He’s currently the most powerful man in my life.  A veritable Pontius Pilate.  If he says yes, we go ahead.  If no…….  I try to prepare for the encounter.  I don’t know the going rate for this sort of thing.  Should I have an envelope full of used £20s handy?  A credit card would be more convenient from my point of view but I don’t suppose he takes plastic.  Cash it is then.  And at what point do I make the offer?  And how?  Push the envelope across the table? -“Here you are pal – treat the missus” or just casually leave it behind?

I’ve never bribed an anaesthetist before (nor anyone else for that matter).  There’s a lot to think about.  I wonder if FIFA run courses?  Given that I’m having an ECG before I see him, I could take a couple of beta-blockers to steady the heart rate.  Or bribe the nurse as well.  Is this a vision of the NHS of the future – where bags of cash and/or credit cards, rather than a GP referral, become the means of exchange?

About a week ago, I saw the Consultant Electro-physiologist at the JR for a follow-up to the flutter ablation.  In his view the ablation procedure has ‘cured’ the flutter, but left me with atrial fibrillation as a side effect.  This is not uncommon. There are three options and he explains the risks/benefits of each – and then leaves it to me to decide.  But he assures me he’ll do what ever I want.  He also assures me that my heart is basically sound; “it (the fibrillation) won’t shorten your life.” 

The options are; (i) a ‘pill in the pocket’, (ii) a permanent drug regime or (iii) another ablation.  The pill in the pocket is designed to be taken at the onset of each episode – it takes about an hour to work and then lasts for about 12 hours.  The permanent drug therapy is designed to stop such episodes happening in the first place.  As an alternative to drugs he could attempt to ablate the fibrillation.  The risks are higher than for flutter ablation and the success rate is lower.

I mull it over.  Annie’s not here and so I’ve done some homework and prepared a list of questions.  Each time I ask something he says, “that’s a good question” and gives a clear and comprehensive answer.  I feel like teacher’s pet.

It’s been 15 weeks since the ablation.  In that time I’ve had 6 episodes of heart arrhythmia (that I’m aware of).  The first three, a week apart, last around 36 hours, 24 hours and 12 hours respectively.  The next three settle down to roughly four weeks apart, lasting around 8 hours each.  They all start, as far as I can tell, around 4.00am.

From this I suggest that perhaps the heart is settling down – the episodes are becoming less frequent and of shorter duration and – in the hope that they may disappear altogether – opt for the pill in the pocket.  At least to begin with.  I’m not happy about a permanent drug regime (I don’t really count the low dose aspirin) and if the atrial fibrillation becomes a permanent feature of my life – and cannot be controlled by the P in the P – then I’ll think about another ablation.  But I’ll try the magic pill first.

I get 10/10 and a smiley in my exercise book.

I explain that I am most concerned about the affect the heart is having on plans for the voice procedure.  Specifically – that the anaesthetist has already cancelled twice because of his concerns about the heady mix of warfarin, arrhythmia and general anaesthetic.  I’m about to have another pre-voice op assessment and I don’t want him to cancel again.

We talk this through – it’s the assessment that’s the real issue not the procedure itself.  My heart needs to function properly when I have the ECG beforehand – “if it goes out while you’re under a general anaesthetic they can just cardiovert you.  I don’t see what the problem is.”  Me neither – they do this all the time on Holby City .

He suggests that if I’m really worried I should take a pill on the morning of the procedure.  He also gives me his phone/bleep number so that the anaesthetist can call him if he still has concerns. What a nice man.

I Google ‘pill-in-the-pocket’ when I get home and come up with flecainide.  One of the side effects is ‘hearing and seeing things that aren’t really there’.  No change there then.

Life is suddenly busy – I have three more appointments within a space of two weeks; a pre-voice op assessment, the anaesthetist and the cystoscopy.  Annie and I have a break to get away from things and go to Liverpool for a few days.  We want to see the Magritte exhibition at the Liverpool Tate and the Antony Gormley ‘Iron Men’ on Crosby Sands.  Annie’s brother Rob is over from France so we also go to Manchester to catch up with him and Annie’s mum.

My friend Neil (from Fat Freddy) recommends a hotel in the centre of Liverpool and it’s late at night when we arrive – we take a wrong turn and become hopelessly lost.  One minute we’re driving down derelict unlit streets – we could be the last people on Earth – the next, we’re in the middle of a party.  A particularly noisy one – the sort where you wonder how you got an invite because you don’t know anyone.

We continue to drive round, passing from light to dark, the gravitational pull of one-way systems keeping us in orbit.  Needless to say I am becoming stressed while Annie is calm; “nobody gets lost forever”.  Oh yes?  I can see us staying here until we run out of fuel and fall back to Earth.

Eventually we spot a Police van outside a late-night shop.  It’s one of the big ones with a grill over the windscreen.  An officer gets out and makes for the shop.  Annie runs over and in her best ‘damsel-in-distress’ routine explains our plight.  They confer; “wait until I’ve got my Lucozade and then follow me”.  And so, with the officer suitably energised, we set off in convoy.  No ‘blues and twos’ – just a steady progress through the back streets of Liverpool – slowing down from time to time as the van picks its way through the inhabitants of this lively city, until he stops and point to our hotel.  We offer profuse thanks but he just smiles and waves.  Another nice man.

We have a great time in Liverpool.  Here’s one of the Iron Men; there are 99 more, just looking out to sea and waiting.

Another Place, Crosby Sands

Back at work I run into my worst nightmare.  I can speak for around 7 seconds on the phone before running out of breath.  So any phone call is a big deal for me.  If the person at the other end knows me they can make allowances – but an outside caller can’t.  And each 7 seconds is precious – I cannot afford to waste it.

The phone rings and it’s an outside call.  I take a deep breath and go for it; almost immediately there’s an ominous silence – I use up part of my precious allowance asking if the caller can hear me.  I go on as long as I can, like a leaking balloon on its last gasps, before I’m forced to stop and inhale.  A voice cuts in mid-sentence and I realise they’ve not been aware of the dropout.  I ask them to repeat what I missed, they ask what I mean, silence again and I run out of steam.  And so it goes on, the content of message becoming lost as each of us tries to fill in the gaps with unnecessary questions.

I rehearse my case; I’ll lay it on with a trowel – the voice procedure is a big deal and is affecting my work, blah, blah, blah.  I’ll play down the singing because some medics see it as a ‘lifestyle’ issue and therefore of low priority.  But I’ll add in a bit about choking – which I seem to be doing more of these past few weeks.  And then do whatever I can to ensure the heart does not throw a wobbly at the last minute and mess up the ECG.

And suddenly, after all this musing the big day arrives.  Today – at 8.15am.  Of course these things are never quite as we imagine beforehand.

I didn’t sleep well last night.  My heart rate is fast.  Tension?  Be still, be still my beating heart/For thee tonight there is no fear¹.   It settles down by morning.  I forego coffee, just in case.

The ECG is a perfect – the nurse is as excited as I am.   She asks the usual questions, current medication, next of kin and so on and then throws in; “how many pillows do you sleep with?”   I wonder why she wants to know this; she explains that after lung surgery some people have a problem laying flat on their back.  “If you were old and crumbly I’d be asking if you could climb the stairs”.  Then she asks if there have been any episodes of arrhythmia since the ablation.  I am, as Alan Clark once put it, economical with the actualité;  “ a couple of times – this is quite normal apparently”.   If she wants to delve it’s all in my notes, but I don’t want to sow any seeds of doubt about proceeding.  And then I wait to see the anaesthetist.

A tall, slim, blonde, very tanned, attractive young woman calls my name.  It can’t be.  It is.  First assumption out the window. Did I mention attractive?  She refers to me as her “gentleman.”  She makes funny remarks, I laugh.  Gush.  We go through a number of questions – she wants to know my level of fitness.  “Can you climb the stairs?”  Perhaps she thinks I’m old and crumbly.  I nod.  “Two flights?”  “I can climb three – and I ride my bike to work”.  I’m showing off.  I don’t tell her I need a lie down afterwards.

She’s happy with all my answers; “you’re in pretty good nick for a general anaesthetic”. And I’m thinking, you’re in pretty good nick yourself.   “So”, I say trying to appear nonchalant – “it’s all down to you”.  She smiles; “I’m happy to go ahead – you can pay me now”.  I’m laughing inside – she actually said that.  On reflection this is spooky – can she have read my blog before I posted it?  Perhaps she’s a mind reader.  Whatever – she’s a very nice young woman.

When I get home I call the hospital admissions office to say that I’ve been given the go ahead; “I was just thinking about you – how did you get on?”  She has lots of patients, but remembers that I had the assessment today.  I explain that the anaesthetist is happy and will write to Mr ENT confirming this.  “I have a slot free next Wednesday – do you want it?”  She’ll need to confirm it with the great man but thinks she can swing it.  Another very nice young woman.

____________________

 ¹Mary Elisabeth Coleridge