Homage to Gaia (58 page)

We were in the midst of ‘industrial action' by the trade union, NUPE (the National Union of Public Employees). The union had recruited the West Indian hospital staff, including the ward maids, whose normal task would have been to keep the ward clean, and, by their cheerfulness, raise the spirits, and hasten the recovery of the patients. But they were now going slow, and were far from cheerful. NUPE—or as it is now called Unison—claimed to take great care to ensure that if there was industrial action patients would not be harmed. My experience in Lonsdale ward showed me how false was this claim. At every level, from our comfort and feeling of security, to the risk to our lives, we were threatened. It was more than just a strike, because at that time, Brixton had passed through a series of racial disturbances. I do believe that the West Indians had real cause for complaint, but to make the ward of a hospital their battleground was no way to gain our sympathy. So blinded were these union members by their grievances that they seemed to see us, the mostly white patients, as enemies. It was an outrage—the ward sisters, who ordinarily would have kept order and an environment suitable for recovery, were wholly frustrated. The least reprimand to one of the ward maids brought the threat of an all-out strike. This blackmail did not merely undermine their authority; it also put our lives at risk.

The ward had two lavatories and, soon after I could move, I asked to use them and not the bedpan. When I reached these lavatories, dragging my intravenous drip and catheter bag behind me, I was sickened to see the floors of both smeared with faeces. On the door, where once there had been a hook to hang one's dressing gown, there were just the screw holes. It had been broken off and never replaced. My long experience researching problems of hospital cross-infection had never shown me anything so gross as this—not even in the Second World War. I felt that I was a casualty in a battlefield hospital somewhere in the developing world, and in many ways, this was the truth of it. I began to think that the greatest threat to our health service came not from the political right or from private medicine, but
from the brutal abuse of trade-union power, perversely the power that enabled socialism itself.

My mother's family proudly remembered their famous relative, Samuel March. For a time, he was Mayor of Poplar, an activist who spent time in prison for a political offence. He was an early Labour Member of Parliament, and an early leader of what is now the Transport and General Workers Union. In those days, we needed the trade unions to fight the gross exploitation that was part, but not all, of Victorian industry. Great-uncle Sam March represented Poplar, and many of his constituents were Irish Dockers who suffered privation and appalling conditions of work. With such a background, I had always voted Labour. The events in Lonsdale Ward were to shake that simple loyalty.

The fourth day after surgery was Christmas. We were delighted by a traditional Christmas dinner, enhanced by having one of our surgeons personally carve the turkey and serve the meat to us, on a table set up in the ward. We were by then strong enough to sit at the table to enjoy our meal and a glass of wine. As the days went by, the reaction to the withdrawal of the opiates set in, and by the sixth day several of us behaved as if we were unhinged. We became exquisitely sensitive to the squalor of the ward, and the pervasive smell of a sticky disinfectant fluid spread on every horizontal surface. At about this time, a West Indian maintenance man came to replace a bulb in the reading lamp of a patient near me. He came, examined the bulb and pronounced it broken; he went away and did not return with a new bulb for about two hours. He looked at it and the lamp and said, ‘I will have to fetch my ladder, to put it in.' Another two hours passed and he returned with the ladder but without the bulb. He went away and I do not think he ever returned. By now, we realized that we had watched a particularly creative act of ‘going slow', the tactic unions use to force a bad firm to recognize their call for more wages or better conditions. Suitable in that context, but what possible justification did it have in our ward? We are foolish to allow our public servants, secure in their jobs, to behave in this uncivilized way. Surely crude and brutal ‘industrial action' is no way to meet their genuine needs.

I have reason to believe that the ‘go slow' at King's has harmed me grievously. I have been unable to uncover the whole story as, quite naturally, the hospital authorities are not happy about telling me everything that happened on the evening of 21 December 1982. I can well understand their caution: in these litigious times, there is too
great a risk that their revelations might serve as the basis of a lawsuit. The facts, as I understand them, are these: when the time came for my surgery, the instruments needed were not available because of ‘industrial action'. The surgical team therefore chose—quite reasonably—to proceed, after sterilizing the instruments used in the previous operation. The method used was to place them in an autoclave chamber and expose them to the gas, ethylene oxide, which is a powerful and effective method for sterilizing metal scalpels and forceps. The gas can also sterilize catheters and flexible airways but, unfortunately, unlike metal, the elastomers used to make catheters absorb the gas, and if the catheter is used soon after sterilizing this way, it slowly releases its burden of toxic and carcinogenic ethylene oxide into whatever tissue it touches. For me this was my urethra. The sequence of events may not have been exactly as described, but there is no doubt about the damage done, and had the hospital been running normally and free of industrial action there would have been no need for the emergency sterilization of equipment at the start of a major operation. I am telling this story because of my anger at the impropriety of overt trade-union activity in the health service and its hospitals. Accidents rarely come from a single cause; they are usually the consequence of a cascade of errors that culminates in disaster. Poor maintenance is a frequent cause of errors that lead to accidents—the chemical and aircraft industries know this well. Accidents in hospitals, I suspect, also arise through a sequence of errors in which poor maintenance plays a part. Because of this, the claim by health-service unions that their actions will not affect patients is cynical and disingenuous. In case you think this is just the complaint of a single patient, I know that I was not the only one in the hospital to suffer from the union's industrial action. However, the surgery itself was good, and by the ninth day, I was walking around the hospital, climbing stairs, and delighting in the absence of angina. On the tenth day, I walked again with my small bag up the stairs to the exit from King's College Hospital to meet my friendly car driver who was to take me the 250 miles to Coombe Mill.

My homecoming on 1 January 1983 marked the start of a new way of life—the feverish days of 1982 were over. Helen was joyous to have me home, and the first part of January was an unusually happy time. I soon found that I could do the five-mile round walk briskly and without pain or breathlessness, but in mid-January I grew aware that I had not yet escaped the consequences of ‘industrial action' at
King's College Hospital: an abscess as large as an egg grew on the wound scar that ran down my chest. My physician arranged for me to have it drained at the North Devon Regional Hospital in Barnstaple and, in the mildly euphoric state engendered by the success of my bypass operation, I took this in my stride as a minor affair, and so it was. By the beginning of February, something more serious began to obtrude; I found that it took minutes to empty my bladder. I returned to Barnstaple hospital again for day surgery to enlarge what was assumed to be a small stricture—a side effect of the heart surgery—and I was not apprehensive, but when I came round from the anaesthetic I was aware of a great deal of pain. I imagined it was to be expected—the penis is a sensitive part, that is half its use. I thought it would soon pass, but it grew worse. A nurse appeared after an hour or so and gave me some tea to drink and said, ‘Try to pass water as soon as you can.' I did try but nothing happened. I recall little from then until I found myself on a bed in a ward of the hospital in severe pain and the discomfort of retention. I tried to pee but it would not flow, and by 7 o'clock that evening, I was feeling desperate. I remember crouching on the floor next to my bed to ease the pain.

After a while, the nursing staff noticed my misery and fetched a pair of interns. I should add that I had not yet realized the necessity of whingeing to get attention. As an Englishman, I suffered unnecessarily because of my stiff upper lip. A white woman doctor and a black surgeon came to my help. The woman gave me a sizeable injection of intravenous Valium, but it was without effect on the discomfort and pain. They then tried unsuccessfully to pass a catheter into my bladder. The Valium must have been working to some extent, because the pain of doing this was not as great as I thought it would be. The young surgeon was most solicitous and said, ‘I'll give you an operation to fit a supra-pubic catheter as soon as I can, but you might have to wait another two hours, because I've two operations now to do, and one of them is an emergency appendectomy that cannot wait.' They left me dazed, in pain and profound discomfort from an ever-extending bladder. Well meant but foolish offers of more tea from nurses I turned aside. Never can I recall time passing so slowly, and it was not until midnight that relief came. They took me to the operating theatre and the surgeon performed his work using a local anaesthetic. It seemed to take an age to cut through the layers of tissue over the bladder but at last he was through, cut a slit in the bladder wall, and inserted the catheter: the relief was incredible. In some ways,
I found the discomfort of retention worse than pain. I remember thanking this young man profusely and then falling into a deep sleep and not awakening until the following morning.

I was now in King George the Fifth ward. A modern form of open ward consisting of bays containing about six beds, three on each side, and dispersed along a corridor. It was better than single rooms, but nothing like the friendly atmosphere of the old Nightingale wards. Architects had fiddled again, and fiddled to no good, with Florence Nightingale's design. I now suffered no pain or discomfort, and the supra-pubic catheter, with its pipe emerging from my abdomen, was doing its job. A nurse came and attached a leg-bag for me so that I could walk around. Helen and Margaret soon appeared, bringing with them my dressing gown, slippers, and razor. As soon as I had changed from the gown lent to me on arrival, I went with them to the canteen, where I tried to tell them what had happened, but did not really know myself. Later that day I saw the surgeon responsible for the disastrous dilatation and asked, ‘Whatever went wrong?' ‘Nothing went wrong,' he said. ‘You had the worst stricture I have ever seen. It went all the way from the glans to the neck of the bladder. I've no idea what caused it but you must have had a roaring urethritis.' Oddly, it did not occur to me then to connect this disaster with the catheter used at King's.

In a few days, the oedema surrounding my urethra subsided, and I found that I could pee at a reasonable rate. The supra-pubic catheter was removed, and I prepared to go home, thinking, ‘This has been rough but now I can resume life again.' The surgeon warned me that it would close up and would need dilating again, but the after effects would not be so severe as those I had just experienced. Within three weeks, the flow declined again to a few cubic centimetres a second, and I was back at Barnstaple. Sure enough, the second time was not as bad as the first and after an hour or so I could pee, although painfully. Every three weeks I was back in Barnstaple for more dilatation, but now after each of them the pain was worse and more prolonged. Margaret Sargent came to collect me from the hospital, and each time the sixty-mile journey over country roads was agonizing. I seemed to be taking antibiotics and codeine painkillers almost continuously. The year before I had almost enjoyed the dreamy but quite bearable threat of imminent death, but I now faced a painful decline that filled me with despair. I knew that I could not go on like this, but even so, I kept up my daily walks, no matter how hard they were to do.

In between the painful excursions to Barnstaple, business kept on as usual. I travelled to London for meetings, and to America to maintain my obligations to my customers there. In April 1983 I visited New York at the invitation of the United Nations University and saw my friend, Walter Shearer, at the United Nations Building. There we discussed the plan for a meeting the following summer in Corsica. I vividly remember having to give a lecture on Gaia to the Sigma Xi Society, of which I am a member, in Washington. I was in severe pain during the introduction by the chairman of the meeting. When I rose to cross the floor, it intensified, and I fainted and fell on the floor. Within moments, I had staggered to my feet, and to the lectern. The audience seemed to think I had merely tripped on a cable. I looked at my lecture notes and saw only a dark blur with no words distinguishable. Somehow, on automatic pilot, I started my lecture, and after a few minutes could see my notes again. It seemed to go all right—audiences could be most tolerant. No one commented on the fraught beginning.

Life from February until June 1983 was a nightmare of pain and despair. What I had hoped would be a cure at King's College Hospital seemed to have worsened my affairs. Rescue came in a letter from a past colleague of my days with the Medical Research Council, David Pegg. He wrote asking if I would give an after-dinner speech at a conference in King's College Cambridge on cryobiology. It seemed an occasion on which I could reminisce and tell stories about the Mill Hill Institute in the 1950s; it also gave me the opportunity to cry for help. I replied, saying that I would love to come, but warned that, because of my frequent visits to Barnstaple, I might not be in a position to do so. I asked him to recommend a first-rate urologist who might be able to cure my affliction. He replied promptly, recommending the surgeon Michael Bishop, who operated from the City Hospital in Nottingham. The next day I had a sympathetic letter from Mr Bishop, inviting me to go there to have the next operation performed by him in July.