Tuesday, August 14, 2007

Another NHS experience

Life was going rather well for Smith in November 2001. True, he'd recently been made redundant from his job at Carlton television, where he was in charge of developing new sitcoms. On the bright side, though, there was interest from the BBC in a medical comedy he was writing and, best of all, his wife was expecting their first child together.

The only thing that was bothering him, in fact, was an unusual numbness down his left side. It was the first sign of the neurological illness that would leave him in hospital for five months. During that time he contracted MRSA; he had a tube inserted into his stomach because he couldn't swallow; he stopped breathing and had a tracheotomy; he suffered a morphine overdose, and the steroids he was given to stop his brain swelling caused such bad hallucinations that he once thought he was appearing with Les Dennis in Celebrity Squares. "Every time I thought `it can't get any worse' it did," he says. Five years later he still feels pain on his left side. But he has managed to write a blackly humorous book about his ordeal, along with Vent, and is working on an ITV sitcom with Ade Edmondson.

Most people emerge from life-threatening illnesses full of platitudes about "marvellous" doctors and nurses. What is remarkable about Smith's book is its warts and all style. He certainly gives grateful credit where it is due, but he also describes pen-pushing indifference, incompetence, and some members of the caring professions who were deliberately unpleasant.

Here he is on nurses. "No one who has spent any length of time in hospital has any illusions about angelic nurses," he writes. "Some are good, some incompetent, a few cruel, a handful brilliant, but almost all are competent but indifferent. And know what? Whisper it, but their pay is good. Better than mine. Overtime is lucrative, private work more so. They're doing less and less hands-on work and wouldn't pick up a J Cloth if their lives depended on it."

And if the tone is a blackly comic romp when it describes Smith's time in Charing Cross hospital, it gets much darker and angrier when he is discharged into the care of the Wolfson rehabilitation centre in southwest London. "Living as a disabled person when you've been healthy is a very difficult adjustment to make," he says. "Fighting for your life is kind of easy. The people I really take my hat off to are people struggling with long-term disability because they just go through battles all the time.

"If you think it's tough inside hospital, well, it's tougher outside because that's when the care really stops. You just get forgotten about. "You pester, and they hope you go away. Well, I just don't go away. I'm a writer: I'm used to rejection. If anybody thinks I'm just going to bugger off, they are sadly mistaken."

When he first came home, he needed help to wash. Now he has a carer who comes to his house in Hastings, East Sussex, to help with the household chores he can't manage, ensuring he and his wife, Michele, a theatrical agent, can still work.....

His hard-won relative good health comes and goes. "I was almost hospitalised last week with a bad bout of pneumonia but I refused to go to hospital. I don't like it. My veins are like Keith Richards's after a bad night out, so unless you're an expert at finding a vein in my body you won't find one. What I'll get in hospital is a junior doctor going bodge, bodge - and I'll get MRSA again."

More here

More detail on the case above:

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.....

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 œ200 (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"....

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.

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.....

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.....

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: 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... 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.

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.

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