I have always found it beneficial to spend some time on the other side of the medical fence. A perforated appendix in my early years as a medical student and a more recent operation for a back problem have been opportunities to assume the patient role and to learn from the experience, writes Dr Muiris Houston
Being the parent of a child undergoing treatment is also instructive. Recently my two younger daughters were on the same ear, nose and throat operating list at a children's hospital. Although having surgery on the same day, they actually had different problems. The eldest had had enlarged tonsils for some time, but during last winter developed sleep problems as a result. The younger girl had had a year of recurrent tonsil infections, deafness leading to problems in school, and had lost weight because of difficulty swallowing. And so, following consultation with an ear, nose and throat specialist, it was time for a "job lot" in the operating theatre.
There was a palpable anxiety as the day approached. I tried to dismiss the tales of anaesthetic mishaps that all medics have encountered or read about. The girls themselves were stoic until the day of surgery, when signs of their own anxieties began to emerge. My wife found the uncertainty of bed availability until the day of admission unsettling; this is now a feature of a health service under constant strain.
On the day itself, I was grateful to be allowed bring my youngest right into theatre, where a kind anaesthetist told me " he knew how it felt" to have to trust your child's well-being to someone else. But I have to say that his sure touch in inducing anaesthesia was most reassuring when the time came to leave the theatre.
While the older girl was scheduled for a tonsillectomy, the youngest was to have her tonsils and adenoids removed, and her ears were also to be examined under anaesthetic, and if necessary tubes called grommets inserted.
"Ts and As" is the medical jargon for an operation to remove tonsils and adenoids. The back of the nose (adenoids) and mouth (tonsils) are encircled by a ring of lymphoid tissue called Waldeyer's ring. In early childhood, this plays a part in the normal development of the immune system. However, in some children, recurrent infection leads to a chronic enlargement of both adenoids and tonsils. Frequent attacks of tonsillitis can result in the formation of abscesses within the tonsilar tissue leading to chronic infection.
While tonsils can be seen easily by depressing the tongue, the only accurate method of assessing adenoidal enlargement is by an X-ray of the space behind the nose. But the decision to remove adenoids is dependent on the mechanical problems enlarged tissue can cause: nasal obstruction, with mouth breathing and recurrent sore throats because of this; an interference with the movement of the palate and as a result, with speech development; or when the adenoids block the eustachian tube, which helps to drain fluid from middle ear to back of the throat.
Tonsils can enlarge to the point where they cause sleep difficulties. Typically, the affected child will complain of snoring and poor sleep. In fact, breathing ceases for at least 10 seconds 30 times or more during the night and is referred to as obstructive sleep apnoea.
This was the case with our older girl. Within days of the tonsillectomy the snoring had ceased and she appears more refreshed in the mornings. The younger has also benefited from surgical intervention, with no more choking on food. Her hearing is also returning to normal; no longer can her siblings get away with derisory comments delivered sotto voce.
When her ears were examined, the ENT surgeon found no glue-like substance when he made an incision into her eardrum; therefore, there was no need for the insertion of grommets (hollow tubes designed to allow air pass freely into the middle ear, thus preventing deafness).
The principal risk of tonsillectomy is post-operative bleeding, estimated to occur in 7 per cent of cases. There are two risk periods: in the first 48 hours after surgery and again a week later if infection sets in. Severe haemorrhage means a trip back to theatre. "Ts & As" are no longer performed as frequently as they were 40 years ago. ENT surgeons now look for evidence of disability resulting from enlargement rather than simply at the size of the tonsils and adenoids themselves. The post-operative diet of jelly and ice-cream has also gone out of fashion; now children are encouraged to eat toast and even crisps in order to hasten healing.
Emerging from hospital with my children two days after surgery, grateful for the exemplary care they had received, I could not help but reflect on what it must be like to spend weeks in hospital with a seriously ill child. Despite much- improved facilities for parents, it must be a gut-wrenching experience. And as we saw with the recent death of Roisín Ruddle, sometimes the health system fails children in a tragic and irreversible way.
You can e-mail Dr Muiris Houston at mhouston@irish-times.ie. He regrets he cannot answer individual queries