After spending two years watching patients undergo surgery and recover, operating room nurse Sam Hunt has revealed the 10 procedures he would most dread having himself.

The Charleston-based OR nurse ranked operations including tonsil removal, haemorrhoid surgery and complex procedures involving the brain, heart and digestive system.

Surprisingly, some of the operations that sound most dramatic did not appear at the top of his list.

Sam ranked a haemorrhoidectomy second because of the challenging recovery, while the Whipple procedure — a major operation involving several digestive organs — claimed the number one spot.

‘These are the top 10 surgeries I would never want to have, especially number one,’ he said in a video.

His list is based on personal experience, not a judgment about whether medically necessary surgery should be performed. Recovery can also differ significantly from one patient to another.

10. Tonsillectomy

Although tonsil removal may appear relatively routine, Sam said the recovery can be especially painful and difficult for adults.

‘These procedures are brutal to recover from, especially as an adult,’ he said.

‘You’re coping with severe throat pain, difficulty swallowing and the reality that you’ve just undergone surgery.’

Adults may need a tonsillectomy because of conditions such as recurring tonsillitis or obstructive sleep apnoea.

9. Achilles tendon repair

Because the Achilles tendon is essential for movements such as walking and running, an injury to it can severely disrupt everyday life.

‘For those who follow sport, an Achilles tendon injury is one of the most brutal injuries to recover from,’ Sam said.

He highlighted the weeks of restricted movement, the need to use a scooter and the lengthy rehabilitation that can follow.

‘Even after completing the lengthy rehabilitation, you may never be quite the same again,’ he said.

8. Craniotomy

A craniotomy involves temporarily removing part of the skull so surgeons can reach the brain.

‘They literally open your skull to gain access to your brain,’ Sam said.

‘Even though surgical techniques have become so advanced, I would still rather not have anyone operating inside my brain.’

7. Limb amputation

Sam also said the impact of a limb amputation can continue long after the operation has ended.

‘This is not only physically life-changing; it is mentally life-changing too,’ he said.

‘It requires substantial rehabilitation, as well as adjusting to life without the limb you were accustomed to having.’

Rehabilitation can include learning new ways to perform everyday activities and, for some patients, adapting to a prosthetic limb.

6. Burn debridement

Burn debridement involves removing damaged or dead tissue from a wound, with Sam specifically referring to severe burns requiring repeated treatment.

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‘Envisioning the worst burn possible basically all over your body, it’s gonna require a lot of surgeries, a lot of debridement and extensive wound care,’ he said.

Severe burns can require multiple operations alongside ongoing wound care and rehabilitation.

5. Open-heart surgery

‘My chest is being sawed open to be operated on,’ Sam said.

‘Again, even knowing how advanced our surgical procedures are, I still don’t want my chest sawed in half.’

Open-heart surgery encompasses major procedures performed through the chest, including operations involving the heart’s valves and arteries.

4. Open bowel resection

An open bowel resection involves removing a diseased or damaged section of the intestine through an abdominal incision.

‘Your entire abdomen is being exposed. You are having parts of your intestines replaced,’ Sam said.

He was particularly wary of how recovery could be affected by having to use your abdominal muscles to move after surgery.

‘Being able to move with your abdominal muscles after tearing through them to get to the intestines is gonna be brutal,’ he said.

3. Spinal fusion

Spinal fusion permanently joins two or more vertebrae and can involve hardware to stabilise the spine.

‘Your spine is getting permanently fused with hardware and recovery is gonna take not days, not weeks, but months to get back to even close to where you were,’ Sam said.

Recovery varies depending on factors including the location and extent of the fusion.

2. Haemorrhoidectomy

Perhaps the most unexpected entry was a haemorrhoidectomy, which Sam ranked above brain, heart and spinal surgery.

‘This might surprise some people,’ he said.

‘The surgery part itself isn’t bad, but the recovery process is awful because you’re trying to heal in an area where poop constantly goes through.’

A haemorrhoidectomy surgically removes haemorrhoids and can be recommended for severe cases when other treatments haven’t worked.

1. The Whipple procedure

The Whipple procedure topped Sam’s list.

Also known as a pancreaticoduodenectomy, the major operation can involve removing the head of the pancreas and nearby structures before reconnecting the digestive tract.

‘This is probably one of the biggest abdominal surgeries. There is muscle, tissue, everything is torn open,’ Sam said.

‘You’re removing parts of your organs and you’re basically reconstructing your whole digestive system.’

The procedure is most commonly used to treat certain cancers and other serious conditions affecting the pancreas and surrounding organs.

Australia’s ban on card surcharges is designed to reduce costs for shoppers, but the savings may not be as straightforward as expected. Retailers could lift prices, while banks may respond by cutting rewards programs to recover lost revenue.

The Reserve Bank of Australia-led reform takes effect on Thursday, meaning customers who pay by debit or credit card should no longer face unexpected fees at the checkout.

Businesses will now have to absorb the cost of card payments or factor it into the prices they charge for goods and services.

They can still encourage alternative payment methods by offering discounts for cash or services such as PayID. Some experts believe those discounts could be as high as 10 per cent of the transaction value.

Cash advocate Steve Worthington welcomed the change after the Australian Competition and Consumer Commission confirmed earlier in September that businesses could legally offer discounts on their displayed prices.

“I suspect a number of merchants will start to do that, to offer a discount for cash,” the Swinburne University of Technology professor and payments systems expert told AAP.

However, accepting cash requires businesses to maintain a float and deposit takings at the bank, a task made more difficult by the steady decline in the number of bank branches. For small businesses, that can create an additional administrative burden.

Even so, Professor Worthington said a 10 per cent discount could prove appealing during the cost-of-living squeeze and encourage more people to pay with cash.

The latest central bank figures show cash accounts for barely 15 per cent of in-person purchases, while debit, credit and charge cards now make up 73 per cent of payments.

“I pay already in cash for certain places because I just don’t like being surcharged because it’s just really pathetic,” Professor Worthington said.

For consumers who continue to tap and pay, some businesses may increase their prices to cover merchant fees charged by banks and payment providers. Those costs were previously recovered through card surcharges.

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An RBA inquiry into surcharges found that about 80 per cent of businesses already absorbed the expense, while smaller operators, including cafes and restaurants, were more likely to pass it on to customers.

The impact of the surcharge ban will also depend on the RBA’s decision to reduce interchange fees—the payments made by a merchant’s bank to a customer’s bank each time a card transaction is processed.

The new cap will be 0.30 per cent, equivalent to about three cents on a $10 purchase, compared with the previous maximum of 0.80 per cent. The lower rate is intended to compensate payment providers, including banks, for the surcharge ban.

“The biggest issue for those small businesses is whether they actually receive the benefit of the interchange cuts,” said RMIT University finance professor Angel Zhong.

“My advice is to call your payment provider now and ask if you can get a better deal.”

Retailers should eventually have a clearer picture of what they are paying. The RBA plans to publish pricing information from card networks, allowing businesses to compare providers and seek better rates.

The central bank estimates that the surcharge ban could save consumers more than $1 billion. But as with any major payment reform, the costs will ultimately have to be absorbed somewhere.

As retailers and shoppers adjust to the new rules, one outcome appears increasingly likely: the banks may not be the ones carrying the burden.

Banks are already trimming lucrative credit card rewards programs and increasing annual card fees because payment processing doesn’t happen for free.

‘Banks – payment providers – they need to make revenue. They’re not running a charity,’ Prof Zhong said.

‘A cake is only so big, so if you’re making one slice smaller or bigger, then you need to change the size of the other slice.’

The murder of Elaine O’Hara remains one of the most notorious crimes in the State’s history. Now, a new documentary revisits how the Dubliner’s death came perilously close to being the perfect murder.

For 14 months after killing Ms O’Hara, Graham Dwyer may have believed he had successfully concealed his crime.

Then, during an unusually dry August in 2013, water levels at a reservoir in Roundwood, Co. Wicklow, dropped to exceptionally low levels.

As the water receded, the carefully constructed plan of the well-regarded Dublin architect, married father-of-three and seemingly settled family man began to fall apart.

A year after child minder Ms O’Hara disappeared in August 2012, several men noticed objects lying in the muddy reservoir bed, an area normally hidden beneath the water. Among the items were sex toys and clothing, which they brought to the nearest garda station.

Several days later, a local garda returned to the site to search more thoroughly. As he made his way down the bank, he spotted something shining in the mud: a set of keys.

He recovered the keys and brought them to the station, where they were sent for forensic examination. The supermarket loyalty tags attached to them eventually confirmed that they belonged to Ms O’Hara.

That discovery proved to be a crucial piece of the investigation. It would ultimately help lead to October 14, 2013, when gardaí arrived at Dwyer’s home and arrested him.

At that point, investigators had yet to grasp the full horror of what had happened. For many people involved in the case, the details would remain impossible to forget.

Several of the gardaí who worked on the investigation now speak about it in a new episode of RTÉ’s The Case I Can’t Forget.

In September 2013, a month after the keys were found but before they had been linked to Ms O’Hara, a dog walker made a disturbing discovery in woodland on Killakee Mountain in Wicklow: human remains scattered across the area.

The remains were soon identified as those of Ms O’Hara, a 36-year-old woman who had been missing since August 2012.

Because Ms O’Hara had experienced serious mental health difficulties for many years, her family had feared that she might have taken her own life at sea.

Her car had been located at Shanganagh Cemetery in south Dublin, where her much-loved mother was buried. Ms O’Hara had visited the cemetery with her father on the day she vanished.

With little forensic evidence available and no confirmed cause of death, investigators were forced to focus heavily on Ms O’Hara’s digital trail.

Detective Sergeant Grace O’Boyle worked through a vast collection of evidence, including CCTV footage, mobile-phone records, witness accounts and online activity. Her task was to build a timeline that could explain how Ms O’Hara’s remains came to be found on Killakee Mountain.

“A crime scene in a forest or wooded area is not an easy environment in which to conduct an investigation,” she tells the programme.

“There are no CCTV cameras and witnesses are rare. From the outset, the location creates significant challenges for investigators working in and around the scene.

“The evidence is also exposed to the elements. Animals can interfere with a scene, making it difficult to determine whether something is the result of natural activity or could be evidence connected to a crime.”

‘Sixty five per cent of the skeletal remains were recovered. It was a female, roughly between 35 and 40. Elaine appeared to have died where the body was discovered.’

The discovery of the corpse and the identification of the keys and phones nearly an hour away in Vartry Reservoir eventually led gardaí to conclude that, not only was she in a manipulative BDSM relationship with her killer, but also that she had met him on the day she disappeared.

As Detective Sergeant Kevin Duggan reconstructed Elaine’s final movements through detailed CCTV analysis and senior crime analyst Sarah Skedd examined phone records and text messages, one name emerged from the reams of data – Graham Dwyer.

From the outset Detective Duggan knew this case was different: ‘I said to myself this is going to be the most significant investigation that you will ever be involved in.’

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A further breakthrough came when the two phones taken from the reservoir bed were able to be reconstructed. 

They were both able to be switched on and all the text messages were readily available and investigating gardaí had the notorious ‘master’ and ‘slave” phones as they came to be known during the ensuing trial.

Detective Duggan described the discovery of the two mobile phones as ‘a miracle’.

Ms Skedd set to work on finding who owned the master phone: 

‘I started looking for unique journeys and I found there was a day when the ‘master; phone was used in the east of Galway city in the morning and had returned to using cells in the southeast of Dublin city early in the afternoon.

‘So the only realistic way of making the journey in that timeframe is to travel along the motorway network passing through the M6 Toll near Ballinasloe and then through the M4 toll near Enfield.

‘[Through CCTV] we found a vehicle that met those criteria that was registered with an owner at an address in south county Dublin.’

To this day, colleagues and former friends say they cannot believe they were duped by Dwyer.

‘He was the most vanilla person you could ever meet, he was so normal, even dull,’ one recalled.

The investigating team were hugely trepidatious coming up to the trial. For them, they hadn’t got Dwyer until the jury foreperson read out a guilty verdict.

‘I felt enormous pressure and anxiety coming up to this trial,’ Ms Sked recalled.

‘It was very important to me that the work that I had done with the investigation team, that it was, most importantly, a true and accurate reflection of what had happened.’

After an eight week trial in 2015, the jury found Dwyer guilty in a unanimous decision.

The year after he was caged, the arrogant killer boasted to a young female pen pal that he would be freed on appeal. 

He suggested that statements made by State Pathologist Marie Cassidy would help to secure his appeal.

The depraved south Dublin architect made the claims in a series of letters, in which he oozed confidence and repeatedly maintained his innocence, while admitting to ‘extreme sex’.

He wrote to the student at the time: ‘I will buy Dr Cassidy a pint and take you out to celebrate!! He he.’

He was referring to comments by the pathologist that she had believed a not-guilty verdict would be returned in his case due to a lack of physical evidence.

However, the Supreme Court would eventually reject his appeal when the judges ruled unanimously that evidence from mobile-phone data at his trial had been admissible.

Asked to analyse Dwyer’s letters to his young pen pal, American psychotherapist Dr Robi Ludwig previously told MoS: ‘He definitely has an agenda, his mindset is he is not guilty.

‘I don’t see any signs of depression. He’s focused on his goal, he’s on a mission, he’s feeling positive.’ 

She added that if you are wrongfully convicted ‘it’s not a happy place’. She said: ‘He’s taking action, he’s on a mission, he’s working with people, he’s flirting and you’re not depressed if you’re flirting. 

‘I think he loves the attention, and at another level, if you are into sadomasochism, for him this is the masochistic part, getting punished and waiting to get out.’

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