Heels On: Week 12 post Acoustic Neuroma Surgery

FeaturedHeels On: Week 12 post Acoustic Neuroma Surgery

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.

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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.

 

 

 

 

 

Realisation

FeaturedRealisation

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.

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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.

 

 

 

 

Will making new doctors work in the NHS for five years improve retention? BMJ Blog

FeaturedWill making new doctors work in the NHS for five years improve retention? BMJ Blog

It appears from the language used in the consultation that there is a desire to seek justification prior to implementation. A recent poll on YouGov reminds me of the quote “you need to ask the right question to get the right answer.” The heavily biased question: “Under new government plans doctors could be forced to work in the UK for at least five years after completion of training or payback for some of their training courses. This is because many doctors leave the UK after training to work in other countries. It costs the taxpayer £230,000 to train a doctor over and above the fees paid by the individual. Do you think doctors trained here should pay some or all of this back if they leave the UK less than five years after training?” gained a 91% positive response.

H L Mencken wrote “For every complex problem there is an answer that is clear, simple, and wrong.” This feels like the wrong answer to the wrong question.

I think back to my early years post qualification. I worked over 80 hours per week doing a 2 in 5 rota. I was taught medical skills and enjoyed great camaraderie with my colleagues, spending time together, and working as a team. In my first house job, I was on the surgical on call rota and there were many more junior doctors on call in 1991 for a shift than there are now in 2017. My consultants took me under their wing and mentored me about my career plans. I spent four years deciding on my final career pathway and enjoyed my jobs. Although I was tired, I felt valued by the system. There is no doubt that the hours did not suit everyone and the reduction in hours was welcomed by the profession.

Now, trainees are working in an intense and underfunded system where staff do not appear to be valued. The environment developed has forced junior doctors to think twice about their long-term career options. Those that wish to stay are galloping through their first year of clinical practice, developing their portfolios to show baseline competence and a competitive CV for their chosen speciality. To achieve the essential criteria, they need evidence of leadership, management, teaching abilities, audit, and quality improvement projects. They need the ability to convene courses as well as be trained, and also be great mentors and colleagues. And of course, they need to pass the necessary exams. Within 18 months they need to have a concrete career plan and they need to achieve a core training post to have any incremental increase in salary. Team structures have been abolished and junior doctors do not feel part of the team.

It is no wonder that trainees feel demoralised and burnt out. They are coerced (outside of any goodwill left) to cover for absent colleagues due to rota gaps and often need a break after two years in a high-pressure environment. They take time out by going abroad, or explore career options in trust posts or as locums to allow them to test out other avenues whilst they decide on their final career pathway.

At present half of Foundation doctors (2 years post qualification) decide not to continue into a definitive career pathway in the UK. The Government suggests that conscription into five years of NHS service post qualification could improve retention akin to military training. The parallel to military recruitment and retention would be welcomed if the terms and conditions were similar. At present military medical cadets are paid a salary throughout medical school as well as educational fees. These trainees are valued by the military and are resources that are heavily invested in, to ensure they are equipped for service. If a military cadet wishes to leave, they can give notice and are required to pay back any expenses incurred. If similar terms were offered to medical students and doctors, because they are a valued resource which is worth investing in, retention would not be a problem and the discussion of conscription would not be necessary. Yet again, the Department of Health is trying to fix a problem with a sticking plaster rather than understanding the root of the problem.

Would a five year conscription improve the retention of junior doctors? Or will it cause an exodus of trainees after five years?

Are these the right questions, or do we need to ask “Why is there a retention crisis in the NHS?” We need to address junior doctors’ morale in order to solve this.

http://blogs.bmj.com/bmj/2017/03/29/stella-vig-will-making-new-doctors-work-in-the-nhs-for-five-years-improve-retention/

Stella Vig has been the foundation programme director at Croydon University Hospital for 10 years and holds many roles, including those of core surgery and higher surgery training programme director, JCST chair for core surgery, and general surgery SAC member. She is one of three clinical directors for Croydon and is keen to see efficiency and excellence in patient care within the NHS. 

Competing Interests: I am a member of RCS England Council and a trustee for the Society of Chiropody and Podiatry. 

13/03/17: I’m 50 & Day 14 post acoustic neuroma surgery

Featured13/03/17: I’m 50 & Day 14 post acoustic neuroma surgery

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!

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

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

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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.

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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.

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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.

 

The Great Escape & Cost of Care (Thank God for the NHS) Day 6 post op

FeaturedThe Great Escape & Cost of Care                           (Thank God for the NHS) Day 6 post op

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.

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My Daddy

FeaturedMy Daddy

12/4/1925 – 26/12/2015

It is Daddy’s birthday today. He would have been 92 years old.

I can only thank the NHS for keeping him with us for the last 10 years. I remember talking to the Consultant Geriatrician who warned me that Daddy might not survive his admission years ago and the many NHS staff who looked after him thereafter. I have often thought, could we have afforded private healthcare? Probably for a while but I struggle to sum up the cost of his multiple admissions, each in a weaker state but discharged able to manage life again and spend time with the family.

The NHS allowed us to enjoy Christmas Day together and he passed away on Boxing Day. He was a wise man and respected education as well as the NHS. These are his words from August 2015 when doctors and their families began to realise that we were not valued as NHS professionals.

‘I am 90 years old. I have seen the world change. For the better, perhaps. We do not seem to have learned valuable lessons and I see cyclical change. This is true of wars where we still see refugee crises as people try to ensure that their children have chance at a better life by living.

At the age of 5, I witnessed my fellow travellers being killed as they were not of ‘the right faith’.  My aya or nanny, saved me because she had taught me religious words from her faith, which when recited allowed me to live. It was so devastating to see the massacre in Kenya recently where the same ideology applied.

I also have seen the cyclical and damaging changes within the NHS. I have seen properties sold off and hospitals that I have used previously being closed. I have seen policies and targets introduced which are ‘innovative’ but seem to be gross errors that just make it worse. There is no culpability and the NHS carries on with an increasing deficit.

Many of my colleagues from India were successfully working within the NHS and contributing to the growth of the NHS. They were and are, service providers as well as educators of others. A draconian measure stopping this recruitment sent a clear message that they were not valued and others should not follow this path.

The consequence? Gaps in rotas and difficulties with the provision of services. The same is happening again with the demoralising and devaluing of the current work force which is pushing them to seek opportunities overseas. What is pushing them overseas from a stable cultural and environmental background?

Doctors are being driven to deliver more and more targets that are unachievable within the timeframes set and seem to have a political purpose rather than a patient focus. There seems to be more interference with clinical decision-making and so many hoops so that the doctors cannot deliver what they wish to, which is great care.

There appear to be many ‘new’ strategies for education which to be frank, I don’t understand but do know that the most valuable educational asset is the desire of one doctor to teach and develop another. I still see examples of this on my various interactions with the NHS but not as many as in previous years.

There are more and more managers within the NHS. I need great care delivered by great clinicians and need to see the value and impact of this increasing spend within the NHS. It seems as if we have developed a system which needs to be managed and so managers have to be recruited who then have to be managed.

Many doctors (and I know from my own), go into medicine to ‘help other people’. I have seen the self-sacrifice, the cost to family life, which doctors are willing to endure to ensure that their practice is delivering the best.  To report widely that this is not valued is a real kick in the teeth that really strikes at their heart. And this is not just doctors. All the nurses, podiatrists, diabetic nurses, physiotherapists, occupational therapists, porters and the lovely people who bring our food, give that extra that keeps the NHS alive.

My plea is that all the pressure groups. who have our interests at heart, work together to improve and sustain the NHS. Without it, my grandchildren will not benefit from the sacrifices we have made as war veterans, taxpayers and as professionals as my fear is the NHS will not exist.

Declared Interests I was a Labour Councillor in North Wales and the father of a Consultant Surgeon embedded in the NHS. ‘

I am saddened by the loss of a great father who along with my mother guided their three children and left great memories. We all miss him everyday but he left a legacy. Daddy was an altruist and  gave much to Penmaenmawr  in North Wales.

I hope that his concerns do not become reality and we lose a fantastic  NHS. There are many who will fight just like my father to ensure a secure future for their children both in education and health.

As Aneurin Bevan said ‘The NHS will last as long as there are folk left with the faith to fight for it.’

Well, let’s keep fighting.

A long night in ITU & BREXIT

FeaturedA long night in ITU & BREXIT

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 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.

 

Me and My Acoustic Neuroma

FeaturedMe and My Acoustic Neuroma

I have been a consultant vascular and general surgeon for ten years and am always busy. I have been tired but I have never been so exhausted as now, finishing a long theatre list on a dark October night.

I walk back to the car and feel unbalanced, especially in my trade mark high heels. Maybe I have just got to the age when I need to wear flats. My trainee comments that I am walking like I am drunk. Alarm bells start to ring.

I pop into the neurology clinic the next morning and explain my worst fears: ‘I think I have a brain tumour’. It is probably just vestibulitis after an awful cold, but it is not getting better. Instead, my symptoms are worse. I have headaches and I report that my right eye feels dry.

The neurologist reassures me but arranges a scan. She phones MRI and they can fit me in straight away. I have my scan and realise, because they need a second scan with contrast, that they have found something in my head. I am a professional but in those few minutes become a worried patient. I think the worst: what type of brain tumour, how large and where is it?

I find the neurologist waiting for me to explain the scan findings. They have found something. I have a 3cm mass in my cerebellum which is compressing my brain, causing the dizziness. It is not malignant but couldn’t have been sited in a worse place. I cry. The neurologist explains that I will need to see a neurosurgeon and their team. I have an acoustic neuroma.

Within two days, I am referred locally and told I need surgery; there is no other choice. I will need three months away from work. Then it gets worse. I will lose my hearing, there is a 20% risk of damage to the nerve supplying the movement of my face, a risk of damage to the sensation of my face, and to my ability to balance. I will feel sick after the surgery and, of course, there is the pain.

I listen and make my decision: I am not having surgery, there must be other ways.  Perhaps radiotherapy or just wait for it to settle. I become an expert on acoustic neuromas overnight. I read all the literature. The patient leaflet explains that if I do have surgery ‘it will attempt to preserve my quality of life’. Great.

I seek a second opinion and am reassured by the surgeon. I finally understand what I teach. To have compassion and to gain your patient’s absolute trust. In his explanations of the surgery, his words are comforting as he has pre-planned management of any complications that might be expected. I explain my own fears; I would struggle with a facial nerve palsy. He listens patiently and discusses all options with me. I take all the advice and it slowly dawns on me, I really do have no choice but surgery.

I start thinking about the cost of care and how fortunate I am in the NHS. I start calculating the cost in America and it mounts up to hundreds of thousands of pounds. I cannot imagine having to make sure that I can pay before taking advice, or letting the cost of care drive my decision making. I have my efficient and thorough pre-assessment and get a date for surgery in February.

In my rapid journey from being a professional to a patient, I have had so many worries. I have however been lucky about one thing. I am in the NHS