Cancer pancreatic tail

Just over a year ago, on 26 September 1996, my dear friend BW died from pancreatic cancer at a London hospital. I wrote about him as he lay dying, because of the huge injustice he had suffered, enduring two and a half years of being shunted from hospital to hospital to psychiatric ward, being told there was nothing wrong with him, despite a drop in weight from 16.5 stone to an emaciated eight stone. His wife is now in possession of two sets of hospital notes from the period. We know it is simply not true that they had found nothing wrong.

BW had called me in the spring of 1995 to say he'd been admitted to a London hospital with acute stomach pains.

At first he is diagnosed as suffering from an ulcer. After buckets of antibiotics, though, his GP is informed in May 1995 that all treatment is to be discontinued. Ulcers are off. From thereon BW's wife and family are told there is nothing wrong with him, in spite of his persistent pain and weight loss.

On 5 June a CT scan reveals increased shadowing in the pancreas: "The appearance in the left upper quadrant may be due to resolving acute pancreatitis." There are other, troubling references to the "pancreatic tail". Yet by November a consultant gastroenterologist writes to his counterpart at a second hospital: "Do we not just have to accept this is a pain of psychological origin and continue to direct management accordingly?"

A reply follows within days to the effect that BW "is going downhill in an alarming way. I must admit I would be very surprised if all this is psychological."

The first consultant persists. "He presents a sorry picture and looks ill, but I wonder if the whole problem is psychological in origin. He has a number of family and other stresses."

A second CT scan is arranged. The notes report: "A CT scan raised the possibility of pancreatic change."

By now BW is on a diet of painkillers. Next he is accused of laxative abuse. His hospital locker is searched. He is on tablets for depression. As the days and months go by he is accused of opiate abuse: hooked on painkillers, is the cry. He is asked whether he is hearing voices, whether he has a hidden desire to be slim. What he has is acute pain beginning in the left abdomen and moving around to the back like a belt, constant vomiting and diarrhoea, and massive weight loss. His only treatment by the end of 1995 has been antidepressants, diazepam and massive doses of pethidine.

By the summer of 1996 BW is a walking ghost. An entire community of friends and relatives is watching him die. Now he visits a second hospital, known for its cancer specialisation. The first question posed in the notes is "whether pethidine dependency is causing related problems?" He no longer eats, he explains, because of the extreme pain he suffers as he vomits up everything that passes his lips. He is accused of having a stash of his own pethidine tablets.

On 7 August 1996 his notes say: "Has had a CT scan recently, pancreatic mass found." They continue: "?Pancreatic cancer. Abdo pain weight loss ?cause." Next day: "went for abdo. No pancreatic mass seen." Now we see it, now we don't.

Three weeks later he is discharged.

Off to another hospital, psychiatric ward this time. He argues, cajoles, insists his pain is physical, pleads with his wife to get him out of this horrible place. Eventually he discharges himself.

Death stalks now. His stomach billows, he feels it is about to explode. He is readmitted to the original hospital, where they decide to operate to clear a blockage. And what do they find? Cancer of the pancreas, confirmed by the pathologist.

The last communication from officialdom is written by the consultant gastroenterologist at the first hospital. He says: "This is indeed a sad story and I am not sure what lesson we can learn except not to rely too much on even the most modern technology."

For myself, I can't help wondering whether a "black, self-confident, flamboyant, unemployed Rasta man", as he is called in the psychiatric hospital's notes, was simply not worth the cost to the NHS of the lengthy treatment of cancer? Perhaps it's just one of those hard choices we are all going to have to get used to.