Tag: NHS

The eyes have it

~ kevinrevell ~ Leave a comment

When I was a callow youth, I settled my ambitions on becoming a musician. I use the word musician in a very loose sense, as I had no talent and no intention of ever learning an instrument, but I thought (incorrectly) that I could front things out by writing the lyrics for songs, pretending to be able to sing, and, most importantly, hanging out with proper musicians. A blog for another time, but the process of starting, and being in a band is a bizarre experience of creativity, relationship building and chance events. And one key factor in forming a band is the Selection Of A Name. It’s a weird process because you’re trying to choose something interesting, that’s going to tell people something about you, in a few words that are likely to bear no relationship to your creative output. But such is rock and roll. 

I prepared for my musician/non-musician future throughout my youth, largely by focussing on the ideal name for a band. So much so that by the time I actually joined one, I had a list of 20 or 30 names, which in the event, were beyond embarrassing and never shared with anyone. By the time I joined my third band (by now a bit less callow and youthful), I was back to square one on the naming front, so resorted to the time honoured tradition of flicking through random books and hoping to settle on something new. I’d decided to start a band with a friend who had a guitar and a good working knowledge of early Buffalo Springfield, and before we knew it, had a few country infused indie songs and were ready for a recruitment drive. That was a process that didn’t really have an agreed end point, and we kept inviting people to join the band until we reached eight of us, and were limited only to the size of a rehearsal room. But that’s another blog. Anyway, just ahead of recruitment, we needed a name, which needed to be sourced from the books owned by me or my friend. 

At which point, we’re edging precariously close to the point of this blog. Because one evening, we were flicking through some old books, and my friend showed me an old medical reference book from the 50’s.  In it was a description of a procedure called ‘Killian’s Eye’, together with a line drawing of how a particular incision on the eye took place. Just looking at the drawing made me feel quite ill. Thinking about it 40 years later still makes me a bit queasy. So, given that it could have that effect, ‘Killian’s Eye’ was the new name for the band. We changed our name about two weeks later, but again, that’s another blog. 

And I mention that whole ‘feeling queasy at the memory of a line drawing of an eye operation’ thing, because almost everyone I know turns an unpleasant shade of green when you mention eye surgery. And, funnily enough, it was exactly that feeling that I had a few weeks ago after a visit to the optician. I’d noticed a. bit of blurring when I tried to use a computer, then found that if I completely closed my left eye then the world just turned into a set of vague shapes. It was quite disturbing really, so I headed off to the opticians a worried man. And after an hour of testing and talking, I worried for a different reason. Firstly, I had cataracts, which would require the 2025 version of some sort of Killian op, but also because it was cataracts. I knew that they were relatively straightforward to resolve, but weren’t they what old people get? My 91 year old mother, for example, was (and is) currently waiting for a cataract op. I asked about that at the opticians. Óh no, we get really quite young people in with cataracts’. Remarkably unconvincing.

And so the process of getting my eyes back on track began. Part of the point of this blog is to shout about what a fantastic process it was, and let’s start by showing some stupendous NHS efficiency. I’m going to do this based on working days:

  • Day 1 – eye test at optician
  • Day 2 – checked that GP had received referral and got an appointment for the next day
  • Day 3 – saw the GP, who referred me to eye clinic
  • Day 5 – received a letter for eye clinic for assessment on day 7
  • Day 7 – cataract assessment from optometrist (both eyes) and appointment booked for:
  • Day 9 – cataract removed from right eye
  • Day 20 – cataract removed from right eye

So, that’s six days from GP to surgery. And an enforced two weeks between right eye and left eye. The conversation with the optometrist went a bit like this:

  • You’ve got a fast growing cataract in your right eye and another in your left. So we’ll need to take them both out, starting with the right one.
  • Yikes, that sounds nasty, how long will I have to wait to have them removed?
  • I’m sorry, but the soonest we can fit you in is the day after tomorrow

Amazing stuff, and with the huge advantage that I didn’t have time to worry about the actual op at all. And to avoid getting cold feet, I studiously avoided any information on how cataracts were removed until the day of the procedure, thinking that the less I knew, the better it would be. And in the event, I really shouldn’t have worried. I had to put some dilation drops in to my eye before I walked to the surgery, met a nurse who put some anaesthetic drops in, and made sure they had the correct eye, before taking me to meet the surgeon, who measured my eye so that the right sized lens would be put in place, then met the nurse who explained that she’d be holding my hand, and that if I at any time felt that I was going to cough or sneeze, to squeeze immediately. Something about that being bad news if it happened when the scalpel was making an incision. Then taken into the operating room, to meet more nurses and the surgeon again, a clamp put on the eye to stop blinking, a cover over the rest of my face, some drops that made sure all I could see were outline lights, then ten minutes of trying not to think what was going on and not squeezing my new friend’s hand, just noticing the odd sensation of touch, rather than pain, and watching the lights move, then the surgeon saying ‘all done’, clamps and cover removed, a clear plastic patch over the eye, which I could see perfectly through, back to the first nurse for some dos and don’ts for the next few weeks, then home. The whole thing took about forty minutes from arrival to leaving, and of that, there was about fifteen minutes in the operating room. And just in case any of us thought that was a lucky break, back two weeks later for the other eye, which took almost the same amount of time, and if anything, caused a bit less discomfort. It’s just staggering.

Now all of this has been done, I’ve allowed myself to have a look at what actually happened. The queasy feeling is still there when you read up on it, but it’s as nothing if you look at what used to happen before a process called phacoemulsification came in around in the 1990s. Before then, cataract surgery would leave you in hospital for about 10 days; the op would need a general anaesthetic, and there’d be months of convalescence afterwards. And we have Charles Kelman to thanks for phacoemulsification – he developed the process of blasting away the cataract through a small incision using a laser after talking to a dentist about a tool being used for laser dental treatment. That was in the mid-1960s, so fairly soon afterwards, everything literally started looking a bit rosier for people with cataracts.

About that rosier stuff. Having a cataract is a bit like seeing the world through a glass of milk, or a grubby net curtain, but it happens quite gradually, so you don’t really notice the deterioration. But when it’s taken away, everything comes back immediately. For me, it wasn’t just the blurring that went, but my sight over distance was much better, I could see the computer properly, and I saw certain colours, blues and greens particularly, really vividly.

There is, of course, always a downside. In this case, it’s about what you have to do and not do after the op. Lots of steroid eyedrops for the following four weeks, which aren’t really a problem once you get used to the technique and a bit of stinging. But then there’s quite a few things that you can’t do – mainly any exercise that would elevate the pulse, and increase pressure in the eye, as that could put the recovery/repair back. So that’s bending over, lifting anything and any active exercise. Definitely no swimming, and no running or cycling or any other sport. This is quite a big deal for me, because I had both eyes done, so that’s no exercise for six weeks, and I’m counting the days before I can go back. I’ve never had that much time away from exercise before, and I’d be climbing the walls if that was allowed, tee hee. The list of do’s and don’ts confirmed some of my initial ‘aren’t cataracts something that much older people have done?’ thoughts. For example, it talks about active sports, but then specifically says that this includes bowls and golf. It then says that patients should avoid sex for two weeks, which must presuppose that a gentle game of bowls is twice active as having sex. Now, I’ve only played bowls twice in my life, but…

You can finish that last sentence off for yourself. As I write, I’m two weeks and three days away from being able to go for a run, so at least that’s over half way. And I suppose only three days before making myself available for, well, a bit of biblical knowledge. As long as it’s no more enthusiastic than half a game of bowls.

My Left Foot (Part Two)

~ kevinrevell ~ 1 Comment

One of my New Year Resolutions, alongside the trusty favourites of losing a stone; writing a song that people would be interesting in listening to; and generally being harder on Jr Emu#3 (a NYR shared by four other members of the family), was to write 12 blogs that people would actually read during 2016.

So far, so not so good, as the score currently stands at: Year Expectations – 4, Emu – 1.

As ever, I’m keen to blame others for my inadequacies, and in this instance, I’m placing part of the responsibility on the ever fragrant Mrs E, who imposed something of a super-injunction on my last draft. I’d spent a reasonable chunk of February preparing what turned out to be a combination of an open letter to Jeremy Hunt, and a love letter to Mrs E, who, as a nurse, is one of his most long standing and long suffering employees. As it turned out, putting the blog in front of her before pressing the ‘publish’ button was definitely the right thing to do, as it received a response along the lines of:

‘There’s no way on this earth that I’m letting you publish that. I’ll lose my job, you twat’

There are few things I really fear in life, but being married to an unemployed nurse who bears me a major grudge would definitely be one of them. Mrs E is already making noises about a third dog to continue her child replacement therapy, and had this episode gone wrong, I could just see her going down the ‘attack-dog’ route.

Anyhow, that was the blog you didn’t get, which was about as negative a read about the NHS as you could experience, and this, by contrast, is the blog that you do get, which, happily, is about the best experience ever, yesterday, also at the hands of the NHS.

For a bit of context, my left foot has been something of a burden to me in my efforts to be a vaguely adequate marathon runner. The big toe, in particular, was hurting like seven shades of hell when I went to my GP at the end of last year – he had a painful poke about and diagnosed an ingrowing toenail. An ingrowing toenail is one of those conditions that you think is way down on the minor list of ailments, but it’s not until you have one that you realise what all the fuss is about. It’s like having a really sensitive part of your foot constantly tattooed by a degenerate biker, so when the doctor said that I needed to have the toenail removed, and that it was a simple procedure, I could have jumped for joy. Obviously I didn’t as I had a fair idea of what landing would feel like, but you get my drift.

‘Can it be done quickly?’ I asked. ‘It’s just that I’m going into a sixteen week training plan, so I need to fit it in with that’

My GP has what I believe is called a ‘lazy eye’, and it’s often quite difficult to tell if he’s staring at you intently or looking up at the ceiling in a a state of disbelief. I like to think that in this instance he was doing both. Anyway, we agreed that I should save the NHS the bother and get booked in for a quick BUPA procedure in February.

Come the great day, and I pitched up for the appointment, had a fairly large needle shoved into my toe, then watched on in awe as the toe was cut open, part of the nailbed removed, and the whole thing cauterised with what looked suspiciously like the last soldering iron I bought in Maplins. (And which, incidentally, brought back some shuddering memories of my vasectomy. The smell of burning flesh will, I think, always remind me of that sunny afternoon in a surgery ten years ago, with my wife and the doctor merrily gossiping on the other side of a green cloth screen. I had naively expected her to hold my hand at the customer end of the transaction, but she mentioned something about ‘professional interest’ and that was the last I saw of her.)

Anyway, I rested up for a few days, got back to running, got the toe nicely infected by doing a twenty miler in the mud in March, got some antibiotics and took ‘constructive feedback’ from various healthcare professionals (see above), and by the start of April, all was reasonably well. Not the prettiest toe you’d ever seen, but vaguely functional.

Then, about a fortnight ago, it started hurting again. Then really hurting. Then ohmygodthatissof’ingpainful hurting. So I went back to the GP, who did the whole intense stare trick again, and sent me off with some antibiotics.

‘This will clear the infection up by the marathon’ he said, filling me with optimism.

I tried a run on Tuesday this week and pretty much had to hop the first couple of miles. It was really, really painful, and probably not that sustainable an approach for the marathon, so the next day it was back to the GP. He looked at me quizzically (I think).

‘I could drill it’, he said, ‘but I’m not sure that’s what it needs’.

Well, if he wasn’t sure, I wasn’t going to encourage him to experiment. So he decided to ‘phone a friend’. He called the podiatry department at a local hospital, told them what he was worried about, and said that this was ‘important, as the patient has to run a marathon on Sunday’. He genuinely said that, not because he necessarily thought it was properly important, but because he knew that it was to me. This was after 5, and whoever he spoke to said they’d have to see if anyone could help, and they’d call him back. They did:

‘Can you do 10 tomorrow morning?’

Yes, I very much could. I wasn’t sure what to expect, but anything was going to be better that the current situation, and so I pitched up at the hospital on time the next day.

And was seen, on time. By two lovely people, who, if they weren’t in the podiatry business, could probably have eked out a living in light entertainment.

Within 2 minutes of me taking my socks off and giving them a brief rundown, they’d agreed on the problem – the nail bed hadn’t been killed off and the nail had grown back, in spikes, back into my toe.

They’d also agreed on a fix.

‘We’ve got two options; either we do the procedure now without an anaesthetic’

<pauses for patient to take this in>

‘Or we do the procedure now with an anaesthetic.’

I don’t think it was the first time that the joke had been told in that room, but I guess that’s ok as long as it’s new to your audience. Which it was. Anyway, we settled on the second option, which involved the familiar big needle being shoved in.

‘This is going to hurt quite a bit. We encourage you to swear’

Yep, it did and I did. And then various bits of jagged nail were poked about, cut off, dragged out, and waved in front of me like fishing trophies. The whole thing was over in a few minutes and pronounced a big success.

‘That should be fine by Sunday, we’ll watch out for you’

Hurrah, I thought, quickly adjusting my race plan.

‘But you’ll need to have the nail bed cut out again.’

Uh-oh, I thought, expecting a three month wait.

‘We’ll do the paperwork now so you don’t need to come back for a consultation, and we’ll send you an appointment for May’

Time to take that uh-oh back then.

I know that all of this doesn’t say anything about the resources and the queues and the beds and the cuts and the overcrowding, and all the other awful things that are happening to the NHS at this time. And I know, that, in the scheme of things, removing an recalcitrant toenail from an otherwise fit bloke primarily so he can indulge himself in a running race doesn’t really stack up against the need for ECG monitors, or decent treatment for Alzheimer patients, or reasonable salaries, or meaningful community care, or any other of the big issues.

But, on the other hand, some really lovely and caring and professional people went out of their way to help me this week. They understood the person they were helping, they stopped the horrible bit from hurting, they could see exactly the problem and the solution, and even told a few jokes to ease the pain. When we shout (and we should) about losing what is dear to us in the dearest of our institutions, we shouldn’t forget that the little things define it as much as the big things. So let’s shout about those as well, ok?

 

PS: Had a bit of a setback on Thursday night as I managed to run over my own left foot while taking the bins out. In my profession, we’d call this user error.

The Doctor Is In

~ kevinrevell ~ 1 Comment

Like any other sane person living in the United Kingdom, I spend a reasonable amount of my time worried about the state of health in the country, and in particular the perilous condition of the National Health Service. I feel fairly well informed in this area by Mrs E, who qualified as a nurse over 25 years ago and has returned from almost every shift since with either a) a shake of the head in a ‘you couldn’t make it up’ style or b) a story about something so inspirational around life and death that makes you think that really, the rest of us are just playing bit parts to the Doctors and Nurses that really make the world go around.

So, it was with a genuine and non-sarky interest that I read of the government’s new initiative to get 5,000 new GPs on the NHS register. In fact, I went straight to the GMC website to check what sort of a difference this would make. If you’re of a similar mindset, head for http://www.gmc-uk.org/doctors/register/search_stats.asp and have a look for yourself. You’ll see that if Dave’s big plan is to announce 5,000 more GPs before the next election, then he doesn’t actually need to do anything more than for the last five years.  If, however, he wants to get 5,000 in the next (say) twelve months, then he’ll have his work cut out, particularly given the number of grads qualifying each year as doctors.

Fortunately, the Emu exists partly to right these political challenges, and using simple principles of supply and demand, proposes an innovative method of getting more doctors into GP practices. It seems to me that there are more than enough individuals wandering around, calling themselves Doctor, that we should just start asking them to step up to the mark and start to save the NHS.  Here is my starter for 10:

1. Dr Dre

Let’s face it, it’s time for the good doctor to leave his past of Snoop Dogg and Ice Cube endorsement and the production of ridiculously expensive headphones, and return to his previous occupation, which, as very few people know, was as a junior GP in a small surgery just outside Sheffield. Rap fans will know that Dr Dre’s son Curtis is now known as ‘Hood Surgeon’, so there’s a great opportunity for the two of them to work together as a family practice, possibly under the banner “Get Well or Die Tryin'”.

2. Dr Who

When I was growing up, our family went to the same doctor for about twenty years. Which was great for continuity and relationships, and Dr Who could offer the same sort of service, what with him being over 900 years old. There would be a problem with him regenerating every couple of years, but that would probably be ok as long as you didn’t get Peter Davison while pregnant. You’d worry about him slipping out of character and into ‘Young Mister ‘Erriot’, and delivering the new born with nothing more than a bar of carbolic soap and a winsome smile.

3. Doctor and the Medics

Looking at the pictures of Doctor and the Medics, it’s quite hard to believe how they’d work out at some of our quieter GP practices, but, on the other hand, how many Doctors will actually come fully equipped with a full set of medics to assist their procedure? In any case, they might be just the tonic for some of the more depressed goths that you find hanging around waiting rooms.

4. Doctor Spock

Not to be confused with Mr Spock (see 5. below), Doctor Spock managed to turn American baby and childcare on its head in the 1960’s by psychiatrist analysis of family behaviours. Something that might not be a bad idea to revisit, given some of the things that you see every day. He also wrote a book called ‘Why Babies Suck’, which might be of interest to the goths currently waiting to be see by Doctor & The Medics (who are, of course, running late again).

5. Doctor McCoy

I don’t know that much about Dr McCoy’s actual medical qualifications, although, on reflection, you never saw the actors in Star Trek with coughs or colds, so I reckon it was a pretty healthy place if you ignored the weekly alien predators. But the overriding reason you’d have Dr McCoy as your doctor would be so that he’d be around to lighten the mood during a family death. You’d ask him (say) if your grandfather was ill. “It’s worse than that, he’s dead, Jim”, he’d say. Even if your name wasn’t Jim, you’d ask him to say it again, and again, and you’d have skipped right to the acceptance part of the grieving process.

6. Doctor Zhivago

Let’s face it, if Omar Sharif was your GP, AND he was a poet, AND a left wing radical who’d been wronged by the system, AND you knew that all he ever wanted was to live a peaceful life thinking wistfully of the woman he loved….well, he could tell you anything really. Terminal illness, high prescription charges, permanent deformities, anything really, as long as there was a bit of soft balalaika going on in the background.

7. Dr Evil

Just along the corridor from Doctor Zhivago, with his soft eyes and gentle touch, is the slightly less popular office (inside a hollowed out volcano) of Doctor Evil. Fans of Austin Powers will remember that the bad Doctor went to Evil Medical School in Belgium, before graduating and embarking upon despicable plans to take over the world. He could at least be relied on to be fairly direct when delivering bad news, and , failing an immediate cure for your ills, could help you to be cryogenically frozen.

8. Dr Indiana Jones

By day, Dr Jones is a renowned lecturer on early history, with a penchant for tweed jackets and an apparent need to employ a butler. In his holidays, he likes to go exploring ancient civilisations and battling with Nazi throwbacks. None of this comes for free, so he’d be an ideal candidate to moonlight at a GP surgery of en evening. Much like Dr Zhivago, he could tell you most things while you melted in his eyes, but with the added bonus that you’d be talking to an expert lasso enthusiast at the same time.

9. Dr Hook

Most people will be surprised to hear that Dr Hook was qualified as a medical doctor, but his was nothing if not a life of contradiction, given that  he didn’t actually have a hook either. Which was just as well, given some of the delicate keyhole surgery he had to perform early in his career with the Medicine Show. Dr Hook was also known for his bedside manner and good nature with relatives, for example with Sylvia’s mother: “Please Mrs Avery, I just want to tell her goodbye…”

10. Doctor Seuss

Doctor Seuss is my outside candidate for greatest American author of all time, so I’m slightly biased, but I really think if every interaction was in the style of ‘The Cat In The Hat’ then even really bad news would be fun:

Would you, could you, step this way

Your blood results are back today

Not, alas the ideal answer

Son, you have pancreatic cancer

On the rare occasions that I visit a doctor, I’ve forgotten the diagnosis about 5 minutes after I leave the surgery. Maybe I need to go to a GP to check my memory loss, but I think it’s more that complex medical terminology and me have never really worked well together. But if Doctor Seuss told me the diagnosis, I’d never forget.

Given the challenges faced by the NHS, it wouldn’t surprise me at all if we had some of these Doctors facing off to the Great British Public before too long. As one of the GBP, I’d be delighted.