Shadows are falling and I been here all day
It’s too hot to sleep and time is running away’
I’m 13 years old, only a youngster, and I’ve cycled into the back of a stationary lorry opposite Chelston Chapel on the way home from school. I’m still lying unconscious on the floor when the ambulance arrives but I eventually begin to come round and, thinking for some reason that it is what one does in such circumstances, I start repeating my telephone number over and over again to anyone who’ll listen. The upshot of my carelessness is two weeks spent in Musgrove Park Hospital on an ENT ward where I fall in love with a nurse for the first but not last time. I’m the only child on the ward and I imagine the nursing staff find me kind of cute in a way that nobody does anymore. I end up having two operations on my nose, and suffer as a consequence that most serious of surgical complications, that first fledgling desire to be a doctor. A few weeks later, at an outpatient review, my mother tells the consultant of my new career intentions. He smiles to himself having, no doubt, heard such an ambition voiced many times before. But years later, as he reviews a child under my care, he looks at me and, with an inkling of recognition asks, ‘Didn’t you once cycle into the back of a lorry?’
A little over thirty years later, now comfortably middle aged, I’m back in the same hospital, this time in a bed on Fielding Ward.
‘It’s the act of a desperate man’, says the cautious consultant’s in response to my asking why I’m to have a PET scan. His attempt at humour is not reassuring, abnormal results from such investigations rarely being associated with happy endings. But it seems it’s not just GPs who have a differing tolerance to uncertainty. He’s not as confident as his colleague that we’re dealing with endocarditis. Not all criteria for that particular diagnosis have been satisfactorily fulfilled and, apparently, ‘we’ve all got a dodgy mitral valve’. He’s decided that further investigations for my night sweats, back pain and impressive CRP are in order. He’s probably right – after all I’d been admitted on a Sunday so, if some are to be believed, it was always likely that I wouldn’t leave hospital alive.
The next day, too weak to walk, I’m wheeled to the scanner, a blanket over my knees like a frail elderly man. The mouths of some in the waiting room drop open, their heads turning to follow me as I pass by. They’ve not seen their GP like this before. Nor, back on the ward, has the bank HCA, herself my patient. She seems to gain just a little too much enjoyment asking her doctor whether or not he’s managed to open his bowels yet today.
And then the waiting, and worrying, begins. How will I tell the children that I don’t have long? The inevitable bad prognosis will, when it comes, give a whole new meaning to the extended leave I’m anticipating later in the year. Reassuringly, confident cardiologist, no longer responsible for my care, seems surprised that a PET scan has been requested when he leans over my bed that evening. ‘It’s definitely SBE’ he tells me and I’m happy to believe him until, a little later, I’m passed a phone. It’s my GP. She’s rung the ward asking how I am. ‘So you’ve back pain?’ she asks me. Unquestionably she must know something I don’t, has surely learnt of some retroperitoneal malignancy by accessing my scan result online. However, it seems that that is not the case since, the following morning, after a long dark night of existential soul searching, the ST3 assures me the report is not yet available. But by midday it is. Cautious consultant will be along to discuss it soon. I can’t, it seems, just be told it’s normal.
Visitors arrive and, finding me just a little distracted, later leave with still no consultant stopping by. Who said ‘No news is good news’? I’ve decided that no news means that he’s waiting till the end of the day, to talk to me when he’ll not be interrupted. Then he’ll have the time to unhurriedly tell it to me straight. Doctor to doctor? Hardly – I’m no doctor now, just ordinary anxious patient.
‘You OK?’ asks Sister, as the evening meals are served.
‘Yes…fine, thank you. Just waiting for, you know, the scan report. It’s back…apparently.’
‘I’ll see what I can find out’
A few minutes later, she’s back – with a plate and a cheery ‘All normal’. Hospital food never tasted better.
And I promise myself to remember, when I eventually recover and get back to the job I long to continue to do, that good news isn’t good until it’s told.
And then, finally, a year ago. I’d only stood up to put the dog to bed when I fainted. And no it wasn’t because I should have taken more water with it. I chose to come down hard, my head striking the corner of a wall. I’m unconscious for a time and behaving oddly enough to concern everyone who is at home with me, not least the dog whose night time routine has been aborted before the provision of his bedtime snack. And so an ambulance is called and before long I’m laid up in casualty waiting for my results. Eventually of course they’re all shown to be normal and I turn down the kind offer of a head injury advice sheet as I’m discharged and, in the early hours of the morning, make my way home.
A few hours later I’m at work thankful for an additional significant event I can add to my appraisal folder but reluctantly agree with my kind and considerate colleagues who insist I shouldn’t be at work. I don’t like not being up to it but I allow myself to be taken home. It’s the day before my birthday – perhaps I need to accept I’m beginning to get old.
Three times a patient, each difficult in varying degrees, but each, in their way, formative and, therefore, helpful. Looking back I’d not have had it any other way.
Behind every beautiful thing, there’s been some kind of pain’
One the stimulus to becoming a doctor, one a help in understanding more of what it’s like to be a patient, and one, perhaps, the first hint that one cannot remain a doctor forever.
In a world that glories in the strong and heralds the individual, it’s good to be reminded of one’s weakness and one’s dependence on others. Even the strongest will one day grow week – even the youngest will one day grow old. None of us will always be able to do what we once could and each of us will soon enough have to accept our increasing limitations, our increasing dependence on others. To value ourselves and each other only by what we can achieve will, therefore, inevitably result in increasing disappointment.
Rarely does a month go by without somebody I have known, perhaps for over two decades, reaching the point beyond which they can continue no longer. And so they stop. One day their experience will be mine and someone like me will draw my family aside and speak quietly to them.
In 1997 Bob Dylan, then 56, sang ‘It’s not dark yet, but it’s getting there’. In the succeeding twenty three years he has produced arguably some of his best work and even today he still continues to tour. I am now just a few years younger than Dylan was in 1997 but I am, perhaps, just beginning to realise for myself what he knew then. Like Dylan, I hope that there are still a good few years left in me too but it does me no harm to remember that, however much I may dislike it, there will come a time when I will have to call it a day too.
‘I was born here and I’ll die here, against my will
I know it looks like I’m movin’ but I’m standin’ still’
*All quotes in italics from ‘Not Dark Yet’ by Bob Dylan
To read ‘Reflections on the death of Leonard Cohen’, click here.