We Are All Individuals

“I’ve seen you, before haven’t I?” asked the friendly Scotsman. I smiled.  In any other circumstance I would be flattered.  On this occasion he was leading me down a brightly lit corridor and into a broom cupboard.  There he would be giving me a local anaesthetic, so I could have my left shut for good.  Finally.

The anaesthetic was administered, and Alana arrived.  She would be performing the procedure.  We were on first name terms now, which in a hospital setting, is not necessarily a good thing.  The surgery was performed without a hitch.  After a complimentary cup of tea, biscuits, an epic wait in pharmacy and a penalty tram fare, I was home.  Phew.

After a fantastic week in Devon I was back on my home turf, the eye outpatient clinic.  It was more packed than usual.  Maybe the raised chocolate consumption over Easter led to more eye issues?  Who knows? Although my appointment was for 1:30pm, I was called through at 2:15pm, which meant I could watch Doctors, which is a guilty pleasure of mine.  So, I arrived in the examining room in quite a good mood.

However, the doctor wasn’t Alana.  It was a tired looking registrar who clearly hadn’t read my notes.  An interrogation ensued, and it was quite clear that I wasn’t giving the right answers.  It revolved the medication I was on which I had forgotten to bring with me.  I’d be damned if I could remember the names of the stupid things.  I just put them in my eye.  End of.  She wasn’t happy.  I was spat out and told to wait for when Alans was next free.

I sat in the waiting room feeling like a right numbskull.  I was easily the youngest in there.  How would my older compadres cope in such an interrogation?  Then I twigged it.  I was at fault because I was individual.  My older compadres fitted neatly into their boxes for glaucoma, cataracts, you name it.  They could be sorted.  Me?  Well I was way too individual for that.

I smiled and thought of one of my favourite films, Life of Brian.  Brian, somehow becomes seen as The Messiah.  In one scene, he opens his curtains, walks onto his balcony, fully naked, only to be greeted by a mob of people shouting “Messiah! Messiah!” Once he has put his clothes on, Brian confronts them telling them that they are all individuals and should believe what they want to believe and not follow him.  The crowd chant back what he says.  His message gets lost and the crowd begin following him wherever he goes.

I felt a bit like Brian with that doctor.  I was trying to tell the doctor my individual condition.  She was repeating it back to me but not really listening.  She was trying to find a nice comfortable box to put me in so that she would know what to do.

It’s very easy to label and box people.  It happens all the time and our tick box culture does not help.  Listening is such a powerful skill and is rarely used.  Patients aren’t listened to.  Parents aren’t listened to.  Children and teenagers aren’t listened to.  Doctors and nurses aren’t listened to.  Sadly, the list gets ever longer.

I finally saw Alana.  She was happy.  My ulcer was smaller, and she prescribed some weaker antibiotics.  I also a week off from going to the eye clinic.  Things were looking up.

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Well Eye Be Damned

“Oh God! Why do the ALWAYS show boring drama programmes in here?” lamented the Kevin the teenager standing behind me in the queue at for the reception at the eye clinic.  His mum mumbled something to him.  I was about to turn around and extol the virtues of Doctors when it was my turn to do my pre-flight checks.  One I had finished, Kevin had disappeared.

After my eye check, I was led through to the main waiting area.  As always it was packed.  Whole families seemed to be there to find out about Nana’s or Grandad’s cataract or glaucoma.  On the goggle-box was some weird Australian drama set in the 1960’s.  It reminded me of those Australian dramas in the late 80’s like The Sullivan’s and Sons and Daughters were more attention was paid to write a catchy theme tune rather than on any plot.

I was trying to get my head around about what was going on, when a doctor I had never seen before, called me through.  I walked in the room and sat down.  He sat by the computer and started to read my notes.  The door was still wide open.  I got up and shut it.  I had a bad feeling about this.  We sat in silence as he spent a good five minutes reading my notes.  Five minutes is a long time to be sat in complete silence.  He examined my eye.  It was clear he wasn’t happy.  He asked me who I had seen in the eye clinic.  I listed practically half the doctors in the eye clinic.  He frowned, He informed me that the doctor who had closed my eye was in clinic today so maybe it would be better if I saw her.  Pass the buck.  Nice.

Back to the waiting room I returned.  It was now that daytime stalwart Escape to the Country.  The budget was £1.5 million.  Completely realistic to the patients in the waiting room at the eye clinic.  I was midway through being shown a six-bed detached house in Cambridgeshire, complete with indoor and outdoor swimming pool, when I was called through, I have a good relationship with this doc.  It’s very professional and she is very efficient in what she does.  She wasn’t happy.  The ulcer behind the part of my eye that was sewn up, had gone.  However, in the part that was exposed, the ulcer was worse.  She asked if I was OK if the Prof had a look.

Prof 2 came in.  He’s very calm and serene, just what you need in someone who is fiddling with your eye.  He had a gander and spoke to medical gobbledegook to my doctor.  From my viewings of various medical dramas, I understood snippets.  Samples had to be taken for cultures.  He left, and the doctor checked if I knew what was going to happen.  Vaguely.  She clarified by saying that they would be taking samples of the ulcer for testing.  They were also going to give me much stronger antibiotics.  I would come back in a weeks’ time and if I hadn’t got better, I would be admitted to have antibiotics intravenously.  Crikey.  We had gone up a notch.

After the samples were taken and I had waited for an hour in pharmacy for the antibiotics, I arrived home to a letter from Prof 1 at the Marsden.  He had written to me, my GP and my oncologist to let them know what was happening.  He said that it was a pleasure to see me.  Could I use that as a reference on my CV, I wondered?  He also said the R-word.  He said the I was “in remission on maintenance Herceptin”.  Yes, I’ll take that.

Eye we go again…

The following week I was back.  I was running low on antibiotics.  As I checked into eye casualty, the cheery nurse who saw me last time walked past.

“Good to see you again, Anna!”

It’s never good, to be on first name terms with the triage nurse, no matter how lovely she is.  After about an hour I was called through.  The doctor was obviously a bit intimidated with my brush with the professor.  He gave me a prescription for more antibiotics and the professor’s secretary phone number.  I was to call her and chase up my appointment with him.  I needed to see him pronto.

This is the thing that shocks people the first time they encounter healthcare for the first time.  The emphasis is firmly on you to chase up appointments, know what medication you are on, when your last scan was and the result of it and a whole myriad of information about you.  It becomes a bit of a test.  In every appointment there is always one bit of information that I have forgotten.  It’s when you see the doctor roll their eyes at this that it hurts a little bit.  I’m not bothered though.  In fact I feel a little flattered that the doctors have shared me a little into their secret world.  It’s the people like the woman I saw in eye casualty walking with two canes.  She was with her son, who was about my age and with obvious learning difficulties. They both needed to see doctors in eye casualty.  It’s those vulnerable people that you worry if they can keep track on what is going on.

The next day, I tried the secretary.  Voicemail.  I left a really long annoying voice mail.  If I was the secretary and heard the message I left, there would be no way I would call back that crazy woman.  I needed another plan.  The next day I decided to call every fifteen minutes until someone picked up.  After the fourth phone call, she picked up.  I told the sorry story in complete grovelling mode.  It worked.  The prof had a slot in his Wednesday clinic.  I was squeezed in.

On Wednesday I went prepared.  The last time I had seen him, he had been an hour late.  So I was armed with a Costa latte, a chocolate cookie and a magazine.  I was in for the long haul.  I had just made myself comfortable when I was called through, ten minutes before my appointment time.  This was most irregular.  It wasn’t the prof, but a doctor I had seen before during my forays into eye casualty.  She looked in my eye.  It wasn’t good.  My eye needed to be closed permanently to clear the ulcer.  This needed to be done asap or I could lose my left eye.  She said she would talk to the prof to admit me for day surgery as soon as there was space.

On the way home I missed a call.  The voicemail left told me that I was to have this surgery the following Monday.  Crikey.  Fasten your seat belts people.

Monday rolled around.  Over the weekend I had contracted an awful cold/flu/cough virus thing.  Although I didn’t have temperature, I had a hacking cough and no appetite whatsoever.  What would happen?  Would they turn me away?  I turned up at the Eye Day Surgery Clinic bang on 7:30am, like everyone else who need day eye surgery that day.  What was clear was that I was by far, the youngest in the waiting room.  Because of this, I was eyed with suspicion.  I was called through by the nurse.  She went through what was happening and reassured me that my cold/flu/cough thing wouldn’t affect anything in the slightest.  As she showed me back to the waiting room, we saw the doctor I had seen in the eye clinic.  She would be performing the surgery not the prof.

“Because you are the youngest person, I’ll be doing you last this morning.  So you can go, have breakfast and come back here at 10:30am.”

Grateful for my slight reprise, I skipped out the clinic onto the joys of Costa.  I checked the time.  It was 8:30am.  Two hours to kill in the hospital.  What to do?

After having a very slow latte and micro reading the day’s paper, I slowly ventured back to the clinic.  They were relatively happy that I had come back.  I saw another nurse and signed the consent form.

“Would you like to go the waiting room with the TV in?”

I said I would.  When we got there, there was indeed a TV showing the Winter Olympics, but also a stressed looking man.  Turned out unlike me, he hadn’t been given a freedom pass and had been stuck in this tiny room, not knowing what was happening.  He was also younger than me.  I told him what I had been told about my age and he rolled his eyes.

“Why couldn’t they have told me that?  That would have been better than hanging around here for the last three hours.”

And that my friends is the problem.  Communication.  If we, as patients are told what is happening, stress levels are reduced.  This poor man had been too scared to even to go to the loo for fear that he would miss having his name called.  I gave him permission to finally go and once he had been, we both chilled out to watch the bobsleigh.

I can’t say how long I waited in that tiny room but eventually, I was called through.  The surgery didn’t take that long.  About half an hour.  But there was something missing.  It was only afterwards, when I was having my post op complimentary cup of tea and custard cream (thank you UK taxpayer) that I realised what it was.  When I had had similar surgery last year, the radio had been playing in the operating theatre.  The song that was playing was Rod Stewart “If You Think I’m Sexy…”, quite possibly the most inappropriate song for such an occasion.  Yet this is what was missing.  There was no distraction.  Just medical gobbledigook between the doctor and her med student.

“You look a bit sad.”  said the nurse, as she handed over my drugs and follow up appointment.

“I’m fine.  Just glad it’s over.”

Red Eye Kitchen Nightmare

It all began last Wednesday.  I was running late for work.  I jogged the dog round the block for her morning toileting.  When I got back, my husband was long gone so I grabbed my bag and ran.  It wasn’t until lunchtime that I noticed.  I had left the eye ointment that I have to apply to my left eye every two hours, on the kitchen worktop, next to the dog lead.  Still, I wasn’t in any pain, so maybe I got away with it.

The next day it was clear that I hadn’t.  I went into ointment overdrive, trying to overcompensate for the mistake I had made.  It was too late.  The damage had been done.  With a heavy heart I called eye casualty.  Just keep applying the ointment and if it gets worse, pop in said the nurse.  No one ever pops into casualty.

My eye got progressively worse during the week.  We tried taping it up at night, applying ointment every hour to no avail.  Casualty beckoned.  On my way to the hospital I began to listen to Desert Island Discs on Radio 4.  The person who was shipwrecked was Angela Hartnett, a top chef who was a protégé of Gordon Ramsey.  Kirsty Young was trying to get her to comment on why they were few top chefs that were female.  Angela was quite guarded about this but said the situation was improving.  Her time with Ramsey sounded brutal.  Although she had kind words for the man himself, the hours were a killer.  She worked from 6:30am until midnight for six days a week with half an hour for lunch if she was lucky.  The rest of the chefs took bets on how long she would last.  The top one was three weeks.  She stayed for a year.  So much energy for a plate of food.

There was a long queue for the reception when I got to eye casualty.  I wasn’t feeling optimistic.  After about half an hour I was called through by a glamourous looking nurse.  We did the usual pre-flight checks.  To my surprise she knew all my medical history. Yes, she knew of the facial nerve surgery and the surgery in October.  She was also horrified I was expected to apply the ointment to my eye every two hours.  This was a first.

She sent me round to have photos taken of my eye and led me to another waiting room.  The TV was showing the US version Ramsey Kitchen Nightmares.  My second encounter with Mr Ramsey that morning.  His target was a seafood restaurant in New Orleans owned by two warring brothers, each blaming the other for its woes.  Ramsey was doing his usual, but I noticed something.  He wasn’t doing that much.  He was a rope provider and getting those who ran the restaurant to hang themselves on that rope.  They were just about to close the kitchen down, when I was called through for my pics to be taken.

Once they were done, it was back to eye casualty where I rather enthusiastically announced my arrival to the receptionist. I took my seat to await the doctor’s verdict.  After fifteen minutes I was called through to see a consultant.  She was surprised to learn that my next outpatient appointment wasn’t until March and bumped me up to go in next Wednesday.  She also gave good advice on how to tape up my eye and apply the ointment more effectively.  In her opinion, the October op hadn’t worked, and my eye would needed to be stitched up again.  But my consultant in eye outpatients would have the final call on that.  I wasn’t too downhearted by this.  I just wanted not to keep getting red eyes.

When I left, I checked my watch.  I had been done and dusted in less than two hours.  The NHS can work, if you see the right people who know how to solve your medical issue.  The problem is that we are losing these right people.  The fact that they are usually working the hours that Gordon Ramsey and co worked at their peak, may have something to do with it.

Bonkers Part 2

The allotted day had arrived.  Even worse it was Tuesday.  Tuesdays are rubbish for me.  Luckily, we are in exam season.  So, I left my class in the hands of a bemused admin assistant to invigilate yet another mock exam for them.  They took this quite well apart from my manager who still signs off any email I send her about my appointments with, “if you could rearrange this when you are not teaching next time.” Yeah, right.

The ENT department is split into two reception areas.  Normally I am in the second reception area around the corner.  I approached the first reception area, feeling nervous.  The receptionist was on the phone speaking loudly.

“Yes, it’s on the FIFTEENTH.” Pause. “Not SIXTEENTH.  ONE FIVE.” Pause “We’ll send you a letter.  A LETTER.”

She hung up and rolled her eyes.

“Yes?”

I said my name and Dr Q’s name.

“Well it looks like you are here today.” She said sounding quite surprised. “Take a seat.”

I obeyed and got my book out.  After about twenty minutes I noticed something.  Patients were being called out two at a time, going through some double doors and not returning.  Bit worrying that.

After about forty-five minutes mine and another patient’s name were called.  We were escorted by a nurse through the double doors into yet another waiting room.

“I’m sorry but it’s another hour wait from this point on.”

I was on my own but the other patient had his wife with him.  We all sighed in unison.  He reached for his phone and both his wife and I resumed our books.  We were lucky.  After about twenty minutes, the couple were called through.  This took the wife by surprise. She spent a good deal of time faffing about much to the amusement of the nurse and her husband.  I smiled and carrying on reading.

After another twenty minutes, I was called through.  Where had the couple gone?  It was my turn for a bit of awkward faffing.  The nurse led me to a room where sat Mr Q looking immaculate as ever.  I sat opposite him. The nurse took a seat in the corner of the room, facing me.  Mr Q and I exchanged pleasantries.  The nurse looked bored.  I was the last patient in the clinic so it must have been a long morning.

“So, can you remind me why you are here?” asked Mr Q.  I gave him a detailed account of the last six years.  It felt quite strange being encouraged in giving such details.  I have become so used to giving quite a watered-down version of events.  He listened and made notes.  After my history, he asked me to do various facial exercises so he could check out how much movement I had in the left side of my face.

“OK.  What for you is the most important thing to be done?”

I was flummocked by the question.  I’ve never been given a choice before.  I remembered our previous appointment.  He had said the he didn’t want to tread on the toes of the eye people.  So, I said I wanted my mouth sorted and then maybe the eye.

He looked puzzled.

“If you want my opinion, you need to get the eye sorted first.  I’ll refer you to Dr S to advise you on that…”

He outlined a possible procedure that involved cuts to my lower eyelid and weights that could be either gold or platinum, inserted in my upper eyelid to ensure my eye closed properly.  Crikey.  But this was merely the beginning.

Once I had had my eye sorted, then work could start on my mouth.  There were three options:

  1. A hoik up. This was the easiest procedure. He would cut along the smile line on the left side of my face. Hoik it up. Cut behind my ear and use a bit of my thigh to replace any facial tissue he had to get rid of.
  2. The thigh nerve. He could take a muscle from my thigh that had a nerve in it. He would attach this to my face and attach the nerve to the nerve endings near my temple. I then could have a faint smile. I think he ruled this one out as he felt that I didn’t have enough nerve endings in my left temple. Lovely.
  3. The nerve graft. The complicated one. A piece of my right facial nerve would be stretched to the left side of my face. Once it had been grafted over, a piece of muscle could be attached to it and over time, I would be able to smile. This would involve two operations. Although he had done the procedure before, he felt I would be better going to a specialist centre for this op. The centres were in Newcastle, Birmingham and…erm… East Grinstead.

It was a hell of a lot to take in.  I was used to no options.  If there was an option there was only one and I had to have that otherwise I would die.  Part of the reason why our house is in a state in disrepair is because my husband and I are rubbish at making choices.  We are both ditherers.  Now I was being asked what choice I wanted to do with my face.

Mr Q picked up on my anxiety.

“Listen.  There is no rush in any of this.  We can take our time.  Come back and see me in a months’ time and we’ll talk about it further.”

I nodded and looked to the nurse for some reassurance.  She looked blankly at me and escorted me out of the building.

Confessions of a Junior Doctor

A&E was packed.  Doctors and nurses were running around all over the place.  This must be in London, Birmingham or Manchester.  One of the great cities of the British Isles that are groaning at their seams.  But no.  This hospital was in Northampton.  It was full to bursting and severely understaffed.

None of this is the fault of the staff.  Nor is it the fault of the patients.  The NHS is a victim of its own success by pushing the boundaries of medical care.  We are living longer than ever before.  Something that our politicians are finally recognising. The problem is that the other vital infrastructure needed to support this, hasn’t caught up.

Governments think of everything in the short term.  This way of thinking has slowly dripped down into all aspects of life.  This short term thinking is in direct conflict with the long term planning that the NHS is crying out for.  It operates by using targets to prove efficiency.  A hospital or a school isn’t a machine.  You don’t pump one thing in one end and get a product at the end.  People aren’t commodities.  Yet the management strategies being adopted fail to recognise or question this.

Healthcare, as well as education and to some degree, law enforcement, involves dealing with the whole individual rather than the illness, the exam or the crime.  The only place where this is really done in society is when someone wants you to buy something.  Go to any car dealership and they are trying to find out every aspect about you to find a car suitable to your needs.  The same goes with property and estate agents.  You are even asked for your name when you buy a coffee which puts in perspective one of the junior doctors who had been so busy, she didn’t have time to remember her patients’ names.

This is something the junior doctors in Confessions of a Junior Doctor know all about.  We saw an oncology junior doctor being brave enough to tell her consultant that she wouldn’t be hurrying her rounds.  Her superior was informed that if she didn’t take the time to reassure and listen to one particular patient, he would get extremely anxious and possibly talk of suicide.

On another ward, another junior took the time to find out why a relatively healthy twenty year old man was only weighing four stone.  What he discovered by just listening, was that the patient was using cannabis heavily.  Although cannabis is famous to inducing the munchies, if overused, like alcohol, it can suppress appetite.  I thought the consultant was going to kiss the junior doctor for discovering this.  The man had often been in and out of hospital and he was a bit of a mystery. Yet the junior doctor found out the root cause of the problem just by listening.

Such stories give you hope that all is not lost.  But these are doctors who are going against the system.  They are doing what they think is right, not what some of their superiors want them to do.  Now they can just about get away with it.  Whether they could get away with this in five years’ time, no one knows.

Supervet

Our family have never been big on animals.  Although both my parents had dogs when they were younger, full time jobs and living next door to a main road put a scupper on me and my sister having such luck.  Goldfish and that was the limit we were told.

When the C bomb dropped, I decided to reduce my teaching hours.  Part of this was health related and part because I wanted to do what I wanted to do. After much umm-ing and ahh-ing we decided to get a dog. What dog was the next question. I didn’t want a small yappy terrier type dog.  We had lived next to one when I was a child and it scared the bejesus out of me and my sister.  I didn’t want a puppy either.  I wanted a fully developed, mature hound.  I’m not sure how we chanced upon greyhounds, but we did.

A visit to a retired greyhound sanctuary was booked just to have a look.  Word to the wise.  You never visit an animal shelter for a look.  Sookie was the first and only greyhound we walked.  My husband, who had owned two rescue dogs previously and therefore an expert, decreed that she was the one.

Papers were signed, home visits conducted and in a couple of weeks we had a fully formed greyhound snoozing on our sofa.  They don’t really warn you, but it’s a life changer.  I can’t image what life was like before.  She is so much part of our lives now.  It would feel strange not to open a packet of cheese and not feel a nose by your elbow.

A programme that documents this love so well is Supervet.  The Supervet in question is Mr Neil Fitzpatrick. There is no alter ego or costume change. It is just Neil Fitzpatrick.  But he can do remarkable things.  He can make legs where there are none in a whole range of animals.  He screws, welds and hammers all manner of stuff together. He does all this in the wee small hours, after his surgery closes. It’s clear to see that it’s his passion.  His life is the animals in his care.  He lives and breathes them.  It’s hard to say if he gets this passion from the animals or the owners.  Possibly a mixture of the two.

Before I had Sookie, I never watched Supervet.  I couldn’t see what the fuss was about.  A dog is a dog at the end of the day.  Since getting our hound, I watch now with enthusiasm and awe on what can be done.  It makes you think that if such possibilities are available to our best friend, what wonders are there for all of us.

Melissa had used her organisational skills to the max and had arranged an appointment for me with Dr B and Mr Q, a plastic surgeon.  My eye issue could now be sorted for once and for all.  The allotted day and hour rolled around.  Back in the lovely ENT waiting room and they were running late.  My appointment was at four and we were well into Flog It.  I wasn’t feeling optimistic.

At quarter to five, I was called through.  Dr B and I exchanged niceties, twiddling our thumbs for the man of the moment to make his appearance.  When he did arrive, it was a bit of a let-down.  He snuck in without much fanfare.

What I’ve noticed during my cancer “journey” is that most health care professionals match their job descriptions. GP’s are often quite “general” because they know a little bit about everything.  This means that they can be vague in certain scenarios.  Junior doctors are eager to please.  They don’t want to mess up.  They take detailed histories and agonise over any decision.  Registrars are smug.  They know it all.  What they don’t need are patients cluttering up their day. Consultants are a mixture of junior doctors and registrars, but in a milder form.  Nurses are the glue that hold everything together.  They are the warriors at the frontline implementing the various plans that are devised to make everything OK.  As for surgeons, they are clear and precise.  They are like the surgery that they perform.  They don’t sugar coat anything.  It’s a bit like talking to a scalpel, if that makes sense.

Mr Q was no exception.  He was scanning my face and thinking of all manner of things.  I explained that I wanted the left side of my face hoiking up.

“Oh yes… we can definitely do some hoiking…”

He outlined a whole range of possible procedures.  I wasn’t really listening.  They seemed to involve cuts on my smile line, cuts to the back of my head and at one point thigh muscles were mentioned.  When he finished, he took out his phone.

“OK.  I can see you in my clinic on 2nd May. Is that OK?”

I nodded feeling cock-a-hoop.  Who cared that the 2nd May was the Tuesday after the May Day Bank Holiday when I would have had to rush back from North Wales from celebrating my Auntie Claire’s 80th birthday?  Who cared that I also had a full day of teaching that day which would be a nightmare to cover, especially with exams in the offing? The man had a plan and that was all I cared about.