Sleep

For once in my life I’m watching a rugby match. This is not a thing I do lightly nor do often. Not that I’m opposed to the sport – rugby was something I once played – but it’s the watching of it, en mass, and the tribal shouting that I find hard. Hysterical commentators. People wearing stove-pipe hats and with their faces painted. Overweight grown men dressed in the tight sporting kit of their teams. Chanting drunks. Middle-aged women in lycra carrying inflatable dragons. Kids dressed as daffodils. The whole deal gets to me. But not today. Wales vs. France, the arch enemy. It’s the 2012 Six Nations Grand Slam which Wales are about to win. And how.

I watch the game on my wide-screen television, polymyalgia subdued for once, a flicker just below the surface. Once the game’s done, an hour and half or so later, and the world has erupted in celebration of Welsh victory, I realise that I’ve been out of the room to the toilet at least 8 times. That’s a lot. Even by my standards.

During the night I shiver, can’t get warm. Then I overheat, can’t get cool. Something isn’t right. Pain in the bladder. Pain passing water. Pain standing up. Pain sitting down. The GP decides the symptoms are those of classic bladder infection. Prednisolone predisposes the taker to infection. The immune system is suppressed. Polymyalgia triumphs again. I spend the week fighting.

Hello toilet my old friend, I’ve come to talk with you again.

The frequency of urination increases. Sleep dissolves into a rapid fire set of getting up. Stumbling through the night’s half-light. Checking the quantity. Pain. Discomfort. Constantly feeling there’s more to come. Then getting back into bed again.

The chemist is five minutes’ walk away. I rush down. There they tell me that all those neat cures offered for sufferers of cystitis won’t work for men. Men have a different structure. Inside, you know, the pharmacist softly says. You could try these. She offers me some sort of branded sodium powders. They stop the stinging. I know it says for women only on the packet but you can ignore that. They won’t do any harm. I try them. Nothing happens. They might even have increased the rate of going, and I’ve got the urge for that. Joni Mitchell once again.

The first anti-biotic used to fight the invader, Trimethoprim, fails. The world closes in. Then Nitrofurantoin, prescribed by the GP after the usual performance of getting an appointment and taken as a sort of second front, starts to work. Turns your pee bright green. Kas, the pharmacist turned tea shop owner at the Waterloo Gardens Tea Shop who I meet in the park on the way back warns me about this. Lloyd Robson sends me an email suggesting that this might be what happened to Rigsby in the film of Rising Damp. Technicolour waterworks.

Passed urine should look like a glass of chardonnay. Mine resembles greengage slush puppy. But like all things, it won’t go on for ever.

By day nine I go out again. Can face the world. Sue reminds me that at the start I was pleading for hospitalisation just to get away from the pain. Now I can walk about in the sun. Prednisolone you two faced whore. You’ve done for me again.

The dose drops. I’m now on 8 mgs / 9 mgs alternating days. The GP thinks it’ll hold the polymyalgia back and it does. So far it has. On a planet which offers two places to go – polymyalgia or bladder infection – which would you choose? At the time of specific suffering the answer is always obvious. But stood back a bit it really is hard to say.

Fear

As a consultation this one has nothing out of the ordinary about it. The clinic is as full as it ever is. People on electric wheelchairs and crutches, the out of shape struggling for breath, the aged lounged in the chairs, the lost, the depressed, the distressed, the misshapen morass of the lumpen majority. Me too. I’m one. Out of shape because the Poly Myalgia (PMR), despite my best efforts, has held me so far back.

We play the expected game of musical chairs. Sit outside for fifteen minutes. Name called. Led into an inner waiting corridor. Name checked. Weighed. Asked how you are today, love. Sat there for a further fifteen. Then called, if you are lucky, in to see the consultant. This little dance is something to do with an Assembly directive on waiting times. If the local NHS can get its patients to queue twice for the same appointment then waiting times will be immediately halved. All delivered with a pataphysical logic of which Alfred Jarry would have been proud.

Only part two, the lounging in the inner waiting corridor, takes one hour fifteen. A bit longer than I might have hoped. But I do manage to read almost all of Jasper Rees’s Bred of Heaven – “one man’s quest to reclaim his Welsh roots.” He does this by learning the language. Been there. He’s a brave man.

When my name is finally called I find myself ushered into a small room manned by a doctor I don’t recognise. The consultant is on holiday, she says. I’m standing in. You don’t mind a few students observing, do you? I look to my left and see a pair of them, young, scruffy-haired, eager faces, minds at the ready.

We proceed. It’s clear the stand-in hasn’t read my file. We go round the houses for at least fifteen minutes with me having to describe my whole medical history and then the onset, diagnosis and treatment of my PMR so far. In fact it’s a little more than round the houses. We go round the whole town. I mention that earlier I’d been diagnosed with what subsequently turned out to be a mild form of bladder cancer. Under treatment now, controlled, and with a good prognosis. Ah yes, says the doctor. Tell me more about that. I do. I tell the whole story: discovery while in America, bleeding into the portaloo at the Cherokee Blue Grass Festival in North Carolina just as Ralph Stanley came on, the fear, the visits to US Emergency Rooms, the rising panic, the American scans and consultations and you’ll be okay, son, and the trip home back to the arms of the loving NHS, carrying my American CT scans under my arm. I leave out the bit about how I turned the whole thing into literature (see Zen Cymru by Peter Finch, Seren Books, 2010). She might get the wrong idea. She might expect the present experience to end up as a poem or be used in a blog somewhere. Perish the thought. The students make notes. The doctor consults my file.

We think, she then says, using the royal pronoun, that the cancer has migrated from the bladder to your spine. Bladder cancer can do that. She looks down at the file while I wobble slightly. My chair has assumed a sort of super real state and feels unmovable, impossibly hard, frozen in time, locked to the ground. It probably hasn’t migrated, she continues. That’s a worst-case scenario. But we need to consider it. I am going to send you for some tests to fid out for sure. We need to look at the bones of your spine.

But I’ve had bone tests, I protest. Bone Density Scans, X-rays of my bones, more bone X-rays and, last Saturday, an MRI Scan. It’s Monday today. The results of that experience and half are not yet through. You’ve had an MRI test, the doctor asks? She’s asking me? She has my file in front of her, doesn’t that tell her? I nod. Okay. The MRI scan will provide a definitive answer. When the results come through I’ll phone you. When will that be, I manage to ask? In the next two or three days, she says. NHS imprecision floats. Now, let’s move on to consider your dose level with prednisolone.

Prednisolone. Do I still care? I’ve got the big C now hanging over me like a dark and evil phantom. Already the sun has vanished. Soon the rest of the world will also shut down. Am I concerned about prednisolone now? I guess I should be. I force myself. I make myself listen.

I want you to reduce the dose more slowly now, she’s saying. Go down from 10 mgs to 9 mgs on alternate days. Do that for two weeks and see how things are. If things are okay you can then try taking 9 mgs daily. At these lower levels we need to make lower incremental changes. I’ll book you in for another consultation in four months’ time. So she thinks I’ll live that long, does she? Better than nothing.

I find myself then in the long UHW corridor among the usual hoards of patients and medical staff all bound for somewhere or nowhere. The purposeful mixing with the lost. I’m clutching a cardboard fragment, torn off the end of a box that once contained latex gloves, with a telephone number biroed on it. This the doctor gave me as I left. It’s the number of the department secretary. I can ring her if something goes wrong.

I sit at home in a state of cold, unmoving silence. There’s a world out there, apparently. But I’m not part of it. I look up bladder cancer, spinal cancer, secondary cancer, cancer migration, cancer treatment and cancer prognosis, all on Google. I then immediately wish I hadn’t. The information uncovered is unclear, contradictory and mostly dark. I make a few phone calls, family, get shocked responses, and then sit staring into the empty distance. My usual habit on returning home is to put on some music. But today I haven’t put on anything at all.

After thirty-six hours of this, including a fitful sleep and much prowling of the house in the deep of shudering night, I find myself at the end of something. The walls seem nearer to me than they once were. The sky is bright white and featureless. The mind churns back through the same furrow once again, the words about migration and it can do that turning and returning.

Suddenly I boil. I can’t take this. Someone out there in the vastness that is UHW knows what my MRI scan showed. They have the answer. And it’s my answer. My spine. My condition. I should know it too. I pick up the phone and dial the department secretary. Manage to press the wrong buttons. Dial again. Engaged.

I take a breath and try once more. The line rings.

The secretary is great. I tell her the tale, my voice as steady as I can make it, and she checks my on screen file. Yes, she says, the MRI result is in. I’ll get a doctor to ring you straight back.

I replace the phone and sit by it. How long will this take? Ten minutes? After five the thing rings. It’s a recorded voice trying to sell me loft insulation. To speak to one of our operators press one. I groan and put the receiver back down.

After sixty minutes and a further nuisance call from someone claiming to be my insurance company who begins by asking me how I am today, a certain sign that they are about to try to sell me something next, I snap. I call the department secretary again.

She hasn’t rung you? Hang on, I’ll do some chasing. There’s a whole bunch of muffled clicking and distant voices and then the secretary tells me that the doctor is in consultation and with her final patient and will call me back immediately that’s over. Won’t be long now.

It’s a further thirty minutes actually. And then I get the voice of the stand in on the line. You’ll be pleased to know that it’s not what we thought, she says. Not cancer? No.

I breathe. I realise that I haven’t been doing this since the phone started to ring. God. Not cancer. I interrupt and ask the doctor to repeat. Tell me again it’s not cancer. You’re certain?

Look, I’ve already told you that, no it’s not, she says. Sternly. Bedside manner not really all that evident. There is a cyst, however, something we call a ganglion. It’s in the lower part of your spine and is pressing on the nerve. That would account for all the non-polymyalgia pains you’ve been experiencing. It can be treated. You might need an operation. I’ll have to talk to the consultant next week and get back to you. Is there anything else? No, I manage to say, thank you. She’ll be going home now. What will I be doing?

I sit for a moment, sort of stunned. Then I get up and I dance. I dance with great big steps up and down and up and down the room.

Running

I’m running. I go past the lake, below the trees and on up the path. It’s a push and it’s a sweat. But then it’s supposed to be that. I’ve done it for decades. It makes you fit. It controls your weight. It makes you young.

I didn’t really begin until I was 40. Went out and found I could do it after all. You ran for half an hour and you didn’t die. Your legs didn’t come off. Felt good the day after too. Ate healthily. Began to get younger. In two months I got myself back to age 35. People I met would say, say you look good. Didn’t you used to be that bloke with the beer belly? Gone. Wonderful. I ran some more. I got back to 34.

After that, though, nature’s natural calendar kicked back in. Age returned. Been like that for twenty-five years now. Run to keep yourself on track. Run to control the weight. Run to think. Run to keep yourself in contact with the physical world.

That was until Polymyalgia (PMR) intervened. Aching legs, aching trunk, aching neck, aching upper limbs. Should I run? I asked the GP. Do what you feel you can was the standard reply.

To be fair my faithful friend Prednisolone has helped. PMR slows you to staggering stop but prednisolone lets you start again. Slowly.

That’s been the trouble. It’s slow. When you cease exercise fitness leaves at a prodigious rate. Getting it back is a mighty task. PMR reduced me from miles to almost feet. Could just about get myself down the lane out back when I felt fit enough to restart. Take 15 mgs Prednisolone, put on the running shoes, clamp the Nano to the ears with Santana on, out for five minutes, then stagger back.

Then the pains began. Leg pains, chest pains. The leg pains could well be skeletomuscular suggested the Rheumatologist. But the chest pains may need checking. Hell, off we go again. Another worry. Something else to get under my skin. I look it up. Furring of the arteries, angina pains. That could be it. Pain which runs across the chest. Is there while you exercise. Yep. Stops when you stop. Yes again. That’s me, that’s what it is.

In cardiology they’ve got me up on their running machine. I’m in day clothes and work shoes and have eight or nine leads attached to me. Just walk, the assistant instructs me. We’ll see how you do. Good, good, she says. Now I’m going to up the incline and see what happens. It’s slightly harder but not much. So the process goes. I walk, she turns up the pressure, I walk some more.

Gradually it gets so I’m running, Heavy shoes not the best for this but she’s so encouraging. You’re doing great, keep on. Many give up at this point but you’re fine. I’m on there for more than twenty minutes. Sort of sweating at the end. You’ve done excellently. I have?

The cardiologist returns and looks the results over. In between a conversational rambles about Ireland, the far reaches of Wales and recent fiction he tells me that I’m totally normal. Not a flicker of heart trouble. Nothing he could detect. Blood pressure brilliant. Cholesterol quite acceptable. Stop worrying about this. The pain is skeletomuscular, my other familiar friend. What do I do about it? Run to get to the other side.

You need to do an hour at a stretch three times a week, that’s the current Cardio vascular advice. I might not manage quite that given my prednisolone disability and the PMR still there deep down below my supressed immune system. But it’s good news. Whoopee.

On the way out I barely notice the smokers. I pass the Council dump on Wedal Road and give the operators a friendly wave. Time for a single malt when I get home. Yes yes.

Mahler, Lieder, Helicopters and Prednisolone

It’s been a hard week trying to reduce the level of prednisolone. I feel a bit like an alcoholic. I deny that the stuff means anything to me and then can’t wait to get the dose down my throat. I’m trying to drop from 15 mgs daily to 10. The advice is to do this as slowly as I can. But every time I manage to reach target the pains start up again. They hover out there in the wilderness waiting to pounce. As soon as my mental barriers are down then in they come. And like police raids they usually operate at dawn.

This morning things were so bad that I considered for a moment not bothering to get out of bed at all. I could hear the drivers in the street outside scraping away at the frost on their windscreens. A couple of them, I know, were using their credit cards. These things have many uses. Portable ruler for drawing straight lines, thing for scratching the side of your nose, opener for recalcitrant front doors when you’ve mislaid your key. Used to be okay for that but I seem to recall snapping my Barclaycard in two the last time I tried it. So maybe Yale has at last got wise.

But I overcome. Rise above it. Get myself up and through the morning’s ritual of tablet taking and healthy porridge. I then through what’s now drizzle to the waiting hospital. Here I am again. I’ve arrived early enough to park on the ground floor and to enter the concourse at the same time as the morning shift. The drifting resident population of blokes with buckets and women in washed-out hospital gowns, men on sticks, relatives staring into space and staff in scrubs looks totally unchanged. We ought to hold a concert or two here, cheer everyone up. Brass band music, bluegrass, a poetry reading. Ifor Thomas with his poetry about the prostate would go down well. I might suggest that.

At the bloods clinic, jammed up the corridor somewhere between eyes and my friend, distant rheumatology, there are at least half a dozen people already waiting. The place doesn’t open for another quarter of an hour. You get there before half eight love and you’ll be first. Hum.

I take a number from the ticket machine rather as if I were at the cheese counter in Tesco. I get 04. Not too bad. Bloods entrance has a large and bold painting of a brown unicorn beside it. The unicorn’s horn is long, thick and severely pointed. I start thinking of needles. I do not get on with needles. Not at all. If I watch I faint. It’s happened before, a grown man helped out of the clinic by tiny nurses. Told to sit and drink some water. Happens to lots of people, love. You have a good rest now. God, there’s just too much of having a rest in life. Live now, rest later. This time I decide that I definitely won’t look.

When the clinic opens there’s a fuss. The electronic number display asks for patient 01 to present themselves but a shouting woman in a wheelchair has managed to draw a ticket numbered 00. I was here before you, she complains to an insistant man holding ticket 01. I’ve been here ages, I have, and I'm not waiting anymore. A nurse intervenes. Patient 01 acquiesces. 00 rolls on in.

Why are they testing my blood again? To measure my CRP and ESR rates. That’s C-reactive Protein and Erythrocyte Sedimentation. These show if inflammation is present in the body and are a good indicator of PMR and how the prednisolone might be going down. Both of these levels were elevated before diagnosis but have come right down to normal since the prednisolone was prescribed. But here I am wobbling on the edge of pain recurrence so I’m expecting something to have changed. Not that I’ll know until I get the see the rheumatologist again next week.

My blood samples will be analysed on the premises and the results put onto the central database. Interested parties can then call details up at will. Well, they should be able to. But the health service seems riddled with slow performing hardware, faulty displays and cranky software systems. This is set against a massive raft of regulatory concern over confidentiality and permission. For me I don’t really care who knows my ESP level. Next week when they tell me I think I’ll post it here.

The test itself is over in under two minutes. I’m secured with cotton wool held in place with what looks like parcel tape. I'm back in the corridor in under five. Could be the day is improving. The walking seems to have lifted the residual PMR discomfort and finding my way back out is a push over now that I’m the next best thing to a resident.

Home and I return to 1967 retreaded. I’m working on a concrete poem sequence in the style of those that once graced Hansjorg Mayer’s poster-poem futura series. Jonathan Williams, Diter Rot, Louis Zukofsky, Augusto de Campos, Ian Hamilton Finlay, Reinhard Dohl. The artist Antonio Claudio Carvalho is reviving the idea for 2012. My piece will somehow mix Mahler, Lieder, helicopters and prednisolone. I’ll let you know how I get on.

Scan

Despite the PMR flare which had me sitting on the stairs with my head in my hands yesterday I decide to walk. It’s a fine day in between winter blasts, low sun streaming down the street in a great headlamp dazzle. I go past the Roath Laundry on the corner of Marlborough and Blenheim, its red brick outer walls still in place but its innards almost entirely demolished. There’s a man in a long ragged coat and knitted hat picking his way across the top of one of the rubble piles like this was a pit village in the 40s. A mechanical digger lifts a rusted RSJ and bends it as if it were rope.

I’m wearing loose clothing as advised. Track suit bottoms, t-shirt, sweat top, trainers. I shouldn’t feel out of place. I’m dressed as much of Kentucky Fried Chicken Britain usually is. But you lose authority weraing clothes like this, don’t you. Could you sell insurance door to door wearing Nike? Or if you read the news on TV dressed as a bag lady would anyone believe what you said? Probably not.

Beyond the parks, full of cyclists now we are suddenly allowed to ride on their paths, the tennis courts and the Lake end roundabout, lies Wedal Road. Before the coming of hard-topped roadways the Wedal was a stream. A tributary of the Roath Brook. It’s piped now, a lost Cardiff river, running below the road’s tarmacked surface. The Wedal Road dump, officially a council Household Waste Recycling Centre, has eighteen notices across its gates. These warn against climbing, arriving by truck, walking, being commercial and driving too fast. The latest, a splendid bilingual banner with a drawing of a pick-up truck at its centre, reminds dumpers that if they intend arriving in too big a vehicle then they will have to book.

Around the corner, beyond what was once the Allansbank but is now the Grape and Olive, is the hospital. UHW. The Heath. I’m heading for my first of four tests this week. Each will be performed on a different day, the relevant departments being unable to speak to each other and patient consideration being pretty far down the list. Today it is bone density. Prednisolone has a detrimental effect on bone thickness. The steroid thins. Osteoporosis sets in. A counter measure is to also take Alendronic Acid and up your intake of calcium. I’m on two Calichew daily and Alendronic (stand up, drink loads of water, then swallow) each week. The bone density test will put a measure on all this. Set a reference point to which in the future I can return. Are my bones now more susceptible to breaking? I’ve asked the GP that. Her answer was yes.

Outside the hospital entrance is the usual clash of signs banning smoking with the smokers themselves. White haired ancients in dressing gowns with bandages on their limbs resolutely puffing. Thin faced young men in wheel chairs with drips on wheels beside them pulling hard on roll ups. Well-dressed doctors and file carrying administrators going by without saying a word.

Bone Density measurement takes place in the Department of Medical Physics and Clinical Engineering, a place I’ve never heard of let alone been to before. It’s situated way up the main drag beyond X ray, Pharmacy and the Surgical Day Unit. The procedure itself is done in no time flat. I’m given hospital trousers as my loose fitting track suit bottoms, worn as instructed, turn out to have metal zips on the pockets. I lie on a machine that vaguely resembles the laser table in Goldfinger but lacks the straps with which to tie me down. This is a Bone Density Scanner but we call it a Dexa the nurse tells me. Put your feet here, stay still, breath, don’t breath, breath, there we are, done. Let’s just check. Okay. Get up slowly so you don’t fall over. Fine. You can go now. Put the pants in the dumper. Results will go to Rheumatology. Take two weeks.

I’m done, gone back down the long corridor to the exit, filled now with slow moving patients in robes and on sticks, theatre staff in blue scrubs, blokes in anoraks from Matalan, a man his head totally bandaged with only a small gap for his eyes, a woman carrying a ladder, a porter pushing a chair, a business man in an expensive suit.

Tomorrow I’ll be back. Bloods again. I can feel the polymyalgia there in my legs, a dull throb. Outside the sun’s still shining. But it’s lost its edge.

Chemists

At the Chemists I am now a familiar figure. The shop is really just another waiting room with make-up and perfumes on the wall, a privatised branch of the NHS where you hang around until your number is called. At this point you once had to hand over cash but now, this being wonderful Wales, you don’t. I’m there collecting the usual shedload of Prednisolone, Omeprazole, Calcichew and Alendronic Acid. Boxes, packets and tubs. For reasons I can’t quite explain the extra Vitamin D I’ve been told I need don’t come on the prescription and I have to buy them myself. But the rest is uncharged, courtesy of Aneurin Bevan, praise be his name.

Usually I get presented with the biggest bag the Pharmacists have and stagger out under its weight but today I’m beaten by the woman in front. She’s wearing a sort of dinner lady’s coat and has a series of dirty looking plastic carriers hanging from her arms. The bag she’s given is so big that it looks as if it might contain everything from oxygen cylinders to a spare artificial leg. There’s a clanking rustle and gush of cold air as she tries unsuccessfully to negotiate the door to get back into the street. I assist. I’m an old school gentleman. I get no thanks, not that I’m asking, just a slight smell of stale dog mixed with wet coat. She ought to bring her wheelie trolley, says the assistant behind the counter. Free NHS forever. I nod.

I’m offered the new we fix it for you and sort your GP deal – complimentary for me and for anyone else that wants it for that matter. The Pharmacy will call my GP monthly and order my drugs. They’ll collect the prescription and then make it up. All I need to do is be at the end of a phone when they call to ask how many tablets I need and then be able to walk round to their shop and actually collect the stuff. So slick. A wonder. I sign up.

But sometimes these things go wrong. Back in my pre-Steroid days when my slight eczema, about the only thing I had wrong with me, was controlled by tubes of DiproBase. I was once prescribed cream but given ointment by mistake. This came in dozens of small tubes which are still stacked in my cupboard upstairs. I should return them, or throw them out. Prednisolone’s one great advantage (other than its main function as a PMR suppressant) is that it appears to sort out itchy skin. But I’d have that back any day.

Back on Newport Road, my main drag, the land where it’s pretty hard to spot a permanent resident, the world rolls on. Up near the funeral home the immigrant Eastern Europeans are standing leaning on their garden wall, cigarettes lit and cans of lager in their hands. It’s a hard life and it’s not yet 10.00 am. The push chairs are rolling and the Africans pass me on their bikes. East Cardiff centre of the world.

Songs with Prednisolone in the title: none

However you can listen to The Steroids, DJ Steroid, The Steroid Kiddies, Steroid Freak Pussy, A-Steroid and Steroid Maximus on Spotify. You can do it anytime you want. My guess is that those bands’ steroids are to do with enhanced performance rather than moon faces.

But back to the blog. You can tell this is an up day, can’t you? I must take advantage. Some days have more black dogs than others. Not all days are the same.

Alarm

Outside the hospital the smokers gather again below the Please Refrain From Smoking notices. They look the part, their faces lined and drawn. They are outside, at least, in the wind. Their hospital issue dressing gowns sop up the pervading drizzle. Inside the usual melee prevails. People on sticks, doctors in suits and gowns, nurses, ancillary staff, mothers with push chairs, a man in a turban pulling a suitcase, folk queuing for sandwiches and papers. Smith’s pushing their huge bars of chocolate, a pound a go today with any purchase, no one buying. This is the NHS shopping mall: St David’s Two without the luxury, Bluewater less the desirability. You are here because you have to be. Unless you are a record collector, that is. The Christian bookshop, stashed over there in the far corner beyond Boots, is selling off a lot of its record collection. I got Rod Stewart and the Steampacket for £2.00. I saw that band, in the mid-sixties when Rod was nowhere yet and Long John Baldry was taking the lead. The Steampacket live at Klooks Kleek. Back here in suburban Cardiff where little ever happened I lived out on that experience for months.

I’m heading for Clinic Six again, Rheumatology, home of prednisolone my friend, and hope for the future. Half way there, wending my way along the patient strewn corridors, the fire bells starts. It’s a loud, piecing scream. It throbs, it pulses. It’s incredibly loud. It enters your ear and it stays there. Your head swims in accompaniment. You begin to wonder if there’s any way you can still get your brain to carry on thinking now this sound has arrived right in its middle. I expect to see fire wardens rushing to the aid of us staggering patients or, at very least, some instruction coming from the NHS’s uniformed staff. But there’s nothing. The alarm is ignored. Staff continue to go about their business as if all this wasn’t happening. Can they not hear it? Why are they not flinching like I am? I shake my head. The sound is entering my bones and making them rattle.

Eventually I reach Rheumatology reception where the woman behind the counter tells me over the racket that because the alarm is intermittent we can safely ignore it. You mean it’s a test, I ask? Someone upstairs has burned the toast I expect, she says. She smiles. And then it stops. The air fills with silence like cool cool water. Glorious.

I’m still in pain, right leg, from the heel to the top. The pain arrives and stays for days. Does it get worse when you exercise it, the rheumatologist asks? Sometimes. Just the sort of answer I am sure she wants. I’m sent out for more tests. We have to get to the bottom of this. X-Rays, trunk and upper leg, put on the list for an MRI scan, sent to bloods to let them have just a little bit more. I feel like Tony Hancock. I’ve given them at least an armful now. Back in two weeks. There’s something happening here but we don’t know what it is, do we, Mr Jones?