Thursday, 31 May 2012

Coming Down The Up Stairs

Coming down the up stairs at UHW, just in front of the frightening full-length portrait of Aneurin Bevan in his overcoat, glowing like a warning to boarders, is a mother under full sail.  This one is wearing heavy flowing dark robes, a squalling child spinning at the end of each arm, a hijab wrapped tight around her full moon face.  She’s talking hands free, full pelt, and at maximum volume into a mobile that’s held to her ear by the hijab’s cloth.  Before her patients on sticks scatter.  I lean into the wall to let her pass.  You have to admire her style.

Outside the regularly ignored clutter of Trust notices banning smoking totally anywhere on the site have been supplemented by signboards that direct users to the newly provided smoking sheds.  These are also ignored.  The limp and the lame continue to smoulder and cough just outside the concourse doors, as they always have.  Gorgon guards.  Emissaries of the alternate world.

I’m back at bloods where history is repeating itself.  There are crowds.  Tickets fail to correspond to the numbers shown on the illuminated display.  The bandaged and the unable battle at the entrance, waving their arms, complaining about disorder.  Time flows by.  I does so slowly.  I read the contents of my wallet.  No book, mine left in the car in error.   Old receipts, a blue twenty, credit cards, bits of paper with phone numbers on them, my prednisolone users treatment card.  This contains stern and vital advice.  “If you become ill consult your doctor promptly.”  I’ll do that. 

Then I’m back at Rheumatology where my cascade of symptoms is noted and new tests talked about, done or booked.  Urine sampled.  BP taken.  Temperature written down.  Outside there’s a sun and it’s shining.  But the future is delineated with a mesh of new appointments and hours to be spent in long corridors waiting for my name to be called.

It strikes me then that none of this ever going to fully pass.  Life rolls from one failing to the next.  That’s its essential nature.  It arrives.  It shines.  It renews.  Then it falls apart.  All that’s in question is the speed at which this happens.  Slowing down the rate  is now my prime objective.  I shuffle in my seat, fish about in my pocket.  Come up with a mint.  Sure sign of age that.  Like admiring country and western music,  wearing hats while driving, and standing up when women enter the room.   A nurse does.  So I stand.  I smile.  Then I sit down again. 

Wednesday, 9 May 2012

How Do You Fill Your Life

According to the private publishers and poet Philip Ward life should be full of books.   For those who don’t know where to start Ward has compiled a list.  His A Lifetime’s Reading lists 500 titles that everyone should be encouraged to  get through.  At the rate of ten a year the quantity is not onerous.  Quite manageable, Ward thinks.  He does, however, allow his suggested texts to increase in complexity as the years roll by.   At my age I should now be consuming Ludwig Wittgenstein,  Giovanni Boccaccio, Nur Ad-Din ‘Abd Ar-Rahman Jami and Abu Bakr Muhamma Bin ‘Abdulmalik Ibn Tufail.  Just a few established mind stretchers that a person of my maturity should be able to manage with ease.

Instead I spend my waking hours navigating the health system.  Dealing with doctors, worrying about what they’ll fine, coping with the NHS.  Ibn Tufail practised medicine, it seems, but back in fifteenth century Cadiz, which is where he came from, they still used leaches and rather than check you by X-Ray they’d pour a mixture of tincture of serma, mercury and wheat germ down your throat and hope for the best.  Prednisolone was unknown.  Their cure for PMR pain was to cut into the muscle and let air into your legs.

I’m heading for X-Ray.  There are muscle pains in my limbs which are at variance with the kind that PMR delivers.  Mine don’t go away when you walk.  Prednisolone won’t touch them.  Instead they hover and pulse. 

The treatment is to be a couple of facet joint injections and a lumbar nerve root block.  The advance information UHW have sent me warns against having this done if I’m taking blood thinning agents (I’m not), tells me that I should avoid driving immediately afterwards and then sternly admonishes me in advance in case I fail to turn up.     

I’ve spent the morning at the gym trying to make myself younger and as it wasn’t raining I’ve also walked to the hospital rather than booked a cab.  I feel fit and awake.  But this isn’t going to last.

I present myself at X-Ray reception and am told by a man who looks a little like David Walliams that today my procedure is being carried out in the children’s department.  Down the corridor, follow the purple octopus.  I do.  And there it is over the door, pointing its tentacles.  You’ll be fine, says the Children’s receptionist.  Must be an NHS word that, fine.  Drummed in at induction.  Everyone uses it. All the time. 

I’m the only patient.  The otherwise abandoned waiting room, stuffed with a disarray of toys, colourful posters and child-friendly furniture feels like something out of JG Ballard novel.  There’s a dark otherness seeping in.  I’m beginning to recognise the signs.

The procedure itself takes around twenty minutes.  Local anaesthetic.  Needles into the lower back. A sensation of ice crawling down my leg.  Lots of encouraging words from the clinician.  The whole deal  is monitored on a sort of video x-ray machine although I don’t see this, lying as I am on my front.

Good, done.  You’ll be fine now.  We’ll just wheel you into the recovery room and let you rest for fifteen minutes.  Back soon. That’s the radiographer.  She is wearing a set of tartan-covered lead panels, a bit like the sort of things newsreaders wear when reporting from Afghanistan.  They are extremely fetching.   I’ll be fine soon.  I try to move my right leg.  Can’t.

And after fifteen minutes I still can’t.  I attempt to point my foot at my shoe and the limb sways and waves.  Misses.  Misses again.  It’s like trying to spear fish underwater.  The tartan clad  radiographer is back and with an assistant this time.  Together they try to get me on my feet.  Legless I sway  and they have to stop me from falling.  You have another fifteen, there’s a love, nothing to worry about.  You’ll be fine.

Fine, fine.    But I’m not.

I fish out my phone and decide to ring for assistance.  It’s obvious that I’m not going to get out of here unaided.  But naturally there’s no signal.  I stop a passing nursing assistant and ask if she can make a call for me.  Can’t.  No outside line here.  You hang on, the radiographers will soon be back.

Time passes.  The recovery room fills and empties.  Patients are brought in and wheeled out again.   Opposite a man who once might have been a miner or a steel worker, ancient tattoos on his arms, rheumy eyes, sits in a wheelchair.  He is having his procedure explained to him by a doctor wearing full operating theatre kit.  Scrubs, head bandana, hairy arms.  Anything else you want to know, Mr Jones?  Mr Jones shakes his head.  It’s all above me, this, he says.  You just carry on.  Right, says the doctor, we’ll be back.

I try to climb down off the recovery trolley, touch ground, and sway precipitously.  Mr Jones opposite looks alarmed.  I grab for the wall.  You stay where you are butt, Mr Jones says.  If you fall I won’t be able to help you.  He waves an arm which is attached to a drip.  His legs are covered with a blanket.

I do another 30 mins on the trolley waiting for the leg I no longer have to make a miraculous reappearance but it doesn’t.  I decide, then,  to make a break for it.  I’ve been here three and a half hours now.  Enough.  I get myself off and balanced against a wall.  Jacket half on half off.  Phone in my trousers.  Tentatively I try walking.  So long as I keep one hand on the wall I can just about manage it.  The missing leg is like a piece of rope trailing.  I haul away and get out into the main corridor.  It’s like joining the M4.  Floods of human traffic rolling in both directions. 

You okay, asks a passing nurse.  I look pained but nod.  Good.  You’ll be fine. Where’s the Concourse? I ask.  She points up a corridor that seems to run on for several miles.  I set off. 

Progress is about as slow as it can be.  I cling to the wall, stumble and half crawl. I’m among the hospital’s surging hordes now.  Uniformed practitioners, suit wearing surgeons, patients on sticks, bandaged, wearing dressing downs, in wheelchairs, on trolleys.  Some stop to help.  Most  look in pain or concerned or both.   

A fat woman in a motorised wheelchair slows.  Can I do anything?  she asks.   She does look concerned.   Doesn’t matter, I say, I’ll be fine.  Hell, even I’m catching it now.

Eventually after two face down falls and one episode of being helped into the lift by a  dressing-gowned man on a stick  I reach the concourse.   Gratefully fall into a seat and check the phone.  Signal at last.   I ring the love of my life for help.  Get me out of here, I say.  I’m overcome with a desire to get seriously down to reading  and have done with all this NHS stuff. 

It takes a good 24 hours for my leg to come back.  Two worried phone calls to the Out of Hours service and one to NHS Direct to check if I’m not going to be like this forever - Wait until tomorrow, they all say.  You’ll be fine -   and then there it is.  A leg that works.  It’s pain free and it holds you up.  Praise be Bin ‘Abdulmalik Ibn Tufail.  I get straight onto Amazon and trying ordering his books.  Any Tuhfat al-Ahrar or Fusus al-Hikam or even the hard to find Haft Awrang, once essential reading everywhere from here to Persia.  Nothing.

They were right, of course.  I am fine.   Bookless I go to the pub instead. 

Tuesday, 1 May 2012

The Urologists Stay Around

They’ve done a survey, the registrar tells me.  They’ve studied those who like to watch medical procedures and compared them with those who do not.  Do those who watch have a better outturn than those who hide their heads?  Turns out that if you like watching then the prognosis for you and your condition is likely to be pretty much the same as for those who prefer to look the other way.

I prefer to look the other way, I tell him.  Behind me is a video monitor on which the insides of my bladder are appearing in a sort of BBC 405-line colour.  Greys and submarine reds.  Dark and light in a fluid dance.  The internal world of Fantastic Voyage made real. 

What the urologist is looking for are signs of growth return.  My unending problem.  70%-80% recurrence normal.  It won’t go anywhere so long as we catch it.  The malignancy is low with these transitional cell polyps.  The consultant told me that in a bright moment in his room just off the side of Ambulatory Care.  Me in my gown waiting to go in for what’s become known as the procedure.  Flexible cystoscopy.  A camera and a light on the end of the flexible tube inserted  through the male body’s smallest orifice. Up the urethra and through the prostate to reach the bladder.  There’s local anaesthetic to dull the discomfort but the whole idea of the thing still makes me wince. 

This time you are clear, says the urologist.  Hasn’t come back.  There’s no bladder blockage either.  How are you getting on with the prednisolone?  The wonder drug.  The fixer of everything.  He asks this as he withdraws the apparatus.   I try not to look but still manage to see a device that looks as if it has been borrowed from the set of Alien, a snaking tube, dripping slowly as it uncoils through the air.    

I’ve got my dose down to 7 mgs daily, I tell him.  The polymyalgia is staying submerged.  No flares, no return.  The fractured sleep is improving.  The nose bleeds have stopped. The mood swings steadied.  The fatness is controlled.  The self-confidence has returned.   

Good.  See you again in six months.  Wiped dry, hospital record marked, nurse thanked.   I’m sent back to the recovery room.  Sat in a chair, there’s a love, given sweet tea, how many sugars?  Shake my head still get two.  You drink that then try to pass water.  Might hurt a bit, it’ll sting,  don’t worry,   you’ll be alright.  You can get changed then, if all’s okay.  Pants and gown in the bin by the door.   

I manage it, it’s easy.  I’ve done this dozens of times.  But the whole process still takes all your energy from you.   Always does.

Here’s your discharge leaflet and your tablets.  Drink loads of water now and take it easy.   The ward nurse hands me a letter to pass on to the GP.  This explains that Finch has been in and had his flexible cystoscopy at UHW and nothing was found this time.  He’s now not exactly full of beans but relieved.  He’s been given his discharge leaflet and is now heading down the corridor at a slow pace bound for the concourse where he’ll buy the latest issue of Record Collector and a Belgian Bun both of which he’ll leave in the taxi he takes to get him home. 

The letter is my passport to the future.  Nothing further to be done this time.  That is what it says.  It’s in my inside pocket where it glows slightly, nestling, making me warm.