Wednesday, 1 February 2017

Meningitis: one year on

So it is now exactly a year later from my previous post, and it seems the right time to note down what happened in detail. Please note that most of the following was written in the days immediately after my illness, and so my use of language might not be perfect.

It was a Monday, and I had had a sore neck over the weekend. Şencan, my wife, had noted I was in a generally irritable mood that morning (or at least more irritable than normal).

Early on I walked with my son Robert (nineteen months old at the time) to Active Ants, a playgroup for children a little over a mile from home. We had a pleasant time, bouncing on the bouncy castle, pushing him around in cars and generally having fun. However I had a slight headache and my neck and shoulders ached, as if I had been carrying a heavy pack for a week.

We arrived home a little after midday, and after a quick snack Robert fell asleep. I put him to bed and went to my study to check some emails. However after a quarter of an hour my head was pounding; I’ve never had a migraine before, but my mum suffered from them and I assumed it was one. This was especially true as the headache appeared to get worse in light. So I went to the bedroom, closed the curtains and went to lie down.

I got a little sleep, but I kept on waking as I could not get comfortable with my stiff neck, however I positioned the cushions. A couple of hours later Robert awoke, and so I changed him and took him straight down to the kitchen for a meal. I felt grotty, so I just opened a can of beans and sausage. He was in a good mood, but after he had eaten I found it impossible to carry him upstairs. I tried to get him to walk up himself, but he just took that as being part of a game.

With hindsight I should have called an ambulance there and then, or phoned Şencan so she could come home and help. However I eventually managed to get Robert into the lounge, where I placed him in front of the TV and lay down on the floor beside him.

Robert usually takes my lying on the floor as an excuse to jump on me, pull my fingers in an attempt to drag me somewhere, or pass me a book to read to him. Oddly though, he left me alone and played by himself, which is almost unheard of – it was almost as if he realised I was ill.

Eventually the phone rang, and I struggled to get off the floor to answer it. It was Şencan: she said she was coming home soon, but when she heard my voice she realised I was ill and said she was coming back immediately. I went to lie back on the floor again and waited.

When she arrived she sent me straight to bed. I was feeling really cold, so I got under the covers whist she fetched me a hot-water bottle and put the heating on. My head was causing me tremendous pain, as if elephants were standing on both sides of my temple, pressing inwards. That was the background pain: in addition there were sharpish spikes that occasionally caused me to grit my teeth, gasp or even scream. I was also seeing strange patterns in my eyes, even then they were closed, and I spent a few enjoyable minutes trying to identify the shapes they were morphing into: a tank became a nude woman; a tree a mountainous landscape.

I’m not really sure what happened for the next few hours: I think I might have slept for a while as the next thing I can recall is Şencan saying she was going to call an ambulance. I did not want her to bother anyone, but I was not in a position to complain. Sometime before this I think the panting and gritted teeth had been replaced by more screams. I was, to put it mildly, in intense pain.

A paramedic soon arrived and introduced himself; he was going slightly bald and reminded me a little of Prince William (it is odd that despite the pain in my head I felt fairly lucid). He asked me some questions and got me to do movements: in particular the fact I could not move my head anywhere near my chest seemed to alarm him. My temperature was 39 degrees, and my heart rate 130 despite having been in bed for hours. The only thing that seemed to relieve the pain even a small amount was covering my eyes with a rolled-up T-shirt to block off all light.

He put a canular in my left arm and started to give me some drugs. I could hear Robert screaming from somewhere in the house; I assumed he was hearing my screaming and was upset by that, Şencan’s concern and the strange man in the house.

Two ambulancemen arrived, and the paramedic started to brief them. During this I asked if I was going to hospital, and he replied that I was. I think I was given some morphine at that time, but even that did not really seem to work. The paramedic started talking to someone on his phone, and he said they were going to ‘stabilise’ me before transferring me to hospital.

Now, ‘stabilising’ is not a word I have given too much thought to in the past. It turns out it is not a nice word to be on the receiving end of. ‘Stabilising’ means that you need stabilising; that you are essentially unstable. Whilst friends may say that I’m unstable at the best of time, I found that word more frightening than anything else.

About half an hour later they got me into some form of chair and wheeled me towards the door. I asked Şencan to throw a few things into a bag: my phone, some clothes, a little cash. I didn’t see Robert anywhere, but I could hear him screaming. This upset me more than my own pain. I wondered how they were going to get me down the stairs, but they had that covered: the chair had some form of tracks that got me down the stairs very gently. It was a sign of my rather odd mindset that I wanted to know how it moved, but was in no condition to get up and examine it.

I was put in the back of the ambulance, and they struggled to transfer me over to the trolley: any movement of my neck caused me to scream in pain. Once I was settled one of the ambulancemen asked me my date of birth, and he laughed: his was the same. Not just the date, but also the year. His colleague laughed when I asked which of us has worn the best.  The crew were from Swaffham, and had done a transfer from King’s Lynn to Papworth Hospital, from where they had been tasked to me. Ambulancemen certainly get around.

They blue-lighted me to Addenbrookes, the first time I have ever been in an ambulance as a patient. They gave me more morphine, for a total of (I think) 20 mg. I also got some anti-nausea drugs to counteract the other drugs they had put into me. They told me there might be a delay due to a queue of ambulances; as it happened we went straight to the front of the queue and I was taken in immediately.

What followed is very much a blur; people were asking me questions, but I could not see who as I had asked someone to drape something over my eyes to protect them from the light. I was soon taken up for a CT scan: there was another potential cause of my pain (stroke?) which the CT scan would remove as an option. In the scan I asked them how powerful their scanner was, and whether it would be able to detect anything as small as my brain.

I was given a cocktail of drugs: more morphine, some antivirals, and other things I cannot remember. The loss of control was upsetting: I had no idea who was doing what to me, and my brain itself felt as if it had been swapped with that of an identical twin. My mind, which I had come to know well over forty years, was a stranger.

They told me they believed I had meningitis, either bacterial or viral. It was odd not being able to see them work around me, but I was glad of whatever was blocking out the light. Time felt odd, as if minutes and hours had done a twirling dance, but soon I heard Şencan’s voice and felt happier. The next few hours passed in rather a blur; I was given more drugs, and in the very early hours in the morning I was taken for a lumbar puncture, the results of which would tell them whether I had bacterial or viral meningitis.

The lumbar puncture was more of a trial than it should have been. A doctor and (2?) nurses tried five times to get a sample, but failed. Eventually I was wheeled through the hospital, and I was surprised how strange I felt. I do not know whether it was the drugs or the feeling of being wheeled around whilst essentially blindfolded, but I felt simultaneously nauseous, dizzy and happy, even as the elephants performed a jig on my forehead.

I was wheeled into a room whilst nurses fussed around me. I could tell Şencan was worried, but I was more concerned about her: it was the early hours of the morning and she would have to get home. Perversely the car parking charges also worried me. My mind was evidently clear enough to worry about such trivia despite the pain.

Şencan eventually left and I tried to sleep. This was slightly difficult; firstly as I was still finding it difficult to find a position where my neck would feel comfortable, and secondly because my left arm was attached to a drip stand that was dripping 873ml of liquid into me every hour.

Now, I drink a great deal of water. But nearly a litre of water every hour is a little much, even for me, and soon the liquid wanted to find its way out. The whole protracted process of getting it out did not help me sleep.

Şencan returned at around ten in the morning, and it turned out she had had very little sleep. A procession of nurses and a couple of doctors came to see me, and I now felt well enough to take the t-shirt off my eyes for short periods. To my surprise, everyone was wearing masks. It turned out that if it was bacterial meningitis it might be contagious, and this explained why I was in a room of my own rather than a ward. The downside of the failed lumbar puncture the night before was that it would be longer before it would be known if these precautions could be dropped.

Just after midday a doctor from the infectious diseases came in. He exuded professionalism, and even looked as if he had just returned from examining patients in a jungle. He managed to perform the lumbar puncture quickly and with minimal fuss even whilst having to work around the four or five holes made by the doctors the previous night. His manner and talk relaxed me, especially when he persuaded a nurse that Şencan could stay with me over the lunchtime period when she was supposed to leave.

The doctor returned in the late evening, a while after Şencan had left, and told me that it was viral meningitis. This was good news as it is less serious than bacterial. He also said I had to spend another night in the room.

The next morning I was feeling a bit better, and I spent a while looking at the building site outside my window, and also wondering if the drip system could be miniaturised and made more convenient for both hospital and patient (despite its size it could only monitor and control one line at a time, which was a shame as at one point I had three feeds into my arm. This led the nurses to have to swap lines over). I had complained about my canular itching during the night, and although a couple of nurses examined it, it was only after daylight that one of them noticed that my arm underneath the canular had swollen like and egg: the canular had come out and it had been injecting the liquid into tissue.

About ten in the morning I started to feel very ill again, and for the first time in about twelve or so hours I was screaming once again as the elephant stomped their way back from their slumbers. I was given some oral morphine, but it was clear that they wanted me to leave.

Not wanting to outstay my welcome, I left. My parents were waiting for me at home, and as I climbed up the stairs Robert started screaming; I can only guess that he had been greatly upset over the trauma of a few nights before.

It took me a few weeks to even get anywhere near to normal (or whatever normal is for me), but I was still plagued with headaches, photophobia and issues with my short-term memory. A doctor said the headaches should last a couple of months, but they continued for much longer. In June I saw a specialist and had an MRI scan; an interesting experience in itself. Sadly a few days later I was being blue lighted to hospital again with what seemed like meningitis symptoms: very stiff neck and shoulders, photophobia, temperature, headaches; the exception was that my blood pressure and heart rate was not very elevated. After spending a few hours in A&E they released me.

I stayed with my parents for a week, and then returned home. In November I had another ‘attack’ of whatever it is, although this was much milder and, after the previous experience, we did not even bother calling an ambulance. Şencan is certain that these second and third attacks were meningitis as well, although doctors doubt it because recurrent viral meningitis is rare.

Now, a year later, I still get frontal headaches most days, and my short-term memory occasionally floats merrily away mid-sentence, leaving me trying to grasp the nebulous spectre of whatever it was I was saying or thinking. Bright lights can be troubling. But I have survived, and 2017 is a new year.

Thanks to everyone who has helped me, from my neighbour Joe who looked after Robert that first night without knowing whether I had an infectious disease, to my sister who drove down in the middle of the night to take over. My parents have been brilliant, as has my brother.


But most of all, thanks to Şencan. It was tough for her to juggle a difficult job, a teething toddler and a sick husband. She has been, and is, wonderful.

The perils of Dry January

Note: the following occurred on this day last year:

In the dying days of 2015 we were assailed by adverts and media chatter for “Dry January”, the campaign to forgo alcohol for a whole month. We were told we’d be wealthier, healthier and happier.
This seemed like a good idea to me. But in my usual over-the-top manner, I decided to also forgo two other nasty habits I had developed for crisps and Red Bull. And not just for a month, but for as long as I could. They were habits I could manage when my hobby was long-distance walking as I burnt off any excess calories, but my more sedentary toddler-dominated lifestyle has prevented that.

Too give myself an incentive, I decided that any money saved on alcohol, crisps and Red Bull would be put into Robert’s bank account. I also decided I could eat ‘gift’ items: for instance if someone offered me a drink, I could accept. The only time this happened during January were some crisps served on my plate at a playgroup, which I ate with some glee.

So when January 31st came along and although I had lost a little weight, I did not feel healthier. In fact, I’d been feeling a little ill. I was not wealthier – the money was going into Robert’s account. And there were times when a glass of wine would have made me happier, if only for relieving stress.
But I was looking forward to the next day when, if you believed the adverts and radio talk about “Dry January”, I would be a He-Man. An Alpha Male. Instead of carrying a rucksack up and down mountains, I would be carrying mountains over a rucksack. I would be an Adonis.

So what happened that next day, February 1st? The end of “Dry January”? Did I feel better? Was I wealthier, healthier and happier?

Was I heck. I was being blue-lighted to Addenbrookes Hospital with Menengitis.

“Dry January”: don’t do it. It’s not good for your health.

(Note: I may have got correlation and causation somewhat confused in this post)

Sunday, 15 January 2017

Books review: 'The Space Shuttle Decision' and 'Development of the Space Shuttle' by T.A. Heppenheimer

The Space Shuttle Decision 1965-1972, by T.A. Heppenheimer.
Development of the Space Shuttle 1972-1981, by T.A. Heppenheimer.

These books are a two-volume history of the Space Shuttle program, written before the Columbia disaster in 2003. The first volume covers the decision to make the Shuttle; how it turned from being a small part of a comprehensive space program into the only part of a much reduced system. The second volume covers the design and development of the Shuttle, ending at its first launch.

As can be seen from the dates, the first book spans a period from shortly after the start of manned space flight, up to nine years before the shuttle's first flight. Mr Heppenheimer does an excellent job of examining all the precursors to the Shuttle to show how the decision to build the shuttle occurred.

And this is vital information, as the Shuttle program was a glorious failure. It was meant to fly 60 times a year, yet only managed 135 flights in 30 years, with two of those resulting in total losses of vehicle and crew. The Shuttle did not reach its schedule, performance or cost-per-flight projections. Yet despite this, it kept the US in the space race.

So what went wrong? Back in the 1960s, at the height of the Apollo program, NASA wanted a small, cheap shuttle that would service orbiting space stations and a manned mission to Mars that was planned for the 1980s. As politicians refused funding for the Mars landings and the space station, NASA was left with plans for a shuttle that had no mission.

To give it a reason to exist (and to keep NASA in the manned spaceflight business), they allied with the air force, who required a much larger spaceplane with superior glide characteristics. This was more expensive, so they had to take all the payloads launched by the US government to make it cost-effective, along with a large proportion of the civilian satellites. This meant that all the US eggs would be in one launch basket, which proved to be a problem when that basket was grounded for three years after the Challenger disaster.

Because the new system was heavier, the costs were much larger. Under the watchful eyes of a budget organisation, the OMB, NASA changed the Shuttle from a fully-reusable system to a partly-reusable one. A move that was meant to save money during development actually made the system more expensive to operate per flight. It also led to critical design decisions that helped doom both Challenger and Columbia.

Although the first book ends years before the Shuttle first flew, it covers the period where the decisions that shaped and doomed the project were made. As such, it is vital reading for anyone interested in that program.

In the second volume, Mr Heppenheimer does a good job of detailing the tasks and problems facing NASA in developing the Shuttle, from obvious big-ticket items such as the main engines to smaller yet critical ones, such as life support and orbital manoeuvring systems.

The development was beset by problems, and the first flight was two or three years later than scheduled (although some of the delays were caused by budgetary rather than developmental problems). American industry worked hard to deliver a working Shuttle, albeit one that was doomed not to meet its targets due to the decisions outlined in the first volume.

Whilst the first volume might best be targeted at economists, political theorists and project managers, the second goes into much greater depth into the Shuttle's hardware. As such, it is of much more interest to the general space buff. It is far less helpful in discovering what went wrong with the program and why the Shuttle was an expensive failure, even if a glorious one.

These books are crying out for a third volume covering the operations of the Shuttle, and the missions it undertook. But despite this missing third volume, these books are a fascinating insight into the entire program. Mr Heppenheimer turns complex, dry topics into a readable history.

Although I ordered hard copies, the first volume is also available in HTML from the NASA website:

The Space Shuttle Decision 1965-1972

Saturday, 7 January 2017

Books read in 2016

Below is a list of books that I read in 2016. A fairly short list due to illness and lack of time but I am fairly happy with the mix between fiction and non-fiction.

01/01/2016: (started in 2015)
Sidney Chambers and the Problem of Evil, by James Runcie
2/5

09/01/2016
Thomas Telford's Temptation, by Charles Hadfield.
3/5

16/01/2016
A twist of the knife by Peter James
2/5

01/2016
Jobs, by Walter Isaacson
4/5

13/2/2016
Tank Rider, into the Reich with the red army, by Evgeni Bessonov
5/5

18/02/2016
Big Blue, by ??? (Annoyingly, I did not write down the authors of this rather ancient (1980s) book.
4/5

06/03/2016
Rebus: Black Book, by Ian Rankin
3/5

11/03/2016
The White Umbrella, by Brian Sewell
4/5

16/04/2016
The Making of the English Landscape, by W.G. Hoskins.
4/5

23/04/2016
Red Storm Rising, by Tom Clancy
5/5

30/04/2016
That Close, by Suggs
3/5

15/07/2016
Elon Musk, by Ashlee Vance
4/5

20/08/2016
The Space Shuttle Decision 1965-1972, by T.A. Heppenheimer.
5/5

03/10/2016
Development of the Space Shuttle 1972-1981, by T.A. Heppenheimer.
4/5

16/10/2016
Wild: a journey from Lost to Found, by Cheryl Strayed
4/5

25/10/2016
The Hundred-Year-Old Man Who Climbed Out of the Window and Disappeared, by Jonas Jonasson
5/5

27/10/2016
Runaway, by Peter May
4/5

02/11/2016
The awards of the George Cross, 1940-1009 by John Frayn Turner.
4/5

Saturday, 31 December 2016

My ten political predictions for 2017


1) There will not be a General Election.
2) Corbyn will still be Labour leader.
3) The Conservatives will be having regular polling leads (see point 2).
4) Article 50 will have been triggered.
5) UKIP will be struggling to find a new policy position.
6) Lib Dems will rise in the polls and continue to win locals, but will have more trouble in any parliamentary by-elections.
7) The SNP will start to suffer electorally from its years in power.
8) At least two MPs will resign from the government over Brexit: one from leave, and one more from remain.
9) Trump and Putin will have a falling out.
10) House of Lords reform will continue to be talked about, but will not be progressed (this one is a banker).

Of these 1, 3, and 4 are the ones that most match my own wishes.

Sunday, 5 July 2015

Another coastal walker

It has been some time since I last updated my page on coastal walkers, so here are the latest additions:

Adam Short set off from Southampton in 2014, and is doing what must be a first: not only is he camping wild whilst walking the coast, but he is also using a pack raft to cross rivers. He has a website at http://uk-coastal-trek.com/aboutadam.asp, with regular updates taking place on his Facebook page

On the 1st May 2015 Steve Cook set off from East Grinstead, walking down to the coast at Brighton to start his anti-clockwise walk around the coast. So far he has reached Dunbar in Scotland. He has a blog at http://www.walkthekingdom.co.uk/the-walk-in-detail/, and is walking in aid of the Drug Free Kids program.

A lady named Melita is currently walking the coast in sections. She set off from London Bridge in January 2013 and has walked the south coast as far as Plymouth in Devon, and the east coast as far as Hedon. She has a blog at http://mgctblog.com/ .

Jimmy Hudson is currently walking the coastline of Scotland in sections; he started from Brewick-on-Tweed on the 3rd August 2011, and he is currently in Drimnin. He has a blog at http://www.travelpod.com/travel-blog/jimmyhudson/1/tpod.html.

Rosemary Fretwell and another person are walking the coast in sections. They set off from Bognor in 1998 and are currently on the west coast of England. Their blog is at http://leftatbognor.blogspot.co.uk/.

A group of men are walking Scotland's coast in sections: details of their endeavour can be seen at http://www.walkingscotlandscoast.com. They have currently reached Armadale.

If you know of anyone else who has done, or is doing, the walk, please let me know.

Friday, 26 June 2015

Railway planning chaos

So the much-vaunted plans to upgrade many of Britain's railway lines have hit the buffers hard. What has happened?

Background:

Network Rail (NR) divides its agreed work into five-year control periods. The current period is known as CP5, which runs from April 2014 to March 2019. NR has been told it can spend £38.5 billion on its work during that period, a figure which includes: (1)

  • capital expenditure (£13 billion); this covers improvements to lines and stations, and new lines such as Crossrail or Thameslink.
  • replacing and renewing older parts of the network (£12 billion)
  • day-to-day maintenance and operating costs (£13 billion). 
It should be noted that three-fifths of this money comes from the government's Network Grant, whilst most of the rest comes from the passengers and freight operators who use the railways. (2)


Much of the work to keep the existing network running is self-financed by NR itself, using money it receives from the train operators in the form of Track Access Charges; last year NR actually made a profit. However new projects - such as electrification - costs more than NR can afford, and the government loans them the money as part of a Network Grant. As such, this work needs to be agreed with the government. In 2013-14, the Network Grant was £3.7 billion (1).

The program to electrify these lines came not from the government, but from Network Rail and the train operating companies, who persuaded the Department for Transport and the Treasury that it was the right thing to do.

The decision:

Yesterday it was announced that some of the capital expenditure on the Midland Main Line (MML) and Trans-Pennine Express (TPE) electrifications were to be postponed. This does not necessarily mean NR is spending less; they will still be spending £38.5 billion during CP5, just on fewer projects. In the autumn a review will state what should happen to these other projects.

What went wrong:

The first stage of the work on the Great Western Main Line (GWML) has turned out to be much more expensive than planned, and is behind schedule. Rather than progress work on the other schemes, the pause may allow NR to work out what went wrong and apply lessons learned to the other schemes. Alternatively, such recalculations might push the cost-benefit ratio to such a level that the schemes are not worth continuing.

Worse is the fact that NR is also failing on their bread-and-butter work: the track renewals and resignalling schemes that are done all the time as systems age. According to Rail magazine, in the first year of CP5, they have overspent by £230 million and are 77% behind schedule on overhead line renewals (that is replacing exiting lines, not creating new ones), 63% behind in signalling renewals, and 7% in track renewals. These are no-brainer schemes that they have wide experience of and should be getting correct.

It is clear that there is little chance of getting the other new work done within NR's £38.5 billion budget over the five years, and therefore a pause, whilst unfortunate, is probably wise.

Whose fault is it?

Network Rail's. They decide on the work that needs to be done, and produce a budget for that work that gets approval from the government. They have singularly failed to meet the monetary or temporal budgets they set, even if those were somewhat woolly in the first place (as mentioned by the Transport Select Committee in January (2) ).

Network Rail have some valid excuses. The sustained, vast increase in traffic (67.3 million more journey over the past year alone) has put pressure on the network and reduced the time available for maintenance works. But this cannot fully explain the delays.

The problem is that it is very difficult to work on lines that are in operation. An example of this was the vastly expensive WCML upgrade; planned at about £1 billion, it came out at £10 billion, over time and did not deliver everything planned. Often they only have lines between one in the morning and six the next morning; in those five hours they need to make the worksite safe, move equipment in and out, and do the work. Often this means that only two or three hours is work done a night, whilst the staff are paid time-and-a-half or double-time for the full shift. It is a very uneconomical way of working, and is getting more expensive as manpower and equipment costs increase, and the netwrok gets busier.

There is also a little fault on the part of the government, who from experience should not have trusted Network Rail's costings and should perhaps have slowed some of the work into CP6 (2019 to 2024) or later

The politics:

This is a major embarrassment for the government. Since they went into the election less than two months ago proclaiming these projects, they should answer when they knew this decision was a possibility, especially as there have been signs that the GWML upgrade has not been going well. However the ORR's report into the first year of CP5 which highlighted these failures was only released on June 12th, so alternatively the government might be congratulated for reacting quickly and trying to get things back in order.

There is another issue: rolling stock orders have been placed for new trains to run on the upgraded lines, and some of these may have nowhere to run. Whilst orders can be cancelled or postponed, perhaps at a cost, there is also a problem in that many of the trains that were due to be replaced were going to be cascaded down to other lines. This entire process will have to be rethought, and will leave people in old, out-dated trains for longer.

It has left a great number of unhappy MPs, mostly Conservatives, who were looking forward to upgrades to existing lines as much as other Conservative MPs opposed HS2. This may well have long-term knock-on effects for the government.

What about HS2? Politically, it makes the project harder; already anti-HS2 groups are using it as a sign that the project's costs will not be kept under control. But as detailed above, building a new line is in many ways simpler than updating an existing one that carries trains. As the disastrous £10 billion WCML upgrade shows, it is very hard to get a handle on the costs of such upgrades. So if you believe that more capacity is needed, this news strengthens the case for HS2, even if politically it is weakened.

Notes:

As a side issue, the TPE is being paused for another reason: some of the work might be replicated by HS3, which is part of George Osborne's plans for a 'Northern Powerhouse'. Whilst it makes sense to ensure that work is not wasted, passengers in the north deserve help now.

For another view, see Paul Bigland's excellent blog.

(1): http://orr.gov.uk/publications/reports/gb-rail-industry-financial-information/gb-rail-industry-financial-information-2013-14
(2): http://www.publications.parliament.uk/pa/cm201415/cmselect/cmtran/257/257.pdf