Sunday, 26 February 2012

A clear, cool, colourless liquid.

As I walked across the road to the hospital entrance it was now 7 days since the first symptoms had shown themselves and who knows how long since the infection first took hold.  Unusually for me I had not just done as the GP said but had insisted on greater help.  I wasn't shuffling but my pace had slowed from it's normal speed.  There was the normal groups of people in and around the doors and foyer but I didn't take in their details, I was just trying to carve a course around and through the slow but ever moving obstacles that they presented.  I followed the basic instruction the GP had given me to find the Acute Assessment Unit, which was basic and fairly straight forward, until I found the door.  This was not an Intensive Care unit but another area with side wards, away from A+E, in which certain medical conditions would have restricted access.

Pushing through the swing doors I saw a large desk on the right, it looked big, like an old police station counter.  I retrieved the letter from my pocket and approached the lady standing behind the desk.  I identified myself and she confirmed that they were expecting me and indicating that I need to go further along the ward to another desk.  I looked down the corridor and my mind registered another desk that seemed a long way off, nodding in understanding I gently pushed away from the desk like an oarsman launching from a mooring and made my way forward.  At the second desk they acknowledged me, took my letter and told me to sit on the end bed, indicating the eight bed side ward behind me.  The ward was empty of patients but I taking this at it's basic meaning I made my way to the far bed in the room and just sat on the edge facing the window, not really taking anything in.

A young doctor appeared and started to question me and I related the tail of the first symptoms and the headache.  He said something and I waited as he disappeared back up the ward to re appear a few minutes later with a senior.  Again we went through the questions and symptoms, and again they both left but this time I overheard a part sentence.  No one had made any mention of Swine Flu until I had told them, not in the phone calls or the letter.  They returned after a few minutes wearing protective facial masks.  And at that point I recognised the junior doctor, it was 'Lewis Hamilton in a face mask'.  Whether I was stunned by this revelation or, more likely my brain succumbing to the infection, I wasn't really taking in the detail of what was being said but just the general message.  They were going to have to perform some tests, requiring Lumber punctures.

Lumbar spinal kit
I was laying on the bed, the top half of my torso naked, with no recollection of undressing or laying down on my side.  'Lewis' began wiping my back with an extremely cold wet liquid.  I recall asking if it was the orange stuff one see's on medical programs, he corrected the colour and told me it's name.  A few minutes later the senior came round the bed to face me, and got me to adopt a semi foetal position as aesthetic was injected.  Something was happening behind me as the senior told 'lewis' not to worry as the Lignocaine takes a little time to work.  I felt the senior place his hand at the base of my skull and neck with a gentle but firm pressure, his other hand reached into the crook of my knees.  And then it started. I felt something touch my back which, in my mind, rapidly turned into a ¼ inch square steel pastry cutter being forced through the skin and spine.  It hurt, it hurt like hell, but the over-riding thought going through my mind was "don't move, don't move!".  There was a brief discussion between the two doctors and then knowing they had to do it again.  I felt the hands behind my head and knees again and then the pastry cutter was inserted in a new position.  Again and again and again, each time needing a fresh location in the spine, until they seemed satisfied.  Yet without me knowing, they had failed to achieve their aim, they had not got the fluid, or sufficient quantities, that they needed.

I was shown into a side room, an individual room, to avoid cross contaminating other patients on the wards. I was to placed in the hands of the Critical Care Unit.  I have no idea how I got there but people were fussing around getting things into place.  My awareness was now following a pattern, at that time I was not aware of this but with hindsight it disturbing how fast things were beginning to deteriorate, I was sinking ever deeper into the abyss, yet entering a domain of compliant acceptance for the needs of staff to treat me.  Sometimes my brain would have 5 minutes of clarity, but that could have been a delusion.  There were a few questions from a nurse, and I was given a hospital gown to dress in, and climbed into the bed.   A doctor, whom I would get to know later, introduced himself and started another round of questions. I only recall the one from a whole series of questions.  He asked when my bowels had last moved, I tried to think, then recalled being constipated but when was that.  I wanted to tell him all but found myself shaking my head and saying softly "no".

My wife got permission to leave work shortly after the news reached her, in fact over the next few days all the family visited although I am only aware of a few visits, and then not all that was discussed.  Arrangements were made to buy some PJ's and other sundry goods after work and get them to me that evening.  The next thing I was aware of was a slight bump as the trolley bed passed through a door.

Spinal tap fluid.
In my mind it was Tuesday, but this. according to everyone, happened the same Monday afternoon.  I had an awareness of a very sterile room, one that was longer than it's width by far, like a galley kitchen would be.  Although I was on my side I was aware of three people in the room.  A senior anaesthetist and what sounded like a young male and female.  An alarm bell, shrill yet flat sounding, rang for a short time.  This must have brought my mind back closer to events.  I could hear the senior tell them to wait, to make sure it wasn't a real alarm, while I just waited in the calm.  I heard the young girl asked what would happen if it were real alarm, the senior told them the patients would be put to sleep before evacuating the building.  I recognised the policy, it was the same for an aeromed flight, when a crash was imminent. There would be no time to help the stretcher cases so they would be put out of their misery first.  I wanted to say "I know, it was OK, I understood, but you just get out and I would make my own way out", but I couldn't so I just lay quietly.  When they were certain things were normal they continued.  There were more lumbar punctures to be done.  I felt very little pain as I started to drift again while I felt, yet again, hands behind my head and knees.  They were guided through their work, I could hear talk of the liquid in the syringe, and after two attempts they seemed satisfied.

Back in my room I was being informed by senior nurse in a dark blue uniform, whom later I was to know as 'nurse Sue' that they would need to insert a catheter.  I have had this done before so told them to go ahead surprisingly I felt little discomfort, unaware my kidneys were failing to function properly.  I was also put onto an IV drip containing Acyclovir.  Whether someone had figured out what was happening to me or whether it was just precautionary I will never know, it was to become the one chance to save my life, but I was to come to hate the sound of the word 'Cannula' by the second week.  Numerous times people came in disturbing my peace to check my vital signs,  but by now I was beyond caring, and anyone entering the room had to wear a face mask.  By the evening I was in my new PJ's, and trying to rest when I felt nauseas.  I grabbed the disposable bowl and duly vomited.  I pulled the cord and asked the nurse for a replacement.  By the third bowl I was offered an injection to help but all I could think of was a glass of cool water.  My mistake, this went on and on till I was into double figure bowls, there seemed to be no stopping this, I finally accepted the offer of an injection and sunk back into the bed exhausted.  A while later I was woken to have a tube pushed up the nasal passage and down into the stomach.  I held the gag reflex until told and they managed this little game first time, and as I lay back I started on series of nightmares and hallucinations that were to shake my world. 

As I opened my eyes I became aware of a scroll in some masonry, it was a soft red stone and finally knew what I was looking at, it was part of the old fa├žade of the hospital.  After some time the doctors broke my peace and asked another series of questions which I did my best to answer, seemingly satisfied they left.  I drifted off again.  Several times the staff had phoned the pathology department to confirm the diagnosis because my lungs were completely clear, and always the answer came back an affirmative for swine flu, the anti-bodies were present in the spinal fluid.  It had targeted my brain almost as if by intelligence. 

I could hear a sound, or rather numerous sounds with a slight echo, it was voices.  The slight rocking of my body suggested I was on another trolley moving through a public area.  I couldn't distinguish individual words, it was like a cage full of muted chickens.  I wondered what they were talking about,  Were they talking about me, were they judging me, what were they thinking as I was being swept past them, and despite the sheet and bed throw beloved of hospitals I felt a naked vulnerability seep through me.  I was parked next to a window in what sounded like a cathedral of a room.  Footsteps moved away till I could hear quiet voices talking.  The window appeared large, and arched at the top befitting a huge room. Other sounds now came, vehicles and footsteps outside the window, I could hear them talking and thought they need only turn their heads to see me and that cold feeling of naked vulnerability seeped through me again.  In the room was a machine. My mind viewed it as a monolithic piece of engineering that would have taken pride of place in any heavy industrial workshop.  I was to have an scan of some sort.  Moving me into position I was told to lie as still as possible as a steel mask, with two slits for eyes, gave a dull metallic clang as it shut over my face.  Then the noises started, banging and thumping in strange rhythmic pulses, until I was no longer aware.

Each day my wife would visit two or three times, and each day although we talked I was to have no recollection of them.  My wife would be briefed before or after as to my progress or not.  Until one night the care staff informed her that if I was to continue on the downward path I would not be taken to the intensive care unit,as they could do no more than the critical care staff were already doing where I was, she was to go home and get some rest but be ready to be called back in that night.  Totally unknown to me I was about to enter battle.  

On one side was a virus, under the flag of H1N1 breeding it's battle troops at an exponential rate, already inside the compound damaging and destroying my communication systems, wreaking havoc with the command centre that was my brain.  On the other side was I, backed up by a small plastic bag containing a clear, cool, colourless liquid called Acyclovir.  This was to be a decisive battle, there could only be one outcome, one winner.  This was, for both sides, a battle for life or death.  

Tuesday, 7 February 2012

A few lines on the page

I don't know what day it was, or what the date was nor for that matter which season, just that it was 2009.  The scant marking and squiggles in my diary that had once meant everything I needed to know about what I was to do or had done are now something of an enigma.  As I tried to decipher them into meaningful stuff all I can figure was that over the period I was delivering lectures to groups about roadcraft and road safety during the working week and off at the weekends.

I have this strong feeling it would have been a Saturday morning, with the light streaming through the window, that I was scanning the news on my laptop.  The homepage on my browser is set to a web news service to keep things straight forward. The normal course was to scan the front page and check for the most likely looking article, click the headline link and read the first one or two paragraphs.  If it was something of interest I would continue to the end, if not then I would look at the other links on that page and click or just return to the homepage and start again. 

This particular day I followed the links and found myself looking at news from the South American section.  I'm not sure how I got to that point or how many links I had clicked to reach that report.  There was just a few lines on the page, three or four, which basically said that two people had died and several were in critical condition, in a village no one had heard of in Mexico.  The local authorities were gathering a specialist team together to investigate a potential outbreak of swine flu.

There was no silent alarm bells, no tingling spider sense, I am not aware of reading the page twice, just staring at it.  It's was as if my sub-conscious brain took over as it extracted information I had learnt before.  I knew the so called 'Spanish Flu' pandemic of 1918 was, in fact, a swine flu but had it's name changed as the government of the day was concerned about the impact on the pig farming industry.  There had been expeditions to Svalbard islands as well as Alaska to exhume victims for viral genetic research.  That the pandemic had wiped out more then 30 million people and the scientific community still didn't have the answers. The recent Avian flu's from South East Asia had travelled around the globe at a rapid speed with modern transport systems reaching the UK in short order even though few people succumbed.

As the days went on, and life continued as normal, another death and several people were hospitalised.  News of the teams arrival, investigation and confirmation of findings were noted.  The thing I didn't notice at first was with each day it was getting easier to find the piece, less and less links.  It was climbing up in the news league table.  The mass media got hold of this item and it went mainstream just before the first case was confirmed in North America.  As the weeks turned into months more cases, more deaths and finally it crossed the Atlantic to arrive in Britain.  By now it was headline news big time, each bulletin started with the recent updates on this.

Life for most people carried on as usual, there was no mass panic, no hysteria, but people wanted answers.  The news studios invited government ministers, health experts, and anyone else and his dog to come onto their programs and reassure the public that all was in hand and stocks of medicine were being made available.  The two clear messages in all of this was that if you suspected you had the infection you were not to go to your GP or to the local hospital, for fear of spreading the infection, but to phone the health service help line who would go through your symptoms and issue the tablets if confirmed.  The second was quite simple- wash your hands thoroughly and wash them often, I even managed to secure an A5 poster to help the children.  Ironic then, it was to be me. 

 As more victims were announced a new phrase came into being.  It seemed that all those dying from swine flu had done so because of 'underlying causes'.  As time moved on there was other incidents, people being flown abroad for treatment, an outbreak at a school in South London, but for the most part people that actually caught swine flu didn't realise it because the symptoms were so mild they hardly noticed a slightly sore throat or minor headache.

Volvo B9R Coach
On a Monday, my brain insists, in the middle of October I was not lecturing but rostered to take a coach cross country, Bedford to Oxford and back then later Cambridge and back. This was a journey I had done many times in the past and was looking to it as a refresher from my normal duties.  The coach I was to take was due into the Station about 3 o'clock for hand over and I would take it on what should be just short a 4¼ hour round trip, just inside the legal limits, traffic permitting, never easy at that time of day.

The first sign anything was wrong was a feeling of butterfly's in the stomach, not lots just one, a huge one.  I could just feel the right hand wing gently brushing up and down every two or three seconds with a slight hesitation at the top and bottom.  I put this down to a nothing, grabbed a beaker of cool water and waited for the coach.  One hour into the journey and I noticed the headache, I tried to ignore this thinking I could take some tablets during the 5 minute turn round at Oxford.  I scrabbled round my bag at Oxford but can't recall finding any medication, the headache was stronger now but figured I could get some painkillers at Bedford depot.  I got caught in the evening peak traffic and by the time I got back to Bedford I was late, too late to take the next coach allocated and would have to wait for the one after mine.  As I sat in the rest room my headache was intensifying and interfering with my thoughts, my temperature climbing rapidly. I was struggling to make rational decisions until I thought 'enough, go sick now!'.  I was much later to find out from colleagues that I looked to be in a right state.

I arrived home after a 20 minute walk, to the surprise of the family, who were not expecting me much before midnight.  A cup of tea, as they fussed around me, my temperature had climbed quite high.  I went to bed with some tablets.

Tuesday was not to bad, the head still hurt but not as bad. I felt lethargic, tired, but had not coughed. I managed to get up but not much else.
Wednesday was something else.  The headache was intense, right round the head with a small extension between the right eye and ear. It didn't pound in the usual way with the pulse but just was.  I managed to get some more tablets and went straight back to bed.  As I lay there I became aware of the phrase 'to smack one's head off the wall', never had I thought of doing this before but for some reason I could feel it quite strongly.  While the new pain may be a distraction I knew that in reality it would not help.  I placed my left hand on the pillow, rested my head in the palm and placed my right hand over my head as if to lock it in place.  There I lay waiting for exhaustion to carry me away.  I didn't wake until my daughter Jacqueline woke me with a cup of tea.  I knew I had to get up or I'd probably not sleep that night.  I don't remember if I got dressed or just slung a dressing gown on before joining the family.
Thursday didn't seem too bad.  We got through to the help line and issued with a personal serial number to get Tamiflu.  The allotted chemist was across town and my wife duly trudged over only to find our number and the chemists number didn't match.  Fortunately the chemist was able to resolve the issue and I got my first dose that night.
Friday was similar in that I managed to get up and around the house, the headache was present but not impossible to live with.  It also brought about the first day I noticed the constipation.
Saturday and Sunday passed but I can not remember any details of those days.

Monday, and the headache was back, I managed to get an appointment with my then GP, and arranged for someone to take me.  I related my tale and he seemed to look at me in a 'what do you want me to do about it' way.  He may not have been but that's the impression I got.  I repeated my tale of the headache, leaving work and the rest, this time with emphasis and finished by saying "I need Help!".  He sent me back to the waiting room while he made enquiries, twice I was sent back and forward till he gave me a envelope.  I was to go to Bedford hospital but not the A&E, I was to report to the Acute Assessment Unit, the meaning of which did not register on me.  he gave me instructions on how to find the AAU and off I went.  I was driven home and had a quick cup of tea to quench my thirst, and walked the short distance over the road to the hospital. 
Bedford Hospital, Main entrance

It was about 11 o'clock in the morning.  As I entered the main doors no one, least of all me, had any Idea how fortuitous that timing had become, my odds were shortening rapidly, the numbers falling away like the back of a parabolic arc.