busywords

The literary life of EDWARD JAMES, author,reviewer, occasional poet and former pension adviser to the government of Kyrgyzstan

CHELTENHAM OR DIE

‘Good Lord, you look dreadful, dear!  You’ve had a heart attack!’

‘Don’t be silly, darling.  Of course I haven’t had a heart attack.  It’s just that I was sitting at my laptop and I saw you coming up the drive and I got up a bit too quickly to meet you.  I’m just a bit dizzy.’

Indeed I was, slumped against a kitchen unit recovering my breath.  I had often been short of breath recently.  Coming up the hill from the village I had to stop on the way and the steeper slopes in the woods were becoming a challenge.

‘You’ve had a heart attack’, declared Ann, ‘and you’re getting straight in the car and I’m taking you to the hospital.’

I can’t have been myself to have submitted to this, but in a few moments we were in the car and speeding to the local hospital.  This was not a ‘proper’ hospital, as it has no doctors, but it had nurses and medical apparatus enough to determine quickly that I had not had a heart attack.  They did, however, find that my heart was behaving oddly, with an extra beat every so often, so they decided to send me to a ‘real’ hospital and loaded me into an ambulance for the 17 mile journey.  Ann said she would follow in the car.

The ambulance set off at full speed, lights flashing and siren wailing. It was the first time I had been in an emergency vehicle in full cry and I was embarrassed.  By now I was feeling a lot better, but the paramedic insisted that I lay down while he gave me gentle advice on living with a weak heart.  He was on beta-blockers himself, he confided.

Towards our destination we ran into heavy traffic and slowed to a crawl, despite our siren. Ann was at the hospital waiting for us.  The rest of the day and much of the night was spent being wheeled around the hospital on a trolley.  They put me to bed twice and each time got me up and moved me to another ward.  I was wired to an electro-cardiograph, had several blood tests and was given intravenous nourishment to keep my stomach empty for an eventual endoscopy. I also completed at least four questionnaires.  The results of the blood tests showed why my heart was behaving abnormally.  I was severely anemic and my heart was having difficulty in getting enough oxygen from my bloodstream.  The cause of the anemia was thought to be internal bleeding, but from where?

I was booked for an endoscopy next morning.  This is an examination of the gullet and stomach by means of a thin tube with a light at the end inserted down the patient’s throat.  So the next morning I awoke in a 20-bed ward and watched the others having breakfast.  No breakfast for me of course, so I read the information leaflet beside my bed.  It told me that this was a men’s surgical ward.  I was not a surgical case and the patient shuffling past my bed was clearly not a man – the hospital was being flexible in its use of resources.

Half way through the morning a junior doctor told me that my endoscopy would be in the afternoon, so I watched the others have lunch and waited.  In the mid-afternoon I was told that there were no specialists available to carry out the endoscopy that day, they were all at a conference.  I would therefore be discharged and given an emergency endoscopy in two weeks time.  I asked for my missed lunch and wished I hadn’t.  It was the left-overs of the food that had been around the wards and tasted like polystyrene.

I had the endoscopy as a day patient.  It was not as unpleasant as one might expect and the doctors did not seem unhappy about what they saw of my stomach.  Afterwards I was given a sheet of results and told to take it to my GP.  There were a lots of words that said in brief that I had gastritis.

My GP said I would be alright if I avoided spicy foods and immoderate quantities of alcohol.

‘But, doctor, this doesn’t account for the symptoms I’ve been having lately. They’ve been getting worse.  I had a lot of pain yesterday.’

‘That’s how it goes’, he replied.  ‘There’ll be good days and bad days’

‘Doctor, when I say pain I don’t mean discomfort.  I mean pain, waves of pain, clawing, twisting pain that won’t let me lie or sit and all I can do is to stand up and cling to something and it keeps on coming at me again and again, hour after hour after hour for up to eight hours and then I’m usually sick.’

He looked surprised.  ‘The hospital hasn’t sent me your notes yet.  When they’ve looked at them they may decide you need a further examination.’

I was angry with the doctor and with the hospital and so was Ann. We started to keep an hour-by-hour diary to confront the doctors in the Practice.  I went to the Practice three more times, taking care to see a different doctor at each visit (there were six doctors).  At the third consultation I found a doctor who seemed as angry as myself.

‘It’s a scandal’, she said.  ‘You need a colonoscopy and as soon as possible.  I’ll get on to the hospital.’  (A colonoscopy is like an endoscopy but it goes into the patient from the other end, to look at the intestine).

Meanwhile I had phoned the consultant’s Medical Secretary.

‘No, Mr James, the consultant has not seen your report yet.  He’s been away and we’ve got a backlog. I‘ve got nine boxes of papers in front of me.’

‘When will he see the report?’

‘Not just yet.  Your papers are in box nine.  If there had been anything urgent it would have been flagged up, but there are no red flags in your box.’

We told the children.  My younger son, who works in the City, offered to find me a Harley Street consultant and private treatment.  My daughter, an NHS doctor in Gloucestershire, rang the Medical Secretary.

‘I’m sorry, Doctor, your father’s papers are in box nine and I have eight other boxes to deal with first.’

‘Listen to me’, sad Kate, ‘there is nobody I love in any of those eight boxes.  Open box nine!’

And because the Secretary always did what the doctor ordered she opened box nine.  I don’t know what else Kate said to her, but I think she had already made her diagnosis.  As she said later, ‘it was worth sending me through Medical School, wasn’t it Dad?’

The hospital offered me a colonoscopy in a month’s time.  My new-found ally at the local Medical Practice protested and it was re-scheduled for two weeks ahead.

The worst part of a colonoscopy is the preliminaries the night before.  One has to drink a vast quantity of saline liquid over a short spell, hold it as long a feasible and then clear one’s bowels violently.  The examination itself is less of an ordeal, as the patient can watch TV.

I lay on my side and watched a large flat screen TV.  Meanwhile two doctors pushed a tiny TV camera through my anus and let it to explore my intestines and send back pictures.

Never have I watched a TV show so intently.  It did not last long.  The roving camera soon found it, a big, blood streaked, lethal looking cancerous tumour. It looked exactly how it felt.

I was sent back to the waiting room and after 15 minutes I was called in for the classic ashen-faced interview with the doctor.  The interview had, however, already been emptied of emotional tension, for we had all been watching the same TV show.

The doctor said I needed a scan, to see if the cancer had spread.

‘When will that be?’

‘I don’t know.  We’ve got a big backlog’.

We told the children.  Kate phoned back on Monday.

‘Dad, I’ve got you an appointment with the cancer specialist at Cheltenham General Hospital for Friday morning.  I know him, he’ll look after you.  You’ll need to quit Kent and move to Cheltenham by Thursday and register with a GP in the hospital catchment area.  OK?’

It was a shock, of course, but not a surprise.  Kate had been on at us to move to Gloucestershire ever since moving there herself. ‘How can I look after you both when you’re old, if you live so far away?’ Now she had forced our hand.

Our elder son, who lived in Cheltenham, backed her on this.  They were genuine in their concern, although there were obvious advantages to both of  them in having parents locally who could meet their own children after school and mind them during holidays and sickness.

To placate them we had been house-hunting in Gloucestershire in a relaxed way for about two years.  We lived in an old house in the country in Kent and at first we looked for the same in the Cotswold villages.  Gradually we realised that if we were serious in being closer to the children, having a shorter car drive to see them solved no problems; we needed to be in walking distance of at least one of them.  Also, if we lived long enough to be elderly and infirm we needed to be in a town where we could use our bus passes (we didn’t claim them in Kent, because the village had only one bus a day).

Eventually we bought a house the exact opposite of our home in Kent, a new property, still under construction, close to the centre of Cheltenham and 15 minutes walk from our elder son and his family.  It was smaller than our Kentish home, but we would have less need to accommodate visiting children.

Even so we were in no hurry to move.  The estate agent said our existing home would sell better if we were still in residence, so we stayed put, polished it up and showed prospective buyers around. The Credit Crunch began to bite and the flow of ‘viewers’ slowed to a trickle.  This was frustrating but we had lived 25 years in the village, I had even written a book about it, and Ann had three organisations she worked for in the county, jobs which she would have to resign if we moved. So we put off making radical changes in our lives.

Now we had three days to quit.

The builders had not quite finished the Cheltenham house.  There was no furniture there and no way to arrange a removal in the time, but my son put in some camping equipment and one of my daughter’s neighbours loaned us a bed and a duvet.  We threw some essentials into the car and drove off to our new life.

We arrived on Thursday, intending to register with a GP on the way to the hospital the next day.  Kate rang to say the appointment had been re-timed, so we had to go there directly and regularise our domicile in Cheltenham later.

‘Are you worried about seeing him?’ asked Ann.

‘No.  All he’ll do is say I need a scan, which I know, and he’ll book me an appointment, sooner than I would have had it in Kent, I hope.’

Which is basically what happened.  The difference was that I had never met the consultant in charge of my case in Kent, or even spoken to him on the phone.  Now I was face to face with the man who could save my life and he was listening to me and explaining my condition.

‘If I don’t operate on you now, you’ll die painfully in the next few weeks, whether or not the cancer has spread.  But I’ll need to know if you’re fit enough for the operation. I’ll send you for a blood test and see you again this afternoon when we have the results.’

I knew about being fit enough for the operation.  My father had died of a similar cancer when he was seventy-one, just a few months older than I was now.  They had operated on him and he had never recovered from the anaesthetic.

Why are there always so many people waiting for blood tests, whenever or to wherever clinic one goes?  We spent most of the morning waiting before my arm was given a big purple bruise by a hurried nurse.

Firstly though I had register with the hospital.  Address?  That was easy.  Post code?

‘It’s a new development, we haven’t been allocated a post code yet.’

‘I can’t register you without a post code’

Of course, how could they save my life if I didn’t exist? and if I didn’t have a post code I obviously didn’t exist.

After a brief argument I gave my sister-in-law’s address and telephone number.  She had moved to Cheltenham earlier in the year, when she had heard we were moving there, and hers being an older house it had a post code.  It was also close to the hospital and had a drive where we could park the car and avoid the formidable hospital parking charges.

‘You’re badly anemic’, said the consultant when I saw him again, ‘but I think we’ll manage. We’ll go ahead, but I’ll send you for a scan first, to see if the cancer has spread.’

‘How soon will that be?’

He looked at his watch.

‘It’s Friday afternoon, but there’s still time.  Give them 20 minutes.  I’ll stay here until the results come through.  Stay in the waiting room and I’ll call you.’

Now was the Moment of Truth.  They injected me with a red radio-active fluid and put me onto the conveyor feeding me into the scanner.  It was eerily like the finale of a cremation service. There was no TV to watch to see what they found.

Two hours later I was in front of the consultant again. ‘Good news!’ he exclaimed. ‘There’s no sign that the cancer has spread. We can’t know for certain but I’ll be operating to cure.  We’ll have you in on Tuesday.’

 

**************

 

I was back in the hospital on Monday, this time for an interview with the dietician. The letter from the hospital said it was very important.

I found my way to the Cancer Ward and they told me to wait in the day room.  I stayed there until I had read all the magazines and then wandered into the corridor to watch the life of the hospital.  A strikingly attractive blonde in civilian clothes came up to the Reception Desk and spoke briefly to the clerk.  I wouldn’t mind an interview with her, I thought.  The clerk couldn’t answer her question and she wandered away. Pity.

The blonde returned and came up to me.

‘Are you Mister James?’ she asked, in a soft Irish brogue.

‘Yes, and I’m waiting to see the dietician.’

‘And they told me they didn’t know where you were. Is there anywhere private we can talk?’

‘The day room is free.’

She settled into an adjacent armchair and pulled three cartons of high-energy fruit juice from her shopping bag.

‘I want you to drink these today.  You can have more if you want – we have a choice of flavours.’

‘I’m sure they’ll be fine’, I replied. ‘But aren’t I supposed to starve the day before my operation?’ I thought that was what you were going to tell me.’

‘We usually do that, but we’re trying a new regime.  You’ll be the first person in the UK to try it, although I believe it’s been done on the Continent.  We’re going to build you up for the operation, like building you up for a Marathon.  It’s called ERAS – Early Recovery After Surgery.’

‘And after the operation?’

‘You’ll go straight onto a normal diet with high-energy supplements three times a day.  And you’ll be out of bed within six hours, the physio will take you for exercises and I’ll be visiting to monitor you each day.’

So that is how I became the hospital’s ‘ERAS Man’.

 

*****************

 

There is no difference between night and day in the Cancer Ward.  Flurries of activity break out around different beds at all hours.  One learns to sleep in short snatches during lulls in the action, like in a war.  Also like in a war there is an intense camaraderie despite, or because of, the ever-presence of death.  The patients who are conscious chatter to each other and when one of them is wheeled away for his “op” the others send him off with cheery words and thumbs up signs.  As in my ward in Kent, this was a men’s ward with female guests.  The women joined the community spirit and seemed as unbowed by their misfortunes as the men.

My consultant came to run through the risk assessment: chances of failure, of infection, of death.

‘You say the mortality rate is four percent’, I said.

‘Well, nearer three and a half.’

I might need that extra one in 200 chance.

The risk was less than in most air raids I had lived through, so it seemed good odds.  What worried me more was the thought of a long post-op course of chemotherapy or radiotherapy.  I had resigned from the consultancy firm I worked for and forsook my place on the Technical Assistance Team going to Afghanistan – that was before the Taleban grew so troublesome again.

My turn to be sent off to the theatre came late on Tuesday evening.  I had last been in hospital in my teens and the anaesthetic had been a jab with the needle and then blackout, followed by a nauseous recovery back in the ward.  Today the procedure is slower and more friendly.  The anaesthetic is delivered gradually by an intravenous drip and as with natural sleep one does not remember the moment of unconsciousness.  On awaking, presuming one does awake, it is like awaking from sleep with no nausea or giddiness. Also it gives the patient time to talk to the nurses in the theatre before the op.

There were five of them, clustered busily around me like ground crew readying a fighter plane.  Each came from a different continent, as if the whole world had sent its best and brightest to help me in my crisis. Behind my head a very regal consultant anaesthetist conducted the orchestra, a tall, aquiline woman from north India or Pakistan.  To my left two girls, one West Indian and the other Chinese, attended to the ‘plumbing’ while on my right a small brown man who I guessed was Filipino or Indonesian took my blood pressure and a Scots nurse went through a questionnaire with me, to ensure they had the right patient for the right operation.

‘How long have you lived in Cheltenham?’ asked the Chinese girl.

‘Three days’, I answered.

There were gasps of surprise.

‘My son lives here and my daughter isn’t far away’, I said hastily.  My presence here was largely because I was cheating the system and although they could hardly send me back to Kent at this stage I didn’t want to lose their sympathy.  I didn’t even have a Cheltenham post code!

‘I know what brought you here’, beamed the small brown man with a flash of white teeth and a flourish of his blood pressure meter.  ‘You wanted to be near your family.’  This seemed to fit nicely with the social norms in which he had been raised and the others all chorused their assent.  I was a foreigner but I was OK, I loved my family.

‘Is it true’, asked the Scots girl, bending closer, ‘that your daughter is a doctor at this hospital.’

So they knew more about me than I had thought.

‘Not exactly.  There’s a lot I’d like to tell you but I‘m feeling sleepy’.

 

 

**********************

 

Clearly that was not the end of the story for me, but that is the end of my story for you,  ‘Cheltenham or Die’.

There were many interesting and sometimes alarming events in the course of my recovery and in settling in to my new home.  But none of the family have regretted our move and for me it has been literally a new lease of life.  These events happened ten years ago now; I delayed telling the story, lest anything untoward  occurred, but now I think I can justly celebrate them and celebrate the wonderful support I had from my wife and children and from the surgeon, the medical team and everybody at Cheltenham General Hospital.

And as a  postscript here is a picture of the author in Lapland ten months  after the operation.  There is life after cancer.

 

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