Derek has an appointment with Dr Gomez at 11:30 this morning.  This is the day we have been looking forward to and dreading in equal measure.  It has been a hard week on Derek and his second week without his cigarettes.  He had not realised how much it would take it out of him.  The anti-biotics are finished, but he is still reliant on the pain killers which are making him tired and listless; and apart from the operation site, the catheter is making him very uncomfortable and at times it is downright painful.  The weather is hot, but he has to wear trousers only adding to his overall discomfort.  Today we really hope that the catheter will be removed and hopefully the metal staples too.   We booked a taxi to pick us up at 10 past eleven, but it did not arrive until 11:25 – not an auspicious start for the day.  We arrived ten minutes late at the hospital and after queuing at the main desk to book in, arrived for our appointment nearly twenty minutes late.  No sign of Doctor Gomez, no queue outside his room and the room was empty, mild panic was setting in.  Gradually, other people joined the queue we had started, but it was three quarters of an hour, before an apologetic Doctor Gomez arrived.  I was so relieved to see him that I didn’t care how late he was or that he still managed to see three other patients before he got to us.  The wait was worth it.  Doctor Gomez is a very caring, patient man who always puts you at ease and takes the time and trouble to explain everything until he is quite sure that you understand.  Today he has good news for us.  The cancer has all been removed with the kidney and there are no secondary sites and the lymph nodes were all clear.  This means that Derek will not need chemotherapy or radiology.  Before Derek can say anything else the good doctor tells him to go to the treatment room so that he can remove the catheter.  The look of relief on Derek’s face is a picture as he makes his way up onto the couch in the treatment room.  Fascinated, I watch as he clips out the metal staples one by one, but leave before he gets around to the catheter – I don’t really want to hear a grown man cry.  However, I need not have worried, because according to Derek he was very gentle, unlike the nurse that removed the one he had after the biopsy, I suppose it is a man thing.  Doctor Gomez tells Derek that he has to return for regular check ups, every three months for the next five years.

That part over, we head to reception and book the next appointment for December 3rd 2008.  From reception we go to Administration to find out their intentions regarding Derek’s front teeth.  Carmen in admin remembers the incident and soon locates the file.  She disappears to the dental department and comes back with an appointment for Derek on Monday September 29th.  I can’t help wondering just what it was she said to the orthodontist.  I mean, was it, “Better do an excellent job on this one or he might sue the socks off us”, or was it, “Get away with it as cheap as possible, they’re only foreingners and won’t know any different how we do things over here”.  Cynical or what?

Today is our wedding anniversary, but we certainly had never envisaged spending it in San Jaime, but as the day dawned early as usual, we had already resigned ourselves to it.  Breakfast and lunch passed by uneventfully, with the usual visits from the nurses toing and froing, changing drips and doing the vitals.  Television pre-pay ticket ran out, so had to purchase a new one, seven more euros to get us through the day.  Another doctor comes to poke and prod Derek – at least we think he was a doctor, but he looked more like the boiler-man just come up from the basement and helping the doctors out.  Anyway he gives Derek the once over, pronounces him fit and tells him he can go home.  Derek asks when, thinking he means tomorrow.  “Now” says the doctor. “Come back in a week to see Doctor Gomez”.  So the drips are pulled out and the central line removed and all we have to do is pack up and leave.  I hand the still unused telly ticket over to the nurse as I am sure someone will be able to use it.  Helpfully, they order us a wheelchair taxi, and with Derek still in pyjama bottoms, we leave the hospital just as the taxi draws up outside.  How’s that for timing?  By 4pm we are home again.  So a pretty good wedding anniversary after all.

Later in the evening my brother, Geoff, rings me, strange that I thought, he generally only rings at Christmas.  He is ringing with bad news.  Our eldest sister, Pamela, died yesterday.  I did not even know she was ill, but by the strangest coincidence, she had been diagnosed with kidney cancer around the same time as Derek.  They told her it was operable, but it was much further advanced than Derek’s (thank heaven for those kidney stones) and she collapsed on Saturday and died an hour later before they were able to treat her.

Day started early as usual.  Opted for coffee instead of tea.  Its not a bad cup of coffee and with biscuits and croissants it’s an acceptable breakfast.  Derek is still feeling poorly, so it does not seem likely that we will be going home today.   He is still only managing a few mouthfuls of food per meal.  The food is generally pretty good, well balanced and always nice and hot.  Derek is on a restricted, bland diet, so it is not very adventurous, but certainly nothing to complain about.  Before lunch he is given a menu card and allowed to choose his own meals.  This is much better and they have quite a nice selection to choose from.  Around tea time we have a new nurse, Marian, come to change the dressings.  We speak to her in Spanish, but she replies in very good English, much better than our Spanish.  She sees that we are surprised and tells us that she only speaks English to people who speak to her first in Spanish!  Now isn’t that confirmation of everything you have always thought.  Derek has to have the wound drain removed, but when she tries to pull the long tube out, it causes him excruciating pain.  Quickly, she stops.  We are both very worried.  She says that she will get the doctor tomorrow to take it out.  Derek says ” what the ****’* wrong with today!”  Nurse exits rapidly.   Some 15 minutes later, nurse returns with Doctor.  A quick twist and sharp pull and it is out.  Doctor explains that it was probably just a little bit stuck and that the nurse had already freed it.  Exit Doctor, followed by nurse.  Said nurse returns 5 minutes later – minus doctor and says in her best English, ” See, I put my arse on the line for you!”  I like this Nurse Marian.

The day started early as usual in hospitals, at around 6:30am with the nurses coming in to take vitals etc.  At 8am the breakfast trolley came round.  Derek was feeling somewhat better by now and looking forward to a cup of tea and a bite to eat.  It had been 36 hours since he last ate.  Two cups of milky water with floating tea bags arrived, accompanied by a croissant, jam, butter and some biscuits.  Quickly I added our own tea bags to the murky brew and produced a half decent cuppa.  Funny, when you are desperate, how good even a half decent cuppa tastes.  Two nurses arrive after breakfast and proceed to give Derek a bed bath.  Quite amazing to watch how they work in unison, making him comfortable, clean and refreshed.  After washing and drying him, they smoothe over Aloe Vera liquid and also sprinkle it on the fresh bedlinen, I am most impressed and Derek looks so much better for a little attention.  Later that morning Doctor Gomez came to see how his patient was doing.  He told us that the operation had gone as expected, that he had removed the kidney, adrenal gland, lymph nodes and urethra and that everything looked clear, but we would have to wait for the final results.  He took Derek off the oxygen, but left the wound drain in and also the catheter.  We were amazed to see the surgical incision held together with large metal staples, much heftier than anything you would use to hold papers together, but Doctor Gomez assured us that these were the best method and gave no trouble when the time came to remove them.  Derek asked how soon the the catheter could be removed and was most disappointed and surprised when he was told not for two weeks.  Rather difficult especially as he had come into hospital wearing his shorts.  I said “What no sex for two weeks!!”  Made them laugh a bit.

Admission went smoothly and we were shown to Room 121 on the first floor,  not a suite this time, but large enough for the two of us!  There was the usual television high on the wall, a sofa bed and a large and comfortable recliner chair as well as the hospital bed.  The nurse followed us in and gave Derek a gown to put on, which he did, leaving his boxers on to preserve a little modesty behind the almost transparent paper gown.  As he did so, I noticed the razor in the nurses hand…….end of modesty then!  So onto the bed a thorough dry shave by the nurse and ten minutes later they wheeled him away to the theatre.  It was still only 20 to nine.  The first hour he was gone went quickly enough, but the time dragged from then on and my worry for him grew, but I could get no further information.  It was nine hours before they came to tell me he was out of surgery and that I could go and see him.   No explanation of why it had taken so long and I was frantic when I overheard one of the nurses saying “….problema…”.  Derek was down on the ground floor in the recovery room next to the operating theatre.  The anesthetist came to see me and explained that when they administered the anesthetic they had unfortunately managed to knock out his two front teeth!  He said that I would be able to see Derek for only 1 minute.  I was shown in and literally given one minute with him before being ushered away again.  They told me he was to be taken to the Intensive care ward – which was normal practise after on operation and that I could come back to see him, accompanied by a nurse,  between 7 and 7:30.  It was 7:20pm  before the nurse was available to take me down to see him, but the ward was not yet open and I joined a queue of other concerned relatives.  Eventually, the doors opened and we were allowed inside, however there was no sign of Derek.  The nurse found me and explained that he was now well enough to go back to his own room, so to return there and he would be back in half an hour.  About three quarters of an hour later they wheeled him back into his room.  He looked so poorly, hooked up to various drips and the oxygen tubes, drifting in and out of a sleepy state.  The anesthetic had not agreed with him at all and he felt very sick, so they kept pumping full of anti-sickness drugs and pain killers.  Still,  it was all over and he spent an otherwise uneventful night.

Set the alarm for 5:30am but did not sleep well.  Up, dressed and ready and waiting for the taxi by 7:15am.  Bang on time, Jose arrives – only it is an ordinary taxi!  He looks at me, by now outside on the road behind his cab, and mutters in Spanish, probably something about getting him out of bed at that time in the morning and then not being able to get in his cab.  Anyway, with a flourish of his arms and a “No problema” he gets on his radiophone to the cab company.  A couple of minutes later he is again telling me no problema and assuring me that there will be another one along in five minutes – where have I heard that before, I wonder?  With that, he gets back into his cab and drives off down the road, leaving me feeling totally helpless in the middle of the road.  Derek is standing in the garden doing what he does best (swearing) and saying that we might as well not bother to go and that he feels fine anyway.  However, before I can even get back through the gate to argue with him, taxi number 2 arrives – wow that was quick!  Could not have been more than three minutes.  So we are loaded in and away to San Jaime; straight to admissions, we know where we are going this time, and all before twenty to eight in the morning.

With the big day looming tomorrow we figure we should work out our plan of action.  We will need a taxi to get us to the hospital and as we have decided it would be easier for me to stay with Derek, then the best idea would be one of the wheelchair taxis to take us.  Tried to ‘phone to book one, but the woman at the other end did not speak English, and refused to understand my Spanish; okay so my Spanish is lousy.  Gerry, our neighbour comes to the rescue and phones them for us, however, wheelchair taxis can not be booked in advance. “You must phone in the morning”  Luckily, Gerry has a friend of her granddaughter, who has a friend, Jose, that has a wheelchair taxi, so that is arranged for 7:20am.  A great weight lifted just knowing that has been booked.  Now just pack a case for two people, not forgetting to take some tea bags (the ones at San Jaime are rubbish),  breakfast/cereal bars and a pack of cards and crib board to while away the hours.  I also take papers to read as I have read that the operation takes 2 to 3 hours.

Apart from going to the main desk to hand over the expired card once more and receiving our sticky labels again, we have no idea of where to go.  This time we are told to go to the second floor – this is new – we don’t usually get beyond the first floor, however we have no idea of what to do when we get there.  We see a short queue at a desk so decide to join that.  Our turn comes and we soon discover that it is the wrong queue.  So off we go, down another corridor and join another queue.  The receptionist takes one of our sticky labels and attaches it to a form before handing the rest back to us.  We then to go to wait outside another door for Doctor Alexander.  Finally it is our turn and it quickly becomes apparent that he has no idea of why we are there!  However, after explaining briefly, he fills in all the right forms and sends us off to get Derek’s vitals taken all over again.  Another ECG, another label;  height and weight, another label; X-Rays, another label.  Derek is grateful that for this time, at least, they don’t require any more blood.  So two hours later and we are back home.

I had just started to prepare our evening meal when the telephone rang.  It was the call we had been expecting from San Jaime.  The surgery has been booked for Thursday 28th August and Derek has to be there at 7:45am.  He is not amused, as he did not really believe that there were two 7:45s in a day!!  First though, he has to see Dr Alexander at 11:45am tomorrow, to go through the pre-op routine again.

We figured that we knew the routine by now, so arrived in plenty of time for our 11:30 appointment.  Waited our turn at the main desk, again handed over the out of date card and received our sticky labels.  Then down the corridor to wait outside of room 13.  After a short wait, that seemed like an eternity, we were ushered inside to see Doctor Gomez, a cheerful looking round faced bespectacled man with a small moustache of around 50 years of age.  He looks serious as reads through Derek’s notes and tells us that the biopsy shows that the tumour is indeed cancerous.  They have also scanned his bladder from inside and are happy that there is no sign of cancer there.  Patiently he explains the procedure to completely remove the kidney, adrenal gland, nearby lymph glands and the urethra.  This last bit is necessary as the cancer is sitting over the area where the urethra joins the kidney, so this is to ensure that no cancer cells migrate down to the bladder during or after surgery.  I ask the doctor about smoking and he tells us that the type of cancer that Derek has is directly attributable to smoking.  After the operation he will have only one kidney, so he must look after it very well.  He wants Derek in as soon as possible, but once again we first have to get the okay from the insurance people.  The hospital will phone us as soon as they know to make the appointment to come in.  It is really annoying that before each procedure we have to get the insurer’s permission and that generally takes a week.  You would think that once they had agreed the the first one, that the rest would just carry on, but no.  So back home to await the phone call.