I was delighted to be interviewed by Sovereign Magazine about my patient journey but also the wider NHS.

Please click here to see the entire magazine!

Happy Mother’s Day to all of you.

This week has seen the celebration of International Women’s Day and ends with Mother’s Day in the UK. It has been a week of highs and lows, realising that so much has been achieved but that there is so much more to do to ensure parity for women all over the world and in every career.

Women and men are different, the basic difference is that we bear children. This is an amazing feat of nature and I have two children that make me immensely proud. This natural phenomenon of having children should not define us: women should be able to make the choice to succeed however they wish.

My mother was a great lady and always stated that there should be no reason why I could not do what I wanted to do (just like my father!).

My mother was born in India in the 1940s and lost her father when she was five. Bringing up 6 children as a single mother was a feat for my grandmother, especially when you consider that all six children were university educated in a system where you pay for your education. My mother was caught up in the atrocities when India and Pakistan separated and the whole family moved from Rawalpindi to Ludhiana. She walked with her cousin, crossing the border, seeing killings at first hand, surviving but never forgetting that time. She never really talked about it but just filled up with tears and so this topic was seldom brought up again.

She had wished to do medicine but as one of the oldest had to qualify and start earning, to help put her younger siblings through university. She mastered in politics and geography and rapidly became a Headmistress of a school in India.

My father had moved to the UK and settled in North Wales, finding the people welcoming in Penmaenmawr. In 1965, he returned to India to visit his mother and an unexpected arranged marriage meant that my mother left her fantastic job and returned to the cold, isolated village of Penmaenmawr, with no friends and no job! She tried to break into the teaching system in the UK but her qualifications were not recognised and all the possible jobs were in Birmingham or London.  She became pregnant with me in the second year of marriage and never taught again.

My mother spent her life working hard alongside my father developing skills that she could not have dreamed of doing in her life time. They refurbished a four storey house, developing this into a guest house and shop. My mother learnt to wall paper, put up polystyrene ceiling tiles, paint and sew curtains.

They opened a successful shop, named Wonderland in Penmaenmawr, when holidaying to the North Wales coast was the way to spend your summer! My mother became a stock taker, saleswoman and continued to be a great mother.

She worked on the markets with my father, supporting him and innovating the business. She put three children through school, embedding a culture of nurturing, success through education and responsibilty in all three of us. She loved people and ensured that all our friends were welcome and always well fed and is always remembered for this!

At every stage, when I questioned how I would achieve, she would encourage and just tell me to get on with it! This included my mad decision to become a Surgeon.

When I qualified in 1991 from University of Wales College of Medicine, there were very few female surgeons in Wales. Although I knew that this was the career I wished to pursue, I procrastinated about my career choice in my first year as a doctor. Luckily I had a supportive husband (boyfriend then) and also a great boss. Mr Kieran Horgan, a Breast Consultant and my first boss as a house officer, sat me down over a drink and said’ If you don’t reach for the stars, you will always regret it and wonder, what if…’

I was appointed as the first Calman registrar in Wales and worked hard, delivering 101%, ensuring that no-one could say that I was not up to the standard required. I had two children and returned to work at 12 weeks on both occasions as I did not want to let the team down, but also because I did not feel that I could take any more time away from work. There was no overt pressure to do this but the culture of surgery embedded this internally as there were no other women around me having children and a career in surgery. I was lucky to have supportive colleagues and although there were highs and lows in training, remember this time as hard work but enjoyable.

Just this week, I met up with four previous colleagues from Wales, four of us had worked together as juniors with our Senior Registrar and we came back together on a course. We remembered our time in Wales with happiness and all three females had felt encouraged by our peers. In the background of this picture you will see a painting that hangs in the Royal College of Surgeons of the Court of Examiners. What is striking is that although many of our old bosses are portrayed in this beautiful painting, that they are white and male!

The surgical environment is changing and now 11% of Consultant Surgeons are women but it is still not an easy career choice. Many students are put off by the myths that:

it is hard, a job for the boys, requires sacrifice of motherhood and a relationship, sacrifice of a social life amongst so many others.

These myths need to be dispelled as all jobs are hard and one does not become barrister, fashion designer, pilot, a success in business without hard graft. This is no different in Surgery and the difficulty is not based on gender.

What shocks me is that when we have had female Prime Ministers, Heads of Police and Fire Service, Presidents of Colleges, Chairs of Education and Business, female medical students continue to believe that a successful career in surgery is not achievable.

The Twitter campaign #ILookLikeASurgeon showed how women are great surgeons and combining all facets of their life with this ambition. Surgery is open to all and it is our responsibilty as the Surgeons to welcome medical students and foundation trainees into our daily lives, encouraging them by valuing them and supporting their career decisions.

The Royal College Women In Surgery held a successful evening on International Women’s Day this week, where many myths were dispelled by male and female role models. Professor Farah Bhatti is the Chair of WINS and is a great role model.

There are now increasing women in the Court of Examiners, as Chairs of JCST, members of College Council and this is much welcomed.

But surgery is a career that should be open to all and we need to encourage the new generation of Surgeons by embedding a culture delivered by my mother:

A culture of nurturing and supporting,

A culture of success through education and belief

A culture of responsibilty and value in the team

A culture where the belief that the sum of the whole is much more that the individual parts is all encompassing.

These are values that need to be embedded into Surgical Training but also into the NHS as a whole. The recent suggestion that NHS staff may achieve a 6.5% pay rise but at the cost of losing annual leave to balance the pay bill undermines the above culture. Unless there is a dramatic and rapid turn around in the value and belief in the NHS workforce, we will continue to lose amazing individuals that will innovate and advance our healthcare system, which has so far been lauded across the world.

This is a series of blogs starting from the day I was diagnosed with an acoustic neuroma. If you want to start at the beginning then please follow this link: 

https://stellavig.blog/me-and-my-acoustic-neuroma/

I have had a wonderful but difficult year since my operation on February 27th 2017. I have celebrated my 50th birthday, my son’s 21st and had a great Christmas and New Year! I have reread my thoughts from a year ago and they are still fresh in my mind but almost feel like those of a different person.

I now realise that I should have listened to my Surgeon and my Husband! (sshh don’t tell him that!) during my recovery as they had realistic timelines for my recovery. I needed to go back to work to escape being a patient and challenging myself to be a professional again. I was lucky to have an employer that valued me and allowed a prolonged phased return to work. I went back on call early, despite advice, as I needed to prove to myself that I could do it! I was exhausted most of the time but this improved slowly.

I finally feel almost back to normal. I still get headaches and balance issues if I get too tired, especially at night. This has made me redefine my abilities and resilience, a process which is so frustrating. It is impossible to multitask in the way I used to but I have developed strategies to cope with this and my friends tell me they can’t see a difference.

My hearing has not improved and I cannot localise sound at all. My kids find this very amusing but it is so annoying. If someone asks me a question when I am giving a talk, I cannot see where they are and cannot hear where they are either! I have to declare my hearing up front to the audience so that they can let me know where they are. My hearing has also become an important part of the WHO checklist in my theatre. This ensures that everyone is aware of anything that might cause a risk in theatre and ensures that theatre staff do not whisper into my right ear! It is really funny when I sit in meetings and the person to my right whispers something into my ear and I have to do a 180 degree turn to find out what they are saying!! Not discreet!

The follow-up scan confirms that although there is a small sliver of residual tumour, it is still benign and not growing. Full resection was sacrificed to ensure that I still have a working facial nerve which was most important to me. It has been confirmed that I will need ongoing scans but at longer intervals and that these can be carried out locally rather than travelling up to Oxford.

The original acoustic neuroma was 3cm in size and although this has gone, I have gained so much experience to guide me to deliver patient care.

I had only been in hospital before with the birth of my two children and needed care when I developed a ruptured anterior cruciate ligament (and was on crutches for 9 months). My other experience was as a daughter with both my parents needing acute care provided both locally in North Wales and in London. My father died two years ago at 91 and required carers as well as acute recurrent care. Although I thought that this and working in the NHS itself allowed me to deliver patient focused patient care, I still had much to learn. I am now still learning and hope to role model and teach this to my trainee colleagues.

The amazing Elizabeth O’Riordan, a Consultant Breast Surgeon who herself developed breast cancer recently said’ The one thing I have learnt through being a breast cancer patient was that I knew nothing about what is was like to live with breast cancer although I had spent 20 years studying it’.

I felt that I was enabled to seek the advice I needed, to consider and develop my thoughts and decisions with regard to my treatment. I hope that this is what I have already practised for many years, giving my patients all options open to them and helping them decide what they wish to do. I am often asked ‘ what would you do?’ and explain that I cannot give them this answer. I found myself asking the same question of my Surgeon but also of my colleagues and getting the same response.

What I had underestimated was the impact on my family and friends. I could not have asked for better care and positivity from them. My current and previous trainees were wonderful and kept me buoyant. My husband, children and siblings were amazing and helped me to recover quickly. My close friends got me up and walking and fed me, my next door neighbour visited daily, more than I would ever have expected. They all rallied around and I just cannot say thank you loudly enough and owe them so much.

My husband was involved in all my decision-making and never once told me that I was wrong. He was able to give support as he had been involved in my consultations and asked questions that helped. We are always taught that if a patient is competent that they can make their own decisions about their care. I was competent and a professional and still needed support to make my decision. Healthcare professionals understand that when we break ‘bad news’. normally cancer diagnoses, that support, often with nurse specialists, is of benefit. Patients are encouraged to bring an advocate with them, not only to support them but also to remember what was actually said and not what the patient wishes to remember. I was given leaflets and advice but learnt so much through the blogs of others and social media. Liz O’Riordan comments on the same. Maybe we should encourage our trainees to reach out to these sites to understand the patient journeys that they start their patients on. A nursing colleague has used my blog in her teaching for her junior staff and I have had many people reach out to me on behalf of themselves as well as relatives, just as I reached out to those who had gone before me in various Facebook groups.

So how do people who are on their own access support? Or those who are not IT literate?  How do healthcare professionals support these individuals if they are on a benign journey rather than one that is supported by cancer nurse specialists?

When I was in hospital, my family were able to be with me and my inpatient time was short. I valued the ability to talk to them and they were reassured by my improvement and desire to get home! Current governance does not allow healthcare professionals to discuss patient details over the phone with relatives unless consent is given. In addition, with nursing and medical staff shortages, often the teams are busy or not available when relatives come in to visit after they have finished work. I have witnessed families feeling lost as they are unaware of what is planned for their relatives, when they visit in a weekend and are told that they need to wait until their team comes back in. Patients may not even be aware of who is the attending Clinician as many teams buddy up care and rotate on a daily or weekly basis. This is where I have really tried to change the way that the teams and I behave. Patients and their relatives need to be engaged in decision-making including timing and dates of treatment and discharge.

In surgery, this process is easier as one can normally judge the time needed to recover in hospital. In medicine, this is much harder as most inpatients are admitted as emergencies and many in crisis, due to a paucity of social care and mental health funding. We often say that discharge planning should be started as the patient enters the hospital but due to staffing and pressures within the system, this may not happen. This may lead to inefficiencies and patients staying a day longer than expected but with the reduction in the NHS bed base, each day and hour matters. All patients should have an estimated date for discharge as they are admitted allowing everyone to plan accordingly.

In a system that is not fully resourced, healthcare clinicians are struggling to provide excellent patient care and this shows with the recent dissatisfaction for the first time with the NHS.

The public and politicians need to decide what they want to do to resource the ever expanding need for healthcare. I received excellent care from my clinicians despite being treated in a Trust recently placed in special measures. The compassion and communication encompassing my care was excellent and enabled my family, friends and I to return to normality rapidly.

Communication is an enabler within the NHS and healthcare professionals need to ensure that this is embedded at every level despite funding and time issues.

The NHS will only survive if we value our staff and ensure that this is both in morale and salaries. There is also a need to empower our patients to regain independence as much as they are able and understand the health choices that they make and encourage them to be the decision makers.

Stella Vig, an NHS Enthusiast and Survivor

Happy New Year!

It is amazing how time passes faster the older you get. It seems like yesterday that we were celebrating New Year’s Eve 2016. It was a quiet one as we were not sure what the following year would bring in terms of my personal health and whether I would be able to return to the job I love, working as a Surgeon in the NHS. We had just told the children of my diagnosis, fearful of their reaction and with the optimism of youth, they were not worried at all!

The appreciation for life also becomes more profound. Family and friends have passed last year and many new ones were born. The grief is intense on losing those who are close, and although people always tell you that time will heal, this is not understandable until you go through it yourself. The grief fades into the background but the memories become more striking with time. They become triggered by the most odd things: scents, foods, colours, words amongst so many things and the menories make you laugh or cry at the most insane moments.

And there are so many memories. I remember celebrating New Year’s Eve with my parents, brother and sister. We would all stay up until Big Ben chimed and then my parents would send us all to bed. As the years passed, we would have to try to keep our parents up until midnight with increasing difficulty.  We have done the same with our children. Watching the London fireworks has become a tradition as has phoning our nearest and dearest. Communication has enabled connections across the world in seconds compared to the old airmails that Mummy would send to India that would take several weeks. These are the times when I really miss Mummy and Daddy. They both continue to give me a drive for life and enable the success and health of others.

I cannot thank the NHS enough for my care last year. I would not be here, back to working, without the excellence of the team at Croydon University Hospital who diagnosed my acoustic neuroma or the skill of my neurosurgeon at the John Radcliffe in Oxford. The care I received was without reference to my background, wealth or culture. How many countries can boast such an altruistic system. It never crossed my mind to seek private healthcare as I knew I would get the best within the NHS.

I am proud to be working in the NHS. I see my colleagues, in all aspects of healthcare, working so hard with the scant resource, trying to ensure that patient care is delivered to the highest standard possible. Time is precious and there is no doubt that there is waste and inefficiency in the system but most of us spend our time firefighting, trying to manage the crisis caused by targets which do not allow longer term planning. Change is being forced centrally at pace and there is no time to evaluate whether this really will be to the benefit of the NHS and the patients it cares for.

The junior doctor dispute was bitter as was the decision to withdraw bursaries for those who wish to pursue roles within the NHS, often as a second career. It sent a clear message to the workers: those who manage the NHS do not value their staff, they are not thought to be integral to the NHS, as people who invest their careers in one company for a lifetime but rather as expendable workers. No wonder so many have left the NHS or changed their allegiance to a different country or even to Scotland or Wales. Brexit has added to these pressures as we have already sent out the message that we do not value our EU colleagues although they are the backbone of our NHS.

These decisions have culminated in a system where there are gaps at so many levels within the NHS. In an effort to make the money go further, there is a cap on locum and bank pay and spend for medical and administrative staff. The NHS needs to cap the salaries of non medical NHS staff in the same way to ensure parity. Those who are still working in the NHS are covering these gaps by working innovatively to ensure patient safety but this cover has now become a struggle.

Consultants are being asked to cover registrar shifts, trainees are missing training opportunities and the NHS has lost the ‘firm’ structure that ensured that we all worked in teams, allowing emotional support, debriefing and rapid feedback. Nurses are staying beyond their shift times to help support colleagues with sick patients and all staff within the NHS are contributing free hours as many of us are altruists and cannot see patient care being compromised.

There are limits to what can be achieved within the cash envelope which is NHS funding. The winter crisis of 2017/8 has been and continues to be difficult to cope with. The NHS does not do Christmas or New Year holidays, everyone keeps the ship running, with relentless targets for cancer and elective care needing to be met. There have been surges of emergencies for many Trusts, due to increasingly sick and frail people as well as those who have self-inflicted the need for NHS care. Mental Health provision is extremely challenged and ambulance services ensure these people find a safe provision of care which is often the acute sector, often at a time of crisis rather than semi elective care. GPs are on their knees and there are reasons that trainees are not choosing to follow this profession and decide on portfolio careers to allow a pressure valve when the NHS becomes too hard. The extra winter funding is a start but without funding for community care, this does not improve the flow through the acute sector. Most Trusts are in deficit and will not achieve the impossible financial control targets and even the John Radcliffe Hospital, a world-renowned centre of clinical excellence, is struggling financially. The NHS is spending millions on turnaround teams and consultancy firms, perhaps we should pay the internal staff better and allow them to get on with running the NHS well.

I am proud to be back in my job, working as a clinician and a manager. I see the skill of colleagues in clinical and managerial practice, trying to balance excellence with finance. We need to make a decision soon as to what we want. The NHS achievements over the last 70 years have been astounding but are costing more and we are all living longer and expecting more.

From an aspiration of care delivered without cost at the patient face in 1948, the only cost implemented is that of prescription charges but even this has exceptions for those in need factored in. Do we now need to think about charging? Or just changing the way we respect the care that the NHS gives? The NHS gives freely, Grenfell, the Bridge attacks, Manchester. Each time the NHS has to deliver excellence, it does. Perhaps the public need to give excellence too.

Why do people fail to attend hospital appointments, even dates for surgery. Each of these episodes costs all of us already but we just don’t see it. Recently, I have witnessed bookers trying to persuade patients to take dates offered for surgery, to be told that these are not convenient as they have social plans. Really?

Each NHS user should be asking how they can do their bit to use the NHS resource as well as they can. Trainees sent out to accompany ambulance crews were shocked at the number of calls for inappropriate reasons but also as to the number of frail, elderly people or those with mental health problems, just about coping at home until that final straw breaks the unstable status quo. Have we stopped being a compassionate society where we looked in and knew the neighbour next door?

I am looking forward to working in an NHS to the end of my career and will continue to invest in it as it has in me. I have loyalty to the NHS as in the past it had loyalty to me. Our younger trainees and staff need to feel valued now as do the Senior Staff who are the memory and innovators of the NHS.

To allow it to succeed, the NHS needs to be unshackled from many of its targets that have become beasts that need to be fed. The fines that are applied for missing targets need to be reviewed: we should be learning not being penalised for processes that need improvement. The question of finance must be addressed this year and a cross party working group may enable how we can continue to deliver a NHS that we are all proud of.

I am looking forward to this year, looking forward to getting my strength and health back to normal. Learning to cope with my hearing loss and ensuring that I develop a new work life balance. I am looking forward to my 50 (again) birthday this year as well as the 70th birthday of the NHS on the 5th July.

I have had another chance at enjoying my family, my work and continuing to chase my dreams. Let’s work together to give the NHS that chance.

#NHS70 #ThankUNHS

This is a series of blogs starting from the day I was diagnosed with an acoustic neuroma. If you want to start at the beginning then please follow this link: 

https://stellavig.blog/me-and-my-acoustic-neuroma/

Happy New Year!

It is amazing how time passes faster the older you get. It seems like yesterday that we were celebrating New Year’s Eve 2016. It was a quiet one as we were not sure what the following year would bring in terms of my personal health and whether I would be able to return to the job I love, working as a Surgeon in the NHS. We had just told the children of my diagnosis, fearful of their reaction and with the optimism of youth, they were not worried at all!

The appreciation for life also becomes more profound. Family and friends have passed last year and many new ones were born. The grief is intense on losing those who are close, and although people always tell you that time will heal, this is not understandable until you go through it yourself. The grief fades into the background but the memories become more striking with time. They become triggered by the most odd things: scents, foods, colours, words amongst so many things and the menories make you laugh or cry at the most insane moments.

And there are so many memories. I remember celebrating New Year’s Eve with my parents, brother and sister. We would all stay up until Big Ben chimed and then my parents would send us all to bed. As the years passed, we would have to try to keep our parents up until midnight with increasing difficulty.  We have done the same with our children. Watching the London fireworks has become a tradition as has phoning our nearest and dearest. Communication has enabled connections across the world in seconds compared to the old airmails that Mummy would send to India that would take several weeks. These are the times when I really miss Mummy and Daddy. They both continue to give me a drive for life and enable the success and health of others.

I cannot thank the NHS enough for my care last year. I would not be here, back to working, without the excellence of the team at Croydon University Hospital who diagnosed my acoustic neuroma or the skill of my neurosurgeon at the John Radcliffe in Oxford. The care I received was without reference to my background, wealth or culture. How many countries can boast such an altruistic system. It never crossed my mind to seek private healthcare as I knew I would get the best within the NHS.

I am proud to be working in the NHS. I see my colleagues, in all aspects of healthcare, working so hard with the scant resource, trying to ensure that patient care is delivered to the highest standard possible. Time is precious and there is no doubt that there is waste and inefficiency in the system but most of us spend our time firefighting, trying to manage the crisis caused by targets which do not allow longer term planning. Change is being forced centrally at pace and there is no time to evaluate whether this really will be to the benefit of the NHS and the patients it cares for.

The junior doctor dispute was bitter as was the decision to withdraw bursaries for those who wish to pursue roles within the NHS, often as a second career. It sent a clear message to the workers: those who manage the NHS do not value their staff, they are not thought to be integral to the NHS, as people who invest their careers in one company for a lifetime but rather as expendable workers. No wonder so many have left the NHS or changed their allegiance to a different country or even to Scotland or Wales. Brexit has added to these pressures as we have already sent out the message that we do not value our EU colleagues although they are the backbone of our NHS.

These decisions have culminated in a system where there are gaps at so many levels within the NHS. In an effort to make the money go further, there is a cap on locum and bank pay and spend for medical and administrative staff. The NHS needs to cap the salaries of non medical NHS staff in the same way to ensure parity. Those who are still working in the NHS are covering these gaps by working innovatively to ensure patient safety but this cover has now become a struggle.

Consultants are being asked to cover registrar shifts, trainees are missing training opportunities and the NHS has lost the ‘firm’ structure that ensured that we all worked in teams, allowing emotional support, debriefing and rapid feedback. Nurses are staying beyond their shift times to help support colleagues with sick patients and all staff within the NHS are contributing free hours as many of us are altruists and cannot see patient care being compromised.

There are limits to what can be achieved within the cash envelope which is NHS funding. The winter crisis of 2017/8 has been and continues to be difficult to cope with. The NHS does not do Christmas or New Year holidays, everyone keeps the ship running, with relentless targets for cancer and elective care needing to be met. There have been surges of emergencies for many Trusts, due to increasingly sick and frail people as well as those who have self-inflicted the need for NHS care. Mental Health provision is extremely challenged and ambulance services ensure these people find a safe provision of care which is often the acute sector, often at a time of crisis rather than semi elective care. GPs are on their knees and there are reasons that trainees are not choosing to follow this profession and decide on portfolio careers to allow a pressure valve when the NHS becomes too hard. The extra winter funding is a start but without funding for community care, this does not improve the flow through the acute sector. Most Trusts are in deficit and will not achieve the impossible financial control targets and even the John Radcliffe Hospital, a world-renowned centre of clinical excellence, is struggling financially. The NHS is spending millions on turnaround teams and consultancy firms, perhaps we should pay the internal staff better and allow them to get on with running the NHS well.

I am proud to be back in my job, working as a clinician and a manager. I see the skill of colleagues in clinical and managerial practice, trying to balance excellence with finance. We need to make a decision soon as to what we want. The NHS achievements over the last 70 years have been astounding but are costing more and we are all living longer and expecting more.

From an aspiration of care delivered without cost at the patient face in 1948, the only cost implemented is that of prescription charges but even this has exceptions for those in need factored in. Do we now need to think about charging? Or just changing the way we respect the care that the NHS gives? The NHS gives freely, Grenfell, the Bridge attacks, Manchester. Each time the NHS has to deliver excellence, it does. Perhaps the public need to give excellence too.

Why do people fail to attend hospital appointments, even dates for surgery. Each of these episodes costs all of us already but we just don’t see it. Recently, I have witnessed bookers trying to persuade patients to take dates offered for surgery, to be told that these are not convenient as they have social plans. Really?

Each NHS user should be asking how they can do their bit to use the NHS resource as well as they can. Trainees sent out to accompany ambulance crews were shocked at the number of calls for inappropriate reasons but also as to the number of frail, elderly people or those with mental health problems, just about coping at home until that final straw breaks the unstable status quo. Have we stopped being a compassionate society where we looked in and knew the neighbour next door?

I am looking forward to working in an NHS to the end of my career and will continue to invest in it as it has in me. I have loyalty to the NHS as in the past it had loyalty to me. Our younger trainees and staff need to feel valued now as do the Senior Staff who are the memory and innovators of the NHS.

To allow it to succeed, the NHS needs to be unshackled from many of its targets that have become beasts that need to be fed. The fines that are applied for missing targets need to be reviewed: we should be learning not being penalised for processes that need improvement. The question of finance must be addressed this year and a cross party working group may enable how we can continue to deliver a NHS that we are all proud of.

I am looking forward to this year, looking forward to getting my strength and health back to normal. Learning to cope with my hearing loss and ensuring that I develop a new work life balance. I am looking forward to my 50 (again) birthday this year as well as the 70th birthday of the NHS on the 5th July.

I have had another chance at enjoying my family, my work and continuing to chase my dreams. Let’s work together to give the NHS that chance.

#NHS70 #ThankUNHS

This is a series of blogs starting from the day I was diagnosed with an acoustic neuroma. If you want to start at the beginning then please follow this link: 

https://stellavig.blog/me-and-my-acoustic-neuroma/