The Thing in TJ's Brain Part 8: The End?

The Great Ham Sandwich Fiasco ebbed into the past. Eventually I started to feel less ill. They noticed that I was dehydrated and put me on a drip for a day or so, and as I began to feel less unwell, I started being able to eat and drink more. It took several days for the results of the cisternogram to come through, but they did and the surgeon decided to operate to replug the hole. Not only would this require a new fat-graft, but he decided to install a lumbar shunt as well. This is essentially a pipe that runs from my lower spine into my abdomen to help drain off CSF while my leak was healing.

The appointed day of the operation came round, and I was once again decked out in the subtle but stylish surgical stockings, gown and paper pants. I was loaded onto a trolley and trundled off. Events proceeded much as before, but this time, the injections into my arm hurt less. I’d mentioned the pain the first time round to the anaesthetist, and she went rather more slowly. Again they fitted the mask, and again I began to feel rather woozy. I lay back, closed my eyes and tried to relax.

After my first operation, I remember being woken up after the surgery, but this time I have no such memory. I lay back and let the anaesthetic do its work, then I was awake and back in the High Dependency Unit, but have no recollection of actually being awakened.

Happily, this time round the operation had been much shorter, since they neither needed to remove any brainlumps or collect nasal stem cells for the advancement of Science. As a result, they’d not felt it necessary to fit me with a catheter, a decision of which I was extremely glad. On the other hand, the nurses in the HDU seemed oddly obsessed with my ability or otherwise to pass urine.

They presented me with a bottle and demanded that I provide some. I explained that I didn’t really need to go at the moment, but agreed to do my best. However, nothing was forthcoming, and the nurses exchanged concerned looks that threatened the insertion of pipes where no pipes ought to be inserted.

Later on, they returned with another bottle and more demands. I felt more of a need by now, and I was able to oblige, at least a little bit. They seemed dissatisfied with my performance, but at least a little mollified. This was repeated a couple more times, eventually persuading them that everything was operating as it ought.

I had new wounds. One on my stomach where they’d taken a new and larger piece of fat to plug my head, one on my spine where they’d inserted the shunt, and another on my side, where I assume they pulled it through and positioned it. I was informed that there had been a slight problem with the installation of the shunt. Apparently my liver is not where it’s supposed to be, or perhaps more accurately is where it isn’t supposed to be. As a result, in feeding the pipe through my innards, they managed to stab my liver, producing a small amount of internal bleeding, which they were able to quickly remedy.

Again I had the wadding up my nose, and again for the first day or two I felt incredibly thirsty. I was returned to my ward where I stayed for another week. They decided to pull the wadding out of my nose again, and a pair of nurses came and spooled it out. Once more it was deeply uncomfortable, but not as bad as before. The wadding seemed to have been coated in some sort of slightly oily substance, possibly Vaseline or something of that ilk, before being inserted, and this obviously stopped it from adhering to the insides of my head as it was tugged out.

I continued to recover, but I was still expected to urinate into a bottle and present it to the nurses. This was a process I found not only embarrassing but extremely inconvenient, especially if there wasn’t a nurse immediately around once one had finished. You’d end up standing rather self-consciously, clutching a cardboard bottle and peering around trying to catch the eye of any wandering nurse who happened to move into the vicinity.

A week after my surgery, I was feeling a little better and the Powers decided I could be paroled again. However, based on my experiences of the journey home during my previous imprisonment, I tried to persuade the hospital to transport me home. This wasn’t out of laziness or a desire to drain the NHS’s already scarce resources. I’d not had a pleasant stay, and I wanted to do everything I could to ensure that it wasn’t repeated.

Initially a helpful and sympathetic nurse went to enquire and came back to say that it wouldn’t be a problem, and that the hospital would be able to transport me home. Closer to the date of my release back into the wild, I asked again, and a different nurse came back to say that this would not be possible. I explained my situation and circumstances, and how awful my journey home had been before.

Their suggestion was that I should get a taxi from Central London to Bedfordshire. I expressed my opinion of this particular scheme, and suggested that they find an alternative. The fact that I’d been brought to them in an ambulance apparently held some weight. Eventually they conceded that perhaps they could arrange to transport me home.

The day arrived, and a chap came with a wheelchair to collect me. After my illness and operation, I was feeling sufficiently feeble that this seemed wise, and I didn’t feel too self-conscious as I was wheeled away. I found that this time, it actually was one of those mini-bus ambulances, which made me feel slightly better about my decision. However, it turned out that I was the only passenger, which made me feel worse. Then, during the journey, the driver told me that he frequently had to go and collect, and later drop off, a woman from Grimsby, and this made me feel better again.

The journey home was relatively good. The driver was friendly, albeit wholly obsessed with sports of varying kinds, so I didn’t feel able to contribute much to the conversation beyond fencing. On the way, we passed London Zoo, where I caught a glimpse of the giraffes, and later on passed through a small village which consisted of nothing but a handful of houses, a tree nursery and a lap dancing club.

Eventually, we arrived home, and I was able to bid the driver goodbye and gratefully collapse into bed. I spent the next several weeks slowly recovering my strength.

One minor hiccup occurred recently. I’d been given an appointment from a follow-up MRI to check that everything is still present and correct. I travelled down to London and presented myself. I filled in the usual form promising that I didn’t have cybernetic limbs or a metal plate. On the other hand, I did have a shunt, so I mentioned this. I handed the form to the radiographer, who glanced at it.

“What kind of shunt do you have?”

“Um, I’m not sure. I was definitely told that it’s one that doesn’t interfere with MRIs though.”

“Ok, I’ll just check.” Off he went.

A little while later, he came back. “We can’t find anything in your notes about the type of shunt, sorry. We can’t proceed with the scan.”

“They definitely said it was ok for MRIs.”

“Yes, but there are some that are only alright for low magnetic fields, and we need to know before the scan. If it’s the wrong type, it might shift inside you, and you’ll have to have surgery to put it back again.”

I immediately had images of my shunt slithering up my insides and trying to strangle my brain, which didn’t sound like a Good Thing.

“We do have a note in your file,” he continued, “but it’s hand-written and none of us can figure out what it says.” Jokes about doctors’ handwriting immediately surfaced in my mind. Ultimately though, they couldn’t risk going ahead with the scan, and all because the left hand can’t read the right hand’s handwriting.

Some time later, I finally had the scan. Beforehand, I had to have an x-ray to help the radiographers figure out what kind of shunt they’d stuck inside me. I’m sure that I remember x-rays being a long and complicated procedure when I broke my arm back in the olden days, but nowadays they’re over before you realise it’s happening. The photographer puts you in a suitably artistic posture, disappears into an adjacent room, and you barely have time to say ‘Cheese!’ before they’re back in again and telling you to leave.

On the basis of this, they discovered that my ‘shunt’ is little more than a rubber tube, and that therefore they could safely load me into the torpedo tube. Once more I donned the earplugs and headphones, once again my head was wedged and caged, and once more I was loaded and ready to be launched. My first MRI was an experience full of interest and curiosity. Having had so many though, the novelty has worn off, and I very nearly fell asleep in there. Eventually I was released and sent home.

A curious thing happened on my way back to the station however. A homeless man asked me for some change. Instead, I offered to buy him something to eat, and we repaired to a nearby café. Here, we got chatting, and when I told him I was a copywriter, he immediately asked me if I’d be willing to proofread and edit his five-volume work entitled ‘The Chronicles of Doom’. I initially assumed that this was a fantasy series, but it turned out to be a collection of prophecies. The titles included ‘The Cosmic Clock’, ‘2121AD’, ‘The Chronicles of Doom’, and a couple of others to do with aliens and doomsday. He offered to send me a synopsis. Intrigued, I gave him my email address. I will be interested to see if he ever sends me anything, and if so, what.

I’m now waiting for the results of the scan, and generally my recovery is going fairly well. My initial feebleness has passed, and even my headaches are only fairly mild. I’m now back at work, albeit only part-time to start with. The vision in my left eye doesn’t seem to have recovered much, if at all, but apparently this could take months, if it even happens. However, The Thing in My Brain has been defeated, so at least it won’t get any worse. It’s been a mostly interesting process, but not one that I think I would either recommend to others or wish to repeat myself.

I will end however by singing the praises of the NHS. Early on in the process I tried to work out how much everything would have cost in the US, and was already into the tens of thousands of dollars even before the first operation. The NHS is by no means perfect. There’s an awful lot that it could do better and more effectively. It can be rather slow and inefficient. Often the right hand doesn’t even know where the left hand is, let alone know what it’s doing. However, it is still a wonderful service filled with hard-working, compassionate professionals, and it strikes me as being a good deal better than the alternative.

The Thing in TJ's Brain Part 7: Sickness, Cisternograms, and Sandwiches

The surgeons were still deciding whether or not they needed to re-operate, and so I stayed on the ward for several days. However, over this time I began to feel extremely unwell. My headaches, which were mostly mild and only occurred when I’d been sitting up for too long, became severe and constant. I started feeling nauseous and dizzy, and began to run hot and cold, especially at night. This was not a good time for me. I threw up at least once a day, and I struggled to eat or drink much. As a result, I lost over a kilogram of weight in perhaps four days, and became badly dehydrated. The painful headache and fluctuating temperatures prevented me from sleeping.

Worst of all though, it was the World Cup. There was a large television at the end of the ward, and this was on constantly. Both inmates and wardens talked about it incessantly, and I had to explain several times that I don’t much care for football, and don't have any particular emotional investment in which country can Football Best. I did have a considerable emotional investment in having the TV turned down (or better yet, off) and in everyone around me shutting up, but this was mostly beyond my powers.

The doctors and nurses were sympathetic to my plight (the illness, not the World Cup), and gave me increasingly strong painkillers, which barely seemed to help. However, none of them seemed especially interested in why I was feeling so ill. They took regular blood samples, and apparently these weren’t showing up any infection markers, and that was that as far as they were concerned.

Another infuriating thing was that during this time, my leak seemed to stop. Several times doctors had come to me and asked me to lean forward to produce a drip. I’d explained that it was only a very slow leak, and they always got bored and left before I could produce even one drop, but now the drip had subsided entirely. I got the impression that they thought I was lying.

My own theory, borne up by my total lack of extensive medical training and scientific knowledge, is that I had contracted some sort of sub-meningitic infection, and the resulting inflammation had swollen my leak shut. When the infection eventually subsided, my leak returned, more enthusiastic than ever, which seems to confirm my hypothesis.

Before this happened, however, several things occurred. They were feeding me regular doses of anti-sickness drugs. To do this they fitted a canula, but the nurse chosen to do this didn’t seem very adept. She first dug around in my left wrist trying to find the vein, but in vain. She then did the same on the right wrist, leaving me with what looked rather like stigmata. Eventually she got it in.

That evening, I was feeling as bad as ever. Meningitis was on my mind (so to speak), since I seemed to be evincing at least some of the symptoms. My neck was rather stiff (although not to the degree I’m told meningitis produces), but I had no rash or aversion to light.

Then I looked down and saw that a rash had suddenly appeared on my right arm. Stoically, and without panicking even slightly, I called a nurse. He came over, examined my arm, and put his face in his hands. If this was calculated to reassure me, it did not. He called a more senior nurse, who said they’d need to monitor it, and see if it spread, or if the blotches grew. Their high-tech method of doing this was to draw around them with a ballpoint pen and come back later.

To my great relief, the rash faded over the next half-hour or so. They concluded that it was an allergic reaction to the anti-sickness drug they’d injected into me via the canula.

The doctors were still deciding whether to operate on me again, and I was subjected to another MRI. I was wheeled down in my bed, and the scan was completed. I was left in the Radiology waiting room and a nurse was called to come and collect me. However, some crossed wires meant that the nurse never arrived, and I was left there for almost an hour. The waiting room was much cooler and far quieter than the ward, and I was actually able to get some sleep before they realised their mistake and took me back.

They also decided that I needed a cisternogram. This involves stabbing a rather long needle into your spine, and injecting a dye up through your spinal column and into your brain. As ill as I was feeling, I was nonetheless curious. The room in which this was done was large and cold, and contained a lot of interesting machinery. Because it involved stabbing a long, flexible needle into my spinal column, it had to be done whilst observing me in real time using x-rays. I was lain on my side and my back painted with local anaesthetic. The surgeon and two nurses donned large, heavy-looking aprons lined with lead and proceeded.

The actual spinal impalement wasn’t too bad. It hurt a little, but no more so than many injections.

“Now, I’m injecting the dye. You may find your headache suddenly gets worse.”

“Ok.” I waited for a couple of seconds. “No, it’s not too… Oh. Yes, alright, that’s really painful. Ow. Oh. Um, also, I think I’m going to be sick.”

One of the nurses acted with superhuman speed and presented me with a bowl just in time. Once I’d finished, they withdrew the needle, cleaned off the excess anaesthetic, and I was wheeled through to another room to be given a CT scan, so they could track the progress of the dye out through my leak.

I was put inside the white doughnut when I was once again assailed by a bout of extreme nausea. Unwilling to throw up on their no-doubt very expensive machine, I alerted the nurse, who was once again able to get there in time. Once the nausea subsided, they were able to complete the scan and I was wheeled back up to my ward.

It was also during this period that the Great Ham Sandwich Fiasco of 2018 occurred. I have mentioned that my usually robust appetite had been badly affected. I struggled to eat more than a few mouthfuls of any meal, and selected the plainest possible options from the menu. One day, for lunch, I chose the ham sandwich. This simple dish seemed best.

Lunch time came round, and my sandwich was brought to me. It was a ham, cheese and pickle sandwich. I called the nurse and explained that this wasn’t right. Normally I quite like these, but in my weakened state I didn’t feel up to the task of tackling such a complex meal. The nurse contacted the catering department, and came back to tell me that they’d said that I was a liar, a cad and a blackguard, and that I’d received the sandwich that I’d ordered. If I’d wanted a sandwich that contained only ham, they said, I should have specified that I wanted a ‘plain ham sandwich’. By merely saying ‘ham sandwich’ I’d clearly requested a ‘ham, cheese and pickle sandwich’.

Too weak to send my seconds down to demand satisfaction, I resigned myself to picking the cheese and pickle out, and jury-rigging a ham sandwich out of what I had been given. During my careful dissection however, I discovered something. Not only had I received the wrong sandwich, it didn’t even contain any pickle! I didn’t want any pickle. I hadn’t asked for any pickle. But since I was told that nonetheless there would be pickle, I thought it only fair that pickle there would be. I pointed this out to the nurse, and told them that they were being defrauded by their catering company.

The next day, the Food Lady came round again and asked what I wanted for lunch.

“A plain ham sandwich please.” I stressed the ‘plain’.

“A plain ham sandwich?”

“That’s correct. A sandwich containing nothing but ham. Ham, and nothing else. In a sandwich.”

“It does come with margarine as well.”

“That’s fine. Margarine is also good. I want a sandwich consisting of nothing but ham, bread and margarine, all in their usual positions and proportions.” I wondered if I wasn’t laying it on a little thick, but they had irked me. Behind the Food Lady, I saw the nurse snigger.

At lunchtime, they brought me the correct sandwich.

To be continued…