Walk The Black Dog

Tag: Health

Sight
9th May, 2018

My Ninja 300 with Shane’s KTM 1290 Superduke, hours before I realised something was going very wrong with my vision.

I’d had a great couple of weeks. I’d just got back from visiting my Dad in Spain, along with my sister and beautiful niece (whom I had never met).

My sister and niece in Salobrena, Spain.

Yours truly in the hills of the Valle De Lecrin, Spain.

Spain had really inspired me this visit, and I dreamed of being able to take a bike to some of those pristine roads in Andalucia. Maybe next time.

A couple of weeks back home had seen the unusually long winter finally give way to rising temperatures, and the longer day allowed riding with friends after work again. I met my friend Shane for a short ride out and meal afterwards to see in the new riding season. During the ride I became aware of something in my left eye; what looked like a large vitreous floater; the kind of ghostly web that one sees occasionally, but much larger. Later on, in the pub, it came and went. I recall thinking that in a certain light it looked as if someone dressed in black was standing in my periphal vision. Due to a sense of optimism and well-entrenched morbid fear of hospitals and doctors, I thought I’d sleep on it and see how it was the next day. I wasn’t especially worried at this point.

Well, you’ve got some blood in there.

I awoke the next morning, and as soon as I sat upright that ghostly floater had turned an inky, impenetrable black. If you imagine your vision simplified as a rectangle, the bottom left-hand quarter was completely gone, replaced by a shapeless dark void.

Obviously this warranted a trip to the ER, which fortunately was just up the road. After handing over $100 (my ‘copay’) I was seen almost immediately. I described the symptoms and had to place a towel across my eyes, sit in the dark for ten minutes, and await the retinal scanner.

This machine, about the size of a coffee percolator, whirs and clicks as it locates your eye, then takes a picture. The ER doctor, a genial, middle-aged man looked at the images and said “Well, you’ve got some blood in there.” He suspected a ruptured blood vessel but was emphatic that he couldn’t say for sure. “We see about two per week. It’s common. Just not to you.” Fair enough, this was the ER, they were not going to be able to do much more. I needed to see a specialist at an eye centre as soon as possible, which as far as the ER were concerned meant the next day. There was no immediate urgency at this point; just a kind of calm hurry.

I called my local eye centre and was greeted by a receptionist with all the enthusiasm of someone that wished you were already dead. She told me they were full the next day, she’d have to ring around and would call me back (narrator: She didn’t call back). In the end I decided to call again and this time got someone useful that booked me in at a location the other side of town the next morning.

Sewickley, PA. 11th May, 1100hrs

Oh, that sounds like a retinal detachment. I hope not.

By this time, it had got worse. If I had to describe it in percentage terms, I’d estimate that around half the vision in the left eye was gone. I was scared, my family was scared, and I was starting to feel the onset of some panic. what could be wrong with me? Was it just my eye, or was something else happening?

The triage nurse was efficient, funny, and had a bedside manner that definitely needed a bit of work. She was also, as it turns out, right on the money. As I described my symptoms and she established what I could and couldn’t see by moving her hand around my field of vision, she casually uttered “Oh, that sounds like a retinal detachment. I hope not.” I could have lived without hearing the last sentence, but in hindsight (ho ho ho) I suspect she was referring to the fact this would not be a quick fix, rather than a gloomy prognosis. I was then left in the waiting room for an hour to ruminate (in an extremely anxious state, as you might expect) on what I’d been told. My eyes had some drops to dilate them, so I strained to read my phone (battery: 20%) to try and figure out just how much shit I was in, all the while sending nearly unintelligible text messages to my wife waiting outside with the kids.

Here’s Google’s card about retinal detachment, also featuring an image of an attractive woman in an art gallery, if you like that sort of thing.

When the wait was over and I saw the ophthalmologist, she was absolutely brilliant, warm-mannered and confident enough to greatly reassure me, and confirmed the triage nurse’s suspicions: It was a retinal detachment. I had three small tears at 9,11, and 2 o’clock, the most common form, known as rhegmatogenous detachment. Why? Age and plain bad luck (National Eye Institute, 2009). It would require an operation, and the Dr. told me she would be calling around to find a surgeon, and that I was not to eat anything as the operation might be that day. It was at this point I realised this was fairly serious, but the nurse and doctor confidently assured me I would be fine.

Word came I was to head to UPMC Mercy for surgery immediately. My wife, cool as a cucumber under what must have been enormously stressful conditions with two children to look after, took me there straight away.

UPMC Mercy, 1445hrs

You’re sitting there, minding your own business, and your retina just decides to go and detach itself.

I’d been lucky. I’d never had surgery. First stop was pre-surgery testing, which would typically involve obtaining blood for analysis, but actually turned out to be nothing but verifying paperwork in my case. No blood work required. Then I was admitted which was a matter of bagging my clothes and belongings, donning a gown and letting the scrubs-wearing ninjas get me ready. The surgeon and the fellow assisting him (both absolutely brilliant guys) came to see me, and he introduced himself with a jovial “You’re sitting there, minding your own business, and your retina just decides to go and detach itself.” They both examined my eye and told me the plan: A sclerical buckle, and probably a vitrectomy, due to the number of tear sites. A sclerical buckle is a small band that is fixed around the circumference of the eye like a belt (hence the name), the purpose of which is to apply pressure and help reattach the retina. Due to the offset of one of the tears, it probably would not be sufficient on its own, so a vitrectomy would be required. This involves draining the vitreous; the gel-like liquid inside the eye which maintains the spherical shape. Two precision techniques, laser and cryopexy are used to bond the torn areas of the retina to the wall of the eye. A gas is then used to form a bubble temporarily replacing the vitreous (National Eye Institute, 2009).

The surgeon marked his initials just above my left eyebrow. He described this was necessary to mitigate what is considered a ‘never event’. I’ll let you guess what…

I’d lost track of time at this point. My pupils were profoundly dilated. My watch had been removed and I could no longer read the clock above the nurse’s station. I was wheeled off to the anaesthesia area to prepare for the op. After a chat with the anaesthetist and a great deal of questions I was rolled into the operating room. An oxygen mask went on, the IV was started, and shortly after that, the lights went out.

I came round with no pain, intense nausea, and a big old bandage over my left eye. I had my face in a horseshoe-shaped pillow; until my follow up appointment the next day it would be necessary to keep my head down so the vitreous gas bubble would maintain positive pressure against the retina (Retinadoctor, 2018). The nurses were fantastic; one of them put something in my IV to relieve the nausea and it stopped in a snap. I couldn’t quite read the clock so I wasn’t sure if it was 915pm or 245am. It was the former, thankfully. My wife and kids charged into the recovery room and I felt a lot better.

The nurses helped me into my clothes and I was on my way, almost 12 hours after the day had started.

Aftermath

As I write this, it’s one week later. The follow up appointments revealed the surgery had been successful, now it was a matter of waiting for everything to heal. I feel pretty fortunate, as I never had much pain and the swelling (which was profoundly unpleasant) reduced rapidly. The vitreous gas bubble has shrunk as it is slowly absorbed and replaced by vitreous fluid; I can clearly see its circular shape in my eye. My sight isn’t quite there, it’s rather fuzzy, but it is improving, and it is all there. Best of all I have my peripheral vision back on the left side; I can drive again and I don’t feel dizzy anymore. There is a possibility of developing a cataract as a result of the vitrectomy (NCBI, 2014), which will require further surgery, but I’ll deal with that down the line. It beats being blind.

Some things fall into perspective at a time like this. One of them is, if you have a problem with your eye, don’t fuck about. I should have got it looked at immediately. It may not have changed the outcome, but it could have made things easier, and the extent of sight loss would not have been so great. I’m also fortunate to have such a great wife. We have no help, it’s just us and one or two friends. My wife looked after everything.

Life is short. One moment I was out having fun with a friend, suddenly I’m looking down the barrel of sight loss. Isn’t it amusing how many of these metaphors involve sight? I can tell you my sense of humour has had quite a workout in the last week.

I’m not dying (well, no faster than anyone else), I didn’t go blind, I’ll probably ride my bike this week. I’m pretty lucky, all told.
References
October 30, 2025
45 pt. 2

Eyes

By March my vision had continued to deteriorate to the extent I was becoming quite afraid. I made an emergency appointment to try and figure out what the hell was going on. I got a visit with an ophthalmologist that just happened to be a retinal specialist. She is French, had only been in the country a few months, as luck would have it, she was absolutely brilliant.

Generally speaking, nost of the senior female medical professionals seemed better listeners, and thus far I wasn’t convinced I was being heard. My wife describes this as a ‘specialist trap’, in other words if a doctor can’t diagnose a problem, they become indecisive and fail to advocate for the patient. You must see the right people. The right doctor at the right time makes all the difference. In the US system in particular, you must learn to stamp your feet. It’s very hard for me, as I am a classic British never-complain type, but when you’re really sick, that attitude can kill you.

This particular specialist took complete ownership of everything, and the more difficult the case got, the more interested she was.

I had some images taken of the eye, and she immediately identified inflammation of the nerve bundle behind the retina. This is generally known as posteriour uveitis, and it’s potentially very serious.

I had to undertake a lot of tests, includng tuberculosis and syphilis,(symptomatically similar) which amused me (yes it came back negative, you shits).

I ended up being prescribed an oral steroid (prednisone) in a shock dose, tapering off as time went on.

Steroids do odd things, it felt to me like I was highly caffeinated; I couldn’t sleep, put on a load of weight (yay!) but avoided going crazy -Apparently some people don’t respond well to them.

My vision stabilised, you wouldn’t call it good but at least it wasn’t getting worse. Uveitis is idiopathic in about half of the cases. In simple terms, it it not known what causes it. At this point it was purely hypothetical that my vision problems were linked to whatever was growing under my arm, immunology is complicated and requires highly specialised domain knowledge, there isn’t a magical test for it. The test is basically ruling out everything else.

Tumour won’t wait

The mass under my arm was no longer leaking, had fully re-accumulated, and was now starting to press on surrounding tissue, which caused pain. Around 1am on the 3rd of Aoril, I realised I could no longer sleep. Heat, painkillers and and ice-packs did nothing. I remember sitting on the bed in front of the wardrobe mirror thinking that I have to do something.

My wife had a continuing concern that it might burst, which could be life-threatening. My plan was to go to the ER, perhaps they could drain it, or at least get me some pain relief.

The emergency room reception wasn’t busy, a TV played one of house-hunting shows where a couple have an incredible budget. It was set in Fareham, just a few miles from my previous home, which made me laugh at least. I got triaged quickly. The feeling of the nurses – rarely hesitant to give an opinion – was that this thing needed to be out. No shit. A young doctor told me she couldn’t do anything invasive as if it was potentially malignant as that could be harmful. so, no drain. In the meantime she saw me wincing with pain and suggested an analgesic. I got a long lecture about opioids “You’ve seen the news, right?” And then they injected something with a long name into my IV

It felt a bit like the drop off the lift-hill on a rollercoaster, I actually held on to the sides of the bed, I felt a kick of nausea, thought I might throw up, then it passed. I was now, to use the medical term, as high as fuck.

The doctor got on the phone to the surgeon (I think it was 3am) and got it done – I would be operated on the next day. My bed was moved to a remote end of the ER and I entertained myself sending Beavis and Butthead gifs to my sister.

I don’t really know why, when you’re stoned everything is funny. It had to bag up my clothes and belongings and put on a gown.

.

Dark, dreamless sleep

I got visited by the anaesthetist, who explained that I would be asleep through it all, and a reflexologist, as the surgeon was concerned my nerves were getting damaged by the tumour, but this was luckily not the case.

My abiding memory of ‘serious hospital stuff’ is the flourescent lighting scrolling overhead as you are moved on a stretcher,that and the smell of alcohol swabs and the chirp of ringing telephones. The operating room actually resembles a hotel kitchen, lots of stainless steel, aluminium, and dark tiling. Only the huge overhead lights set it apart, and large pieces of equioment that go ‘beep’. I had to move laterally onto the OR bed and had my inflatable stockings switched on, which feel a bit like a python constricting around your shins. That’s all I remember

Waking up from a general anaesthetic is abrupt, it sounds like people are shouting.You wake up with a start, It’s such a deep sleep. I wasn’t aware of any pain, but my armpit felt like it was completely gone, which was weird but also a relief. My treat was a cup of crushed ice. I hadn’t eaten in about 17hrs.

I spent a night in the hospital in a very pleasant room, and stood up for the first time in hours. I had a drain fitted, which is a plastic line from the surgical wound terminating in a rubber bulb.

Wound and drain line

This fucking thing would be the bane of my existence for a week. A fwwnurse ran in and told me if I needed to urinate it had to be into a plastic flask about the capacity of a litre. I filled that fucker to the brim, handed it to her and said “enjoy”. She didn’t even smile- heard it all before, I expect.

The surgeon visited and instructed me to monitor the drain, as he did not want it in there any longer than necessary, as it’s an infection hazard. He also explained the surgery was a success apart from having to leave some tissue which had tied itself around a vein. This would cause almost 5months of discussion as nobody seemed to think anything should remain in there, given how fast the tumour developed, but that story will have to wait.

At home, I had to learn to live with the drain, which was a great annoyance as the slightest pull on the tube was sharply painful. I had to sleep on my back (which I never do) so it was a tough few nights. On the very day I had just got used to it, I made the appointment to have it taken out.

It would be many weeks, and several labs before the tumour’s classification was known. In the meantime my oncologist wanted to discuss options. At that time it was possibly some radiation therapy along with some chemo. Great.

Black May

I had so many appointments in May I lost count. I’d had my drain and stitches out, my oncologist informed me that the mass was classifed as a ‘metastatic melanoma of unknown primary’ in other words, skin cancer, but no skin lesion would ever be found. This supposedly true in 10% of cases. I had the feeling the onvologist was not that convinced, but genetic markers gave him treatment options. I would be put on immunotherapy, which had the reputation for miraculous results.

I would require immunotherapy every three weeks for a year. I watched an educational video about chemo, and I mostly learnt to be grateful I wasn’t having chemo. The treatment building is a squat, brutalist structure near the mall. It struck me that nearly all of the people there looked very worse for wear. I asked the nurse if they looked like me when they walked in, but I don’t think she saw the funny side. </p

To be continued

October 30, 2025
Death and all his friends

February 16th, 2005

I’d got the call I was waiting for, from my older sister. “You’d better come”. It was time. My mum had been fighting terminal cancer since the previous August, over the new year we were waiting for the other shoe to drop. She’d become increasingly frail and had lost a shocking amount of weight. A couple of days earlier – Valentine’s Day, just to twist the knife a little – she’d had a precipitous decline. I didn’t fully understand the biological mechanism, but her failing liver being slowly consumed by cancer (which would go on to kill her) meant she was slowly poisoning herself, most evident of which was the loss of mental faculties. I had been warned she was in a pretty bad state, neurologically.

I had understood some of this when I arrived in Southwark, but not the extent of it. Leaving the underground at London Bridge and walking to my parent’s flat, a journey I had taken so many times in happier days, I did not know what to expect.

My sister opened the door. As I walked into the entryway I caught sight of my mum sitting upright in bed, apparently trying to get on her feet.

Is that my boy?

The words were feeble and quiet, but It sounded like an anvil dropping to my ears. She was obviously in very poor shape but wanted to get out of bed to meet me, to put on a bit of a show, to let me know she was alright. She wasn’t alright. Those four words were the last coherent thing I would hear from her. For the rest of the day she just looked into the distance, making no sound.

want to trip inside your head
Spend the day there
To hear the things you haven’t said
And see what you might see
I want to hear you when you call
Do you feel anything at all?
I want to see your thoughts take shape and walk right out

There was no life in her eyes. This hurt most of all. I remember looking deeply into them to see If I could see any flicker, any remnant of my mum in there (that U2 lyric would be swimming around my head for days. I still cannot listen to that song without thinking of the lonely evening train up to London) I was struck by the thought that his person – my mother – was no longer there; that all she was and ever had been had been taken from me, leaving just this corporeal thing, an empty shell. It sounds dramatic, but I had about 15 minutes alone with her and the memory is still absolutely devastating to me. She was so still and quiet. The slow destruction of a person -a parent – is a terrible thing to witness. In time I recognised this was worse than anything that followed. I wanted to scream, I was so upset, so confused, so absolutely wounded, but I kept it all in, because i was desperate to reach her. For me, this was worse than death; someone stripped of their faculties and their dignity, helpless, frail, and dying. What this disease can take of a person made me loathe it. This woman carried me into the world, and she had been so greatly diminished (she was tiny, tiny by the end) I still wince at the memory.

She would hang on for another 9 days, before passing away with us all there around 6.30pm on February 25th, 2 days after her 62nd birthday. I think my dad thought she’d held on for it, but I’m not sure if she had sufficient awareness to know either way. I almost had a nervous breakdown during that period, it came out as a bit of a tantrum in Tesco at Surrey Quays, but I was sleep deprived, under severe stress, and starting to crack. I had to get her a birthday card, and it sort of lit the fuse. No, I was not alright. I don’t know if I’m alright now.

I swore at the time that if anything like cancer happened to me I would not let it go that far, that I would not want anyone to see me like that. I have no idea what that might have entailed. Maybe I would jump off Beachy Head, or go and walk into the sea somewhere, let the waves claim me. I was, of course, completely full of shit, because I would get to find out. Life, as the saying goes, is a bitch. Also Irony when I think about it, thanks Alannis.

Who said God had no sense of humour?

Fate would take a run at me. I would get get the disease, not the same kind and mercifully not as severe, although in fact very dangerous. Melanoma is a big, big killer, and I really won the lottery in getting to remission. I may be half-blind, but in all likelihood it’s not going to kill me. Yes I’m tempting fate, but fuck fate.

Bad days are better than no days

There’s a sticker that says this at the reception desk at the infusion centre. It made me laugh at the time, because it’s a bit Oprah, but it’s definitely true. it’s easy to retreat into solipsism and self-pity, and I have definitely had those moments (“why me?” Why anyone, dickhead…) but you have to just keep going and be there. It’s a different story when you have a family. You learn to eat some shit and smile, then eat some more. Every day is a small victory. I know that if the worst were to happen to me, my family would be there to the end, and they would deal with everything that followed, because when the time comes, people find it in themselves. Every three weeks I sit down and get 200mg of immunotherapy drugs. The people there always impress me. Some are very much in the trenches with their illness, but they have such incredible spirit. It’s not at all what you might imagine a chemo treatment centre to be. I mean, it’s not cartwheels and fireworks – it’s still a godawful situation for all concerned, for fuck’s sake, but everyone just grins and bears it. For obvious reasons, I’ve a bad association with hospitals – the smell of disinfectant, rumbling air vents, and prospect of death – and I’ve come to realise it’s not like that at all.

This helped me understand what happened with my mum that day, finding that last shred of strength and dignity to try and show me that she’s okay; that through all she was enduring she would stand tall for her son.

I recently started to dream about her pretty regularly. The illusion of dreams is that you don’t really question context – “What am I doing here? Why can I fly?” I never question that she shouldn’t be there – although I had those dreams in the past. It’s just normal, she’s alive and we’re doing mundane things.

The month before she died, I think it was the first week of January, she had a distinct rebound, a period of high function I would learn is not unusual in the course of terminal illness. We had a nice weekend together, we chatted and watched a film (2004’s Collateral) and I thought for a moment that maybe she’s getting better. But it was not to be. Anyway, I mention because that’s how she is in my dreams. Just normal.

I don’t question it too deeply, but it’s a pretty comforting thing for my brain to do. Her headstone in a quiet hilltop Andalusian cemetary reads “Until we meet again”. I don’t know if that will happen. I don’t know if I believe such a thing is possible, but we’ll see I suppose. Hopefully later rather than sooner.

MCT, 23/02/43 – 25/02/05

October 30, 2025
Matterhorn

The cafeteria is little more than a small concession up on the first floor, sitting in the atrium between treatment areas. I’m aware that I’m sitting with a slump, my left arm covered in a half-dozen gauze pads. I look absolutely defeated, and crack a half smile at the pathetic figure I must be cutting.

I am inhaling a bottle of chocolate milk, a protein bar, and a sandwich because I’ve not eaten since 6pm the previous day; my blood sugar is on the floor. I have already passed-out from the repeated needle sticks (apparently this is my new thing).

Oncology. I came back here to this place, having been away for a year, because they asked me to. I didn’t want to; I’d had enough of it. It had been four miserable years of my life and I just could not do it. Nobody seems to understand, not even people closest to me. You get pulled into the machine and ‘care’ starts to feel like an elephant on your chest.

The facts are I had a very dangerous cancer, my chances of survival weren’t great, but the treatment worked, and I am still here. However, I started to feel a sense of dread and suffocation around doctors. I barely saw a doctor for most of my adult life. I’d like to go back to that, thanks. I can’t for now, because as a result of diagnostics they’ve found things they want to look at, so now I am looking at a surgical procedure to take a lymph node out of my neck because the scan pinged it. I don’t think it’s anything. I hope it isn’t anything. It’s fun, isn’t it?

I have a little joke that oncologists cause cancer. “I was fine when I walked in there, I leave and I have cancer. I don’t make the rules.” I think it’s funny, fuck you.

My PCP (GP for the NHS people out there)…God bless him, nobody tries harder, but people keep asking me why I don’t go back to see him. Well, it’s because he is obsessed with things going up my arse. He’s become a colonoscopy salesman. Yes, I know I should, but there’s a key concept here: I don’t want to. Change the fucking record mate, I don’t want things up my arse right now. Maybe in a year or two I’ll feel the need. Until such time I’ll rely on the radiology surveillance and take my chances. No, I’m not being reasonable, it’s okay.

To top off what has been a stellar week, I was waiting in my car at a red light when a young man lost control of his vehicle, smashed into mine from the left side, then got out of his car and ran off, like a sort of crackhead Forrest Gump. Police caught him further up the road as a witness called it in almost immediately. So there’s that to deal with. Police and insurer have been great, less I have to deal with right now, the better.

Rant over.

October 30, 2025