The Mysterious lump in the night

This is not a technology post.

About a month ago I discovered a small lump between my shoulder and my spine. With my usual cavalier attitude of “It’ll be OK and sort itself” I ignored it for a week or so until it became clear it was growing at a rapid rate and it was starting to constantly hurt. After a few days of trying to get a GP (local Doctor) appointment booked, the earliest I could get being about 4 weeks away, a recurring pattern in this post, things started to get a lot worse and the mobility in my right hand and arm began to degrade.

Work were very understanding and I started to camp out in my GP surgery waiting for an emergency slot or a cancellation. Two days in, with the level of pain pretty constant, the lump spreading and my mobility decreasing I managed to get seen and within a couple of minutes got my diagnosis - it was an infected sebaceous cyst. Normally these are harmless if unsightly but an infection in one makes it a much bigger problem; words like “rupture” entering a conversation isn’t a good sign. In my case it was also in the perfect place to put pressure on the nerves controlling my right arm. The GP assigned antibiotics to help with the infection, leading to the first of many awesome conversations:

  • “Are you allergic to antibiotics?”
  • “I’ve never taken any so I don’t know.”
  • “You’d know by now if you were allergic.”
  • “How?”
  • “You’d know.”

I was also advised “don’t wait for a referral as they take months, go to Accident and Emergency (A&E) until they can operate.” Here you’ll see more evidence of the lack of slack in the system. Due to the lack of planned slots for routine checks I instead turned up at A&E every day to see if the swelling had gone down enough. All I’d really done is make myself a drain on a more critical part of the NHS. It’s a great example of local optimisation at the cost of the wider system. Every day for over a week of waiting for the antibiotics to work I’d take a daily A&E trip to find out if I could be operated on and then go to work rather than sit at home. “Luckily” I do as much talking as typing these days so the increasingly dead weight of my right hand wasn’t completely stopping me.

The breaking point was during a work away day. Someone came up to speak to me from behind and to the side and as I tried to turn to acknowledge them it hurt enough that I knew it was time for something to happen. I went back to a different hospital and after a long wait and an ultrasound I was told I had to have surgery the next day. As someone who’s never had surgery before the general reassurances I’d had throughout the process of “it’ll be a local anaesthetic and a short process” were rudely and very abruptly shattered when I was asked to sign the consent forms for “fully out like a light” general anaesthetic and had all the risks of permanent loss of mobility explained to me. In all honesty this was the moment I cracked, and it wasn’t even the risk of not waking up. It was the idea that I’d only have one working hand and arm. Forever.

After a discussion about possible alternatives, which came down to not treating it and then sepsis / septicaemia followed by death, I agreed to the operation. Spoiler: I didn’t die. The cyst has been drained and removed and I now have a 3cm hole between my shoulder and spine. 3cm doesn’t seem like a very big number until you consider it’s both a depth, and inside me. It’s been nearly a week since the surgery and while the mobility in my shoulder isn’t back to how it was (which could be the wound dressing or me subconsciously stopping myself from making it worse) my hand and fingers are recovering nicely. I’ve not done any real keyboard work (or played any games) but the little I’ve done has been more fluid than when I had the cyst pressing down and I’m hoping with more recovery time I’ll be back to my old standard.

In the meantime I was very naive about what would happen after. I assumed (or probably just hoped) that it’d be - make a small hole, drain it, put a covering on it and done. In reality I have to go to a hospital for infection checks and dressing changes everyday for the first 2-3 weeks and then once every 2-4 days for the next 3-6 months. So no foreign travel or conferences for me in the near future. Due to the depth of the wound they pack the whole thing out with dressing to stop anything apart from the very bottom of the wound from healing. This stops it covering over and leaving an open, trapped, pocket that can become a later issue. In theory this should be handled by my local GP surgery but apparently I can have an appointment with them in 3 weeks time and then another a few weeks after that.

I’ve always been a massive supporter of the National Health Service (NHS) and this experience has reinforced my views. While my experience with my local GP surgery has not been a helpful or pleasant one everyone in the hospitals I’ve visited has done an exemplary job. I’ve been treated fairly and with compassion at every stage and all the problems and issues I’ve seen can be explained by the fact that the NHS is being underfunded and under resourced. There doesn’t appear to be any slack in the system. An inability to engage with the front of house via simple things like GP surgeries and Practice Nurses causes an increase in people being sent to walk in clinics and A&E. This places a further burden on those more critical services and increases the pressure and demands.

For the American readers that have made it this far I should probably mention the direct financial cost of all this. While we may not get seen as quickly as you do the only times I’ve had to pay for anything are when I’ve had to purchase my own wound dressings prescription (another example of how under resourced the NHS is) coming to a grand total of 36 GBP each week. Which would have been even cheaper if I’d have known about the Get a prescription prepayment certificate service a little earlier.