Monday 10 July 2017

Emotion and Mortality

David Deanshaw

brandy sour

There was an air of concern in Nora Sheldon’s mind when Doctor Roger Browning said to her husband Martin “you may get dressed now, there will be a slight feeling of discomfort until the dye passes through.”

Nora sought her husband’s hand, squeezed it as much for her own reassurance as that of supporting Martin.

“Well Mr and Mrs Sheldon,” said Dr Browning, “I think that you should take care to put your family 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.”

Nora gulped, screwing eyes tightly. “Well what action is to be taken?” she inquired tentatively.

“Diet, hopefully, but if not - then surgery,” was the bland response from Dr Browning, - her immediate emotion was that he did not seem to care what the patient might think.

“Is there an in-between option?” Martin asked.

“Yes, grin and bear it.” was the blunt reply. This time Nora squeezed Martin’s hand; it was clammy.

Nora led her husband to the car in the hospital car park.  “Why has he 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.”  But her face was at odds with her words.

Nora Sheldon used to be radiographer. She moved to start the car, took a deep breath and secretly hoped that she could stay strong at least until they reached home.

She loved her husband deeply and had provided him with the occasional lesson in biology, since he had occupied his frame for over 60 years and did not have a clue how it worked.

Her experience had run to working with a wide variety of highly qualified people 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, she knew that Dr Roger Browning was not one of these.  The fact that he had the name of a great poet was his only connection with sensitivity.  Nora shook her head at the thought. .

Nora’s husband had complained of the pain for some months, but it had been intermittent.  All of this made them determined to enjoy what was left of his life. She yearned to be able to spend time with him now that retirement beckoned.  She also had to face the possibility that surgery might deny the pleasure of time to be spent together seeing the countryside, lunches out and no financial worries. This was a new problem.

The call for an appointment with the surgeon raised some concern in 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?

Nora, his wife, was less concerned – “”It could be that he is off on holiday soon and wants to get you over with.”  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.  For a moment she relaxed until she saw what he was offering.  The picture appeared to be a photograph of a large grapefruit, only its colour was pink with orange tinges.

“What is this?”  She asked nervously.

“I don't know yet.  But it is in a difficult area to reach.  It's near the junction of the large and small intestine.  This is a sphincter muscle of some significant importance.”

“Is that what you have found inside me?”  Sheldon’s voice became very hoarse as he grasped his wife’s hand; it was clammy again.

“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 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 - “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 intestine 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 had been a shock.

“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 fumbled with his buttons as he did as he was asked.  “What about this suggestion about putting our affairs in order?”  Nora could tell that seeing her husband lying there that he felt vulnerable and 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 growth is malignant, nor do we know how old it is, it is necessary to remove it.”

“So was he 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?”  Nora croaked her question with real difficulty.

“Simple – your husband will carry a colostomy bag for the rest of his 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 be 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.

“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 major headaches for both.  He had overcome migraine years before, but this shock brought on a major throbbing in his temple. Nora’s practical nature came to her rescue. She sat quietly and started a series of lists.

Wills, family trusts, finance, shares and investments were all suddenly major priorities. Then the more difficult issue – what if... he did not survive?

“Sorry to hear about this Mr Sheldon, but I can see 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 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,” was 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 Sunday?”  The request had a pathetic ring to it.

“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 she imagined reading his final letter.

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.  He nodded at Nora and noted the redness in her eyes.  “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.  Have you anything you wish to ask me?”

“Yes, I suppose I have – for the sake of our 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.  Nora squeezed his hand for the umpteenth time and tried to smile.

The nurse moved closer and brought the machine alongside the bed.  “Let’s take your blood pressure,” she said trying to assure them, then realised that she had failed.  “Mrs Sheldon, I think you should go home now and let him get some sleep. I’ll call you afterwards.”  No mention of “when he comes round” was Nora’s instant thought.  She nodded and moved to share what could be a farewell kiss with the man she loved.

After she left his room she paused for a moment to collect her thoughts. Naturally, she had stayed for most of the day until the pre-med had taken effect. She knew from her professional training two real truths. Firstly, that all surgery is dangerous; and, secondly, that the man she loved was in the best possible hands. She recognised that there would be no point in staying until the operation was over, Martin would then be in intensive care for some hours. She was realistic as a medical professional, she was nervous as a wife, who may not see her lover alive again. The surgeon had made clear that he would be making Martin the last on his list because he expected complications. She calculated that if the operation were started at, say six in the afternoon, it might not finish until an hour or two before midnight. She would go home and try to sleep in the hope of a call in the morning.

Fifteen hours later, the call came.  Nora realised that the Almighty still had work for him to do. Her relief brought tears and what is more - laughter

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