THG/SMS/5051621
13 October 1999
Dept. of Otolaryngology
Royal Hampshire County Hospital
Romsey Road
Winchester
Hampshire S022 ~5DG
To Whom it May ConcernRe: Mr Keith HARRIS
Mr Harris was presented to Mr Latif, Consultant ENT Surgeon, at Orsett Hospital, Grays, Essex RM16 EU on 3 December 1987 with a long standing history of left-sided ear discharge with a high frequency neurosensory hearing loss. Examination showed an attic perforation with cholesteatoma in that ear. The right ear apparently had been normal.He was admitted on 15 February 1988 for an open cavity mastoidectomy when it was found that the head of the malleus and the incus were eroded and the stapes superstructure was missing. The facial nerve canal was intact and there was a possible small fistula into the lateral semi-circular canal, but this was not explored because of fibrous granulations. A standard open cavity mastoidectomy was performed, but there was no specific attempt to repair the ossicular chain. The ear subsequently healed, apart from the development of one or two small bits of granulation tissue that settled with silver nitrate cautery. He was subsequently found to have a cholesteatoma on the other side and on 15 May 1989 underwent a right modified radical mastoidectomy when the malleus head and the incus were again found to be severely eroded although in this ear the stapes superstructure was largely intact. Temporalis facia graft was used to form a Type III tympanoplasty and the ear steadily healed and settled.
I first saw him in December 1990 when he had dry stable bilateral mastoid cavities and we continued to follow him at intervals in the clinic, largely to remove wax. We last saw him in August 1993 when both ears were quite stable.
Yours sincerely,
T. H. GUERRIER FRCS
Consultant ENT Surgeon
Have you ever had one of those days when you just know you’re dying but not yet?
It started when I awoke and stopped to think about myself. Infrequently, thankfully, that can start the equivalent of a cobalt chain reaction.
I got up three times but gave up each time. Then the pains in my head started.
Not because of the thinking process, but because of a medical condition noted on my records as "the head of the malleus and the incus were eroded and the stapes superstructure was missing, the facial nerve canal was intact and there was a possible small fistula into the lateral semi-circular canal that was not explored because of fibrous granulations...".
I went back to bed thinking I’d be safer there. Then I got to thinking that if I continued to lie there I’d just die and no-one would know until the flies started to crawl out under the apartment door to freedom, presumably when there was nothing left of me to feast on or infest with maggots.
I had an appointment due at 3.30pm and it was now --- damn, there goes the doorbell and I’m still in bed thinking about the fact that I’m thinking about the fact that I’m like dying but I’m not and was that the smatterings of a kaleidoscopic heart attack?
I raise my head two inches from the bed and shift a few limbs to let them know I hadn’t forgotten about them then collapse exhausted the two inches back to the mattress. It wasn’t turning into a good day.
I maul myself a few times just to convince myself there is still something fleshible to maul, ponder what to do next and try instead to sleep. Twenty minutes later I am mad enough to beat the mattress to a pulp of mangled steel spring and soggy dowd filling so instead get up like someone dealing with octogenarianism for the seventh time and sing meaningless songs to my guitar.
Have you ever had one of those days?
Hoople’s cat knew about them and was only trying to soothe the angry grimaces appearing on Hoople’s face while Hoople slept the sleep of Hoople and Hoople’s cat accidentally fell asleep on Hoople’s face and is now in deep lifelong penance in the Caterwaulkie Mountains with Boris the tom and Thug the one-footed canary.
And you know the worst of it is that it hasn’t ended. The day, that is. Yet.
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