In Limbo

I never meant to leave writing behind, honest. At the same time, it seemed that, by the time of the last entry here, some sort of milestone had been passed: the shock diagnosis of September 2010 had led directly to the absorbing project of two significant tussles with chemotherapy, with all their associated procedures, subsidiary medications and appointments, finishing off with some minor surgery, the final flourish of a third bone marrow biopsy and the welcome assessment from my consultant that I am currently in a good and deep remission. It felt like time to take a rest from self-examination, return to the consoling (ha!) rhythms of work and just let normal life drift its way back in like the returning tide seeping across a sandy summer beach.

That tide has indeed come back in, bringing with it some interesting bits of driftwood along with some less attractive flotsam. Yet I have not lost the urge to write, record, reflect and, occasionally, to inform. In the years before encountering the good Dr Waldenström and his eponymous lymphoma I had occasionally put pen to paper to make some sort of record of the passing moments and their associated thoughts and emotions, but never for public consumption and certainly not with any great sense of purpose. Being unwell with a rare disease changed that, as it did a lot of things, and I now face the fact that some sort of minor muse has taken up residence in a corner of my psyche, occasionally emerging from her cramped quarters to nag me into action.

So, what has been going on medically of late? Until recently, I had been grumbling along with one of those tedious upper respiratory tract viruses that lumber one with a ragbag of minor symptoms, whose accumulated weight slows the body down, interferes with simple tasks and announces to people around by means of hacking coughs and frequent sniffles that giving you a wide berth would be in their best interests.  A visit to the GP established that I had a small secondary infection in my upper right chest, so a week of the standard entry-level antibiotic, amoxicillin, was prescribed. A tickly cough proved obstinate for quite a while, but the little capsules finally seem to have done their work.

Rhatany and Cocaine Pastilles
Believed, er, no longer available. What reputable drug companies used to be able to get away with, eh?
Rhatany is a name given to krameria root, whose astringent biological action is ascribed to rhataniatannic acid, which sounds like a drum rudiment.

One of the things I am far from sure of is the state of my immune system post-lymphoma and post-chemo. From what I can gather, what may have really taken a clobbering while the lymphoma was assembling its forces and in the subsequent battle against it with the help of powerful poisons—rather like relying on mercenaries supplied by Stalin—would have been my acquired immune system, the bank of antibodies acquired in response to specific pathogens as I engaged with the world outside the womb over more than five decades. For some months now I have been battling a little colony of minor warts on one of the fingers of my right hand. Many people have to deal with such things at some time in their life, but I cannot help wondering whether they would have surfaced in the old days before diagnosis.

The possibility of infection is a constant theme for WM patients and some people have had a much worse time with compromised immune systems than others. I have certainly had my low points, needing strong antibiotic intervention, both in the weeks that followed soon after diagnosis in 2010 and while having my stem cell autograft in 2011. What I have found since is that I have not caught everything going, but there is always the apprehension that some virus that previously one might have shrugged off will grab hold and take permanent lodging like some raucous gatecrasher at an elegant social occasion, opening the windows to allow his friends to storm in, swipe the drinks and puke on the carpet. 

Infection is one thing (it's of course far from that, being a countless horde of things) but a bad back is quite another. Over the last few years I have experienced increasing lower back pain, which more recently, in fact preceding the WM diagnosis, has hardened into a nodus of sometimes marked discomfort on the right side, accompanied by hot and cold nervy numbness down my leg and into my foot. Walking can be significantly hampered by stiffness and pain, particularly by the end of the day, although it is even ground, such as pavement, that presents the most difficulty. In summer 2011, and even since, uneven ground has made for more comfortable walking: 5-mile Cornish cliff walks have been as pleasant as ever. Also, cycling does not tax my back but let me not bore you at this point with what it does to my knees.

Who needs the dubious ministrations of rhatany and cocaine pastilles when you have Cornish cliffs to help you breathe (and walk) more easily?
This is Trevone Bay in North Cornwall, a favourite holiday destination for me and my family since 1993.

In all conditions to which we attach the label "medical" it seems that we reach a tipping point at which the interference of symptoms with that assemblage of events, habits, duties, emotions and the like on which we place the tag "normal life" is such that we find ourselves saying words to the effect of "something must be done". In the case of my back I found myself rocking on this fulcrum of misery some time ago, but by then back pain was getting mixed up with the general slowing down and lack of energy and ease of mobility contrived by lymphoma; indeed I wondered if the back problems were a symptom of WM.

Now that I am well in the haematological sense I must address the back and its linked problems.  First stop, earlier this year, was referral to the local physiotherapy services, who, after detailed examination and history-taking, prescribed some floor exercises and stretches that I have been following as religiously as I ever can anything. These are providing some relief, even relaxing me sufficiently at various points for the cat to feel comfortable sitting on my stomach while I go through the routines: all very well for her but not very helpful for me, so she is swiftly evicted.

However by a few months ago it was clear that exercises alone would not deal with the fundamental issue. Time to go back to the GP, who referred me for an MRI scan, which would be carried out by a company contracted to the NHS to provide scanning services. The scanner in this instance would be housed in a trailer that does the rounds of various locations and in due course I was given a date when the expensive device would be in my area: the venue turned out to be the generously sized car park of a GP surgery in Teddington, a couple of miles or so down the road from my house.

There was a small waiting area in the trailer and a locker in which to leave any metal objects that would interfere with the scanner's magnets: keys, watch, loose change... I also had to sign a declaration that my body did not harbour any metalwork, such as orthopaedic pins, plates and screws. There were two staff in the trailer: one to clerk me in and deal with admin and the other, significantly older, to operate the scanner and process the images, which were displayed on a screen that he was watching intently for most of the time.

An MRI scanner – The Tube Ride With A Difference
Somehow you can tell this photo was produced for the private healthcare sector, can't you?
People smile in the NHS too (quite a lot, actually).

After about 15 minutes it was time for me to enter the scanner room, escorted by the older man. I lay down on the couch that was then raised to the height of the scanner's central tunnel, ready to be slid into place. Headphones were provided, through which the sounds of an MOR radio station warbled thinly. I was also given a rubber bulb to hold throughout and squeeze if I panicked and wanted the whole proceedings to end. After telling me that the noise of the scanner would eclipse the meagre sounds of the pop music and advising me to keep my eyes closed throughout the scan, which would last about 20 minutes, the technician manoeuvred the couch into the tunnel and resumed his place at the monitor screen, closing the door behind him.

I was completely unprepared for the noise of the scanning process (or, rather, processes, since there were several in succession). The noise like a road drill stopped, allowing Mark Knopfler to surface briefly in the headphones, only to be drowned out by a numbing techno hammer beat the experience of which could be likened to being locked in a particularly minimalist disco. There was periodic notice from the technician through the headphones of the duration of each scan and it was all over soon enough, but not before the reason why the technician had counselled against opening my eyes was borne in on me. Some way into the proceedings my nose started to itch and I lifted my hand gingerly to scratch it, finding in the process, as my hand made extremely rapid contact with the roof of the tunnel, that the scanner was much more confining than I had thought. Although my own neuroses tend to constellate around bridges or any other high structure with low railings, in order to avoid allowing my synapses to admit claustrophobia to the population of hang-ups I kept my eyelids firmly together.

The Millau Viaduct in southern France, the tallest bridge in the world.
I don't care if it was designed by Norman Foster, I'm not going on it.

Released from the device after the final sonic assault, I collected my belongings and left the trailer with what I hoped was a reassuring smile for the next patient in line, who was sitting in the waiting chair I had occupied a while earlier.

In about two weeks a letter arrived from my GP inviting me to make an appointment to discuss what the scan had revealed. I had long suspected what the problem might be: another condition with a long Greek name that I had first heard of 38 years ago, when I was 19 and had a back X-ray after a road traffic accident. A motorcyclist, careering on to the pavement after colliding with a car whose driver was foolishly overtaking him at the bottom of Richmond Hill, had jammed my back against some railings by which I was sitting with some friends at the end of an afternoon of pleasant activities in the park. The name is "spondylolisthesis", which, off the top of my head, means something along the lines of  "displacement of vertebrae". At the time I was advised it was no big deal.

Spondylolisthesis
Not very nice.

Sitting with my GP as he went through the MRI report, describing a kink in my spine formed by lumbar 5 riding out over sacral 1 and causing the disc between them to make contact with, and irritate, my sciatic nerve, I wondered whether the deformity might be traumatic in origin rather than, as is more usually the case, congenital. Maybe I will find out but, whatever the cause and however innocuous the condition at first appeared all those years ago, it has now evolved into something that has a marked impact on my comfort (pretty much constantly) and mobility (sometimes). As medical people say, it has become a "quality-of-life issue".

My GP sometimes seems to share that uneasy view of surgeons that physicians can harbour, leading one to think that the two halves of the medical profession see themselves as separate species. On this occasion however he was in no hurry to spare me the ministrations of a spinal orthopaedic surgeon, although he did say that the surgeon might recommend an injection rather than manoeuvring the offending bits of my spine back into place and securing them with the sort of metalwork that would bar me from ever again having an MRI scan (how ironic that would be). I think he was just trying to spare me anxiety, since, if what I visualise going on in my lower spine is anything to go by, it seems likely that ironmongery will be called for. It's a bit of a strange time to be me: seeing two different surgeons in one year after a lifetime avoiding the knife. Mind you, it seemed at one point as if the two consultations would not top and tail 2012, as the chosen consultant is much in demand and until a few days ago I thought the Yuletide turkey would be facing the knife before me.

It has been taken several months since the scan was first arranged to get this far, but the period in limbo should end during the first week of December, when I go the National Hospital for Neurology and Neurosurgery, Queen Square. I will keep you posted.

Limbo dancing
Naaaaah! Think I'll sit this one out.

A Good and Deep Remission

Readers, I am so sorry to have left you high and dry after the last entry, written in February. The truth is, I have been waiting on what is now a rather old-fashioned thing: a statement in black and white—involving actual paper and ink, albeit the variety of the latter that comes from a digital printer—about the status of my disease. Well, now I have the statement, although I have known it is on the way for a couple of months. Everyone started telling me some weeks ago how well I looked, so much so that I had no alternative but to believe them and accept that my health really had returned.

Although I fully expected that my bone marrow biopsy, carried out in February, would show the marrow to be clear of malignant B-cells, the simple statement in my consultant’s most recent letter to my GP that she is confident that I am “in a good and deep remission” is music to my ears, the cream in my coffee and the spring in my step. I have a “completely normal” blood count, which would explain why I am now rather pinker than I was in the dark days of September 2010 and why my energy and concentration are, at least sometimes, better than I have been used to for some years. Brains need oxygen and without enough haemoglobin they struggle.

I am still living with and working through the implications of the fact that my genes harbour a serious blood problem that is expected one day (but not for several years if all goes according to the general run of things) to reassert itself. There is nostalgia for the days before a kind and wise haematologist told me about Waldenström’s macroglobulinaemia, while  photographs of myself taken in the weeks and months before diagnosis are like vignettes of a vanished and more innocent world. I inspect snaps from the years before that—WM being slow and insidious in its development—for signs and clues of what was to come. Although on my guard for odd symptoms like never before, yet I am eating well, keeping active and living a normal life, not on any medication at all and back in the City at the work I love. There was some good advice in an online WM forum today in answer to a question about life expectancy for WM patients: “Look at the number, tuck it away, and live life”.

Some people have a much more difficult journey with cancer and a whole host of other diseases than has so far been my experience, but I am not ashamed to say that I have been enriched by what living with this rare and quirky lymphoma has brought me: the selfless support of a loving and beloved wife and the deepening of existing friendships and family bonds; a wealth of simple acts of kindness, thoughtfulness and generosity; the best that the National Health Service can offer in the way of care and facilities (but let’s not mention the food); riches of more profound communication with friends and strangers alike; a clearer vision of what to take up and what to put aside; the enjoyment of simple moments and pleasures; a strengthened faith in God torn from the grasp of despair.

It has been like a rather prolonged spiritual retreat, from which I been allowed to emerge slowly. As I come out of the hermit’s cave my eyes are getting used to new light and changed surroundings, finding familiar landmarks but brighter colours. However, as I have re-engaged with the everyday, old temptations to cynicism have reasserted themselves. Only last night, as many of us celebrated the Jubilee, a close family member was burgled. I have spent the moments since hearing this unwelcome news devising exquisite revenge on the perpetrators, knowing all the time this will solve nothing, achieve nothing.

Consider this passage from the First Letter of John in the New Testament (Chapter 1: 5-7):

“…God is light; in him there is no darkness at all. If we claim to have fellowship with him yet walk in the darkness, we lie and do not live by the truth. But if we walk in the light as he is in the light, we have fellowship with one another, and the blood of Jesus, his Son, purifies us from all sin.”

I know of no other secure hope or foundation for living than to walk hand in hand with God, stumbling and failing maybe (make that “definitely”) but never alone. There are many circumstances of life that can fill us with dread,  drain our endurance or drive us mad with rage, but there is another way and I want to walk that path until my last breath, trusting the Love that holds us all and lies beyond all. As St Paul says in his First Letter to the Corinthians (Chapter 13: 12):

“Now we see but a poor reflection in a mirror; then we shall see face to face. Now I know in part; then I shall know fully, even as I am fully known.”

Thank you for being with me on this journey and for being so kind about what I have written in these virtual pages. Its main work is done, I feel, but I may pop back here from time to time. My love and good wishes to all who read this; my prayers as well.

Reflecting on life

Sharp Practices

A couple of weeks ago I had my first follow-up haematology appointment since before Christmas and also since my small op. Was disappointed and not a little puzzled that my haemoglobin had dipped down again, this time to 12.3. The consultant was reassuring though, commenting that my overall blood counts were not showing anything concerning and that recovery after such chemo as I had last summer can show peaks and troughs along the way. Odd itchy patches and occasional digestive disturbances were also consistent with an immune system building itself up again but not quite there yet. She does not want to see me in clinic for another three months in any event and I continue to feel very well, January’s operation seeming also to have been a success.

Last week it was time to go back to work. I will be going into the office three days a week and working at home the other two days. My sudden departure back in September 2010 and prolonged absences thereafter were the catalyst for recruiting an excellent part-time administrator who, with another colleague, has made great strides in dealing efficiently with vital day-to-day tasks. This will leave me freer to concentrate on projects, which I really welcome. It was wonderful to be back in the City, although by the end of the week I was pretty tired.

Having started back I then had to take some more time off last Tuesday morning to be poked with yet more needles, as it was time for my third bone marrow biopsy, aimed at assessing how successful last year’s stem cell autograft has been at clearing my system of wonky cells and beating back the disease. BMBs have their moments of unpleasantness and apprehension as, even with generous quantities of local anaesthetic, there are twinges of nervy pain and feelings of bruising when all is over that last for a few days. It is key to the success of the procedure from the patient’s point of view that the person performing it has a calm and communicative approach. Conversation helps the whole thing go much better and there was plenty of that on this occasion, as there were two nurses present, one of whom was there to learn the ropes, or rather the needles. Glad to say that this particular biopsy went as well as possible and I was soon striding down Tottenham Court Road to catch the Tube to work, pausing briefly to drool over cameras and computers in the windows of the high-tech shops that line that particular street.

The results of the biopsy should be through later this week, but in the meantime here are some pictures. There is a good description of the procedure and its aims here

I got to look at this colourful picture of exotic birds as the BMB was  carried out

The first part of the procedure is the obtaining of bone marrow "aspirate", semi-liquid bone marrow, which is drawn up into a syringe and then smeared onto glass slides for analysis by various tests and clever people.
The blobs you can see show that good samples have been obtained, I was told.

Bone marrow trephine, a core sample of bone marrow, not as painful to obtain as the aspirate.
The purpose of biopsy is to test the makeup of the bone marrow and the relative concentrations of the different groups of blood component cells that are produced there.
When I was diagnosed in September 2010 the concentration of malignant B-cells was 85%. At my second biopsy in February 2011, my bone marrow was clear of the little blighters.

Go on – Knock me out!

Anaesthesia is different from sleep: pretty much instant and rather disorientating. On this occasion, at least, I rather enjoyed it, in spite of having been rather nervous beforehand, this being only my second experience of complete knockout in over 40 years. 

Crucial to making my little op a good experience was once again the standard of care given by the staff at UCH: warm, empathetic, open to questions from the patient. You will notice that I am once again referring to the hospital by its original name, University College Hospital. A taxi-driver friend put me right when I referred to it on facebook (crikey! am I connected or what?) as UCLH, which stands for “University College London Hospitals”, which is the trust that runs the hospital: what my friend referred to as a “branding cock-up” some years ago. The hospital itself—being the destination he has doubtless delivered many people to in the course of his work—remains UCH.

If you are still awake after that burst of pedantry, we will get back to the events of Friday 20 January. I slept little before rising at shortly after 5am, when I took what would be my last drink for several hours and pottered around a little too much, emptying the dishwasher and fretting slightly, so that I managed (just) to miss the fast train I had intended to catch into town. The slow train soon after that still got me to Waterloo in time to make the short connection to Warren Street and the now familiar white and green tower of the hospital that meets the gaze as soon as one emerges into daylight from the Underground.

I have reflected before and since on the journeys we make in life and their many and various purposes. Each step in the journey may be small, but by the end you are in a very different place emotionally and psychologically from where you started. To outside eyes I was any other commuter, but on this day I was once again to be a patient, making a transition from the plod of the everyday into the shallows of surgery. After presenting myself at reception on the sixth floor (“Adult Inpatients”) I sat in the waiting room for about half an hour before being called by a young doctor from the anaesthetic team. I was glad to have got this far as the only identity evidence I had on me was my appointment letter. I had been advised not to bring valuables and was only carrying cash to cover my rail fare and provide a modest surplus: no credit cards, no mobile phone, not even my door keys, since my wife would be coming to collect me when the medics had finished their work. Alongside anxiety about the forthcoming surgery wild scenes had been playing in the theatre of my mind about outlandish complications resulting in my being in the middle of London without enough cash or other means of payment (my principal credit card doubles as my Oyster card, the modern way of paying for public transport in London) and without the ability to make phone calls. While there was only ever the slightest risk that I would have to fall upon the mercy of strangers to procure the cost of a fare home or other emergency expense, I nevertheless felt a peculiar sense of nakedness being without the contemporary props of relative affluence and security that I had previously taken so for granted.

The anaesthetist looked at my throat to check that it would accommodate the tube that would help me to breathe while unconscious, asked whether I had any loose teeth that might be vulnerable to being knocked out by the passing tube (not a common occurrence), and accepted my assurance that I had no allergies to any drugs.

Back to the waiting room for another distracting read of the magazine I had brought with me. After another vague interval—I was not watching the clock but trying to go with the flow—a young surgeon called me out of the room and back to the curtained area where I had seen the anaesthetist. Here she gave me an explanation of the procedure that lay ahead to supplement that given by the consultant I had seen before Christmas and I was relieved to find out that the resulting wound was not expected to be as substantial as I had first thought. Fistulae are tricky items though and the surgeon does not know quite what procedure will be needed until the patient is out cold and can be probed to see what possibly devious route “the abnormal communication” (as the medical profession rather coyly calls it) has made through the nether regions. Those unfortunate enough to be abducted by aliens of course undergo such investigation without the benefit of anaesthetic, if their accounts are to be believed; you’d think beings savvy enough to make it all this way across the far, uncharted reaches of the cosmos would have figured out all we lesser creatures have managed to about pain management, but perhaps their persistent ignorance on the matter will have to remain one of those myriad inscrutable mysteries of the universe.

Back to the waiting room again until I was called by a nursing sister, who took me through the paperwork and wrote my name, date of birth and hospital number on plastic bands which she then fastened around each of my wrists. That done, I signed the consent form. She gave me a large plastic bag into which I would later put my clothes and shoes, but which at this point contained: hospital-issue gown and dressing gown, paper underpants, tight anti-embolism stockings and foam slippers. After this further step in the overall rite of passage I returned to the waiting room for a final period that turned out to be the longest yet, as one is not asked to change into surgical clobber until the patient ahead in the list is quite well advanced on their own path. An hour passed but then it was my time and another nurse called me from the room.

These preceding stages had all helped accommodate me to the atmosphere of surgery and I was quite calm as I changed out my everyday things and into the kit supplied. I wrestled a bit with the stockings though; the mistake was to try and follow the instructions on their cardboard packaging rather than apply common sense. Once I had got the tricky items on and looked down on my now more visually pleasing legs, I could reflect on the fact that calf-enhancing hose was common wear for men for several centuries.

"Mmmmmm, nice pins, Sir Walter!"
"Yes, stow that in your hold and sail away, Sir Francis!"

I shuffled alongside the nurse in my cheap foam slippers to the antechamber of the operating suite, where there was a nurse in theatre garb checking patients into…another waiting room. This one was very different in atmosphere to the first: it had fewer chairs and even fewer patients, just me and another man, also of course dressed ready for his own encounter with anaesthetic, knife and whatever other instruments the surgeons had in store. I made my way to a chair, joking that I needed to make sure that it was what it appeared to be as by now I was without my glasses and everything was blurred. We exchanged simple remarks but then an unbreakable silence fell between us: this was no place, radio and spacey blue light feature notwithstanding, for casual conversation. Every encounter with surgery, however minor or routine, confronts us with our mortality and everybody knows it; we may come back from that precipice on any particular occasion, but we are inevitably sobered by the experience and the thoughts it brings. The professionals, at least in this hospital and on this occasion, behaved with a priestly calm and the sensitivity to be expected of pastors, lightened by humour. In a little while I was the only patient left in the room and the attendant nurse came in and, after asking whether I would mind, retuned the radio to Magic FM from the classical station that had been the preference of the patient who had just left. I was ready for a change of soundscape as Shostakovich’s 5^th Symphony, while an excellent piece, was fraying my nerves somewhat with its martial passages. An anaesthetic nurse came in and sat beside me, asked a few questions and then asked me what I did for a living; a short but lively conversation helped things feel more natural until it was at last time to go into the next room to meet the anaesthetic consultant.

Here I lay on the couch placed centrally in the room and tilted up at one end, while he introduced himself. I took the liberty of looking closely and myopically at his name badge to make sure I had heard his name correctly. We spoke about the distant country from which he had come over five decades ago. After I had pumped my fist a few times and the nurse had squeezed my arm above the elbow to raise the veins in the back of my left hand, the anaesthetist placed the needle through which the same hypnotic chemical that did for the King of Pop would soon pass into my own system. First there was a premed that made me feel slightly drunk and slurred my speech. I was given oxygen to breathe through a transparent mask and after a minute or two came the coup de grace: a large syringe of propofol that soon sent a mild ache up my arm and followed this with oblivion.

I woke up in exactly the same position and did not immediately grasp that I had been unconscious, let alone for any appreciable period of time. Minutes passed but I had no strong sense of this as I took in my surroundings again, growingly conscious of two new sensations: a raspiness at the back of my throat that testified to the passage through it of a breathing tube and a very mild discomfort at the operation site. It still took a while for me to conclude that the operation was over and that I was now in the early stages of recovery. Faces appeared at my side and voices asked me how I was feeling. I asked them how long I had been under: about 50 minutes. I felt greatly relieved and very peaceful. How much of this blissful mood was drug-induced and how much the work of my own onboard chemical factories? Each surely played a part, but knocking seductively around my mind was the thought that I wouldn’t mind more of whatever cocktail it was they had given me.

Still lying on the couch, I was wheeled to a curtained recovery area and a jug of water and a tumbler were placed on a table within reach. I was offered a hot drink and chose tea (milk, no sugar); digestive biscuits and shortbread fell from the heavens as I was encouraged to eat and drink again. I ate slowly and with relish at each mouthful, sipping the warm tea and the cool water. More tea and biscuits were offered and eagerly accepted. My clothes and shoes reappeared in their plastic bag. Time passed, I dozed some more, but by now the nurses were chivvying me along a bit. They had telephoned my wife and she was on her way; no, she was already here, waiting for me in the car at the rear entrance of the hospital just as I was putting my shoes on, having first retrieved my glasses, wrapped in a sock, from one of them. It was still all a bit trippy, a bit weird, but things were working out; the fog was clearing with gentle grace, not outstaying its welcome.

A nurse escorted me down in the lift to meet my wife and in no time at all we were home. I could sit in the car and did not have to lie down on the back seat as I had anticipated. Since then I have had only mild discomfort and have not needed the codeine and paracetamol painkillers the hospital gave me to take home. The surgeons want to see me again in eight weeks. If I have any problems my first port of call will now be the GP. I have been pottering about at home over the last few days, still sitting down carefully but feeling, sleeping and eating OK. Today I managed 26 press-ups.

Perhaps you remember the TV advertising campaign for Tango fizzy drinks that began in the 1990s, in which, typically, an unsuspecting person has a swig from a can of Tango and then looks disconcerted. The footage is then “replayed” at a speed that “reveals” that the man has been approached by a bizarre individual (in one advert, for example, dressed as Napoleon—a classic trope of lunacy) who has rushed up to him as if from nowhere and subjected him to some indignity too fast for him to take in consciously. The Napoleon figure waves a large orange rubber glove in the man’s face; on another occasion a man shouts "Oranges" into a woman's ear while she is waiting for a train. The slogan, hysterically announced at the end of the short film, is “You’ll know when you’ve been Tango’ed!”

I knew the medics had done something, but I didn’t see them do it. Anaesthesia is like sleep, but different.

Shifting Goal Posts

If you read the last entry you will be expecting that I will have had the operation. Sorry to disappoint, but there has been some more shuffling of dates in the last 48 hours or so, with the result that it should now be all-systems-go on Friday, 20 January. This is an improvement on the previous dates, as it happens, because my wife will not be expected at work for the four days after the op, which are when I expect to need her help the most.

I will let you know how it all goes.

In the meantime here is an image from the annals of medicine, or is it religion, or is it magic?

A skull that has received the attentions of Inca brain surgeons, or were they priests, or shamans?
A case of trepanning the light fantastic (sorry!)

New Procedures and Old Truths

Today I went back to UCLH to meet some new people and in the process have my fitness assessed for the forthcoming operation (now due on 18 January). Specifically pre-assessment focuses on one’s ability to cope with anaesthesia, in my case 10 minutes or so of unconsciousness.

I made my way to the clinic over a bridge in the hospital atrium in whose floor were inset enlarged photographs of medical life in the early decades of the 20th century. One was of a woman closely resembling our own dear Queen standing rather stiffly beside a bed made more child-friendly by the presence of cuddly kangaroo and plush teddy bear. The little girl in the bed and the nurse standing by looked very chuffed to be in the presence of royalty and the shot leaves one in little doubt that the visit of Queen Mary would have aided the patient’s recovery no end. Surely the late Queen smiled on occasion but are there any photos showing this? Perhaps, as with our present monarch, the everyday cast of whose features tends to the solemn and inscrutable, Queen Mary’s smile was a sunny benediction.

It was all pretty quick and I was in and out of all three stages of the pre-assessment in just over an hour. Stage one was a series of questions about my medical history from a nurse, who also weighed me and measured my height, as well as giving me a couple of leaflets about the joys of anaesthetics to read on the train home plus instructions not to eat after 2am on the day of the op or drink after 5am. I find myself more apprehensive about being knocked out next week than I was the last time this happened when, aged 12, I had several teeth extracted to make room for more.

If the first stage was rather dead pan, stage two was a bit more jolly and the quickest electrocardiogram I have yet undergone. The nurse conducting the process said that this was because I was relaxed. It is reassuring to know that I am doing something right although, if this is relaxed, show me tense.

After I had taken the printout of the heart examination back to the reception clerk, it was time for the final stage of the pre-assessment: the now all too familiar blood test. Going about his work the phlebotomist sang along quietly to Adele as the sound of her latest release drifted across from the radio on the opposite side of the examination suite and we found a brief rapport in our shared appreciation of her wonderful voice. On this occasion I did not have to wait for the result of the test, trusting that it would be added to my surgical file in due course.

Free to go, I had time to spare before I was due in Richmond for lunch and so I made my way to the British Museum, but not before heeding the advice displayed here and cleaning my hands with the gel provided.

Animated virtual nurse projected within a perspex outline giving free advice by the hospital exit.
Part of a plan to have all leadership and advice dispensed in time by human simulacra.
Hmmmm, come to think of it, has anyone seen the real Andrew Lansley recently...?

I walked to the museum along streets that I have long loved, but whose rich heritage I came to value with a new intensity when I trod them with my wife and brother while undergoing chemo last summer. On the journey I noted the blue plaque commemorating the first general anaesthetic procedure carried out in England. In 1846 the house at 52 Gower Street, no longer standing, was the home of an American botanist, Francis Boott. Here, on 19 December of that year, a dentist named James Robinson removed a tooth of a Miss Lonsdale under ether anaesthesia. Two days later at University College Hospital, Robert Liston amputated the leg of a chauffeur, Frederick Churchill, while a medical student called William Squires gave an ether anaesthetic. It is comforting to know that there has been such a long history of pain management at my favourite hospital. Probably not much of a pre-assessment in those early days though, let alone soothing leaflets in plain English.

Once at the British Museum I rode the lift to the Upper Floor and ambled through rooms gleaming with priceless artefacts to the displays of European articles from the 16th century, my chosen period of study. Here I saw mazers, wooden drinking bowls for shared use that came to be replaced by individual vessels, particularly among the more affluent. Also chalices and plate, produced in greater numbers as the Protestant Reformation bedded in and the common churchgoer increasingly expected to take Holy Communion rather than that this should be the privilege of the priest alone. There were elaborately decorative gilt clothes fastenings–hooks and clasps–both on display and illustrated in small reproductions of contemporary portraits so that one could see the devices in use.

In a separate display was the Waddesdon Bequest, the gift of a Victorian member of the Rothschild family. This is a staggeringly impressive collection of craftsmanship, particularly in religious objects from mainland Europe. This little item held my gaze for many minutes. I never knew such things existed.

A rosary bead carved in boxwood in the early 1500s, Flemish work.
Such exquisitely crafted objects were produced to aid the devotions of the wealthy and the nobility and were highly prized. The bead measures no more than a couple of inches in diameter and opens up to reveal intricate scenes from Scripture in high relief.
The uppermost scene here is of the Crucifixion and in it the spears of the soldiers are as fine as hairs.
Do go and see it if you can.

On the more vernacular side I spent some time contemplating trenchers: in this case circles of wood, like large coasters, whose plain side was used for the serving of various sweetmeats at banquets and the like. Once the goodies were consumed, the trencher was turned over to reveal its painted side decorated, for example, with painted flowers, scrolls and various other curlicues framing short verses setting out various contemporary conceits. This verse sets out a bittersweet truth of human experience. Enjoy the antique spelling.

There is no sweet within our power

That is not sawled with some swore.

For so it fawles out now and then,

The worser luck the wiser men.