I've always found cottage hospitals fascinating. So much history and such an important part of the local community. I guess there aren't too many of them around nowadays. It's like walking into a museum. They're a world away from their multi-storey counterparts of today, filled with bleeping monitors and trolleys with desperately ill patients lining the corridors.
I met the second nurse in a small hospital in a market town in the same county as the city where I lived. It wasn't a cottage hospital but could easily have been an example of what came next. In its heyday it probably had a handful of wards and a small 'casualty' department. But it had since been repurposed for outpatient clinics and admin offices. It was nice and quiet. Just the way I like it.
The second nurse had an office close to the reception area. I thought she was excellent. Very friendly, attentive and a keen listener. It must be so much easier to run an outpatient clinic knowing there isn't a queue of people checking their watches outside the door.
By way of a preamble she explained this was a satellite clinic of the main Dermatology department located in the city's Royal Infirmary. I actually lived a stone's throw away from that place and now understood why I'd been offered a day out in the country along with my appointment. She also told me she was going to take some photos, upload them with her notes on to her computer and send them off to Dermatology. After that, someone would be in touch with me in due course.
I listened with keen interest and tried to remember any healthcare appointment I'd ever had where the clinician been so diligent about setting the scene with such clarity. She was really good and, as this story explains at a later point, would become unforgettable for all the right reasons.
She then proceeded to ask me a series of questions that I can easily recall because I subsequently accessed my medical records:
1) Do you sunburn easily? No, I replied, before telling her about my dislike of sunshine. I also assured her that I used Factor 50 at every opportunity and also wore sunhats. In fact, I even had a spare sunhat in the car in case I broke down in unexpected sunshine. With hindsight I was obviously missing the point. I was taking precautions to this extent because I knew I might sunburn easily. But my answer to this ambiguous question was a very clear No, and that's the response that got a tick in its box.
2) Have you ever lived somewhere hot and sunny? Thankfully not.
3) Have you ever spent a lot of time outside for work or hobbies? This one got a Yes, because I've always loved to walk. The relevance of my love of walking will also become apparent later in this story.
4) Have you ever used sunbeds? Absolutely not.
5) Did you ever have severe or blistering sun burn as a child? I stared at her. This one had come out of the blue and was as close a trigger to a traumatic memory as I'd like to get. The answer was a definite Yes . . .
When I was a young child we used to take family summer holidays abroad. This was in the late 1950s and early 1960s. Package holidays and sun cream had yet to be invented and few people had ever flown. For days we drove through Europe in a dormobile made by a firm called Thames, camping on the way, and eventually ended up in Italy. Our destination was the Lido di Jesolo on the coast near Venice, where we stayed for several days before returning home. At the time, it was a beach campsite with a wooden hut the size of a barn where we ate in the evenings (I had cheese omelette and chips and not much else). It's now an endless sprawling expanse of pubs, clubs and concrete.
Those long drives through Europe were a never ending nightmare to a young child. Two things kept me going. Chairlifts in the Dolomites (I preferred the single seaters because it felt like flying through the trees) and the Adriatic Sea. I used to spend all day wearing my mask and snorkel, spreadeagled on the surface under the best the Italian sun could throw at me. I was sunburnt every day. But it never stopped me going back for more the following morning.
My mum knew there was no keeping me out of the water, so she brought a very big glass bottle of calamine lotion on holiday with us. It helped. A bit. And then my parents had the bright idea of making me wear a T-shirt in the water. That helped a lot.
The second nurse then asked if it had ever been so bad that my skin peeled off in strips. Well, yes, most nights it did. But how, I wondered, could severe sun burn on my back as a child cause a problem on my scalp 60 years later? When she replied it wasn't so unusual I was very surprised.
6) Have you had a previous skin cancer? No.
7) Has a member of your family ever had skin cancer? Not as far as I know.
8) This one related to immunosuppression attributable to various conditions and was also a No.
9) She then read out various statements asking me to describe my skin type. Did I tan easily? This was tricky and required some discussion. I was obviously very slow on the uptake but she had patience in spades. It eventually dawned on me that any change in skin colour is regarded as tanning (whereas up to that point I thought tanning referred to glistening bronze scantily-clad bodies lined up beside a Mediterranean pool). So when my hands start to darken ever so slightly after driving in early summer, that's tanning? Oh, I see. And I'd never even considered I might have a particular skin type. What on earth's a skin type? She went through her list again, and again, and I eventually opted for Type 2 (Fair skin that usually burns, but may gradually tan).
10) Her final question was one for her to answer and I only ever became aware of it when I received my notes:
Which pathway was the patient referred on?
She'd ticked something called squamous cell carcinoma (SCC), whatever that meant.
