Cancer 15: Breaking Bad (it could be worse)

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Cancer 15: Breaking Bad (it could be worse)

Paul Brasington 2023
Published by Paul Brasington in Good health · Saturday 31 Jul 2021
Tags: Cancer
Last night I received the unwelcome but not altogether surprising news that I'm going to need a course of chemotherapy.
I don't know many details yet. I don't know whether it's because the histology on my tumour suggested there was direct cause for concern, or whether this is mostly precautionary. I will agree to it in any event: this is not the moment for winging it.
I have seen chemo at first hand before, supporting someone through her breast cancer, so I know something of what to expect. I've been told that the version used with colorectal cancer tends to be milder in its effects: perhaps some temporary hair loss, (as if I needed any help in that respect), an unpleasant neuropathy which makes it difficult to handle anything cold, some nausea and perhaps a 50 per cent reduction in your normal energy levels during the two week duration of each cycle. (A "cycle" in this case starts with a few hours in a chemo unit hooked up to a drip, followed by two weeks taking some pills. You then have a week off before the next IV session. You would normally have four of these cycles, so they stretch over three months.)

I feel I can take this in my stride, though I don't suppose it's going to be fun (there's also the dread thought of having to endure daytime TV while in the chemo unit, something particularly infuriating about the inane chatter of Bargain Hunt while this therapeutic poison oozes into your veins). The neuropathy may mean I can't play the violin. The sessions will probably start in early September and go through to the end of November. We need to time them so that somewhere in the middle, the week of remission coincides with my wedding to Mary, which we'd rescheduled for 23rd October. The latter was only ever going to be a family affair, and I just hope that even such a modest scale will still be possible.

Dealing with the shock
I've been trying to understand since hearing the news why it should come with the force of a shock, when it was certainly not a surprise. Certainly I'd hoped for something different, while understanding that my chances of avoiding chemo were at best 50/50, and perhaps that disappointment is at the root of the shock.

But I think it's because I'd been enjoying the feeling of having escaped so lightly from my brush with cancer. I had been enjoying the look of gladness on people's faces when they saw me, enjoying being able to give the reassurance that cancer might not always be the monster we fear so much, and it's probably true that the worst of it is now behind me. I'm still a bit sore around my stomach wounds, though the dressings and clips are off and they appear to be healing well and cleanly. I do get tired more easily, which is hardly surprising (it's still barely four weeks since the operation), but otherwise I remain remarkably well.
I was enjoying the sense that I'd somehow defied expectations, being able to tell people that I was really well, and now it feels as though I'm back in a darker place of illness and treatment.

Not least it brings yet more uncertainty. Until I speak to the surgeon (probably in a couple of weeks) I won't know what my prognosis is. I imagine it's still okay, but I don't know. I don't know the timing of all this: I'd really love to be able to get away to our French house before the chemotherapy starts, but I don't know whether that's going to be possible, and that in itself would depend on the government climbing down from its quite clearly indefensible position on travel from France.

Talking of idiotic government, I had planned to write about the state of the NHS in this particular blog. Events overtake us, but there were things I wanted to say, so I will.

Several pence
On my second night in hospital, and the first in which I'd been able to eat, I'd ordered a chicken casserole, thinking (rightly) it would be easy to digest while offering a helpful protein boost. When it arrived I found myself looking at a large dumpling in the middle of the plate, covered in a kind of soup with sparse elements of carrot, mushroom, and least of all chicken. That was it. Then I thought, I can't complain, since I'm not paying directly for any of this and it probably has to be produced from a budget of several pence.
Hospital food aside, the NHS just saved my life. It is probably the best distinguishing feature of this country, and it's under threat from a minority group of political extremists who see it as a challenge to their ideology.
It's been said that for the British the NHS is like a religion, as if our attachment to it was a matter of faith, not reason. But the irrationality is all on the privatising side.
Of course there is waste within the system: it's a huge system, and the biggest employer in the country. But in terms of healthcare delivered per pound it has always been among the most efficient in the world (and a far smaller proportion of GDP goes to healthcare in this country than in other comparable nations).

The Conservatives like to say they have no intention of abolishing the NHS, but these are always weasel words. They are ideologically determined to change its nature, which would effectively destroy what distinguishes it from other lesser systems. True believers in their own religion they argue that forms of marketisation and competition will improve the NHS' effectiveness and or/efficiency.

Health is complex
The lazy assumption here is that public sector managers don't care enough about waste in the system to do anything about it. It's more likely that the necessary complexity of a healthcare system (which after all touches every aspect of our lives) means that local managers don't have the levers that would make a difference. Letting private companies grab the more easily managed bits doesn't begin to address the problem of this complexity. The corporate world has no experience of such complexity. On the contrary for many decades now its primary response to complexity has been to attempt to break things down into smaller parts so you don't have to work with the big hard stuff. In the immortal truth articulated by HL Mencken, for every complex problem there is an answer that is simple, clear and wrong.

On the contrary, we need visionary but practical, bigger joined-up thinking about healthcare, thinking that is capable of accounting not only for the costs of treatment, but the wider costs of ill health in the economy. It means thinking cohesively not just about the balance between primary and hospital care, but everything from food education in schools through the promotion of junk food, to wider personal well-being, from research funding to care for the elderly. It means thinking not only how we distribute taxation, but how we talk about it, and how people can understand its relationship to their well-being.

I should stress that none of this implies increased centralisation. It seems self-evidently desirable that decisions should be empowered as closely as possible to the people they affect. But effective empowerment itself depends on a systematic coherence that keeps broader consequences connected to those local decisions, that works against a destructive and blinding fragmentation. This won't be easy, but as long as people in authority pretend that it could be easy we will be condemned to sticking-plaster "reforms", which include cherry-picking privatisation.

Such big, radical and joined up thinking has never been more important, not just for the NHS, but for the ways we must adjust our lives, our priorities and political assumptions to address the truly global challenges of environmental crisis. From the Covid pandemic to this summer's floods and heatwaves that crisis is clearly no longer theoretical, and we're already in the bizarre position of what is essentially a far-right government vastly increasing public spending in order to keep our heads above water.

Characteristically that government seems to have learnt nothing from the experience and is looking for ways to retrench, including its systematic underfunding of the NHS, so we have the grotesque juxtaposition of people standing on their doorsteps clapping for the dedication of the people in the service, while their government effectively cuts their wages (which is hardly helping the chronic shortage of staff in many areas). Boris Johnson and his cronies are as shameless as they are incompetent. It is our tragedy that at the point where we need both imagination and critical intelligence in government like never before we have a health secretary who has clung to an adolescent admiration for the ideas of the shockingly stupid Ayn Rand.  

Healthcare will always need more money, but that doesn't mean funding increases are futile. On the contrary, we are already facing the bill for the last decade of neglect. There will have to be a major, real terms increase in funding for the system, and if the government fails to do this, the costs will just go uncontrolled into other parts of the economy: in a real sense health is a fixed cost across the economy, and as the pandemic has shown, intrinsically tied to economic health. The real question is how that cost can be most effectively addressed, or to put it another way, how it can be most equitably levied across the different aspects of society that benefit.

I am not Walter White
The NHS saved my life, and has done so in the most challenging circumstances. My gratitude (unlike Boris Johnson's) is total, but the fear has to be that without a radical shift in direction the resources that saved me will become yet another benefit denied to coming generations. The recent parliamentary bill to give government more control over the system does not augur well for the future, or at least not in the hands of our current idiots.
In the meantime, I will unhappily and gladly embrace my chemotherapy, and thank God that I don't live in a system that underpinned the narrative of Breaking Bad.

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