Nigel Smith
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Wednesday, November 14, 2001. So I’m in the surgery talking to this locum GP, an urbane old duffer who looks like Colonel Sanders. I tell him why I’m here; I have this numbness thing going on. Left side of tongue is numb, ring and fourth finger of left hand, left half of left foot, oh yeah, and left side of my face is heading that way too. I’m turning into Igor.
“Ramsay Hunt syndrome, old boy,” he chuckles, like I’m his naughty nephew with a grazed knee. He does everything but ruffle my hair as he ushers me out. He’s busy, he’s got 4,000 chickens to batter and stuff into stripy buckets. “Couple of days and it’ll sort itself out.” He was right about that. Two days later and I certainly wouldn’t have been back for a second consultation with anyone but God. For whom I’d have a few questions.
I learn later, because I do become something of an expert on this subject – something that annoys doctors – that my presentation (the posh word for symptoms) indicates a classic neurological problem. “Indicates” is not strong enough. Imagine I am walking about with a giant sandwich board with “this man’s got a brain problem” written on it in neon spray paint, with the arrow pointing straight at my head.
Instead of sending me away with a smile and a shrug to die at home, he should have immediately referred me to an NHS consultant for an urgent scan. Though the first available scan date would have been six to eight weeks later, and would have come through just as my headstone was being carved.
After my consultation I don’t quite make it home because I’m feeling a bit poorly. In fact I have a little sit-down in the waiting room. I ring my mate and sometime writing partner Phil Hammond (the guy on Have I Got News for You when they can’t get a proper comedian). Phil is a clap doctor but, in the same way country folk prefer to talk to vets than doctors, I give him a call on the moby.
Me: I’ve seen some bloke who’s told me I’ve got this syndrome but I think it’s doctors’ rhyming slang to get rid of me – you know, that I’m a bit of a Ramsay Hunt.
Phil: No, that’s not in the book. We use acronyms, not rhymes. Like, women who are into alternative medicine are Grolies – Guardian Readers of Limited Intelligence in Ethnic Skirts.
Me: Right. Funny. See, but I’ve got this numb . . .
Phil: Or on the notes we might write CK Bundy.
Me: Go on then.
Phil: Completely Knackered But Unfortunately Not Dead Yet.
[We laugh a bit.] Me: Back to me. [I tell him my presentation and await the usual knockabout stuff. Pause. A proper, uncomfortable pause.]
Me: Phil? Phil: You serious, mate? Me: Yeah. What you reckon? Phil: I reckon you’re f*****. He tells me to get a scan. I ignore him and go home. My wife rings him and he tells her to tell me to get a scan. I ignore her and to prove I’m fine, go straight to bed. In the afternoon. Look, tomorrow’s another day. And bloody hell, it certainly is.
THURSDAY: I get up. I fall over. Not a good start to a Thursday, I think, as I proceed to chuck up. The wife would be quite justified in telling me off for not listening to her as she bundles me into the car, but she’s being nice. Now I’m worried. As we stop again for me to stagger about and throw up in the gutter, she’s passing up a gilt-edged opportunity to say she told me so. I put my now insane dizziness and sickness down to my not having had any breakfast and her driving, which is, I perceive, quite fast.
We pull up outside a private doctor’s in South Kensington. He took half a look, did a brief 'touch your nose with your finger no that’s your eye try again ow now that’s my eye', and pointed us in the direction of the Cromwell hospital. Go straight to the MRI scanner, do not pass go, do not collect £200 (in fact, hand over a couple of thousand).
Magnetic resonance imaging enables neurologists to see parts of your brain that were previously only available to them postmortem, sliced on a Petri dish. Probably with some fava beans and a nice chianti. But if it’s so damn smart, why is it so bloody noisy in there? It’s like shoving your head in the bass bin as a death metal band warms up.
But there it was. Deep in my medulla, the signal junction of my brain, the top end of the spinal cord, the vital link between the thought and the action, the area that controls everything from temperature to erections, from heartbeat to breathing, from eyes to feet, in there, was something. And something wrong. What it was was another question, and one unanswerable from this type of scan, but what it was doing was clear.
It was killing me. Here’s something I only learnt later. When the radiologist was handed the scan, he asked, “Righto, where’s the body?” He was quickly shushed as I was sitting about 10ft away. Shame I missed that cos I could have done with a laugh. The verdict came quickly – unlike paying off the bill for the scan, which I only did about a month ago . . .
The lovely old boy who delivered the news was one of those proper old-fashioned consultants with a bow tie, Rumpole nose, a bootful of golf clubs and a basement chocka with Montrachet. He was adamant about three things: that I needed to go into hospital yesterday, that the thing – now given the scientific name of “lesion” – in my brain wasn’t a tumour, and that we were, however, in for “a rocky ride”.
Good old British understatement. When my number’s eventually up I hope I get someone like him to deliver the news. He’ll tell me I had a good innings, was beaten by a tricky googly and it’s time for a short walk back to the pavilion.
The wife asked him if he could admit me to the Cromwell. He said he could, but asked if I had private-care insurance. “No,” she said. “What do you think it might cost?”
“Your house,” he answered, WELL, the consultant knew what he was saying. We were in for it, all of us.
My lovely Michele had just announced she was pregnant with our first child, a revelation that had been greeted with joy by James, 7, and with a more cautious whoopee by her daughter Tara, 13, watching her share of family attention – and inheritance – get sliced up again. They, together with my mum, who was about to take the next train down from Wolverhampton and not go home for 18 months, were in for a right old battering.
Character descriptions in scripts are pretty telling. They have to be short as everyone hates reading them. You boil down a complex character to the barest essentials, like: BASIL FAWLTY: Frustrated middle-aged snob who runs a hotel but hates his guests. Terrified of wife, too mean to hire competent staff. Desperate to climb the social ladder.
I’ll have a go with Michele. MICHELE: Showbiz agent. Thirties. Cross between Sharon Stone (looks) and Arnold Schwarzenegger (everything else). Working class but hides it well. Loving, fiercely loyal. Not to be crossed.
Well, that’s 26 words and it’s a start. It doesn’t tell you that in her life she’s faced several disasters and losses, meaning she’s exactly the kind of person you want on your side when the chips are down. And my chips are not down, they are buried.
I’m seen by a variety of polite junior doctors who really don’t want to get involved with this at such a delicate stage in their career and dash off to find some real doctors. Who do the same thing until eventually someone senior enough not to give a monkey’s takes the decision to begin treatment.
Because there’s no diagnosis apart from “holy s***, he’s going to die”, they decide to give me everything. In drips. A tip: the only people you should let near you with a needle are the overworked middle-aged West Indian nurses with six kids, or the anaesthetists. Everyone else needs at least five botched attempts.
I don’t know this yet. I get the junior doctors with their Cambridge accents and trembling hands and eventually up go the drips. They block 10 minutes later. Then along comes another chinless doctor with a saline syringe to shove in until the veins in my hand start to desiccate. After several goes and some polite shouting by Michele I finally get an overworked middle-aged West Indian nurse with six kids who does it properly.
I’m babbling to Michele. The thing in my head is growing; and the swelling, unless stopped, will eventually force my brains out of my ears. I read somewhere that they usually don’t let that happen because they have a man with a little chainsaw who lops off the top of your head to relieve the pressure. I’m not sure I believe this but not sure I don’t . . .
I find I am babbling. Oi, isn’t this what the Celts used to do, several thousand years ago? Isn’t this tre-panning? Do you think I’m possessed by evil spirits? I’m starting to get a reputation for being awkward.
There is a moment at 8pm called “the handover” when nurses smoothly change shifts. In reality it results in complete inertia from about 6.30 to 9.30. Some time towards the end of this limbo I was shifted to a ward. A bed was free at the end of the room because it was next to a broken radiator. Broken in an impressively extreme way – blowing out freezing air at about 30 knots. Straight on to my left side, which was freezing up of its own accord, thank you very much.
Michele called a nurse. Who already knew about the problem. The radiator was broken, she informed us, and stood there for a bit sympathising. It had been like that for days. Terrible, isn’t it? Unfortunately she was not authorised to call the engineers. Michele got another nurse. Same thing. Michele got the staff nurse. She also agreed it was broken and agreed it was terrible. She was not allowed to call the engineers.
Michele demanded to see the night administrator. He would be allowed to call the engineers. She knew there was a night (or duty) administrator because she used to work in the health service. There are certain code words you have to know in the NHS. This is one of them. It was a good card to play and it threw the trio into action.
By now my core temperature was close to that of a frozen fish finger stuck to the back of the freezer. Finally, up minced the deputy night administrator, a man so limp I thought he’d donated his spinal column premortem. He was in a nice suit, which was a worry. In the NHS, the nicer the clothes the less the work. He also agreed the radiator was a problem, but in a more chippy and less appeasing tone. The engineers had gone home.
Michele’s blue touchpaper, which had been nicely fizzing, expired. Ozzy Osbourne would have blushed. And so . . . the duty engineer appeared, as if by magic. He took the top of the radiator off, turned a knob from “blow out freezing air” to “off”, and put the cover on. It took under a minute.
“Why didn’t anyone call me before?” he asked, puzzled. FRIDAY: My left side is failing. My left hand is turning into the Claw. I’m being switched off, room by room, like a man turning the lights off in his house as he prepares to leave. Why me? As I’m wheeled about I see people, old people in gowns chatting away, looking much better than me. Why are they here? Why are they trying to get better, the old f******? They’ve had a life. I’m 36.
They begin my angiogram and now I’m strapped to a table and spinning around very fast. In my disoriented state it was spinning before it began to move but now the vertigo is so great I think I will black out.
Then they do something so extraordinary I almost, somewhere, smile.
You are not going to believe where they shove the needle in to inject dye into your brain. (It’s a photographic procedure.) In your groin.
That’s right. The needle starts off right by your knackers – sorry, just move that out the way, mate – and passes up some handy, if surprised, vein, through your heart and into your equally unsuspecting grey matter, where the dye is squirted in. My wife often said the quickest route to my brain was via my groin. Apparently she was not just being cheeky.
After this there was little time to recover before it was down to the basement for some more touch-your-nose, hammer-your-knee, walk-in-a-straight-line-whoops-you-okay? And then an EEG, the first thing that looked proper. They put an electronic Ena Sharples hair-net on you, then show you pictures. Nothing very interesting, just shapes and lines and patterns, but better than daytime telly.
Back to the ward and they think it’s all over. No, it’s time for a lumbar puncture. Two words that go together like “root” and “canal”. A lumbar puncture draws off fluid from your spinal cord. The only way to get at this very necessarily protected, fragile area is to shove a needle in between two vertebrae in your lower back – the lumbar region. It’s worse than it sounds. I had been dreading this ever since my uncle Bryan, a bear-like 6ft copper, told me of his, years ago when he had meningitis. He went white just talking about it. He said even now, when he sits funny, he can still feel it.
So I was not gleefully anticipating the experience as human robot Matt approached with some gubbins and a sodding great needle.
I curl on my side, widening the gap between my vertebrae. Matt inserts the needle. Ow, ow, ow. It’s over. He wipes away the blood. That wasn’t too bad. No, that was just the anaesthetic. Now he brings out a really big needle.
F***. They tested the fluid for something that to this day I can’t make out what they’re saying. “Oliver Cromwell bands”, I think, or maybe “Olga Korbut bands”. Any rate, they were bands and the first lumbar puncture was inconclusive so I had to have a second one. This time the young ginger doctor did it. And this time I knew she’d probably only done this on an orange before so I tried to stretch my vertebrae extra wide, but no. It really hurt. And you know what? When I sit funny, I can still feel it.
And that was inconclusive as well. SATURDAY: Today the flowers start coming in. From my work-mates. How ill must I be?
I’m only being told I’ve got flowers, because I’ve just been moved to a “high dependency ward” and I’m not allowed flowers. They might compromise my immune system.
This is getting silly. How knackered is my immune system if a couple of begonias could see me off?
The high dependency unit was designed by a Ba’ath party inquisitor. To make sure I haven’t died and messed up their statistical averages, two Filipino nurses come round every two hours, day and night, to take blood pressure, Sats (oxygen levels) and temperature readings. But they also make me hold their hands, squeeze, and answer the same damn questions.
“What is your name?” “Where are you?” “Who is the prime minister?” About 2am I’ve had enough. My name is Tony Blair, I am being held prisoner by the security services and the prime minister is an impostor from the planet Arse.
They start observing me every hour after that. SUNDAY: Weekends in hospital are scary times. No one important is about. Other people’s visitors arrive and some take an interest in me. I’m the youngest in the ward by about 12 decades. Suddenly I’m a kid with a grazed knee again, being clucked over by a bunch of grannies just itching to spit on their hankies and rub my face. MONDAY: Opposite my bed is a fat old dear in a short nightie. She has kicked all the bedclothes off in her sleep and she’s obviously hot because she’s writhing around the bed. And I can’t move my head. Help nurse, heeeeelp.
Finally the nurse appears. I indicate the show and she giggles. She gets a friend over to giggle. Then finally they rearrange the bedclothes and I thank them.
“Don’t worry,” one says. “She’s been watching yours wave about all night.”
And then something strikes me. It’s a notion that, along with my family, rescues me. I realise the real battle in the hospital, the one you have to win, is for dignity. You must understand a body is just a shell around the real me, the real you. That shell can, and will, go wrong. It will s*** and piss and vomit and collapse and bleed and lose control. It’s simply what these shells we are housed in sometimes do. You have to let go, and let go of the fear of letting go.
And when I begin to laugh somewhere at the utter absurdity of a wardful of sick dicks flapping about I know I am holding on to the essential me.
I am thinking about writing a sit-com version of my situation (but who would want to hear it?), when my medical team enters. I do more touch-your-nose, follow-my-pen rubbish until I shoo the sodding Mont Blanc away and ask for some answers. And the truth, mind. Don’t hold anything back. I’m a big boy, it’s my body and I can take it.
So the bastards only go and tell me.
A demyelinating lesion of the brain stem. Of unknown origin. Probably viral. Which sounds impressive but is really modern medicine’s version of “evil spirits”; they don’t know where they come from, how they work, or how to get rid of them.
Myelin is a sticky protein that covers your brain cells like plastic around an electric cable. It is impervious to electricity, so when the brain sends out electrochemical signals they pass smoothly through the brain cell system to the bit of you that needs the information.
If you take the myelin away – ie, if you demyelin the cells – well, remember when aged 11 you tried to fit that plug on the toaster and let the wires touch and plugged it in? If you were lucky there was just a small pop and a bit of smoke; if you were unlucky your Dualit blew up. In my case I set fire to the house.
So that is the first problem. The second is the positioning of this patch of demyelin, the thing they call a lesion. It is in the brain stem, or medulla. The medulla is the grapefruit-sized ball of nerves hanging below the brain proper. It is the signal box linking the brain to the central nervous system.
It is easily possible to have a lesion in this area and feel very few effects – perhaps one of your fingers will become numb, or an eyebrow will twitch, or somesuch. Maybe your lip will curl into an interesting and sexy sneer like Elvis’s or James Dean’s. No such luck with me. My lesion is in a “very eloquent” area. Which means it does everything. And is now stopping doing everything and hurtling rapidly towards doing nothing.
Tests have eliminated bacterial infections, which can sometimes cause these symptoms, so my best hope of survival is that it is a virus. Treatment, I am told, is simply to tackle the symptoms and hope the virus will go away.
There is a further possibility – a tumour, which absolutely means game over. If it is a tumour, it is in an inoperable site. And, given this thing’s aggressive growth, it is time to say some goodbyes. And fast.
© Nigel Smith 2007
Extracted from I Think There’s Something Wrong With Me by Nigel Smith to be pubished by Bantam Press on August 27 at £10.99. Copies can be ordered for £9.99 including postage from The Sunday Times BooksFirst on 0870 165 8585
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The ailing in terms of professional competence AND bedside manners NHS is not only British. When my mum was admitted to hospital with mild symptoms suggesting a stroke, the first CT scan revealed a brain haemorrhage. The treatment consisted in lying in bed for a month, on drips and pills whose details were not to be disclosed to the patient. The doctors - paragons of arrogance and professional aloofness - mumbled to each other in some obscure jargon while hovering over the "case's" bed, not deigning to speak to the relatives. When they did speak it was only to scare us with a diagnosis never reflecting the reality. On night 1 we heard that mum had a 1:2 chance of survival (this said about a fully conscious, and moving patient). A month, an inflammation of the urinary tract and a begrudged second CT scan later, there came a diagnosis of a brain tumour, probably metastatic. It took us a fortnight of agony and a switch to private care to learn it was an angioma that needed no surgery.
Monika Orlowska, Cracow, Poland
Have to say that I feel a lot of the doctors responding to this article miss the point - and getting very defensive. Nigel Smith has chosen to take a light hearted look at what was clearly a life threatening illness, the problem is that no one apart from his wife and friend seemed to take any notice of this problem.
Doctors are trained to diagnose and treat illnesses, but with disturbing frequency in the UK they forget that these illnesses can be extremely frightening to those who suffer them. A bad bout of the flu can cause you to feel like death warmed up but at least its common, imagine if you have an illness that is not so easily explained? Of course it may take extra effort for you to diagnose it, but if it was your life or that of a family member, i'm sure you'd be motivated to be more thorough. If it turns out to be a false alarm, not one will begrudge that - it's certainly better than ending up dead like Nigel Smith would have if he took the advice of Colonel Sanders.
James, London,
Mr. Smith's experience mirrors our own, and brought back many unhappy memories. My husband developed an "encephalitic illness" (never fully diagnosed) last year and was in hospital(s) for 3 months. Because he was in 4 hospitals we were able to compare the care he received, and the description "competant but indifferent" describes very well the average standard of nursing care in 3 of them. Some of the care fell below even that barely-acceptable standard. Wythenshawe Hospital was the exception - a very high standard of care at all levels except for the night staff. He contracted c.diff.; he lost about 67 kilos; so many of the drips and injections were incompetantly administered that it became almost impossible to find a vein that could be used; hygiene was patchy at best and absent at worst - I can hardly bear to go on because of the dreadful memories it brings. Like Mrs. Smith, I had to be constantly vigilant and vocal. I send Mr.Mrs.Smith my very best wishes.
Heather , Totnes, Devon
What a captivating way to tell such a traumatic story. I will certainly get the book when it's released here. Hope this means you recovered from your ordeal? Thanks for sharing your experience.
To the med student, don't get so testy - you wouldn't want someone doing hit and miss with needles if you were in that situation. My son is a newly qualified doctor, and he had some graphic stoies to tell on this very subject.
This is a story which stays with you, makes you aware of your good fortune - thanks again.
Caroline Pascucci, Cape Town, South Africa
I'm not surprised the GP didn't pick it. To what medical problem is a GP the solution?
Frank Upton, Solihull,
Regarding the repeated questions asked in HDU,they are to help monitor the patient,as one writer said. However, repitition can be a bit boring. An eminent legal person of my acquaintance whowas recovering from major,major brain surgery replied to the question about who was PM with the words Why? Has there been a coup?.. A light touch always helps. Good luck Nigel.
susan kelly, Sydney NSW , Australia
Yeah, yeah, very funny, but my experience was quite different. In the States, where some of your correspondents are so happy, the insurance companies wouldn't have allowed the doctors to go ahead and treat my multiple myeloma because the statistics for recovery looked so bad. Here, the doctor looked at me as a patient, and carried out the bone marrow transplant that I needed ... eight years ago.
It's certainly not true, by the way, that health care costs less in the States ... and what about the 20% of Americans who don't have or can't get health insurance anyway?
andrew taylor, oxford,
I'm a medical student. How am I supposed to become polished in carrying out procedures if I have to pretend to be an overworked nurse with six kids before anyone will let me near them? A couple of attempts at getting a drip up won't hurt you...
Med Student, Edinburgh, UK
All very worthy of course Dr. Patel, however my wife had a hip replacement 3 years ago in a private room in an NHS hospital, i myself personally had to clean the bathroom on three occasions as it was unfit for a family household never mind a post operative suite.
Recently at the same hospital for the removal of an enlarged mole (albeit a minor surgery) floor fitters next door were creating a dust cloud which was drifting into the area, their van was parked outside the fire exit (door open to facilitate removal of debris)
unlikely people could get out in any emergency.
The door being open, allowed pigeon and other feathers to drift into the waiting area landing and staying put in a small play area, the surfaces of the equipment and books covered in a film of dust and god knows what else.
Lovely sign on the wall asking for people to be alert to MRSA, in closing it was a private consultation and there was coffee, tea and magazines available so that's all right then!
gerry, Scarborough,
I'm with Dr Patel. This is ONE patient with an unusual problem. And why would you put a slice of brain on a petri dish?
P Donaldson, Edinburgh,
I've just moved to the UK for a teaching job. I love the south of England, and was positively inclined toward the NHS...untill I got here. Then stories like this began attracting my attention. *gulp* What have I gotten myself in for? In the States, I was at the ladder rung where I was well taken care of thanks to my employer and a reasonable middle class income. I'm all right Jack...but god help the poor sot on the bottom of the US ladder. (And if he was serious, Bob Evans whould know that he is an Anglican Catholic.)
Mike Pod-, Chichester, UK
~So few have poor experiences compared to the numbers who do well. Yet you only ever write articles damning the NHS and doctors. You show no respect to those of us who give so much to try to keep you well. Yet you laud the celebrities who have often done nothing to earn the praise and attention they receive. This is what is wrong with UK 2007.
Dr S Patel, London,
I'm confused, did he in fact get private treatment or did his private scan etc result in follow up action by the NHS ?
Either way, a terrifying ordeal.
Stan(expat), USA,
Hmmmm. No thanks, Mom, I think I will stay with the Yanks over here in America. The health insurance is cheaper than your NI (and all paid by my employer). And I don't pay anything to see the doctor the next day, or to go to the hospital the next day if she recommends it. And, I stay in a delightfully clean two-bed room (I've never heard of a ward here) in a modern (as in new) hospital run by Catholic nuns where the food is great, the TV better than home, and a telephone next to me that is free. And when I get out, the prescriptions are only two and a half American dollars each, regardless of how expensive it is to the nuns (they are a shrewd lot). Yes, they know I am Anglican, not Catholic.
Bob Evans, Anaheim, California
Sound like Ramsay Hunt to me (see website) - but now you've been in hospital = God knows what else you'v got now!
Your doctor friend should have warned you about hospitals in August - full of newly qualified doctors who do not know their gluteous maximus from their olecronon.
MJ , Harlow , Essex
Couldn't have put it better myself. Recently took a holiday at my home country, Spain and, to cut a story short, ended in a Spanish hospital diagnosed with peritonitis, caused by a ruptured appendix. Not funny at the time, glad the family was nearby and that I thankfully wasn't in a MRSA ridden British hospital. Luckily survived the experience to have learned an important lesson we may feel we are strong individuals in ourselves but how frail the wrapping of the real us is!!
Tino Gonzalez-Lacoste, London, London
Get well soon !!!
Graeme McLeish, Chengdu, Sichuan
Nigel Smith has written a reasonable humourous account of a very serious condition but one cannot help but feel that those people involved with his care would consider his stereotypes somewhat dated.
Should we check that he nurse puitting a needle in is west-indian, has six kids and is overworked before i let her near me?
Should i insist on flowers in a HDU (one step below Intensive care) and not care about the real risk of infection to myself and other patients?
When i am that unwell and the nurses (who really cares what their ethnicity is) are trying to monitor me to ensure that i am not deteriorating so that urgent care can be started to leave me alone and allow my family to complain when it is too late?
I applaud Mr Smith for the originality of his observations of the health service and await with great anticipation more such original humour
a. doctor, London,
This isn't nearly so amusing, but my experience of the NHS is completely different. Whilst visiting the UK in 2002 I suffered a stroke. I was hospitalised in the Stroke Rehab Unit of Perth Royal Infirmary for 3 months and received excellent care from the nurses( 2 per patient ratio), plus physio- plus occupational therapists. The ward( 3 patients) was cleaned every day by friendly, pleasant ladies. It's probably the "luck of the draw", but I got a straight flush.
Bill Peter, Kuala Lumpur, Malaysia