The 4th edition of my Seapower book has just come out. It's an update and a revision and
has some new material later reinforced by the visit to the library of Salisbury
cathedral mentioned in an earlier blog. It's a bit longer than the previous
version because, try as I might, I couldn't abandon as much material as I took in for new. I'll be interested to see whether aficionados of maritime strategy will
spot the tiny Chinese ensign on the mast of the ship on the cover and, I hope,
get the hidden message. But my initial reaction to its appearance had nothing
to do with any of that.
This was because under the pressure of a tight
deadline from the publishers (who were nonetheless very sympathetic) the book
was completed during those very difficult final months of last year when Cherry
was slowly failing. I wrote the book's dedication to her knowing full well she
would be unlikely ever to see it in print. I didn't show the draft to her,
thinking she was well aware of what I felt and that it would upset her. Ever
since, I have wondered whether I took the right decision. It's one of those
countless things I could have said or done, but now can't, that contributes to
the guilt I feel as I survive and she doesn't.
It's a natural reaction I suppose - and so is the
sense of anger bubbling away underneath. It all seems so unfair to me, as I'm
sure it does to everyone else in my situation. Inevitably, when bad things
happen there's a tendency to find someone or something to blame. In Cherry's case, it's hard to avoid
focussing on the apparent failures of the many health professionals in
Singapore and the UK that were involved.
The full story of this will have to wait until I
feel able to go through my diary (which at the moment I couldn't face) but
briefly things started to go wrong on Cherry's last birthday at a very
enjoyable conference-trip to Sri Lanka in November 2016, when she lost her
appetite at our birthday celebration by the sea and nearly threw up on the
flight back to Singapore. We thought she might have picked up a bug of some
sort and so a couple of weeks later as she was still feeling below par she saw
her GP back in the UK. On the second morning of a Christmas trip to London when
we went up to see some exhibitions and stayed, for convenience, at the Paddington Hilton, Cherry frightened
the life out of me by suddenly saying she 'felt funny' and then passed out
rolling onto the floor in a dead faint. She came to five minutes later just as
I was calling for a doctor. We abandoned the rest of the trip and came home.
Her blood tests were inconclusive and didn't indicate anything very much so we went back to Singapore, hoping for the
best.
Back in Singapore, Cherry just felt marginally
under the weather, running low temperatures and with less energy than usual
though, as usual, she made the most of what she had. She was operating at about
80 per cent I would say. However on Valentine day, she rang me to say she
suddenly felt much better. This seemed wonderful, but sadly, it didn’t last. The lady doctor on
campus wasn’t very sympathetic initially, dismissing her symptoms as mild to
imaginary, but despite that in early February sent her to a consultant who did
more blood tests and then they dramatically pulled her into the brand-new all
singing, all-dancing Ng Teng Fong Community Hospital. The Singapore system is
very good, its staff generally trained in the UK and US. The hospital even has a shopping centre in the basement
which patients, in their pink or blue pyjamas can use as well as the public.
Initial thoughts were an abscess on the liver. The first really bad moment was
when Cherry was wheeled back to the ward, telling me tearfully as I met her in
the corridor, that they found they couldn’t drain it, and so the prognosis
seemed wrong. She realised this at the
time, seeing the look of surprised dismay on the doctor with a tube trying to
do it down at her side.
Now that cancer seemed increasingly likely, they
rapidly did more tests. One day I went in and Cherry cheerfully greeted me from
the bathroom. So I was shocked when she
told me that the Consultant had just confirmed that it was cancer. I remember
putting my arm around her, and her saying something like – ‘No, don’t I’ll fall
to pieces…’ That set the tone for the rest of her time. Superficially we treated everything as
matter-of-factly as we could. Shortly
afterwards we had a long discharge talk with the Consultant who showed us all
the scans, saying that they showed the disease was actually gall bladder cancer
that had spread to the liver in a complicated way. He said we should get back
to the UK as soon as we conveniently could, business class he recommended, and
gave us a package of documents and a CD of the scans for the further treatment.
Long term low fever, he said, was a cancer indicator. His prognosis was that
Cherry had ‘good prospects of long-term survival.’ Cherry reminded him of her
congenital heart condition and he admitted that was ‘a complication.’
Once back in the UK, we swung into immediate
action and rapidly found that Cherry’s heart condition was much more than ‘a
complication.’ Also, when the specialist first felt the tumour I could see from
the expression on his face that he was already very concerned. That was bad
moment for me, which Cherry of course didn’t see. All the same through March
and into April we found everyone first exploring her heart condition and then
saying that this would have to be treated first - and of course recovered from.
The gall bladder/liver op would be like ‘running the marathon’ they said, and
she would probably not survive it, otherwise. We were both totally frustrated
by this knowing that all the time the cancer could well be spreading. ‘I’m
prepared to take the risk of an op’ Cherry said, but we were assured that no
surgeon in the UK would perform it without the heart condition being resolved
first. We even got a second opinion from another cardiologist, without effect
They set a heart repair operation in train in
Bristol, but on April 25th, we heard that the latest scan showed that after six to
seven weeks of fiddling around the cancer had now spread to the stomach wall. This
being the case, there was no point in proceeding with any of it, and the view
was that Cherry was best advised to make
the most of the time she had left. This was the worst moment so far. The
journey home from Bristol that night in the rain and dark was ghastly.
Thereafter, under yet another consultant, the
accent was on palliative care – making the available time as long and as
enjoyable as possible. Part of this was a fairly mild form of chemo-therapy,
administered by some really nice people at the Bath Clinic. Cherry even bought
a wig, only to discover than it wouldn’t be necessary. Bad side effects were
very few but after an encouraging start, the course was stopped when it became
clear that it wasn’t arresting the disease. We learned afterwards that palliative chemotherapy in this case only works for one in three people.
And so in all this where was the fault ? Of course, for everyone it was an uphill
battle anyway since gall bladder cancer is difficult to detect in the early
stages when more easily managed. And from the start the way it had attacked the liver meant surgery would be 'challenging.' But it’s hard not to conclude that the real
problem was the heart condition, which added complexity and cost several weeks
of potentially valuable time. Cherry had always known, but not worried, about
this condition which was inherited from her mother- who suffered no
consequences and died at the ripe old
age of 92. Her heart was supposed to be
regularly checked by the NHS but this somehow fell by the wayside many years ago and it
was only when she was being checked for something else towards the end of 2015,
that we discovered that the situation had deteriorated and become ‘acute.’
Shortly afterwards in 2016 this was then checked
at the hospital in Salisbury. Even then, the consultant there said there was nothing to
worry about and that they would only do something if and when the condition
became ‘symptomatic’ and Cherry still had no symptoms at all from this
condition and in fact never did. They
said she would probably need surgery in about five years time. Six monthly
check-ups were recommended and the next showed no change but we heard no more after
this. In retrospect, we should have been more proactive about this in early
2017. So if there was a fault in all
this, it was both our letting the matter ride (and especially mine in making us so busy and
always rushing around) and partly the
minimalist policy at Salisbury in taking the relaxed position that it did –
none of us taking into account that though this wasn’t a serious issue in its
own right, it could really become so when combined with something else. On that
basis, a more proactive policy would surely have been better ? This point will
be made to Salisbury. The several weeks spent on further investigation when
back in the UK probably didn't help either. The cards were stacked against us,
one way and another.
Getting back to the original point about anger
management point, the uncertainty in all of this is I suppose one reason for
resigned acceptance of the situation as just bad luck rather than anyone’s
culpable fault – the sort of thing that could, and does, happen to anybody. The
gall bladder cancer could well have killed Cherry anyway.
The corrosive consequences of getting too bitter about all of this for enjoying
the remembrance of the much, much longer and happier past and making the most
of the present and the future is another reason for restraint, but that isn't
to say it's at all easy. I think about
this, and all of the 'if only's' nearly all the time. But I mustn't let it
poison things and so welcome distractions.
….Even bad ones ! Such as coming back very late one night
from a short trip to London to find an agonized message from Jenny the
cat-minder that Minnie was missing and had probably gone AWOL, two days before.
I searched all around the garden with a torch, and drove slowly around the
village with headlights full on fearful of finding a pathetic mangled little
brown bundle by the side of the road.
The following morning I did a repeat job in the daylight, with equal lack
of success. Unless she'd been carried off by a buzzard (something Cherry always
worried about as Minnie's so small) I couldn't work out what could have happened
to an old blind, deaf cat. So I phoned the vets. 'A small brown Burmese ?' they
said. 'We've got her !' I couldn't believe the first story, that she's been
picked up by an America tourist in the village of Horton, a mile away -and it
turned out a Dutch tourist had found her wandering around outside our gate and
thinking she might have been winged by a car took her to the nearest vet (which
happened to be ours) and offered to pay any medical expenses.
(That's another phone call to make). She
was totally unharmed and had been spoiled rotten by the nurses during her two day stay. She still
wants to go out in warmer weather and I have now a complicated system of closed
gates and chicken wire to confine her to the garden !
Other much more welcome distractions are continued
encounters with friends and family and
the highlight of this has to be our revisit to the SS Great Britain in Bristol
with Great Aunty Shelagh. They have a scheme where small people can climb the
rigging but it was unappealing in the rain of our last visit. This time the
weather was gorgeous and Barney and Martha scampered up the rigging and then
across to the ends of the yard-arm, high, high above our heads with the
fearless agility of young monkeys. I knew it was perfectly safe, but am not
amazing about heights, so taking pictures of them drove all other thoughts out
of my mind !
