Category: NHS

No Pain, No Gain?

pain

The most amazing thing to me about the operation to remove a substantial chunk of my right lung, the upper of three lobes to be precise and, thinking about the method of entry to the chest cavity, what has to be cut through before you even get to the lung, was the relative lack of pain – from that day to this.  As I write I fear that I may live to regret so bold a statement when the nerve endings start to repair themselves but just for now it feels like an almost pain free experience.

The same cannot be said for the two chest drains that were of course an essential part of the process.  These remove both air and interstitial fluid that builds up in the thoracic cavity following an operation of this sort.  The fluid is normally carried away by the lymphatic system but given the damage done to it during the operation and the amount of fluids being produced, the lymph needs help for a few days.  Air, of course, whilst it may sound perverse at first but becomes obvious when you think about it, is not something normally found in the thoracic cavity, it’s supposed to be inside the lungs, inside said cavity.  Air inside lung – good.  Air outside lung – bad, lung collapses and you risk death from asphyxiation – something to be avoided if at all possible. It is they that; have been the source not only of the minute to minute aching (that is for the most part entirely bearable and when not is easily made so with a dash of morphine or a tramadol capsule) that; have forced me to lie flat on my back to sleep (something I’ve never mastered in my life and thus have had very little sleep until last night) and that during removal (of the first one) gave me the most excruciating pain imaginable.

I’m sure it must be possible to have worse pain, perhaps I just lack the imagination to understand how any pain could actually get any worse than that pain was, except by continuing for longer.  Is it more painful to have your leg hacked off at the knee with a machete?  How could I ever know without experiencing it and I’m pretty sure that if I were to experience it, the knowledge of what was being done to me, the nature of it as a malign attack rather than a palliative process and the understanding of how long this was going to go on for would ensure that I placed it higher in my list of lifetime’s painful experiences but, the question has to be asked, would the actual amount of pain second by second be any greater?  Would it not just be pain, pure and simple, governed in volume by the number of nerve-endings responding to the stimulus?  I don’t know the answer, maybe there’s a scientist or two who do but I’d say it’s always going to be a somewhat subjective issue.

The fact is that removal of the first chest drain, which took place in the hospital, was excruciatingly painful.  I found the reaction of several of the nursing staff, to my tale of the event, curious indeed.  I got the impression that I was being regarded as some kind of wimp, making a huge fuss over nothing.  Well, let’s be entirely fair here, suppose I was a huge wimp and was making a big fuss over something that most people find so pleasurable that it’s a toss-up between, ooh I don’t know, popping down the pub for a drink with your friends or, nipping next door to your mate, Kevin, and asking him to whip a garden hose out of your chest without anaesthetic.  Yes, let’s suppose that’s the measure of the seriousness of the procedure to the average bloke.  Well, here’s a thing now, pain, as I mentioned before and as we all know by established research, is a subjective issue.  The fact that one person can stand an amputation of a limb whilst biting on a stick of wood, as all good cowboys do, whilst another would actually suffer a heart attack as a result of the pain and die, is what makes it subjective and, being subjective, it is all about the subject, in this case the patient, and not about the practitioner, in this case the medical staff.

So the question first arising here is what should be the relationship between practitioner and subject, between medical staff and patient.  Primum non nocere is a Latin phrase that means “First, do no harm”, it is a fundamental precept of medical ethics known to every medical practitioner everywhere in the world.  That is all that needs to be established about this relationship for my purposes but let’s broaden it a little and say that, of course, one of the primary functions of “medical care” is one of “care”.

That’s a word that has many sub-definitions, meanings and connotations but I think we all understand what it means when used in everyday parlance and particularly in a medical context.  Care is diligence, doing one’s job carefully, omitting nothing, overlooking nothing, considering everything.  Care is also concern and compassion, actively wanting to “do no harm” indeed, wanting very much to take one out of harm.  In this subjective instance, to relieve pain wherever possible, not to cause any additional pain unless it is entirely unavoidable, to consider the individual patient and their perception of pain, to work to alleviate the fear of pain which is, of course, a very large part of the actual experience of pain.  That fear causes physical tension and tension exacerbates pain so if one can bring someone to a relative relaxation there will be less experience of pain, even though the pain stimulus may be exactly the same.  We all know these things, I’m not telling anyone anything they didn’t know before but that, perhaps, is one of my central concerns.

It is these things that we all know so well that often get overlooked, forgotten about, disregarded when the pressures of the day to day, the very familiarity of it, risks bringing with it an unconscious disdain.  Cultural issues also play a part as do generational, age-related ones.  Pain is regarded differently in different cultures and it’s probably true, the more westernised a country becomes the less acceptable certain levels of pain become.  In this country, of course, we also have to measure up to that level of stoicism inferred by the phrase persistently attributed to the British caricature with their “stiff upper lip”.  It’s the same stuff and nonsense that causes even modern day liberal parents to train their children in the “big boys don’t cry” theory that blights most of their lives and is considered in professional circles to be at the root of much violence and spousal abuse…but that’s another subject for another day.  For now the point is that this so called stoicism has worked well for a country that, in times of war, rationing, poverty and deprivation needed to find ways of maintaining morale.  Well, folks, those days are long since over and I hope we no longer judge people as to their “Britishness” on whether or not they can cope with apparently intolerable pain, suffering or deprivation without so much as a whimper or a sniffle and I’d like to think we were, these days, encouraging boys to shed a tear rather than bottle up their emotions like a pressure cooker until they kill someone.

So on the day that I’m told I can have one of my drains removed I am both elated and nervous.  The elation does not need to be explained to anyone who has ever had one or, in my case, two of these buddies tethered to your body.  For the rest consider the, “wherever you go, I go” principle of the attachment with all the discomfort, complication and restriction that places on every movement from planning a trip to the lavatory ten minutes ahead of time to wanting to roll over in bed without ripping a half inch hole in your chest cavity which will inevitably strangle you in the same instant as the rushing inflow of air crushes your lungs.  It’s rather unlikely that such a thing could ever happen but not in one’s imagination it’s not, there it is an ever-present threat.  The opposing nervousness comes, of course, from those self same roots, how on earth can it not be painful to remove a half inch hose from your chest wall after your body has been busily doing all it could to accept it as part of  you and welding tissue to the tube by way of reconstruction.  Thus it is indeed the case that I approached the moment with a not inconsiderable fear, about as considerable it must be said as the bronchoscopy I had endured some three weeks earlier or the subsequent CT-guided biopsy, involving a very long needle through that very same chest wall.  In the first case I was given mild sedation but had to remain awake because my cooperation was required.  In the latter, no sedation for similar reasons but as much local anaesthetic as was called for that turned the process into something that, in my mind never really happened.  A very clever surgeon assured me at each deeper penetration that all he was doing was giving me more anaesthetic and the half of my brain that was shouting “don’t listen to him, you know exactly what he’s doing, he’s assaulting you with a very large sharp steel instrument” was subdued by the other half of the brain that readily accepted the much more pleasurable and acceptable premise that all we were doing was getting ready for a procedure that was not going to happen until I was properly anaesthetised.  Now that surgeon, one Simon Padley to give him his due credit, knew exactly what games he was playing and the benefit to both of us in playing them.  Here’s the thing, he would no more have thought to stick a needle through my chest wall without a local anaesthetic than he would to remove a hose pipe from the very same place without one.

As I later described it, these two prior procedures accurately reflect the usual situation where the fear of the procedure was some ten times worse than the actuality.  In the case of this first chest drain removal the actuality was ten times worse than the previous fear of it and that is how I knew something was not right.  From my own research and deduction, I now believe I have a pretty full picture as to why this was and what caused the very real and excruciating pain that I experienced and which continues in much abated form, just by way of reminder, to this day, five days later.

I have scoured the web and read many professional documents on the subject of chest drains and, in particular, on their removal and what considerations are given to the questions of pain and appropriate anaesthesia.  I have arrived at several conclusions:

  1. There appears to be no single authoritative work on the issue to which practitioners can turn with confidence.
  2. There are conflicting opinions as to the level of potential pain and the steps to be taken to ameliorate it.
  3. There are, incredibly, medical professionals out there who do not believe that anaesthesia is required even for INSERTION of a chest drain – that should make interesting reading for the justice profession when considering what action to take against youths on sink estates shoving penknife blades into each other’s chests on a Saturday night.
  4. Rather than the “national” health service conducting research and publishing established guidelines, each individual hospital is apparently charged with investing our hard-earned taxes many thousands of times over in conducting their own research and formulating their own individual policy to apply in their very own hospital assuming of course that they think to even do so – good god almighty what lunatics are running this enormous NHS asylum?

What comes across loud and clear, as if one needed such research or evidence, is that there is a sufficient body of it out there from around the world – the English speaking westernised world so far as my research was limited – that one cannot deny that there is a very strong likelihood that the patient will experience significant pain when a chest drain is removed and therefore that local anaesthetic should always be applied in addition to intravenous or oral sedatives such as morphine.  Of course, there must be instances where no anaesthetic was used and no pain was experienced by the patient, else there would be no variance of opinion but why on earth would that lead you away from taking the precaution of administering a little lignocaine just to be sure?  Primum non nocere.

Growing up in the fifties and sixties I learned to equate the word “dentistry” with the synonym “extreme agony”.  How did I manage that?  Well I’m sure I’m not the only one but the inevitable result was that as soon as I was responsible for my own decision making, quite early on in my case, one decision was that henceforth I would be visiting dentists over my “dead body” so to speak.  Put more simply, I simply wouldn’t be visiting them ever again.  Thus it was that by my mid-twenties and a decade or more of dental neglect brought about the very pain I had been so strenuously avoiding.  Mercifully a friend recommended their “private” dentist and it was from him I learned that, his words not mine, “Robin, there is no reason for you to ever experience pain from dentistry and so long as you are my patient I give you my guarantee that will remain the case”.  Thirty odd years and two or three dentists later (don’t they retire early, these guys?) not to mention fillings, caps, bridges, root canals and nerve extractions, I have never to this day felt any pain in the dentist’s chair nor needed to take more than one dose of painkillers after the event, when the anaesthetic wore off.  So why the difference?  Simple, it’s a cultural thing but its also a capitalist thing.  These guys are in business, they “get” customer service, they want you coming back to them to help fill that pension fund that enables them to retire early and in relative luxury.  They best do that by making sure you have not the slightest fear of visiting them – and EVERY fear of visiting someone else.  Hey presto, professionally administered, pre-emptive pain relief materialises as if by magic and absolutely no procedure commences until the patient confirms that the anaesthetic has done its job.  There’s a lot to be learned here but, unfortunately, because of the irrational structure of our “beloved” NHS we have to try to achieve this in the absence of a profit motive, which, after all, is just a motivation to give excellent customer service.  If the staff are excluded from that motivation then I’m afraid we lose an essential driving component but, what we lack in the construction of the service we can at least attempt to bolster by way of policy and training.

Gloria and Glena are both very experienced and capable nurses, of that I have no doubt.  I took to Gloria immediately, I felt very safe in her care and from various things we had chatted about I felt we could relate well.  I had never seen Glena before in my life and so when she walked into my room and was briefly introduced to me, I assumed she had been brought in from a general ward somewhere because of her specialist experience in chest drain removal.  She was to officiate with Gloria assisting.  Fair enough, it seemed like a good combination but on reflection it occurs to me that there was little or no discussion over what was about to happen – apart from some guidance on breathing instructions that I would be given again at the time.  All of this conversation, such as there was, took place behind my back, quite literally.  I was laying on my left side looking at my wife whose hand I was holding.  Gloria and Glena were behind me.

Glena’s touch was very gentle, yet very sure and I was comforted immediately.  Given she was a total stranger to me (and yes I do believe that is a major issue in the way we deliver health care in this country, one that can be solved simply and inexpensively with a little thought and conversation) the touch of her hands was my only real way of assessing how safe, comfortable, assured I would feel and it helped me to relax initially.  I hadn’t read up on what was involved, who does on such a relatively minor procedure?  No-one had explained it to me but I had automatically assumed that a local anaesthetic such as lignocaine would be used, it just seemed so obvious.  I don’t recall at exactly what point I asked for this but I believe it was Gloria that advised me that “nurses aren’t allowed to administer anaesthetic”.  I have no idea how accurate a statement this is, whether its a misinterpretation or misconstruction of an actual policy ruling but the question formed instantly in my head was the one I repeated to all those involved later: “How is it possible that it can be ok to allow a nurse to remove a hose pipe from my chest cavity with all the attendant risk that such a procedure implies and yet not allow that same nurse the responsibility to administer appropriate analgesia?”  It beggared my belief then, in agony on my side, as it does now in my very comfortable and painfree home, bathed in warm spring sunshine.  It beggars that belief to the point that I don’t believe it and because I don’t believe that Gloria would lie to me then I must assume that it is some kind of misunderstanding.

I put this point to several of the nursing staff later, during a shift change ward round and I think they misunderstood what I was saying.  I was inferring that I have no problem with the nurses doing the drain removal and thus, given that level of trust, no problem allowing them to administer local anaesthetic.  It appeared that some people thought I was implying that as nurses were not allowed to administer local anaesthetic, they should not be allowed to remove chest drains.  The two interpretations could not be more starkly contrasted and, of course, such a misunderstanding would have reflected very differently on me indeed.

Something else I recall Gloria asking me, when I was trying to make it understood just how much pain and distress I was in at that time, is what gave me clues to my later findings.  She asked me whether it felt like burning.  Well that was it, precisely.  Until she verbalised it I hadn’t considered the nature of the pain, my mind was so full of the pain it left little room for other tasks unless prompted.  As I described it to her then it was like someone had taken a burning hot flat iron and held it to my side, the way one’s skin sticks to a dull black hot metal object like a surprisingly hot chimney flue.  The only thing wrong with that analogy, I clearly remember thinking at the time, is that a flat iron has a very particular shape and the shape of this pain in my mind was square.  It might seem odd but yes it really did have a ‘shape’.  A couple of days later, still trying to mentally bridge the understanding gap of those who made me feel I was making a mountain out of a molehill and my own vivid knowledge of what I experienced, it was this shape memory that prompted me to ask my wife about the substance that had been used to disinfect the surrounding area.  I recall Glena and Gloria discussing preparing a sterile area around the drain, I remember Gloria warning me this would be cold, and it was.  There was almost no interval between the application of this preparation and the beginning of the task of removing the sutures retaining the drain tube and the almost immediate pain I started to feel.  The pain grew and peaked every time Glena sought out a thread or made some other touch to my skin, it was indeed as if this square of my body was on fire and the slightest additional stimulus was a gallon of fuel poured on the flames.  “Was it that yellow stuff?”, I asked my wife, who confirmed it was exactly that, “Betadine” she advised knowledgably, that being the brand name, in the U.S. at least, for a range of povidone-iodine (PVPI) topical antiseptics.  I was already wondering about a reaction to iodine and this confirmation sent me off in that direction.

Sure enough, I discover reams of information about adverse reactions to iodine based preparations, including Betadine, everything from life-threatening allergic reactions to the much more common reaction that I experienced.  My experience was of course exacerbated because of the substantial use of morphine based sedatives since the operation, those sedatives causing an over production of histamine which, as I crudely understand it, creates a set of circumstances which combine into a severe skin reaction.  So severe, in fact, that the following day the skin around my dressing was red raw and had actually blistered.  My wife has been treating it with TCP and Savlon these last few days and it’s starting to clear up, the blistering just bled out last night.  I have no idea what the policy is for testing or checking whether a particular patient is going to react to the use of a given preparation such as Betadine.  With what I do now know I suppose I can assume that where a policy does exist it will be different in each and every hospital across the country which, as I’ve intimated before, appears lunatic to me.  What I know though is that a pause of a few minutes, literally 2-3 minutes, between application of an iodine based preparation and the subsequent procedure would have allowed time to detect the reaction and countered the effect, delaying the procedure until the situation was resolved.  Whilst being a safeguard against my situation, that of course would not protect those who have the more severe allergic reaction so I’m rather surprised that there is no scratch test or similar as a matter of course before application of such substances, given there is no emergency being addressed here.  I guess someone might conclude, perhaps rather presumptively, that if the patient had just gone through major thoracic surgery that the same substance would have been used and that no reaction was noted.  That however is hardly a sound basis from which to presume and does not take into account the other factor referred to in respect of the build up of histamines.

Forewarned is forearmed, as they say, so it will be no surprise to anyone that when it came to removal of the second drain I was fully equipped with all the information I needed by which to direct how things were going to proceed.  I had made an appointment with a thoracic surgeon at my local private hospital for 8am on the Saturday, four days after the first drain was removed.  An hour beforehand I took a 10mg dose of oral morphine as a precautionary general sedation.  I explained the background to this new surgeon and requested that he use an alternative to iodine for the disinfecting process and that he use lignocaine prior to removal.  He clearly noted the residual inflammation and blistering and so to say that he had no hesitation in agreeing my proposals is to understate it, both he and the attending nurse displayed a healthy degree of incredulity that anyone would attempt removal without a local anaesthetic.  I normally have no problem with injections and so the acute sensitivity I felt to this particular lignocaine injection confirmed to me, beyond doubt, just how sensitive this area had become.  That said, the pain was gone in a second and the rest of the procedure was entirely pain free.

I could spend the next six months researching this topic but, frankly, life is too short for me.  For the profession, I really do think this is something that should be looked into seriously and urgently.  The questions I would want to address would be:

  1. Why do we not have national policy guidelines, developed as a result of research conducted by the most eminent professionals available and imposed automatically across the entire NHS?
  2. What training do we need to deliver to medical staff on the methodology of minor surgical procedures? Preparing the patient, allaying fear, making sure where possible that there is a bond of trust before the procedure is started?
  3. How do we best redress cultural obstacles throughout the NHS to effective pain management practice?
  4. What tests or procedures should be adopted to prevent experiences such as mine, within reason and where practicable?

What I went through was hardly life-threatening and what I was being cured of most assuredly was!  It is therefore clear that a relative perspective must be maintained here but to suggest that such minor issues should be ignored given that the patient should “thank their lucky stars” that they are still alive, is not exactly the kind of professional approach I would expect from a civilised and wealthy society such as ours.  Patients heal better and faster when their pain is well managed, it’s a simple fact.  Patients that heal faster are cheaper to treat.  Patients that do not experience pain are easier to manage.  The whole topic is a no-brainer surely, instead of the moronic “no pain, no gain” maxim we need to instil “no pain, we all gain”.

Ode To The Hitch

Ode To The Hitch

NSCLC

Friday, February 17, 2012

I started this blog at the beginning of a fairly traumatic and fatalistic journey which would explain the opening line I first wrote: “And so to journal the end, which is nigh, it seems.”

Well, whilst that statement could be construed as true in just about any circumstances, on a personal level I feel now that it gives the reader a less than perfect impression of what follows so I’m going to offer the following alternative beginning so as not to hide the good news that my friend will want to hear. Most of this was written almost live, just after it happened or even as it was happening, some was added after to fill in gaps, so on occasion the context might appear not to quite fit and the construction definitely leaves room for improvement:

And so to journal what could so very easily have been the end, which is not quite as nigh as I at first thought, it seems.

I’m not sure quite what I expected when I decided to go (finally) and ask for an investigation into what I was already sure was that dreaded beast, the cancer. Admittedly, I feared it was the same as dear Christopher’s, (Hitchens) the esophageal kind. For once the doc appears to have been correct in casting aside my self-diagnosis, proffering the much more likely (and somewhat inane) alternative of the lung kind and writing me up for the low tech scan of the x-ray kind.

It wasn’t fear that caused me to delay getting my ass to the hospital, any more than it had been the cause of the twelve month’s procrastination over getting into the doctors surgery. It was far more mundane a cause than that. In the case of the doctor it was the groan at the thought of the hurdles the surgery places in the way of dispensing it’s services – a rant for another time. That coupled with the fact that every time it occurred to me was in the middle of the night when symptoms presented and woke me up. A cough to be precise, a dry, back-of-the-throat cough, the very kind I had heard was the early symptom of Christopher’s kind, the kind that gets ignored until much worse symptoms arise- the difficulty in swallowing; change in voice; coughing up blood. Hence the poor survival rate, fourteen percent if I recall the stats correctly. No-one suspects the cough, why would they. Everyone coughs don’t they. At least every smoker coughs and smokers get more bronchial conditions and that usually presents as a cough and when the rest of the symptoms wane, the cough persists, doesn’t it? And it’s hard to judge when the cough should have stopped…but after a while you know. you just know.

So every time I tell myself, time to get your ass to the surgery, which doctor will you see? Any one, it doesn’t matter, you’re going to get “any one” anyway regardless what you plan and, “anyway” it doesn’t really matter does it, so long as they know how to refer you to a man who actually knows something – a real doctor, a “specialist”. And then you drift off to sleep and in the morning you wake and the treadmill starts over. One thing takes over, then another and so on. Occasionally I remember and write a note and then the other thing, the hurdles thing, pushes it to the bottom of the pile of “much more important” stuff and next thing you know, it’s the middle of the night, you’re awake again and you’re coughing again…

It could have been the same with the x-ray but this took me only a few days. I didn’t worry about it, didn’t fret, just figured I’d get it done in a few days, no rush, I’d taken the big step, no big hurdles with this one. And nor were there, easiest interaction I’ve ever had with the NHS. I turned up, parked (legitimately) right outside the front door, checked in at radiology reception, no queues, no hassle, no delays, ten minutes later I’m having my innermost secrets photographed in not so glorious monochrome. Including the conversation with the radiologist as to why one removes one’s shirt for a machine that can penetrate all bar lead – buttons and unusual stitching in case you are wondering – the entire process from parking to departing took twenty minutes dead, if you’ll pardon the, oh never mind. I guess all those billions have achieved something after all, to be fair, though it seems to us mere mortals that this wasn’t rocket science – we understand why rocket science costs billions.

Looking back I can see how this might seem odd but at no stage did I fret over the results. Having consciously sought out a scan and an investigation to satisfy my conviction that by now, and given my symptoms, I must actually have cancer, it never actually occurred to me that I did – does that make sense?
I’ve had my blood pressure checked, always well within range, my cholesterol: “perfect”; Liver function: “fine”; this lump just here: “fatty lump, sir, nothing to worry about”. Easy for you to say, I thought back then, but this perfect person doesn’t do “fatty lumps” that appear for no particular reason and aren’t even a symptom of a disease – but given they’ve been there a good few years now, don’t seem to be going anywhere, and generally seem to mind their own business – apparently I do do these innocuous things.

You get my point? I’ve indulged a few investigations over recent years and all my fears have always proved groundless to the point that I begin to fear a reputation as a hypochondriac, though I’m not. There was absolutely no reason to suspect that this would be any different. It was a formality I had to go through because I owed it to myself, and to others, to get it checked so I could say that I’d done all the right things, proved there was nothing to worry about and now I could put it behind me and move on. Just like all those other formalities undertaken for precisely the same reasons and in every case, the caution exercised, the investigation complete, there was absolutely nothing to report”….

So it’s Friday evening, around 5.45 and I’m chatting to Simon in the office because Simon is always the last to leave and I like to talk to Simon. I like Simon generally but he’s especially good to share things with and generally have a pleasant rant about the state of the world, the galaxy and everything.

My phone rings, I was expecting nothing and so whatever it was would have been a surprise but, on reflection, some surprises are not as nice as others. “It’s Dr Fulker”, now that I was not expecting, on so many levels. I wasn’t expecting a call from a doctor because that doesn’t happen, at least not to me, no, it just doesn’t happen. I wasn’t expecting a call from Dr Fulker who I had only met once, a week or so ago. I certainly wasn’t expecting the next part, “I have the results of your x-ray”

…what x-ray? What’s she talking about? Oh, that x-ray, no,that’s not possible, I only had it done two days ago….and all the time that these parallel, rather than sequential thoughts, were firing in my synapses her other words only registered on a semi-conscious level and, even then, it wasn’t the words that made me pause and reflect. It was the quality of her voice. Having only met her briefly I didn’t have the usual tools to draw upon, the familiarity with inflection or intonation, but it was there, unmistakably. The measured, uncertain but gentle, hesitating sound of someone delivering bad news. Someone sitting next to you on a couch, knees closed, turned toward you, a wish to reach out and touch a knee as they speak, as if to stop you taking flight, both to reassure, to express empathy but as much to tempt you to stay seated, “…now don’t take this badly, but…” but not done, the touching knee, because you just don’t know each other that well, in that way.

All of this was in the voice. Who would want this job? The woman doesn’t know me, has no reason to care about me, doesn’t care in any personal sense but she is human and she’s fallible, almost vulnerable in a situation like this. All that professional deportment, that education, that status, it doesn’t take away a person’s humanity, that innate sense of compassion for another human being, especially when she knows, better than most, the likely finality of the message she’s delivering. She didn’t make the call because she wanted to, because she cared, she called because that’s her job and she wishes it wasn’t and because she has to, the act of doing it triggers the compassion. What a shit end to her day, she must feel.

She must wonder, when she puts down the phone, how I’m feeling. Did he understand the significance of those words, she must ask herself because she knows she didn’t explain it and I didn’t ask (because I knew) and was he just taking it very well? Was that why he seemed so calm and measured, so matter of fact, so polite? “Thank you so much for calling to tell me” isn’t what you expect, now, is it? She will also have wondered about the other option, the truth. “Shock” would be far too superlative a description but did he really take in what I just told him?

And that’s the truth, I heard every word, I understood every word and the meaning contained in those words but I can’t claim that I fully “took it in” on a conscious level. My body’s visceral and emotional centre took it in ok. The hairs on the back of the neck, the shiver rising from somewhere, the tightness in the throat, the tremor in the tear ducts – the control mechanisms cutting in on auto-pilot to suppress it – because that’s what we do, it’s what we’re trained to do. It’s what we have to do.

“The x-ray shows a four centimetre lesion on your right lung”. Long pause, not waiting for a response, letting it sink in, searching for what to say next. “I’ll arrange a referral to a respiratory consultant as soon as possible. It’ll probably be seven to ten days.”

“On your flamin’ nelly will it be seven to ten days…”. Even then, with all this swirling around in my head, even then it kicks in, even before I’ve actually absorbed the enormity of this thing. Save your approach for the passive ones, they need it, I need to take this on in my own way. I can’t beat it, I know that but having done this to myself, having procrastinated all by myself, now the objective is revealed, the gears get engaged, at least now I can actually take part in this thing. The challenge, the problem to be solved, the obstacle to be overcome, the emotions subsumed, subdued, there’s a problem to deal with, an urgent problem, no time for indulgences and certainly no time to hand over the fate of the outcome to someone else, especially someone that represents the laissez-faire bureaucracy you cannot abide. You’re not one of the followers, it’s innate, you dig out the facts, you learn what you need to know and you make your own judgment, make your own arrangements – for better or worse but it’s yours, not theirs.

“Well, Simon, that wasn’t the best news I’ve ever had”. I relate the conversation, not over egging it in any way, playing it down if anything. A moment of sharing, it felt comforting to share, it was the last I was going to feel for a while. “Please keep this between us, Si”. “Of course”.

There’s a burning desire to tell everyone you know, to get on the phone and call all your friends, muster help and support, make those apologies, arrange meetings, journeys, visits, all those things you know you’ve put off – as if you can make up for all that previous indifference – but most of all just to share. And then you quickly realise all the things that are wrong with that.

What if it’s a mistake? What if it turns out to be one of the other curable things that, at the absolutely outside chance, it just could be? You put your friends through all that grief for nothing…that’s an important issue right there, you’re putting them through grief. False alarm or not, what right do you have to do that? When is it right? What about Ri, my wife. If I tell her she won’t just be worried sick, she’ll be devastated, debilitated. No, I have to handle this myself until I know more, at least that. If it can be sorted then you can tell the story in hindsight and bask in the happy ending. If it goes the other way then we can at least wait until we have all the facts so that there’s no room for supposition, hypothesis. Facts are facts, you can plan, put things in order, face up to it squarely, even learn to be accepting of it. Uncertainty is constant questioning, what if, if only, try this, perhaps that. I can’t be doing it. There’s a way to deal with this like everything else. Figure out the facts, put them in sequence, get on with them and all the while continue to function, to carry on with those things that need to be done on a daily basis, a minute by minute basis. The pets still need to be fed, the dog needs to be walked, there are people relying on you, you have staff, you have customers, you need to sleep, to wash, to get up and start your day as if there were some point to it. No, no one must know, sorry you had to, Simon.

Simon leaves, I think he’s upset (see, it proves my point). I turn to the nearest computer, nip downstairs and pull out the file on the health insurance policy I’ve paid all these years and never used. Back upstairs with it so no one can see what I’m looking at. Ok, how does this work, better call them, start a claim and figure out how it all works. “Office hours 8am to 6pm” Damn! What are they on? People only get sick 9-5? Damn that doctor, why didn’t she call earlier in the day, now I have the worst of all worlds, its Friday evening, there’s an entire weekend ahead, I’ve just been handed a potential death sentence and I can’t begin work on a potential reprieve until Monday ruddy morning! …and I can’t even share it with anyone, can’t rant, can’t dump…can’t cry, can’t scream.

Gotta be practical then, what can I do? Read the file…the hospital list, ok, how does this work? Three lists, “Countrywide”, “London extended list”, “London super duper list” and you know, don’t you, before you even check…of course you do, these were both optional extras weren’t they? How were you to know, you’ve never been seriously ill, why would you think to include all the hospitals you would actually want to use should you ever need to, The Wellington, The Royal Brompton, The Cromwell. I check their web sites, yep, they are exactly what I need. Ri has a fabulous respiratory surgeon at Royal Brompton, her insurance covers her for the Royal Brompton, it doesn’t cover her for Toby Maher, the bright young guy she really needs and got a consultation with because we paid for it directly. Hers, of course, is the only insurance company that doesn’t cover him. This is the kind of thing that gives privatisation of health a bad name, unfairly so because it doesn’t have to be this way.

So I spend an hour or two researching who I need, the best consultants, the best hospitals. Of course, they are all the ones I don’t have access to. Let’s do it the other way around, take a look at those on the London list that I am covered for. Mostly NHS hospitals that have sought private clients as a way of making additional cash, so run on NHS principals but with nice food? Nothing impressed. The only one I felt I could accept might be Royal Marsden, not because of any good news on the web site but because of it’s fame and reputation. I resolve to call them first thing Monday morning, given that’s really the only option.

Monday morning: I call the Private Patients Appointment secretary.
“I have lung cancer and I need an urgent scan and a consultation with your top specialist”.
“Have you been referred by your GP?”
“No, I have no GP and I have no idea where the one who gave me this news might have referred me. I am paying privately, I don’t need a referral.”
“I can’t do anything without a GP referral”
“You do realise you are offering private health care? I don’t have a referral, I need a specialist, privately.”
“I can’t do anything without a referral from your GP”.
OK, I could have explained to her how our surgery works, the fact that I hadn’t a hope in hell’s chance of getting a referral letter out of them in less than two to three days and that I was not planning on wasting my time trying but, I figured, let’s skip that obstacle for now and move on.
“So, suppose I can get my hands on a referral letter, and suppose I deliver it to you by hand, how soon can we arrange an appointment?”
“Well it normally takes seven to ten days….” Where have I heard that before, oh yes, from an NHS GP…
“I don’t think you quite understand the situation. The average lifespan of someone diagnosed with lung cancer is 52 weeks. I have absolutely no intention of wasting one of those fifty-two waiting for you to make me an appointment.”
“Well, it might be less than that…”
“Thanks but I think I’ve heard enough. I’ll make alternative arrangements.”

I call The Cromwell. Within two hours I have an appointment for a PET/CT scan for Weds and an appointment with one of the world’s most highly qualified pulmonary oncologists. The consultation is at 6pm on Tuesday and, the lovely Lina asks, “please let us know if you can’t make it for any reason as Dr Lewanski is coming in to see you especially”. Those words, I wanted to cry as I pondered the wonders of chalk and cheese. These were total strangers to me but Lina cared, this consultant cared, it was evident in every word, in every act, in every call and the attention to detail, ensuring that I was kept fully informed at every step. This is health care.

It’s Tuesday morning and I’m in the shower when the phone rings. It’s the appointments secretary from East Surrey Abattoir, sorry, hospital. I literally shuddered at the prospect. “Thank you but I already have an appointment.” “Oh? When?” “I have an appointment for this evening at The Cromwell”. “What, today?”. “Today, yes. Thank you for calling. Goodbye”.

I’ve been working, it seems pointless but you keep going until you can’t, that’s what I learned, I don’t know from where. I guess from my mother. I kept smiling at how important people clearly felt their inane issues were. I pandered to them. I kept up appearances. It all seemed so empty, so well, like I said, pointless.

With Lina’s words in my head and me figuring “like I would miss this appointment for anything in the world”, I decided to play completely safe and give myself oodles of time. Travelling up on the Gatwick Express I started writing this little blog. It seemed important to write it all down so that…I don’t know. It just seemed important. It also gave me something to focus on. Arriving at Victoria with more than two hours to spare, I waited till everyone else got off the train. They were all in such a rush, why? Here I was with less time than any of them and I was not in any kind of a rush. I wanted to distance myself from their rush, take my time, everything deliberate, calm, remembered. These were important days for me and I wanted to remember them. I would walk to The Cromwell, it was an unseasonally beautiful sunny February afternoon and I wanted to experience it in a very close and personal way. Crossing up to Eaton Square, eyes turned upward, as always when walking in London, to see all the things that are so overlooked as people hustle and bustle through their busy lives. I noted the prevalent use of clipped box and other topiary, even the odd Niwaki – obvious if unimaginatively used plants when all you have is a balcony to sculpt with. I was studying people too. Al kinds of people, the well heeled and the not so well, the students and the retired, the busy young things, the busy working people, the constant rush of the traffic. Through Sloane Square, up Sloane Street, down Brompton Road, past so many so familiar places, past the Vistoria and Albert, passing the Natural History Museum that cathedral to the things I love and my totally absorbing fascination, life itself.

The reception staff in the Radiotherapy department were welcoming, smiling folk who knew exactly why they were there and what their visitors were going through. “You’re very early?”, they said. I explained that Dr Lewanski was travelling in especially and they thought this was very considerate. “This is one appointment I was never going to miss” I countered to assure them that altruism is a two way street. Alina, in the way of someone showing you the ropes you were going to get very familiar with, showed me how to work the coffee machine and which was the strongest brew.

Dr Conrad Lewanski, greeted me with a warm, gentle smile and a firm handshake. We sat and he asked me all the things you would expect. He took his time, an hour of his time. He let me talk about things that were clearly not important to the reason I was there, he encouraged it and joined in. Every now and then he would steer us back to “business”. He wanted to make sure that I knew everything I needed to know, that I had asked all the questions I wanted to ask. When my eyes welled up, as they did several times, he would pause and respect my embarrasment. Most of all he wanted to tell me that there were lots of good reasons for remaining optimistic but there was no time to waste. He wanted to know what other symptoms I had and was clearly excited by the fact that I had none. I told him about my walk from Victoria, at which he happliy crossed “breathlessness” off the mental list of typical symptoms. My scan was moved to Thursday at a time when the required starvation would be less of a burden for me. An appointment was made for another consult on Friday, at which time he would have all the results and we would know the situation for sure. He urged me to remain optimistic, implied that he had a good feeling about “this one”. He allowed me to hang on to the possibility that it might not be cancer though he also let me read between the lines sufficiently to appreciate that was all that it was, a hope. It all hanged, in reality, over whether this little invader was a well-behaved individual or an exploding fire-cracker sending it’s starburst seedlings throughout the rest of my body in minute fragments.

So, it’s Thursday and first off I have to give blood for the tests, wouldn’t do to try it with the green-glowing radioactive blood that I’ll have after the scans. Then off to have my lung function tested, fabulous nurse who gave me every possible encouragement to keep blowing when my head felt like it would explode. 112% on the initial blow (that’s 12% better than average for the arithmetically challenged) but overall 76% of normal. Not bad, Conrad guessed it would be around 70% so, hey, this is ten percent better than that, right?

Then, here I am in a small room, sitting on a bed, dressed – if you could call it that – in one of those silly hospital gowns that I haven’t figured how to fasten. So it’s just wrapped around me…there’s some debate over whether or not I should have drunk black tea and coffee when told to fast. I assure the lovely Claudia that Dr Lewanski did tell me that was ok and that I confirmed it with the guy who called yesterday to confirm the appointment – I even repeated back, “so just water, black tea, black coffee, no sugar, right?” “That’s exactly right!” he says to me. I realised an issue with The black tea thing as I was getting ready – Ri isn’t an incredibly observant individual, especially first thing in the morning but it would be just my luck for her to spot it and realise that a) this lack of milk was a total break from the norm and b) as a veteran of many hospital exploratory missions and operations that “no milk” was the order of the day…I needn’t have worried, she didn’t spot it, which is just as well as I didn’t have any clever excuse I could think of.

Claudia stabs my finger and checks the blood sugar – can she see that I had some in my first cup of tea? An injection of radioactive glow juice, but a warning I might need another, something to do with the coffee, my Pet/CT becomes a CT. followed by a PET. No effects of the first injection at all, (really shouldn’t have put that quarter spoon of sugar in the first black tea…).
I’m escorted back upstairs and handed over to Michelle in the CT room. A little difficult to understand, her east-Asian accent, very nice but not big on the charisma thing. Seemed to really struggle to get a vein up in my left arm, she felt the right had been abused enough with the blood tests (did I mention those? oh no well there were the blood test phlebotomy appointment first, interesting conversations about rubber gloves and people smuggling drugs through customs (programme on TV, Nothing to Declare). She could see “a nice big juicy vein” but for some reason didn’t get it to come up the way she wanted. Lots of rubber straps, clenching of fist and finger slapping later it appeared the cannula was in but I didn’t feel it happen so good on yer, Michelle, nice one.

When that stuff starts pumping, whatever radioactive goo it is, your face gets a flush like the biggest blush you’ve ever felt, simultaneously your bladder feels warm and full, in a comforting way as if you could lie there and wet yourself and not fear doing so but rather indulge in the warm comfort of it. Odd how it’s not just the mental surrender one feels in the impotence of the situation, the abboragation of responsibility, the deference to the professionals but even your body becomes similarly compliant to whatever forces are deployed upon it.

It’s an entirely comfortable, almost comforting experience, the knowledge that your body is yielding up its deepest darkest and hitherto well hidden secrets to the overpowering might of modern technology. No longer are these things strange, awe inspiring secrets of the science of the body, they have been conquered, they shall be revealed in all their base ordinary mundanity. So much the better if these steps are taken early enough, the fear is that we are not looking at a nice, tight, contained circular lesion but rather a scattergun pattern of itty bitty cancers swirling around looking for a dark, secretive hiding place amongst the maze of the lymphatic system. If that’s what we find then, folks, let’s get real here. If on the other hand, it turns out to be the most orderly and well mannered of evil critters – strike you as a bit much to hope for? – then hey, they can cut out a piece of my right lung and toss it away and Bob, as they say, becomes a close blood relative.

So CT over I’m escorted back down the stairs into the care of the antipodean Claudia (Melbourne actually) who politely parks me in my waiting room for half an hour with the lights turned down with instructions to just rest and relax. Not the most arduous of preparations I’ve ever had to undergo but leaving me in silence with nothing but my own thoughts doesn’t come without its own special challenges. When she collects and shepherds me into the room containing the waiting space-age marvel of a modern day PET scanner the first thing I spot is the CD in the boogie box, “Do I get music?”. Indeed I did and great it was too, perhaps it’s a sign of the average age of today’s cancer patient or perhaps it’s such fabulous and timeless music that it will endure across the ages for ever more. If I recall the sequence, Dionne Warwick, The Four Tops, Jimmy Ruffin, Smokey Robinson, after that I’m a little hazy but there were only a few more tracks before the whirring sounds and the various horizontal manoeuvrings of the table bed ceased and I was delivered to the brighter lights outside the machine signalling the end of my all too simple, too pleasant experience.

Back in my little room, removed from the strange embarrassment of hospital gown, slippers and robe and once more in my own comfortable skin, the inevitable impatient question but, what do you know, she’s forbidden to reveal anything. Not so much as a nod or a wink or the proffering of glossy literature on suitable funeral homes. A bit of a disappointment but not unexpected. At least this is NOT the NHS and so I only have to wait until midday tomorrow, one more difficult to explain trip to London – these interminable legal meetings, oi vey! So midday tomorrow and Conrad will tell me what? Can he tell that it is, incontrovertibly, the dreaded cancer, I think he can but they will still want to do a biopsy of course to determine which of the seven (yes, seven) different species of cancer if might be. They range in severity from the benign “I was just sitting here because it seemed to be a nice piece of real estate upon which to hang my hat” variety through to the raging, ghengis khan types that just want to kill, conquer and ultimately commit suicide by literally biting the hand that feeds and killing me, its obliging host. I can’t help but wonder, well, wouldn’t you?

So, my array of tests over, I met with Daniel yesterday, what a lovely man. I felt I had to share this with him, for very practical reasons, and felt relatively easy about it because on the one hand, though we are very friendly, he’s not what you would describe as “inside one’s circle of close friends – so he’s less likely to be deeply affected by the news, I hoped. On the other, not being in that circle, the information was certainly safe in his hands. I need new trustees for the trust, and I believe I can trust Daniel to treat such a role both professionally and in a way that he would think I would have wanted. I also figure the issue of a will has kinda become rather important and, it occurs to me as I write, it would be a good idea to prepare a list of people who should be advised of my departure so that Ri doesn’t have to cope with that in the midst of what will for her be considerable grief. But back to the will, again I need an executor and who better than Daniel to both draw it up and execute it. All in all this is quite a considerable burden to place on one person, I must make sure he’s properly compensated so there is no contention in his mind, or anyone else’s, when it comes to rendering an account for his services as executor on both matters. He readily agreed to everything i asked of him, went out of his way to reassure me in various ways and proffered his help in any way at all whenever I might need it. Last night he sent a very touching email just to prove that my first contention was entirely wrong. He was clearly very affected and has just moved to the heart of that aforementioned circle.

So I’m once more aboard the Gatwick Express, it’s Friday and I’m heading in to meet Conrad, Dr Lewanski, to get his verdict. One more invented business appointment to satisfy Ri’s curiosity which is fast becoming ‘suspicion’, even the ubiquitous “are you having an affair” enquiry this morning. I am strangely calm. In a sense, this is the biggest event of my (only) week long journey to date – it seems much longer. A genuine Pullman Belle train to my right! Fabulous sight and has got the whole train buzzing and phones/cameras clicking. See what I mean? Calm, as always, it’s a thing, a task, a challenge, something to be dealt with. Gather the facts, assess it calmly, decide on a “solution”, a course of action at least. Here we are at Victoria, no rush, let the crowd move out, my time is precious and I again refuse to join in the hectic bustle for no apparent reason. Twice this week I’ve walked to The Cromwell. This time I don’t have the spare hour. I’ll walk part way and hail a cab to finish the journey…

Sloane Square, by a different route this time, good place to stop, sit, I know, I know but also to have my “last” cigarette. That’s three different routes I’ve used and on the way, a piece of memorabilia. “Eaton Continental” on the corner of Eaton Terrace and, what, Chester Row? A little grocer-cum-reckons-itself-a-bit-of-a-speciality-foods store, a customer from circa 1979/80 for my Redmile-Gordon Provisioners (Wholesale Division). Wow, I’d completely forgotten.

From here I can walk a little more, grab a cab later or grab it now and walk locally. Don’t want to be late for my own sentencing now do I? I think we play safe and grab the cab now.

On the radio in the cab, a discussion about the mansion tax, talk of poor people walking out of the estate agent’s with a cheque for two million quid because they had to sell the house as they couldn’t afford the tax…”Not a problem you and I are likely to worry about, eh, cabbie?”. After that of course we spent the next five minutes putting the world to rights and then I’m here. Familiar smiling faces in Radiotherapy reception, I remember the coffee machine instructions. Bizarre, there’s apparently something special about Fridays, a sort of club has formed. Three guys all around my age or more, everyone knows each other, chatting about the different people they see, calling out pleasantries to the reception staff – about whom they have clearly learned some personal details. Is this what it’s like when you start a treatment programme? I guess it would be. People you don’t actually know but whose shared experience removes all barriers and the need to explain or apologise. Hmmm…

“You guys sound like regulars”, I volunteer to introduce myself. “Us, we’ve got loyalty cards, we have”, jokes one. I laugh. I was going to make a crack about living long enough to collect on the points but that’s the kind of crack reserved for established friends or acquaintances, not Londoners you just met thirty seconds ago. “This your first time?”, asks his friend. “I’m here for my sentence”, I offer, I quickly tame it down but still got the chuckle I was aiming for,”Well, my diagnosis”.

It’s 12:10, he’s running late. On one level it seems cruel, on another it likely means he’s spending time with someone who needs that time. Who wouldn’t want the same thing in his place?

A mature nurse chats to some of the patients, clearly familiar with them and genuinely great in the way she relates, like a kindly aunt. “Is this your daughter?” she enquires of a guy about my age, mid-eastern origin, cool looking, westernised. When he confirms, the nurse turns to the daughter and, for conversations sake, asks “So, how is he behaving himself?”. “Not so good with the smoking”, she replies. You can feel the unspoken plea behind the words, it’s gut wrenching stuff. 12:20 now.

At 12:25 and fearing I’m supposed to be meeting somewhere else I step up to the reception desk just as Conrad is approaching to invite me in. By the way, that’s what happens in a private health care environment, doctors come to you and invite you in, they don’t summon you with a bell or at the bidding of an underling.

I don’t know where I start, how I carry on relating the story from here. I guess I have to explain it all but mostly I just want to run out in the street screaming, jump up an down shout, hug perfect strangers and generally CELEBRATE! I don’t understand why they don’t keep a fully stocked bar in reception for just such occasions – I suppose it would be a little insensitive for some but I’m sure most people in this situation would just want to share in any good news story that was going. We, Alina/Lina/Stephanie and me, we’re going to lobby for one.

I guess I should explain, to myself more than anyone. Yes, I do have cancer, that’s now an established and indisputable fact. Yes, I do have a 4.2 cm spitulate lesion on my right lung. Ugly looking little fucker. That’s what we’re celebrating. That’s what I’ve got. That’s the sum total of what I’ve got, that’s the good news – all I have is lung cancer!! I don’t have fifteen other cancers, I have nothing creeping around in my nooks and crannies, I have nothing in my lymph, in my spine, in my throat (despite the huge lump that’s there right now), in my groin or my bladder, in my prostate or my colon, nothing, not a solitary sausage, not a minute fragment. I just have what looks like one huge evil creepy looking, spiky lesion that looks like its crawling, hunting, espying it’s prey as it feeds glutton-like on the sugars in the fluid they injected. It feeds so much, it steals so much of the available sugar and consumes it with such energy that it glows white hot on the CT, white hot! Other organs consuming said sugar at a fast rate only rank yellow on the full colour display, the colour being heat sensitive.

But that’s it. Evil as it looks, voracious and aggressive as it clearly is, it has actually behaved itself impeccably, keeping itself to itself. It has not exploded its cells into a myriad parts and scattered them across my finite internal universe. It appears operable. It appears that whilst I have to donate an important and irreplaceable part of my lung – and my resulting lung capacity – this thing can be removed. It can be cut out. In short, it can be destroyed – before it destroys me.

Conrad, we’re operating on first name terms at my request, after all, as I said to him at the outset of this consult, he’s likely to be the most important person in my life, for the rest of my life, however long that may be, or not. Anyway, Conrad was just great. He was almost as excited as me. He showed me all the scans, turning my whole body around on the screen in glorious full colour 3D, pointing to my various organs and showing not just the total absence of any black specs (we’re on the PET scan now not the CT, come on, keep up), but also the perfectly healthy appearance of each of them. He has of course combined that with the blood test results which confirm exactly that. Cholesterol: perfect, Liver function, all the numbers: perfect, this is a body that just keeps on trucking regardless, it just does its thing, it works, there’s just this one bastard invading organism that it couldn’t stop. “With a liver like that you can drink yourself silly”, says Conrad with a big smile on his face.

He’s spoken to a colleague of his, Brian O’Connor who would do the bronchoscopy that I need. They give me a sedative and then slide a camera/whatever/thingumy up my nose and down into the lung where they (hopefully) see the little critter from the inside, bite a small chunk out of it and take it away for analysis. A biopsy if you will. There is a possibility that it is of a kind that they can’t easily remove but Conrad really doesn’t think so – he’s been right so far so I’m inclined toward optimism.

He calls his friend who operates out of the mews near the hospital entrance and yes, he will see me more or less immediately for a consultation. At his request, Alina offers to escort me over there and on the way she said something to which my eyes, throat and tear ducts responded in telltale fashion. Without hesitation she grabbed me and gave me a big hug, sweetness itself and how wonderful to feel that gentle human contact, it took every effort I could summon to let go.

Brian is a lovely man, a big softly spoken Irishman, a Dubliner who migrated twenty years ago and time has softened that Dublin accent so much I thought he was from the west. He looks at all the pictures and is clearly amazed at what a lucky little sod I am. “Normally”, he says, “when I’m talking to someone with lung cancer my eyes are down on the floor because, frankly, I’m usually looking at a death sentence.”. He continues, “In your case, you know what? I think we’ve got it just in time”. Again with the throat thing and the tear ducts, for about the tenth time today. I feel like a great big stupid soft thing but then, in my more self-forgiving moments, I figure I have some justification.

We talked about the smoking. We talked about the insurance company. In this context Ri cropped up in conversation, the ironies of fibrosis for a non-smoker, and he asked who her lung guy was. “excellent guy” he says when I tell him about Toby Maher, “leading world authority”. “I don’t know him personally”, he continues with perhaps the most glowing reference of all, “I know his ‘boss'”.

So I’m on the train home, writing this and I get the call I’ve been waiting for from the insurance company – they will cover me after all. Seems this is my lucky day.  Thank you Hitch.