October 2009 - In praise of the NHS .

How does one start the first page – perhaps with some history – or a time line or some background – or a bit of all three... so here goes - into the story of the last 2 months...
What can happen in a month or two is breath-taking when it breaks into a life that seems, if not in a rut, to be rather settled. As we started our summer holiday in the second half of August, I had an aching left shoulder and right hand - tired after several months of work pressure. The healing soft light of the Scottish Highlands beckoned and all would be well. Indeed over the next 2 weeks, My angel's company, together with our special time spent reading, resting, hill walking, cycling and running all worked their usual magic and we recharged our batteries, the aches and pains went and on the last day we walked, cycled and climbed 25 miles to the top of Mount Keen and back to the cottage. We looked and felt 100%.
By 9th September, tummy pains interfered with my normal 3 mile run. At M and G’s wedding dance on the 12th I danced all evening, but was felled with a sore tummy the next day. Two days later I ran a temp of 40oC in a surgery and careful colleagues started me on treatment and took expert advice, arranging for me to see Dr M in Edinburgh on 22nd September by which time I had some aches in my belly and shoulders again and felt more tired. He kindly arranged for an MRI scan of my liver on 30th October to confirm everyone’s suspicions that I had a kind of liver scarring with chronic infection.
Then came October – a full month with roller coaster rides of emotion and information...
2nd October. 07.50am. A phone call from Dr M in Edinburgh asking us to come to meet him later that morning and “discuss the scan results which are not good.”
12.30 After pleasantries, the diagnosis (now more than half feared or expected) is gently broken – probably gall bladder cancer with liver spread. To confirm the diagnosis and then plan what treatment (if any) will help, a CT scan has been arranged for this afternoon and a liver biopsy for Monday morning, then an outpatient appointment in 10 days to discuss those results. Ishbel phones the practice to cancel my evening surgery.
13.15 Togehter meet our son for lunch in the hospital canteen and tell him. He works in RIE liver unit for Dr M at present!
14.30 CT scan in the RIE xray department
18.00 Together go into the practice to start telling partners R and C and staff
20.00 Visit my Dad to tell him (and my nephew) at his house 3 miles away
21.45 Together meet our unsuspecting daughter off the train in Berwick and tell her in the car on the way home.
3rd October. Start telling friends. D and his wife come for the weekend and we all have a great time together – loads of tears and laughter and start making plans for the future (what future?). Our motto is going to be “plan for the worst, live for the best”.
5th October. All day in RIE medical procedure unit and 8 hours rest after a biopsy of the right lobe of the liver expertly and efficiently explained and performed – another thing to tick on my continuing professional development plan – what to warn patients about when facing a liver biopsy. 2 shots to get a juicy sample from one of the liver lumps. Dr P is gentle but the second shot ... relaxing is not so easy when you are about to be stuck in the ribs for the second time – the second time you know what’s coming! 8 hours of rest – no getting up or out until 8pm is a long time. D reappears and drives me home for company and a long talk. Our daughter is flying to Africa tonight for two and a half weeks.
Now 8 days to wait for the results. Needing regular paracetamol to manage the liver pain and feeling more tired but otherwise managing work. I plan to take holiday at the end of the month and stop working after that until the way ahead is clearer.
13th October. 12.30 Dr M gently explains the microscopic and CT scan results confirming gall bladder cancer and liver spread. He has arranged for us to see Dr W that afternoon to discuss possible treatment options and wishes us well for the future.
13.00 Lunch with D and S
14.00 Dr W introduces herself and explains a recently published 400 patient study in the UK that offers two chemotherapy drugs in a 3 weekly cycle that seems to prolong life expectancy from an average of 2-4 months to 11 months – seems pretty good to us! We look at the scans together – it is good to see that the lumps are where I get the pain and they are round the edge of the liver. Plans are made to start chemotherapy next week at the Western General Hospital – gemcitabine and cisplatin intravenously over 5 hours with anti-sickness medicine – all carefully explained and the potential ill effects discussed. We go shopping afterwards for ramps for my father’s buggy as lifting it in and out of the car is not an option now for Ishbel or I.
16th October. Ruth suggests Dexamethasone for liver pain as paracetmol is not effective on its own.
19th October. Dexamethasone is helping most of the liver pain but it still needs six hourly analgesia so Alan and I agree to change to morphine (oh dear- this is real!) and the pain goes completely for the first time for weeks.
23rd October. 09.00am Western General Hospital. A smart newly decorated and tastefully furnished office-like reception greets one, without the proliferation of notices and educational leaflets that seem to adorn all other NHS waiting rooms. These are usually stuck on walls everywhere to “educate or inform” but only end up looking untidy and unkempt. Here the unit is staffed by friendly, welcoming and very expert nurses, there are some talkative fellow patients – and others with their own more private tale of hope and fear I am sure, but not for discussion now. What an efficiently administered day of chemotherapy! All this while Ishbel went shopping – I am ravenous when I get out at 1700 so we go bun hunting in the nearest shop. No post chemo nausea and no ill effects until crushing lethargy 6 hours later. It lasts for a day.
26th October. 11.00 H1N1 Immunisation – the first dose for an immune-suppressed patient – that’s now me!
29th October. 06.00 start to get to WGH by 9am with neighbours who commute daily. Breakfast en route at sister in law’s house. Blood test results are fine so chemo starts at 1100 and finishes on time at 17.00. R collects me, gives me tea and toast and another friend drives me back home by 19.30.
30th October. Our daughter comes north by delayed train arriving at 5pm shortly after which I have flare up of an old “friend” – colicky tummy pain due to colitis operation scars from 18 years ago. It always settles with rest after a sleep on my right side....but not this time......by 2am and then by 4am .... it hasn’t and I am clearly developing small bowel obstruction. A call to the Borders Emergency Care Doctor agrees I should go into the surgical department at the Borders General Hospital (40miles away). My suggestion of driving there is relinquished to Ishbel after the first 7 miles – it’s more comfy sitting and not trying to drive as well.
31st October. 05.30 IV access, admission by the surgical registrar and onto the ward after an abdominal x-ray to wait to see the consultant. I feel sorry for the difficulties of Mr R.... J and I were in the same year at university – he has a good reputation but I don’t think anyone likes ‘opening up’ a colleague and a friend...CT scan in the afternoon confirms the need for a laparotomy at 1900. J kindly explains his plans to the family who go out for a meal and leave Dad to face the music! Dr C, the anaesthetist,introduces me to the blessings of epidural anaesthesia in a painless and effortlessly efficient way that provides brilliant pain relief for the next 3 days. I wake at 2100 in ITU where I start a 5 star, 3 day stay nursed by a succession of experts in pain care, embarrassment reduction, ice cubes and good humour.
Thus ends October 2009 – I was let home from hospital on 8th November with no need for bowel resection. Saved by the gentle division of adhesions and good post op care, I can restart chemotherapy in two weeks at the Western General and the wound is healing well.
I have had in the month:-
1 MRCP, 2 CTs, 1 plain x-ray, 1 ultra-sound guided liver biopsy, 1 laparotomy, 1 epidural anaesthetic with general anaesthesia for surgery, 1 ITU admission, 1 Medical day care admission, 5 days in a general surgical ward, the first cycle of 3 weeks (2 days) of IV chemotherapy, 1 dose of granulocyte stimulating factor and the 1st dose of H1N1 immunisation.
As well as:-
3 out-patient consultant appointments,
Several inpatient consultant consultations,
The services of a physiotherapist, a dietician and many nurses – both specialist and general.
All this as well as General Practice advice, support and prescriptions.

The NHS comes in for lots of criticism but I am proud to work for it and happy to be looked after by it. Our situation could have been so much worse – if we had lived in nearly any other country in the world, such care would not have been an expectation, let alone the privilege that it is to have received it. We have been blessed.....
And of that more next time.