A distinct moment of deja vu last Thursday 31st August at about 1730 as I sat in the same chair, in the same place in the same Emergency Triage Unit having the same procedure as I'd had at about 1730 on Tuesday 21st February. The only real difference being that this time the cannula went in properly at the first attempt. Bloods were taken. Copiously.
Questions, questions, questions answered by my ever present keeper of records. Moved into the very next ward in the bed nearest the chair in which I was sat. I was once again in the Acute Medical Unit. It all felt too familiar, or it would have done if I was conscious of acknowledging familiarity.
The established pattern had not disappointed. Chemo #7 followed by a good weekend. Last Tuesday chemo #8 preceded a Wednesday that slept by and eventually gave way to a Thursday morning during which I felt well. Well enough to make coffee. Well enough to print a trio of photos to send to Dad. Well enough to reduce a trio of the freshest tomatoes it is possible to reduce to a thick sauce, into which a few slices of diced chorizo were stirred before being wrapped with cheese and a trace of mustard in eggs. It was a lovely omelette.
No sooner had it been eaten than the usual tiredness reared its unwelcome head. An hour or two in bed and I felt pretty poorly. Back downstairs on the settee my constant carer recognised the signs, poked a thermometer under my tongue, noted the results and waited till 37.9°C before making the inevitable phone call. Installation in the ETU was expedited with military precision and the swiftness brought about by preparedness born from experience.
A grab bag has been beside the door constantly. As soon as the order was given it was executed the only additions to the grab bag being iPod, Android tablet, phone, DAB radio, earphones, charging leads, external battery pack and 13A USB charging plug. None of it needing any input from me.
Thus it was that I was now in AMU. Again.
From the far end of the ward a familiar doctors voice was calmly and patiently dealing with a man convinced that he'd had a heart attack. This was not substantiated by any of the test results but the patient wanted this clearly set forth so that when the doctor was found to be wrong the compensation claim would ensure his family was secure. It was utterly awful to hear this patient's whingeing and whining. The doctor exhorted him to exercise and eat more healthily. One felt that this patient's idea of exercise was opening the card box that the burger came in.
Whilst this was going on I had yet another ECG. The pads were not easily attached as the areas of attachment were somewhat bristley from the previous ECGs. Eventually it was done and again it showed no cause for concern.
The recently undeservedly assailed doctor appeared alongside. Mutual recognition meant a head start to the proceedings which wasn't difficult as it was a rerun of the previous rerun. IV antibiotic and saline. Chest x-ray and maybe a scan but I'd need to be seen by an Oncology specialist first.
His departure was followed by a need for another blanket, then that blanket needed reinforcing by a dressing gown and even my raincoat. My right hand was squeezed reassuringly but it was all I could do to look at the ceiling. It was now that the shakes began to take over.
Initially you can semi control the shaking but in no time at all they take on a malicious identity of their own and respond only to antibiotic which I was already on although not yet effective. During this period I felt rotten. It was different to previous manifestations. So hard to describe. Struggling and failing to stay afloat usually but this time I went through the feeling delicate stage almost as fast as through the fragile stage to find myself in another arena hitherto not experienced.
I knew it wasn't a good place. I just felt broken up inside. It's so hard to describe, you feel that your skin is holding lumps of broken you and stopping them from escaping but all the lumps want to do is to agitate and find a place where they'd be comfortably fitted to their adjacent bit. It's like your innards are in pieces and each piece at war with each other.
It was getting out of control, as were my words. When words get out of control they're best not spoken. The hand in mine trembled and shook but at a different frequency. All I could do was look at the ceiling, burble on inflicting unintentional anguish on the one most precious to me and wait for the antibiotic to have it's way.
I was going to be in for a while and as darkness came my comforter was exhorted to go home with my clothes, shoes and anything else not essential. This she did.
Shortly after her departure the IV drips were removed and I was moved to the Oncology ward next door. The Oncology ward uses different IV drivers to any other wards. I'm far too familiar with these drivers but I wasn't immediately hooked up again.
I was immediately seen by a cancer specialist. We'd met previously. The infection was pretty severe and would need some different antibiotic which he was in the process of arranging.
More ceiling observation ensued but my contemplation of irrelevance was broken by a vaguely familiar voice from distant days. A young lady in blue stood before me smiling and then laughing and reminding me of good days. I first saw her when she was starting out as a teenager, I last saw her near the end of her teenage years. Always a smile, a cheerful rougish smile which hadn't changed. Now she was a wife to Tom, a mother of two, a 3yr old and a 9month old and now she was my nurse for the night. The ceiling contemplation was supplanted by trawling through long forgotten memories and the struggle to fit few remembered faces to even fewer remembered names. It was a blessing to be thus occupied as the little hand went through its 30° increments.
My reverie was disturbed every hour or so by the taking of obs and replacement of bags. The obs showed low BP, good pulse and oxygen saturation but my temperature was having a fit of pique. 38.9°C from 2200 till sometime just as the sky was lightening. I asked why they couldn't just put up a big bag of antibiotic and not these postcard sized ones that only lasted 20 - 30 minutes. The answer lay in their potency. Each bag had to be prescribed. Prescription was based on need and need was determined by obs.
It wasn't daylight when I slept but it was close to it and I'd managed to put names to faces long since thought forgotten. A pleasant distraction from a wholly unpleasant experience. Sleep meant calm, and calm meant that the broken bits had found their place and were once again content to rest in it.
Not long after dawn the doctor was back. Hmm, aaaaah, I think this, that and need to speak to the consultant who'll be along shortly. Shortly there came a trio of serious medics, your infection this, that, maybe, perhaps we need to seek advice.
That advice came in the tall, lean, elegant, decisive form of my familiar Oncology consultant at about 1100.
Leadership is a rare attribute found in few, good leadership rarer still but true leadership is to be found in far, far fewer. This lady exudes it. So like the surgeon 50 miles away. Leadership needs, intellect, so often ridiculed, it needs knowledge, so undervalued, it needs experience, so denigrated because if properly understood and fairly gained it precludes youth who so seem to hate the experience of others mistakenly believing that experience can be found from a screen.
But leadership involves far more. It needs the modesty of willingness to observe, to listen to colleagues and the intelligence, understanding and experience to discount the erroneous and the confidence to ignore the uninformed. This process of sifting the dross and weighing the residue against your informed position is the essence of wisdom. Even all this does not guaranteed great leadership. For that you must have the discretion and certainty of mind to sit alone, make a decision and then to take the responsibility of conveying that decision to the needy.
So often leadership is lacking most of those characteristics. Sometimes it lacks one or two but if recognisable decisiveness is not there it is not leadership. I have seen those in leadership founder and have no, zero, zilch sympathy for them as it seems to me that when they crack up it is invariably because their ego is unable to float in the shallowness of their ability.
This lady has all that is needed for exemplary great leadership. No this, that, others, no if, buts or maybes, no referrals to higher authorities. Just decisions made and conveyed. That she executes this leadership all day everyday in matters of life and death is testimony to her ability and the absence of ego and high regard held by all who hear her name is testimony to her genuiness.
Her self effacing manner is the manifestation of truly being able to cope with her job better than any others in her area of expertise. Her confidence is my confidence, her calmness mine, her certainty of the rightness of her decision making is my certainty.
This, when you're not good is what you need so the matter of fact bedside manner, the minimal of formalities and the swiftness of the consultation is just exactly what the doctor ordered.
Striding in alone, standing erect and clearly conveying her decision was an example of professionalism of the very highest quality. We have choices to make, she announced. Your risk of mortality is greater from the colingitis(sp) than the cancer. Your body controls the infection until the chemotherapy reduces your bloods' immune systems ability to maintain that control.
The choice is to carry on with the chemotherapy and treat the infection each time knowing that a time will come when we will have no effective antibiotic left, we can stop chemotherapy and let your immune system do it's job or we can look into the infection itself. That is not really an option as it would be exceedingly difficult to establish it's source although we believe it to be in or around a liver duct, even if found there would be no straightforward way of doing anything about it.
I have cancelled all further chemotherapy, prescribed a course of oral antibiotics which will be delivered this afternoon, you will then be free to go home and I will make an appointment to see you in three months. Goodbye.
With that she gracefully turned and went. I felt that I could hear a lingering whistle and then a bombshell went off in my head.
It was over. On this Friday 1st September it finished. Done. Over. No bloods on Monday, no chemo on Tuesday, no scheduled hospital trips till November.
Susan, the cancer nurse came and explained things a little more fully, flying South, travelling far, manual labour, physical exercise, all had caveats and proscriptions. My expectations were not to be set too high. It's all about the long bones. The chemo stays deeply embedded in the bone marrow where it will carry on doing it's thing for months to come but do what you can, listen to your body, don't expect too much too soon and don't underestimate just how long it will take for your stamina to recover to a useful level.
The consultant made the appointment. The drugs arrived. We went home.
To have had the quality and depth and quantity of medical professionals working for my unmerited and wholly unworthy wellbeing is unforgettable, our gratitude to them is unquantifiable, indescribable and, at this moment the relief overwhelming.
Life. It's a gift. It's a joy. It is precious but most precious are those you share it with and those Providentially placed to do what needs to be done when it needs doing.
Over but not yet out!
Peace, Joy, Love.
