I am writing this very slowly indeed, so please bear with me if it's taking too long. An awful lot has happened since Monday, let me go through it step by step.

Monday started off very busy indeed. Doctor after doctor came and examined me, asked me how I had the accident, where it was sore etc. Then, crucially, sign the consent form(s) for the various procedures. All of the doctors are first-name people. There's Simon, the junior doctor who only started working about 4 years ago. Charlie, the House Officer, who hopes to make Registrar in a few years. I don't actually get to meet the Consultant who will actually be doing the operation - a very very experienced orthopaedic surgeon called Mr Fox.

Ben, the baby faced anaesthetist, tells me about whats involved in surgery. Since I've never had surgery before, he takes his time and goes into a lot of detail. He explains how the anaesthetic works, how they bring me round again, the various people on standby just in case, all of that stuff. He then tops it off with a Martin-esque "You'll be fine".

Time to go, I kiss The Missus goodbye and walk down to theatre. I am wheeled into the anaesthetists area, where baby-faced Ben and his jolly colleague Charlene are filling up and arranging an impressive display of hypodermics and needles. I don't like needles, and seeing more of them than on the floor of a pine forest puts the willies up me.

Ben gives me a sharp scratch whilst he puts the canula (small rubber tube) in. He then tells me that he is "putting me to sleep ... now".

The next thing I know, I am in agony and screaming. I have just woken up in recovery. Baby-faced Ben starts plugging me with morphine and hooks me up to a morphine pump which will deliver morphine straight into the vein every time I press the button.

Back upstairs to the ward, pressing this little button like mad - god it hurts. What they've done is:

• opened me up
  
• dislocated and reset the shoulder
  
• pushed everything back to where it should be
  
• joined the shards of collar bone together
  
• took a bone graft from my hip to provide cement for the bone
  
• put four screws in the surrounding bone
  
• wrapped everything up in a nice shiny titanium plate

then stitched everything back together again - I don't know how many stitches but the scar is about 8 inches long.

Theres a big hole in my side where they used something like an apple corer to take out some bone from my hip to use for grafting.

Sleeping is a nightmare, and I am in a lot of pain. My little R2D2 morphine machine bleeps away and keeps me pain-free though.

Medically, injury-wise, the doctors are happy. The procedure went well. My shoulder is back in place now. They are not alarmed by the fact that I am in an awful lot of pain - they expect it after the kicking they gave my shoulder getting it back together.

The nice doctor knew I wanted to be home rather than in hospital, so he prescribed something to help me sleep. Sleeping properly is very important in keeping bipolar bouts at bay.

When I asked for this medication, I got the agency problem right in front of my eyes. Not only that, I saw a power struggle played out. I had heard of it happening, but never experienced it.

Hospitals are like the Army - there is a very strict chain of command. Not only that, there are two chains of command, two reporting structures:

• the doctors
  These guys are effectively the officer corps
  
• the nurses
  These guys are effectively the enlisted troops

Now here's what I've heard but never experienced till now. I have heard of staff nurses being in their job for 20 years and they obviously become good at it. A new junior doctor comes along, just out of university, and starts ordering the staff nurses around. He's maybe half their age and has little or no clinical experience. He also, in the nurses view, doesn't have respect for their 20-odd years of experience on the ward.

You have to kind of see the nurses point huh?

How about this though - here's a more tricky one. The doctor prescribes medication. This is an order. This is what the doctor wants to happen. The medication is one that the nurse "doesn't like". She doesn't like dispensing it. She spends a half hour calling all over the hospital, speaking to anaethatist after anaethatist asking the same question - "I'm not happy about dispensing drug XYZ with drug ABC. Is it OK to take both?". The anaethatist asks a few questions of their own, to do with medical condition andthe like, and indicates that these two drugs are fine to take. This happens 4 times. The fifth anaethatist, bingo. This anaethatist agrees that, ideally, you don't want to mix those two.

The nurse, her arse now covered, explains to me that she won't give me the medication because the anaethatist thinks its a bad idea. She didn't know that I had heard all 5 phone calls.

The doctor also asked that my dressing be changed - this one was all clogged up witrh blood and nasty stuff. The nurse "knew" that the Consultant - Mr Fox - doesn't like dressings to be changed, so she could just safely ignore the request to change the dressing.

This is nothing more than a power struggle. It is a defiant nurse, very experienced, who obviously feels that she isnot getting the respect she deserves from a junior doctor. These two need to sort it out - it is going to run and run and run.

I didn't want to give up my little machine. When you consider the above, and the fact that I have been waiting 2 hours (still waiting) for painkillers, then why would I want to lose the ability to deal with my own pain without needing somebody to do me a favour - which they may be too busy to do?

Waiting on drugs to take home, and then I can leave and go home and rest. Shoulder is killing me. Pain relief is going to be an issue I think. They "don't like" to give you painkillers that are too strong.

Looking forward to getting home. Getting back into our own bed, cuddling The Missus, being annoyed by the Wee Yin in the middle of the night. Even looking forward to walking the crap dog. I hate hospitals.

As Martin would say - "don't fall off then".

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