Back to the Brompton. A Christmas Ordeal.

On Tuesday 22nd December we had an appointment at the Respiratory Clinic at the Royal Brompton. In the months coming up to the date, it was tempting to rearrange as the thought of travelling there and back and being stuck in that hospital corridor all afternoon two days before Christmas was pretty dispiriting. But back in November the local Respiratory Nursing team advised me not to postpone. His cough reflex, they told me, is so weak now that we need to talk about cough assist machines. This caused the usual skipped heartbeat for me - which I notice is what happens when I recognise an MND landmark moment.

So we didn't postpone. I arranged time off work (once again, thanks to Paul and Amy) and arranged for hospital transport on the day. I alerted our friend and neighbour Michelle to the imminent arrival of an ambulance (to allay the fears its arrival would inevitably cause amongst concerned neighbours) and made the necessary preparations. The ambulance arrived early and off we went. They had left plenty of leeway in case of traffic, which meant we arrived 45 minutes ahead of our appointment time. And so the waiting commenced...

We have plenty of time to observe. There is tinsel everywhere and a rather nice Christmas tree at Outpatients, downstairs. Several female staff members sport jolly Christmas earrings.

The appointment is for 13:00 and the usual routine is followed today. First, but not until 13:30, Roch is called for the FVC (Forced Vital Capacity) test, where his lung capacity is measured by blowing into a tube ("Take a deep breath, now blow - keep going, keep going, keep going..."Lung capacity is measured on a chart, which is added to his file. Then we return to the corridor to wait for the blood test. Eventually he is called the the Blood Room (in my head I call it 'The Bloody Chamber' a la Angela Carter). As described in previous posts here, the patients are given a choice - wrist or ear? Roch usually chooses wrist as this tends to bleed less, although it's more painful. However, there are fewer nurses with the skill to extract from the wrist and we hadn't spotted the usual skilful individual so he chose ear. Mistake. It still hadn't stopped bleeding when I was putting him to bed that night.

Back in the corridor, ear sporting an enormous wad of cotton wool, held in place by a cartoonishly large clip in startlingly bright blue, we wait again, senses on the alert for any sign of an elusive Consultant. There are always two at the Clinic. We hope to see Professor Polkey but today there is no sign of his tall, genial presence. Instead we see the female Consultant we saw last visit and my eyes immediately meet Roch's in a mutual "Oh no!" We do not want to have come all this way, waited all this time and be met with well meant platitudes. Might as well have stayed away and wrapped some presents. More useful.

Then I spot a vaguely familiar figure striding past. I don't remember his name but I know we have met him before. There is something instantly likeable about the way he interacts with a patient who stops and addresses him in the corridor. His manner is friendly and respectful and he gives her all his attention, although given the growing line of waiting patients, he must be keen to start his clinic.

So now we wait and wonder which Consultant it will be who emerges to call Roch's name? We see both conversing at the end of the corridor and they disappear together into one of the consulting rooms, presumably to divide up the afternoon list.

The female Consultant is out first and to our relief, she calls a different name. As the patient and his companion follow her down the corridor we hear her explain loudly that she is one of the Consultants this afternoon and that she often takes this Clinic. Do  I imagine I see their shoulders droop in disappointment? The door closes behind them.

Next the gentleman I spotted earlier emerges and calls Roch's name. Relieved, I pick up the respirator bag and follow Roch as he drives the wheelchair down the corridor.

This is Dr. Matthew Hind and I am right, we met him when Roch had the PEG fitted, back in February 2014. Dr. Hind appears to remember Roch, too. This is a good start. After a preliminary chat, he gives us the test results, which are extraordinarily good. Blood gases are excellent and FVC is unchanged since last year. What? That can't be right. A whole year and no change? It means his respiratory function hasn't disimproved at all. Dr. Hind is surprised himself, but there is no doubt. He tells us that he has no explanation for this. Roch is unusual. This is not the way the disease usually progresses and he cautions Roch against advising in online forums based on his experience. Roch is aware of this, however. Roch, as usual, describes himself as a Freak. Dr. Hind smiles but does not agree.

Throughout the consultation Dr. Hind's manner is energetic, interested and engaged. He is careful to include me at all times. He has clearly read through Roch's file and his attention is fully focused on Roch, who he watches carefully.

I draw his attention to Roch's cough reflex and he agrees that this is weak. When I enquire about cough assist machines he asks if we have ever been shown how to use the ventilator as a cough assist? No? Well, then, let's get someone up to demonstrate that now, shall we? Immediately he picks up the phone and Adam is asked to come up from Victoria Ward to carry out the demonstration. We chat for a few minutes and as there is no sign of Adam, I suggest that we return to the corridor to wait as I am aware that there is a long list for the afternoon. Dr. Hind simply says "Would you? That would be great." But I note that the suggestion didn't come from him. We say our goodbyes and return to the corridor to wait for Adam from Victoria Ward. Thank goodness I brought the ventilator, I think.

At this point it's about 15:00 and I am starving. Roch says he's okay but he's only had a Fortisip for breakfast so I doubt this. I ask the nurse from the Bloody Chamber to check the ear and she removes the blue clip and cotton wool. As it's still bleeding steadily she puts two plasters on. Roch urges me to alert Hospital Transport for the trip home and I do this reluctantly as I'm afraid they will come to pick us up before we are done with Adam. Ha! I need not have worried about that.

Adam arrives within fifteen minutes (we have met Adam before, he supports Shrewsbury - football banter ensues) and we follow him down to Victoria Ward, where he explains that the ventilator aids by giving Roch more air (he holds it in) which then gives more strength to his cough. He shows me how to use the ventilator for this purpose and guides Roch through the breaths. He also shows Roch how to breathe in, close his mouth and sniff twice through his nose to build up enough air to fuel a stronger cough, without using the ventilator. It works. Let's hope it works when it matters. Both Dr. Hind and Adam think that at present, Roch doesn't need an actual Cough Assist machine. We are relieved as it means one less piece of equipment for the present.

Adam advises us to go straight to the Hospital Transport waiting area on the ground floor and we get there just before 16:00. At this point I am 'wall falling' with hunger (I imagine that means the stomach walls are actually on the point of collapsing inwards and sticking together. That is certainly what it feels like.) But I approach the rather cross gentleman on the phone and wait hopefully.

"Benfleet (?) I don't care where they are. Just get them back here NOW. What are they playing at?" Then he slams down the phone. I presume he is the Person In Charge. I give him Roch's name and he tells me he's waiting for the Crew to get back.

"He's down for collecting at five," he tells me with a glare that says 'Don't argue with me, love.' In my head I add the inappropriate endearment - he looks the type. He needn't have worried as I am so weak from hunger I would be incapable of forming another sentence. Any strength to resist has evaporated. Perhaps this is why they arrange lunchtime appointments. Mental note - next time bring food.

Hoping very much that Roch hasn't overheard this exchange, I return to him to tell him we may have to wait a while. I can tell by his face, which gets that set, angry look, that he is not pleased. I don't blame him. I ask if he wants a coffee or anything to eat. He refuses so I go in search of sustenance for myself, vaguely remembering that on a previous occasion, the small coffee dock was closed when I arrived on a similar errand. Happily, today the smiley lady is there and I grab a packet of crisps, a twix bar (no surprises there) and a hot tea. Why is it that hospital shops only seem to provide unhealthy food? However, I am not complaining and return to the dark alcove that is the Hospital Transport waiting area to devour my treats.

Another couple wait there, he is in a wheelchair, she sits with her head resting wearily on her hand.Having eaten something, I am sufficiently restored to take notice. She asks where I got my drink and I tell her although I fear that by the time she gets there, Smiley Lady will have closed up shop. Moments later she returns, empty handed. I smile in sympathy and a conversation ensues. Her husband tells me that he has MND and I share the fact that Roch also has MND. At this point I can see Roch is growing very impatient and is in no mood to converse with strangers. I don't blame him one bit - in fact the area is not conducive to his repositioning the wheelchair for conversation. I am happy to be distracted while I wait and the couple are very interesting. Out of the corner of my eye I see Roch manoeuvre his wheelchair so that he can approach the desk to complain. The Person In Charge having left, he argues with someone less belligerent in manner but equally unhelpful. I am even happier now that I am engaged elsewhere, although I guess being stuck in that chair since 11:30 this morning with no food and having to wait around constantly cannot be easy.

I don't think I can share all that couple told me here, as it wouldn't be right.  But to my amusement, they too say they had noticed the Lady Consultant and their hearts sank as last time they saw her -"All she did was blab, blab, blab," the woman confides. Just as with us. Sadly, the news they had been given was not as good as the news we had received. My heart sinks for them but they have  already agreed to seek a second opinion. They have not been in touch with the MND Association although like Roch, he was diagnosed in 2009 and I suggest they make contact. They smile politely. He also has lower limb progression. I liked them both very much and truly wish them well.

As we wait, a driver attempts to chat and passes round some chocolates in an attempt at Christmas cheer. Nobody takes one. "They're Belgian," he urges. He can't believe anybody would refuse a free chocolate.

At 16:30 Roch's name is called and we leave the hospital. We get home around 17:20 and although I am glad we endured it, as we saw Dr. Hind and had a good report of Roch's respiratory condition, Roch is adamant he is never going back. I have to agree, it is something of an ordeal.

He will have to go back, of course - Respiratory care is essential - but Dr. Hind says he doesn't have to go back for a year, unless something drastic happens.
"Let's make it Christmas Eve next time," Roch says, with uncharacteristic sarcasm.
"I'll be here," Dr. Hind replies, unfazed.

When we get into the house, Roch heads straight for the back door, and cigars and beer must be produced, in that order. The only man in medical history whose respiratory condition improves with cigars. I ask you.

The mood is black.

"I'm sick of it," he says. "Sometimes I wish they'd tell me I'm worse, so I could just get it all over with. How long is this going to go on?"

I cannot lie and say I never ask myself the same question, in darker moments.

I know he is tired and hungry. I know with food and cigars and beer, the mood will improve. Or at least, he will be able to put those thoughts away for the present. He has always been good at distracting himself. He is a man with resources - his reading, his music. Years ago, when he left Dublin for London, his mother told me,

"I don't worry about Roch too much. He can be alone. He has the inner resources." Mary knew her son well.

I think of the couple I met in the waiting area. I wonder how we would feel now, if the positions were reversed. If we were talking about a second opinion because the news was bad, and they were at home, she lighting his cigar, he declaring he would never go back. It's an interesting question, because I am not quite sure of the answer.