Postcard from the cuckoo's nest

Picture: Philips

In the midst of all this brouhaha over leaks and flat refurbishments, it's been easy to forget little Matt Hancock, the eager-to-please Secretary of State for Health & Social Care. In the last week or so he's been pushed out of the limelight by the psychodrama surrounding his boss, but that doesn’t mean the erstwhile minister has lost his boyishly obsequious zeal for saying - at any opportunity and usually when a camera is near - how NHS staff are the most amazing people on the planet.

In truth it’s one of the few areas that Hancock and I agree on. Actually, it’s one of the few things that I’ve had much cause for alignment on with any politician, especially over this last year, not being a great fan of the breed. It is, though, the common bond that had us all on our doorsteps, clapping on a Thursday night for those months of spring and summer last year until the custom fizzled out. We did it partly out of community solidarity, but it was more than an empty gesture. Some of us needed to feel good about the rapidly unravelling situation, as COVID-19 took hold, but it was also the realisation that it was carers and NHS workers in particular who were thrust onto the extremely attritional front line of the coronavirus. And while we may have felt ever so slightly smug, clapping with our neighbours, just as Boris Johnson was doing on the front step of 10 Downing Street, or Sir Keir Starmer was doing outside his Camden abode, it was also good PR for an institution that deserved it. 

Johnson, you could say, had more reason than most, especially as he was visibly in the first throes of COVID when he first took part in the Thursday clap. By the time the prime minister emerged from a very serious encounter with the virus, his appreciation for the NHS should have been enhanced beyond all recognition. That, of course, remains to be seen, given the derisory pay round that has been offered NHS staff. I, on the other hand, have gained my own renewed respect for the NHS frontline. As I write, I’m into my third week in a hospital as a patient. Three Saturdays ago, I had a podiatrist look at what I’d thought was just a stubborn-to-heal foot blister. Thankfully, she knew precisely what she was looking at, and promptly sent me off to A&E at Kingston Hospital, where I’ve been ever since. Evidently the blister had ulcerated and become seriously infected (a perennial risk for people with diabetes like me). The infection was so aggressive and invasive that it had entered the metatarsal, the so-called ‘Beckham Bone’. Three days later I was taken into surgery, where the formidable orthopaedic surgeon (one of the UK’s best, I’m told) worked on the problem at one end with sharp metal, while I relaxed to Coldplay at the other. Post-surgery, I was prepared for what would become a long, steady recovery process, one that has kept me in hospital (albeit in my own room, which is a touch) receiving round-the-clock antibiotics. The wound left by the surgery - a complex procedure to remove a nasty infection that had found its way into the cavities and micro pockets of the foot - is still healing. I’ll spare you the gorier aspects, but the surgery left me with a lot of dead tissue which needed removing to ensure healthy healing overall. At first, this was addressed by wearing a clever ‘vac’ device which, plumbed into the wound, sucked out the dead tissue and gaseous remnants of the infection. It was my ball and chain, requiring 24-hour use and minimal movement, with only a brief disconnection to take a daily shower. However, its progress was slow, which led to an uptick in treatment, and a therapy that is, quite frankly, remarkable: maggots.

There be maggots in there

While you regain your composure at the notion (I know, I had to at first), the premise is incredible: the wound is packed with a ‘tea bag’ containing around 200 larvae - 100 of each gender - who get to work on eating up all the waste. It sounds gruesome, and probably is if I had to watch it, but it’s painless (in fact, it’s completely unnoticeable, save for some discharge - I suppose they’ve got to get rid of ‘stuff’ just as we do). 

According to Swansea University, which cultivates the maggots for this purpose in South Wales, the technique has been used to treat wounds in various indigenous cultures for centuries. During World War One, soldiers’ wounds in the trenches were seen to heal much faster when maggots that had resulted from flies laying their eggs in open injuries got to work. Within the NHS it’s only been in use for the last ten years, but is now sworn by, with clinical trials demonstrating that the maggots are more effective than other treatments to remove wound debris, cleverly cleaning out troublesome hidden microbes that even the best surgeon’s knife can’t reach, and antibiotics can’t kill off.

I won’t dwell too much more on what’s going down there as, tediously but necessarily, it’s continuing for the time being, and I’m still mostly confined to bed, with the extent of travel limited to the toilet and the shower. My view is also somewhat restricted to an imperious sweep of Kingston-upon-Thames out of my 7th floor window (if I sit up and squint I can just about see the very occasional plane taking off from Heathrow). I live a 40-minute walk from here, but I may as well be on Mars with the Ingenuity mission, such is the slow “direction of travel” my stay has required. But I can’t complain, even if the boredom is mind-sapping. 

This has only been my second inpatient experience in 53 years on this planet. Some go their whole lives without seeing the inside of a hospital, save perhaps for the maternity unit where they entered the world. My stay, however, has been truly profound. Who knows what would have happened had I not been admitted to A&E three Saturdays ago, but I’m assuming it would have ended with losing a foot, or worse. That’s not a gloomy self-assessment, but a reflection of the grave tone the surgeon took in the days after she’d performed her magic. But, from the moment my girlfriend dropped me off at the front door, I entered an incredible system, a complex and dynamic clinical care machine that has had me surrounded, from the get-go, by a vast pit crew of doctors, nurses, surgeons, caterers, porters, cleaners and many more that I've never been exposed to. 

Throughout each day I've had fresh drugs plumbed in, my blood pressure, blood sugar and temperature checked at various times of day, my bloods extracted for analysis of infection markers, injections for blood thinners, tablets for this, tablets for that. When you add it all up, I have been the beneficiary of an enormous clinical and service resource. I’d hate to think what it has all cost. I can’t begin to imagine what the bill would have been if I’d been in the American healthcare system. I am living proof of what a burden Type 2 diabetes is on the health service. All of this because of a foot blister, ironically caused by a new pair of trainers bought to further enable the exercise regime that has been key to managing my condition. Of course, this has been a wake-up call: just as I’d thought that I had everything under control, with the three-monthly HbA1C checks showing excellent blood sugar management, the critical arbiter of maintaining my health. And, yet. I’ve had to drain an almighty resource, adding to the estimated £8 billion diabetes costs the NHS every year.

Picture: Philips

It’s not, though, just the cost that’s giving me a form of survivor’s guilt. It’s the people looking after me. And looking after me they are. Over the course of two weeks you become familiar with everyone, even with ever-changing 12-hour shifts of day teams and night teams. One even joked this morning “You still here?!”, which despite its relative inappropriateness, was the kind of levity I appreciate (especially as my now-tired joke with anyone who’ll listen is that if I remain here any longer I’m going to redecorate). Each and every one who has been looking after me has been a hero. God knows what they must think of my folly, after the year they’ve had. 

We all know how these people have been, literally, on the frontline of the pandemic. The roll call of casualties, drawn across the spectrum of NHS functions has been nothing short of appalling. In January, the Mirror newspaper reported that some 52,000 NHS staff were off sick with the coronavirus and that 850 healthcare workers in the UK were thought to have died from COVID-19 between March and December last year. The attrition rate was horrendous. Just as a war cemetery depicts a given battle, with captains and corporals lying alongside each other in the date order in which they were felled, the rollcall of NHS staff of every rank makes the organisation look like unwitting cannon fodder as the virus raged through corridors unabated. While the health service didn’t completely collapse under the strain of admissions at the pandemic’s peak - the feared premise for lockdown to begin with - it was close. What the people who’ve been looking after me have been through, I can't begin to imagine. Wards normally devoted to routine conditions were effectively turned into field hospitals. Staff were redeployed to cope, regardless of their area of specialist expertise. Doctors, surgeons and nurses of every level of experience and capability were retasked with working the wards just to cope. It’s almost hard to fully understand just how a health system that was struggling before COVID-19 has coped under it. 

So why did they allow themselves to succumb? Simple: dedication. The same dedication that has been treating me. There’s nothing altruistic about this. To a worker, the nurses and doctors have clocked on for their shifts because there’s been a job to do that they’ve been highly trained for. While my foot was under the knife, I had an enjoyable chat with the young doctor monitoring my vital signs. He told me how at the peak of battle, he was put on general clinical duties within the hospital, and rather than finding it a chore - even though it was - actually found it quite rewarding. He said that while he might have specialised in orthopaedic surgery, he was still a doctor, he still had invested in an education that could be reapplied. He wasn't alone: no matter what your area of expertise was, if you had a medical degree you were put to good use triaging the COVID-sick as they came in. 

My admiration was undimmed before, but having been in the NHS's midst now for a while my admiration has only been emboldened. The NHS must never be a political football. It must never be treated as a matter of convenient doctrine. It’s birth, on 5th July 1948, almost three years into the austerity of post-war Britain, instigated an institution like no other in the world. Yes, it may be flawed; yes, there will be inefficiencies as there will be in any public body of its size and scale. But what it delivers, the innovations that it relentlessly applies, and the supreme dedication that its chronically underpaid and, invariably, under-appreciated staff deliver is something to truly behold. 

When I’m eventually discharged I will continue for a while as an outpatient. At a time when there is much to gripe about in our country - our economy, our politicians, choose your target - we should never take for granted, nor fail to appreciate what the National Health Service represents: one of the best, if not the best things about Britain.