I sat back on New Year’s Eve 2021 reflecting the worst was over and we would all begin afresh. Little did we know how hard this year was going to be. Covid has not gone away and the economic crisis has hit hard. We have started to live ‘normally’ again, whatever that means. The triumph of vaccination has stopped the need for restrictions but Covid is now embedded in our DNA. It has hurtled us into a new age of digital and social interaction but has thrusted an imprint on all of us, whether we recognise it or not.

The images of the faces of healthcare workers after wearing masks 24/7 are hard to forget. The smiles were gone, skin furrowed where the masks had cut into cheeks and foreheads. I still wear a mask in theatre and clinical spaces, now with annoyance rather than the fear when it was mandatory. I know it makes a difference, when we gather together and one turns positive, we are not all sent home to twiddle thumbs, feeling alright and wondering if we going to get the dreaded virus.

Masks make us feel safe but do we really take them off? We spend time with people and get on with our jobs. We interact in shops and restaurants but it all feels superficial now. I see and talk to people every day. I talk to colleagues and patients, the hello in the corridor, the invitation to share symptoms and  progress in outpatient clinics. Moreover, in these important contacts, we only just scratch the surface rather than invest in a deep conversation.

When you stop and consider what is being said and follow up with interest, curiosity and compassion, incredible experiences are disclosed. People come to work everyday and do not readily reveal the enormous changes that have occurred in the last two years. The havoc that has ensued losing loved ones or caring for those with long Covid. The fact that family members have lost jobs and that living on the breadline is not a statistic but an everyday lived nightmare. The emotional assault of being locked away in lockdown, isolating people, taking away the normality and safety of human interaction, and leaving mental turbulence unleashing mental health needs.

And this is playing out when pressures at work, especially in the NHS, at an unimaginable high. The drum beats the NHS battle rhythm, day after day. Who can go home, who needs to be admitted, trying to make the numbers add up but they do not. How do we find safe ways of managing the tsunami of need presenting to the emergency department. The novel ways of stemming demand failing, senior decision makers at the front door, diversions to other providers of care and streaming to same day emergency care. The media suggest that primary care has ceased but colleagues are working equally as hard but failing to manage demand.

Funding is needed to make a difference. Virtual wards and investment into social care will make a difference but the investment needs to be immediate into the workforce. They are emotionally burnt out, altruists balancing professional and personal lives, where both need increased attention. Staff went all out to support Covid care with little knowledge of the risks to themselves nor whether the PPE they wore made a difference. This merged seamlessly into the desire to treat those patients who were waiting in the ‘backlog’ for elective care and an increasing public behaviour change where the emergency department was the easiest way of getting care. Mental health services are overwhelmed, underfunded for many years, and emergency departments have morphed into mental health wards without the supportive services that people with mental health needs, at their most vulnerable, require.

I am proud to work with my colleagues, not just clinical, Allied Healthcare Professionals, Nurses and Doctors. So many jobs in the NHS are still unrecognised. Those in ‘backroom’ jobs that make the NHS work. The administrative staff, our bookers and schedulers, our cleaners and porters, the volunteers and our HCAs. They continue to work in the most difficult circumstances and have ensured that the NHS has continued to deliver elective and emergency care.

When I visit centres, the pride of those who are achieving innovation and exceptional care cannot be underestimated. It is breathtaking and all consuming as it envelopes you, and entices you to do more. It is wonderful, and should be rewarded, so that the moral injury that is hides is mitigated. We need to create an NHS that we are all proud of working in with an environment that is clean and fit for purpose. That teams have appropriate rest and on call rooms. Free parking and bike racks are a minimum with a desire to understand and support our NHS staff. This is for Provider Chief Execs, NHSE and Government to decide, as individuals we can support in a much simpler way.

Each of us is exhausted; we are looking forward to planning holidays this year. We have worked out how taking days around bank holidays will stretch our annual leave out as much as possible. It is important that we do look after our families and ourselves. It is also important that we look out for our colleagues. Take time to ask how people are and listen to responses. Only recently, I said hello to someone I had not seen for a few weeks. I asked how they were and whether they were okay. They had taken a few weeks off as their partner had died suddenly. They had to come back to work as they have young children and do not have family to support. We sat and chatted, and even though I had nothing new to offer, the fact that someone cared made a difference. It is now so easy to hide our true emotions behind masks, and because we are all so busy, to accept the masks on colleagues. We use social media and WhatsApp that allows us to be positive and present a facade of golden normality. WhatsApp allows us to talk without picking up the phone and listening to the catch in a voice that betrays the fact that everything is not right.

This year, I will try to talk to people more often rather than dropping social media messages and to meet up with people rather than spend an extra hour at work. I will try more than ever before to be compassionate and curious at work, to support colleagues and I ask you all to do the same.

I published this 5 years ago. I was diagnosed with a large acoustic neuroma and underwent surgery 5 years ago today. A 12 hour operation and life changed. It changed so much for me but re reading this blog, some of the lessons I learnt then, still apply now.

Do read and share, if you enjoy reading this and the rest of my blogs!

This blog is the hardest to write as I had the most difficult night so far. I was so tired and my brain was obviously not functioning normally but I learnt so many things in the first 24 hours.

Lessons learnt so far…

1. My Name Is..

The late great Kate Granger championed ‘My Name Is’ as a mandatory component of NHS culture. It is an introduction that I have always felt to be important, not only to introduce oneself, but also to ensure that patients have a name to refer back to when further questions need to be asked.

The John Radcliffe Hospital in Oxford runs 12 hour nursing shifts so the same wonderful ITU nurse looked after me for the majority of my stay on ITU. She introduced herself to me and I repeated her name so that I did not forget it, a method I have used for a long time otherwise I forget names at parties instantaneously. This time however it did not work as I repeatedly forgot her name, calling her something similar, and had to keep asking her to clarify. She was patient with me and reintroduced herself until I finally remembered. She was compassionate and attentive, constantly keeping an eye on me. I was unbelievably thirsty after surgery and constantly asked for a drink of water. I was lying flat, as apparently the more you sit up the more you suffer with a headache, and drinking laying flat is a real feat. She was amazing, with ice-cold water and a straw at my beck and call.

A relationship developed as I just could not sleep and we chatted about so many things . She needed to go on her break and another nurse covered for her during this time. This new nurse also introduced herself but I did not catch her name as I must have drifted off. When I woke up feeling thirsty a few minutes later, I did not feel that I could call her as I felt rude not knowing her name at all and just shouting ‘nurse’. She did check up on me and asked if I wished to have water.  I asked her name again and realised how important this small introduction really is for a patient. Without knowing her name I felt very vulnerable but also guilty that I might be interrupting an important task rather than feeling empowered to ask for help. As a professional, I must remember to make sure to introduce myself to a patient at the beginning of a conversation but also make sure I remind them again at the end so that they have a name to remember if they wish to. Even more importantly, I need to make sure that I do not assume that patients will remember my name from one ward round to another even if on the same day.

2. Sleep is SO important

I slept for an hour and fourty minutes during my ITU stay. Nationally ITUs are noisy! If you are intubated, then it is probably okay but if you are awake trying to get some sleep….

The poor nurse did her best to help me. After surgery my hearing has altered so much. I think I can hear a little from my right ear but noises sound so different. Immediately after surgery, I felt as if I was one of those superheros with amazing hearing, as I could hear everything but could not pinpoint a direction. I could also hear a sound that I thought were vehicles reversing outside of ITU, through the window behind my bed, and only realised the next day that it was the noise of the flotron boots (intermittently inflating boots that you wear on your legs to stop development of a deep venous thrombosis or blood clot in your calves). This also meant that background chatter, bins being emptied or monitor alarms going off repeatedly interrupted any chance of getting sleep. Next time I will ask for ear plugs!

I had slipped a disc many years ago and this had been irritated again during my positioning for surgery. I developed sciatica which was very painful and affected my left leg. I normally struggle to lie flat when I am sleeping as my back becomes uncomfortable, so laying flat after surgery with sciatica was a real challenge. Even more of a challenge was working out which position might be comfortable. I had an incision on the right side of my head and neck which was uncomfortable to lie on if I was rolled onto my right side. In addition, I had a catheter inserted into the vein in my right groin (right femoral). I also had two drips in my right arm. So rolling onto my left side sounded ideal apart from the fact I had a left radial arterial line (a catheter into the artery of my wrist) which was measuring my blood pressure continuously. I also had a catheter into my bladder and the aforementioned flotron boots on both my legs connected to a pump at the bottom of my bed! I could not work out how to lie and so just kept having to move so as to stop the leg pain which was much worse that the headache!

The dedicated nurse tried to get me as comfortable as possible by repositioning me. This was no feat as it meant two nurses helping me to move but they did it regularly without any indication that this was an imposition even though they were so busy.

I still could not sleep and eventually I think drifted off as I was just exhausted at 5am and then woke up again to have my bloods done at 6.30!

3. Let others help

I was laid flat and had slipped down the bed. Hospital beds are so slippy and the stockings to stop you from getting DVTs (TED stockings) mean that you have no grip to move yourself around. I could not really move myself much anyway as I was so tired and uncomfortable. The nurses asked me if I needed help to move up the bed. Miss Independent here thought she would try by herself. That was a big mistake, a) I could not and b) I was promptly sick! I learnt that lesson very quickly ie ask for help.

Nausea and sickness were issues. I was thirsty and sipped water regularly and was promptly sick. The nurse suggested an anti-sickness medication. I thought that the vomiting would settle so I refused. Wrong decision, others know better as they look after patients like me regularly. I needed the anti sickness medication later on and this was important as vomiting increases your blood pressure and this carries a risk of a cerebral bleed (bleed within the brain at the site of operation). Letting others help when normally you are the helper is really hard. I cannot imagine that this is very different for anyone else as we all try to be independent in our own lives. Being a doctor brings the additional difficulty of having specialist knowledge in one small area and trying to apply it in another. Making assumptions causes problems and I had to keep remembering to stop thinking what was best for me and let others make these decisions.

4. Time passes slowly

There was a clock on the pillar opposite my ITU bed. I could not sleep soundly and was grateful when I drifted off. When I regained consciousness, I felt as if hours had gone by. Sadly it was only ever a few minutes and the night felt so long. The clock suddenly became the focus of my attention and this made time pass even more slowly. The nurse pulled the curtain around my bed so that I could not see the clock and this made my night slightly easier! This really was the longest night ever.

5. Yes, you can 

After little sleep and a cup of tea, I was informed that I had progressed well and I would be transferred to the neurosurgery ward once a bed became available. The right femoral line and left arterial line were removed and I sat up a little. The physiotherapist came to visit me and suggested that I could stand. This would improve my breathing as my oxygen levels were a little low as I had been laying flat all night. I laughed. I could hardly sit up and could not pull myself up in the bed. And she wanted me to stand? Remember what I said ‘Making assumptions causes problems and I had to keep remembering to stop thinking what was best for me and let others make these decisions’. This applied again, I was in her hands. She asked for help from other nurses and patiently sat me up on the edge of the bed. I felt nauseated and strange but I managed it. I thought she might be satisfied with this as it had been very hard work. But no, she really did want me to stand! I was really anxious as my left leg was so uncomfortable. With the help of two, I did eventually stand and it felt so good. I felt like I had achieved an important goal but was so glad to get back into bed. I felt like I had done a marathon and really needed that second cup of tea!

6. Believe what the doctor says

I was eventually moved to the ward. I slept, took painkillers, had observations and slept. My surgeon visited and was pleased with the progress and reminded me that I should expect to feel exhausted and although this would improve, it would last three months or more. Although he had told me this prior to surgery, I had not believed him. I cannot explain how exhausted I felt. Thinking hurt, sitting up in bed hurt, coughing hurt, turning my head hurt as did brushing my teeth. Lying still and flat in bed did not! Tuesday and Wednesday passed without much change. I required another CT scan on Wednesday and all was well. The dreaded urinary catheter was removed on Thursday morning and this meant I had to get up and get to the toilet as otherwise I would need to use a commode. This felt like a challenge and I love a challenge. I needed the help of two nurses but I managed to get there and back but again felt like I had achieved a Herculean task and went back to bed. The physiotherapist came to see me and persuaded me that I could do one more walk to the door and back. I did it and was then again straight back into bed! She also suggested that I try to brush my hair as otherwise this would become an impossible task. This took me 20 minutes as lifting my arms seemed to be so difficult.

I really wanted to have a shower. The male member of nursing staff suggested that he would help me after lunch. Miss Independent came back into action. I really wanted to do this myself. My nurse helped me into the bathroom and brought everything to me. I sat in the shower and explained that I like to get on with it but would ask for help if needed. It took me an hour but I did it. But I did need to ask for help. I managed to dry myself, get my pyjama top and underpants on. I managed one leg of my pyjama bottoms but then ran out of energy and could not get the other leg on!!! My nurse came to the rescue and helped me to finish dressing and then get back into bed! In my mind I had planned to leave hospital on Sunday and this now seemed to be an impossible task.

7. Compassion and Diversity: worth their weight in gold

I had outstanding care through these days from a diverse workforce spanning from the Indian subcontinent, the Caribbean, the EU as well as from UK institutions. The one conversation that unified the nurses looking after me was the lack of assurance to colleagues from the EU living in the UK. The majority of the nurses from the EU were at the beginnings of their careers. Their biggest concern was that their original plan, to spend a period of time here and then return to their home countries with an enhanced skill set benefitting their own communities, was now uncertain. This was forcing many to rethink their decisions, and consider travelling home and forging their careers there or in another country.

You might anticipate, that in this hard pressed environment, these EU nationals would just work out their contracts, preparing to go home.

Absolutely not. I received the highest standard of care. There was excellence in care from all staff groups including those unsung heroes who cleaned the wards and ensured that all patients were fed and watered. I witnessed many staff going beyond what would be expected as normal professional behaviour.

The hard-working nurse who looked after me in ITU took her break and did personal development plans with her team. The nurse managing a difficult patient with memory problems went out of her way to ensure that this patient was looked after with dignity. The member of staff managing the patient, who had returned from surgery for head trauma, patiently managed the expectations of the patient and their family. The junior doctor looking after me came to see me four hours after his shift should have finished to reassure me that my CT scan was normal.

The compassion, goodwill and professional care of the staff in the NHS is worth its weight in gold. The NHS is in crisis with its workforce and surely this is not the time to hold the EU NHS staff group as a bargaining chip in the BREXIT discussions? There is a motion calling for a guaranteed right to live and work in the UK for all EU citizens working in the NHS and care services. Surely this be supported, as without it the NHS will collapse and patient care will suffer.

All I know is that without these fantastic individuals, my care as a patient within the NHS would have suffered. The question remains today as it did 5 years ago. How do we recruit, retain, value and reward our wonderful NHS staff, who continue to deliver more and more. Especially when they are now harrowed and exhausted having battled with Covid-19 over the last two years?

This is a series of blogs that started when I was diagnosed with an acoustic neuroma (a benign brain tumour) and if you find this blog interesting, then please do read the rest. My surgery was 4 years ago and my life has changed so much since, and then more so with COVID. Stay safe everyone!

The first thing to say about today is that it has ended well. My biggest concern was damage to my facial nerve. Of course, I listened carefully to the 20% risk of nerve injury but also to the 80% chance that there would be no long-term damage. I had read of all the possible management options depending on the degree of injury and had discussed the options to mitigate this complication with the Surgeon. I had made my choice and now I was in the hands of others.

Today started with an inability to sleep and getting up at 5.30am. I waited in bed after brushing my teeth, washing my face and taking my tablets. Wanting to have a shower, I went in search of the nurses as I needed my operating gown. The nurses were at the handover desk at the end of the ward and I had worn my brand-new slippers (and my new pyjamas and dressing gown!). The majority of patients were asleep, the ward was dark and quiet but the nurses were still busy with the patients that were unwell. Trying to stay as quiet as possible, I tiptoed through the ward, as I had learnt from my many nights on call but despite this my bed slippers were squeaky and whatever I did they did not get any quieter!

The nurses gave me my gown and two fresh NHS towels, reminded me of the need to wash in the triclorosan and to take my tablets with a little water. I showered, enjoying the hot water and the feeling that I was independent, a feeling I knew I would lose in the short-term. 

I thought how different today would be compared to the lovely family meal we had yesterday at an Oxford pub. There were so many pubs to choose from to enjoy a Sunday roast but the one that had caught my eye was the Eagle and Child. Apparently, this is where J R Tolkien and C S Lewis frequented and where my favourite books were born, The Lion, the Witch and the Wardrobe and the Hobbit. It was good to spend family time, although rushed, as I needed to be admitted at 4pm to the West Wing at the John Radcliffe. 

I got out of the shower and dried myself on the towels. To the NHS, please make your towels bigger as many of us are not a size 8!!!! I put on my gown and remembered to do it up correctly so that I maintained as much dignity as I could for as long as I could!

Having tidied the room, putting all my belongings away tidily and not being able to think of anything else to do, I got back into bed. 

My husband and kids arrived, followed closely by the duty registrar who consented me. The second anaesthetist also arrived and made sure that all was well. My Surgeon also came and reassured me that all was on track and that I should be on my way down to theatre by 8.30am. He asked if I had any further questions and I replied that I did not but I needed to get on with it! My husband was worried and the Surgeon promised that he would contact him as soon as he had finished or in between if there were any concerns. And he did what I do regularly. He took the phone number down and wrote it on the notes, as there it cannot get lost and is on hand if you are scrubbed in theatre and need someone else to find the number for you!

I kept it all together until I left my husband and kids. As soon as I laid down and started being wheeled out of my hospital room, a feeling of sheer panic overwhelmed me. I have never really experienced this before. I should know better and knew the operation was a calculated risk that was in my favour, and that doing anything else was not an option. How absurd and silly, but the panic was there as I really had lost control and there was no going back. 

I closed my eyes and went on the journey to theatres and into the holding bay. I confirmed my details and shuffled from my bed onto the theatre trolley. I was then taken into the anaesthetic room. Everyone was professional and calming. The anaesthetic team had a great balance of humour and professionalism that really did confer a sense of normality to this bizarre situation. 

An intravenous infusion of propofol (I assume) was attached and one minute I was talking normally and the next I was asleep!

I have no idea as to what happened next. I know I needed a catheter, an arterial line, a femoral line as well as other new venous cannulae. I was placed on an operating table in a park bench position (lying on my left hand side). I had holding pins to make sure that my head did not move during surgery. I am glad that this was all done when I was asleep as there was no further anxiety or concern regarding dignity from me. 

The operation apparently took 10 hours. The operation involved a craniotomy (making a hole behind the ear through the skull) and then pushing the cerebellum back to allow access to the tumour. Neurosurgery is complicated and involves changing the way the brain functions by reducing the fluid around the brain and so allowing access for the surgeons to operate as there is a very limited space within the skull. The tumour had grown into the brain, was stuck to the brainstem and was slightly different anatomically to what had been anticipated. The growth was towards the lower part of the cerebellum and brainstem so the auditory (hearing) and facial nerve were preserved as much as possible. 

The Surgeon did not phone my husband during surgery as there was no need. Apparently, my husband did get a phone call from the hospital at around three hours in and this caused him to worry. It turned out that it was the ward asking him to take all my stuff home as I would be moving ward on my return after surgery. 

I took a long time to wake up causing enough concern to send me straight to the CT scanner. The CT scan was normal and reassured the surgical team. Most of the tumour had been resected and there was a little air (as expected) and no blood or signs of a stroke to cause concern. 

I remember being wheeled across to recovery and thinking, I am glad to be alive, and then, I can hear. My back was painful and I seemed to have severe left-sided sciatica (pain from your hip to foot). The nurses in recovery were patient with me and the anaesthetic SHO who came to see me was reassuring and understanding of my concerns. 

The Surgeon came to see me and explained what he had found. He told me that my facial nerve had been preserved and I had no obvious facial dysfunction. I had been very lucky. I trusted him and did not ask for a mirror to check. He was happy with the surgery but knew I would need a night in the intensive care unit (ITU) to recover. He had already phoned my husband and the family would come and see me in ITU. 

My head was painful and I was so sleepy. I had no energy and could not wriggle or move my body to get comfortable. Smells were different and my mouth tasted weird. I was also thirsty but also so sick. Once as comfortable as possible with the pain, I was moved to ITU. 

I imagine that those first hours must be how it feels to be on drugs as the world just seemed to slow down and fact and fiction seemed to merge. I was introduced to my nurse in ITU and her name drifted in and out of my head so that I kept having to ask her to clarify her name. My husband, two boys, and brother and sister visited in pairs and were obviously relieved to have got this far without a major complication. At one point, someone’s phone rang and I remember telling them off for having it on in ITU and being told that maybe my hearing was better than I thought it might be. 

I was now very tired, my head hurt and I asked everyone to go home and get some sleep as well. It had been a long day for everyone and we had several months of convalescence to get through and everyone needed their energy. 

I tried to get comfortable and drift off to sleep but also to remember anything that might be of value for others going through this experience. 

I had been awed by the complete honesty of others who had been through this process already and who had taken time to get in touch with me. These were strangers who wrote on the blog and gave me an alternative to the despair that I read on the internet. The desire to help each other is immense and I cannot tell you how moving and deeply honest these posts and direct messages were. Other messages were from previous trainees, friends and colleagues who shared experiences of their own (aged 5 as well as older) and of family members, which again, were realistic yet full of hope.

Other messages, which are the real reason that this blog will continue to record my progress and hopefully become a resource for others, are from people about to go through this journey. If there is only one sentence that you find helpful in this sea of words, then I will feel that my blogging journey was worth it. Of those of you who offered me support via direct message, I will ask you later whether you are willing for me to share your words of wisdom with others, as they truly meant a lot to me.

All I can say for now is that I am one of the 80% who has kept full facial nerve function and so my ambition from now on is live life to the full!

PS

I have added a resource page to my blog and will continue to add resources that I have found helpful. Liz O’Riordan’s blog as well as the blog from Maureen Kenny are a great read. The late great Kate Granger’s blog is a must read. Please let me know of any others that you have found useful or interesting. Thank you.

The NHS turns 72 years old today and never have we needed her so much.

I have worked within the NHS for the last 30 years. It is a career that brings challenge, heartache and so much pride but anything witnessed before has recently been blown out of the water.

I am so proud of the NHS teams that I have had the privilege to work with. I am seeing surgeons, physicians, nurses, physiotherapists, managers, GPs, porters, radiographers and so many more just coming together as #TeamNHS. The support networks have been amplified with food, well wishes, hand creams, masks, scrubs and even small hearts!

We have turned wards and theatre recovery areas into intensive care units, normal wards into intensive respiratory wards and challenged our staff at every level to work harder and harder. We have seen such death and illness in a short time frame and have done our best in difficult times.

We are used to looking after ill people, it is our bread and butter. The tragedy of illness and death is interwoven with the human interaction, a squeeze of a gnarled hand, the smile of a memory and a shared laugh even when death can be the only outcome. Patients and relatives rely on the human interaction, meeting with doctors, learning how to cope and the joy of going home to loved ones. All of this has had a hard stop with COVID-19. The masks, gowns and need to physically exclude friends and families have added barriers to patient care in a way never seen before.

Healthcare professionals talk about emotional injury where we support you and relatives in illness and death, but we keep the emotions we feel, of sadness and pain, internal. This is balanced by your thank yous and the joy of discharging a patient in better health, able to resume their own lifestyle.

This mental stress that has challenged our wellbeing has been added to by the daily battle for personal protective equipment causing a fear of coming into work, especially for those from a BAME background.

COVID-19 has stripped us all of the ability to cope. We are not NHS Heros, we are normal people, trying to do an exceedingly difficult job. The emotional injury has been high as wards have dealt with heart wrenching stories that have developed often overnight. Relatives relate seeing their loved ones deteriorate rapidly, taken by ambulance to hospital and then not seen again. This has been even more difficult when these patients are one of our own and were working with us days before. The numbers of healthcare staff affected has been huge and the faces of those who have passed are remembered in the picture below. To make this time even more difficult, the solace of families and colleagues coming together for funerals has been destroyed.

The NHS is beginning to open up services again, so that patients awaiting operations and outpatients clinics can visit safely. As the levels of COVID-19 decrease both the NHS and society can start breathing again. I hear talk of going back to normal, but we will never go back to normal.

Within the NHS, we have learnt to use technology to communicate with patients and colleagues. Rather than bringing you to an outpatient appointment at a time that maybe inconvenient to you, we can reach out whilst you are still at work, so that you do not need to take a whole day off but rather just a 15 minute break,

Rather than travel into London for a short meeting, we can Team in, and get so much more done. We have moved healthcare into communities and redefined our paternalistic view of healthcare risk. Perhaps we have finally realised that the patient knows best.

This new norm comes with societal responsibility if we hope to enjoy the freedom of social interaction, good health, travel and economic growth.  As a society, we need to realise that we have to work and care together if we wish to develop an equitable society.

The recent scenes of beaches on the south coast or in Soho and Brixton are just appalling. COVID-19 has not gone away, it is just hiding, waiting to raise its head again. The loud voices protesting that they are young and therefore invincible should remember the vulnerable (and often in ways invisible to the naked eye). It is their lives that you put at risk when travelling home or during your food shop on your way home from your day frolicking in the sun. Social distancing must be the new norm unless we have a true track and trace or a vaccine for all. Huge gatherings with no public toilets open just is too ugly to think about.

So much good has been and can be achieved. We have seen a shift change in the care of people who have become homeless. We now need to see dramatic shift changes in many other aspects of societal norm.

Organisations must address inequalities of representation within their workforce and senior boards. Historic privilege will be challenged and equity, inclusion and diversity representing those around us must be the new norm.

This is the time where kindness and doing the right thing must be the minimum standard. So many people have shielded for the last four months and are now taking tentative steps to developing a new routine. Let us support them and each other by thinking of the greater good.

Those who say that we are going through the most difficult time, need to remember that our senior generation have been through two world wars, an economic depression as well as wars such as Vietnam. They have been through rationing and the harshness of a global recession.

What are we asking society to do? To wash hands, wear a mask and keep a social distance.

Is this so hard? Let us set the standard together and challenge ourselves to protect others. This is not about COVID-19. This is also about flu, norovirus,and everything else that challenges the NHS in the winter months.

So Happy Birthday #NHS, let us raise a huge cheer for what has been achieved and for overcoming what is to come.

Happy Easter to all of you.

This holiday weekend makes us reflect on religion, family and the world at large.

Yesterday, we watched an amazing programme by David Attenborough, which was a ‘call to arms’ to the world to slow down climate change. The risk of global warming within the next 30 years seems inevitable unless we change our own carbon footprints as well as those of major industries. A small rise in temperature may completely change coastal communities as well as drowning historical sites and London itself will be under threat as water levels rise.

We have seen the odd swings in local temperatures with huge surges in rainfall which overwhelm local drains. Wallington in Surrey, saw flash floods that caused chaos within a few hours.

London is under a greater threat and this is becoming increasingly visible.

There are a row of large lions’ heads, cast in bronze, that line the side of Victoria Embankment. They were sculpted by Timothy Butler for Sir Joseph Bazalgette’s Victorian sewage works programme in 1868-70. These are important as they allow a visual guide to the risk of flooding in London. The old rhyme states: “When the lions drink, London will sink. When it’s up to their manes, we’ll go down the drains.” The mouth of each lion holds a mooring ring and the rhyme suggests that if the lions drink the water from the Thames, London will flood. Although the lions have never been submerged to date, certainly high tides now seem to lap the heads regularly.

This makes us all consider how we #ChangeTheNorm.

The world is changing around us. We are all living longer and expecting more from life. I want my children to enjoy their lives and look forward to their children achieving and living happily and successfully. Stratton and Scott suggest that an individual aged 20 now has a 90% chance of living to 103 in the Western World. Someone who is 7, is likely to live to 107!

Authority is being turned on its head. It is humbling that 16-year-old climate activist Greta Thunberg is leading the charge to ‘wake up the adults’ to what is threatening their future. “We had everything we could ever wish for… now we probably don’t even have a future anymore.”  She also says the planet’s future “was sold so that a small number of people could make unimaginable amounts of money”.

So what do we need to do to?

Small changes will make a difference. It is easy to order on Amazon and get a delivery today. It is convenient but does it really matter. Why can’t it wait until tomorrow? Or next month? I think back to the time when we were little. Asian food was not sold in North Wales and we would wait til the monthly trip to Manchester to buy the groceries from the Indian shops there. Now all the food from the world is available in my local superstore. Previously we would enjoy the fruits of the season and now we enjoy them all year round. But do we? How many times does fruit over ripen in the fruit basket and then get thrown out.

We all need to consider what we want from life. We have become impatient. We will watch an entire box set or chomp through a box of chocolates because there are no more boundaries on life. Rules that existed previously have been over written.

Perhaps now is time to rewrite the rules. There will have to be an exchange of values as we no longer live in an altruistic world. If we suggested that you stop buying online, it would never happen. What would be valuable is to attribute a carbon footprint cost to everything we buy.

You may have a choice to buy strawberries.  Choice should no longer just be based on cost. One carton maybe slightly more expensive but is produced locally whilst the other has been flown across the world. An understanding of the carbon footprint might alter your choice and start to change the way that we live and eat.

Are we able to repair items and make them last longer rather than throw them out and buy new? Do we really need that new phone just because it is the new release? Should Amazon offer a discount if you agree to a bulk delivery once per month rather than the delivery of an item under £5?

We all have to #ChangeTheNorm for many reasons.

I reflect back on the last few years with regard to my health.

I developed a loss of balance and tiredness nearly three years ago and struggled to understand why. I still remember the fear of the diagnosis of an acoustic neuroma and the desperation to stop being a patient and live my normal life. I remember the amazing team that looked after me in the John Radcliffe in Oxford. Mr Richard Kerr was my NeuroSurgeon and operated on me for 12 hours. The night in ITU is unforgettable and I have never felt so vulnerable and weak as in those first five days. Headaches, nausea, dizziness and sheer frustration began and have never completely resolved but are so much better than at the start.

In truth, I went back to work too early (yes, everyone was right!) and it took me eight months post-surgery to be anywhere near normal but the NHS was a great employer and my friends, family and colleagues at work supported my journey.

I have recently undergone another post-operative MRI.  This proves that there is no increase in size of the small remnant of the acoustic neuroma. Hurrah!!! No more scans for another 6 months.

Everyone was pleasantly surprised at the pace of my recovery and outwardly there is now little evidence of the surgery. Even the hair that was shaved has completely obscured my scar and I am now more comfortable putting my hair in a bun!

The improvements that I noticed post operatively that allowed me to return to normal have now all slowed down. I have gone from hearing perfectly to unilateral deafness. Voices become less distinct when there is a lot of background noise.  My brain does not switch off and my sleep is frequently interrupted. I now must make notes to ensure that I do not forget anything as my short-term memory works very differently. My balance has improved but is noticeably different when I am tired. I no longer feel that I am invincible and am more aware of my health and the need for a work life balance.

I love being back at work and being lucky enough to have had such little post-surgical complications. This carries with it a guilt for all those who had a much tougher post-operative journey. I still manage my long lists and the education and training of junior surgical colleagues. Both as a Surgeon and as a Clinical Director, the patient experience is invaluable. It infuses everything I do and on most days.

But the most important lessons are being learnt now. I will never go back to my ‘normal’ but I have had to develop a new norm. Those that know me are slowly forgetting my recent journey and I must remind them that I am deaf in one ear as they whisper to me or talk quietly in a meeting. I get tired and must pace myself and so have had to say no!

I am also learning that the world is not forgiving of disabilities. In a shop recently, a woman faced me angrily and told me she had been asking me to move out of her way, in a busy shop full of Christmas shoppers. She pushed past and walked away before I could tell her that she had been talking to my deaf side! I cannot pinpoint noise and feel like I need to wear a sign that explains that I am deaf on one side.

I have learnt to be grateful for the one life that we have, in which we must live, love and share happy times with family and friends. I have a new life, different to the one I had two years ago but one that I intend to live to the full. I want this for my children and their children too.

So Happy Easter to you. In the next few days, let us all consider what we can do to #ChangeTheNorm and make this planet, our wonderful planet, continue to be a place where we can live long and prosper.

Merry Christmas to all of you! I hope that you have found time to eat, drink and enjoy the company of loved ones and develop new memories to cherish forever! I am on call and treading the delicate balance of ensuring that any patient well enough can get home if they wish, especially if it is likely to be their last Christmas.

It is always a difficult time of year. We try to get patients home but sometimes home is not the cheery warm house with the open fire, a Christmas tree and presents all around. Sometimes it is a bleak place that is lonely and cold and patients choose to present to accident and emergency to be admitted and enjoy company and good food in hospital. Others would love to go home but are hampered by the need for social care which is a scarce resource. They may need mobility aids or food delivered to home or sometimes, just someone to pop in and check they are okay.

As cuts have hit, many convalescent homes have closed, which used to offer respite for patients, allowing an interim between an acute episode of care and home. The wider social network has also diminished as the societal norm of the extended family has changed with smaller family units and a desire to move to independent family homes. It seems simple that a family member could come and stay or that the patient could stay with a close relative but the interconnectivity between NHS Trusts, community and social care are so poor that it takes an age just to set up dressing changes in a different postcode location. There are therefore, patients who are desperate to go home who end up in hospital over the Christmas period despite best intentions.

The desire to get home does seem to add a miracle into the medical mix as patients summon inhumane energies to get better. I wish I could bottle this up as an everyday get well potion! There is great evidence to show that a positive attitude reduces the length of stay of patients in hospital. This seems to drive the same positive gains as the #EndPJParalysis campaign. This global social movement emphasises that having patients in their day clothes while in hospital, rather than in pyjamas (PJs) or gowns, enhances dignity, autonomy and get them home quicker!

The lead up to Christmas has been a busy one. We have celebrated the 60th wedding anniversary of  my in laws with a surprise party as well as attending the wedding of a dear friend. The 60th celebration cake was unbelievable!

It has been busy at work and we have tried to say thank you to the people we work with everyday. We wrapped up 250 Christmas socks, with chocolate coins and Christmas pens! This was a small gift to say thank you but we enjoyed spreading good cheer in the Directorate!

As we all start to celebrate, we have to ask what is Christmas? A holiday, a religious time or just a state of mind, where we all enjoy goodwill and mercy to each other? This year more than ever, has demonstrated the undercurrent present in our society, which engenders distrust, chaos and division. As we drive through the streets festooned with lights and holiday spirit in the air, society seems to be conjoined in ensuring a good time for all. And then there are glimpses into the alternative reality with the homeless on the streets and BREXIT looming.

I write today on Boxing Day. My father passed away three years ago on this day. He died peacefully at 92 having led a hard but successful life.  I am glad he is not here to see the divide that is developing in this country. He arrived in 1955 on the RMS Strathnaver and then married my Mum. Together they brought up three children and encouraged us to work and play hard! The ethos of working to improve the lives of others is embedded into all of us and we have worked hard to honour Mummy and Daddy. Daddy himself played a important role in North Wales, where as the first Asian Labour Councillor, he advocated for an investment into the fabric of Penmaenen. He has left a legacy not only in us but in Penmaenmawr. It is now hard to imagine an alternative scenario where Daddy had been refused UK entry and the three careers which add to society as well as the hopes and dreams of our children rendered null and void.

This Christmas has been quiet, with only four of us celebrating, especially with my week on call. Christmas in North Wales was full of laughter and presents and was the one time when we were all at home! To the kids dismay, I am looking forward to the time when they have families and we have young children running around again!

I hope that you all have had time to spend with family and friends and wish you good cheer!

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/

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/

Last week a friend attended an important medical appointment and was told ‘Chemotherapy may not make a difference’. When we were discussing this later, my friend was still unsure whether this was because the prognosis was so good that it would not make a difference or because the prognosis was so poor… The consultation had lasted an hour!

Communication and language are at the heart of the healthcare professions but we seem to be losing the art of speech and compassion. Even interactions between healthcare professionals are becoming more pressured and dictatorial in the normal working environment and the healthcare professionals, who are largely altruists, are being harmed. Trainees are asking for advice with difficult conversations and often trainers need to point out that the altercation is often not about the way they behave but rather the stress of the individual they have encountered.

Losing 50% of my hearing has made me appreciate language and communication now more than ever. I watch others and find that non verbal signals fill in many gaps of a conversation as increasing background noise obscures my hearing. This observation also demonstrates the unease and dismay when hard-working professionals try their best to provide excellence within a hard pressed NHS environment but they face words used by others which clearly evidence a lack of value and respect.

A factor must be the limited funding within the NHS causing undue stress and that desperate strive to do more with less. Words used as drivers are efficiency, productivity and income. Quality, safety and excellence risk being lost and we are all responsible for ensuring that these words continue to be flagged alongside the daily conversations within the NHS at every level.

Is another factor the introduction of the electronic patient record into the NHS environment? Members of nursing staff now sit in ward bays on computers inputting patient observations and drain outputs. The laughter and banter, where staff and patients interacted, is still present but is a rarity as the pressures of the new safe staffing ratios and lack of workforce bite. Doctors work with antiquated computer hardware with software that outstrips the bandwidth in the NHS so that the system churns so so slowly. The doctors continue to do ward rounds and desperately try to enter the patient information on the ward round in the fewest words possible as there will be no time once the ward round finishes. Nursing staff are seldom on ward rounds as there are multiple specialities rounding at the same time.  Speciality wards have long since disappeared as the number of beds within the NHS have reduced in cost cutting exercises. Gone are the days (when I qualified in 1991), where Sister would send all visitors out, in preparation of the Consultant ward round, with all prescription charts and notes made available at the end of the bed especially the x-rays in brown packets! Woe betide the house person who did not find that missing x-ray packet as that would be the only one the Consultant would ask for! There are certainly many improvements with the electronic patient records as the charts and x-rays are readily available but it is at cost of patient facing time and the art of conversation.

Recently on a ward round, we approached a patient who was clearly visually impaired. As normal, I introduced myself and took her hand. I asked what she could see, as each patient has a different visual impairment. The team introduced themselves and we discussed her clinical symptoms and management plan. It was important to individualise the management plan with her due to her visual impairment. She cannot see her feet and therefore is unable to recognise the early signs of problems with her foot. In fact as her foot is insensate, all early warning signs fail. This increases her risk to sepsis with a foot infection as she is diabetic and systemic infection can take hold very quickly. The juniors asked me afterwards how I worked out that she was visually impaired so quickly as I had not met her before. To me it was obvious as she was not watching what was happening on the ward but I learnt the skill of observation and deduction from my seniors and time spent with patients. It is now very easy for the entire medical team to log on to a computer remote from the patient, review their history and clinical symptoms without even talking to the patient. A second ward round in the afternoon may assimilate blood results which completely change the direction of a clinical management plan. As this decision is taken in an office, the junior team may forget or be too busy to go back and ensure the patient and their family are aware or even more fundamentally, the nursing staff who will enact the plan. We all need to work harder in the NHS to role model the communication that you or I would wish and deserve to experience in any medical interaction.

The frustration with communication in the NHS was also exemplified when my father was in hospital. Trying to find out what had happened during the day in my father’s care was a daily battle. Working families struggle to visit in ‘normal working hours’ of the medical staff and out of hours medical staff do not have the time or knowledge to address family concerns. This year at Croydon, we will try a communication board at each patient’s bed side where both family and patients can write down any questions they wish to have answered, I will let you know how we get on but if anyone has a good idea to overcome this particular challenge, please do let me know!

The challenge of communication in the present day does not seem to be isolated just within the NHS. I was talking to a Black Cab driver recently whose father had recently been into hospital (and could not praise the NHS enough). He commented on the diversity in the NHS workforce and expressed his concerns with BREXIT looming on both morale and workforce numbers. As with most Black Cab Drivers, his communication style was interactive and that innate ability to put you at ease as soon as you got into his cab. He shocked me with the stories of abuse he had received, both verbal and physical during his hours as a cabbie. Despite innovation in technology, we seem to have lost courtesy and respect as a high value commodity. Community welfare has been exchanged for individual prosperity and development. Has the I replaced the We?

My hope is that is has not! The world has become a much smaller place. My father travelled by ship from India to the United Kingdom in the 1950s which took weeks. Letters from my father to his family would take an age as they travelled by Airmail and then he would wait even longer for the reply. Now we email, Skype and FaceTime to stay in contact with our friends and family across the world. People have migrated across the Continents, have settled and married between different cultures and created new rules by adopting the best from both. What an opportunity to respect, value and embrace cultural norms as well as differences. Would I be viewed differently at work if I wore a sari, a suit, a dress or salwar kameez? Sadly, I think I would, despite the clothing worn by the same person. How do we teach society to be tolerant and have value and respect for all cultures?

We all need to role model the behaviours that we cherish and value. We have a responsibilty to call out behaviours and words that do not attest to a society that values all. Our politicians and celebrities carry a heavy responsibility to evidence their integrity. Respect and value should be their mantra every day, every time. Society needs to make clear this is the expectation of the public. We should not ban cultural dress nor dialect but embrace and incorporate this into our multicultural world. There should be a common understanding that what is said may not be heard in the same way by others as our cultures vary. This high level communication skill should be embedded into our training programmes in all public facing services to ensure that we all hear and understand the common language. What we should all expect in return is common courtesy in an old-fashioned way.

The national headlines recently have been alarming.

Hundreds of patients have had operations cancelled, many more than previous years as the NHS Crisis continues.

The John Radcliffe Hospital cancelled all non-urgent operations in Jan 2017 and is quoted as one of highest pressured Trusts.

These are just statistics and each data point represents a patient and their personal circumstances. As a NHS, we cancel patients every day and just shift them along a few days or weeks. These are difficult management and clinical decisions but must be taken as the NHS juggles elective and emergency care in the under resourced and under bedded NHS. However these patients are people and the NHS should not be in this position.

We try and ensure that patients with a cancer diagnosis are not cancelled nor patients with special circumstances or who have been cancelled before but the NHS cannot guarantee that this has been 100% delivered this or last year.

I do not have a Cancer, I am not an urgent or an emergency so I could wait if necessary. And I will if needed and I will understand. And the anxiety will increase just like any other patient. At best I will be cancelled one week, at worst…

And there is a huge personal cost to this wait, that is hidden from the NHS deficit. Each patient carries a personal cost, which is relatively small, but added up across the nation, must be huge.

Personally, I have suspended my work and have only just managed to finalise the business cases, delegated tasks and ensured I have handed over both clinical and managerial duties. I have planned a return to work date and the Trust are paying for a locum to cover me. Any delay with the date of surgery pushes that return date back as well as increasing the cost.

My husband (a Surgeon) has booked a week off work and has planned operations and appointments for cancer patients on his return. If my surgery is delayed, then these patients will either need to be delayed or a plan made for others to cover if possible, often on goodwill but potentially at a cost. He has booked somewhere to stay for a week and has paid up front. This is not available the week after and he will need to rebook and pay a further cost and will lose the money for the first week if my operation is cancelled.

My sons have given notice at University for one week and have booked tickets and accommodation.

My sister has delayed a business trip and has planned to be around me initially and has arranged accommodation with my brother. She has arranged flexible leave with her company and will travel as necessary. My brother is flying in from abroad and is here for two weeks. He cannot rearrange his flight without a cost to him. He has also had to plan his work around his absence for a few weeks. All are using their precious annual leave. They don’t need to come but we lost our father last year and mother many years before that and it feels important to be around. As orphans, siblings bond even closer together and we have always been a great family unit.

I was supposed to phone at midday today to check whether a bed was available but got a phone call at 11am telling me that I should come in. I am overjoyed as this is the first step. I can be admitted at 4pm and need a further CT scan to ensure that there is no change since my last scan.

I have naseptin, a nasal antiseptic containing chlorhexidine which causes an acute sniffly nose and I am sneezing everywhere! I am worried I might get cancelled by the anaesthetist but she sees me that night and tells me not to worry.

I am seen by the on-call registrar who informs me that there are 6 ITU beds for the morning and although he cannot guarantee a bed, things are looking good.

Lying in bed on the eve of surgery is scary. There is no going back once the operation is done. I will need to work hard to rehabilitate and get my balance and appetite back. I have read all the literature and have kept myself as busy as I can so I don’t think about it. I have washed in the special soap and will stop eating at midnight as well as stop drinking at 6am. I am dreading the surgery but know it needs to go ahead, so have signed the consent form.

I will not know whether there is a bed until tomorrow morning. I don’t know if any of you have seen the television series titled ‘the Hospital’. A gentleman was taken to theatre, prepared with the access lines, catheter, monitoring etc and was cancelled at the last minute. My heart went out to him and his family as this is just not fair. I know that even if there is a bed that this could be cancelled at last minute and this fills me with fear.

I will wake up early and have a shower. I will follow all the instructions given to me and behave like a good patient. I have plenty of time now as I have nothing else to do. It is an odd time as the family are not here, I am a patient in a bed with nurses and patients around me. I am an ordinary person, stripped of all identification of who I am, waiting patiently for an ITU bed that will allow my surgeon to go ahead with necessary surgery.

I feel sorry for the staff, surgeons and managers who have no real ability to manage this bed resource as it depends on the acuity of admissions overnight. Is the NHS funded correctly, are we using this resource wisely, is there enough social care funding to allow flow through the hospital, should we separate elective and emergency care? I don’t know but there is a NHS Crisis right now and I am now on the other side seeing it for myself.

I know that I can be delayed safely and will not publish this until after my surgery as I do not want any special treatment.

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 am back at work! And I am exhausted.

I was so desperate to get back to work. And I managed to get back at month 3 and a half!

When do you know it is the right time? I don’t know. I had an occupational health check and was told to start on half a day per week! I managed to negotiate this to a day per week and then to phase it as I felt fit. We agreed that I was to start on administrative and management duties only, then build on the clinical and eventually start operating, which I will do in the next week (first week in September).

I look in the mirror and I see an older but normal me but I know that I am not really back to normal. One of my colleagues stated that ‘once you let air to the brain, it is never the same again’. It certainly feels like my brain has shifted in the way that it works and I really hope that it will go back to normal. I have to write thoughts down and am constantly texting myself lists so that I do not forget anything. My brain does not switch off at night and I am struggling to sleep well. I find that my balance does change when I am tired and I get tired very quickly. It is difficult to moan as there are many people in the Facebook group who are still off work at 6 months and really do not feel able to start back as yet. They have had occupational health visits at home and describe the feeling of not being believed as to how they feel, as they look normal and have to explain their headaches, dizziness and fatigue.  Everyone is so different and you are the only one who will know what is right for you.

Others in the Acoustic Neuroma support groups also talk about the travel insurance policies, which are shockingly high pre and post surgery, which might be expected. Acoustic neuromas are very slow-growing and if found when small, can be managed on a watch and wait policy. I was shocked to find that these patients are also having to pay a much higher insurance policy even though the medical risk is very, very small. I am sure we need to educate the insurance policy makers that these acoustic neuromas cannot just be included in the ‘brain tumour’ category!

Being back at work is strange as I am not really responsible for the patients on the ward as there is an excellent locum covering my duties. I am picking up my Clinical Director duties and it feels as if I have never been away. The NHS finances are very tight, there is no doubt that we need investment but it is our duty to make sure that we use the public purse well. Even thought the NHS is stretched so thinly, the NHS family are desperately ensuring that this disinvestment does not impact on patient care and safety and I feel very strongly that this aspect should not be compromised. I enjoy the budgets and business part of the NHS as much as looking after my patients and trainees and it is actually quite nice having protected time to do it as well as I can.

I keep getting hugs and well wishes from my trainees and also from my patients who spot me in the corridors of the hospital. Each time this happens it reminds me how lucky I am to be working in Croydon, where most patients who live in Croydon come to Croydon University Hospital and so you get to know people really well over 14 years! My colleagues are shocked that I have come back so early and have been very protective of me but yet so supportive. I still keep getting flowers!

Whilst life inside the hospital does not seem to have changed very much, life in the real world has been a whirlwind.

In the last three 3 months, there has been a General Election. I watched with excitement as the NHS became a political ‘hot’ topic again and really hoped that whoever won, there might be a change in the future planning of the NHS and then was very disappointed to see that there is no real change. There appeared to be a public movement to ensure that the NHS remained publicly available and accessible in the way it was founded and I hope that this continues. This was palpable at ‘The Specials’ concert that I attended with my family. They were amazing but the NHS was central to the banter between the crowd and the band. If you have never heard of the Specials, then take time to listen to one of their tracks over the weekend! Lots of memories from my childhood.

And then there was the Grenfell tower fire. I have never seen anything like it. I was interviewing when I first heard about it and was shocked to see the extent of what had happened so quickly. I am sure my emotions just copied everyone else. I was brought to tears on hearing and seeing the horrific events that unfolded, amazed and proud of the people in this country who just came out to help and saddened by the lack of organisation demonstrated by authorities at the time. I started crying seeing the mountains of donations and realising that there were so few survivors to actually claim them. The shocking revelation as to why the fire may have gripped hold so quickly followed by the assessment of so many towers across the UK just brought home the message that we need to manage the public purse but not by putting people in harm’s way. The haunting image of the firefighters sitting exhausted against the backdrop of Grenfell tower with tears in their eyes will remain imprinted in my memory forever.

There have also been two tragic attacks in London and the attack in Manchester.  I had friends and trainees involved in the care of the London victims. The toll on the victims and their families cannot be imagined. There is also a toll on the Emergency Services and the NHS staff who also need debriefing and will take time to come to terms with what they have seen.

I went for a drink with my sister in a London roof top bar. We spent a lovely evening in the sun and I had my first drink of alcohol since my surgery. As we both looked out across London’s skyline and the bridges that span the Thames, we could not stop feeling saddened at the events of the previous weeks and of Manchester where innocent adults and children had become victims of a war that has not been declared officially but had become an entity insidiously.

Even though these events had occurred so recently, it was great to see London alive and kicking. We will not give up our liberties and way of life through fear and violence!

I also spent a great evening with friends in Twickenham at a restaurant ‘Mosaico’. It is a lovely Italian restaurant and I went with friends from across the world. We sat and ate gorgeous food, drank wines imported from the globe and listened to Jazz music played by a Brazilian group. This is how we should be living, enjoying the best of all cultures and respecting that there are differences amongst us all but that they CAN be overcome.

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/

Weeks 6 to 12

Determination has now taken over from Frustration. I need to set myself daily tasks that MUST be completed by the end of the day.

Scented flowers, some of which I have never seen before, seem to be a feature of my recovery and continue to arrive! I know in the future the hint of flowery perfume will transport me back to this time. When my mother passed, I inherited all her beautiful silk saris, some handpicked by my father as wedding gifts. They have their own place upstairs and whenever I open that wardrobe, I can picture my mother wearing each sari to a cherished special occasion. I can also imagine Mummy standing beside me as the waft of perfume that my mother used to wear hugs me.  Somehow that wardrobe continues to provide comfort. The saris are classically beautiful and vintage, some embroidered with gold and silk threads, they will be worn again and again and then handed down but only I know their true worth.

I have dried all my flowers and have started making items for a charitable sale in the future. It is a healing activity. I have to concentrate and plan each frame. It is detailed work and makes my headache return each day but I feel a real sense of achievement every time I finish one. My sister posts a finished frame onto her social media site and I get a sale!! How exciting. Now I am spurred on! My collection is growing and I will arrange a celebratory gathering in the future with an aim to raise money by selling all my wares.

Life is normally so busy and it is rare to get a chance to slow down. This illness has forced me do so. My two children bought me a beautiful painting set at Christmas pointing out that I used to love to paint and suggesting that this forced time off work would be a good time to restart. I have had the wooden chest containing the oils and watercolours out for several weeks but have not had any energy to get going. I now start slowly and rediscover the joy in painting. Why is it that we get so consumed with work and children that everything else is put aside. Or maybe it is just me.

I have my first check up at the John Radcliffe. I get up early, get dressed and actually put some make up on. I look okay and decide that I need some wedge heels to complete the look. This will be the first time since my operation but I am determined to manage my heels today. I wear flats in the car but change to heels walking to my outpatient appointment. There is a notion that suggests that what patients wear changes the patient’s perception of illness as well as the clinicians’ thoughts on discharge. Pyjama paralysis is the term used to describe the inertia that creeps in when you are in pyjamas even when you are in your own home. And this gets much worse in hospital. One of my previous Consultants used to say that if a patient (female) had lipstick on then they needed to go home. As trainees, spurred on by this, we would encourage our patients to put lipstick on to persuade this Consultant to send a patient home when the patient was desperate to do so!

My sister reminds me to write down any questions I may wish to ask as I will get distracted when I get to see my Surgeon. I know the two most important ones. I really, really want to start back at work and would love to drive again.

Thinking of my current inability to drive takes me back to the time when I really disappointed my Daddy. At the age of 88, he was still driving but was becoming unsafe (in my opinion). I felt that he really should stop driving but knew that this would take away his independence. We did discuss this as a family, all of whom agreed, but I was the one who had the conversation with him. He was so irritated by me and it was only when we promised that we would take him for an independent driving test, that he agreed to consider this any further. The driving test was as expected and the team felt that Daddy could drive but only in the daytime and only to and from a limited number of destinations (all very close). They messaged this so well that Daddy felt empowered to make a decision that if he was not a 100% safe that it was probably better not to drive. I learnt many lessons about communication that day!

My sister drove me to the John Radcliffe and the trees en route have never looked so good. The cherry blossoms are in bloom and seem to have peppered all the hedgerows as we travel to Oxford. I have many pictures planned in my mind when I next find an opportunity to paint. Talking to my sister, I realise that I am struggling with the right-sided deafness which is worse than I ever expected. In quiet conditions or in a one to one conversation, I am fine. In the car, with music on, I struggle with hearing my sister clearly and I am sure that this in itself makes me feel tired. My facial movements are completely normal but I have a very dry right eye but because I keep rubbing it, I have developed great bags underneath this eye that no amount of eye cream will improve. My balance is manageable and I know that this will get better. The tiredness and inability to hold multiple thoughts is frustrating but now expected and I will just have to manage. I have started texting myself everytime I remember something I need to do otherwise I forget.

I have joined many Acoustic Neuroma groups and feel guilty reading posts from others. I have been so lucky post operatively whilst many fellow patients have not. Surgeons are skilled clinicians but my father was always the one to point out that ‘no matter what a surgeon does, Mother Nature is responsible for healing’. I managed to escape in the healing process without any major complications so certainly all the good wishes and prayers sent to me, worked.

I follow the progress of ordinary people like me who have undergone surgery previously or in parallel to me. Some have made the same progress as I and I laugh when I see that our milestones and frustrations have paralleled. Others have had a much slower and debilitating progress. I cannot tell you how lucky I feel but I have to put myself in the shoes of others whose whole lives have been turned upside down. Some have had significant facial disfigurement and are wondering out loud on social media how much recovery they will have. Others are still nauseated and very unbalanced. Others are six months out of work and are still struggling even with a phased return to work.

Every Surgeon that I know goes to work aiming to improve the lives of their patients rather than cause life changing events through surgery but complications happen in all of our hands even when surgery is really straightforward. This is why we ensure our patients are consented fully and are aware of  what might happen. I do this every day I practice but the absolute gamble as to whether YOU are the one who will encounter these problems cannot be foretold and I had completely underestimated the anxiety that this causes.

I attend my outpatients with my Surgeon. I think he is pleasantly surprised when I walk in. I still look a wreck despite my make up as my hair has become white. On men this looks distinguished, on a woman, well I just look old. He is pleased with the scar although this is still healing. I explain that I wish to dye my hair and although he agrees, his Nurse Specialist suggests that I wait another two weeks until the scar is fully healed. He knows that I am keen to go back to work and suggests a phased return at three months. He warns me that I will continue to be tired and I explain that I really believe him now.

The Surgeon and I had discussed the compromise of leaving some neuroma behind in order to maximise the preservation of the facial nerve. I have already had my follow-up MRI last week and we go through the scan results together. There is a 5mm residual part of the neuroma wrapped around the facial nerve which is very easy to see. It will need monitoring and if it grows, it may need cyberknife therapy in the future. My Surgeon explains that I will need another scan in October. That is a long time away and I forget about it. He is happy that I can start driving when I feel ready and when looking over my right shoulder stops hurting my neck. I feel like I am almost back on track.

I am so elated that I go shopping into Epsom the following day with my neighbour. I wear flats and enjoy looking around. But this is too much, too quickly. My body tells me to slow down and I fall asleep exhausted in the early evening.

I seem to be making steady progress and I reevaluate my previous commitments. I had enrolled in the Kings Fund Senior Clinical Leaders course and originally decided that I would not attend module 2 as I would not be up to it. I had not made any promises to myself after desperately wanting to attend the Association of Surgeons in Training conference at week 6 and really just being so naive at thinking I would be able to make it! I feel that I could attend the Kings Fund if I get a taxi and sleep there and back. I get my hair dyed as soon as I can so that there is some semblance of normality and I feel back in control. The course is excellent but I cannot physically attend on day 3 as I am so exhausted and end up in bed all weekend.

I still cannot engage with emails as I struggle to concentrate for long enough and I have not dared open my work emails. Twitter has been great way of communication, and a saving grace, as it makes you feel that you are part of the real world. You can Tweet from your bed and it takes very little concentration as you can dive in and out very easily from any conversation.

I am beginning to feel normal though and the weekend of Week 12 has been a great goal to look forward to. My sister and I have booked birthday presents for each other and this has ended in a personal shopping expedition, a styling session, a photo shoot and an overnight stay in the Tower Guoman in Central London. We travel into town and book in. We have a fantastic room overlooking Tower Bridge and there are crowds of people in town. We travel into Oxford Street and start the session with the personal shoppers. One takes her time and understands her client and guides her to exactly the right styles for her body shape. The other, does not get to know her client well and pulls clothes that are completely inappropriate and makes the client feel quite deflated. This reminds me of our current trainees, if you take time to get to know them and what they need, they tend to do well and flourish in a firm. If there is no educational engagement then the trainee gets along but does not feel invested in and just about survives in the current environment.

We go out for a Chinese in the evening and I look around at people walking past. We have no idea how people are managing in their lives, whether they are sad or happy, well or not, financially secure or just coping. We all wear our own facades and get on with our busy lives. Perhaps we should all take a moment or two to really look around and smile or do a good deed but not let anyone know.

The following afternoon we enjoy our photo shoot. I look at the photos which show the aftermath of illness which cannot be hidden by make up. I think back again to my companions on the acoustic neuroma journey.  Everyone has their own story and determination to back to as near normal as possible. The sharing of stories has always been a way of helping each other. Knowing what has been achieved by others gives us the hope that we can achieve this too. I look forward to the improvements and updates shared on social media and thank everyone for their honesty.

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/

Weeks 2 to 6

The last four weeks have been amazingly hard as well as fantastic. I have been at two ends of that spectrum on a daily basis. It is incredible what an operation does to you. The exhaustion that follows surgery makes you feel vulnerable as your independence fails and you need help for so many things. On the other hand, it sets the hurdles that become sequential challenges on the way to recovery.

The second week really reset my own barometer as to what I should expect to do for the first few weeks.  Simple tasks such as brushing my teeth, having a shower and having breakfast remained major challenges. Sleep became a necessity and I slept most of the day just waking up to be fed. Cleaning the house, cooking and ironing were not a priority.

I have a wonderful neighbour who visits everyday and has made me (yes made me) go for a walk as long as the weather is good. I am glad that I have not bumped into anyone else for the first few weeks as I have been out wearing pyjamas and a coat.  Just walking to the end of the drive seems such an achievement and walking to the end of the road feels like finishing a marathon. Even though it is cold, I am wearing my flat open toe shoes which is my excuse not to go for a walk when it rains. I think it was in week three that I tried wearing my heels in the bedroom as a test run. I haven’t tried since.

The children have been home which has been a welcome distraction. I cannot believe that they have finished their second term at University. My parents used to say that time seems to pass by quicker the older you get. I think I finally understand what they meant. This year is a milestone as both boys went to University at the same time and the ’empty nest feeling’ became an entity.

I think back to the start. When we found out in October that I had an acoustic neuroma, we made a decision to let the family know when we had made a decision as to when and what we were going to do. Telling the children seemed to be a special hurdle and I really did not want to tell them. It seemed wrong to tell them during their first term at University when they should be having the time of their lives so we decided we would tell them when they came home for Christmas. Even then, I tried to get out of it. There just seemed to be so many things going on which were perfect excuses. We spent the first weekend of their Christmas break at my in laws at a Christmas party. The next week was busy as I was on call and then it was a friend’s birthday party the following Saturday. We had a family dinner on the Sunday and the boys went upstairs to play computer games when we decided we really did have to tell them as otherwise it might ruin Christmas. My husband called them down saying that there was something that we both needed to discuss with them.

Eventually they both came down and my husband explained what was going on, my diagnosis, the need for an operation and potential complications. Neither boy seemed phased by this, were very supportive and said they would take time off from their studies during this time. The oldest one seemed perturbed and then declared ‘You know we thought you were going to tell us something else’.  Then he explained what he meant. He had noticed that I had not drunk alcohol at both parties and that I was and looked tired. In addition, as my balance became much worse when it was dark, my husband had helped me back to the car the night before, he had noticed that Daddy had become VERY lovey dovey! There was clearly only one reason for all of this – I must be pregnant, after all the boys had left us on our own for ten weeks!!!!! And apparently, this would have been a more disastrous scenario than the diagnosis of an acoustic neuroma. I am not sure why we had been so reticent in telling them as they took the information in their stride and have just been wonderful.

I managed to avoid visitors during the last few weeks as trying to socialise continues to be tiring. Very good friends and immediate family have come to visit and looked after themselves, making me tea and bringing even more flowers and chocolates. My hearing started becoming an issue. I seem to have lost the ability to isolate the direction of sound as well as hear when there is lots of background noise. The noise generated by a handful of visitors caused a headache and was irritating as I could not follow a conversation in the room. I needed to pace myself as I certainly developed more symptoms when I was tired; my balance changes and the side of my head becomes increasingly more painful. The more I slept, the better my symptoms seemed to be.

After four weeks my friend decided I needed to go out as I was going stir crazy! She pushed me hard and finally got me to say yes. We decided to aim for afternoon tea at a local tea shop. She had chosen one that would be quiet and also would require the least amount of walking. I pulled on trousers and a top, washed my hair and dried it but still could not summon the energy for make up sadly. I looked in the mirror and still looked exhausted. I went grey around 30 and normally have to dye my hair every 6 weeks. Men with grey hair seem chic whilst women look a little old unless they can wear the look well. As I am not allowed to dye my hair for 8 weeks, I was developing a real badger streak but there was nothing I could do about it in the short-term. I had also noticed that the side of my scalp on the operated side was slightly numb and was more sensitive to changes in temperature. A good scarf seemed to manage this problem so I ventured out wrapped up warm and cosy.

I was driven down to Headley and we went to a really lovely small tea room and village shop. It was perfect, no one else was around and we had the table by the window just as the sun came out. We ordered scones with jam and tea although I could have quite happily order the whole menu. The scones were freshly baked and warm. The butter was just soft enough to spread and there was heaps of home-made jam. The tea was served in a mish mash of old china crockery which matched by the fact it was all vintage. What was not to love? We spent several hours chatting and I felt amazing! If I could do this once, I could do this again.

http://gahoashoo.wixsite.com/headleytearoom

I spent the next few days recovering as my energy reserve seem to be at an all time low. It was almost as if my energy was rationed, if I used too much energy on one day, I would have to pay back on another.

I developed small ways of keeping myself busy over these few weeks. I have (with help) put all the flowers I have received into silica gel so that they will dry. This has been trial and error but we seem to be getting better at it. As the flowers dry, they have been stored in plastic boxes in my kitchen and it now looks as if I have a workshop rather than a kitchen. I make plans to do something creative with them and have ordered some frames and paper butterflies. If I can make some items, I will sell them for charity at a later date. I also decide I can make rose soaps and candles so order some moulds and wicks. I also decide that I will make the flower pictures for my two boys and keep them as fiftieth birthday presents for them. I therefore order two large frames and borders. Now that all plans are being actioned, I wait for the Amazon deliveries to start arriving!

We really are so lucky to have the two boys. They both came home for Easter to spend time with me but also kept themselves busy. The youngest one has been lambing and has really enjoyed seeing the birth of new life and taking responsibility for decision-making that ensures a good outcome for the sheep and their new lambs. There was sadness too with one lamb being born with a neurological condition that was debilitating and required a humane end to its life. My son was impressed with the passion of the farmer to ensure that his flock got the best care and start to life.

This joy of life was in contrast to the experience of the oldest who went to Poland with friends to visit the remains of Auschwitz in Poland during the same time period. He recounted the emotions and feelings when visiting the vast area. He described the unimaginable scale and the efficiency of a sheer killing machine which was only understood when you visited in person. He was clearly moved and could not understand how such evil could have been inflicted on so many.

Having been through surgery and feeling as if I have been given another chance at life, I feel even more emotional at the evil that still exists in society. The lessons of the past need to be remembered to ensure we do not drift into further atrocities. We need to stand united and enjoy each other’s differences and do what we can do to influence in our small circle, hoping that the positivity flows out and gains momentum.

Wishing for peace in 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/

Today is my 50th Birthday!!!

I have been home one week and time seems to have stood still again. I have managed very little. Although I was warned that I would be tired once home, the reality is very different. It is impossible to do anything without feeling so fatigued. The need for sleep is immense but not always possible and I find myself awake for hours at night, with endless random thoughts and dreams. Partly because of this, I have not managed to get downstairs after a shower before 2pm. My head hurts and my neck aches but all the time I am grateful that I did not have any visible facial complications or major balance problems.

I have not been outside of the house yet and my plans of daily walks have gone out of the window. Daytime television and the internet are fantasies, as I cannot concentrate on anything for a long time without a serious headache. I am reminded how hard our brains normally work without humans paying any attention to these inner workings. I count myself lucky that I have such fantastic colleagues and friends that I have been able to delegate all my activities with confidence and have left my trainees in great hands. Despite this, odd thoughts keep flitting into my brain  of things I have not completed but these are very random and it is difficult to hold onto these thoughts to make any decisions! I am really struggling to see how I am going to return back to normal.

I have had the follow-up phone call from the John Radcliffe and am progressing as expected by all apart from myself! I will know next week whether this was a benign tumour but in my heart of hearts, I already know that all will be fine.

I think about today. I had started planning my 50th birthday a year ago. My sister and I had considered many ideas as to what we could do and had started to buy various little accessories for the party. I had never considered that I might not be well enough to throw a party. My diary is normally overfull and I could do with expanding my day from 24 to 30 hours. I really enjoy being busy and being organised (at work that is) and have many commitments in the diary a year in advance of now. This illness has made me realise the value of time and the need to enjoy the now. I know that I would not have stopped to consider my career and life plan without a serious illness to stop me and I am just so lucky that this is one illness that will let me get back to as near normal as possible.

When I woke up today, there were many cards, and the flowers have continued to arrive. I had so many beautiful bouquets since I arrived home and the doorbell has not stopped all morning with further deliveries. Each one is thoughtfully chosen with a heartfelt message attached and a trigger to make me cry. Patients, colleagues, friends, neighbours, trainees and complete strangers have left messages on the blog, Facebook and Whatsapp. How can I not feel better?

I struggle to get out of bed and have breakfast. I have been trying for two hours but I know what I want. I have developed a longing for toast with lots of butter. We must all go back to happy, safe times when we are in need. My mother and father were market traders when I was little. On Saturdays we would travel to Holyhead in Anglesey, North Wales. We used to arrive very early and would unload the van and set up the stall with my parents, brother and sister. In the far corner of the market, there was a huge bakery stall. They sold freshly baked bread, which first thing in the morning would still be piping hot. The smell of fresh bread drew so many customers and was good for trade for all in the market. They also sold homemade Welsh butter and jam. The three of us would enjoy doorstops of fresh bread with melting butter aplenty for breakfast and so the smell of bread always takes me back to this time. Holyhead market which was held in a Grade II listed Market Hall which was designed in 1855 by J Edwards Thomas. My brother, sister and I visited North Wales last summer and were saddened to see the ongoing demise of this beautiful building, I am so pleased to have learnt that Holyhead council have won a £2.4 miilion Heritage Lottery Fund grant and will restore it to its glory. Daddy would have been very pleased.

http://www.anglesey.gov.uk/empty-nav/news/press-releases-2017/january-2017/holyhead-market-hall-restoration-set-to-begin/130839.article

See I told you I hold random thoughts! I really do need to get up nd I need to have a shower. The plastic chair in the shower is a godsend as my legs feel so weak and I cannot stand for a long time. I feel like my 90-year-old father who needed a seat in the shower in the latter years! It still takes me around an hour to shower and get dressed. I cannot dry my hair with a hairdryer and natural drying leaves me with very frizzy hair. I have not been able to summon the energy to put on any make up and contact lenses are a luxury. There will be no photos of me on my birthday then!

The immediate family will be gathering in the evening and I am further grateful for mother nature’s best gift to me, of health and well-being. Everyday I am thankful that I have not had to manage a shortened life expectancy nor a  physical life changing event. Those that do are so courageous and I can only empathise but cannot even start to fathom the emotions and decision-making undertaken by those individuals.

As I try to choose what to wear, I am reminded of previous birthdays. One of the delights of working in the NHS is that you develop an extended family. Traditionally we have had a family celebration and a work celebration. Somehow over the past few years the trainees have started baking me cakes and decorating them. The trainees are so talented! Every year the themes have become more amazing and the cakes are so professional.

One of the trainees has turned professional and baked my sister’s 40th birthday cake. She loved it!

She also made my Daddy’s 90th birthday cake which was incredible.

We added photos of the many friends and family whose company Daddy enjoyed on smaller cupcakes. Everyone enjoyed finding their own ones!

We often celebrate with my NHS family in a central London venue as this is convenient to all. One has become a firm favourite and we get very special treatment. Yet again a few years ago, we all had a very enjoyable evening and then I was surprised with my birthday cake.

I can only try to describe the horror on the faces of the other guests at the venue. We all work in a clinical setting and there are many situations which would make people turn away but it is the bread and butter of our workload and we get on with it. I think we forget how alien these situations can be to other people not in our profession. There are so many sad times, when as Daddy used to say, we cannot halt the natural timeline when people pass away, that we find a way to manage the strong emotions within our groups of friends.

The cake was amazing and the trainees had clearly thought about the things I really care about. I am passionate about ensuring that patients with diabetes do not develop foot problems and if they do that they get rapid access to care. Sometimes patients need minor or major amputations, which causes great mental and physical anguish to these patients and their families. We use maggots alongside surgical treatments for these patients. We call the maggots, minute surgical operatives, as they eat any dead tissue and clean a wound beautifully without destroying the healthy tissue around the damaged site. In the early days we would use free ranging maggots that would sometimes escape the bandaging containing them. Nowadays we use maggots encased in very fine netting which allows them to work but keeps them in one place!

This cake was a replica of a diabetic patient’s foot complete with an amputated toe and maggots which had escaped the netting! We were enthralled but my apologies to any non NHS staff who were put off their food that night!

Last year, I had another wonderful cake and really did not want to cut into it! I remember feeling exhausted during the evening and it is only in retrospect that one can explain why.

This cake was decorated to resemble a open human abdomen and came complete with surgical instruments with blood still dripping off them! It took me all evening to agree to cut and share it as it was absolutely beautiful.

This year feels very special. Yes of course a 50th birthday is special but this year feels as if I have been given a second lease of life.

I have spent each day post surgery in pyjamas as it takes too much energy to get into clothes but I have had to make the effort today. I seem to have spent the whole day having a shower and getting into trousers and a top. I cannot summon the energy to put on make up and as I am not allowed to dry my hair yet, I come downstairs looking like a bedraggled rat!

I must have my stitches out today and rather than wasting the time of the district nurses, I have asked my husband to take them out (with full permission from my Surgeon). There are millions of stitches and he takes them out for me very carefully and slowly. What a great birthday present!!! It is really odd how each of these very small steps feel like a gigantic leap towards being normal again.

I am spoilt by neighbours and family and I have a gorgeous cake bought by my husband (and a second one bought by my sister) but I am so tired. I cut the cakes and open my presents and cards but I just want to go back to sleep.

We make a decision that I will have a 50th birthday again next year and make sure I invite all my friends. It is saddening to think of my close friends from my early years, who I am in touch with via Facebook and LinkedIn but have not actually met or talked to for many years. I make a promise to myself to get in touch with all and try to meet up at least once in the next year. And I know that as soon as we start chatting it will be like we only talked yesterday. Children and work seem to take up all available time but I need to find time to catch up with things that really matter.

I go to bed as I have a headache developing. Thoughts start to wander into the future. My children are 18 and 20. I start to think about their 50th birthdays. What will life be like 30 years from now? 30 years ago we developed the mobile phone, disposable contact lenses and CDs effectively wiping out my beloved cassettes. The Mackintosh computer was the in thing! How we have changed. The current mobile phones have as much computing power as a roomful of computers and music is downloaded and played so CDs are going out of fashion. In contrast vinyls are making a comeback. What will be in vogue in 2047? Driverless cars, flying cars, communication by telepathy, travel by thought? Who knows?

Will global warming have caused shifts in water levels with London being flooded? Will the Great Barrier Reef still be colourful? Will we have inhabited Space? What kind of world will we live in? I say we but I will be 80. A macabre thought fills my head. Will I still be here by then? My Mummy suddenly passed away 63 of a heart attack and everyone tells me that I look like her.

Will the world have found peace or will it become more divided than now? Will it still be here? Too many questions and no answers. Now my head has started to hurt. More thoughts wander in and out. I have so many flowers. Perhaps I can dry them and turn my 50th birthday flowers into a present for the kids for their 50th. I start to consider all possibilities and fall asleep.

Friday morning. Another restless night. It was difficult to find a position to sleep in and the wards were noisy. I made a decision last night that I would go home on Sunday as I had planned preoperatively. I now needed to persuade everyone else.

Yesterday going home over the weekend seemed an impossibility but I calculated what I would need to do to manage this. The critical task would be to do the stairs under the watchful gaze of the physiotherapist to ensure that I was safe to go home. Without this tick box, there was no way anyone would let me escape! The journey home would also be an hour and a half and I would need to ensure that I could sit in a car without motion sickness. Game on!

I managed to have breakfast and have a shower before lunch and then fell asleep. I was woken by the physiotherapist who suggested that as I was so tired that I should leave the stairs until Monday. I think I must have got myself out of bed and into the wheelchair in the quickest time possible. I managed to get myself up the stairs and down again and then back to bed. Mission accomplished! Not sure where the energy came from and my brother and sister were shocked that I had done this so quickly. 

My Consultant and the team visited and said they would review me over the weekend and if I was well, would agree to my discharge. Interestingly, throughout my stay, I saw more senior than junior doctors. This is worrying, as it is sharing the experience of senior decision-making that allows trainees to develop.  Trainees find that they are forced to work odd shifts that prevent them from learning from the continuity of experience that we enjoyed in the 90s. On two occasions, the most senior registrar had no team accompanying him, as there was no-one, and he was doing all the work that two or three people do by himself!

I did little on Friday and Saturday apart from eat, sleep and contemplate. Privacy on the wards is difficult and the staff were excellent in ensuring that dignity is preserved at all costs. Patients around me were travelling on their own difficult journeys but even when ill, it was noticeable that there is a recurrent strong human desire to connect with each other. Whether that is just a smile, a greeting or alerting staff when a fellow patient needs help. I had moved within the ward and therefore had to walk further to the bathroom. This was a challenge of course as Miss Independent was desperate to ensure she could do this and have the confidence of the nursing staff, so she could go home. The husband of the patient next door  was very sweet and although he did not say anything, he kept a careful eye on me walking whenever he was there. 

You cannot but overhear conversations on the ward and patients were concerned with paying £12 for the bedside television. Many years ago, each ward used to have a patient area with a  free television that encouraged patients to leave their beds and spend time and conversation with family and other patients.  Many tv lounges have been replaced as there is a greater need for bed space in our hospitals. Now we charge for the bedside tvs. I do often wonder if these tv companies reduced the price for each bedside session by half, whether more people would actually use them and they would increase their profits.

Overnight many patients were admitted and discharged. The turnover through the beds was immense as well as those needing longer term neurosurgical care. One young patient had been in or several days and was desperate to go home. The patient was keen to take their own discharge against medical advice and the staff worked hard to understand the concerns of patient and family to ensure a safe, timely discharge.

Another patient was very keen to go home. They had an accident whilst they had been away from home and their family had travelled to stay near them during their acute admission. Finance was obviously being stretched as the area around the John Radcliffe is not cheap to rent. They and their family were keen to get an early discharge as otherwise they would have to pay for another night in a hotel for three of them. 

This made me start thinking again about the NHS. We are privileged to live in a Nation where we do not have to think about the cost of care as we make decisions about interventions for out health.

Daddy was 90 when he died. The last few years required repeated hospital visits and care as his medical health changed and dementia set in. We were able to access this without a concern that we would not be able to afford it nor whether we should take him to hospital. 

I thought about my own care and listed all my treatment so far:

Medical outpatient x 2

Diabetologist x 3

Cardiologist x 2

Neurologist x 2

ENT Surgeon x2

Neurosurgeon x 5

Audiologist x 1

Nurse preassessment x1

Inpatient stay of 6 days

ITU stay 1 day

Procedures:

Craniotomy for an acoustic neuroma 10 hours

CT scan x 5

ECG x 2

Echo x 1

Dobutamine stress Echo x 1

CXR x 1

Bloods Full blood count, Urea and Electrolytes, Glucose x 4 Cross Match x 1

Medication: 7 days

Estimated Costs 

Private Costs in the UK: £20, 000

Private Costs in the USA: $50, 000 (I have been advised by many readers that this is a gross underestimate and that $500, 000 is  a more realistic figure)

Cost in NHS: 0

There must be many who feel very strongly with regard to the NHS and surely it is time to ask the public what they want and how to fund it. I am eternally grateful for my care as it will get me back to active life doing what I love and enjoying time with my family, colleagues and trainees.  

I was in awe of the night staff in my bay, who had a very difficult job managing a patient who had a bleed within their brain. This caused nausea, vomiting, confusion and a need for expert nursing and medical care. The dedication of the nursing staff was exemplary in the way they were able to manage the patients concerns and fears. Despite the nursing staff being so busy with this patient, I still felt I had the attention I needed to ensure that I had pain relief and all my observations were done. Despite the fact it was only day 7, I was already fed up of the needle prick to ensure my sugars were fine and developed real empathy for my patients with diabetes.  I needed to get out of hospital!

I knew that I would have a long journey on Sunday and was really worried about feeling sick whilst travelling. So we decided that I would visit the coffee shop in the wheelchair. I soon discovered that this was going to be an uncomfortable journey but my brother was a great driver! It was great to get out of the ward, even if just down to the main foyer. I was beginning to feel quite depressed and wondered how my patients managed being in for many weeks. When staffing levels on wards seemed better  many years ago, I remember Ward Sister (with whom you did not argue) asking junior nurses to take patients into the sunshine in wheelchairs, when they had no family or friends of their own to do so. Not sure we do this now at all?

The next day, my husband arrived bright and early. I was given my medications and take home letter. My dressing was changed and I managed to escape on Sunday morning. I had planned to change into outdoor clothes and flat shoes but did not have the energy to do so and left in my pyjamas, dressing gown and slippers. 

The journey back was long. Every bump in the road made my head hurt. I had taken painkillers before I left but these did not seem to make a difference. My body ached but it was such a relief to sit in the car knowing I would be home soon. I am not sure why but I started crying as soon as I sat in the car in the car park of John Radcliffe much to my family’s dismay. I discovered that travelling with my eyes shut seemed to be the best and my husband had to drive reasonably slowly otherwise I felt quite queasy.

Home was strange. Suddenly you feel very vulnerable. I was worried as to whether I would manage the pain but I had several strong painkillers sent home with me. My sister posted on Facebook for me and I felt that I started to reconnect with the real world. When she left later on, I opened up the computer and started to see what had been going on. I began to feel quite tired and made the difficult trek upstairs and tried to sleep having taken the strongest painkillers. 

My brain was obviously not used to thinking and concentrating and it rebelled. I had the most awful headache and just could not sleep. I spent a very restless night and was unable to get out of bed in the morning. I did not touch the computer for several days!

The next few days were spent in bed, in pyjamas doing nothing. I was so exhausted and just could not get myself going. I ate, drank and slept. It is interesting how we all return to our basic needs. My family was wonderful and made sure I had my pain killers on time. We rediscovered my father’s neck warmer which was a godsend. 

Then the flowers, cards and best wishes started pouring in. 

I was surrounded by the scent of flowers and humbled by the good wishes and prayers to help me get better. This is my kitchen table by the end of the first week! Thank you to all of you. When there are so many evil occurrences in the world, gestures like this make you realise how wonderful human kindness and caring can be.