THE NEW NORMAL #28 – FRIDAY NIGHT AT THE MEDICAL ASSESSMENT UNIT

For anyone who is or ever has been married, you’ll be fully aware that the first year of marriage features the repeated and mundane question “so, how’s married life treating you?”. It’s a well-meaning question but one that very rarely gets a unique or interesting answer. I am now developing a long and horrifying answer to that question which will make anyone who poses it deeply rueful and probably late for their next appointment. Don’t get me wrong, I love my wife more with every day that passes (she really is the most wonderful woman) and our trip to Mexico was incredible but beyond that my health has been struggling and last week, well, it fell flat on its face….in a gravel car park….in the rain.

Following a thoroughly wholesome half term visiting our friends in the North, we had made a stop over in the Somerset village of Sandford which shares its name with the village in Hot Fuzz but is also home to the Thatcher’s cider brewery. Having made plans to make a swift visit to the brewery shop in the morning before heading to my Aunt’s 70th birthday party, we headed to bed in our Airbnb cottage. All was going well until around 2.00am when I woke with a familiar but unwelcome pain in my lower left abdomen, so I moved downstairs to the sofa and saw dawn break over Somerset. Despite the protestations of my wife and forgoing the cider shop, we made our way to the birthday party in Dunster but I couldn’t eat, could barely keep my eyes open and was about as much fun as fire marshal at a fireworks display. Inevitably, we left early, and I slept from North Somerset to South East Cornwall and then began 5 days of steep decline.

I was uninterested in food (I know, shocker), losing weight rapidly, thirsty beyond anything I’d ever known, I couldn’t get comfortable enough to sleep, I had less energy than a Wilkinson’s AAA battery and even climbing a flight of stairs had me grasping for something to lean on and recover. By the Wednesday, I had to go to the GP for a previously booked diabetes blood test but was also given Co-Codamol for the pain and Omeprazole to ease digestion. On the Thursday, I was informed that I did indeed have diabetes and, to complete my terrible reworking of the Craig David classic ‘7 Days’, on Friday I was slumped in my GP’s office being told I needed to get into hospital quickly. To be clear, I did not make love to my GP.

On arrival at the Medical Assessment Unit, I was asked to wait with my wife on some junior school chairs and my fatigue had reached such levels that I was borderline hallucinating. However, when a young man dressed as a sailor arrived, nobody else flinched so I have to assume it was real. This was one of the junior doctors who was here to explain that my pancreas had stopped producing insulin and, as a result, I was suffering from something called Ketoacidosis. Essentially, without insulin my body could not absorb the energy it needed to keep it running normally so it switched to the back up generator of body fat which was broken down to keep the heart, kidneys and brain running. A by-product of this process are things called ketones which are a toxin that gets into your urine and blood as well as making your breath smell like you were locked in a pick’n’mix overnight. Normal ketones levels are 0-0.6 millimoles (no idea how much that is but I like the idea of measuring things in moles), dangerously high levels kick in at around 3.6 and I was measuring at 5.6 so people were understandably concerned. I don’t remember a huge amount about the discussion, but I do remember the phrase ‘life threatening’ being used and the subsequent look of dread, fear and pure loss on the face of my long-suffering wife. Not the best way to spend a Friday afternoon.

Now, this next bit is third hand as I was too out of it to recollect but apparently I was plugged with two cannulas to fill me with potassium, glucose and insulin, monitors were attached to my chest, a blood pressure cuff was attached to my around and a heart rate monitor to my finger. They tried giving me Oramorph (morphine lite) but I threw it up spectacularly and I deliriously offered to walk from one ward to another when I could barely string a sentence together. I had the easy job, however, to be compliant and let the medics treat me whereas my wife had to look on with those words ‘life threatening’ ringing in her ears as NHS staff moved, and I’m quoting here, “faster than I’ve ever seen them move”. Sorry love.

As my body responded to getting the right stuff put in to it, I started to get a grip on my mind and was aware of a doctor talking to me but I could only listen as words like ‘Pancreas’, ‘ketones’, ‘insulin’, ‘diabetes’ and ‘glucose’ floated around me without settling in any coherent order like ash from a bonfire. I was fairly sure he was real, but I never saw him again and he was particularly chirpy so maybe I was tripping on potassium, who knows? As Saturday morning rolled around and I struggled to move without yanking a tube or a cable, I managed to text my wife and let her know that I’d met her request and not died in the night so that was a good start to the weekend but then the real work began. I was on maximum observations which meant temperature, blood pressure and heart rate checks every hour on the hour as well as finger prick blood sugar tests which left my hand looking like I had been playing catch with a hedgehog (to be clear, I mean using the hedgehog as a ball not throwing a ball back and forth to a hedgehog although that does sound like an ace way to spend an afternoon. Also, to be doubly clear, I would never use a hedgehog as a ball).

Energy levels increased, nausea reduced, blood sugar dropped, ketones dropped and the drips, well, dripped their goodness into me, bringing me back from the brink (a phrase used by more than one medical professional over the last few days). Then my temperature went up a bit. Nothing mental, just a degree or two, but enough for one of the doctors to get spooked enough to get me in for a CT scan and do you know what they found? Not only did I have a mild case of Pancreatitis, but I also had a blood clot on my Spleen which was making it hard for me to digest food comfortably. So, more drugs, more injections and more resting – the most frustrating thing about stuff like this is that you want to do something to help yourself but all you can do is sit/lie and let your body recover which is pretty tedious. For some reason, my brain decided that this was the perfect opportunity to binge watch all three series (and Christmas special) of Gavin & Stacey which took me away from the hospital ward to the magical world of Barry Island and Billericay. I’m still not sure if I enjoyed it though – I mean Bryn and Mick are a hoot, but Stacey clearly needs a bit of a slap and Smithy needs to grow up.

In between sitcom episodes and blood tests, I was visited by the diabetes specialist nurses and shown how I would need to test my own blood, ketone levels and administer my own insulin once I was allowed home which felt quite daunting. Four blood sugar tests a day and four insulin injections (plus ketones tests if the blood sugar is too high) might not seem that much but I’m a man who has managed to eat a donut without noticing in the past so I’m going to need to get disciplined quickly. I have been told in no uncertain terms that I have an insulin deficiency which doesn’t fit in to the Type 1/Type 2 pigeon holes but is closer to Type 1 than anything else so I need to learn to mimic what my Pancreas used to do and then I can live normally. In the future, I may be able to be fitted with a pump for insulin and a skin patch that will constantly read my blood sugar levels to save me the hassle – kind of like a diabetic iron man with a very limited set of powers (none of which could cope with a donut).

A narrow escape, then, as I recovered and got my head around a future of injections and watching my calorific intake more carefully. And I know there will be those among you who will be thinking “well, you are a bit chubby, so you’ve brought it upon yourself really, haven’t you?”, and you’d be right to an extent but this story has a sting in the tail. You see, what the apparitional doctor had been revealing to me (which was later clarified by my skin cancer specialist nurse) was that recent scans of my abdomen had found that the melanoma had yet again spread and, you guessed it, this time it had got in to my Pancreas. The stress my Pancreas was under trying to fight off the melanoma allowed the Pancreatitis to develop which shut down my insulin production and that chain of events is what brought me to the hospital on the Friday. So, the cancer is back again, and the next steps are still a little unclear – total or partial removal of the Pancreas, Immunotherapy or Chemotherapy, chips or rice (sorry, slipped into takeaway mode there). What is clear is that this is melanoma on my Pancreas rather than Pancreatic cancer which is certainly the lesser of two evils and the Oncology team were primed and ready to reveal their plan to me on 12th November, but my Pancreas didn’t quite make it that far.

The simultaneously funny and tragic part of all this is just how normal all of this is becoming for me and my family. We know the best cafes in the hospital, my 5-year-old is unphased by seeing tubes and wires snaking out of his dad’s body and we know how to administer various medications from previous visits which always throws the nurses. We don’t want to know this, we don’t want this normality but it is our normality and we can either meet it head on and deal with it or bury our heads in the sand and deny it. Personally, if there is to be a big cancery juggernaut charging towards me then I would rather be facing it with a chance to jump out of the way than face down in the dirt thinking “what’s the rumbling noise?”.

So, yeah, that’s how marriage is treating me.

 

 

 

 

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