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Tuesday, 16 November 2010

The Battle of Knobbly Knee

Dateline: 16 November,2010:

Its 8 am and excitement at Large Mansions is practically at fever pitch. In truth, I have not been able to sleep and I cant wait to find out what's going to happen.

"Have some toast, at least" says RHB, "You're too excited"

I refuse, and have to admit I am too excited. As a general rule, I love birthdays, and as a specific rule, I love my birthdays. Also as a general rule, I love presents, and as a specific rule, I love presents that are for me. , Convergently then I love shiny presents just for me, and today has dawned with the possibility that I will receive a particularly unique present built only, and specifically for me, and being made out of titanium, extremely shiny.

There is a down side, however, because in order to access said present, I have to travel across Hull to the Spires hospital. By way of explanation, the gift I am expecting,the thing I want more than anything else in the whole wide world (even more than a 1966 Fender Precision or a new Shimano gear assembly for the Crosstowner) is an operation on at least one of what Grasshopper has characterised as 'the knobblies'.

Without blathering on in too much detail about the circumstances arising that have required some repair to the knobblies, it became apparent two years ago, shortly after arriving in this country, that a hit and run accident whose major effect had appeared to be a demolision of the right elbow, had in fact resulted in far more serious, but less obvious damage to both knees. During recuperation from this spectaculrly broken elbow, knee problems which had previoulsy been 'niggles' became worse and worse. A brief consultation with the Sport Scientists at our gym revealed some pretty bad, but eminently fixable cartilage problems. SO, I booked an appointment with my General Practitioner who referred me to the physiotherapist attached to his clinic. That appointment went not well, mostly because I called the physiotherapist an idiot.

I was then withdrawn form that doctor's surgery and, here I have to admit some culpability, abandoned the matter for a while. However, shortly prior to our vacation in Turkey last year, I decided to re-address the issue, applied to a new General Practitioner and a made an appointment.

I would like to report that this resulted in a flurry of activity. Surely, I thought, the prospect of Hull losing its best scenic carpenter through injury would speed up the process. And doubly surely, dont I always hear on the news how 'Britain' has got the best health service in the world? So when I heard that Grasshopper had approximately the same injury, but diagnosed years after mine, I thought to myself 'HO! She (Grasshopper) thinks she's a bit of a smarty pants living in Canada, but now we'll see who's the clever socks. Living here, as I do, amidst the World's Best Health Service, I will probably be fitted with bionic implants while she's still being pushed round Walmarts' carpark on a sled. And, when Canada does eventually get round to fixin' her up, it will probably be some primitive beaver bone and moose hide contraption attached to her leg, while I shall have mini nuclear reactors powering my leg muscles.'

It was therefore with some jealousy that I recieved a missive from GH, some two months after her injury, describing an unpleasant period of enforced immobility, but an otherwise entirely successful medical procedure. GH's treatment (and I should'nt breach confidentiality here but I will) consisted of a two minute visit to her doctor, a quick coffee with the consultant, and the next week a relaxed keyhole procedure while evryone in the operating room drank Tim Hortons and ate donuts. By contrast, in the home of the Best Health Service in the World, it has taken five specialists, two scans, three different locations across the city and about eighteen months before, last month, I was referred to the local musculo-skeletal clinic, which ironically is two minutes walk away form my house.

AT that appointment, the specialist was examining my xrays and nodding sagely:

" do you see this?"

He pointed to the xray attached to the light box.

I leant forward and agreed that I saw the x-ray.

"Well that..." he said, pointing at the xray of my knee " an xray of your knee"
He looked at me expectantly. I said nothing, mindful of RHB's exhortations not to call any 'professional' an idiot, especially if they were (apparently she's just read some research about how bad people are at judging their own competence and the less competent they are, the worse they are at arriving at arealistic assessment of same).

He continued " and this xray does not show significant damage to the bone"

He looked at me again, but I maintained discipline.

"So, its probably some soft tissue damage" he hesitated slightly "which probably means a minor surgical procedure, which..."

"When?" I interrupted

"What?" he said

"When can I get it done? Now ? Let's do it" I began rolling up my trouser leg.

I should point out that I didnt actually say the above, nor did I roll up my trouser leg, but by God, King HArry and St George at this point I had been so frustrated that I wanted to and had even contemplated carrying out the operation my self utilising Toshack's supersharp claws as surgical tools and some elastic bands as replacement cartlidge. What actually transpired was that I left the appointment under the impression that a surgical procedure was imminent, and all I had to do was wait for a letter. I made chilli for RHB that evening in a fizz of excitement as I told her the news "Its finally going to happen".

When the letter arrived, I opened it carefully. Scanning its contents twice, I could see no sentence saying "Your appointment for an operation is ...." Instead, I was invited to call yet another telephone number, this time the number for Patient Choice, an initiative designed to help patients self-select their best options for care. I dialled as instructed:

"Hello, Patient Choice, how may we help?" a friendly voice said

"Well, I dont know" I said " I need to arrange an appointment for a knee operation"

"I see" said the voice," and who do you want to see?"

"I dont know" I replied "I know practically nothing about knee surgery. I suppose I would want to see someone good?"

"Well" said the voice, slightly less friendly " All the surgeons are good. Its up to you to decide which one though."

"Well" I said "What about seeing the best?"

"I regret we dont give out that type of information, I'm afraid" said the voice, sounding neither afraid nor regretful.

I began to worry I was in danger of alienating the voice, so instead of asking what the point of empowering me in respect of a matter that I know absolutely nothing about, I just asked to be booked into the soonest available date - 16 November, 2010. I put the phone down and called RHB "Its the best birthday present I could wish for" I told her. "Dont get your hopes up" she told me.

The end of this very long tale is that of course, this morning's appointment was not the operation, just the final, pre-operative consultation with the actual surgeon. I asked him as I left "Is his definitely it? definitely surgery?" . He concurred. "And all these other examinations, scans, xrays - there's nothing else wrong is there? Some serious underlying problem that you're not sure of?" No, he said, it just routine. Then ( he seems a very nice man) he went on to explain how the efficiency measures of the last few years, designed to filter out unnecessary appointments, focus treatment and act as a barrier to the (very) occasional hypocondriac have built up a layer of triple redundancy that is incredibly inefficient. Furthermore, at least in me, these efficiency measures have led to unnecessary appointments, no (so far) treatment (let alone unfocused( and the development of severe hypochondria in that I suspect I also have thrombosis, gangrene and a necrotising phage, such is the number of scans I have had.

NOne of this is a reflection on the front line staff, who on the whole are very professional, its more a function of an already bureaucratically inclined Government having no idea other than an ideology. While I never imagined my knees being involved in anthropological argument, it is here that we return to the idea of complexity and the collapse of society. Right now though, as long as it doesnt happen before the knobblies get fixed, I'll be happy.

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