Saturday 31 July 2021

A CT-guided needle biopsy at Papworth hospital

Stepping into the Royal Papworth Hospital is like entering a modern cathedral to science. It is a vast circular complex of five stories dedicated to cardiothoracic medicine and surgery, equipped with the latest technological advances in nuclear medicine and imaging, and was only opened two years ago by the queen when it was given its royal status. They start dealing with day cases every half hour starting at 07:00 and my appointment time with the high priestess of CT-guided needle biopsies was at 08:00, so I had to be on the ward early and starved, so Edwin called round at 06:15 to take me in.

Because of Covid (isn't everything now), there was a guard on the door admitting only patients with an appointment letter, so no visitors or family to accompany we who were assembling. The vast entrance hall and inquiry desk are covered by a glass dome with corridors angled off, but all strangely silent and deserted, as only a small trickle of patients drifting through. In the day unit I stripped quickly to don a backless hospital gown and the priestess came through to explain the ritual and what I might experience like some initiation ceremony, driven by pain to drive the demons out. I was first on the list, but could hear through the thin curtain screens what torments awaited the other supplicants for better health. One, a bronchoscopy, for possible lung cancer; another, a stent for blocked arteries; a third was due a lung transplant. Papworth serves the whole UK as a specialist hospital, and the transplant woman had been driven up from Luton by her mother, who was forced to wait in the carpark for news before she could go home.

The procedure itself was simple, from my viewpoint. I had to lie prone for nearly an hour, one hand above my head the other by my side to rotate my shoulders slightly and lift a rib clear for the passage of the needle. I then had to lie absolutely still as the long needle was inserted between the ribs to reach the lesion, somewhere deep within the lower lobe. They repeatedly drove the bed with me on it into the heart of the huge doughnut-shaped scanner, then pulled me back calling out mysterious numbers to move the needle about as they probed to find the centre of this unwanted addition to my body. Then a series of loud clicks as the needle closed in the cells. Finally it was over, the needle withdrawn, a large pad pressed and taped against the wound, and I was wheeled back to the ward to lie still for another hour recovering, before I was allowed to sit quietly in the chair. It was all relatively painless.

Later, I was given a sandwich and cup of welcome tea, before being taken for a check X-ray which showed a small pneumothorax, where air had leaked through the puncture wound in the lung and tracked up to sit as a bubble above the lung. A repeat X-ray an hour later showed this bubble had grown, so they wouldn't let me go early until a final X-ray late afternoon suggested it had stabilised, and Edwin could come and fetch me. The specialist said she had obtained good specimens, but the results from the micropathology would not be available until next week, when the team would discuss them and my management. I think I can feel the partially collapsed lung pulling in my chest, but perhaps knowing it is there fires the imagination. Now it is no more than uncomfortable, but I have been told to avoid violent coughing, strenuous exercise, sexual intercourse and lifting for a few days. At least part of that injunction is easy to do.


Thursday 29 July 2021

Luke comes to stay and visits Cambridge

Luke among the Banksys

Our Grandson, Luke, came to stay for a couple of days. He too has a dog, so is well used to canine ways and has known Bronte since a puppy on her early outings, so we enjoyed a good walk in the woods behind the Swan. Settling in the beer tent afterwards for a cooling drink and a bite to eat, the manager, Nick, informed us that the chef had walked out on Thursday so there was no menu. Nick said she had put on some kind of strop as an excuse, although Nick thought she had just been offered more money by a rival concern. Ann thinks it more likely that Nick upset her, but there appears to be a general shortage of skilled workers and poaching is rife.


On Monday, we went to Bury. Luke thought it was his first visit, but I remember he had seen it before - but only as a toddler when his mum and dad came to stay. We visited the Moments Exhibition in the museum, surprisingly poorly attended for such a great display of contemporary art with Banksy, Tracy Emin, Damien Hirst and others; then saw the old town and the Abbey before going on to Sudbury for a welcome meal at the old Mill Hotel. We dined outside, watching the cows come down to the river like a Constable painting. On Tuesday he drove to Cambridge, which he definitely had not visited, to stay with Edwin and Andre. They gave him a good time, including punting on the Cam and visiting the computer museum. Here, I dutifully went for my Covid test ready to go into Papworth Hospital tomorrow.

Cows in the River Stour

I walk the dogs each day and it has become a tradition for Byron to find a lost ball. The car is now filled with tennis balls he's discovered, but the last time I walked in the fields he found a football. Today he found another and loved running round in front of goal evading the backs (Bronte) as he weaved towards the goal mouth. 

Bronte and Byron play football


Saturday 24 July 2021

Bad news eased by a lovely evening

Cambridge urban fox
Friday was a difficult day. I had been sleeping badly for the last few nights, so lay down after lunch for a catch-up snooze. I had just reached that state of pre-sleep drowsiness when the phone rang and Ann came in, apologetic for waking me. It was the nursing team from Royal Papworth Hospital. The team had held a conference about my scan results and decided I would be best served with a biopsy to determine just what the shadow is. I have to go into Papworth early next Friday, having starved overnight, and to take an overnight bag in case I have to stay in. 

Because of Covid, I must go alone and be collected when I'm finished. Also because of Covid, I must have a full Covid test at West Suffolk Hospital on Tuesday, then go into isolation until the biopsy. Luke is coming to stay with us on Sunday, and we had planned to take him to Cambridge on Monday and to King's Lynn on Tuesday to see Matthew and Rosie. Matthew is working on Monday, so Edwin has kindly agreed to take Luke overnight and show him Cambridge on Wednesday. 

Ann and I were naturally upset by the news that I now need another biopsy, but Edwin came to our rescue. He was going out to dinner with Andre and two Brazilian friends, but invited us to join them. They had tickets for the theatre afterwards, but again Edwin phoned and bought to extra tickets so we could stay with them and take our minds off things. It was a brilliant play, "A splinter of ice", set in Kim Philby's Moscow  apartment in 1987 shortly before his death, when he was visited by Graham Greene, an old friend and fellow MI6 agent. The play cleverly brought in the history of the Cambridge five spy ring, and the motivation behind Philby's betrayal. 

Walking back to the car, we caught a pair of foxes walking fearlessly round the lawns outside the flats. They even came up to us hoping for food, so Ann was able to catch a good photo of them despite the darkness of the evening.


Wednesday 21 July 2021

Some retrospective views of the Referendum Debate

Five years ago, in Feb 2016, we were still pondering the Referendum Debate. To leave or to stay – surely one of the greatest decisions we could make, and one that felt as though, for once, power was in our hands.

The case for staying was a simple one: to continue with what we knew, without risk of change. To this end, the camp brandished fear as their chief weapon, firing indiscriminately a volley of minutiae and trivia to hit their targets with a wild salvo of disingenuous rumours. Vote leave, and that holiday to the Costa Brava would suddenly cost more; vote out, and you may be out of work. Vote for separation, and the well-established channels for communicating and sharing intelligence across Europe would dry up, and Interpol would cease to function. Even the argument that leaving might return control of our borders and check immigration was twisted by the stay group who insisted that future trade agreements would be contingent upon our taking large numbers of immigrants, or no deal would be struck.

My counter arguments were equally simple: no, no, no. Flight costs for package holidays had fallen for many reasons, and included many destinations outside Europe. Their cost was based on economics, not politics. Employment in Europe had plummeted, and the appalling results on high youth unemployment were evident in many countries, especially Spain and Greece, whilst in contrast, the UK had seen continuing growth and prosperity, with unemployment at enviably low levels. Interpol has a membership of 190 countries and is the second largest political organization after the United Nations in terms of international representation. Britain has continued to be a full member, and does not need membership of Europe to tackle crime. The intelligence services will continue to support each other fully outside Europe, for it is in no country’s interest to block reciprocal information about international threats.

I run my own small business providing consultancy services to the pharmaceutical industry, and I fully appreciate where European membership has been beneficial in harmonising the management of clinical trials and the regulation for licencing medicines. The European Medicines Agency (EMA) was a decentralised agency of the European Union (EU), located in London. It had been operating for over 20 years, and was responsible for the scientific evaluation, supervision and safety monitoring of medicines developed by pharmaceutical companies for use in the EU. I visited their headquarters on many occasions, and was proud that we hosted it in Britain. Leaving the EU triggered the loss of the EMA, which moved to Amsterdam, and the UK now has the local MHRA but this is something I am willing to face. The regulation of medicines is becoming more truly international, with harmonisation ranging across the USA, Japan, Australia and South Africa, and increasingly into China. Britain will remain at the forefront of much of this international effort even outside the EU.

David Cameron would have appeared more honest if he had declared at the beginning his intention of staying in Europe whatever the outcome of his renegotiations. He could have made a firm case by saying that he would work for better terms, but to stay was to our advantage whatever the result. By pretending that they would be swayed by his own efforts was disingenuous and resulted in him arguing for the In campaign with the most minimal of ammunition.

Likewise, Boris Johnson was wrong to boast that we shall succeed because Britain once ran a great Empire. This does not resonate with modern Britain, nor with most people’s knowledge of history. We shall succeed if we leave because we shall have no choice but to make it work. Every company, large or small, will continue to make efforts to export, to both the EU and to the world. The difference will be in the agreements we can make; they will be dictated by our own interests, not the blind, petty, rules of Europe that seem so biased towards the self-interests of countries other than our own.

Immigration must surely be the biggest factor in many minds right now. The figures suggest over a quarter of a million people coming to Britain every year. This is simply not sustainable on any measure, and the limitation of benefits will not touch these numbers. For any great country with central command, be it the USA, Australia, Russia or China, one central government would take control of its borders and do whatever was required to make them secure. For Europe, this has been an abject failure. There is no central political decision-making, no unified policing or military control, no uniform leadership or policy in any form. The whole edifice is floundering under overwhelming numbers. I cannot pretend to offer a solution to this, but I could see that the EU had no solution either, other than reverting to the closure of individual countries’ borders to force the problem elsewhere. This was not a system that deserves my vote. Today, illegal immigration continues across the Channel, but Project Fear was wrong to state we would be forced to accept immigrants as a condition of trade. Put simply, the EU has no wish to ease trade with the UK under any circumstances: but this will gradually ease as mutual benefit begins to assert itself again.

The case for leaving was not based on fear, although I did and still do fear the direction in which the EU is drifting through impotence rather than objective forward planning. The case for leaving was driven by the excitement of freedom from imposed regulation; the unshackling of our economy from a moribund Euro; the reassertion of our own sovereignty against anonymous and undemocratic centralisation; the freedom from the imposition of silly laws and regulations that are only beneficial to some self-interest group somewhere on the continent.

The EU was born as a dream in the aftermath of war; a dream of shared purpose and prosperity, to maintain peace in a world of turmoil. But lacking a common history, language or culture, the incessant drive towards federalism lacks both cohesion and charisma, and the dream is becoming a nightmare from which we are slowly awaking, Covid notwithstanding.

So my call was to vote No to the weak arguments of fear. To say Yes to the opportunity to cut free from the overwhelming and unaccountable bureaucracy of Brussels; Yes to returning power to our elected representatives who gave us this one chance to demonstrate true independence of thought; Yes to the opportunity to develop trade links to the rest of the world without EU restrictions; and above all, Yes to forging a strong independent country that, through honesty and enterprise, may become a beacon to the world.

Has it worked out? The disruption caused by covid worldwide makes any true assessment impossible at this time. Perhaps we will need another five years until covid, like the 'flu, has become no more than an occasional distraction controlled by annual vaccinations. Perhaps then we can judge Brexit more fairly; but perhaps also the EU will continue its political and economic decline, and suddenly the true case for the "Yes" vote will be apparent to even the most ardent opposer. 

Tuesday 20 July 2021

Matthew has an announcement

We are "enjoying" the current heat wave - days of unbroken sun and broken sleep. It is too hot for gardening, or lazing indoors. In childhood, my father used to drive us for picnics by some river or lake on days like this, where we could spend languid days in the cool of some trees or a grassy meadow, dipping in and out of the water as the mood took us. Ah! Idyllic memories - but I wonder sometimes what the truth of those blissful times was, behind the mask of hazy memory of golden hours. Never mind, dreams of our youth should be relaxing and somnolent. Byron has the best idea: every time we get the hosepipe out, he dashes back and forth through the stream, ending up soaked but happy and cooler.

I am not good at looking at my phone messages, and often forget to carry it with me. On Saturday, I discovered two missed calls and a recorded message from the hospital left the day before. Also on Saturday, I got a letter and an email telling me of a new appointment for Tuesday (today). Yesterday, I had another text message telling me to read my appointment list on the hospital website, and then the secretary rang again asking if I know about the appointment. They must be having a problem with missed appointments to be so determined to get me there! I shall have to skip one afternoon meeting to get there, but I guess this is an appointment I'd better keep or I might be black-balled.

Player 4 has entered the game

We had a joyous phone call from Matthew and Rosie yesterday to inform us that Rosie has been for a scan and is 11 weeks pregnant, so congratulations to them both. This is a second baby that will clearly be welcomed. Wasting no time, they have sent a photo of them all in matching T-shirts saying Players 1, 2 and 3 are ready. They have had a new tiny T-shirt printed saying "Player 4 has entered the game".  I am not a game player myself, but I do appreciate the metaphor for life. We are indeed all minor pieces in some strange galactic game. Most of us suppress the thought but this makes it explicit. May they all play the game well and enjoy the moves in store.

Coming out of the hospital, the hot weather has broken over East Anglia, where thunderstorms have greeted us. The weather is cooler now, without the need to water the garden, but Bronte hates the thunder, and tries to hide behind our legs, needing calming with attention and fuss.  Dr Pulimood, the respiratory consultant, was the most thorough and patient of all the specialists I have seen. He spent 40 minutes discussing my recent scan before sending me for yet more blood tests. There is some scarring and a small nodule on the lung that he wants to keep an eye on, and which may be leaving me a little breathless when I move too fast. I realised how slow I have become when, walking back to the car recently, an old lady with a stick and carrying a full shopping bag passed me and was in her car and away before I even reached the car park.

Our house is of an age where things are breaking and needing repair. Yesterday, we had to have a new water softener. The fitter was only a young man, but forgetful. He had forgotten his drill, so asked to borrow mine, then when he left he forgot to take his card machine, so I had to phone the office to contact him to come back. Now the side panels of my workshop are rotting, so tomorrow our fencing man will come to replace them. I have taken the opportunity to begin to clear the workroom. We have so much stuff left from our boating days, but much of it can go now so I have filled the bin with old pieces we can never use again and tins rusted and solid with time. I even have an old anchor and anchor chain, too heavy to drop in a bin and too awkward to carry to the tip. I have left them heaped in a corner for another day.


Saturday 17 July 2021

Covid pings and summer zen

Two days after Edwin had taken Ann to the dentist and me to A&E (see Edwin's Emergency-Journeys), he was pinged by the Covid app and has to remain quarantined for ten days. The message said only the day he was in contact with an infected person, not where it happened, so naturally he wondered if it had occurred when he was out with us. Then Andre also got pinged, so they figured it must have been when they were together somewhere, but apart from the driving lesson (Edwin teaching Andre), they didn't go anywhere much together on Monday. However, an article in the paper this week warned that some false pings can occur through partition walls, so they now wonder if they got it through the thin wall of their apartment block. 

Fortunately, they have each had their first vaccination and both remain well. Ann sent for a Covid test set, so we have also tested ourselves and remain negative, but nearly half-a-million people are currently off work because of these pings, and many children are missing out yet again on their education, including our granddaughter in the village because someone in the school tested positive. Some people are now deleting the app because of this, and I have not added it to my phone as I don't want false pings to stop me going out. Ann has taken the opposite view and has now downloaded the app to see if she gets pinged at all.

It is summer, my favourite part of the year. Autumn brings early frosts and the hint of decay; winter sees me shivering under heavy jerseys and a blanket, with the long hours of darkness bringing tiredness and lethargy, while Spring, for all its promise of new life, is often heavy rain with the earth sodden and late frosts. But summer gives light with long days, so often filled with glorious sunshine and warmth. A time to sit in the garden to read or watch the swallows, or take walks with firm ground under ones feet rather than squelchy mud, when age brings the possibility of slipping and a bad fall.

Cutting metal for the crane

When we built the patio and added the pebbled zen garden, I promised Ann I'd to try to construct a Japanese crane to complement the area. Yesterday, I began to make good on my promise. I have a large sheet of mild steel, salvaged from the back of the dishwasher when we had to replace it. I have drawn the shapes on it for body and wings, and am in process of cutting out the pieces. I am using a reciprocating saw with a metal cutting blade, and wear protective goggles, gloves and ear plugs, but it is tiring and the noise of sawing through steel is horrendous, so I can only do it for short periods. As the new creature emerges, I will post progress on this blog.

We watched a biopic on Alex Ferguson recently. I was impressed with has wonderful managerial style, with his intellectual analysis for coming to decisions. One particularly difficult choice was when he pondered whether to drop his regular goalie to bring in a new man. He was filled with uncertainty, but in the end said, "when there is doubt, there is no doubt" and took the decision. Manchester United went on to win the game and the tournament and never looked back, although the old goalie never spoke to him again. One must not dwell on 'what might have beens', but it is a maxim I wish I had had at several critical times in my life, and will now carry forward.



Tuesday 13 July 2021

Edwin's emergency journeys

Swan attacks in Clare
Walking the dogs in Clare, we passed a pair of swans guarding their new brood. They reared and hissed as we passed, but the dogs were good and walked calmly to heel past them. Back at the house, Ann’s swollen face remains very sore from her dental surgery and seems red and hot. Edwin took her back to the dentist this morning and she has been started on antibiotics for infection. 

Later, hurrying back to the house from the studio through torrential rain, I missed my footing and tumbled forward onto the wheelbarrow. I have cut my head open to a gaping scalp wound so Ann insisted I go to A&E (or ED as it is now called) to get it dressed and assessed. She has been drinking to ease the tooth pain, so she phoned Edwin to take me. He was in Bury taking Andre through his driving test but came back to take me to hospital. He was delayed by a road traffic accident. A car was on its side in a ditch so the road was closed, but he diverted and finally I am at the hospital following Edwin's second emergency dash in one day.

Because of COVID no one can stay with me, so I’ve been sitting alone in Waiting Room A for 2 hours. More people keep arriving and ambulances are drawing up but none of us are called. Eventually though, I am taken through for triage. The nurse straps a wet dressing to the scalp then sends me back to the waiting room for the doctor to see. 

It’s all happening here. A young man has staggered in after skidding and going over his handlebars in the rain. He says he heard the bone snap and now can’t move his arm. A woman has tired of waiting and is sobbing at the reception counter saying she can’t wait any longer and must go home. A young couple sit opposite, scantily dressed. The girl is shivering with grazed bare arms and a low-cut dress. Now an alarm has gone off and six people have rushed into the night through the door to see goodness knows what. 

Grandad John with new bonnet
I downloaded Tetris to pass some time but after two goes it has switched to Candy Crush and will let me play Tetris no more. Now my head is throbbing and Its so late I just want to sleep. Some people are signing themselves out saying they can wait no longer. I am persevering. I am a few feet from the double doors. Both are wedged open to the night and it is getting cold. I need to walk to keep warm but I’m too tired. I have moved to a different waiting area to stretch my legs. There is a trail of fresh blood across the floor. A cleaner is loading a fresh mop to tackle it. 

Two policewomen came in to interview the young couple sitting opposite. They had been in the crashed car that delayed Edwin. The driver said he’d hit a patch of water and the car started to aquaplane; it rode on a sea of water “like ice” and skidded off the road. Luckily both were well but shaken and bruised and in for check-ups. 

At last I see the doctor, a lively young man training to be a GP. He says the skin flap is already dead and cannot be stitched, but the wound is not deep. He cleans the dried blood and old leaves from my hair and wound, and rebandages it with a simple patch. I text Edwin who arrives with Ann in the car, both glad to have their concern eased. We finally get home at one a.m. just five hours later.


Sunday 11 July 2021

Peace and strife

Peace

I love trees 
their leaves 
bring a whispering mystery 
to calm the frantic soul, 
While unquiet spirits storm 
and find no rest, 
I only need a tree 
to calm my breast.

We have returned from a great break in Northumberland, staying at a magnificent country house. Technically, we were in a small wing at the back of the house, the former servants' quarters, but it was still luxurious with large bedrooms, multiple bathrooms, and a huge kitchen and sitting room. We had hoped to have visitors come and share with us, and Edwin and Andre did come for a few days by train. Lucy and family visited on a day trip but did not stay over because of schooling. During the visit, Ann was reminded on her great love of peace and her passion for trees, ultimately the most peaceful of symbols in a living, lively world. 

Some years ago when we lived in Clare, we had a local Clare-based dentist. Unfortunately, many of his patients developed problems with their dental work and complained. Eventually he was struck off for incompetence and dishonesty. Last week, so many years later, Ann also became a victim of the man's efforts when a crown he had fitted worked loose and came off during our holiday. She attended an emergency session with our new dentist in Hadleigh, who diagnosed that the remaining stump, to which it had been attached, was too small and damaged to re-crown and the the thing would need extraction. This he judged too difficult for his meagre abilities so arranged an appointment with a specialist odontological surgeon.

On Thursday, the operation of Ann's mouth began. The session had been booked for half an hour, but the root was a small, fractured and half-buried remnant so the poor girl had to have repeated injections as the gum was incised and the broken adherent root fragments drilled and grinded, gripped and heaved at. She was in the chair for one and a half hours and needed six stitches. Coming out, a sizable queue had formed as she staggered down the stairs. Because of the stupid Covid restrictions, I had been standing outside in the rain to wait for her, but I was glad I did because she needed my arm to steady her as we returned to the car park. Then, walking the dogs in Clare next day, a new sign in a shop window proclaimed Ann's belief. Tree Action Society of Clare (TASC) proudly proclaims they also stand for trees. Let's all go plant a tree for peace. Now, three days later, Ann has a huge hard swelling over the jaw and a huge pain she is desperately trying to suppress with various pain-killers. I am cooking her omelettes, the only thing she can eat besides her diet of soup and milk.

Also in Clare, I had to drop a prescription in to our doctors. While the dentist has remained open throughout the pandemic, seeing patients in the most intimate of ways via their maskless mouths, for eighteen months the doctor's surgery has greeted the ill and dying with a locked door and this sign: "STOP!!! Knock on window if you have an appointment". No one I know has seen their GP in all this time, and I am ashamed of the profession or to admit I once was a GP.