A patient's diary: episode 9 — misplaced organ

26 AUGUST

Yesterday morning Hilda revealed that she had made me an appointment to see Dr Teacher. It seems that she has been worried about my state of mind ever since they told me at the New Hospital that they couldn't find anything wrong with my liver. Well, naturally, one feels a little disheartened when a leading liver specialist confesses himself beaten by the insidiousness and subtlety of the disease processes working within one's body. Where to turn next, I wondered. America? Could be expensive. Russia? They are good at sewing back severed hands but how much do they know about the liver?

It was thoughtful of her to make the appointment, but quite honestly I didn't really see what else Dr Teacher could do. He is, after all, only a GP and not even one with a Special Interest. Personally, I would rather have gone to Dr Brenda, who, while not a specialist either, tends to have an intuitive feeling about things. But she is on holiday so Dr Teacher it had to be. Good of him to take an interest anyway.

In the event I was quite glad to have an appointment to go to in the evening because, during the day, an entirely new pain came on, in the region of the liver but quite different from anything I'd experienced before. It felt as though a blocked bile duct had swollen up like an over-inflated balloon and was about to burst. In the midst of my pain I was cheered by the thought that things might at last be coming to a head. I remarked to Dr Teacher that this might be the breakthrough we had been waiting for. Did he think, in the light of this new evidence that Dr Portal at the New Hospital might wish to reopen my case? Dr Teacher shook his head. No he didn't think so. He showed me a letter on the screen in which Dr Portal said that all my tests were normal and he had reassured me strongly. Might he take the liberty (the letter went on) of suggesting a course of antidepressants which he often found helpful in such cases? Antidepressants, I said. Aren't those the ones that give you a dry mouth and make you feel like a zombie? Dr Teacher said nowadays there were better ones which were almost free from side effects. And there was an interesting questionnaire that I might like to go in for which could tell you if you were depressed and if so by how much.

Look here, Dr Teacher, I said, are you trying to tell me that depression can give you a pain in the liver? At this he put his fingertips together, leaned back in his chair and looking very thoughtful said: ‘The mind's a funny thing, you know, Norman. Most of it is unconscious, just like an iceberg.’ Then he went on about anxiety levels generating activity in the limbic system and hippocampus that could affect every organ in the body by way of hormones. I think he must have been on one those courses they send doctors on to stop them getting rusty and prepare them for revalidation. Meanwhile, my new pain was getting steadily worse. I asked the doctor if he would mind examining me just once more? ‘Very well, Norman,’ he said genially, ‘if it will set your mind at rest.’ So I lay down on the couch and unfastened my braces to let him have a really good look. At one point he dug his fingers in quite hard and I nearly leapt off the couch. ‘That was It’ I said excitedly, ‘you were On to It.’ But he murmured about a bit of muscle spasm in the ascending colon and said maybe a little borborygmine would help — together with the new antidepressant. I was to come back next week and he would assess my progress.

Back at home, the pain got steadily worse. I hardly touched my supper. Hilda was quite worried and said should she call Dr Teacher. I gave a hollow laugh, more of a groan really. Have you forgotten, I gasped, between stabs of pain, that they don't do ‘on call’ any more. All you get is an interrogation from NHS Direct and a visit from OOHDOC! in about 10 hours. It was just pure luck that Dr Teacher happened to be doing OOHDOC! the night Dennis was so ill. In any case I had a much better idea. I felt that if only I could get to see Dr Portal again at the New Hospital he would be convinced that my liver needed urgent treatment. So, despite Hilda's protests and the pouring rain, I got the car out and she drove me to the Hospital. The Outpatients where I'd been before was closed, but there was a big illuminated sign saying EMERGENCY DEPARTMENT that looked very inviting. We went in and joined a subdued little gathering of fellow sufferers. Some had cut fingers, some had bad backs and some just looked as though they had nowhere else to go. A fierce nurse asked me why I hadn't contacted my GP. I told her I had, but the pain was getting worse. Was Dr Portal by any chance in the hospital, working late on his research? She had no idea about that but the casualty doctor would see me in a few minutes and I was to lie down on a trolley.

After that, my recollection of events is patchy and confusing. Lots of doctors in white coats kept coming and prodding my stomach and asking if I'd had anything to eat? Very kind of them but I really couldn't face even a sandwich. Finally, one of them (I think it was the consultant, Mr Cutler) said: ‘Mr Gland I think we had better open you up and take a look at that liver of yours’. I signed a piece of paper and then I think I must have passed out. I woke up in a nice crisp hospital bed with a drip in my arm and Hilda beside me with a bunch of grapes. Later on the surgeon explained to me that he had taken out my appendix which had been on the point of bursting. He drew me a little diagram to show where they found it (just near my liver), and why the pain wasn't in the usual place for an appendix. In the afternoon who should come to visit me but Dr Teacher himself! I felt very honoured that he should take the trouble to come and see me in spite of being so busy.

‘You know, Norman,’ he said as helped himself to a grape, ‘I ought to have spotted that appendix of yours. I feel I have rather let you down.’

‘Please, Dr Teacher, ‘I said, ‘you must not reproach yourself. How were you to know that I had an undescended caecum with the appendix in the high retrocolic position? Mr Cutler says it is very rare and only occurs in two per cent of cases. Naturally you assumed the pain was coming from my liver and thought no more about it.’ I think he felt better after that. And now I must get some sleep …