My Decision May Surprise You

Last Friday evening I was invited by a friend to the Richmond Theatre to see the 1950s play ‘Twelve Angry Men’. You may remember the famous film, in which Henry Fonda played the character of Davis or Juror #8 who is the only one of the twelve jurors at the start of the play who believes that the defendant may be innocent. All eleven of his fellow jurors think that it’s a ‘no brainer’ that the sixteen year old boy accused of stabbing his father to death, is guilty and should face the death penalty. Over the course of the play, Davis gradually puts enough doubt into the minds of every other juror about each part of the evidence, that by the end all twelve agree to return a verdict of Not Guilty.


I mention this because last week I asked you to help me to make a decision, which, in its own way, could mean life or death. There were well over 100 wonderfully thoughtful responses (thank you so much!) and by a factor of about ten-to-one your overwhelming advice was to go ahead and have the full body and brain MRI scans that I have been offered for free. 


Some of you even used the term ‘no brainer’, because you could see only upsides and few, if any, downsides to making the decision to have such a thorough investigation into my current state of health.


So you may be somewhat surprised that I have decided to do a Henry Fonda as Juror #8 and say that for me there are sufficient reasons to doubt whether this is actually the best course of action for me currently. And, like, Juror #8, I am going to attempt to explain why these doubts have led to my decision not to accept the offer of full body and brain scans as part of the UK Biobank project*.


1- The MRI scans are being done for research not because they have been ordered to investigate a problem. I am a well person of 76 years of age, living life to the full and am, to date, without any obvious symptoms of disease. As a result, my life is free from any medical ‘paraphernalia’ - appointments with doctors, consultants, surgeries, hospitals, procedures, operations, medicines, diagnoses and so on and so forth. For as long as possible I’d like my life to stay that way.

2- My experience of spending aeons of time in two different hospitals during most of 2012 at the bedside of my special granddaughter, India, observing and evaluating everything that was going on around me, is that doctors are neither omniscient nor omnipotent and nurses are not always angels - although some are. 

My own parents were both very badly let down by one particular consultant (same doctor, a general surgeon), and I believe that my father’s death was ultimately caused by an unnecessary medical procedure, carried out under anaesthetic and to which he did not consent. 

To say that my mother was ‘fobbed off’ by both her GP and that same consultant, would be an understatement. Her metastatic liver cancer was diagnosed just three weeks before she died, despite months of pleading for help with severe back pain and brown urine. Please don’t condemn me for my huge scepticism about medical interventions. I realise it is irrational and very many of you will tell me otherwise, but trust in the medical profession is a huge issue for me. My recent somewhat alarming experience whilst having a BCC removed from my scalp has not helped one little bit.

3- The argument for early diagnosis and therefore the likelihood of more successful treatment is perhaps the most powerful one. Throughout my life, I have been offered and jumped at the chance for regular bowel, breast and cervical screening for cancer. And if I was twenty years younger I would most likely jump at this chance too, possibly because it would feel very low risk. Now, not so much, especially when most cancer is found in people over 75, and some of those cancers will be undiagnosed at death. I just feel this overwhelming reluctance to open that particular can of worms when I feel so well.

4- And finally, the trickiest argument of all for me to make, which is about the notion that quantity of life should always be the paramount consideration.  I have seen at close quarters what very poor quality of life looks like, in the form of a six month old in intensive care attached to machines for breathing via a tracheostomy, and eating via a naso-gastric tube and a stomach peg. As such it was extremely difficult to play with India, dress her, bathe her, lift her from the hospital cot to cuddle her and of course, she needed twenty-four-hour constant medical supervision. Thankfully India’s physical condition gradually improved over 4 years, but, as someone in the later stages of my life, I would take a shorter life of high quality over a longer one with greatly compromised quality every time.


I’m going to give the last words on this to a hospital doctor, Xand Van Tulleken. I am extremely grateful to the three or four of you last week who recommended that I watch a programme called ‘Cure or Con’ broadcast last Friday 9th February. A question was posed by an older male viewer, like me currently in good health, whether he should have full body scans in case he had early signs of the cancers that killed both of his parents


 This is (verbatim) what Dr. Xand replied - the italics are mine:


No. You should definitely not have a full body scan. But it's hard to explain why not, because it seems like such a good idea. If you are worried about cancer, having a look inside and catching something early would [seem to] be very sensible. The difficulty is that when we do lots of these scans, and I used to spend a lot of time in the scanning department in our hospital [is that] when you scan healthy people, you start to find lumps and bumps and growths, and when you don’t know what they are you have to investigate them. 


A lot of them aren’t cancer, in fact the majority aren’t, but in doing the investigation, you end up sticking needles into people, doing operations potentially to do biopsies and things and you can end up doing harm and even those procedures can be fatal. So I would really caution against these kinds of scans. They give you false reassurance and they can even put your life in danger.”


Instead of the scans, Dr Xand suggests simple health checks and being vigilant about potential symptoms: “so many people are in denial about their symptoms. They don’t want there to be anything wrong, so they avoid going to their G.P. So, go to your G.P. and say “This may be nothing but I want to get a bit of reassurance, can you look into it?” 


So that is exactly what I am going to do. I am going to book myself an appointment at The Mole Clinic for a complete check on all the various moles etc. which may or may not warrant further investigation. Why? Because I have already had 4 Basal Cell Carcinomas removed and my mother’s primary cancer was melanoma. And then I am going to get some simple health checks done on things which can have a big impact on an older body like mine, like my blood pressure and cholesterol levels, bone density and perhaps a mammogram too while I am about it. 


I wonder if, like the jury in Twelve Angry Men, any of you have changed your mind as I have done, about the advisability of having the full body scans I’ve been offered? When I asked you last week I was really struggling for all the reasons I’ve given here, but I had very nearly decided to put all of my concerns and fears to one side and sign up, especially as the weight of opinion from all of you in favour of the scans was so overwhelming. However, my Juror #8 has come in the form of Dr. Xand Van Tulleken who has tipped a balance that was fairly evenly weighted in my mind firmly into the ‘definitely not’ position. 


And, honestly, having made the decision, I just feel the most enormous sense of relief.


*For those who think that I should do the scans for medical research rather than selfish reasons, Biobank is asking 1 in 5 of its volunteers to participate in this study, so if I decide not to do it, another person will be given the opportunity in my stead.


Tricia x

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