News from the Front

Cheating death by needlework

Chemo cycle 3 week 2

Monday

 I started vomiting at 8.00 pm at my sister’s, where I was staying. Then went very cold with uncontrollable shivering. After several phone calls to my oncology support team Celia was told to take me hospital. By the time I got there at 10.00 I couldn’t walk and Celia found an ambulance driver to push me into A&E in a wheelchair. Once there, on being told I had to wait 15 min for triage, despite my care team having rung through to prioritise me, Celia replied no we can’t wait (attagirl!), the receptionist took one look at me and in 5 min was seen. I had the dubious honour of being no.1 in A&E. Then I had my first needle for blood tests and a cannula fitted. Later they struggled to get another needle in to me because my veins had collapsed in my arms from dehydration.They did eventually. I had after all vomited 70-80 times in a dozen waves and had become semi delirious, strangely thinking I was in France at one point. This state, combined with a high temperature meant I experienced unfathomable depths of unwellness. An injection stopped the vomiting and was put on a rehydration drip. We waited till 4.00 am for a bed on a ward. All is now a blur and I remember very little of that night. 

Cause : chemo damages the gut lining and low immunity allows bacteria probably from prawns eaten at lunch in Zizis restaurant to create havoc. Severe gastro-enteritis- both ends then leads to rapid and life-threatening fluid loss; similar to stage 2 of the 3 stage Ebola process.

Tuesday-Thursday
The gastro-enteritis had overwhelmed my immune system and caused a drop in neutrophils the body’s white T-cells triggering Neutropenia, a dangerous level of vulnerability to systemic infection. My doctors activated the Neutropenic Sepsis Protocol and I was moved to quarantine and for next 3 days monitored every 2 hours (blood pressure tests) causing sleep deprivation and turned my arms, back of hands and stomach into pin cushions; between 25-30 injections of various gauges and administered with various ability followed. My particular favourite was the daily abdominal two step; two injections one left and right into the abdomen. Meanwhile being aggressively rehydrated by an endless number of liquid bags above my head into my veins. 

The protocol the hospital followed may have saved me from neutropenic sepsis which I have found out is 7-10 times faster than Ebola at sending one to the next world. Death comes with a 70% chance in only 24hrs. Everybody knows about Ebola but I did not know about Neutropenic sepsis which is entirely a risk of a medical treatment – chemotherapy. One is warned about the danger of a raised temperature while undergoing chemotherapy but not of the potential deadly consequences. 

Friday
Fate had one last surprise in store. I was ready to leave the hospital but beforehand I had asked for my 3 monthly injection for hormone suppressant. This is a 10.8mg implant administered to the abdomen by syringe using a 14 gauge needle meaning its 2.11mm thick, more akin to a small screwdriver. I had asked for an experienced nurse for this procedure. At 3.00 pm a senior nurse appeared in a smart dark blue uniform- a badge of seniority, telling me the one supposed to do it was called away and she would do it. Twice I asked her if she knew this procedure and twice she said yes. I didn’t quite believe her but given her rank, level 6, I thought ok let’s get it done. The last one I had took less than half a second; painful but quick. She took 10 seconds to slide that tool into me, leaving me hurt and angry. Mortified, she then confessed she hadn’t done it before. As a red flower of blood seeped through my pyjamas, I felt sorry for her. Somehow it felt that the room had morphed into a crime scene. She and I bound together by the unspeakable intimacy of perpetrator and victim, joined by the promise of secrecy and her guilt. 

One endures tortuous treatments because of trust in the administrator and the good intention of the procedure. Medicine depends on such trust it all falls apart. Every injection is a submission to be hurt by a well-intentioned stranger. 

Conclusion

I have been changed by this week; I am mentally stronger, more resilient and now battle-hardened. Physically I am currently more frail; At first I shuffled about like an old man and even holding a newspaper was tiring. Two friends I have seen initially failed to recognise me. But my happiness has returned and I feel somehow victorious in this battle. Pity it was with the dumb Orks of my chemo army attacking indiscrimately rather than the real enemy, my disordered cells. 

Through good needlework my doctors Tom and Alastair coordinated a campaign to keep sepsis at bay. And in the process I have learnt all about needles, their size, and the various places they go and the intimate dance that takes place between nurse and patient at the moment of insertion. I like the way the nurses offer a choice of where to be stabbed, thigh, stomach hand or arm.

Overall the care I received at the Royal Free in North London was first class and I got to talk to nursing staff from a wide variety of countries from all over the world, a truly multicultural organisation. I saw the best and the worst in human nature and all in one short week.

1. I now know to get to hospital in one hour of getting the smallest temperature. I have been shocked by the speed at which a body can decline towards death when things go wrong. 

I plan to go to the Italian Alos this week with a friend and have put detailed plans in place for Evac off the mountain in an emergency with volunteer locals so I can get to a hospital in 60 min in all weathers and at any time.