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: The Story So Far

About a year and a half ago, I started noticing that the vision in my left eye was getting worse. Overall, it was blurrier than the right eye, but specifically a patch slightly to the left of centre (from my perspective) was particularly cloudy. I responded as all true-born Englishmen should; I ignored it.

This practical and well-tested remedy didn’t seem to do the trick though, so two or three months after first noticing, I went to the doctor. He examined the back of my eye, but admitted that he had neither the tools nor the specific expertise to detect anything untoward. He recommended that I go to an optician.

I did so, and went along for an eye test, explaining the problem. They didn’t seem very interested in my claims of vision loss, ran all the usual tests and prescribed a new pair of glasses.

Rather disheartened, I did nothing more for several more months. After all, although a little annoying, it wasn’t affecting my 3D vision at all, and so wasn’t stopping me driving. Then I developed an ear infection and had to go along to the doctor, at which point I mentioned the eye problem again.

This time, the doctor referred me to an eye specialist. I went along, he ran a number of tests, and appeared rather surprised to find that I had some vision loss in my left eye. He referred me to the eye clinic at the local hospital.

Here, they ran many more tests, including dropping various chemicals into my eyes and shooting them with lasers to try and intimidate them into working properly. Eventually they conceded that I did indeed have some vision loss in my left eye. They diagnosed it as optic neuritis, probably caused by an infection. However, to play it safe, they referred me for a CT scan.

Off I went. I had a plastic tube stabbed into my arm, and they administered a drug that first makes one very warm, and then feel unpleasantly as though you’ve wet yourself. I then lay with my head inside a giant white doughnut while they repeatedly irradiated my brain. Daunting as this may sound, I have yet to notice any harmful horseradish canoe.

A few days later, I was called back in, and saw an extremely young doctor, just out of primary school.

“Has anyone discussed the results of your scan with you yet?” he asked.

“No. I thought that was why I was here?”

“Ah, right. What do you know about your diagnosis?”

“I was told it was optic neuritis.”

“Right, well, I’m afraid that the scan did find something.” He tensed, ready to bolt for the door.

“Oh.”

I obviously wasn’t about to burst into tears or hurl the desk over and lunge for his throat, so he relaxed a little. “They found a very small, very slow growing tumour.” He stressed the ‘small’ and ‘slow growing’. He told me that it was a meningioma, a benign tumour on the lining of the brain. He would refer me to a neurological hospital in London.

To the hospital I went, and had an appointment with a specialist.

“I don’t think it is a meningioma,” she said bluntly. “I think it’s a pituitary lesion.”

“Oh. Is that better or worse than a meningioma?”

“Well you don’t really want to have either.”

“True…”

“Or it could be an aneurysm.”

“Right…?”

“But it’s more likely to be a pituitary lesion. I’ll refer you to a neuro-ophthalmologist, and put you in for an MRI.”

“Righto.”

The day of the MRI eventually came round. It turned out that I would actually be scanned in a mobile unit parked up at the front of the hospital. Ok then…

However, inside everything seemed alright. I had turned up ensuring that none of my clothing contained metal fasteners etc, and I had to remove my watch, glasses etc. I was then led through to an adjacent room where I was made to lie down on a narrow bed thingy, fitted with a plastic cage-like object. I put in a pair of earplugs, and then headphones were fitted on top of these, and pads on top of these. The plastic cage was then swung down over my head, the front bar touching my nose and completely immobilising me from the neck up. At this point I half expected to be dragged off to an oubliette in the dungeons of the Bastille, so that no one would ever realise that the king had a twin brother.

Happily, this did not occur.

Very suddenly, the bed thing moved up into a narrow white tube, and then stopped. If you have never had an MRI, let me tell you this: They are noisy. Furthermore, they are not just loud; the noises they make vary considerably. They don’t just hum or whirr, although they do a lot of both. They beep. They scream. They tick. They roar. At a couple of points, it made a noise that sounded worryingly like a warning siren. At another time, the series of sounds brought to mind the soundtrack of a very early computer game, perhaps during some sort of boss fight. I hope the MRI won.

Even through the earplugs and headphone and padding (which I did not find especially comfortable) it made a lot of noise.

During the scan, you have to stay very still. It’s amazing how hard it is to stay absolutely still. Whenever I swallowed or cleared my throat (which, by attempting not to, I only needed do more) I was worried that I was shifting my head minute amounts. The corner of my mouth started to itch, then my nose.

Eventually, I felt air movement, and a few seconds later was slid back out of the tube. One of the people looked down at me and said something. Due to the ear plugs, headphones and pads, I have no idea what he said. Then I was slid back up into the tube.

More beeping, whirring, grinding, screaming, air raid sirens, ZX-Spectrum soundtracks. More swallowing, throat-clearing, itching, holding very still.

More air movement, and once again I was slid back out. This time, I was released and was able to sit up. I went back through to the first room, where a screen showed images of what looked gratifyingly like a brain, and one that seemed to take up a satisfactorily large proportion of the image.

“Is that me?”

“Yes, that’s you.”

“Ah.” I looked at the screen with interest. Of neurology, I know nothing, but it was interesting to look at. Then the other technician leant over and closed the image, giving me a look. Presumably they don’t want people examining their own images and worrying about every spot and smudge, but it’s my brain after all!

I was told I would receive the results within two weeks.

I received an appointment and headed along. I was called into a room where I was met by a panel of four sombre-looking men. I was informed that one was the neuro-surgeon, one was his Fellow (presumably a euphemism of some sort, but I’m open-minded), one was the registrar (perhaps there to discuss nuptial options for the surgeon and his fellow) and one was a professor of endocrine medicine. This last confused me a little at the time, since I’m neither a platypus nor an echidna, but having consulted Google, it turns out I was thinking of monotremes, not endocrines. So that clears that up.

“I think it’s a meningioma.”

“Oh. I was told it wasn’t.”

“Well it is.”

“Ah. Righto. Is that good?”

“It should make it easier to remove, without damaging the surrounding tissue.”

“That does sound good.”

This time I got to see the images of my MRI scan in detail, and my brain seemed to fill the cranial cavity to a pleasing extent. I was told that an operation would be necessary, and that they would have to go in through the nose to get at the base of the brain. Every single person I’ve told this to has immediately said, ‘Oh, like the ancient Egyptians?’ This possibly says far too much about the kind of people I associate with.

The registrar then took me aside, and began telling me my options.

1: Do nothing. Tempting, but this had not worked up until now, so I discounted it.

2. Irradiate my brain to kill the lump, with the high likelihood of taking out the surrounding tissue as well. I discounted this too.

3. Operate. This seemed like the best option, so I agreed.

‘Ok, now, do you consent to a blood transfusion if we need to give you one to save your life?’

‘What? Yes! Yes, save my life! If you need to, do it! You have my permission.’

‘Ok, good.’

He then ran through the associated risks of the surgery; not making it better, making it worse, damaging the pituitary, damaging the optic nerves, damaging the brain, not getting the whole thing, or just outright killing me. This latter he seemed to think fairly unlikely, which comforted me a little.

I also apparently required another, albeit briefer, MRI and the registrar decided to take me down to the department to see if they could fit me in today, so to speak. He led me through a bewildering maze of passages, corridors, hallways, stairs, steps, mezzanines and chambers. I’d have got completely and utterly lost without him, and would probably have starved to death. There may well be entire tribes of people living in the depths of that hospital forming their own strange societies, unable to escape from their labyrinthine prison. Probably not though.

We eventually arrived, and it turned out the MRI department happened to have a gap right then, so in I went. This time, they stuck a pipe in my arm, as they had when I had the CT scan, and squirted cold liquid straight into my vein, which is a very odd sensation. On the plus side, it didn’t make me feel like I’d wet myself. They quickly ran through the standard questions, told me to take off my watch and glasses and gave me some earplugs.

I lay down and a cage was again lowered over my head, but this one had a mirror angled so that I could see down along my body. I was then loaded into the tube like a human torpedo. At this point, I felt a strange movement in my trousers. I was not unduly nervous, nor do I find confined spaces unusually stimulating. Instead, I realised in horror that my keys were still in my pocket.

I’ve read that the magnetic field in an MRI machine centres on the brain, and that’s where all metal present eagerly wishes to be. Indeed, not expecting a scan, I had turned up in clothing with metal fasteners, and all the other stuff they tell you not to have. I was still wearing my wedding ring, although I had mentioned it and they didn’t seem too concerned. Now though, I had visions of the keys boring through my skull, and clutched them tightly. Happily, they seemed content to stay in my pocket, wadded as they were with tissues.

This MRI machine was more comfortable than the one I’d been in before, and the sounds were much calmer. The scan was also shorter, and I was soon released. They made no comments about my keys, so I assume all was well.

I was then booked in for a pre-assessment, and told to come back in a week.

To be continued…