Tuesday, January 07, 2014

New Year, New Look

It began around a month ago: a growing, but frustratingly nebulous feeling of 'wrongness', accompanied by an appetite for afternoon naps that increased in length. I remembered my wife's warning - "Don't you dare be ill at Christmas!" - and tried to carry on as normal, quietly ducking out of as many social engagements as possible.

I read a lot, including the new Paul Theroux, a mammoth Trollope novel and the wonderful 'Stoner'.

During a drive to see some friends in Hampton, just before Christmas, I wondered how I was going to get through the day and resolved to see a doctor as soon as possible. But what would I tell them? There is an undefined territory between wellness and illness that I've never been able to map. I procrastinated.

Christmas and the New Year were the quietest we'd had for years, so I was able to conceal my growing inability to cope with everyday tasks. I largely kept my worries about the possible causes to myself and resolved to have a full medical as soon as possible.

But three days ago, everything changed. A growing pain in the centre of my stomach quickly became excrutiating as it migrated to the right side. I consulted Google and felt fairly certain that I had appendicitis, but was a trip to hospital justified? I wasn't sure.

I had a vision of a James Robertson Justice-style doctor pressing down on my stomach and annoucing to his young cohorts "Ladies and gentleman, this man has been admitted with suspected appendicitis. I will now demonstrate that it is just wind."

Then I read an entry about the complications that follow a burst appendix and my mind was made up.

The Accident and Emergency department of Brighton Hospital was surprisingly empty for a Saturday night. The only people waiting to be seen were a young couple in their 20s, a rather malodorous homeless man and three Chinese people, who kept changing their seats every five minutes, possibly in an attempt to fox the queueing system.

After what seemed ages, but was probably only 20 minutes, I was assessed and moved to a holding centre, where people lay on beds in cubicles. Opposite me lay a well-spoken woman, who faintly resembled the 122-year-old Jeanne Calment. She appeared to have forgotten what was wrong with her and the nurses' attempts to coax information out of her were largely unsuccessful.

On my left, a curtain concealed a woman who sounded as if she was in her 50s. Unlike Madame Calment, she was able to remember every detail of the last 24 hours and proceed to give a blow-by-blow account of the minutiae of her day: "Then I went to me mum and dad's and I sat down on the sofa, put on the telly and I 'ad a sausage roll..." and on she went, until she eventually proved that ad nausea wasn't just a figure of speech.

When the woman mentioned sausage rolls for the second time, I started to get the giggles. Each movement of laughter produced a spasm of intense pain, so I turned my attentions to the old woman.

I thought how absurd it was that doctors and nurses were going through the charade of treating the old woman as if she had a curable illness, when the truth - the 'elephant in the room' - was she was just very old and had probably reached the natural end of her life. But what was the alternative?

What upset me most of all was that the old woman appeared to be alone in the world. I thought of all the elderly people my mother knows who book unnecessary chiropody appointments, just so they can be touched by another person.

After a pain relief drip failed to make any difference, morphine was introduced. That didn't work either, but after three further doses, I noticed that although I could still feel the pain, I felt curiously detached from it.

I listened to the voices in the distance. Someone was being aggressive, but it was clear that they were very frightened. Another person kept talking in affected genteel accent about their 'anterior', trying to add a certain gravitas to their account, but undermining it with malapropisms.

As I listened to what was going on around me, what impressed me most was the utter professionalism of the staff, who appeared to treat every patient with an unfailing courtesy and respect. I had plenty of opportunities to eavesdrop on conversations and was impressed by what I heard. Lame jokes were laughed at, dull anecdotes listened to with interest and confusion met with patience.

I was less impressed by the patients, who were a rather rum bunch. A woman on my ward was booked in for an operation, but because she was obsese, diabetic and smoked 20 a day, the doctors wanted to run some tests on her heart first. Instead of being grateful for these precationary meaures, she whinged and moaned incessantly: "I wanna go 'ome today. I don't wanna hang around in this shithole."

I didn't like the woman's sense of entitlement, particularly given that her health problems appeared to be largely self-inflicted, but a universal healthcare system is there for the feckless, the irresponsible and the gluttonous as well as the abstainers, the joggers and the vegans.

An elderly man with the strongest Sussex accent I've ever heard complained about the meals at every opportunity: "Oi've got no complaint 'bout the 'awspital, but the food 'ere is doiabolical!" A Filipino nurse replied "If you don't like the food, I can get form for you to complain if you like." The Sussex man snorted: "Forrrm? Caahn't see that it would make any difference, moi dearr. S'no point tryin'. Nawbody listens."

Admittedly the food wasn't haute cuisine and it was appropriate that it was usually served by Eastern Europeans, as the last time I'd tasted anything like it was in communist Czechoslovakia, but it was still vaguely edible. As for the wards, they were anything but a 'shithole' - spotlessly clean and comfortable.

Perhaps I have lower standards.

My only complaints about the hospital were its design - which resembled one of those mazes that scientists use to induce stress in rats - and a litigation-avoiding obsession with doing everything in triplicate. When someone pressed down hard on my appendix, I consoled myself with the thought that now the diagnosis was complete, I'd never have to experience that pain again. How wrong I was.

But I had music with me, which helped more than anything else. If you're ever waiting to go into surgery, I can strongly recommend Mozart's sublime 'Soave sia il vento'.

After the operation, which wasn't the keyhole surgery I was hoping for, I spent the night in a dementia ward (the only place with an available bed) listening to one man yell "Ben!" every ten seconds for most of the night, while another shouted "Push down hard on the fog 'orns boys" (I don't think the sea view helped).

In the morning, I saw the full horror of dementia - a condition that I had only understood in an abstract way before. The person calling out for Ben turned out to be an Irishman named Bill, who had reached a state where he couldn't remember what a cup of tea was for and regularly tipped the contents all over his bed as he examined the cup, trying to guess its purpose.

Under the influence of morphine, the sound of Bill calling for Ben brought back the theme tune of a children's 'Watch with Mother' programme. But sadly the introduction of opiates into my system didn't result in any epic poems or symphonies.

People compare the very old to young children, but infants learn and remember. Bill was unlearning, becoming less competent with each day. Here was a man who once made people laugh, had a job and made love, reduced to a state where he could no longer recognise everyday objects or remember where he was for longer than two minutes.

Caring for Bill was draining. When he wasn't shouting for Ben, he yelled "Nurse!"every five or ten minutes and required a constant change of sheets. In the coming decades, the National Health Service will have to cater for a steadily increasing number of Bills. At what point will it become unsustainable?

But my experience during the last 48 hours emphasised the strengths of the NHS more than its weaknesses. The medical care was second to none and the wards were clean and comfortable. It made the current controversy in the US about Obamacare seem even more absurd.

This excellent cartoon has been doing the rounds recently (click on it to see the full cartoon). It lacks subtlety and the 'Anywhere but America' claim is inaccurate, but it still makes an important point:

Of course the NHS is far from perfect. People wait too long for important tests, operation waiting lists are often unacceptably long and the labyrinthine bureacracy can sometimes be hard to deal with, but overall, the sum is greater than its parts. It is a noble idea that, most of the time, actually works.

Long may it continue.


Little Nell said...

I’m sorry to hear of your pain and discomfort, although I have to admit that I laughed at the descriptions of your fellow patients. My family has a lot to thank the NHS for and we were always grateful for the care we received. For every whinger there are probably ten who thank and praise the staff (I sincerely hope so anyway). Fingers crossed that you are well on the road to recovery now - Happy (healthy) New Year.

Rog said...

Jeez Steerforth! It really sounds like somebody has got it in for you recently. Looks like the NHS has done you proud though (apart from the ward and the holes in those socks) and very pleased to hear you are through it.

I've managed to refrain making a cheap joke about "Book Seller with Appendix removed". Just as well.

Anyway a speedy recovery and a HAPPY New Year!!!!!

Steerforth said...

Thanks Nell. Overall I feel grateful and relieved that it was such a straightforward problem compared to some of things several friends of mine have been through recently. The NHS have been good to my family too, with one notable exception - my father-in-law. I hope you're right about the ration of whingers to grateful people.

Rog - I was very tempted to do the appendix joke too. I don't know why the socks have holes in them, but apparently it's for sound medical reasons. My nurse - a very camp Irishman - said "And if you want to hang onto them afterwards for, you know, 'personal use' *wink* just remember not to tumble dry them".

Gill said...

Happy to see you back and on the mend. Just have to share this article ... 2nd paragraph from the end. My son who lost his appendix years ago brought this to my attention recently. Who knew!


Steerforth said...

Thanks Gill, I didn't know about the probiotics. I do eat a lot of live yoghurt but will take extra care to make sure that I don't go without. I thought that the appendix was completely obsoletee, so it's interesting to read that it still has a purpose.

The Poet Laura-eate said...

Thank goodness it was an (ahem) open and shut case and you received top quality care.

Nevertheless it must have been somewhat traumatic, and a departure from how you intended New Year to pan out.

I think that all immigrants should have to pay taxes in UK for two years before qualifying for free NHS treatment and that would really help the burden on the NHS. I would also fine each individual £500 if admitted to A&E for drunkenness (and being drunk and disorderly is still a crime anyway, is it not?) Perhaps then they would think twice about putting themselves and others at risk.

helenalex said...

Aren't disassociative painkillers great? 'Still in pain, but no longer care about it. Will call this a win.'

I think the socks have holes so that when you walk around on the lino floors you're less likely to slip over. My hospital nurses were always incredibly alarmed when I walked around in normal socks, even though I'm in my 30s and have no problems with balance etc.

Anyway, glad the worst appears to have past, and enjoy the next bit of guilt-free lazing about reading and mucking around on the internet.

Steerforth said...

Laura - I agree that some people from abroad have misused the NHS, but the one thing that struck me was how it would fall apart if it wasn't for the contribution made by immigrants. My ward was partly staffed by people from America, Ireland, Spain, Germany, the Philippines, Poland and several countries I couldn't identify.

Steerforth said...

Helenalex - Yes, I feel reassured that my final moments could be spent feeling rather indifferent.

The holes theory makes sense, but they're not nice to wear.

Annie said...

Glad that they sorted you out, wish you better.

Some sentences did make me laugh...

"... an undefined territory between wellness and illness that I've never been able to map..."

"... was a trip to hospital justified?"


Lucy R. Fisher said...

"The one thing that struck me was how it would fall apart if it wasn't for the contribution made by immigrants. My ward was partly staffed by people from America, Ireland, Spain, Germany, the Philippines, Poland and several countries I couldn't identify." My experience in hospital recently. The NHS and its staff are wonderful.

Debra said...

I'm crossing my fingers that my French daughter living in England will not need to spend a bout in hospital...She fell through the French social security system in between England and France, so only qualifies for NHS now.
Ah... the joys of expatriation.
I am glad that you are better.
It sounds as though you were lucky at the hospital.
I try to stay as far away from doctors and hospitals as possible now, in whatever country they may be, particularly since industrialized medecine started making great progress, and has taken over.
As for irresponsible people using the NHS, this seems to be a particularly.. Anglo Saxon attitude that seems to stem from the idea that we all need to be the most.. perfect as possible, in a hygienist sort of way, in order for paradise on earth to arrive...(of course it never does, since the more "perfect" we become on one level, the more imperfect we become on another, but we never seem to learn this... collectively of course.)
I think that we could possibly get axed from the best intentions.
I also think that maybe the next extermination camps could be for the oldsters, when we have decided that they must be suffering (from our perspective, of course...), and thus need to be put out of their misery for humanitarian reasons, on a very large scale (also a very convenient idea while we're at it).
This is a nasty thought, right, (that other people have had...) but.. WE are indeed capable of it, and with the best of intentions, of course.
We have already proved this... in the recent past...with a different population, of course.
Anyway, glad that you are better.

Canadian Chickadee said...

I'm glad that you're recovering so well. And I can't fault your logic. I agree with you wholeheartedly about the state of health care insurance in the United States. But then, having spent much of my youth in Canada (which has socialized medicine) and in Britain as an adult, my perspective is probably different from that of many Americans. Because I too have seen how the system(s) work, and why people are so glad to have this social safety net to rely on.
Get well quickly. Here's to more posts soon. Happy New Year and God bless. xoxo Carol

Dale said...

All the best for a quick recovery, and I hope your family are coping well in your absence. Surgery is never fun.

Save those sexy socks. I've been hospitalised three times in the last two years and it was good to know the saved socks were getting some wear! (The first time, they tried to treat me for appendicitis, too, before discovering that it was actually gall stones pushing their way through the gall bladder wall causing the pain. Not so simple.)

I think the worst thing in shared wards is the gadgetry people bring in with them these days. You have to suffer through a constant miscellany of loud beeps and assertive ringtones, and conversations at four in the morning when someone feels the need to share every detail of their ghastly symptoms with friends and family. Or like the one in my ward, demonstrate her karaoke prowess.
I had to remind myself that seething was not conducive to healing!

Tororo said...

So sorry to read this. Please feel better soon, Steerforth, so you can enjoy, no matter how belatedly, a well-deserved réveillon de Saint-Sylvestre.

Annabel (gaskella) said...

I'm glad you didn't delay any longer before going to hospital, Steerforth. Hope the recovery continues to go well.

As I had my appendix out when I was ten, I always wondered what use it was. Funnily enough, although I'm skeptical about stuff like pro-biotics, I do feel better gut-wise when I use them - now I know why.

Steerforth said...

Annie - I know, it seems absurd in hindsight, particularly as I've just read that some people go to A&E once a week!

Lucy - Yes, they are wonderful. I couldn't do their job in a million years. I was already a fan of the NHS, but after last weekend, I admire them even more.

Debra - I agree, there does seem to be an Anglo-Saxon obsession with continual improvement and the pursuit of growth. Blame the Enlightenment for circulating that myth.

That's why I've moved to a town where the opportunities for growth, development and 'improvement' are strictly limited.

The prospect of an increasing population of people who have severe dementia is chilling in so many ways and I don't doubt that the time will come when some very unpleasant decisions have to be made. As you say, they'll be made for 'humanitarian reasons'.

Have you ever seen the film Soylent Green? It's very good.

Carol - I think the USA deserves an NHS of its own. I know that self-reliance is a key part of American culture, but so is egalitarianism and fraternity.

Dale - Luckily, my fellow patients were too ancient for MP3s and smartphones, although they made enough noises of their own.

I found the harsh lighting and constant noise draining, but a lovely nurse gave me some earplugs.

Sorry to read that you had gall stones. I'ver heard that on a pain scale of one to ten, they hit eleven.

Tororo - Thanks. I don't think there'll be any réveillons for quite a while, but I'm looking forward to the opportunity to read some very long books without feeling guilty!

Steerforth said...

Thanks Annabel. I agree about the pro-biotics. I read an article recently claiming that they were largely a placebo, but if I have a dodgy tummy, a large pot of plain live yoghurt usually helps.

Lucille said...

So glad you are out the other side and didn't tarry. My brother's peritonitis was diagnosed as wind at age 4. He nearly didn't make it.

Nota Bene said...

Nice frock...was it a Christmas present?

Apart from that, glad the NHS sorted you out...its a much under appreciated organisation, and full of the most wonderful people intent on doing good to and for others...

...happy and healthy New Year to you

Steerforth said...

Lucille - How awful! Poor little chap. Thank goodness it was discovered in time.

Nota Bene - I have to say I was quite taken with the frock. Very comfortable indeed. Why would a woman ever want to wear trousers?

Andrea said...

I'm sorry about your trouble, but very glad you're getting better!

Loved your description of the hospital. There's nothing quite like the exposed vulnerability, sadness, and absurdity of an emergency room.

Steerforth said...

You're right Andrea. All human life is there and illness is a great leveller of social background.

Anonymous said...

Your account of your stay in hospital proves what fertile grounds they are for a writer. It's one positive at least, particularly from your time on the dementia ward.
Did they give you Horlicks? It was the one joy my mother found during an extended stay in Southampton General (which, incidentally, has a Burger King actually INSIDE the building: the Horlicks trolly arriving during Eastenders. I wondered about this until a recent cold led me to purchase some (an inexplicable desire for malted, hot, milk). It is jam packed, rammed indeed, with vitamins. 150% and more of most of one's daily dose. This is how the NHS ensure adequate nutrition during a stay in hospital. The food is mere entertainment. Get well soon.

Canadian Chickadee said...

Self-reliance my left foot, Steerforth. You're being too kind, and polite. The forces driving the opposition behind Obamacare's problems are two-fold.

First, the vast amounts of money to be made by the private insurers and drug companies as long as health care is not government mandated and monitored.

And second, the religious right whose knickers ALWAYS get in a twist the minute anyone mentions paying for birth control or abortions under any circumstances whatsoever, even incest or rape. And until this puritanical mindset changes, Obamacare is going to have a very tough row to hoe.

So, even though the program passed a couple of years ago, it will be touch and go to see if it ever gets fully implemented.

Steerforth said...

Scribbler - No, I was only ordered tea or coffee. Coffee is the last thing I'd want after surgery! You're right about the Horlicks - packed full of vitamins and far better than the food.

It's odd how hospitals sell unhealthy food, but I suppose they raise vital funds. It's still sending out the wrong signals. And I was annoyed when I couldn't find a drinks machine that sold real fruit juice, only ones with sugar and chemicals.

Carol - Ah yes, I forgotten about the religious right. If Jesus came back tomorrow, they'd probably accuse him of being a socialist.

It does seem as if many of the most sensible ideas - gun control, free healthcare and public transport - fail because they're undermined by very powerful lobbies.

In her excellent book 'Dark Age Ahead' the late Jane Jacobs gave an example of how the oil and motor industries effectively bribed local politicians to dismantle a very successful public transport system so that people would have to buy cars. I can't remeember which city it was.

Another idea that has been suggested is that many white Americans are unwilling to invest in a system that, in their perception, is largely for the benefit of other ethnic groups. I don't know if there's any truth in that.

Dale again said...

And the US likes to export their medical ethics: one of the biggest blocks to the US and New Zealand achieving a Free Trade agreement at present (apart from their clinging to agricultural subsidies as though their votes depended on them) is the US insistence that we hobble our Pharmac, a drug-buying collective that keeps medicinal drug prices in New Zealand low and allocates them fairly.

Apparently Pharmac represents the worst kind of Communism and should be abolished in order to let the US drug companies rule the world, I mean, operate without legal impediment or fair competition.

But as a cheerful user of socialised medicine, perhaps I'm biassed...

Brett said...

Sorry your opiate experience was not more rewarding. A hospital ward is not a conducive setting. Anyway, doesn't Brighton already have a pleasure dome, or have they torn it down? I'm very glad you are past the crisis, and are recovering.

I gave up hoping for socialism in the U.S. a long time ago. I saw that if I wanted to be "coddled by a nanny-state", I would have to get a government job, which I did.

Steerforth said...

Dale - It's appalling isn't it. The pharmaceutical industry holds us to ransom, claiming that the money mostly goes towards research and development, but apparently cancer drugs are simply priced at "a level that the market will bear". In other words, what they can get away with. There is no ethical dimension to their business, whatever their saccharine PR might claim. Only recently, they tried to stop Indians getting cheap cancer drugs.

I'd establish a not-for-profit state-run pharmaceutical sector, in competition with the cartels, to drive the costs down.

Brett - I think socialism is quite alien to the American character, but there is a spirit of communitarianism, or simple 'neighbourliness' that goes back to the days of the setlers and the pioneers, which has been eroded in the postwar period.

But it hasn't been completely crushed. Your library is a beacon of hope - a place where some of the most vulnerable people in society can get help applying for a job online, or discover their legal rights. A local hospital, offering unconditional free healthcare to all, wouldn't be Un-American, it would be neighborly.

Debra said...

Comparing American culture to Continental culture is a subject I never get tired of.
I'm a kind of American Tocqueville, if you like, although I will never write books about it.
Compare : My French family has recently become very gung ho about bio foods, and spends mucho dinero on bio food products. BUT... the average French person is only interested in bio products to save his skin and innards, and doesn't care a flying fuck about the planet. He is worried about his intestines, and catching cancer.
The country that put brotherly love on the map with the French Revolution has some of the most individualistic people I have ever seen. But many of these very individualistic people stand around with their hands lolling at their sides, waiting for somebody to tell them what to do, because their imagination and initiative have been sucked out of them early on.
Self interest is taken to great heights in a country where people I hang out with are constantly congratulating themselves on being progressive, and liberal. (France is the country that put progressive on the map, too...)
On the other side of the ocean, I met several Americans over the web, and even before who are unwilling to put up money for national health care, out of the belief that they shouldn't fork out for somebody else.
Who is more individualistic, in your opinion ?
I am still refraining from drawing any hasty conclusions.
If you live in France, you will understand what a SOCIALIST country is. It is a country that promotes an anthill mentality, basically. (So.. maybe the U.S. is a socialist country now, too ? Adolf figured out if you heard somebody say something often enough, you would eventually take it as truth, even if it didn't fit your observation. Nobody says the U.S. is a socialist country, but... from a certain perspective it looks a lot like one.)
For many years, I was a good socialist. Then something happened, and around six years ago, I suddenly lost all faith in the anthill mentality. The web is an excellent example of the anthill mentality at work, moreover.
The more we think we are individuals, the more we are kidding ourselves... in the anthill.
Good for you, Steerforth, if you manage to read those long books, and if they are good ones. You will be a true aristocrat, in my book, and that's not an insult, coming from me. And...although you may not escape from the anthill, at least you will be able to feel its outline and grip. (I'm not sure that's a blessing, either.)
Last night in a bio store, I told a man that I considered myself rich, because I had lots of time at my disposal.
That's one way of looking at it, and not such a bad one at that.
Happy reading !

helenalex said...

In defense of fast food places in hospitals: sometimes the patient just needs to eat *something*, even if it's unhealthy in the long term. Hospital food is often pretty rubbish, and the average patient doesn't have much of an appetite, so getting them a Big Mac or whatever is great if it means they will actually eat. Particularly if they have lost a lot of weight; fat and calories are good things sometimes. The heavily processed nature of the food can be a good thing too - it makes it easier to digest.

Of course it would be better all round if hospital food actually tasted good, but given the logistics of feeding hundreds of people with dozens of dietary restrictions between them, on a limited budget, I can't see that happening.

Steerforth said...

Debra - France is a unique case, quite different from any other country I've encountered. Like many English people, I've always been in awe of its rich cultural life, but felt baffled by certain aspects of the national character. But I don't know enough about the subject to pass comment.

The point about the attitude of some Americans towards the idea of an NHS backs up what I read in a book a few months ago. The author claimed that because American society is made up of distinct ethnic groups that don't interact very much, one group would be reluctant to pay for a system that would largely seem to be for the benefit of another.

Helenalex - That's true. All I've fancied during the last week has been poached egg on toast, ice cream and Frosties. My lentil soups, avocados and healthy snacks don't appeal at all!

TEL Dranlor said...

Hey Steerforth, Very pleased to know you're out the other side and recovering. All I can add at this juncture; knowing so much of your past, is that if you woke up under the influence of opiates in the mental care ward - it's a very good job you didn't utter 'Aldric hitch up the horses' again, or else you's still be there !

Steerforth said...

Lord Dranlor - apparently I spoke in my sleep last night as well. I said: "Can I have seven £1 stamps please?"

How mundane can you get?

lividlili said...

Nice socks, but great corner.

Steerforth said...

Yes, I think the other patients were very jealous of my corner.

Prudence said...

Hi Steerforth, I first read you on the Dabbler and have been checking into your blog ever since. I also had a "shitty" Christmas and spent most of December suffering from a kidney stone {now removed}, a horrible cold, and then a nasty bout of the flu.I laughed in sympathy, when I read your experiences in the hospital. I was distracted from my misery in Emergency by listening in to cell phone conversations, nurses gossiping and the constant din of voices.I decided that the Emergency Ward was the "great Equalizer", as people from all walks of life, all nationalities, rich, poor and middle class were brought together by sickness and pain.I am in awe of the people that work in hospitals and truly appreciate our Canadian Healthcare system, despite its flaws, even more after my experience. I enjoy your blog and am now going to search for the books you have recommended.Take it easy as you are able to!