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Date: 07/02/24

Ablative Case

May I apologise now? You know, just to get it out of the way and so that we both know where we stand?

For two things: firstly, my ever-lengthening silences which mean that I have posted only two items to the whole site since the beginning of the year. And secondly, for the fact that I have now broken my latest period of muteness by tapping out yet another long, tedious piece about me and my health.

The story so far can be found here. This is what has transpired since where, in short, things have happened but nothing much has moved on.

The case conference which had been scheduled for December 23 didn't actually take place until January 4. I was subsequently sent an outline of the discussion (I don't remember asking for this and - whilst I'm grateful for being kept 'in the loop' - I rather wish that they hadn't; seeing all my 'issues' set down baldly in print all in the same document was, to be blunt, horrifying). In between times, I was called again by one of the specialist nurses to discuss The Way Ahead.

As I had suspected, the plan was to replace the pulmonic valve altogether, and that nice Dr. Jenkins had managed to persuade her colleagues to treat me as a Priority 2 (a status which might be defined as, "He's not going to die any time soon, but we should get this done a.s.a.p. anyway to minimise the possibility") and to get it done before the end of February.

In order to do this, however, the cardioversion would have to successfully take place. This was agreed verbally for February 7, with the Transcatheter Pulmonic Valve Implantation (TPVI) taking place two or three weeks later.

Once I had absorbed the information, I have to say that I felt little in the way of trepidation. "Something has to be done, this is the Something, so let's get on with it", has been my attitude since.

Worried that I hadn't received any written confirmation of the cardioversion appointment, I attempted to contact the arrhythmia nursing team, but had to leave a message on their answering machine and wait.

I still hadn't had a response when, last Friday morning, I was contacted by the PA to the surgical team at Broad Green asking if I would go up there on Monday so that I could talk to the 'Interventionist', that is to say, the doctor who will be 'doing' me. An immediate problem arose with this, in that Monday was my niece's birthday, and I wasn't going to make her spend that day on another spin of that fine old classic "Ferry (An Old Fart) Cross The Mersey"; she does more for me than I could be ever be entitled to expect anyway. So I told the PA that I would check the train timetables and try to get there for 1100hrs. She reassured me that there would be no problem if I were to be fifteen or twenty minutes late, which I thought was very good of her.

There was another reason why I volunteered to fly solo on this occasion, though. The last few months have been - as you could probably tell by my earlier pronouncements, or lack of them - a real burden on my psychological well-being. The physical debility I have long been used to and have become largely inured to. The sense of not being able to do very much has, however, burrowed into my brain and has meant that I either haven't been able to put together any creative thoughts (hence the silences), or have succumbed to a feeling of utter cantbearseditude which has meant that I simply couldn't be bothered anyway (hence the silences). In short, I have come to behave as if nothing is either doable or worth doing. This, I thought, might be a way of breaking out of the pattern. I felt that it was worth the try.

I checked the train timetables and found that I could reach Broad Green station by shortly before the appointed hour. However, the one sticking point was that I would have to walk from there to the hospital, and I wasn't sure how far that was. Maps can be deceptive when it comes to distances (and G**gle Street View is even worse in that regard, in that you advance along your chosen route in such short steps that it gives an ordinary residential road the apparent length of the Trans-Siberian Highway), and whilst the distance didn't seem in any way inordinate, I felt it likely that it would take me at least twenty minutes to cover it, and I hate being late for anything (I was born a day earlier than expected, and have been rather more than punctual ever since).

So an earlier train had to be caught. This would involve my catching the first train at Wrexham General at 0802. This in turn would require me to catch the bus from outside my gate at 0659, because I couldn't depend on the 0729 getting me there in time, especially as it would involve a hundred-yard walk because Arriva removed the bus route which went past the station two and a half years ago. So be it.

When dawn broke on Monday, I was standing on Platform 4B at Chester station waiting for the connecting train to Liverpool Lime Street. I had actually risen some two and a half hours before after a night where I had slept no better than I usually do nowadays. I had made Wrexham General in good time, bought my ticket (and you must admit that 14.20 is very reasonable for what amounts to a seventy-mile round trip) and crossed the footbridge to Platform 2. When the Cardiff-Holyhead train arrived (only a minute or so down), I could see that once again our nation's main south-north service was running with only two carriages. There was enough room for the twenty or so of us embarking, though, and we set off for the border.

Crossing into terra infidelium, I got off at Platform 2 at Chester, crossed the bridge to 4B and waited for about twenty minutes for Merseyrail. Boarding what looked to my untutored eyes (it had been over six years since I'd last travelled by rail) like new rolling stock, I was then transported up the eastern side of Wirral...

(Note for trainee pedants: it's not 'the Wirral', just 'Wirral', although one may correctly refer to 'the Wirral peninsula')

...until we finally disappeared into the bowels of the Earth after - appropriately enough - Birkenhead Hamilton Square, beyond which all was subterranean until Lime Street. Getting off at Platform A, it was then a question of negotiating a flight of stairs and the enormous escalators (as described here) to the upper level. Where I discovered that the train for Wigan North Western (via - inter alia - Broad Green) which I had intended to catch had been cancelled, so I had to wait over forty minutes for the next one at 1015.

It's only about ten minutes by train to Broad Green from there, and I got off at 1025, noticing as I did so that the subway beneath the line linking Platform 2 (off at which I got) to Platform 1 (on at which I would be getting later) was closed. I put this to one side for consideration later.

So I began to trudge - slowly but reasonably surely - up Old Thomas Lane, then on to what should logically and by application of typical Scouse wit have been called 'Young Thomas Lane' but wasn't; there was no age designation attached. Then it was a case of crossing the dual carriageway that is Thomas Drive (I don't know who Thomas was, but he clearly got about a bit), before entering the grounds of the hospital and making my way to the main entrance. Having availed myself of the gents' (I'd been holding it in since at least Rock Ferry), I then followed a series of corridors to what is known as the Willow Suite (their suites are named after trees; there was also an Aspen one, for example. I looked for the Elder Suite which should logically have housed the geriatric facilities, but once again I was disappointed). I checked in to Reception at about five to eleven.

Then began the usual round of preliminaries: firstly, the latest in that long-running series 'The Ultrasounds', with special guest star Vi Le Jelly. This episode was presented by a very personable (if at times slightly over-chummy) young man who pressed his apparatus firmly to my chest (slightly bruising a nipple in the process) and murmured "Perfect!" every so often. He then passed me on to a nurse who connected me up to the ECG machine and quickly produced what she was looking for. She in turn sent me to another colleague who took my blood pressure, and then it was back to the waiting room.

After a few minutes, I was collected by another nurse who ushered me through to the room of Dr Narayanan, the consultant. He turned out to be an amiable man, ready to smile and to be someone I felt I could have a real conversation with. He showed me the ultrasound scans of my heart, although they might as well have been of a giant red pepper for all the sense they made to me. Nonetheless, I nodded with fake sagacity in an attempt to keep up my side of the discussion. He (and the nurse who had brought me in, who had joined us) then went through what the 'procedure' would involve and what the benefits and risks of it were. The fact is that I knew the benefits already, not least of which was the chance to get some sort of a life back. As to the potential problems, I was willing to take the (albeit minimal) risk to gain the prize of not having to struggle through my days. The nurse then told me that my stay in hospital would likely be no more than three days: they would do the angiogram on day one, the TPVI early in day two and then monitor and test me into day three before letting me go, after which the full recuperation period would be little more than about ten days. This was in line with some of the things I had been reading, but it was good to have it confirmed anyway. I asked Dr Narayanan whether the replacement valve would be a mechanical one, only for him to tell me that no, it wouldn't: it would be bovine tissue. I have to say that this doesn't faze me at all: knowing my luck with machinery, I wouldn't want to trust something with moving parts. And at least I might not have to buy milk anymore.

There was, however, a snag. I'll come back to that in a moment.

I mentioned the cardioversion, and was then told by Dr. N. that there had been a mis-communication, and that that would not now be going ahead. Instead, he and a colleague had come to the conclusion that it would be better to go straight for ablation. That involves another catheter going up into a region of the heart and either freezing out or burning out the neural pathways which are causing the arrhythmia. That would be done in Broad Green, possibly in early March.

As regards the TPVI, the snag I referred to above relates to something most people wouldn't consider relevant to the matter in hand: teeth. Because of the increased risk of endocardial infection due to an implanted valve, and that the mouth is one of the prime origins of such infections, I need to have my teeth in good order. Unfortunately, I haven't been to my dentist for four years, and there's an awful lot that will need doing, and it will be take some weeks, not to mention being painful and expensive. That is, if I'm still registered with them; someone said that practices tend to remove from their lists anyone they haven't seen for two years or more. So I may be up Shit Creek on that score.

At the very least, this will set the date of the TPVI back to April or May at the earliest, which is a bit of a kicker.

I left Dr. N.'s room and was then taken back to the same nurse who had taken my blood pressure so that she could weigh me (I'm overweight, I know it), take some swabs (both nostrils, inside of the mouth and the top of my groin, because that's where the catheter will be going in eventually, although what use it is taking a swab of that area so many weeks out escaped me) and take a blood sample. I was then led by another nurse to the X-Ray department, where a nurse who looked no older than about seventeen stood me up against the plate for a moment or two.

I was then free to go. It was about 1230 by this time and - once I had done my best Theseus impression (without assistance from any passing Ariadne either!), went and sat in the cafeteria/waiting area by the main entrance to eat my Sainsbury's prawn mayo sandwich and my Cadbury's Twirl (to my annoyance, I discovered that I had forgotten to pack a bag of Seabrook's cheese and onion crisps; I had been looking forward to them).

I sat there until shortly after 1300 before deciding that I had better get going, as my train into Lime Street was shortly before two o'clock and I wasn't feeling quite as energetic as I had on the way up.

Traversing the Thomases of all ages in reverse order, I found myself on Platform 2 of Broad Green station at about 1335. But the Liverpool-bound trains went from Platform 1, and I could see no way - the subway being closed, as I mentioned earlier - to get from one to the other (or rather, from the other to One) without wings. I asked another man standing there how I was going to get to Platform 1. He advised me that I needed to go back out onto Old Thomas Lane, turn right onto (Young) Thomas Lane, go under the bridge carrying the M62, then turn right again up Bowring Park Road to the other entrance.

I didn't dare look at the time, but off I shuffled. I reached Platform 1 at about 1345 and waited. It wasn't long, and I got into Lime Street, headed for that long escalator again and descended into the depths. I had no sooner got onto Platform A than the Chester train arrived and I headed off under the Mersey and down Wirral again.

I have to say in passing that I've always considered rail a very civilised way to travel, and so it was on Monday. Apart from a couple of lads on my outbound journey who had their phones playing something (slightly irritating, but not by any means in the 'neddy'(*) category), the whole thing was a pleasant experience. It's also interesting in residential areas, because whereas the front gardens of people's houses may be all very ordered, with nicely cut grass and even an ornarment or two, the backyards may often be the truly revealing aspect of the occupants' lives, containing a half-demolished shed or the gearbox from a Ford Ka.

On reaching Chester, I had assumed that my connection to Wrexham would be leaving from Platform 2 as it usually has been in all the years I've used it, so I crossed the footbridge, only to be baffled by the fact that the next train my way from there wasn't due for about an hour and a half. The display boards weren't of any immediate help in clarifying the situation, so I had to go online to discover that my train was destined for Birmingham International and would be leaving from Platform 4B...which was on the side of the station I had just left. So it was a case of shambling back over the footbridge to wait. In the meantime, I phoned my niece to inform her of the day's developments.

When the train came in, there was no display on the front, back or sides (or even, as far as one could tell, on the roof or the chassis) indicating where the hell it was going to. I - and another chap I got talking to - were also thrown by the fact that it had come in more than ten minutes before its departure time; we're not used to things like that nowadays. We both decided to board anyway, where the internal displays weren't showing anything either. Eventually, the screen came to life to assure us that, yes, we were heading the right way (the other chap was going to Wellington), and we were soon off. Backwards.

Getting into Wrexham, I knew that I couldn't reach the bus station in time for the 1600 service 12, so took my time (as if I had any option by that point; I was knackered) and waited for the service 14 at 1620, arriving home at about ten to five.

And there, bothers and misters in the systeries, is where things stand at present. I'm going to have to get down to my quondam dentist's on Thursday to see what can be done and how soon.

I could have said no to the whole journey, of course, citing my debility. But I needed something to boost my self-confidence, to show myself (if no-one else) that I could still do things like that; mind you, I was shagged out all day Tuesday.

So I find myself slightly becalmed. Things have changed, but nothing has actually happened. At least it gives me time to finish making my will (something which my niece and my sister-in-law have been prodding me about for months) and setting out my funeral requirements (it's all going to be very nice, and I wish I could be there to enjoy it myself). But things will move fairly soon, and perhaps I will be restored to something approximating good health - physically and psychologically - within a couple of months. Just in time for summer, in fact.


* A cross between a 'ned' and a 'scally'