The spot returns

The spot returns -
bigger than before.

A stressful day yesterday. I had to be on the ward at 7am, but they had given us an overnight room so it was just a brief walk. The waiting room was full and I was last there at 6.55, so was surprised by the nurse calling my name. "You're first on the list," she announced, and led me through to a single room. I just had time to text Ann before they took my phone as they stripped me off for their dowdy nightgown, and pulled tight elastic stockings over my feet. Then I was sat in a chair and wheeled away to theatre. Addenbrooke's  is huge, and I was taken to theatre 22; all the others looked busy already, full of bustling staff even then.

Old assumptions live on

They laid me on the table and passed the catheter into the vein, and I knew no more. There was no time for fear. They didn't even ask me to count to ten! I awoke in the recovery ward, dripped and groggy. They said I'd had a large haematoma which was drained well, and my oxygen was low, so a cylinder was pushed onto my legs with a nasal feed. Finally, taken back to the ward to be greeted by Ann and Edwin - a most welcome sight, but I couldn't sit up for them. I felt sick, dizzy and miserable, and could only manage sips of water. BP low, pulse slow, O2 down, but I knew I had to wee for them to let me go. Finally, I managed to stand and move to the toilet. After a long time, I squeezed a drop out, probably residual from the morning, but I could truthfully tell the nurses I had PU'd and they said I could go home, with a gash across my neck and minus half an ear.

I couldn't resist this picture of the nurse call. I think they must date back with the hospital to pre-equality days.

Watch this spot

My first visit to Addenbrooke's, for the pre-op assessment. BP, bloods and ECG, and groin swabs for MRSA. It used to be arm-pit swabs, but too many people now use deodorant which throws their cultures. A doctor marked the scar with a pen, then on to get a photo. The spot is back - but this time more like an indelible line.

A German boy, boarding in the UK, was in the clinic with a nurse trying to reassure him. "Lots of people lose their thumbs," she said. "At your age you soon won't even miss it. You'll stand out from the crowd and people will say, 'there's the boy with no thumb.'" He didn't look over-convinced and the bandaging looked serious.

Wives not allowed

Next day, Edwin left us at the hospital, to walk a long corridor for cream and a dressing to the ear to numb it, then an even longer corridor to the Department of Nuclear Medicine for my radio tracer injection. The technician was a burly man who seemed to take relish in giving me four separate injections into the tiny fleshy lobe. They contain Technetium-99m in a new colloidal suspension used in USA but new here. He said it would be too much for a single injection, but it stung like four wasp bites despite the cream. Then down to the radio-imaging department, and another long session waiting for the tracer to move to the nodes, with the rotating cameras brushing my nose to take 360 degree 3-D images of my ear and neck. The final images looked magnificent though, like an anatomy model of the lymphatics.

CT Scanner ready for the ear

Finally, back to the Plastic Surgery Unit, where an Irish trainee consultant moved a gamma-ray probe across my neck to map the hot spots. I asked about the drainage of the ear, and she went into a long spiel about the complex embryology of the pinna. I asked where she had trained. "Cork Hospital," she answered briefly. "Ah - I trained at St Thomas'," I rejoined, "but it's a long time since I learnt about brachial arch embyology." She looked sheepish then, and said, "I didn't realise you were a doctor. It should have been in the notes! I'm sorry I talked down to you." But she was much more sympathetic then, and didn't patronize me.
Now I've ended up with three more black spots for the surgeon to aim at tomorrow.

The Black Spot

This week is the saga of the ear, unless I am too ill to post a report. I am quite attached to this ear. I have had it for a long time, but now we must part company. Old pictures of me with the ear show the Black-Spot goes way back.

Black-Spot on the London Eye in 2003

The dermatologist discovered a melanoma on the lobe in January, and referred me to the plastic surgeons. I was seen by Mr Silitoe in February, and he operated on 10th March. He is a formidable man, solid in appearance, with one blind eye that I tried not to stare at, though I had read on line that he had been done for speeding in a Jag. He also had a huge swelling upon the wrist, covered with a little bandage, which hung before my gaze as he performed the op under local. My medical curiosity longs to know his history, but as a patient I must assume the role of silent acceptance. 

I could hear the knife slice through the cartilage, and the nylon stitches squeaked as they were drawn through to close the excision, but it was clean, quick and pain-free. He did a good job, that healed well with barely a scar, and little change in the profile.

Black-Spot exchanged for little scar

It had been a very small black spot on the lobe, that had been present for years, but had recently changed. It looked nothing at all, other than a cosmetic blemish, and at follow up OP clinic, I was certain he would tell me it had been excised, and other than routine check-ups, nothing more to worry about. But he didn't. "It's over 1.5 mm deep," he said, which is beyond the threshold for a Stage I. I was disappointed, and a little stunned by the unexpectedness of it. "I recommend having further wide excision, and sentinel node biopsy," he concluded, punching the words at me. I resisted the urge to ask him if he still had has Jag.

So now I am lined up for Addenbrooke's under the care of Mr Durrani, with the intention of losing more of the ear and a node biopsy. People ask, "how are you?", and "are you worried?" but the emotions are not of fear or distress (heavens, I removed enough small lumps myself as a medical student and surgical houseman in the old days). No, I think the over-riding emotion is anger. One sees the world going on as it always does (disturbing though it be in the UK this year), oblivious to one's own future or outcome. But the anger is not even against the indifference of the world - I think it is internal, to know for certain one's days are numbered. Even given another 10 years, it seems too little when still enjoying life and living, and wanting to do so much more. I am angry that the days close in, circumscribed by a wall we cannot climb. Angry at the time wasted and misused, even though probably I would have done nothing much or anything different. But in youth there is potential to do much. With age, even potential is stripped away by limiting time.

Moroccan Interlude

I feel such anger for the wholly unnecessary trauma May has put us through with a future as uncertain as I have ever known. Single handedly she has brought Labour back from the graveyard of history and emasculated the Tories as a voice of government. Her inept handling of the heart-retching Grenfell Tower terror compounds an inmate weakness within her soul and she will be despised by her party and the country for years to come. An away-weekend in Marrakesh. Morocco is an exciting country and so restful and seemingly peaceful after the many recent traumas of poor old Blighty. We stayed in Riad Ilayka, an authentic small Riad with traditional family values, a superb courtyard complete with banana tree, and a roof top terrace and mini tower overlooking the city. Some of the best food and service i have experienced. But never have I experienced such a warren of narrow covered alleyways nor so many tiny shops selling such a variety of usefulness and tac. The temperature rose to an unseasonable 42C, too hot to look in comfort and we could only move from drink to drink, stopping at a wonderful perfume museum en route for shade and yet another drink. Drinking in public is hard, knowing the people around cannot drink till the end of Ramadan at 7:45. I stopped at one café for a Fanta, and watched an old woman in the square stitching names into straw hats. One of the café men threw her a water bottle and I supposed she might be excused the fast on account of her age, but she merely poorer some water on her bare feet and down her neck, then splashed the rest around the cobbles to keep the dust down. She drank not a drop. Now at the airport, a tropical thunderstorm has broken with lashing rain and thunderclaps overhead. It is a most beautiful new building of contemporary design incorporating Islamic motifs, but still the roof has one or two leaks with puddles forming. Update: thunderstorms have now forced our plane to divert to Casablanca. Stocked up with goodies from shop and hankering down in lounge to await news. (Update2: plane finally arrived approx. 3 hrs late for most rapid turn-round, and finally we left for home. Charlie picked us up and arrived back approx. 4am. He and Ann chatted all the way – I don’t know how she stays awake for conversations, but it kept Charlie alert).

Charlatan's Petruska dances in Syria

"Donald Trump launches US air strikes against Assad regime in Syria with 59 Tomahawk missiles" reads the day's headline.
What madness, what folly, what insane and crazy dances we are seeing in this ancient land. Putin, the Machiavellian Puppet Master, seems to pull many strings. Would Trump by in power without the strange coincidence of timely email releases weakening Clinton? Would Assad drop chemical weapons without a nod from the Kremlin? And by doing so, the Puppet Master must have finely judged Trump’s response, after his rhetoric against Obama’s inaction. But to what hidden purpose does the Charlatan bring Petruska to the dance? We may only speculate: perhaps for the further destabilization of a desperate region, and the hardening of Middle-Eastern opinion against the USA.
There can by only one outcome from more bombing and external involvement. In such an unholy conflict, there should be but one rule to live by: in dubio abstine. But there is no great statesman to cut the strings of conflict, and the war wages on.