David Deanshaw
champagne
There was an air of concern in Martin Sheldon’s mind when
Doctor Roger Browning said “you may get dressed now, there will be a slight
feeling of discomfort until the dye passes through.”
Hospitals are such forbidding
places, especially for ordinary non-medical people. For a start, there is that
persistent whiff of antiseptic, which pervades the air. Then the blood pressure
thing – it is always higher when taken by a doctor – it’s called the “white
coat” effect. So what would happen with a barium enema?
Would he speak to the patient now,
or just say he would report to the surgeon without giving the patient any
indication of his findings?
“Well Mr. Sheldon,” said Dr
Browning eventually in a matter of fact way, “I should take care to put your
affairs in order. I shall write a full report to Mr. Amber-Hill your surgeon.
He will make his own decision on the basis of what I have seen and will
suggest.”
“Well what action is to be taken?”
Sheldon inquired tentatively.
“Diet, hopefully, but if not - then
surgery,” was the bland response from Browning, - he did not seem to care what
the patient thought.
“Is there an in-between
option?”
“Yes, grin and bear
it.”
“Come on seriously – what is the
prognosis with surgery?”
“That is something for you to
discuss with Mr. Amber-Hill when he has read my report, so you must ask him. Do
excuse me, I have an urgent appointment.”
Sheldon’s wife was waiting in the hospital car park, ready to
drive home, when he got in. “He has told me to put my affairs in order! What
do think that means?”
“He’s probably got to the end of a
busy day and thought he would spice his own day up a bit.”
“Do doctors do
that?”
“Sometimes, but he has obviously
got you worried. But he should not have said it anyway.”
Nora Sheldon used to be
radiographer. It was her in depth knowledge of the health service that had kept
his almost complete lack of knowledge of the human body and its functions on
some form of even keel throughout their marriage. Indeed she regarded her
husband as a bit of a standing joke in that he had occupied his frame for over
60 years and did not have a clue how it worked. She loved him deeply and had
provided him with the occasional lesson in biology, a subject not done at his
northern grammar school. His cold analytical cutting edge was reserved to
marketing strategies or market research.
Her touch with patients had always
been sensitive without becoming emotionally involved, especially in life limited
situations. “Most of us recognise that a patient is a statistic of one as far
as they are concerned, yet we see these things every day. Anybody who is
trained to recognise symptoms of danger needs to have a human side.” She
assured him that there were very few senior people in medicine who did not care
about their patients. Her experience had run to seeing a wide variety of
professionals, so she was able to assure her husband that most radiologists were
very professional, even sympathetic people. “We are all trained to develop
empathy with patients, particularly since we may be the first to discover a
delicate or tragic truth.”
However, Dr Roger Browning was not such as these. Knowing he
had the name of a great poet was his only connection with sensitivity. He was a
clinical professional who felt he should have climbed higher, but there had been
just one blot from years ago.
Today was just another day of
dealing with those who would soon die, unless some drastic action could be
taken. Some years earlier his over-reaction to diverticulitis symptoms had
caused a major expense for the NHS operating system. When the patient died on
the table, the surgeon claimed that the operation should not have been necessary
had Roger Browning read the data in another way. The subsequent internal Inquiry
had supported the senior surgeon’s argument that the data could have been
read differently. However since Browning had already achieved his PhD having
written a thesis on just that topic - the interpretation of data - the findings
were therefore a whitewash. Browning kept his job and the surgeon moved away in
high dudgeon. A bedside manner was for nurses not a scientist. He would just do
it for the money now.
Martin Sheldon had suffered the pain for some months, but it
had been intermittent. Sometimes it was searing; sometimes just a grumble. But
he had had a life time of pain over his 61 years. TB had cost him his right
kidney, in-growing toe nails trampled on during his sporting life leaving him
with deformed feet, and then in his 40s, asthma and gout had ended his playing
career. Cricket had been the only sport he had played to any representative
standard. All of this made him determined to enjoy what was left of his life.
Such was Martin Sheldon’s luck.
Now he had a new problem.
The wait for the call for an
appointment with the surgeon was not long in coming. The real concern was that
it arrived first thing on a Saturday morning.
“Mr Sheldon, could you come in
first thing on Monday. We have a full clinic but Mr Amber-Hill would like to
see you before he starts, could you manage 8.00?”
Martin was not a man given to panic but the off-hand manner
of Dr Browning and the urgency of the call suggested that there may be some
cause for concern. Nora, his wife, was less concerned – “”It could be that he
is off on holiday soon and wants to get you over with.” Martin thought that she
did not really sound convinced herself.
The surgeon stood up to shake hands when they were ushered
into his consulting room. It was a bland place, with white walls, a modern desk
and a couch in the corner. It could have been any private hospital
anywhere.
“Good morning Mr Sheldon, Mrs
Sheldon. I am pleased that you were able to get here so early.” Briskly, he
opened an ordinary looking brown file which contained the X-Ray films of the
barium enema.
“I would like to show you the x-ray
films as well as this picture. Mrs Sheldon, I gather you used to be
radiographer, so you will be familiar with what we have here.”
His manner was calm and
knowledgeable.
The picture appeared to be a
photograph of what looked like a large grapefruit, only its colour was pink with
orange tinges.
“What is this?” Sheldon asked
nervously.
“I don't know yet. But it is in a
difficult area to reach. It is near the junction of the large and small
intestine. Your wife will know it as the ileocecal valve. This is a sphincter
muscle of some significant importance.”
“Is that what you have found inside
me?” Sheldon’s voice became very hoarse.
“I do not wish to frighten you into
thinking that it is really the size of a grapefruit. I have magnified it 100
times so that you will be able to understand. Not every patient has a wife or
husband who would know these terms; you are a very fortunate
man.”
“But what does it mean? How long
have I had this? How will you deal with it? Why did Dr. Browning suggest I put
my affairs in order?” The questions started to flow.
The surgeon raised his hand to call
for calm and then asked for it: - “I want you to be very calm whilst I explain
what the options are – is that ok?”
Sheldon nodded and sought his
wife’s hand for consolation. He felt her grip and realised that she too was
concerned. She squeezed his hand gently more than once to soothe
him.
“Because it is where it is, I
cannot reach it easily. Many cases of intestinal surgery can be resolved either
by approaches from either end or sometimes with key-hole surgery. Sadly not in
your case.”
“Well what are you going to
suggest?”
“At its simplest, that I cut it
out.”
“Is that a simple operation?” The
words croaked out of Sheldon’s mouth.
“No operation is simple, but it is
really is quite routine these days. Bowel cancer has been known for some time
and the procedure is quite straight forward?”
“But in view of the location, is
this not a little more complex?” Nora asked tentatively. The very mention of
the word cancer was a shock to both of them.
“Yes it means that I will need to
cut quite a length of bowel to be able to ensure that there is no peripheral
damage and hope to be able to do a simple plumbing repair. It is the location
which is the cause of the major surgery. If you like to take off your shirt and
lie on the couch I will point out where the incision would need to
be.”
Sheldon did as he was asked. “What
about this suggestion about putting my affairs in order?” Lying there he felt
vulnerable and slightly helpless.
“Well it was perhaps a bit early
for him to have said that, but he is very clear in his view that although we do
not know whether this polyp is malignant, nor do we know how old it is, it is
necessary to remove it.”
“So he was being alarmist?” the
question was urgent.
“No. And I am also going to
suggest that you put your affairs in order. I must just tell you that nobody
has died on my table for over ten years, but that does not mean that it would
never happen. I am sure that all will be well. But, please, please, be under
no illusion, this is a complex operation by virtue of the difficult location.
It means major surgery and a lengthy recuperation. I will not minimise the
danger. Looking at these notes, I see that your heart is strong that is a major
boost to the process. And I have done it before – many, many
times.”
“Is there an alternative to
surgery?” Sheldon croaked his question with real difficulty.
“Simple – you will carry a
colostomy bag for the rest of your life – no major exercise, no sudden
excitement and above all, no sex. This is not like replacing part of an exhaust
pipe – the intestine is a sensitive tube. I can cut out the infected part
easily, but cannot guarantee to join the ends successfully. If the join fails,
there will bodily sewage sloshing around your inside with the potential of
infection, without any chance of scientific monitoring. Is that a risk you are
willing to take?”
The devastated couple were
dumbstruck. Silence reigned.
“You need to recognise that at your
age there are things you can no longer do, so using one’s imagination is a good
substitute. I had a similar experience with another patient some time ago and
since he started to use his imagination, he can be an Olympic swimmer, score 100
goals a season and write best sellers.”
Martin Sheldon pondered on these
words, part in shock, part in anger and perhaps most of all in
resignation.
“I can do the operation three weeks
on Monday. Will you have sorted family matters by then?”
The journey home was depressing. The turmoil of so much
still to achieve and now the prospect of an early death initiated a major
headache. He had overcome migraine years before, but this shock brought on a
major throbbing in his temple. Sheldon’s knowledge of logistics came to his
rescue. He sat quietly in his study and started a series of
lists.
Wills, family trusts, finance,
shares and investments were all suddenly major priorities. The farewell letters
would really take some thinking and writing. Then, the impact on his business;
short term whilst he was hors de combat; longer term, the business would
close.
Then the more difficult issue –
what if... he did not survive?
“Sorry to hear about this Mr. Sheldon, but I can see you and
your wife on Wednesday. If you could let me have some details in advance by
email, I will have some thoughts to present to you. Shall I prepare a Power of
Attorney as well?” Bernard Bridges had acted for the family in the amendment to
their wills five years earlier. He was a kindly man, despite his relative
youth.
“Yes whatever you advise, thanks,
we will be with you at 10.30 Wednesday.” A solemn response from
Sheldon.
“Look darling, these operations are routine now. When the
Almighty is ready for you, He will decide. In the meantime we must tell the
kids and they should be made to understand how serious this is. It would be
helpful for them if you could be strong and not become morose.” Nora, practical
as usual, tried to hide her own anxiety.
“Can we arrange to have dinner
together on the Sunday before?” The request had a pathetic ring to
it.
“Why don’t you choose the menu?
Remember that after breakfast on Monday there will be nothing until about
Friday!”
“I will lose some weight
then?”
“That’s good – keep being positive
darling! Remember only last month we were talking about how you would toast
your beloved daughter at her wedding next year. Then there is your season
ticket at Aston Villa when you and our son would bond even more. What are you
planning for this evening?”
“I will sit down at my desk and set
out where you should look for various papers if it all goes wrong. Then I
suppose I will try and write some letters.”
“My darling, if you are reading this, the operation will
have failed. Please remember that I loved you more as the years unfolded. It
just got better and better. Thank you for the children and all the care you
have lavished on me and above all for being my best friend. All my love.
Martin.”
The tears had poured as he typed,
knowing the same would happen when he penned some thoughts for his daughter, the
apple of his eye; and his son – the only one to carry on the family
name.
Sheldon ended each day on his
knees. He was not sure just how much faith, if any, he really had. At this
stage, perhaps it was not worth taking any unnecessary risk. How well would he
sleep was uppermost in his mind.
Monday morning dawned with golden sunshine just after six as
usual in August. He was not required to report to the hospital until after
lunch, having had breakfast and then nothing from nine o’clock. Why not try and
sleep? It was a hopeless thought for a man who believed that this day may be
his last.
Promptly at one thirty, Mr
Amber-Hill bustled into Sheldon’s room, armed with a file accompanied by a nurse
wheeling a blood pressure machine. “I hope you have settled in and are
comfortable.” It was not a question, merely a statement of fact. “I cannot
predict how long I will need for your procedure, so you are at the end of my
list – probably five thirty-ish. Do try and get some sleep. I would like you
full of strength – the anaesthetist will be here to discuss some practical
issues with you and so on. Have you anything you wish to ask
me?”
“Yes, I suppose I have – for the
sake of my family, how confident are you?”
“I did say that I have done this
sort of procedure many times. Unless this lump is malignant and more
importantly soft, I do not expect any problems at all.”
“And if it is either or
both?”
“Please stop worrying. I know my
business!” With that he left.
The nurse moved closer and brought
the machine alongside the bed. “Let’s take your blood pressure,” she said
gently. “You know he really does know his business, it’s just that he has a
long list and two of the patients may not last the week unless he removes some
malignant growths.” She said assuredly.
“Is that what they still called –
growths? That’s how they were referred to years ago.”
“I just used that term because I
was not sure how much you understood.”
Sheldon knew she was obviously
trying hard. “Just breathe normally now whilst I measure your blood pressure.” She wrapped the pressure bandage around his bicep. “That’s good – it’s a bit
high but only to be expected. Let me find a vein now, so that we can put you to
sleep when the time comes.” She did so easily and placed her hand on his
sweating forehead. “He really is the best. You are really lucky to have him.
Now see if you can get some sleep.”
At 1.45 a man in a white coat appeared. “Hello Mr Sheldon,
my name is Dr. Graves; I am going to put you to sleep later on. Tell me, are
you allergic to anything?”
“Just bossy women,” he offered
trying to be brave.
“Good, just let me give you a
little shot now to relax you. Then I will see you later on. Sleep well.” Then
he was gone.
5.30 came and went.
6.00 came and went.
At 6.15 another man opened the
door, this time wearing a green coat, carrying to clip board. “Mr Sheldon?
Just confirm your full name and date of birth.” He ticked some boxes on his
clip board. “Right – it’s your turn now. Just relax.”
The bed was wheeled through the
door, along the corridor at a pace faster than expected; they reached the lift,
the door opened immediately. The lift doors closed and then went down two
floors. The lift doors opened. A blast of cold air met the trolley on which he
was lying.
“Right Mr Sheldon,” Dr Graves
lifted Sheldon’s left hand and said, “This will bring a chilly feeling for a
moment. Just give me a nod as you feel the cold along travel your
arm.”
Martin Sheldon nodded slowly and
his eyes closed, perhaps for the last time.
Twelve hours later, in intensive
care, he realised that the Almighty still had work for him to do.