On the first post-operative day I got out of bed unaided because I didn’t need help. I’d been encouraged to get out of bed. Initially just sat in a chair beside the bed feeling mildly sorry for myself because by that time I was getting some discomfort, more related to movement. It was still the case that at rest I was completely comfortable but when I moved there was, there was pain but I had six small incision sites including the drains so pain was no great surprise.

I was discharged from hospital with a small supply of two different types of catheter bag, one being a day bag which is strapped to the leg with a sort of elasticated Velcro strap and it has a capacity of I think 750 ml or thereabouts. And that has a little valve at the bottom to allow you to drain the bag in a toilet whenever you need to. And I was also equipped with night time bags which have a capacity of I think about a litre and a half or two litres. So unless you have an excessive fluid consumption in the hour or two before you go to bed that’s more than adequate for an average night time.

What I was not equipped with and I don’t even know whether such things exist was any kind of a catheter bag stand or rack or something to actually put the thing on. They had these things on the ward, little racks that they can then hang on a chair or on the side of a hospital bed but I wasn’t equipped with anything like that to go home with. So I needed to rig up a sort of a Heath-Robinson arrangement at home particularly at night time of course with a night time bag to make sure that the basic hydrodynamics of things were properly managed because you can’t expect water to flow uphill as it were. So you need to arrange things. And it took me a couple of nights to get the hydrodynamics right with that.

I confined myself to my own home and garden for the first two days at home, simply because movement was uncomfortable and also because maybe this is a male psychology thing but even though I knew nobody could see the catheter bag when I was out walking around outside of my own home just getting used to the idea of having a catheter bag strapped to my leg when I’m walking past neighbouring houses. It took me two days to get to that point where I was willing to take the plunge and take a stroll. But from Day 3 really onwards I walked further and further and probably by Day 5 I was walking maybe a mile a day pretty slowly but nevertheless a mile a day. And the only reason it wasn’t more was that I would need to get back to drain the catheter bag. Sometimes you can take advantage of a handy tree somewhere but it’s actually not that quick a procedure to drain a catheter bag.

And do you want to say anything else about recovery?

In the first couple of weeks I was still taking quite powerful antibiotics. Doubtless they were doing their job from an antibacterial point of view but they had a powerful gastro-intestinal affect. I was eating and drinking normally but very definite signs of intestinal hurry that left me actually feeling a little bit debilitated and uncomfortable.

So diarrhoea sometimes?

Just so, yes. Compounded by the fact that the surgeon had been quite insistent that whether I thought I needed it or not I should persist with taking lactulose. So there was I taking powerful antibiotics and having some relatively acute diarrhoea also taking lactulose. Anyway it lasted for about 10 days and then subsided pretty quickly and it was bearable. It was an inconvenience at worst no more.

They elected to keep me in or rather they invited me to stay in for one night after catheter removal so that I could have in the safe surroundings of the hospital the experience of going through a full night without a catheter and with bladder filling up overnight so to speak. And then they particularly wanted to check that I could void, empty my bladder properly in the morning. So that was fine. One extra night in hospital, pleasant enough. No big deal. The following morning up bright and early, quite mobile and to my great surprise my first post-catheter removal night had been an entirely dry night. I’d not been led to expect that. I’d been led to expect the near certainty of torrential urinary incontinence for quite some time after catheter removal or after surgery more generally. But my first post-catheter night was a dry night and indeed every night since with only two slight exceptions have been also dry. So I was discharged the following morning after I had demonstrated that I could void my bladder ok and that I was pain free and comfortable. Back home and I’ve just gone from strength to strength ever since.

And how many weeks did you say you were off work?

I was off work in total for four weeks. So that was 10 days during which I had the catheter and then roughly three weeks after that point. I, I could probably have resumed work earlier than that. Indeed to a degree I did resume work earlier than that because I dabbled at E-mails and odd bits and pieces from home.

I then spent the remainder of December, all of January and all of February voraciously consuming information from the Net, and from The Prostate Cancer Charity who I found consistently marvellous incidentally, and from a variety of other sources including various clinical friends in the NHS. And went through quite an organised process of arranging my thoughts and judgments about the competing merits of the available treatment options. And I spread-sheeted those in a sort of a decisions matrix.

So effectively how that worked was I took a fairly early view on what did I want as outcomes from this saga and how would I weight each of those outcomes relative to each other, so they each then carried a weighting. And then as far as I could by trawling through the evidence and information available to me I then rated each of the available options. So I looked at open radical prostatectomy, laparoscopic radical prostatectomy, robotic radical laparoscopic prostatectomy, high intensity focused ultrasound, brachytherapy, external beam radiotherapy and the, the less plausible ones including cryotherapy for example which I think I ruled out very early on as an option to which I was patently unsuited. But, but I went through and scored each of those options using a, a weighted arrangement and really arrived at a pecking order that had two options scoring almost equally at, at the top as it were, one of which was a time-limited option and it was to do nothing, to simply content myself with watchful waiting, repeat PSA tests and biopsies at sporadic intervals and then intervene when the necessity arose to intervene. And the other was robot-assisted laparoscopic radical prostatectomy.

In the end prior to my follow-up outpatient appointment in February I was erring very much on the side of decisive intervention through surgery largely on the basis that the watchful waiting approach would almost certainly culminate eventually in a decision to intervene but by that stage A) I would be older and correspondingly not quite such a good anaesthetic risk and secondly I would be completely reliant on the accuracy and timeliness of investigative tests to chart accurately the progress of the disease. And I didn’t feel comfortable with the risk that watchful waiting might ultimately place me in a position where not only was I a poorer anaesthetic risk but also the disease had progressed to a more grisly stage.

My hospital stay was a 3-day stay. So there was a pre-operative day, an operative day and one post-operative day and then I was discharged on that first post-operative day. So the day after surgery I was discharged.

In terms of the process the pre-operative day I guess was relatively standard for any surgical procedure. It was about being clerked in, having assorted bloods and other investigations done, signing various pieces of paper, being visited by your anaesthetist, being visited by the surgeon, being visited by assorted other doctors and nurses. So, for example, I was seen by the specialist urology nurse. I was seen by the specialist continence nurse to make sure that I had an accurate grasp of how to do pelvic floor exercises correctly and appropriately and at the appropriate frequency and so on. So that first pre-operative day was just a blur of a steady succession of people wanting me to sign things or wanting to tell me things or wanting to investigate or analyse or stick needles in me or whatever. And it was all perfectly straightforward other than the usual doldrums of hospital food.

On the operative day I was starved from the preceding midnight or nil-by-mouth from midnight. I was taken down to theatre at about 10’00, 10’30 in the morning. I was not given a premed. I didn’t need a pre-med. I believe premeds are still used for patients who are more agitated or anxious about their surgical process but I was fairly relaxed about it so I went down unpremedicated to theatre. Spent a short time in the anaesthetic room where all the documentation was checked. My identity was checked. All that was fine. A venflon [plastic tube] was put in my hand, I think only on one side and I was put to sleep so to speak.

And the next thing I knew I was waking up in recovery. I’m told that on waking up and I can’t imagine why this would have happened because it seems quite out of character for me but I’m told that on waking up my first words were that I wanted a chicken chow mein and a bottle of Budweiser [laugh] which I wouldn’t normally want as soon as I’d woken up but there we are that’s patients recovering from anaesthesia for you. I do have a recollection that in the recovery room after surgery I was entirely pain free, probably still slightly euphoric hence the chicken chow mein and Budweiser reference but I was entirely pain free and I felt lucid whether or not I was lucid I think is very doubtful but I felt lucid.

I do have a recollection of seeing other patients also in the recovery room. Some who were fully screened but one of whom, a rather large West Indian lady was not adequately screened and some quite intimate things were being done which frankly I ought not to have seen. So theres that privacy and dignity thing I still think probably doesn’t feature as prominently in the mindset of some clinicians as it ought in hospital.

Anyway the recovery from anaesthesia was uneventful and relatively swift. I was taken up to the ward at about 3’00 in the afternoon. So left the ward at 10’30. I was back on the ward at about 3’00 in the afternoon where I spent a couple of hours asleep and then was quite awake and alert by about 6’00 pm, slightly nauseous but no more than I would expect after surgery. I treated food and fluid with extreme caution on that first day. I started out with small sips of fluid gradually escalating to a cup of tea. I don’t think I actually ate anything on that first day. I could have done. There was no reason from the nurses’ or doctors’ point of view why I shouldn’t have done but I’ve had an anaesthetic once before in my life and recall eating a little too swiftly after anaesthesia and regretting it almost immediately as did the cleaners.