I have many worries but paying for care is not one of them. I am so lucky to be treated in the NHS As a consultant vascular and general surgeon, I am always busy. I’m used to long hours but have never been so exhausted as now. I’ve finished late and as I walk to my car on a dark October night I feel unbalanced, especially in my trademark high heels. Maybe I have just got to the age when I need to wear flats. My trainee comments that I am walking like I am drunk. Alarm bells start to ring. I have felt unbalanced before and have had the odd headache but for someone else to notice suggests something is wrong. My medical school lecture on brain tumours comes to mind. It is probably just dizziness or a leftover from my recent awful cold but it is not getting better, rather my symptoms are worse. I visit the neurology clinic in the morning and explain my worst fears: “I think I have a brain tumour”. I have headaches and I report my right eye feels dry. The neurologist reassures me but arranges a scan. I have one and realise that as they need a second scan with contrast, they must have found something. I am a professional but in those few minutes I become a worried patient. I think the worst: what type of brain tumour, how large and where is it? The neurologist explains the scan findings. They have found something. There is a 3cm mass in my cerebellum compressing my brain. She explains that I have an acoustic neuroma, a benign brain tumour that is causing the dizziness. Acoustic neuromas grow on the nerve used for hearing and balance and cause problems such as hearing loss and unsteadiness. I am sure my hearing is normal but the tumour has grown in such a way to cause imbalance. I cry. The neurologist explains that I will need to see a neurosurgeon and their team to decide how to proceed. Within two days, I am referred locally. The consultant surgeon tells me I need surgery, there is no other choice. The tumour is too big to be treated with radiotherapy or to plan a wait and watch policy. He explains the post-operative course patiently as he understands the impact on my professional life. I will need three months away from work. Immediately I think of all the roles I fill and how many projects need to be completed. I will lose my hearing. This was expected and I feel I can cope with this. I will have to learn to walk again as my balance will be affected. I am sure I can manage this. I perform amputations for patients who have serious diabetic foot complications or a poor blood supply that cannot be improved. These patients strive hard and walk again using a prosthesis. I can do the same and I am lucky as I will have both my legs. I will feel sick after the surgery and of course I will experience headaches and pain. Then the explanation gets worse. There is a 20% risk of damage to the nerve supplying my face movement and a risk of damage to the sensation of my face. I panic. I am at the frontline of patient care, how would I manage that if my face was distorted? How would patients react to me? Would I be able to continue the job I love in the NHS? I listen and make my decision: I am not having surgery, there must be other ways. I cannot risk my career or accept the complications associated with surgery. Perhaps radiotherapy might be better or perhaps I’ll just wait for it to settle. I become an expert on acoustic neuromas overnight. I read all the literature. I find little solace. I decide to seek a second opinion. I sit near my surgeon, close to him without the desk as an artificial barrier between us. He sets the scene and immediately talks about my worst fears. How does he know? He must do this every day but for me the discussion feels personal. He has pre-empted many of my concerns and treats me like a patient but with an understanding that I am a colleague. He does not assume I know everything and explains the rationale with diagrams. I love using diagrams to explain diagnoses and treatments to my patients and therefore find this a very comforting gesture. I explain my own fears, I would struggle with a facial nerve palsy; he listens and discusses all options with me. Slowly it dawns on me, the second opinion is no different to the first. I have no choice but surgery. I am normally in control of management decisions and giving that control away for my own care is frightening. I must tell my family, friends and colleagues but I do not want to be treated as if I am sick. I want to remain independent and I know I won’t be in the short term. The one worry I have not had to face is the cost of care. I cannot imagine having to ensure that I can pay before taking advice or letting the cost of care drive my decision making. I am so lucky. I am being treated in the NHS Source
