video assisted
 
...thoracic surgery.
 
That’s it. And that meant that they could then remove, the so called offending bit, get it analysed, if it was cancer, they would remove part of the lung.

 

 

Anyway, I went on the 15th, we got there about eight o’clock we got there, I was booted and suited by half past eight, quarter to nine I was being lead towards the theatre for the operation, I was first on the table. Next thing you know, I was coming round, all wired up and a big drain coming out of me and all the rest of it. Yeah, I was a little bit non-plused, you know, in and out of consciousness. But yeah, my wife and my son come to see me on the evening, desperately tried to stay with them while they was there, sort of nodding off all the time, and I did, and then the following day the nurses came round, got me out of bed, sat me in the chair, I was eating and drinking, and, yeah, a little bit uncomfortable, OK, so I was a bit uncomfortable...
 
Did you feel prepared for the operation, as in did you understand what was going to happen?
 

I under, well I thought I understood what was going to happen, I didn’t really know what was going to happen, all I knew was that it was going to be done by keyhole, that’s all I really knew. There’s a chap on the estate, he had his done five years ago, went for his last consultation yesterday, and he was cut from the top of his shoulder blade, right the way down past his ribs, almost to his hips and he couldn’t believe that I’d had mine done by keyhole surgery. Because I’ve got two, well three little scars I’ve got now.

 

Before surgery the hospital will send instructions. One man of South Asian decent described the things he took into hospital for his pneumonectomy. He was a vegetarian and was given special permission to take his own food to the ward.

 

Remembers what he was asked to take into hospital and describes his pneumonectomy.

Remembers what he was asked to take into hospital and describes his pneumonectomy.

Age at interview: 69
Sex: Male
Age at diagnosis: 66
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Now the day before when I went, actually I had a letter from the hospital with a list of things to take. They were very minor things like toothbrush, toothpaste, pyjamas, towel and again they said, "Even if you can't, the hospital will provide that." They only suggested that because they are more personal and it is better to have our own things with us. But there's not, it was not a big fuss as such and the staff is always helpful, they even brought me the pyjamas and I said, "No I have my own," and so they were happy. So there was nothing much to worry about, they took full care of me, they saw that I don't eat anything after 7 o clock, which I normally don't eat at all. And so in the morning they came, they again checked my blood, took to the theatre and what happened in the theatre of course I don't know because I was given the injection before I went to the theatre and even reaching the theatre they gave me another anaesthetic injection which kept me lying down for almost 12 hours. And when I opened my eyes after 12 or 13 hours I saw my wife with my son and they were all happy, they were all smiling like me, and here I am as I said quite happy.

And they had removed your left lung?

They removed my left lung completely which I was told two days after the operation by the same professor. He came and said "Sorry I have removed your complete lung because I did not want to take chance that it may occur again. But be sure after some time it will feel as if nothing has happened," and he was quite right. Even with the one lung I am moving about, I am doing all my natural things, daily things and nothing much to worry.

 

Explains his habitual special diet and says he was allowed to keep food in the fridge while in...

Explains his habitual special diet and says he was allowed to keep food in the fridge while in...

Age at interview: 69
Sex: Male
Age at diagnosis: 66
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When you're in hospital do you need any special diet or anything like that?

Yes I'm a pure vegetarian, no eggs, no fish, no meat so they do give the special diet in the hospital. Although it is not to our standard because they may not have the good stuff in that particular section, otherwise there's not a problem. Because we live on a very, very simple diet and so normally for me my wife used to bring everything from home. I was even given special permission so that she can keep things in the fridge, she can make tea, coffee, anything what I need, just like my home.

On arrival in the ward members of the hospital team, such as the anaesthetist, may ask questions. The doctor explains what is going to happen, and asks for written consent for the operation.

 

Describes what happened when he had his lobectomy.

Describes what happened when he had his lobectomy.

Age at interview: 55
Sex: Male
Age at diagnosis: 50
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Right in December, November 97 I was asked to come back in once they done x-rays and when I went in the doctor explained everything out and the anaesthetist came up, asked questions and that, very reassuring that everything was going to be alright. So that was fine and...

You went down to the theatre?

Yes I went down to the theatre and they cut us right around the back as well and they took the tumour out which as I say was about the size of a tennis ball. They did try keyhole surgery which they decided not to do because the tumour was too large; and went down, got the operation [lobectomy] and the tumour was removed. I felt sore, but they give you pain killing injections, you start getting better. And on December 5th that was the day I got my operation and I got my operation and...

How long did you have to stay in bed, in the hospital?

About ten days, I stayed in the hospital and they kept monitoring me all the time and very reassuring the staff, nurses, doctors.

Patients are not allowed to eat or drink for several hours before surgery. Usually a 'pre-med' (a sedative) is given. The patient is then taken to the operating theatre, where the anaesthetist may start a 'drip' (intravenous infusion).

 

Describes what happened in the ward and operating theatre before his lobectomy.

Describes what happened in the ward and operating theatre before his lobectomy.

Age at interview: 43
Sex: Male
Age at diagnosis: 43
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I was in hospital for five days, initially they take you in the day before your surgery so obviously there's a certain amount of monitoring done on your state of health, psychological state and so forth and so on. You're not fed, what they call nil by mouth from midnight the day before your operation, so for twelve hours you wouldn't have eaten anything obviously this affected, could be affected by anaesthetics. They give you a pre-med which is basically just a way of relaxing you, it's supposed to relax you and then they get you ready for theatre.  

Then they wheel you off in your bed (laughs) through the corridors to the theatre suites where you're, you're taken to like a reception area where obviously your surgeon, the anaesthetist and so forth and so on have gathered. And they would take you off to prepare you, they transfer you from your bed onto like an operating trolley. There are several lines going at that point, IV lines for various reasons obviously you have lines which they use for the anaesthetic and others that are feeding you saline, fluids basically whilst you're on the operating table. There's also one into your jugular vein, I believe this is for, if they have to, if you crash whilst you're in surgery they have a line that goes directly into your mainstream, bloodstream through your jugular vein. I think that's probably because it's so quick, the idea is obviously that anything that they give you reacts very quickly.  

The operation is done under a general anaesthetic, but the patient may also have an epidural anaesthetic at the same time This may be kept in place for a while after surgery to prevent post-operative pain. One man described how an epidural combined with a self-operated pump, also known as a patient controlled analgesic device (PCA), stopped all the post-operative pain. He also remembered being given oxygen.

 

He used an epidural infusion to control the pain after his pneumonectomy.

He used an epidural infusion to control the pain after his pneumonectomy.

Age at interview: 52
Sex: Male
Age at diagnosis: 50
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I think I was in theatre for four hours and then they kept me there on observation for an extra two afterwards. I think the reason behind that was with me being overweight and with me, I tend to have coughs and that sort of thing, I think they just wanted to be sure before they sent me back up for observation on the ward. Nonetheless when I got back on the ward and became aware again I was  told that they'd taken away the whole of the lung and part of the pericardia which is something that surrounds the heart. They warned me that they'd gone dangerously close as he put it to the voice box and that my voice may be affected but that he had felt that things had gone very well and that he had got the whole tumour out which obviously was a great relief to us all. But at that time, I mean at that time I was, although I was relieved I was very weak and very, I had what the ladies have when they're pregnant, to keep the pain away?

An epidural?

I had an epidural and a little button to press when the pain came along. And that was a great comfort to me because at one stage before I realised I could help myself the pain got quite bad. And seemingly they had told me to press this button but I must've been in a daze and I'd forgotten so they came over and said "You don't even feel the slightest tinkle, you press the button and we don't want you feel anything at all." So that, I mean in future I used the button.

 

Describes the epidural and morphine pump that he used for pain control after his pneumonectomy.

Describes the epidural and morphine pump that he used for pain control after his pneumonectomy.

Age at interview: 70
Sex: Male
Age at diagnosis: 70
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And I was strapped up with epidural and what is that thing called, morphine, and then I had to breathe in this machine which was giving me oxygen and all that there. And I didn't use half the morphine because I wasn't in pain.

That's good.

I wasn't in pain to be honest. Although they was giving me pain pills every so often and water pills and I think I had a steroid at one stage, probably that killed all the pain but I never experienced any pain at all.

Did the epidural stop the pain?

It must've done because it was in my back, two little tubes or three tubes in my back, it must've stopped the pain because I never received, I never got no pain.

Oh that's good.

I can't say I got any pain but I was taking pain killers and I didn't, well I suppose I had to take them, they made me take them you know.

You could give yourself, was it a morphine pump, could you give yourself?

Yes I could give myself some and then after about the third day I said, "Could you disconnect this one?" They said "Well are you still using it?" But apparently they do the check and they can tell how many times I pumped away, well they said "You haven't used none," I said "Well take it away then."

One woman had had an epidural, but due to low blood pressure after her lobectomy it had to be discontinued. She had severe pain in the area where she had the drainage tubes and was given morphine to relieve it.

 

Her epidural had to be stopped because her blood pressure dropped, which left her in pain.

Her epidural had to be stopped because her blood pressure dropped, which left her in pain.

Age at interview: 53
Sex: Female
Age at diagnosis: 50
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So what sort of anaesthetic did you have in the end?

She gave me an epidural and then obviously the full general anaesthetic.

As well?

As well, oh yes thank God for that. Yes so obviously I had the, she injected the epidural and then I was taken to the operating theatre and they did the full general anaesthetic. The next thing I was aware of was obviously the recovery room which I remember quite distinctly because I was in severe pain with my shoulder, and one of the nurses was massaging my shoulder.  She said, I remember her telling me that she said the pain was because I'd had my arm up in the air for like five hours, I'd been in there five hours and that just did sometimes happen, I think I'd got like frozen shoulder or something. So that's all I remember was that severe pain in my shoulder.

Where was the epidural exactly, which part of your body?

Down the bottom of the spine. They then took me back up to the high dependency unit and I felt quite well at that point.  I remember waving as I came back up because I'd made friends with some of the ladies in the ward and thinking thank God it's all over, now we've got to wait and see you know what the results are. But I did feel quite, quite good at that point, apart from the pain in my shoulder.

Did you have any painkillers for that?

They came, they sent a specialist along, a pain specialist along. They first of all tried heat treatment on there. I was already being given, they wouldn't give me any other pain killers because I'd already got the epidural so they were just trying heated pads on there to see if it eased it.  It eased a little bit but not a great deal.  In the high dependency unit unfortunately my blood pressure kept dropping so they decided that they would take the epidural off because apparently that sometimes happens with epidurals. They would replace it with morphine but I couldn't have a great deal because my blood pressure kept dropping. So that was pretty horrendous because nobody had prepared me for what pain it was going to be. I think the pain was awful. I've had operations before and I've never experienced pain like that one.

Where was the worst pain?

The worst pain was actually here where the drainage tubes were. 

For mesothelioma at an early stage, an extra-pleural pneumonectomy (removal of the lung, all the pleura, the diaphragm and the pericardium), can sometimes be performed. However, so far it remains uncertain whether this surgery helps. Extra pleural pneumonectomy is rarely done in the UK and is no longer considered appropriate by the majority of surgeons and chest physicians for the treatment of mesothelioma. 

One man here described his experience of the radical surgery extra-pleural pneumonectomy for mesothelioma. Like other patients, he spent some time in the High Dependency Unit after surgery. 

 

Comments on his extra-pleural pneumonectomy and the time he spent in the high dependency unit...

Comments on his extra-pleural pneumonectomy and the time he spent in the high dependency unit...

Age at interview: 54
Sex: Male
Age at diagnosis: 53
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Yeah I was accepted for the operation by the surgeon and it was planned to be done on June 2nd 2003, the operation was an extra-pleural pneumonectomy which was as I explained removal of my left lung, my diaphragm, my heart lining and my chest lining and having the linings replaced with Gore-Tex. I had to go to the hospital which was about one hundred and fifty miles away from home to have tests. Because the operation, it's quite a big operation they'll only do it you're really fit and so right up until the day before the operation I was having tests.  

So I'm not quite sure how long the operation took. I was, from leaving the ward to going back to the ward was about nine hours. When I came back into the ward, initially in the recovery room, I was in a lot of pain, my shoulders were very, very painful. But in the recovery room they sorted this pain control out somehow or another I'm not quite sure. So I eventually got back to the ward and I was really covered in, I had a tube up my nose, I had tubes in my side, I had a catheter fitted, I had lots of wires connected to my chest. I had six cannulas which are things that they can put drugs into all in one array on my chest to allow them to put antibiotics and things. But generally I didn't feel too bad. A little bit uncomfortable but nowhere as bad as I thought I would do. And I had quite a comfortable evening with my family, the hospital was very good. Their high dependency unit was part of the ward and my family was allowed to stay with me all the time. They actually found, they actually had accommodation within the hospital grounds for my family to stay with me as well and they could stay in the ward as long they liked which was comforting. And then the next day, round about half past 8 they got me out of bed (laughs).

 

Discusses his pain control and nursing care after his extra-pleural pneumonectomy.

Discusses his pain control and nursing care after his extra-pleural pneumonectomy.

Age at interview: 54
Sex: Male
Age at diagnosis: 53
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How many days did you have the epidural?

The epidural stayed I think five days but that was my choice when to have it out. What each day the, after the first day they took my chest drain out and just seemed, each day they could get rid of a few tubes or wires so that each day was better.  On the second day after my operation they actually had me up and walking around the ward, albeit with nurses holding the drips and things like that. And again I didn't feel too bad but I presume it's because I had an epidural, other pain killers, and so you know lots of drugs. But I was certainly quite lucid, I didn't feel as zonked out or anything like that, I felt as if I knew what was going on. The nurses were really good.  In the high dependency unit I had my own nurse twenty four hours a day. It was very uncomfortable sleeping because it wasn't until, my wife took some photographs of me every day and so of course I didn't really know the extent of the wound or anything like that so my wife took a photograph and was able to show me on my lap top and the wound probably came from half way on my shoulder blade down through my back and under my arm to my waist and I had around about ninety metal staples in it and so that made it a little uncomfortable to lie on. And that discomfort stayed for three or four weeks, even after the staples were removed.

After a short time in the High Dependency Area, patients return to the ward with one or two chest drains in place. These are usually removed after a few days. Patients may also have a catheter inserted into the bladder, which is kept there for a day or two until urine can be passed normally. 

 

Describes what it was like to have a drain removed after his lobectomy.

Describes what it was like to have a drain removed after his lobectomy.

Age at interview: 43
Sex: Male
Age at diagnosis: 43
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And then when did the drains come out?

The drains started coming out, I was actually in hospital for five days, so day three would've been the first one, which would've been the lower one, obviously they put one at the top and one at the bottom. The one at the bottom is obviously gravity fed fluid, the other one is obviously taking it directly from the operation site. The first one comes out, it was, let me think about two minutes and it's all over and done with, literally. I was actually watching, it's done by a nurse and literally they just pull it out and stitch the skin and that's it and it's, I presume it's fed through the side of your, in between your ribs so it's quite strange, a bit of hose pipe being pulled, and that's what it looks like its just a bit of plastic hose pipe, nothing special about it you know it was quite simply that.

Postoperative recovery in the ward includes physiotherapy. Patients are encouraged to cough up phlegm, and are taught to exercise their arms, shoulders and legs.

 

Recalls that after surgery he was told to bring up as much phlegm as possible.

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Recalls that after surgery he was told to bring up as much phlegm as possible.

Age at interview: 52
Sex: Male
Age at diagnosis: 50
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On the other hand one of the worst parts of my recovery was that to, I had to bring up any phlegm, which was to be tested actually, they gave you cups to bring this phlegm up into because it was tested each day a,  presumably for the cancer I'm not quite sure. And to see if there were any, anything wrong in it. But, it is actually horrible trying to force yourself to bring this stuff up, it's not very pleasant to be doing in front of other people and I've no doubt not very pleasant for other people to see you do it. Nonetheless it was something that had to be done. And it was there throughout the day for you to do so (laughs) whether visitors were in or not it was something you had to do was to bring it up. And you had to do it as best you could because you were teaching, basically you were teaching your one lung to do the job of two and it, that's how the doctor said it to me that the better you can do this the more training you are to keep the, any kind of infection or anything like that out of your system and now that you only have one lung you had to kind of get your one lung to do the job of two so this was part of the rehabilitating and, but it is horrible, it's not a very nice thing to be doing. And there was such a lot lying on your chest over the, probably because you're lying down and that, it wasn't coming up in the normal fashion so you had to force yourself to bring it up.
 

 

Describes the physiotherapy he had after surgery and shows his scar.

Describes the physiotherapy he had after surgery and shows his scar.

Age at interview: 62
Sex: Male
Age at diagnosis: 59
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So which lung did you have removed?

I had my right lung removed and I seen the doctor who did the operation, he came round every day to see you, but it's not just him, one or two other doctors are there and other people who've had different operations on all that. And he said, "Well how do you feel?" and I said "I feel great," I said "I'm okay." "Do you feel strong enough to go home?" I said "Get me out the bed and I'll show you." So the therapists come along and they said, "Right we're going to take you to climb two flights of stairs," because they won't release you unless you do that. So I walked with her, got to the first steps, stood on them went [pretends he can't get his breath], "That's enough." But I was playing the nurse up. So we went up the first fight of stairs and come to a landing, "Are you alright?" I said "Yeah fine." She said, "Don't rush, don't rush," "I ain't rushing." I felt at the time I hadn't had an operation, as if I was as normal as anything. 

How many days after the operation was that?

That was a week

Right.

That was a week, and I climbed the next set of stairs, had a quick breather and then come back down again." She turned round, she says "Fine," she said "you can go home," so...

What sort of exercises did the physiotherapy get you to do?

Well what they do is, they get you to do is put, hold your arm, put your arm up like that, lift your arm up, hold your breath, they count one, two, three release. You do that two or three times you know then you should be able to now have a wash and shave, have a shower and all that, did all that in hospital. Because I felt you know as if I hadn't had an operation that time.  

How big is the scar?

It's from my shoulder down to, do you want to see?

Well do you want to show it on the film?

I'm not bothered, I'm easy [he pulls up his shirt and sweater].

We're just looking at the scar. Do you want to say anything about the scar?

Well when I first seen it I thought, 'Cor my life!' you know what I mean, I said "It's a big scar there for me." And but they said it's, over time it will heal up and you probably wouldn't know it when you see it.

Patients are usually allowed home after 5-10 days. The wound heals gradually and the district nurse may remove the clips or stitches. One man, who had surgery in 2002, was happy to show the long scar on his back. 

 

Describes his post-operative recovery at home; the district nurse removed the stitches.

Describes his post-operative recovery at home; the district nurse removed the stitches.

Age at interview: 53
Sex: Male
Age at diagnosis: 51
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I convalesced at home, it was a bit sore for quite a while, spent a lot of time in bed. We'd get up and sort of strut around but each day I was getting that little bit stronger. Our house has stairs and I started off more or less crawling up the stairs after the operation and then I got to being able to walk up a couple of them. There are 13 steps, or 13 treads on the stairs and my goal was as quickly as possible to be able to walk up all 13. And then once I'd achieved that, and I achieved that quite quickly it was to be able to do it twice in a day and then three times and then to be able to go up them and come back down again and go up again. And that took a while, but we got to it. It was being aware of the fact that you were breathing.  

We never, if you think consciously you never think about breath but when you've had the sort of operation, a complete lung taken out you actually start being aware of your breath and each breath you take. That feeling dies eventually but you know I was trying to get myself off the drugs, I felt like I'd been taking too many for too long so I was cutting them out as quickly as possible, I was taking fewer and fewer painkillers and getting the type of painkillers reduced so that eventually I was only taking paracetamol and I was then only taking that when I needed it.  

Did you have stitches to remove?

Yes I had to get the stitches removed. My district nurse came in a couple of weeks after the op and removed these.

 

Describes the scar from his pneumonectomy and shows it on film.

Describes the scar from his pneumonectomy and shows it on film.

Age at interview: 48
Sex: Male
Age at diagnosis: 48
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And then finally you said you wanted to say a little bit about your operation scar?

Yes, the first time I saw the scar, the day, on somebody else the day I was going for the surgery I was quite alarmed by how ugly it looked and when you come home it is indeed an ugly scar and the flesh above the scar sags down over the wound and it looks ugly and unsightly and then it does tidy up, it shrinks back and it settles down. It's still a big operation, it's still big, evidence of a big operation but it's much more tidy now, I'm quite happy to show it.

 [SHOWS SCAR] 

Yes, you can plainly see the scar there and two drain sites, and the swelling around the scar shrinks back and its now quite tidy and there is no discomfort there to me at all, and its less unsightly than it is immediately post op, when it is quite scary.

After such major surgery people may take a while to recover, although some reported feeling much better within a week. Three months after his operation one man said that he could do an hour in his garden but then he had to rest. Some people are left with long-term side effects. One man felt that he would never really recover from his operation. (See 'Side effects of lung cancer surgery', and for information about Cryosurgery see 'Cryosurgery and other treatments for lung cancer').

 

Describes his recovery and getting back to work after his pneumonectomy.

Describes his recovery and getting back to work after his pneumonectomy.

Age at interview: 70
Sex: Male
Age at diagnosis: 70
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And then what could you do when you got home, what sort of life could you lead when you got home, what could you do, what couldn't you do?

I couldn't do a lot, I used to have someone come in to help me, I used to sit about quite a little bit. I used to be able to make tea, I couldn't lift nothing heavy, it was impossible to lift anything heavy and I couldn't do a great lot myself but I, fortunately I got, as I previously stated I got a lot of friends who virtually came and done everything, done anything for me.

And how many weeks did it take to start to feel more like your normal self?

About four to five weeks and I had the operation, oh gosh in September, 15th, I think it was 15th September and here we are now nearly the end of December and I'm on top of the world.

You look good.

I'm on top of the world. I can work now and do little things but not for long. I can do a hour's work and then come in and sit down, do an hour's work steady, not overdo it and then come in and rest then.

What sort of work would you be doing?

Oh a little bit of gardening.

Oh good.

Yeah a little bit of gardening, then tidying up and that.

 

He has not fully recovered from his operation and his activities are limited.

He has not fully recovered from his operation and his activities are limited.

Age at interview: 62
Sex: Male
Age at diagnosis: 59
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So how many weeks did it take you to really feel you'd recovered from the operation?

You don't really, in my eyes, I don't think you really do recover. When I say you don't recover you, I mean you do but it's going to take time, it does take time because when they open you up they're cutting through your muscles and moving your ribs and they're cutting through your tissues and whatever else just to get to your lung and whatever.  I mean... 

It's a big operation.  So what's the whole impact of all this been on your life would you say?

I'm annoyed because I can't go to work, simple, simple as that. I've worked, I've always worked, I was on security twelve hours, fifteen hours, sometimes I never, my wife would never seen me because I worked day and night. And I've always been at work and now I feel guilty because I'm not pulling my weight but what I don't do at work I do here. I can go down and vacuum, I can clean windows, but I have to watch what I'm doing. I mean if I'm going to stay doing [he reaches up] that's when it starts hurting me or if I over-stretch myself by cutting the lawn.  But at the end of the day I'm sore and I can do a bit and I mean I can iron, do some ironing, I iron the babies' clothes. But generally it's just looking after myself now. So I'm eating more, where I never used to eat before I'm eating a lot more now and I'm eating the proper foods now, I'm eating a lot of vegetables which I don't normally eat. I mean I couldn't stand cabbage but I'll only eat a certain kind of cabbage, which is that white cabbage what you call it and carrots, a load of greens now. But generally I'm okay. But there is times when I do have an off day and I'll say to the wife "I'm going to bed," she knows exactly what I'm going for I'm going to bed and I just stay in bed for an hour or may be half a day or all day long, I just go into bed.

For more information sources see our Resources.
  

Last reviewed May 2016.

Last updated May 2016.


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