The medical team

The medical team was good - being able to write this is evidence of the same - and I should be grateful to them. And I am. But, it's a job, albeit a job well done. Nevertheless, I want to make a couple of twisted and treasonous comments.

The chief surgeon is a giant - he is over six feet tall - with the voice  of a missionary. I wrote a filler about my decisive consultation with him. Here it is...

A voracious chestnut

He turns the monitor so I can see what is on the screen. I see the side view of a head, my head, full of weather map colouring.

‘There it is,’ says the doctor and points to a dark smudge. It is the size and shape of a chestnut. I have a chestnut lodged in my mouth, just under the tongue. ‘In all probability, it’s malignant. You see the edges – they are fuzzy. We will need a biopsy to be sure.’

I look at it, as if it is a textbook illustration – a false image that has nothing to do with me.

‘That’s a conker,’ I say.

‘It certainly is – and it will have to be cut out. It’s not going to go away. You’ve probably lost a lot of weight…’

‘I’m down to the bone. Look…’ And I bare my arms, which are visibly emaciated.

The doctor nods, and peers at me for a few moments as if trying to judge just how much of the reality I can take.

‘What we will do is open up your jaw. Like this…’ joining his hands and then opening them up like a tulip on a fast-frame morning. ‘We will cut your lower jaw right down the middle, and from left to right, and open it up. Then cut out the tumour and replace the lost tissue with a piece from your thigh. It is an eleven-hour operation divided into two parts. First we cut out, and then we re-construct. The reconstruction takes most of the time since it has to be done under a microscope.’

‘Any questions?’

There are dozens of admissible questions.

‘These tumours are relatively rare. But when they start they can be voracious.’

A voracious chestnut…

©

He did not mess about - he told it the way it was and I should be grateful to him for being frank with me. But I am a bit put out by him at the moment. He cut me up with precision, and he put me back together again. I see him from time to time so he can examine his work and declare that all is going well. And that is the end of his story. He has nothing to offer in the way of therapy - that is, getting back the use of my mouth in all its dexterity. 'All in good time,' he tells me. Am I supposed to sit around and wait for my tongue to come back? Or should I seek to accelerate the process? Well, I am accelerating the process - by subjecting myself to therapy following making parallel consultations with other experts. My surgeon limits himself to strict post-operational considerations. 'You are making remarkable progress,' he says. I tell him, 'All my own work.' A bit of integral attention would be nice. A single consultation, a gorgon-figure that can point me in all directions, without feeling like a fish that has slipped the hook and darts about with little or no idea where to go, or like a chicken without a head, scurrying blindly in circles.
And then the members of his team...  I remember, I am in the hospital, sitting in an armchair – though it is actually a tuned-up wheelchair. The changing room has no windows, and the artificial light has a stainless-steel purity about it that is far from soothing. The colours that surround me are green and white – green bib, green uniforms, white curtains and walls, green and white screens, green armchair. I like green – it is perhaps my favourite colour. Green – the colour of life, leaves, vegetables, lettuce, grass. It is also the colour of mould, of decay and suddenly I feel mouldy, decaying, as if the green-life within me has come to a halt and has begun to putrefy. The thought does not frighten me. But it does make me sad. I realise, if I had not already done so, that things will never be the same again. They may fix me – but I will emerge deformed, in body and mind. The team arrives (smiling and unshaven) and they explain to me, not for the first time, what they are going to do to me. Their explanation is not very graphic, and it sounds almost enjoyable. Still, it is part of the process of patient communication – still-borning any tendency to panic or refusal to go ahead. ‘A Scotsman,’ they say. ‘A highlander. Then you won’t have any problem. A tough guy…!’ Ludicrous commentary that only suggests a certain lack of expertness in patient communication; a silliness that seems out of place. I almost prefer the cold-bloodied frankness of the chief surgeon...

The team came to see me later, many times, always smiling - fascinated with their handiwork and non-committal. 'All in good time,' they said. The team did not serve as a bracing force. I found the all too obvious thrill they got from a job well done, and their almost exclusive interest in the mechanics of the operation, both irritating and disquieting. And they celebrated the success of my operation...by going out to dinner! And then telling me about!  I hope I do not sound like one of these petulant patients who think the whole medical system should be at their beck and call. Nothing could be further from the vague idea I want to convey. It is clear the extreme specialisation of the medical team enables it to achieve results where a more generalised surgical team may even fear to tread. This specialisation compels an all-exclusive interest in the operative technique and result, leaving all other aspects of the prognosis to other specialities. And that is my point. The diverse specialities that converge on the occasion of, and falling after, a major surgical intervention ought to be more integrated, enabling a logical flow from one speciality to the next, and avoid the case of a patient who seeks answers from people not specialised in giving those answers. Maybe it is like that in other places.