At around 7:00 pm on 1st July last year, Claire drove me to John Radcliff Hospital in Oxford with high fever and acute pain in my lower back and legs.  As she drove, with mounting concern by both of us, my situation deteriorated rapidly; my breathing became shallow and laboured.  My state of health was such that we both thought, but did not dare say it, that this could be curtains for me.  I was still generally unwell and heavily medicated as a result of recurring bouts of sepsis, the last of which was a month earlier when I spent a week in hospital being tested then aggressively treated at home with, yet another antibiotic course administered daily by district nurses.

But that July day was different, very different in terms of severity and speed of deterioration.  By the time Claire parked the car at the hospital, I was barely able to answer her question when she asked if I could make the short walk from the car to the ‘Accident & Emergency’ building.  Claire found an abandoned wheelchair nearby and wheeled me into a very crowded waiting room.  She parked me in the nearest available space, and rushed over for the reception desk, and explained the severity of my situation.  Within minutes I was fast tracked for assessment and immediate help.  By that time, I was in a truly bad shape with barely any blood pressure, added to the original symptoms of fever, muscular pain and laboured breathing.

As they collected data from my fast-failing body, I was passed on from a nurse to a junior doctor, to an experienced emergency doctor then another doctor.  The only thing they administered initially was oxygen to help me breathe. In the meantime, my blood sugar level dropped dramatically, and they had to administer glucose shots quickly. With my blood pressure barely registering, they then had to administer drugs to encourage the flow of blood in my veins.  I remained conscious but not in a state to comprehend the reality of what was happening to me.  Claire did most of the talking, listening and answering their questions about my medical history.  I just maintained a single thought of ‘keep going, don’t give up, this is no time to go to sleep’.

Finally, a cannula was attached to my right arm, signaling the attempt of the medical team to administer drip medication of some sort.  The antibiotic medicine, prescribed by the doctor on duty called Dr Ruth Corrigan who it turned out specialized in antibiotics, was dripped through the cannula, but I remained feeling very unwell.  Claire would disappear and then reappear and talk to me to give me a summary of what was going on around me.  I took in some of what she was saying but most of it did not register, I just knew I was very ill and not quite up to the intellectual level of understanding the nuances of my state of health beyond how I was feeling.

At some point that night, Leila turned up with a look of fear and concern on her face.  The first thing she said to me was: ‘what the fuck are you playing at?’  That amused me but I was unable to show my appreciation of this reality check however, I thought it was quite a funny thing to say in the circumstances.  Leila and Claire had a conference with many questions by the daughter and answers by the mother.  A short while later, might have been an hour or so, Rosy, Faye and Adam (Faye’s fiancé) also arrived.

I remained out of it as though I was a casual and uninvolved observer.  What I remember at the time was requesting more blankets as I was feeling cold and staff being reluctant to oblige as my temperature remained alarmingly high.

I started to feel a little better and attempted to sit up in the trolley bed and discovered I did not have the strength to even raise my head and shoulders without the help of the young ones.  I was propped up and took in the chaotic atmosphere of the emergency ward.  It was manically busy and with me having Claire, Leila, Rosy, Faye and Adam, we did not help the situation where the staff must have been frustrated with so many of my family competing with them for space in the treatment cubicle.  Eventually, the young ones were persuaded by an assertive nurse to go home for some rest as things were stabilizing.  They left reluctantly, leaving Claire to keep vigil.

Late that night or in the early hours of 2nd July a consultant interventionist from Intensive Therapy Unit (ITU) turned up and spoke at length to Dr Ruth Corrigan.  Finally, the ITU doctor walked over to my trolley bed, introduced himself and explained that he was in charge of the ITU.  After examining my case and discussing it with the emergency doctor, he felt that it would be futile to admit me to the ITU as there was nothing more they could do for me that was not being done already.  He more or less said that he would rather use an ITU bed for someone who is likely to benefit and recover from their dire condition.  By that time, I was feeling a little more with it and could just about comprehend the implications of what he was saying.  However, I dismissed the idea of my terminal condition and resolved to wait for another blanket.

Strangely, although I was not wheeled to the ITU, I was kept in the emergency ward rather than just being admitted to a normal ward.  As it turned out, Claire later explained that staying under the care of Dr Ruth actually saved my life because she prescribed the right medication and dosage that proved to be the right one for my specific condition.  But it was many hours/days later that I came to appreciate that fact.  Dr Ruth finished her shift, spoke to Claire at length but I never saw her again, and wish I had, to thank her for what she did.  However, Claire subsequently looked her up and thanked her for her help on that fateful night.

At some stage after that long, long night, one of the hepatology consultants who had dealt with my case for the previous 5 months turned up and he too went into a huddle with the staff on duty in the emergency ward.  He finally came over to me, pulled up a chair and sat down to explain to us where things stood.  He said I was in ‘septic shock’, where the body’s vital organs fail one at a time until the whole body is beyond saving.  I asked how bad my condition was, so he reached out and touched the back of my right hand with his index finger for a second and pulled away then said my condition was terminally bad.  I asked him to be more specific in terms of how long I had left, and he said, not long, maybe hours or a day or two at best.   I asked to go home and spend my final hours in my own bed. This request was refused, and I was told I wouldn’t survive the journey in an ambulance. He then made the ‘generous’ offer to stop all medication immediately, thus curtailing my suffering!  If nothing else was working to get me back to some degree of ‘compos mentis’, his dreadful words did the trick.  I was alert and alarmed so, I refused his ridiculous offer.  He finally left me with Claire, and we had one of those awful and morbid hand-over chats about what she needs to do after my departure and reminding her of important and not so important matters to attend to.

Although I understood the difference between sepsis and septic shock, I still had a small grain of hope and determination to fight my way out of this tight spot.  I went to sleep, and Claire went outside to rally the troops again, to come and say goodbye, in case the hepatologist’s predictions turned out to be accurate.  They arrived fairly quickly. Leila, Rosy and Faye arrived with Kirk and Adam – Nabil, who was on duty, would arrive later that afternoon. Two palliative care nurses arrived to introduce themselves, promising to return later.  I was then transferred to the ward I had come to loathe – The liver ward on the fifth floor.  We were given a small side room, where we all spent the rest of the afternoon alternating between tears and laughter.

Before joining us in the side room, Nabil who as a doctor himself, was able to speak peer-to-peer to the hepatologist who gave him the same grim prognosis he had given me a few hours earlier but in technical terms, was shocked when he came into the room to see me looking not as bad as someone who is about to die.  At one stage I got very emotional and gave the six of them final instructions on how to be there for one another, no matter what!  They all nodded their agreement either to humour me or to end my cringy soliloquy, or both.  Having completed my performance, I promptly fell asleep.

When I woke up in the morning, I could barely remember what had happened a few hours earlier.  I had an urge to go to the toilet and realised I was hooked up to a drip but, after a year spent in hospitals in Cyprus and England, I was very familiar with how to steer the whole mechanism to take myself to the nearest bathroom.  I then realised that Claire was asleep on the floor next to my bed on the same side as the drip.  That was the first time Claire had spent the night in hospital with me but, I was more concerned at that stage to get myself to the toilet.  I sat up in bed and maneuvered myself to get hold of the mobile drip unit and steer it with me towards the toilet but without waking Claire up.  This took forever but I finally made it to a small toilet within the small private room I was given.

When I returned to my bed, I began to assemble the events of the previous night trying to make sense of what had happened.  I could only remember the last conversation I had with the hepatology consultant who promised my imminent death.  I was heartened by the fact that I was still there, that I was not shaking violently, and my breathing while was not brilliant, was much improved.

Claire woke up and if she was surprised to see me alive and sat up in bed, she didn’t show it.  Soon, a palliative care person appeared and put on a sincere look while explaining that she and a couple of colleagues would like to come later to discuss with us the finer details of how to see me out of this world in the most comfortable and agreeable manner.  The nurse in charge that morning was a lovely woman called Myfanwy.  She made an appearance and cheerfully promised to look after me well.  Myfanwy measured my blood pressure and temperature, decided I needed more fluid and left to make the necessary arrangements.

A second hepatologist consultant (female this time) came briefly to arrange for a meeting to discuss final discharge and palliative care arrangements with us.  I had met her on a few occasions before and she did empathy much better than her colleague and was more suited to delivering final bad news than him.  We agreed to meet on Friday morning, 5th July 2019 with all the family there so that they could ask questions and get a first-hand understanding of my terminal condition.  I was unpleasantly surprised they planned to keep me for so long, but the consultant explained they needed to administer the antibiotics intravenously and that can only be done in hospital.

The day somehow went very quickly in spite of the fact I was constantly being prodded, measured, sampled and medicated.  Claire stayed for another night, which was long and unpleasant because nurses kept on coming what seemed like every three minutes to check on me; I am not sure whether they wanted to see if I was still alive, or to make sure I remained alive.  Whatever their reasons were, I made it to the following morning feeling better than the day before.

On Friday morning, the gang gradually assembled, and we were quite upbeat for some reason.  The palliative team of three soon joined us and explained that I would be handed over to a local team near where we live in Wiltshire who would go through the process in more detail.  They were kind and sympathetic but, seemed to be ill-fitted in the ambience of the room at the time.  They checked our contact details, said their goodbyes and left.

Finally, the second hepatologist arrived and sat down surrounded by eight of us and subjected herself to a barrage of questions from all but one of us.  Nabil kept his powder dry until we all finished asking our laymen questions.  Finally, Nabil and she sensed he knew more than a layman so, in answer to her question, he ‘confessed’ he was a nephrologist (ever the modest type, he is actually a consultant paediatric nephrologist).  He asked her to confirm a few facts regarding my treatment going forward and why had they not considered a specific type of antibiotics (Co-Trimoxazole) as a prophylactic.  She said she didn’t feel it would be useful but promised to look into it.

When the hepatologist left, Faye and Adam disappeared for a while and came back to explain that they had asked the hepatologist if the hospital would be prepared to write and explain I was in a terminal state.  They had decided the previous night to bring forward their wedding arrangements from May 2020 to as soon as it could be fast tracked, in the hope I would make it to walk Faye down the aisle.  Normally wedding licences take a few weeks to be issued, unless there is a serious situation that compels haste, such as imminent death.  Setting aside the emotions and tears, etc. of this unexpected announcement, I now had a motivation to drag myself, one way or another, to the wedding day.

To celebrate Faye and Adams’s news, we all decided to go down to the hospital restaurant and feast on fish and chips – yes, even me, who wasn’t even supposed to be alive.

After the first dramatic 48 or so hours, not much happened until I was discharged.  Nurse Myfanwy kept to her promise of looking after me, and I was seen by junior doctors, who no doubt reported to the consultants that I was still hanging in there.  Claire spent four nights sleeping on the floor of my hospital room and finally felt confident enough to leave me to go home and get a change of clothes for the both of us.  On the Saturday, I had a visit from our niece, Nadia.  In between being examined, medicated and quick visits, I had plenty of time to reflect on what had happened to us, wondering if I was really going to die soon and if I would get another terrible septic shock first.  I kept going back to the same positive thought of wanting to live until after Faye and Adam’s wedding.

Before being released, the male hepatologist consultant turned up with a junior hepatologist and had three matters he wanted to address with me.  firstly, he confessed to getting it wrong as I evidently had not died yet, but he said he didn’t mind being proved wrong in such situations, I agreed with him fully.  Secondly, he asked if we should arrange for a further consultation visit and having asked the question, he quickly volunteered the answer by saying: probably not.  Once again, I agreed with him fully.  We in fact agreed that I would be permanently discharged from the John Radcliff Hospital because I may still die soon anyway.  Thirdly, he confirmed that, as suggested by Nabil, Co-Trimoxazole antibiotic would be prescribed for me upon my release.  He left the room and I believe he on the one hand and Claire and I on the other were relieved we would not see each other again, not in this life and hopefully, not in the afterlife either.  We more or less resolved to seek a second opinion elsewhere.

After a full week of a complete intravenous antibiotic course, I was finally discharged from the care of that hospital to be left in the hands of the local palliative care team in Wiltshire and in the unlikely event that I needed further treatment; I would go to Swindon Great Western Hospital a few miles down the road.

In contrast to the journey to the hospital in Oxford a few days earlier, the journey home was a happier, more comfortable one.  On the way to hospital, we suspected I might die.  On the way home, we spoke about a second opinion, suspecting I might live.

On 18 July, a beautiful English summer’s day, I proudly walked our lovely Faye down the aisle in a period house (Purton House), close to where we live, set in picturesque grounds, originally owned by a wealthy local family, now adapted for functions such as weddings and corporate events.  Yes, I was weak, yes, I was still in danger of getting another bout of sepsis or more likely a final septic shock but, I did not give a damn!  The wedding reception was held in the garden of our house with about thirty of us and we really had a wonderful time; a day to remember for as long, or as short, as I live.

With help from both families and close friends, the wedding was beautifully arranged from formalities, to wedding cake, wedding dress, venue selection, catering and so on all accomplished in less than two weeks!  As it turned out, with the Covid-19 Pandemic, Faye and Adam’s wedding, originally scheduled for May of this year, would have been cancelled due to the Lockdown rules we were under.

A full year on and feeling much better than I did since my initial operation in Cyprus two years ago.  We occasionally discuss that first week of July 2019 and express astonishment at the way they dealt with us in Oxford, but in all honesty, medicine is not a precise science, a lot is based on experience, intuition and laws of probabilities.  Any doctor is likely to get it wrong every now and again.  Some of the family members wanted to write to the hepatology department saying I was still alive.  I see no pleasure or satisfaction to be gained from such an action besides, why tempt fate?  I derive satisfaction from knowing that with a big dose of luck, an equal measure of determination and a large amount of family and friends’ love, anything can be achieved.

Faye and Adam will have their first wedding anniversary soon and I cannot wait to congratulate and thank them for giving me a reason to live.

I wish you all good health.

Acknowledgement: Due to my state of health at the time, the above story would not have made sense at all as a coherent blog without a significant input from Claire who provided the facts, times, dates and entire events.  Thank you, darling!

Mufid Sukkar; 1 July 2020