There are days when I can’t ignore my illness, and days that are so core to my strategic plan for dealing with my illness that I can’t afford to ignore them.

There are days when even I need to re-cap. Exhibit A: a CT scan report that tells me of a node on my upper left pulmonary hilum with a small loculated effusion. Exhibit B: a letter requesting me to report for surgery at 07:00 Tuesday August 18th.

Remind myself: patients with cancer have tumours in the bronchial wall (or externally compressing the bronchus) or in the area around that (the hilum). These tumours block the airways until the alveoli are unable to fill with air. The lung parenchyma collapses onto itself. A collapsed lobe is called atelectasis (“ah-ti-lec-ta-sis”). It is harder to breathe, the collapsed tissue is irritating and coughing up mucus and blood occurs frequently. Coughing up blood is known as haemoptysis (“heem-op-ti-sis”).

Although it affects me daily, I’ve not focused so much on that tumour. It hasn’t changed much in the last few CT scans. Instead, my attention goes to the smaller tumour on the anterior mediastinum. It may be small, but it has done disproportionate damage by touching a nerve that has led to unilateral vocal cord paralysis.

Tuesday 18th was the day we were supposed to correct that. The procedure is called a vocal cord thermoplasty. They put you to sleep and then inject collagen into the paralysed left vocal cord. The effect is that it is bigger, and the working right vocal cord can touch against it more easily. This stops your voice sounding hoarse and being unable to rise above a whisper in volume.

I got to the stage where I’m in a hospital bed and all dressed up with gown and surgical stockings. I’m on first, due in theatre at 08:00. There will be routine visits first from an Anaesthetist and an ENT Consultant.

Except the visit from the Anaesthetist is anything but routine. He’s saying that he refuses to give me a general anaesthetic, due to my atelectasis. He says (and I quote) that any monkey could send me to sleep, but that he is worried about waking me up. He apologizes that this is late news, but that he only saw my case notes the day before. He had asked a senior Anaesthetist, who advised him not to proceed.

Now, I sort of get it that presence of atelectasis could be a “red flag” condition that precludes the use of general anaesthesia, since atelectasis is a common risk during anaesthesia.

But if so, why isn’t it known and flagged as such? Why would an experienced ENT specialist get as far as the morning of a vocal cord thermoplasty before it is raised by someone else as an issue? Why didn’t either my Oncology or Urology consultants know that my atelectasis precludes me from any surgical procedure that requires general anaesthesia, and warn me to this fact?

If it is a case-by-case consideration, why did the Anaesthetist not review my case notes earlier than the “day before”? His summary was full of errors: he said that my last “report” said it had got worse. Just wrong. They sent me for an X-ray (when he should have called Oncology to discuss the much more accurate CT scan results).

Anyway, he had power of veto and the ENT Consultant was obliged to tell me it was off. I made my feelings known and my opinions clear, but then I had to trudge home. Untouched.

I spent that day searching: trying to confirm that atelectasis precludes the use of general anaesthesia. I could not find any evidence that it does. Even if atelectasis occurs during anaesthesia, they have ways of dealing with it. I’ve just run into a junior Anaesthetist who thinks doing his job involves a quick read on the night before surgery, and deciding procedure on the fly.

There is an alternative to the procedure that requires a general anaesthetic. It’s called medialization thyroplasty or thyroidotomy, and it involves an incision of the larynx through the thyroid cartilage. Then they push a silicon implant under the vocal cord, using the hole they made in your throat.

That has to be scheduled, and I reckon another six to eight weeks has been lost. Then, imagine the scenario. Only a local anaesthetic, and a surgeon approaching your throat with a scalpel to cut it open. I’ll fight the fear and will see it through, but that Anaesthetist  has done me no favours. Especially as I hoped to follow this with a second “running repair” operation that also requires anaesthetic. At least that one can be done with spinal anaesthetic instead of general anaesthetic. At least, I think so.

My plan to reach the Plateau of Relative Normality has been dealt a blow. It is a setback.