Professor Swinford is an excerpt from my medical memoir – a work in progress. The genre is creative nonfiction. It is based on real-life events. All names have been changed to protect the identity of the individuals involved. Professor Swinford is a fictional name in place of the professor who I saw.

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Chapter Five

London

July, 2014

Professor Swinford was the professor of ophthalmology, to whom Mr Badawi referred me. I had to move to a new GP practice first so that I could get the second referral that Mr Badawi explained that I would need. I contacted NHS England, and explained my situation to them. NHS England registered me at a new GP surgery. The new surgery accepted me as a patient under the agreement that I did not request home visits because I was out of their catchment area. A locum GP at the new GP practice seconded Mr Badawi’s referral to Professor Swinford. My first appointment with him was in July 2014 at a large NHS teaching hospital in London.

I had a horrid taste of metal in my mouth as I waited for Professor Swinford to come and get me from the waiting room. He was small, with short, curly grey hair and a distinctive pimple on his cheek. Underneath his stained white coat, he wore casual attire, jeans, and a checked shirt. He looked like he was in his early sixties and walked with a limp, which I noticed as I followed him along the lengthy corridor to his consulting area.

The ophthalmology clinic was a large open-plan room with no windows. There were ten ophthalmic consulting stations dotted around the sides of the room, where ophthalmologists with different specialities saw patients. At each station, there was a black leather examination chair, a slit lamp, a phoropter, a retinal camera, and an ophthalmoscope. There was a close smell of acidic substances and a more distant stench of mashed potatoes.

The Consultation

The clinic was busy. I could hear conversations between clinicians and patients that were taking place around us. We sat face-to-face under a bright spotlight. I sensed a barrier from professor Swinford, which I suspected came from him reading the notes that Mr Badawi sent him. He knew it was a ‘complex’ case. Professor Swinford was a well-spoken man. He talked in a quiet tone, but he maintained eye contact with me when he spoke. I told him about the pain that I was feeling around my left eye, particularly around my temple area.

‘What are you currently taking for pain control?’ he asked.

‘Rifampicin,’ I replied. ‘I feel better than I did, but it’s not getting rid of the pain around my eye.’

His eyes scanned my left eye region. ‘Let’s take a closer look at your eye,’ he said. I rested my chin on the ophthalmoscope. He twisted the dial so that the bright light came right up to my retina, making it challenging not to blink. ‘Everything looks OK inside your eye,’ he said.

My Left Ptosis

I asked Professor Swinford about my small left eye. ‘It hurts,’ I said. ‘It’s smaller than my right eye.’

‘Yes, you’ve got a left ptosis,’ he said.

‘What’s a ptosis?’ I asked.

‘The levitator muscle on your eyelid has collapsed.’

The memory of when my eyelid collapsed was still close. It was shortly after I had finished using the Maxitrol eyedrops, and I had that awful sensation of worms wriggling in my lower eyelid. I was standing in a sunny hotel room in Southport, and my left eyelid fell.

‘Can you do anything about it?’ I asked.

‘It needs corrective surgery.’ Using his middle finger and thumb, he raised my upper eyelid to where it should be.

‘That feels better when you do that,’ I said.

‘Yes, it will feel better, but it’s not safe for you to undergo corrective surgery while you have these symptoms. It could make matters much worse for you.’

‘Is there a surgeon at this hospital who could do it?’ I asked.

‘Yes, we have an excellent oculoplastic team here who could correct it.’

Professor Wong didn’t tell me about my ptosis. I felt a wave of nausea thinking about that intimidating meeting with him and his colleagues in January 2014. I had shown him the photo on my BlackBerry phone of my small eye, but he shooed me away, like I was a stray cat. It was a relief that Professor Swinford had diagnosed my ptosis, but I was frustrated that he had no interest in finding out what had caused my levitator to collapse. I wanted to find out what was causing the pain and swelling around my eye and cheek, and my symptoms in general.

Resistance

I could feel the resistance from Professor Swinford to diagnose and treat my condition.

‘What about the swelling around my eye?’ I asked. ‘It hurts.’

‘Yes, I can see the swelling. It’s the soft tissue, that’s the problem.’

‘Can you help with that? I’m in a lot of pain.’

He shook his head tersely. ‘I don’t deal with soft tissue problems. I specialise in uveitis, which is inflammation of the eye itself. You don’t have that. Your problem is with the tissue surrounding your eye.’

What I found hard to fathom was the lack of curiosity, a wider intelligence, a desire to help, or a general feeling of care that these medics didn’t have. They were nonchalant. They found a way out of having to take any responsibility for my clinical problem. I had severe pain and swelling around my eye. Professor Swinford was a professor of ophthalmology with a notable reputation who had identified that I had a problem with the soft tissue and that something had caused my levitator to collapse. He had a team of 20 clinicians under him who could have helped me, but he used a feeble excuse for not helping, saying that this wasn’t “his speciality.”

Surprise

He did surprise me, though, with an outburst of anger mid-consultation about the fact that they weren’t treating me up north.

‘Why are you down here seeing clinical teams? Why aren’t they treating you back up north?’ He asked with reddened cheeks and a stern frown.

I started to speak, but I tripped on my words.

‘Why are you paying all of this money to see this private rheumatologist? Why are you paying for your antibiotics?’

 I looked at him head-on, ‘Take that up with your colleague, Professor Wong,’ I said. ‘He will fill you in.’

No more was said.

‘Keep taking the Rifampicin,’ he said. ‘What about steroids. Have you tried them?’

‘Yes, I have tried oral Prednisolone, but it made things worse.’ I replied.

‘Would you be willing to prescribe linezolid. It really helped me before,’ I said.

‘No, he said, shaking his head. I won’t. I’ll keep you monitored and see you again in 3 months’ time. We’ll see how things are then.’

It was busy on the Embankment when I exited the hospital. There were mime artists entertaining groups of tourists and buskers playing music. My first appointment with Professor Swinford left me with mixed emotions. I was relieved that one piece of the puzzle had been found (my ptosis), but angry that he wasn’t going to address the actual problem. He told me the truth, in part, but he also chose to turn a blind eye to a clinical problem that he identified.

Reflection

I noticed when I saw Dr Bhan again, who had received a copy of Professor Swinford’s clinic letter, that he was more attentive now that there was a diagnosis of my ptosis and that Professor Swinford said to continue taking the rifampicin. Clinicians work together under a system of agreement and do not like to wrong-foot one another. They follow one another’s opinion, even if it is contrary to what the patient is saying.

I was up and down from Yorkshire to London a lot over the summer months of 2014, and I needed to find somewhere to stay when I came for my appointments, which were in south-east London. I found somewhere that became very dear to my heart, and I began a new and long-lasting love affair with the city in which I am from.

My Mother’s Legacy

My mother was frugal. She was a posh bird by trade, but she was none the comfier, tucking into a chicken salad and drinking a mug of ‘builder’s tea’ at the local community café. If I tried to egg her on to go to the Hungarian café on Finchley Road, she wouldn’t have any of it. She was from a well-to-do Jewish family, but she had a no-frills approach to life. Two failed marriages had left her bereft of wealth. She was a single mother of three children, whom she raised on a part-time wage as an NHS receptionist, so she had to watch the pennies.

My mother was a thrifty woman. She would banter with the fruit and vegetable stallholders at Swiss Cottage Market and could always get a few pennies knocked off a pound of tangerines. Growing up in the Primrose Hill area, most of my friends came from wealthy families. I couldn’t afford the latest Nike Air Max trainers as they all could, but my mum’s thriftiness made sure that I could just about keep up to speed with the latest trend. We would go to Queens Crescent Market early on Saturday mornings, where she would find me a pair of knock-off Nike trainers that looked like the real deal for under a tenner. Because of my upbringing, I gravitate generally towards ungentrified places, where bankers have not yet turned old muck into shiny gold.

Walworth Road

I found my slice of heaven in the Walworth Road area of Elephant & Castle. Walworth Road was lined with greasy spoon cafés, electrical discount shops, pawn brokers, and, of course, East Street Market, where you could get a bag of apples and pears for under a fiver! Not a Costa Coffee in sight, I felt at home here, even with the sound of sirens constantly whizzing by.

I found a hostel in that area. It was in an old converted church with airy rooms that had steeple-like ceilings. Depending on the time of year, it could be quiet with one or two travellers, or it could be heaving with big groups of tourists. The manager knew that I was coming down to London for medical appointments, and in the winter months, when the hostel was quiet, he would give me a wink; room 12 is empty. It’s all yours, darling.

Then I got a dormitory all to myself. Mostly, I was in crowded rooms with overweight men who snored, but this was my home when I came to see Dr Bhan or Professor Swinford. I travelled by Megabus from Bradford to London the day before my appointment, headed to my hostel, got a box of curried goat and rice from the Jerk Chicken shop, and bedded down for the night.

I fell in love with southeast London. It wasn’t a part of London that I had explored before. Camden and Islington had been my stomping grounds during my teenage years, and where I had spent most of my time, while growing up. It was great to discover areas like Tooting, Greenwich, and Deptford, all understated places buzzing with diversity, and there were no memories of my past in this part of London. It was a blank canvas to explore.

A Pattern of Behaviour

I could see a pattern of behaviour emerging with these medical professionals. There was evidence that there was a clinical problem. They knew that there was something wrong, but doctors don’t like cases where patients have seen a lot of other professionals. My case was not attractive. I don’t think that they had anything against me, but there was an invisible wall that was erecting before me, a wall that was built on a silent agreement between these clinicians to not name or diagnose what was wrong, because to diagnose or name it would be to admit fault somewhere along the line. It was playing out like a game of Chinese whispers.

There was a definite defensiveness coming from medical consultants, but with my body reminding me every second of every day that there was something wrong, I had a duty to push against their collective resistance.

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Photo Credits; Tima Miroshnichenko, Olgalioncat and Suzy Hazelwood on Pexels. Sander Sammy, Jon Tyson, Dylan Nolte and Christina Langford Miller on Unsplash. Leroy Skalstad, Roszie, Andrew Martin and Norwich-blueprint on Pixabay.