The First Diagnosis

After my appointment with the second nurse I continued with my usual everyday bits and pieces. My forthcoming outpatients appointment was always in the back of my mind, but that wasn't going to happen for a while and life needed to get back to normal.

So there I was one morning a few days later, probably glued to sailing videos on You Tube, when my enjoyment of a good stormy passage was disturbed by a letter landing on the hallway floor. It wasn't Christmas or a birthday so it had to be junk mail. I sat back to enjoy my favourite entertainment of watching some extremely keen and very wet sailors hanging on for dear life.

When I later emerged into the hallway and headed to the kitchen for a top up something caught my eye. I immediately realised that on this occasion the post wasn't destined to go straight to the recycling bin unread. It was a letter, and it looked suspiciously like a standard NHS mailing. That was very efficient, I thought. An appointment date already.

I was right but also wrong.

It was indeed a letter from the Department of Dermatology at the local Royal Infirmary.

I think the Macmillan community guidelines quite rightly don't look favourably on the appearance of medical letters, redacted or not, in blogs. But I need to include some details in order to set the scene for subsequent events. So, here are the letter's essential points in the order in which they appeared (with my initial thoughts italicised):

1. The photos had been reviewed by a dermatologist. That's good. I wonder if I'll see the same person at my appointment.
2. The diagnosis was actinic keratosis. That's a bit of a mouthful. Is it good or bad?
3. There were no signs of cancer. That's definitely good.
4. My GP would prescribe Efudix cream which needed to be used for 4 weeks and would make my skin quite sore and red. That sounds horrendous.
5. The following basic info about skin protection was then listed exactly as follows:
   1. Covering up with broad-brimmed hats and clothing. I'm doing that already.
   2. Seeking shade in the middle part of the day (11am - 3pm). But isn't the hottest part of the day later in the afternoon nowadays?
   3. Using a high factor (SPF 50 and 4- or 5- star UVA rating) sunscreen to exposed skin when outdoors. What's a UVA rating?
   4. (Links to a UK, Australian and New Zealand sites were also included, as was an information sheet relevant to my diagnosis).
6. I had now been discharged by the Dermatology Skin Lesion Assessment Service. But what about the appointment I'm waiting for?

As with most NHS letters, it wasn't actually signed. The sender wasn't a dermatologist. The letter had been sent by someone whose job title was a Coordinator, and I'd never heard of the organisation she coordinated.

I glanced at the date on the letter. It had actually been typed the day after the photos were taken. How on earth was that possible, I wondered. To turn things around as quickly as that, review the photos, review the notes, dictate a letter and get it in the post? In a department that I presumed was no different from all other specialist dermatology services. Straining at the seams to the point of bursting for good. I was astonished.

Somehow or other, I needed to make sense of this. I returned to my desktop and began a search, no doubt hopeful those sailors wouldn't be shipwrecked before I was able to join them again.