Return of the Superbug

I received a call from the Marie Curie Hospice in Hampstead last Thursday, and was told that I no longer have MRSA. The news came as something of a relief, even though I have been functioning quite normally for the past few months, despite being infected with the “hospital superbug”. Indeed, I even took a certain mischievous pleasure recently in bringing a polite drinks party conversation about the awful dangers of hospitals to a stunned halt by announcing “I’ve got MRSA at the moment actually.” The looks of horror and disbelief that greeted my remark, not to mention the visible acts of recoil, were a perfect joy to behold.

Nevertheless, having now had MRSA on three separate occasions over the past five years, I’m not sorry to be pronounced “clean”. The infection has made my frequent visits to hospital significantly more vexing and complicated, and this recent bout of the disease also prevented me from paying my weekly visits to the hospice gym.

I originally caught MRSA during a five-month stay at the Royal Free Hospital in 2003. It did have serious consequences on that occasion as I was profoundly ill, and I certainly could have done without the bout of pneumonia that it precipitated. Relative to my other problems at the time, however, it was not a major concern, and when I was eventually discharged I had apparently been cured of the bug.

It was therefore mildly distressing to be told 18 months later, after a routine test following further surgery at the hospital, that I had acquired the infection once again. I began a new programme of treatment and testing, but whether I achieved three consecutive clear sets of swabs, which is the condition for being pronounced officially cured, remains unclear. I believe I did, but some of the nursing staff at the hospital were not convinced. The tests were so protractedly haphazard and the results buried so deep in my copious records on the hospital computer, that it proved impossible to prove either way. The staff simply couldn’t find all the relevant data.

Thinking myself to be “clean”, however, I was slightly dismayed and perplexed to be informed by one of the nurses at the hospice recently that I had MRSA yet again. Given that I had been back in the Royal Free for another operation earlier in the year though, and that I only seem to have to set foot in the place to contract the bug, I suppose I shouldn’t have been surprised. The wound from my surgery was still spotting blood more than six months on, and a swab taken from the site revealed that MRSA was the reason.

This time, however, I was in a much better context for having the problem dealt with. The staff at the hospice gave me a tube of cream to rub on the wound for 10 days, and then organized regular weekly swabs to see whether I still had the infection. Within a month I had achieved the magic figure of three clear tests and was told that was “clean”. Which only leaves me now to ponder the banal miracle by which a few smears of ointment have vanquished such a legendarily potent – or at least persistent – superbug.

The Future of Hospital Care

The gleaming, new University College Hospital in London is a state-of the art institution. It is equipped with all the latest medical hardware; the wards are discreetly secured from unwanted intruders; many of the phones have mobile handsets so that staff can take calls as they go about their other duties. Although when I took Anna there last week the revolving door at the rear entrance was broken and the visitors’ toilet on her ward was blocked, after two years of use the environment remains impressively clean and well-ordered, and the staff clearly take pride in the high-quality facilities that the hospital provides

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The sense of cutting-edge modernity also extends to the procedures for admitting and treating patients, all of which have a comparably streamlined efficiency. Anna was admitted at 7.30am on the day of her operation, having been trusted to stop eating and drinking as required and take her ”bowel prep” at home without supervision. She went initially not to the ward where she would stay, but to an Admissions Lounge. From here she was called into a bay where she changed and saw the relevant doctors and nurses for her pre-operative consultations and checks. Then, when they were ready for her in the operating theatre, she made her way on foot down to the third floor where she was received by the operating team.

The surgery – which proved quite complicated and lasted a couple of hours – was performed “key-hole” using cameras in tubes and laser scalpels. Afterwards she was taken to a ward on the 13th floor where she spent the night. The next day, just 24 hours after the operation, she was discharged and came home. Twenty-five years ago, the same operation (to remove an ovarian cyst) involved a large 12 centimetre cut across the abdomen, a week to 10 days in hospital, and several months of painful recovery. Last week Anna left hospital – admittedly still weak and sore – with just four tiny incisions, each sealed with a single stitch.

Medicine has made extraordinary progress in recent decades and continues to do so. The sleek briskness with which Anna’s surgery was accomplished reflects the pared-down and highly focussed institutions that hospitals are now becoming. Preparation and recuperation are made the patient’s responsibility, with the hospital offering fantastic treatment but limited care. The patient is not reduced to prostrate passivity the moment she enters the building, but remains independently mobile until almost on the operating table. Relations with the nursing staff are restricted as the stays are so brief, and different people are responsible for admission and after-care.

Although primarily cost-driven, in general these are welcome developments for the patient as well as the NHS budget. No one wants to stay in hospital longer than they have to, and the more patients are able to retain their autonomy the better. Based on our experience last week, however, I do have a couple of small caveats. Anna’s operation was scheduled to take place at 10.30am (she was second on the surgeon’s list for the day) and expected to last up to an hour. Allowing for some slippage and time spent in the recovery room after she came round from the anaesthetic, it therefore seemed reasonable to expect that she would be back on the ward by 2pm. When I rang then, however, she had not returned, and since the ward only deals with the patients after their surgery the staff could not tell me when she actually went to theatre, nor of the reasons for any possible delay. I remained relatively philosophical at this point, but when I rang the ward again at 3.30pm and Anna still wasn’t there I began to fear the worst and imagine dreadful complications on the operating table. In fact she’d been in the recovery room since well before 2pm waiting for a porter to take her upstairs. With patients walking themselves to theatre, fewer porters are available to transport them when assistance is required.

The half-hour of mental torture I endured before a nurse called to say she was all right (sadly we have much experience of things in hospitals not going to plan) is perhaps a small price to pay for having her home so swiftly later. But along with the problems faced by patients who do not have relatives to care for them at home when they are still very weak and needy after surgery; as well as the increased risks of MRSA and other hospital-acquired infections resulting from the system of “hot-bedding”, these are the downsides that need to addressed if the pattern of high turnover hospital care which undoubtedly represents the future is to prove a genuinely brave new world.

Rain or shine?

For the past seven years Anna, my wife, and I seem to have been like the pivoted figures on a Swiss cuckoo clock that move in and out to predict the weather. Shortly before Christmas 2000, at the age of 43, she was diagnosed with bowel cancer, and retreated into the shadow of illness while I “stayed out” as the public face of our marriage. Two years later, after surgery, chemotherapy, some unexplained side effects and living with an ileostomy, she seemed well on the path to recovery and ready to emerge from the gloom. She had an operation to re-connect her bowel which we hoped would mark her return to “normal” life.

But on the day following her surgery, I was diagnosed with a tumour in my own bowel. As she moved into the daylight, I retreated into the murky depths of the hospital world where I was destined to remain for an unexpectedly long time. A series of fairly catastrophic complications following surgery to remove the growth meant that I spent five months in hospital, and was left so depleted that I have spent almost five years recovering. Gradually, however, I have regained my strength and begun to resume a life that is about more than just hiding in the shadows at home. A book I have written about our experiences is due to be published in February, and I feel that at last I am starting to move back into the outside world with everyone else.

However, just as this is happening Anna is retreating once more into the shadows. This week she returns to hospital to have an ovarian cyst removed. So the countervailing pattern of our health continues, and we both find ourselves wondering when we might be able to spend some time “out” in the light together.

Still, one consolation is that this time it’s a different hospital – the gleaming glass and steel of the new University College tower in central London rather than the decaying concrete of the Royal Free in Hampstead. Since ancient times there has been a belief that life moves in seven-year cycles or “climacterics”. Perhaps this shift marks the start of a new seven-year cycle for us. If so, I only hope that it proves less gruelling and traumatic than the last.