The sound my pump made that afternoon was not like the other sounds on the neurology ward. It was nothing like the jaunty ping of the obs machine, which measures vitals and plays the opening bars of the Magic Roundabout theme as it starts up. It was nothing like the distant lowing of phones on the front desk or the creak of porters wheeling beds over uneven linoleum. Around two, my pump suddenly produced an angry, insistent electronic bleating, the unmistakable voice of something going wrong.
Lemtrada is a chemotherapy drug that has proved useful in the treatment of multiple sclerosis. It kills lymphocytes, which have been described to me as the attack dogs of the immune system, roving around and savaging anything that looks suspicious. In multiple sclerosis, these lymphocytes find their way into the central nervous system, where they are not meant to be. Once there, they begin to shred the coating of the cells that make up the brain and spinal cord. By killing these lymphocytes off, and allowing new lymphocytes to replace them, Lemtrada is one of the most effective treatments people with relapsing-remitting MS have.
It is administered in hospital via an IV over the best part of a week. I came in for my first session in 2016, and for four days I sat beneath bags of Lemtrada as they trickled into me. The line of the IV passed through a pump that regulated its flow. On the fourth day the pump jammed, creating a bubble. Bubbles in a line, if they are of a suitable size, can enter a vein and cause air embolisms, and an air embolism might conceivably give you a stroke or a heart attack.
Out of nowhere, Annie appeared. Annie was one of a handful of nurses who worked the ward, doing the thousand different jobs that make up a nurse’s day. Annie was brisk as she silenced the pump and removed the line. The bubble was huge. She located a valve near the point at which the line entered my wrist. “There. I’ll get the bubble out there,” she said. I think she also added that it would take a minute or two for the bubble to move into position.
Then – and I will never forget this – she rushed off and changed a bed. She tracked down an obs machine for another nurse, and she reminded someone on the front desk to take a break. She arrived back at the line and nodded to herself. Moments later she bent over the valve with a syringe and removed the bubble. Then she disappeared back into the ward.
I have told this story many times since, adding, as a coda, a conversation I had with my wife, Sarah, shortly afterwards. “Do you think she will ever think about what she did for me?” I asked. “I think she’ll probably go home when her shift ends and never think about it again,” Sarah replied.
This episode still leaves me in a state of moony wonder. But when I tell others, it strikes them as being ordinary. This kind of thing is what people expect of nurses. Of course they save lives. Of course they are competent and decisive. And of course they have too much work to do, yet they do it anyway. This is all part of the busy narrative around nursing, and it is part of the way, I suspect with considerable shame, that I have sometimes made peace with my apparent helplessness when confronted with the cruel short-sightedness of endless NHS cuts. These people are superheroes, aren’t they? Surely, they will simply go on being superheroic for me. This might also explain why it’s another story I sometimes tell about that week in hospital that has a greater impact, even though it’s far less dramatic.
Lemtrada is administered through a cannula, a line that is placed in the vein and then stays put throughout the treatment. A needle and tube taped to the skin, a cannula is not a pleasant thing. Over time it can cause a dull pain in the flesh, and the site of the puncture may become itchy. I always feel compromised and vulnerable whenever I have one in. I never feel entirely human.
You must take your cannula everywhere. It’s this that introduced me to Annie in the first place. On my second day on the ward I woke early and was determined to wash for the day ahead. Before I went into the shower, Annie explained, I would need the cannula covered so that it didn’t get damaged. Actually, what Annie said to me was, “Let me just take care of this baby.”
And she did. She swept off and returned with a plastic bag and some surgical tape. She smoothed the bag and bound it tightly around the cannula and then she explained that she always folded a little edge of the tape back on itself so that it would be easier for me to remove afterwards. Even though I was groggy after a night kept awake by the sounds of a neurology ward, I could tell that Annie’s handiwork was special. That cannula covering was beautiful, bespoke and radiating the care that had gone into it. My humanity started to return a little.
It was a tiny detail, but I now see that a stay in hospital is made up of these insignificant kindnesses. It is that exuberant hourly piping of the obs machine. It is the oily film on a steadying hospital tea. And it is the many things nurses do to maintain the sense of calm and purpose on the ward. I knew nurses were lifesavers. What I didn’t know was that they are capable and willing, in among the chaos of healthcare, of doing these vital, nameless jobs that make patients feel a little more like themselves. Jobs like arriving swiftly for an air embolism, say, but without broadcasting any obvious hurry. I realise now Annie’s aim on my last day on the ward was not simply to avert an emergency but to soothe any sense of one.
A year later I was back as a day patient for my second dose of Lemtrada. I saw Annie as I was leaving one evening. I rushed to catch her in the corridor as if she were a celebrity. A new haircut, I noted. “It is so good to see you,” I said. “I’m so happy to see you again.” She smiled and pretended kindly to remember who I was. “You look different,” she told me. “You look much better.”
Christian Donlan is the author of “The Unmapped Mind: a Memoir of Neurology, Incurable Disease and Learning How to Live” (Viking)
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This article appears in the 04 Apr 2018 issue of the New Statesman, Delusions of empire