Do You Feel Lucky?

We talk a lot about luck in our house. At first, we couldn’t believe how unlucky we were when my partner – an otherwise healthy, non-smoking man in his fifties – developed a rare form of lung cancer. Our bad luck seemed to progress with his disease, as a combination of late presentation, misdiagnoses and delays in reporting meant that by the time it was diagnosed, his lung cancer was inoperable. Things went from bad to worse as blood tests revealed my partner had none of the bio markers that would make him eligible for some of the new immunotherapy drugs, and a needle biopsy failed to yield enough tissue to allow participation in a new genetics trial.

But then our luck seemed to turn. My partner underwent chemotherapy that only had a 1/5 chance of working – and against the odds, it did. The cancer was pushed right back until his lungs – once a cloudy fog of white – now looked almost normal. Alas, the cancer grew back, and four months later we were once again staring at a scan of white lungs, cursing our bad luck. The second line chemotherapy only had a 1/10 chance of working, but my partner seized on this slender chance, and luckily, amazingly, it worked. Once more, the cancer was pushed back, and despite a few hospital admissions, my partner survived one of the most gruelling chemotherapy regimes with his health largely intact.

But we both know it could come back, so after discussing the risks with his marvellous consultant, my partner agreed to undergo an open lung biopsy at New Year to see whether he has any of the genetic markers that might make him eligible for some of the new medicines currently being trialled.

This week, our luck seemed to take a catastrophic dive when my partner was admitted to hospital with chest sepsis and pneumonia. Sepsis is the body’s overwhelming and life-threatening response to infection which can lead to tissue damage, organ failure and in 30% of cases, death. It is fast, frightening and can be fatal. 44,000 people die of Sepsis in the UK each year. After a week of excellent treatment and hospital care, my partner came home last night, and we are still processing what happened. We started to talk about how lucky we were that I hadn’t travelled to London the day he developed symptoms. If the sepsis had developed 24 hours earlier or later, I wouldn’t have been with him, and my partner (who doesn’t like to ‘make a fuss’) might not still be with us.

But as we talked with the boys about how ‘lucky’ we were, I remembered something I heard Nick Robinson the BBC presenter, say about his lung cancer. He argued that it wasn’t ‘luck’ that meant his disease was diagnosed and treated early; it was due to the professionalism of the doctors who saw and referred him. His comments made me think back to that dreadful Thursday morning when things went so very wrong so very quickly.

It was lucky that I happened to have an appointment with our GP at 7.40am with my youngest son that day, so that I could mention I was a bit worried about my partner who had wakened at 4.30am with a sudden temperature and increase in coughing. I thought she was being kind when she told the receptionists to ensure we got an appointment with a doctor before 10.00am, but now I realise that this was her professional expertise.

By 10.00am, my partners oxygen was dangerously low, his temperature, pulse, and respiratory rate sky high. The young GP – who we had never met before – wasted no time in calling an ambulance for a suspected case of sepsis. We thought it was all a bit dramatic and unnecessary – particularly when the receptionists bought in oxygen canisters for my partner. I suggested in an oh-so-British way that we should sit outside so that the GP could see other patients whilst we waited for the ambulance. I thought she was just being kind when she insisted that my partner was her priority. I realise now that she was using her professional expertise and judgement and was making sure that my partner remained safe whilst waiting for the ambulance.

We half-expected the paramedics to dismiss us when they arrived, as surely the oxygen would have made him better. But again, they used their professional judgement as they wheeled him into the ambulance, insisting on hooking him up to some fluids before we even set off for the hospital. As the brilliant paramedic chatted to my partner about football and Scotland, I thought he was just trying to take his mind of the cannula going in, but now I realise he was using his expertise to stop my partner going into shock and me going into a full-blown panic. He then rang the hospital to alert them that a suspected sepsis case was on its way.

Because of the communication between the paramedic and hospital, my partner was admitted immediately to a place I later realised was the Resuscitation Ward. Horribly pale and breathless, he was hooked up to a lot of machines that again gave scarily high readings for his heart, pulse and respiratory rate. I clung to the fact his oxygen levels seemed to be improving, not realising that this was only because he was on an epic 15 litres of oxygen. Again, my partner was attended to by amazingly calm and excellent professionals who performed a series of tests and assessments with the grace and skill of a well-practiced ballet. X-ray machines appeared at his bedside, blood was taken, symptoms measured and all of it was reported and assessed within minutes.

It was quickly established that the cause of the sepsis was not some post-operative complication from the biopsy, but severe pneumonia in both lungs. After waiting for the super-strong IV antibiotics to hit his bloodstream and some of his symptoms to stabilise, my partner was admitted to a ward, whilst the A&E staff continued to use their expertise to save other lives.

I could go on forever about the excellent care my partner received during the week he was in hospital, but my point is that although we kept saying he was lucky to be alive, none of this was about luck. The GP and Consultants who treated him were the product of investments made over fourteen years ago that allowed them to train in their profession; likewise, the skilled nurses and physios who will have begun their courses perhaps over five years ago. The fact that my partner was seen and treated for sepsis so promptly also wasn’t down to luck – it was because the hospital and community health care system had worked together to develop and implement a ‘Sepsis Pathway’ which meant that a strict and urgent protocol was followed. The fact that we left the hospital after a week of super expensive care without a penny to pay was because seventy years ago Nye Bevan had the foresight to create the NHS, and that subsequent generations have continued to support it.

We often say we are ‘lucky’ to have the NHS, but it isn’t luck. It is an active choice we make as citizens about how we structure and fund the system of care in this country and as I said to my boys, we mustn’t obscure important decisions about (lack of) investment with the language of luck.

As my partner recuperates, there will be skilled histopathologists in a laboratory somewhere, analysing the tissue from his lung. In the next few weeks they will report their findings to our Consultant Oncologist, who will use his skill and expertise to assess whether he has any of the genetic markers that might make him eligible for some of the new stratified medicines currently being trialled.

Wish us luck.