Carpe Diem

Lumps, bumps and safe landings

As I begin the journey through my seventies, certain things become obvious. I am in what one friend calls “the drop zone”, and another “sniper alley”, and have been for a few years. The bullet-proof, if somewhat corpulent body of years past shows significant signs of internal and external wear and tear. Hair thins and whitens, minor niggles become medical issues. Friends demonstrate worrying signs of imminent mortality. Accidents seem to happen more frequently, and an optimistic outlook and sunny disposition is no protection when the medical shit begins to fly. The only protection you have - apart from staying as fit as possible (of which more later) - is a fully functioning public health service, and I’m very pleased to be able to report that New Zealand still has one - despite the efforts of the current government to cut it to the bone and beyond.

The story - for this is one - begins a couple of years ago when, after my first and so far only encounter with covid, I noticed a change in my neck. I had just recorded a podcast (with video) about truffles, and watching the replay I became transfixed by an obvious lump on the left of my neck. I did what any man does; ignored it and hoped it would go away. Unsurprisingly, that didn’t work.

A few months later I started to take my non-transient lump more seriously and took it to the local medical centre. This eventually led me to a specialist, two biopsies, and placement on the operating list for a hemithyroidectomy - a fairly straightforward operation to remove the lumpy half of my thyroid gland. There was a small, but not insignificant risk that the nodule might be cancerous, so I hoped it wouldn’t take too long to get done.

It took a year. I was warned that the waiting list for surgery was long, but in fairness to the system I had several last minute offers of operations - including one when I was in London - that I had to turn down. Finally, I was given a date of Tuesday, December 10^th. It would be a relatively short operation at St George’s Hospital in Christchurch, followed by an overnight stay. If all went well, I would be back on the farm on the 11^th. I’d ordered muesli for breakfast.

All did not go well.

I went to sleep in St George’s on Tuesday afternoon, but woke up in the intensive care unit at Christchurch Hospital on Thursday afternoon with Camille holding my hand, looking relieved. I was groggy, with a sore throat, a drain in the scar across my neck, a catheter dangling from my nether regions, and no idea what was going on. It took me a couple of days to piece it all together in my own mind - prolonged anaesthesia does not improve mental acuity. It was hard to concentrate on anything more demanding than photos on Instagram, and it was the weekend before I could read anything more complex than a social media post. Visits from the anaesthetist, the surgical team and my family eventually filled in the rather large gap in my timeline.

Fifteen minutes into the operation, an allergic reaction to something - probably the muscle relaxant rocuronium - caused a full-on anaphylactic episode; swollen tongue, the works. They got me stable, decided to finish the thyroidectomy, and then I was shipped off to the ICU at the main Christchurch hospital to recover. I was sedated and intubated until the swelling of my tongue and throat subsided enough to allow me to breathe unaided, and then I was woken up. It may have something to do with the drugs, but I’ve never seen so many beautiful nurses before.

I spent the next four days recovering on a general ward. Gradually bits of me were unplugged, the drain removed, and I could shower. The first night I slept poorly, but had some of the most vivid and colourful dreams I can ever recall. Strange, Dune-like landscapes, wading through deep sand trying to find a way into a locked office building; standing outside our farm as military trains ran past, and then being unable to get down the road because of a huge pile of discarded jeeps and tanks; walking around our local town transmuted into a run-down alpine village; dreaming about sleeping and dreaming in a recursive loop. Not exactly nightmares, but after nearly three days without normal sleep, my brain was obviously desperate to catch up on REM sleep, and had a lot to process.

My recovery went well. I had very little pain beyond a sore throat - two days with a tube down your throat will do that to you - and I was being fed intravenous antibiotics. A blood test post-op had turned up evidence of a possible Staphlococcus aureus infection, and the infection control team were not about to take any risks. I was given an echocardiogram to make sure the bug wasn’t causing any heart damage, and fitted with a PICC (Peripherally Inserted Central Catheter) line from my arm to my heart to handle a couple of weeks of infusions of antibiotic.

One small irritant: I’ve spent a lot of time riding bikes over the last 15 years. Over the last two or three I’ve increased the distance I ride in a fairly successful attempt to improve my fitness metrics - to give me the best possible chance of a healthy old age. The end result is that I have an estimated VO2max (a measure of how efficient you are at processing oxygen during exercise) in the top range for my age, the equivalent of a fit 40 to 50-year old, with a resting heart rate of around 50 or a bit below. If I don’t get three or four good bike rides every week, I get antsy. I also aim to get to the gym twice a week, to maintain and improve my functional strength¹.

In hospital you have your blood pressure and heart rate monitored several times a day, and in medical terms, a resting heart rate below 60 is called bradycardia. If you’re getting old and not fit, it’s bad news. Every time a nursing shift changed I had to explain again (and again) that for me, a resting heart rate of 48 was not unusual. Once or twice I had to pull out my iPhone and flick back through weeks of heart rate data from my Apple Watch to prove my point. According to my release notes, I’m “bradycardic, but asymptomatic”. I’d rather they’d said “cyclist”.

My overall fitness played an important part in my ability to cope with the aftermath of the operation, and made my recovery a lot more straightforward. In effect, I was trying to get over three things - the thyroid operation and managing my metabolism with only half a thyroid gland, a prolonged spell of anaesthesia, and a potential S aureus infection. All three were made easier by the strength and endurance I’d built up in the saddle. That is why I gave the young doctors briefing me before discharging me from hospital a stern lecture on the merits of being cyclists. I hope they listened.

When I was allowed home, I was definitely still groggy, and not ready to resume normal life, let alone exercise. The PICC line, with its attached bottle of antibiotic strapped to my waist, was an inconvenience and a limiting factor. Our wonderful district nurses made daily visits - including on Christmas Day - to change bottles. Christmas was a lot quieter than planned, but the PICC was removed on the 27^th, and the next day I was on the bike and feeling a lot better about life.

At the time of writing I’m waiting to hear from the allergy clinic - a nine month waiting list, apparently - but (after a nervous wait) discovered my nodules showed no signs of cancer. Meanwhile, my bike times are more or less back where they were pre-op, and what’s left of my thyroid seems to have picked up the slack and kept my metabolism ticking over. But there are two lessons I’d like to draw from my experience.

The first is that the NZ health service is a national taonga (treasure) and should be treated as such by politicians of all stripes. The people working in the system are incredible - from the surgeons and anaesthetists, to nurses and technicians, the staff feeding and watering the sometimes grumpy patients and the district nurses who deal with remote rural patients with skill, care and compassion. None of this cost me a penny (apart from the taxes I happily contribute to the greater good), and virtually every aspect of it is underfunded to some extent.

The health service is critical to the well-being of all New Zealanders, and a key determinant of the quality of life we all experience. It is also one of the great social achievements of the last 100 years, and should be defended against attempts to restrict or privatise the services it provides. It is not a cost to society, it is an enabler of growth and social cohesion. With an ageing population making greater demands on its services, and substantial inequities in outcome between different groups, we need much greater investment in preventative care as well as having modern ambulances at the bottom of cliffs.

Finally: carpe diem. Something of a truism, but there’s nothing like a medical emergency to give the notion of seizing the day some teeth. It acquires urgency with age, of course, but my run-in with unforeseen and unforeseeable medical emergencies has certainly made me reconsider the way I look at the future. There’s little point in putting something off until next month or next year if bad luck means you never get that far. You might say I’ve finally grown up…

1. Broadly speaking, I try to follow the advice given in Peter Attia’s book Outlive. I have been known to gift copies to friends. There is also an excellent overview of exercise and its benefits by Rhonda Patrick here (pdf)