Exactly ten thousand days ago today, driving home on a gently warm afternoon in the middle of September 1996, I was on the receiving end of the first of three serious road traffic collisions (RTCs) that wrote-off the succession of vehicles I was driving and increasingly damaged my neck: leading, ten years later – despite hundreds of physiotherapy sessions, and many, various minor operations – to major, and extended, surgery: when my cervical spine was stabilized from the front with four surprisingly lengthy screws and a sizable titanium plate. (My neck was so badly deformed – like the poor cars before it – that a bespoke mechanical replacement for one of my cervical disks had to be forgone; and the two vertebrae surrounding it were instead fused together.) I have not seen my shoulders since.
Because of the concomitant nerve damage, that first impact (there are no such things as motor ‘accidents’) also kicked off the continuous severe pain I still experience. In addition, the second RTC brought regular debilitating migraines: some of which have been serious enough to warrant time in hospital – including my first hemiplegic one: which temporarily paralysed the left side of my body. I also started losing my hearing, thanks to the genes I inherited from my late mum and maternal grandad. Add to these the asthma I was born with; the kidney stones I have experienced since my first year at university (probably inherited from my late dad); the hypothyroidism that emerged after my neck surgery; the Asperger syndrome I was finally diagnosed with in my forties; the sudden onslaught of unexplained food allergies and anaphylaxis that tried to kill me in my mid fifties (finally converting me to veganism); as well as the series of cardiac arrests that tried to kill me in my late fifties (leading to a diagnosis of Brugada syndrome, and the implantation of a defibrillator (S-ICD) just under my left armpit); and it should be readily apparent why I also experience grievous clinical depression and insomnia. It should also be obvious that I require regular, managed care, delivered by a relatively wide variety of medics.
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Before I moved to the west coast of Cumbria in August 2021 – fulfilling a lifelong ambition to live in, or very close to, my beloved Lake District (I am inches outside the National Park boundary!) – I was extremely fortunate to be under the care of a GP who I met with monthly; a clinical psychologist who I often saw at least as frequently; an audiologist I visited at least annually; a cardiology department that reviewed my heart’s output remotely every week, then called me in for physical examinations every six months; and a specialist asthma nurse who gave me thorough yearly check-ups… – all of whom worked for the NHS; nearly all of whom knew me by sight and called me by my first name; and, in the case of my extremely compassionate, thoughtful, wonderful, magical GP, could recite my extended inventory of medical problems by heart (sorry), as well as the twenty-one repeat prescriptions which just about keep me functioning.
Compare this with the two recent visits to the local audiology department (which left me with hearing aids signally unfit for purpose), or the three GP appointments I have managed to make since I moved here – the initial one taking two years to book: and then only after a formal complaint (that the practice made no allowance for those who could not use telephones to contact them) was eventually upheld. Even now my emails and messages sometimes go ignored, or are only partially, irrelevantly, read and responded to – even if I deliver them in person to the receptionists at one of the four local surgeries (which would have been three, had the management had their way). And I still have not been subjected to the first of my ‘annual long-term condition health reviews’ – which was due a month after I moved here.
It is no better, it seems, for those who can use the telephone: the tsunami of calls, first thing every weekday morning, being described by locals as a “lottery” (obviously a less-known subsidiary of the ‘postcode’ one that we appear to have been given no tickets for): the principal reason being that our area has fewer than a third of its required GPs – which means that the existing ones (and my practice states that is at least seven doctors short of the current “national average”), as good as they can be, are all under-funded, stressed-out, frustrated and overworked (some days, I am told, “working 07:00 to 22:00”) trying to catch up with a demand that is as possible to fulfil as Zeno’s first paradox. (And this in an area that features one of the most hazardous workplaces in the UK: Sellafield – although this does have nurses on-site 24/7, and a doctor on-call overnight. Lucky sods.)
To add insult to all these injuries, despite having the shiny “redeveloped” West Cumberland Hospital (WCH) – due to be fully open this year – within walking distance of my home (although not a distance that I can walk); and which lists Cardiac Rehabilitation, Cardiology, and Neurology amongst its many departments; it seems that I will somehow have to travel across the northern Pennines for much-needed treatment for my poor old heart and head – one suggested driving route passing within spitting distance of the large Cumberland Infirmary complex at Carlisle: which also (supposedly) delivers cardiology services.
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As part of preparation for an appointment with an NHS neurologist – after he had seen just how badly my migraines were affecting me – my new GP had requested MRI scans of both my head and neck: it being quite a few years since I had last had these carried out. However, possibly due to the inconvenience of requiring a cardiologist’s presence throughout (to deactivate, monitor, and then reactivate my S-ICD (see below)), these were downgraded (although I don’t know who by) to a single CT scan of my neck (which I have had – just not the results). Alternatively, someone decided in advance that it must just be further physiological deterioration of my neck that is the problem; and has therefore – confirmation bias in hand – set out to find proof of this, and this only.
This comes with several major disadvantages: the primary one being that this CT scan will not have captured any possible damage caused to my brain, say, by a lack of oxygen when I had my last – and worst – cardiac arrest (which left me not quite dead in intensive care: emerging with mild cognitive impairment (MCI) – a possible precursor to Alzheimer’s disease). Nor will it highlight any other problems inside my skull: such as those which could explain a sudden change in not only the ferocity and frequency of my migraines, but also in my eyesight – which appears to be worsening rapidly. (By the way, because of the purported shortage of Cumbrian cardiologists, I would have had to travel to Newcastle upon Tyne to have that cancelled MRI scan. Ironically though, when I asked about seeing a neurologist privately, I was then directed to a hospital in the same distant county without any qualms!)
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It is a similar story with regards to my cardiac care. After almost two-and-a-half years of me, my GP, and several dedicated members of my previous cardiology department (294 miles away, by car) frequently struggling to get “my heart’s output” directed to somewhere more ‘local’, that data (which I upload from my bedside via the Internet every Monday morning) has ended up now being siphoned to a hospital a mere 122 miles (a mere two-and-a-half hour drive) away in Middlesbrough (where I presume I will also see a cardiac consultant, eventually). Over four years since my S‑ICD was fitted – with a predicted minimum battery life of only five years (which will require yet another operation to replace, or remove) – my coronary information may be travelling somewhere somewhat closer(!), but I am still left hanging on a waiting list to see some unknown cardiologist in some unknown place at some unknown date in the future to discuss my Brugada syndrome: a congenital illness that can be provoked into initiating a cardiac arrest by something as simple as a high body temperature. (It may be worth noting that I was, at one point, actually on another waiting list to join this more recent one – having been triaged via a telephone conversation that I struggled to comprehend, for obvious reasons – so perhaps I should be more grateful.)
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The Lake District is not the remote backwater it was before Coleridge and company set about writing tourist pamphlets for it (unfortunately); nor is it as denuded of visitors as it was when I embarked on my addiction to the place, fifty years ago (when you could romp along Striding Edge on a sunny Saturday afternoon without encountering so much as a border collie other than your own). And yet, it seems that for anything complicated – apart from, say, bowel cancer – one must be exiled to where dragons be for medical treatment. However, the west coast of Cumbria is also nowhere near Westminster; and therein may lie the answer. If we are to be ‘levelled-up’, health-wise, it seems more likely that it will be explosive radioactivity that will be the cause, rather than the necessary and urgent long-term injection of government cash and staff into what is left of the local NHS.
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