Plan B

Hail.

I had this blogging thing all worked out - the subject of the next few blog entries - the overall structures, the imagery: the "next in series" about the three other terrible deaths that happened in that last horrifying weekend in ICU, then a lighter entry about the truly remarkable happiness of Mr Stonemason and where it came from, and lastly something responding to something I read in the NYT - a career-ending entry on doctors and nakedness, the whole nude/naked/stripped continuum.

And I was going to reply to comments, and go to the pub with my friend, and do some study, and maybe later write a brief entry on the drunken man one of our nurses found in her back yard last New Year's Eve. He had fallen asleep on their child's swing, with his black tee-shirt pulled up over his head. When she woke him, calling cautiously from a distance, there was a moment's horrified stillness, and then he convulsed and jerked about, shrieking that he'd been struck blind. It took her several moments of careful explanation to assure him that this was not so.

And then my manager spoke about when her cleaning lady quit. Said elderly Irish cleaning lady had come over to the house one time and found my manager's cat apparently dead. Horrified, she had picked up the cat and ran the few hundred metres down the road to the veterinary surgeon. She burst in with the stricken animal and the vet performed CPR, including that modified mouth-to-mouth they do in these circumstances, and the cat coughed and came back to life, promptly being sick everywhere.

It was all very dramatic. Everyone was very grateful, and my manager lauded the woman to the skies, but three days later she rang in to quit.

"I just can't go back," she said.

"But why? You can't quit, we need you... anyway, why?"

"It's.... the cat," she said.

"Bobbles? The one you saved? But why? You brought him back from the dead!"

"I know," hissed the woman, in tones of the utmost horror. "I shouldn't have. That cat.... is evil!"

And she wouldn't be convinced, and that was that. Apparently five years later evil Bobbles is still continuing on his undead way, lying satanically out on the patio and chomping on his cat biscuits in what I assume is a decidedly demonic manner.

But these are not the main issues. The main issue, the reason no study and little work has been done and why we have been driving and phoning all around the countryside this last week or so, is Sarah is sick. Here is how it happened.

(I should point out that Sarah has told no-one any of this. She is like one of those feline predators, some desert cat or something, that never shows weakness. Not out of any machismo*, just because she's not someone who expresses her emotions like that. Me, as I've said, if I get a paper cut I call my scattered family around my bedside. Sarah's probably had three out of the top seven causes of pain, and she continues on at half my size under weights that would crush me).

Anyhow, ten years ago Sarah and I were in a car rollover. We were driving off to visit the horses and slowed down to turn right and there was a squeal of brakes (even now I remember thinking "Hmm, that's close") and some guy in a big old Statesman hit us driver's side rear. The minivan rolled two and a half times. I remember looking up and seeing Sarah still strapped into her seat, shaken from side to side as the van jolted, her head shaking back and forth. I was lucky - my seat snapped in half so I was able to lie down through the whole thing, curled up like an apostrophe.

Anyway, the van stopped and I clambered out and extricated Sarah and suddenly the road was full of people trying to help, and they took her inside and let her lay down on the bed and then the ambulance came and took us off to Fremantle Hospital.

She was a bit sore for a while but came good and for a while it like she had got away with just some whiplashy kind of stuff, and several years of exaggerated caution about turning right in a car. All seemed good.

Then a few years later, when she was in final year medical school, she noticed some clumsiness. Just a little at first, dropping things she would normally be able to handle, intermittent at first, but subsequently all day every day. She also noticed a deadening feeling, a loss of sensation over the thumb and forefinger of her right (dominant) hand. After a few weeks she could feel or do nothing.

This was all in the final year of medical school. It's part of the reason she's not a surgeon.

Shortly after that the weakness set in, and then the neuropathic pain. Neuro pain is a whole different kettle of worms to visceral or somatic pain, a deep, aching, drilling pain that doesn't respond to opiates, that nothing will shift and nothing will fix. She kept up with it as long as she could - I was driving, having to do everything for her - and when we finally got in to see the neurologist she was on a hundred milligrams of morphine a day, nauseous all the time, sick and sleepy and feeling as close to stupid as she ever got.

The neurosurge reg got her in to see his boss and he spread the CTs and the MRIs across the desk and we talked about what was going on. The nerve root, the thick, soft branch of nervestuff that comes straight off the spinal cord, threads through the foramina of the vertebrae, becomes the muscles that allow you to feel textures and write and pick things up, was being compressed. One of the disks between the neck-bones had swollen out and was crushing it, stopping sensation, stopping fine and gross movement, causing that horrible constant pain. Additionally, it was bulging inward, pressing on the spinal cord itself.

Mr Brophy suggested a minor response and a fairly major response. The minor response was something called a posterior discectomy - they cut a zipper-shaped scar in the back of your neck and carefully slice off the bit of disk that's bulging inwards, pressing on the cord. The major response was called "anterior fusion". In an anterior fusion they cut your throat open from the front. They slice back and cut out the entire disc between the vertebrae and replace it with a bit of bone they took out of your hip. No disk, no problem. You can't turn your neck at that joint any more because there is no joint - it sortof grows around the bit of hip bone - and that's that.

Sarah opted for the minor operation, about three hours. She woke up groggy and upset and for a few days felt not much better, a change in the nature if not the intensity of the pain, but over the next few days it began to recede and she did well. She never got full sensation back in her right hand, but she didn't have the pain any more and she wasn't crippled and I was deliriously grateful to her expensive-suited and gigantic headed neurosurgeon**.

Anyway. All that was ancient history, until last week when the numbness came back - but on the other side, the left hand. And then, in hindsight, she put things together - the difficulty taking blood the other day, the coffee cup that slipped from her fingers, the clumsiness feeding the kittens.

What we suspect has happened obviously is same disc, different side, and that means relatively emergent surgery. We drove in in the small hours of the morning to the Allnite Pharmacist - the 24 hour pharmacist in the city where we send many of our most violent patients, I got out the car looking around like an amphetamine paranoiac, planning to hospitalise anyone I didn't recognise who got within six feet of us - and we got some prednisolone. I got her into CT at Florey the same day, with maybe an MRI if they reckon she needs it later, neurosurge appointment the following week.

This is not good, for a number of reasons. For a start, our income protection insurance does not come into play for another few months. Second, prior to this we had been arranging an orthopaedic surgeon - Sarah has what Dr White calls a polyarthropathy and needs at least one hip, maybe two resurfaced - and Dr White pointed out that any anaesthetist is going to want to have a very good look at Sarah's rather-the-worse-for-wear spinal cord. When they put you under a general anaesthetic they sortof bend your neck back to fit the breathing tube in and in anything other than the most careful hands things can actually go very very wrong. You need your neck.

Anyway. Back to talking about me now - I have been rather concerned about this. I think it is possible that the more you know the more you can imagine going wrong. I oscillate between trying to reassure Sarah and imagining all manner of increasingly unlikely scenarios. I woke up early this morning, lay there in the pearl halflight, with the magpies outside the windows and the cats padding silently around in the lounge room and watched her breathe, slowly, in and out, dependable.

When I found out about all of this I was enraged, a kind of intransitive anger, an anger without object, all the more frustrating because of that. I wanted to fight, to smash, to hit something so it broke like bone breaks, kill whatever was threatening her and somehow make it all okay. But instead I lay there and listened and watched until it was light and then got up and made us both cups of tea.

Anyway. Speak soon, reply to comments soon too.

Thanks for listening,
John

*Still less out of any marianismo, which is a bloody depressing word.

** He was a remarkable looking man. A truly giant head, almost the same proportions as Charlie Brown, and long, slim, tapering fingers. I don't know if that's what he actually looked like or if that's how everyone to whom I have spoken remembers him, like some fifties pulp alien, here to bring peace and universal enlightenment to all mankind. Either way, it's reassuring, and he's very very good.