TGI...

As for many, Friday is my favourite day of the week.  Now that I ‘work from home’, though, not for the usual reasons.  It begins with an individual tango lesson, where for an hour or so I enjoy expert professional guidance and the full attention of my good friend.  I leave feeling energised, optimistic and cycle to the Amnesty bookshop on Mill Road for my weekly volunteer slot.  The next two hours are unpredictable – sometimes busy, sometimes solitary, often enlivened by encounters with – well, unusual individuals.  I regularly come away with something new to read and always with a sense of satisfaction: it’s rarely one-to-one, but something about the couple of hours I spend there has that added value feeling.

So I wasn’t particularly looking forward to last Friday’s extra: from Mill Road on the Number 2 bus to Addenbrookes to take part in the ‘microbubble survey’.  Also voluntary, the opportunity arose from a recent diagnosis and I knew more or less what to expect.  Under local anaesthetic, my right breast would be injected with a (colourless) dye which would then be tracked via ultrasound along its route to the lymph nodes, where the first port of call would be clipped.  The accuracy of the ultrasound procedure would be confirmed or not during surgery after the weekend. No direct benefit for me, then, but the potential for developing improved and less invasive treatments for future patients with breast cancer. 

I was up for a bit of pain, although in the event there was almost none.  In fact, it was fascinating, the minor discomforts of squirming round on the bed more than outweighed by watching the dye magically solidify into identifiable grains which crept steadily along to their destination.  In duller moments we talked roses and gardens, so that the sanitised air of the consulting room filled with the lingering scents of last summer.  I was almost as excited as my team of two radiographers when the sentinel node was identified and clipped; I even got a photo of the result!  They treated me as an equal and with friendly respect, a person-centred approach which left me with an extension of that Friday feeling, and which has characterised every interaction with the unit over the last six weeks, so that I’m outraged by the recent clamouring to get on the bandwagon of rubbishing the NHS.  I think of how our mothers and fathers and their mothers and fathers fought for a public health system that didn’t depend on the ability to pay (my mum still can’t go to the doctor without worrying herself sicker) and of friends of mine who worked for years abroad because they wanted to share the benefits we enjoy with those who had less.  I visited clinics in Tanzania where water had to be boiled.  I remember the day we had a car crash in Mexico and were taken to a public hospital where the police watched our every move, even in the toilets (no doors), and the day shortly afterwards when my genial (private and expensive) doctor sent me away with the reassurance that my stomach cramps were ‘only wind’ just hours before I lost the baby.  A similar tale of health care (or the lack of) abroad in Friday’s Guardian from NHS chief Sir Bruce Keogh highlights just how fortunate we are.

Of course there are mistakes; in a system which employs more than 1.7 million and deals with over 1 million people every 36 hours, how couldn’t there be?  The latest news story (the closure of the children’s heart unit at Leeds Infirmary) is a troubling example but, even if the figures are correct (and Paul Taylor on ‘Rigging the Death Rate’ in the London Review of Books reminds us how misleading such statistics are likely to be), this represents a local and specific failing rather than a failure of the whole enterprise.  I think it’s criminal that stories like this one are used as a stick to beat the health service with.  Imagine how it feels to be working within the NHS, doing a good job in difficult circumstances as so many do, and waking  up to this kind of drubbing day after day!  After years in the classroom I know all about being demoralised.  I remember the horrors of Ofsted, both pre-arranged and then unannounced, and all our sleepless nights, and how we got better only at weathering inspections.  I can remember driving to school in the later years with the radio on and thinking if I hear one more report of incompetent teachers in bad schools, I won’t be able to finish this journey.  Six years after I left, I still have anxiety dreams about being a failure as a teacher.

This weekend we’re in Norfolk.  I come down early to find mum in the kitchen, bag packed, coat on over her nightie.  What are you doing here? she says.  We’re at the cottage, Mum, I say.   Oh I thought I was in someone else’s apartment and I panicked.   If I’d come down ten minutes later, would she have been wandering along the village’s main road?  We’re just about at the point where we need more help and all my dad’s BUPA payments aren’t going to save us any more than they did him.  Perhaps he got his money’s worth?  In his last weeks, though, it was the good old Derby Royal Infirmary that stepped in and looked after him, and us, as if he were a king.  Or rather, as if he and the rest of the family were really worth something just for being human.  When his wonderful consultant Dr Chakraborti arrived on the ward to see him, as he did every day, you could see my dad grow in the warmth of his regard.  Despite the cancer, the NHS gave my dad a very easy death.

Of course there’s cancer and cancer.  Mine, apparently, is ‘Grade One: favourable’.  Here’s how it goes: after a routine mammogram, I get a call-back.  There is a small shadowy area in the right breast.  After much searching, the ultrasound picks up a tiny lump, buried so deep I would never have found it.  There’s a biopsy and, a week later, the diagnosis, delivered in person by the consultant/surgeon and his team.  What happens next is explained clearly, so that I turn up for the operation feeling reasonably confident.  I queue with the others to get into the ward at 7 am.  ‘Passports?’ a joker in the line says.  Actually it’s more like a railway station.  Some are sent straight to beds; others, like me, to a waiting room.  On a wander I bump into my (‘my’!) surgeon in a knot of people in green scrubs.  He is still wearing his jacket and an interesting tie.  O hi, he says.  How are you?  A bit hectic in here this morning, but don’t worry, we’ll find a bed for you soon.  I’m not worried; again, I’m feeling like one of the team.  Everyone I meet knows who I am, where I am.  I spend the morning waiting, reading, striding to other bits of the huge hospital site for an injection and to have a guide wire inserted so that they don’t have to poke around too much to find what they’re looking for.  I make a new friend whose lump is Grade 3 – like a hard-boiled egg, she says.  She has a marvellous tattoo of a bird in a rose bush which winds its way across her hips and up the side of her body.  Shittin hell, she says when it’s her turn.  And then it’s mine.  I get to walk down and into theatre; like a grown-up, I think.

I believe this is a good thing.  Those days of being a patient, lying back and quietly suffering while things were done to you, no questions asked, are dead and buried, or should be.  We know about diet and exercise and have access to a world of information to help us stay healthy.  If you suffer from a chronic condition, it’s easy enough just to take the tablets and get lost in the system but better by far to ask for what you need, make a fuss, take some responsibility for what is, after all, your own body, your present, your future.

Behemoth and Leviathan, watercolour byWilliam Blake
 from his Illustrations of the Book of Job

The following Friday is Good Friday.  And two days later, Easter Sunday, I get to remove the dressings: two neat rows of steristrips; no pain; no swelling or infection.  All set for a complete recovery.  You might think I’m one of the lucky ones.  Of course I am, but I reckon so are all of us.  I’m sure, like me, you signed all the petitions to protect what Bruce Keogh describes as our ‘greatest social icon’.   Whilst he is dedicated to improving the service, he reminds us that, according to surveys, 90% of patients think the service they got was good or great.  Jonathan Freedland, also in Good Friday’s Guardian, suggests that the North Staffs scandal was a mark of human weakness rather than an NHS problem.  Today I feel like focusing on our strengths: if a Behemoth like the NHS can manage a wholly person-centred approach, maybe that’s a cause for celebration.  As well as something worth fighting for.