Open Writing

When you are striding our with your mates in the northern hills on a sunny day the conversation naturally turns to medical matters.

Alan Nolan continues his hilarious narrative of a coast-to-coast walk.

To purchase a copy of Ancient Feet visit
http://www.amazon.co.uk/Ancient-Feet-Alan-Nolan/dp/1906510970/ref=sr_1_1?ie=UTF8&s=books&qid=1258967135&sr=1-1

Signed copies of the book are available from Alan http://apn.thelea@yahoo.co.uk

I crept up the first flight of stairs without incident and, as I quietly approached the second flight, I was concentrating so hard on avoiding another crack on the head as I turned to commence the final ascent, that I failed to remember the creaking floorboard conveniently positioned to alert the landlady to returning revellers. My carelessness caused me to straighten up, banging my head again and, before I had finished swearing, she was on the landing with a bottle of wine in one hand and an empty glass in the other.

'Care to join me?' she asked, raising her eyebrows in what I interpreted as a suggestive expression. Suggestive of what, I was not sure. Resisting the temptation to reply with an 'I didn't realise you'd come apart,' I said:
'That's very kind, but I need to make an early start in the morning, so I think I'll go straight to my room.'

When I awoke next morning, I felt awful. Mind you, the en-suite toilet had proved a boon as I did not disturb the other residents by lugging the wardrobe about in the middle of the night. I had a shower and still didn't feel any better, but dragged myself to the dining room for breakfast. I was getting into the habit of not bothering with a packed lunch so as to save carrying the extra weight, so breakfast was an important meal and, of course I had placed my order the previous evening when I had been feeling on top form and anticipating having the appetite of a particularly ravenous Sumo wrestler who had been fasting for a week.

I struggled to eat anything much, which was a bit of a worry as this Monday would be the third consecutive day -when we would not pass anywhere where we could purchase provisions en route. As I packed my gear and prepared to meet the others, I felt so ill that I wasn't sure I would be able to make it to the Youth Hostel, let alone the sixteen mile hike to Shap. Why did I feel so ill, I asked myself. Had I eaten too many posh pasties the night before? Was it the effect of walking in full sun for three long days? Or was it simply that I was not used to walking for so long, day after day? I was too fit for any of those explanations, after all my preparation, I told myself. The landlady must have slipped one of those date rape drugs in my tea the previous evening, I decided. Didn't she realise that she needed to administer a much stronger dose to subdue someone as fit as me?

I settled up and trudged slowly to the hostel. Even though it was only a few hundred yards of flat walking, I was exhausted by the time I arrived, with sweat dripping from me. Ahead lay a sixteen mile walk through remote country with nowhere at all to pick up refreshments. Not that I felt like refreshments at that moment. The day's journey would take us out of the Lake District, but not before going to the highest point on the whole Coast to Coast route, Kidsty Pike at 2,560 feet (except for those of us who had taken the high route on the second day). Just what I didn't need. It would be another tough day even if I had felt well.

I met the others outside the hostel and we said our farewells to Andy:

'It's such a pity you can't carry on...'

I couldn't take one more step. I can't remember if I cried.

'Let's go, quick, before he gets to the chorus.' It would have been sad to leave him in any circumstances, but we had an extra worry because we knew that he can be prone to bouts of depression and the thought of him returning to an empty house, knowing that he should still be enjoying himself with us, might just trigger another dark period in his life. However, there was nothing we could do at that stage, but Tom would contact him as soon as we got home.

This was the fourth day of glorious sunny weather but, as we reached the open fell, I was not relishing the prospect of the initial ascent to Boredale Hause which is not difficult, but is at a gradient which makes it very tiring, even when not suffering from the effects of illegally administered drugs.

My lassitude certainly wasn't caused by the vol-au-vents as I had seen Paul filling his face with them the night before and, once again, he was disappearing up the track. I had to force myself up the slope and, despite my determination, had to stop every few yards to rest and wipe the perspiration from my face. At least the frequent stops enabled me to take in the fabulous views of Ullswater and the Helvellyn range which were lost once we reached Boredale Hause and continued the ascent towards the beautiful Angle Tarn. Whether it was the beautiful scenery, or whether the drugs were wearing off, I don't know, but I began to feel a little better.

Thank goodness. At one stage, I had been thinking that I might not be able to keep going.

It was apparent that there had been some significant changes since we started the walk on Friday. Then, the party had split so that we ended up walking individually but now it was noticeable that Joe was content to walk at Tom's pace. Clearly, he had paid the penalty for trying to keep up with Paul on Friday and his attack of cramp had brought him to his senses. Don seemed to be in better spirits, even though the size of his pack still made me wince. What I did notice was that the umbrella was no longer strapped to the back of his pack, so at least he had had the good sense to dispose of one useless item somewhere along the way. I never did find out what happened to it, but assumed that it had been damaged when he was scrabbling about in the bracken on Grike.

The fact that the four of us were walking together made it seem more like a joint venture and seemed more like what I had anticipated beforehand.

We took a break by the tarn and I took advantage of the stop to go behind a rock.

'Bloody hell, Al, that took a long time, didn't it' Tom commented when I returned. 'Are you having problems with your flow?'

'Don't we all as we get older?' I replied,'But it's okay. I've had a couple of health screenings over the last few years and all's well. I have a client who's a GP but he does some private work doing health screenings at a private clinic. He says it's hard work, but it's money for old rope, I'd say.The first time I went, I had to take out a second mortgage so that I could pay for the privilege of being told that I was fit and well, but at least I was reassured about the cost when they told me that there was no time limit for the assessment, so I could get my money's worth.'

'That makes a change from the five minute slots at the GP's surgery' Don said, 'usually you're just reaching the interesting symptoms when the printer prints out a prescription and you're slung out.'

'Anyway the first three quarters of an hour of this assessment was spent with a nurse, who weighed and measured me, tested my sight and hearing, completed a detailed questionnaire, took blood and urine samples and explained in great detail how she left her first husband when, if I understood this correctly, she found him in bed with the neighbour's German Shepherd.'

'That's unusual,' Tom said, 'although I've heard of an Irish Wolfhound being cited.'

'All the time that I was with the nurse,Tim, that's the doctors name, was in the next room working extremely hard doing the Telegraph crossword but, eventually, I was escorted to the inner sanctum and he swung into action. First, he had to lift some strips of coloured paper and carefully dip them in the urine sample and then he exerted himself by asking some questions, before telling me to strip off so he could watch the nurse shave patches of hair from my chest, arms and legs, before attaching electrodes. He must have been worn out by this time. When I was attached to the electro-cardiogram by about a dozen wires, he made me walk and then run on a treadmill for quarter of an hour. This must have been exhausting for him. At the end of all this, I was set free from the wires and he explained that the results of the ECG would be sent to an 'expert' for interpretation!'

'On the odd occasion that I have to visit a GP' Joe said,'I get the impression that the last thing he wants to do is examine me. It's as though he's thinking 'don't get too close or I might catch something from you. After all, you wouldn't be here if you weren't ill.' So he completes an ALD (that's an arm's length diagnosis), prints a prescription and sends me off, taking great care not to shake hands.'

'Yeah,' I said, 'but have you noticed that he'll make an exception to an ALD when he spots an opportunity to perform an internal examination. Never tell a doctor you are having a bit of tummy trouble. His eyes will light up and he'll be reaching for the rubber gloves before you have chance to mention any other symptoms that could lead to an ALD. Take my advice and describe other symptoms first, although even that doesn't always work. 'A headache? Are you sure your tummy's all right?' he'll ask.'Let's just have a look at you' he'll say and, after shining a light in your eyes to lull you into thinking he's investigating your headache, he'll jab you in the belly with all four fingers and ask 'did that hurt? Yes? Get your pants off then.'

But, I must say that Tim is ideal for the job of health assessments because he has a very pleasant manner and a chatty way of putting people at ease. Even so, I became a bit suspicious when he started questioning me about urinary function. Being over fifty at the time, I knew about the possibility of changes 'down below' involving slow flow and more regular and urgent bladder emptying.'

'It's true,'Tom agreed,'in fact, I find it very embarrassing now if I have to use a public urinal and a young man stands next to me and is zipping up before I've even half-finished, despite my best efforts to speed up the flow.'

'What I try to do,' Don said, 'is give the impression that it's taking so long because I'm absolutely bursting, so I make little semi-orgasmic noises of relief, hoping that my neighbour doesn't spot the feeble dribble in the drainage channel at our feet.'

'I aim at the plug hole,' added Joe, 'that makes a louder noise,
as though you're peeing like a power jet.'

'It helps if there's a discarded crisp packet in the channel to aim at,' I said 'even a dribble sounds like a torrent when splashing off that. In fact, I know one bloke who won't go out without a crisp packet in his pocket (two if he's going to be out more than an hour).

Anyway, back to the health assessment; I realised that all Tim's questions about urinary flow were leading up to testing for prostate cancer to which, as you know, the over fifties are vulnerable. He told me that there's a test known as a PSI test, which I always thought meant pounds per square inch for measuring tyre pressure. I imagined that he was going to ask me to pee on a crisp packet to measure my own pressure.'

'It's a PSA test, not a PSI test, you pillock,'Tom pointed out in his subtle way.

'Yes, I know that now. I realised when he started to talk about prostate-specific antigens, or PSA. Apparently, it's a simple blood test but straight away he started telling me that it's not particularly reliable which made me wonder why he had raised the matter in the first place. 'Is there any alternative?' I asked in all innocence. 'Digital rectal examination' he beamed, and reached for the gloves.'

'So that was why you looked so worried when I got out the rubber gloves the other night,' Tom laughed.

'Too bloody right,' I said, 'so I told him I'd have the blood test, but he wouldn't give up. 'Well, it's up to you but the DRJE is much more reliable,' he said,'I recommend all my male patients over fifty to have one each year as a matter of routine. Quite recently, I was able to refer a patient to a consultant when I found an abnormality during a routine check and he received treatment at a much earlier stage than normal.'

'How many patients have you examined?' I asked.

'About two thousand,' he said.

'I'll have the blood test,' I told him.'

'Good for you,'Tom agreed.

'Yes, but he never gives up. A few months ago, I decided I'd saved up enough to afford another health check and he tried to convince me again.'

'And what did you say?'

'Told him I'd do my own test: 'I'll stick to pissing on a crisp packet,' I said.'