AA Gill's final cancer article finds a compassionate NHS
The health service is not the envy of the world but it has a human face
One of the saddest, most poignant articles of 2016 was that of the restaurant critic AA Gill’s chronicle of his final days with lung cancer including a comparison of his experiences in the private healthcare system and on the NHS. It’s worth going beyond the paywall to read it.
News of his death last week hit the world of reporters hard; it featured in most newspapers. It hit me hard too. Who else could cheer up my Sunday morning hangovers now with comments such as comparing a scallop to eating a dolphin’s adenoid?
Most journalists chose to highlight the fact that Gill could have lived longer if he had been given the immunotherapy based Nivolumab. Nivolumab costs £60,000 to £100,000 per year for a lung cancer patient and is unavailable on the NHS – in England, that is.
In Scotland, he would have got the treatment. In America, Sweden or Germany – with the right health insurance - Gill would have had Nivolumab and not platinum chemotherapy, his oncologist said. Yet again, the NHS had failed, the headlines said, now cruelly snatching one of the UK’s finest journalists from us. The NHS fails partly because it is chronically deficient in money compared to other first world countries but somehow that always gets glossed over.
But there was another point to his final article. Usually when a big name journalist gets treated on the NHS, there follows an article about all its failings: the doctors/nurses/midwives (mostly the doctors) were not compassionate enough, they didn’t give enough information or choices, the patient felt out of control etc.
Journalists have a love-hate relationship with the health service: it’s unwieldy, error-prone and erratic, political fodder but provides great copy for tragedy stories replete with photos of wronged patients with identical me-the-victim expressions that photographers seem to be able to conjure out of them.
Instead Gill did his usual job of fine observation, dissecting out the truth and spotting things for what they really are, much like his derision of sharing plates and any restaurant that describes themselves as a ‘concept.’
The NHS is not the envy of the world, he wrote. We tell lies about it, he said. But he felt it was the best of us as well. “You can’t walk into an NHS hospital and be a racist. “But it’s almost impossible to walk into a private hospital and not fleetingly feel that you are one: a plush waiting room with entitled and bad-tempered health tourists.”
Yet there was still something in the public sector for Gill: the compassion. Although his cancer was diagnosed in the private system, he opted to have the rest of his treatment on the NHS because of its human face.
Yes there was still a series of “antiseptic tragedy expressions” of doctors trying to shield their own emotions from Gill’s bad news. (We don’t look like that, do we???). Yes there was the tiresome bureaucracy of being asked for his name and date of birth again and again in order to “collide you with the right kind of cancer” on the system.
In the end though, he found an oncologist with whom he could have an honest, one to one conversation. He found Charing Cross Hospital, “a monstrous, hideous, crumbling patched up mess,” the result of “dozens and dozens of attempts to make it better”. But he loved it. “It’s how I feel.” He found the nurses funny, comforting, optimistic, sincere.
The end of the story isn’t ever happy if it means the patient dies. A footnote to the article mentions that Gill started Nivolumab (presumably he paid for it privately) after writing the article but it came too late.
Gill finds himself on a trolley in A&E in agony, giving his name, date of birth and address yet again. Behind the blue curtain, a shouting man is being held down by three policeman. Gill gives his name and date of birth and address yet again and is told that by a surgeon with a granite case that the cancer has spread to his pancreas.
Later the chemotherapy nurse comes searching for him on the ward: why has he missed his appointment with her? He looks away but he thinks she is crying. “Oh f***”, she said.
“You can’t buy that with private health insurance,” Gill wrote. It was to be his final words in print.
Dr Claire Davies
GP and editor of the Network Locum (now Lantum) blog
