Dr Bhan is an excerpt from my medical memoir. This is 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. Dr Bhan is a fictional name, in place of the doctor who I saw about this issue.

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Chapter 4

London

May, 2014

It was a long train ride down to London to see Dr Bhan. I was weak. Walking was an effort. The left side of my face was so sore that I was unable to sleep on my left side. My jaw region was rock hard, and I had chills rushing up and down the left side of my face. I felt nauseous and downright awful.

The night before my first appointment with Dr Bhan, I stayed in a hostel in Kennington, not too far from London Bridge. It was on a leafy street. There was a café next door. It resembled cafes that I had been to in San Francisco. There was ambient dub music playing, and there was a solo cyclist sitting, drinking coffee while web browsing. I was sharing the dormitory that night with two Japanese women, and I was in and out of the toilet, throwing up most of the night.

‘You sick?’ one of the women asked.

 ‘I’ll be OK,’ I replied. ‘I’m seeing a doctor tomorrow.’

A Private Hospital

The private hospital was within walking distance of London Bridge station. It was a tall building with large stone pillars in front. This new team were rheumatologists. Their speciality was connective tissue diseases, mainly Lupus and Sjogren’s syndrome. I wasn’t sure why Mr. Badawi had referred me here when I had a suspected soft tissue infection. But I walked through the door anyway, in the hope of some help.

The doorman was a beautiful-looking Ghanaian man named Dodzi, who flashed me a welcoming smile as he opened the door for me. The building smelt like grapefruit mist, and it had an old-style birdcage elevator with a manual scissor gate. I exited the lift on the second floor to a waiting room with plush brown carpets and large windows that overlooked the River Thames. The concierge was a short, middle-aged guy. He was called Graham. He booked me in for my appointment. Graham had a broad Bermondsey accent, which made me feel immediately welcome.

The back of my neck and the palms of my hands were sweaty as I waited nervously for Dr Bhan to call me. Dr Bhan was a rheumatologist. He was a tall man of Indian descent who was wearing a pair of casual chinos and a burgundy tank top. He appeared at the door of the waiting room with a wide-open smile and sparkling white teeth. ‘Felisha Solomon,’ he called, and he led me along a corridor to his beautiful consulting room. I had never seen a doctor’s room like this before. It was huge. There were large windows behind his desk, out of which there was a cinematic view of Tower Bridge and beyond. The sky was belting blue, and this expansive vista inspired a feeling of hope in me.

The Consultation

‘Please take a seat,’ he said politely.

There was a stream of my medical records on Dr Bhan’s desk. Mr. Badawi had faxed them across. Dr Bhan clearly knew the backstory with Professor Wong. However, with a consultation fee of £195.00, I hoped that he would give me a decent hearing.

‘I’ve had a read-through of the story so far,’ he said. ‘Where exactly is your pain now?’

‘It hurts around my eye and jaw area,’ I replied, ‘my jaw feels rock hard and it hurts to open my mouth.’ I told him how ill I felt and about the chills running up and down the left side of my face. I also explained that I had not had any medication for five months since Professor Wong stopped my treatment.

‘You do look ashen-white and very unwell,’ he said. ‘I want to do an examination of you and do some urgent blood tests to see what’s going on.’

Dr Bhan was well-spoken. He had a deep and soothing voice, and he emanated a charm and professionalism that you couldn’t fake. I didn’t know where in India Dr Bhan was from. I thought that he perhaps came from the Kashmiri or Punjabi region. His face was narrow, and he was light-skinned. He didn’t have the darker shade of skin of the Tamil people. I lay on an examination table. Dr Bhan prodded my abdomen and groin area. He examined all of my joints but he then spent most of the time examining the area around my left jaw.

 ‘Your masseter area does feel very tender, he said. ‘I can feel that there’s something there.’

Blood Tests

I got dressed. Dr Bhan returned to his desk to jot down some notes. ‘Can you tell me which antibiotics you have tried?’ he asked.

‘I have tried most of the macrolides and doxycycline.’

‘Let’s get some blood tests done, and then we’ll come up with a plan,’ he said, handing me a green slip. ‘I’ve requested a full blood count, along with your ESR and a renal and liver function test. I also want to see what’s going on with your antibodies and electrolytes. Once they have done your blood tests, just return to the waiting room. I’ll come and get you.’ His politeness was such a welcome contrast to the volatile disposition of Professor Wong.

I made my way along a carpeted corridor to the blood test room, where a smiling phlebotomist was waiting for me. Rafael was from the Philippines. He had been in England since the age of 14. He had an infectious smile and a magical way of distracting my attention away from the prick of the needle going into my arm. My blood tests were all done and dusted in under ten minutes.

The speed at which private healthcare moves is incredible. I was sitting in the waiting room for under half an hour while Graham told me all about Manzies, the local pie and mash shop that still served jellied eels, before Dr Bhan called me back in. He had all of my blood results on his computer screen.

‘There’s definitely something going on with your white cell count,’ he said in a pacifying tone. ‘Your neutrophils and ESR markers are raised. Your red cell count, haemoglobin count, and mean corpuscular haemoglobin concentration are too high. I would just like to examine your masseter region again,’ he said. He stood up.

A Lightbulb Moment

Dr Bhan pressed into my jaw area with his thumb and middle finger. I squealed.

‘Is it painful there?’ he asked.

‘It’s agony, Dr Bhan,’ I said, ‘Please can you help me?’ A tear dropped from my eye and landed on his Jesus Creeper sandals, which he was wearing with socks.

‘I’m on your side,’ he said, holding my hand. ‘I think you may have some lymphatic drainage damage.’

I looked into his wide brown eyes and studied the small tufts of blackened hair around his ears. ‘What’s lymphatic drainage damage?’

‘Well…’ he began before clearing his throat. ‘Pervasive infections like this can sometimes damage the lymph nodes. This means that lymph fluid cannot drain away as it should, and this can create stubborn swelling and repeated infections.’

He just admitted that I had an infection. ‘What can we do about that?’ I asked.

‘I don’t know, Felisha, this is a challenging situation,’ he replied. He pronounced my name the American way. It grated a little, but I liked him too much to correct him. ‘It’s rare to have this condition in the facial region,’ he continued. ‘Most patients get lymphoedema in the arms and the legs.’

Empirical Treatment

We sat back down. I felt a weight lift off my shoulders. Someone was trying to help me. The midday sunlight was streaming into his consulting room. Dr. Bhan pulled out his prescription pad. ‘I can’t provide a diagnosis at this stage, but there is clearly something wrong. The blood tests show evidence that you have an infection, and your masseter area is tender, but I’m going to have to treat this empirically.’

I didn’t know what empirically meant, but I looked it up in the dictionary when I got home. Empirical treatment is the initiation of antibiotics before identifying what the infecting microorganism is. He was going to treat my illness with antibiotics without knowing the exact cause of my disease. Fine with me. He removed the cap from his beautiful black-and-gold fountain pen.

‘OK,’ I replied.

‘I don’t know are three of the most difficult words for a doctor to say. I’m afraid that I don’t know exactly what this is, but I’ll hang in with you until you’re better,’ Dr Bhan said.

I loved this guy. I didn’t love him in an inappropriate way, but instinctively and innocently. He was a deeply intelligent medic who had an enquiring mind and the ability to be honest and humble in a way I had never seen in a doctor before. We talked through different antibiotic options.

‘I’m going to try you on Rifampicin,’ he said. ‘It’s an antibiotic that treats tuberculosis, but it’s potent. It may help to alleviate your symptoms. I’ll give you two weeks’ worth of capsules and I’ll see you again in a fortnight. We’ll see how you are then.’

I watched as he wrote me a prescription. He had broad cursive handwriting. Dr Bhan handed me a pink private prescription and a blood test form. ‘I’d like you to get these blood tests done before I see you next,’ he said, and he walked me out of the department with his characteristic grace.

Relief

I made my way down to the hospital pharmacy. The Rifampicin cost £70.00. The blood tests cost £200.00, and the consultation with Dr Bhan was £195.00. The pharmacist handed me two boxes of antibiotics and warned me that my urine might turn darker while I was on them. I quickly swallowed two burgundy capsules with a cup of water that I got from the water cooler. I sat on the leather sofa opposite from where the dispensary, and I asked them if it would be OK for me to rest on the sofa for a few minutes.

‘Certainly, Madam.’

I must have laid down. My memory is hazy, so I can’t remember, but I woke up on the black leather sofa three hours later. It impressed me that the staff had left me to rest. I felt a deep relief, like I was just recovering from a burning fever. There was still that stubborn pain in my face, but the change in how I felt systemically was radical. I thanked them and left the hospital.

After I left the hospital, I wandered through Borough Market, enjoying the cheese stalls, the bright tulips, and the fresh fruit and vegetables for sale. The Asian aromas wafting from the Oriental food stalls reminded me of my travels to India. I found a cafe, where I bought a cuppa for £1.00. I drank my tea while listening to the rail squeal as trains drew into London Bridge. The relief that I felt from having taken those Rifampicin capsules was miraculous.

Waterloo

I walked towards Waterloo. The ambience was more vintage than I remembered. There were quirky bookshops and funky restaurants dotted around. It was early evening. The sky was still bright, and the temperature was warm. There were groups of people sitting outside drinking beer. I found a Persian restaurant, where men sat outside puffing on hookahs. I was starving. Because of feeling so nauseous, I hadn’t eaten properly for weeks. I ordered a kebab and flatbread, which I scoffed. The Middle Eastern taste of caraway seeds blended with turmeric was wonderful. Then I headed across the road to the Young Vic Theatre, where I bought a ticket to see a one-woman show. It felt like a celebration. I wasn’t better. Far from it. But I had found a doctor who ‘was on my side,’ and I finally had some medicine in my system.

Antibiotics & Steroids

I saw Dr Bhan every two weeks from May to October, 2014. After that, my appointments with him became monthly. The oral Rifampicin didn’t affect the pain and swelling in my face. The capsules did, however, alleviate those awful chills and my malaise. We cycled through different antibiotics, including fluroquinolones, Ciprofloxacin, and Levofloxacin. Unfortunately, Levofloxacin gave me severe Achilles tendonitis, which I still have after 9 years. Levaquin is a lethal drug, which I believe Janssen Pharmaceuticals stopped making in 2017.

We looked at the option of Dr Bhan prescribing Linezolid, the effective antibiotic that Professor Wong had prescribed, which is known to penetrate soft tissue and muscle better than other antibiotics. But a private prescription for one week of Linezolid was £1000. Back in 2014, Zyvox had the patent, and there was no generic brand. As a paying patient, that was out of the question.

Dr Bhan tried me on an eight-week course of oral Prednisolone with a reduced weekly dose, but the steroids made my symptoms worse. They produced a nasty feeling of pressure, like someone was pressing a heavy sheet of iron across my face. We didn’t try them again.

It was a difficult one. My neutrophils, red blood count (RBC), white blood count (WBC), and mean corpuscular haemoglobin concentration (MCHC) came down to within the normal range when I took the antibiotics. I felt less unwell systemically, and those nasty chills diminished. However, my facial pain only slightly mellowed. When I came off the antibiotics, my symptoms returned within days, and my infection markers shot up. There was no explanation for this, but I was certain that there was a stubborn infection going on in my facial soft tissue.

A Small Triumph

I felt the imprint of Professor’s Wong’s decision to terminate my treatment every time that I paid for my appointments with Dr Bhan. Each visit, including travel to and from London and an overnight stay in London, was around £590.00. This included the blood tests and medication. However, I was, thankfully, able to return to my Master’s degree in October 2014, thanks to Dr Bhan’s care. I had only missed one term. It was challenging to write with the persistent pain around my eye. I could only write for short bursts, and attending supervision meetings on campus took a lot of effort. I exerted that extra bit of effort because I was determined to carry on living my life in spite of my uncured illness.

Photo & Video Credits: Gustavo Fring, CottonBro Studio, Orlovamaria, Kampus, Ketut Subiyanto, Tonywuphotography and Alena Shekhovtcova on Pexels. Gerd Altmann, Kranich17 and Darko Stojanovic on Pixabay. Taras Chernus and Diego Ph and Michael Heise on Unsplash.