Wednesday, April 04, 2007


It would be fair to say the old batteries have been a bit flat lately. Work and home contrived both to be busy at once, leaving little time for contemplation. So much so that even dear old Radio Four hasn’t managed to get me going at all lately. Still things appear to be calming down a bit now, so, for the time being at least, normal service might be set to resume (in so far as there ever was “normal” service here).

Today I have to tell you about one of those weird juxtapositions that throws the absurdity of what I do every day into stark relief. Please forgive me in advance if parts of this narrative come across a little more jaundiced than intended, as I said earlier it’s been a tough couple of weeks….

Just over a week ago Mrs. Snell arrived in surgery. She is a regular attender, sadly all the more so in recent months. Around a year ago she developed an annoying symptom. Neuralgia. Several times a day she is gripped by a sharp but enduring pain in her jaw, akin to the “mother-of-all-toothache”. This pain will last for minutes at a time, sometimes hours, and has no reliable preventative remedy. Capricious pains of this nature are also hard to manage with painkillers since the pills will take anything up to thirty minutes to kick in unless taken all the time, and in this time the pain will often have abated anyway. Medically the problem has a considerable nuisance value, and to Mrs Snell it is a torment that is slowly but surely driving her crazy. However it remians essentially trvial.

In the past six months she has seen a variety of dental, anaesthetic and alternative practitioners, taken their conflicting advice to heart, juggled with a complex regime of analgesics (up to and including Morphine), anti-epileptics and anti depressants, all of which form a part of the standard armamentarium of neuralgia treatment, and none of which are affording her lasting relief. At this consultation, as at several in the past I have had to advise her she might need to withdraw one of her several medications since it seems the side effects are outweighing any slight benefit it initially seemed to offer.

And every time we have to do this she gives me “The Look”. You know the one. It’s the look that says “I know what you’re really doing is trying to kill me”.

On any other day this would have been part of the normal cut and thrust. Sadly not on this last occasion. That same day was the day that Grace had died.

Grace came to see me around sixteen years ago, not that long after I had arrived at the surgery. She had gone through menopause six or seven years before that, and was a little put out to find she was bleeding again. One urgent referral, an admission and a lot of tests later she emerged from hospital with an inoperable gynaecological cancer. Undaunted she allowed herself to be put through the rigours of radio and chemotherapy, lost all her hair, but was put into remission. (And yes her hair did then grow back again).

As with all cancer diagnoses, especially when inoperable, she was then watched by her oncologist, initially every three to six months, then, after five years or so, annually, for evidence of recurrent disease. Sure enough, eventually, around eighteen months ago it happened. Despite poor odds, and the threat of repeated hair loss (no small thing for a lady at any age), Grace cheerily submitted to one more pulse of radiation and several courses of chemo, but by New Year it was apparent the treatment was no longer helping. She began to experience significant and increasing pain. In the end she bowed to the inevitable and accepted that paracetamol on its own was not going to see her through, and a couple on months ago she finally accepted a tiny dose of opiate analgesia, and we made one small increase in her dose a couple of weeks after. From that time on she told us she was pain free (though I have my doubts). She remained alert and coherent to the day she died, and only took to her bed in her final few days. Her outlook throughout was as positive as poor Mrs. Snell’s has been negative, and she achieved the best ending possible for herself and her family.

I know full well that knowledge of this would help Mrs. Snell not at all with her current problem, and am left fervently hoping that she will never be tested as Grace was.

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