Memories of Paul

When I was a student I shared a house with two friends, one of them was Paul. Everyone loved Paul, he was intelligent, easy-going and fun to be with. Perhaps too many people loved him, because sometimes he would request that if this girl or that girl turned up at our house, we were to tell her he wasn't in. On one occasion he insisted vociferously that we go to the pub (something we did not normally need to be persuaded) only to return to find out why: a girl he had met at a party had decided to call round, and she was so intent on seeing him that she had broken into our house and was waiting for him in his bedroom. It was all part of the rich tapestry of student life.

When Paul finished his degree he got a job with an accountancy firm to train as a chartered accountant. The office was in another town, where Paul moved, but he was still registered at the GP on campus. Whenever he had a GP appointment he would call into my lab so that we could go for a coffee. At that time it did not occur to me that it was odd how many times he was visiting his GP, but I later learned that for a while his immune system was compromised. Paul was very fit: he had been a county level cross country runner, was a keen cyclist and he did martial arts, so frequent trips to his GP was not normal.

Then early in January he turned up at my lab. Over coffee he said that he was about to see his GP because he had discovered some lumps in his armpit. It sounded worrying, so I asked him to call back after his appointment. On his return he told me that his GP was very worried about the lumps and said that he needed to see a cancer specialist at the University hospital just over the road. The problem was that this was 1988 and when she called the hospital she was told that there was a three month waiting list. Paul then asked her if his health insurance would help. At the end of December he had worked for the accountancy firm for six months and this meant that he was now part of the company's health insurance scheme. His GP told him it would, and called the hospital again. This time he was given an appointment for the same specialist the next day.

Then followed a whirlwind of activity. The specialist confirmed that it was cancer - a tumour in his neck - and two days later he was operated on to remove the tumour. Then he had months of chemo in a private hospital out in the country, and radiotherapy in a local NHS hospital. For his chemo his girlfriend would drive him to my house the night before, and we would have our own chemo session in the local pubs. The next day I would drive him to the hospital and a few days after his girlfriend would pick him up from the hospital to take him home.

As an accountant he cast a beady eye over the care he was getting. I don't know if he had requested a copy of the bill, or whether it was standard practice, but he took an interest in the cost of the drugs he was given. I remember him telling me how shocked he was over the huge levels of overcharging, but since it was being paid by the insurance company (and the premiums paid by his employer) he really didn't feel able to complain.

On one of these chemo sessions Paul took ill. It wasn't the usual nausea, it was far worse, so bad that the staff at the hospital called the specialist immediately. This was the same specialist who worked in the NHS hospital. I remember Paul telling me that the specialist turned up in a dinner suit - he had been bleeped while in the audience at the opera. It was a provincial theatre, so the opera must have been touring and hence the specialist was probably missing a performance that was unlikely to be repeated for a long time. Private patients were that special.

Then Paul needed an MRI scan. This was the early days of MRI. The technique had been developed fifteen doors down the corridor where I worked, but because it was a research lab they did not have the facilities for really sick patients. Instead, Paul was scanned in the University Hospital over the road. This hospital was one of five in the region that had clubbed together to buy their own MRI machine. It was installed in a container which was driven around the contributing hospitals on a regular schedule, spending a week or so in the car park of each one.

Paul described to me what happened. He was driven from the private hospital in a private ambulance. At the University Hospital he was put in a wheelchair and a porter took him to the queue of patients waiting to be scanned. Some sat on seats, some were in wheelchairs and others on trolleys. Paul was pushed past this queue of patients. He was pushed past this pitiful collection of humanity and pushed right to the front of the queue. I know that Paul had been grateful for his health insurance, because he had been told by the specialist that he may not have survived the NHS waiting list, but I knew from his voice when he told me about the MRI scan that he was truly ashamed of being pushed to the front of the queue. He could have waited but his status as a private patient meant that the other patients, regardless of how sick they were, did not count.

Paul recovered. He had two years of remission, and then the cancer returned. This time he was treated in an NHS hospital closer to his home. Although he still worked for the accountancy company, the health insurance no longer covered him. Sadly, his specialist could not determine the cause of the cancer. He had various operations to remove tumours from various parts of his body. Then it was discovered that he had a tumour between his spine and lungs. It was inoperable. But worse: the mineral balance in his blood was haywire and his lungs filled up with fluid which required a painful procedure to drain them.

By this time, I had changed jobs and moved house. My new job was unreasonably hectic, but luckily one weekend I did not have to work and so I visited Paul for the day. It was shocking. This once fit energetic man could barely move, and even the simplest of actions was difficult for him. I remember that the chairs in the sitting room had bricks under their legs: this was so that the seats were higher so that Paul could manage to get up after sitting down. He was too weak to get himself out of a armchair.
We spoke at length about his treatment, but his wife, a midwife, kept quiet. I later learned that she knew more about his condition than he did, she had asked the specialist the questions that he could not bring himself to ask.

The following weekend I phoned him to see how his treatment was progressing and he told me that his specialist had told him that his chemo had been stopped. I immediately recognised what was happening, but Paul was an eternal optimist. He told me about how there was an ultrasound technique that the hospital were trialling that could be used to drain the fluid from his chest. He told me about a new drug that he would be given once he had rested a while and regained his strength. He knew he had a future, I knew that he had been sent home to die.

The following Friday was my birthday. It was one of the few weeks that year that I was working in the office rather than on site. Mid morning I got a telephone call from my wife. She was tearful, she had had a phone call from the brother of Paul's wife (who, coincidentally, was the other student I had shared the house with). Paul had died that morning. He had drowned from the fluid in his lungs. The cancer had killed him.

I hated the job I was doing then. I felt bullied by my managers to work far longer hours than I was contracted to do and I felt that this company was making me neglect my family. When I found out when Paul's funeral was to be I told my manager - not requested, but told him - that I was going to the funeral. Paul was 28 when he died, in our modern age, and in peacetime, we do not expect people to die that young. I realised that life is too fragile and too short to allow others to exploit and abuse you. I changed jobs a month later.

Paul was never an advocate for private healthcare: during his years of remission he told me that his treatment had convinced him of the need for the NHS. It was partly the waste of the private hospital, the fact that they could charge whatever they wanted and the bill would be paid. This shocked Paul because it meant that they had no incentive to limit care to just what was needed. But I think his experience of being wheeled past the rows of NHS patients and taken to the front of the queue had a profound effect on him. I remember him describing the queue of people, and how he realised that the NHS treated everyone.

Now the days of Paul's treatment are returning. Thatcher's NHS was dire, but at least the service had real terms increases that could be counted in billions rather than Cameron's that can only be counted in millions and only then on a good day. Now patients are being denied NHS care: they are being told that they are not blind enough, or in enough pain to have the operation they need. Most of us thought that such days had been banished to the past, that the NHS existed to give us the care we needed, when we needed it. But now it is getting worse, we are seeing the return to the Thatcher doctrine that people should expect to pay for private care, either out of pocket or through insurance, and that those of us who could not afford private care would, like the queues of patients waiting for their MRI scan in that 80s hospital, be second in line to the private patients.

We are going back to the NHS of when Paul's cancer first appeared, but sadly, it can never bring back Paul.