A model of Van Gogh’s severed ear: a routine ear operation caused years of head pain for one patient. Photo: Getty
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The man with his head in an invisible vice – and the puzzle that took a decade to solve

Dr Phil Whitaker’s Health Matters column. 

David was a patient during my earliest years in general practice: an otherwise fit man in his early sixties who needed an operation on his ear. The procedure went without a hitch but afterwards David noticed that he was markedly off-balance and he developed dreadful headaches. His description stuck in my mind: he said it was as if one side of his skull was being “squeezed and crushed in a vice”. He illustrated this with his hands, clamping and pressing them against his scalp as he tried to explain.

Initially, I hoped it was something that would settle spontaneously: side effects of the general anaesthetic or the painkillers, perhaps, or some deep bruising that would take a while to resolve. After a few weeks without improvement, I organised blood tests and examined everything my training suggested might be relevant. I drew a blank.

My ear, nose and throat (ENT) colleagues were similarly perplexed when he attended his six-week follow-up appointment. The surgery had been successful, they confirmed, and everything was well healed. They were at a loss to explain his new symptoms.

So began a tortuous process. The ENT surgeons approached the problem from every angle they could: head scan, X-rays, more blood tests, specialised tests of balance. Each flurry of activity was interspersed with interminable periods of waiting for the next outpatient review. Eventually, after many months, the verdict was delivered: they could find nothing wrong and could only suggest I refer David to a consultant neurologist. 

A year later, David was no further forward. He continued to complain bitterly of the grinding headaches and the disequilibrium. The neurologist and an ENT second opinion had failed to produce a diagnosis. As so often with “medically unexplained physical symptoms”, the spotlight began to shine on the psychosocial sphere – were these symptoms an expression of emotional turmoil?

David was emphatic: he had emotional turmoil, all right, but that was because the bloody operation had left him in pain and no one seemed to have the first idea how to put him right. His relationship with the medical profession reached rock bottom and though I tried to support him as best I could, I began to dread seeing his name on my appointment list, so impotent did his case make me feel and so angry had he become.

Eventually, I moved to another part of the country, leaving my first practice and David’s insoluble symptoms behind. A decade later, I went in for dental surgery under general anaesthetic. Shortly after getting home, I began to feel giddy and off-balance and I developed headaches that felt as though one side of my skull was being crushed in a vice. I tried various measures but nothing helped. Memories of David inevitably came back to me.

In the intervening years, I had seen a number of perplexing musculoskeletal problems respond to chiropractic treatment where conventional medicine had reached a dead end. I went to discuss my situation with an experienced chiropractor and he knew immediately what had happened: the surgeon, in manoeuvring my head to get access to the back of my mouth while I was under the anaesthetic, had unwittingly deranged the alignment of the bones at the top of my neck. With a few manipulations, my debilitating symptoms melted away.

Since learning this lesson, I have seen several similar cases in which patients can date the onset of back pain or headaches and dizziness to receiving a general anaesthetic. Most doctors are mystified because there is nothing in medical training that teaches us that this kind of thing can happen. To a chiropractor, however, it’s unsurprising. If you haul insensate bodies from trolleys on to operating tables – if you twist heads this way and that while the protective neck muscles are paralysed by anaesthetic – you will very likely put vertebrae out of kilter.

Medicine is a lifelong education. The training that we get in our early years is only a starter guide. Life experiences (our own and those of family and friends), the patients we encounter and the stories we hear continue to expand and refine our understanding of the myriad ways human beings work and don’t work. As well as learning lessons from chiropractors, I have also seen startling results with homoeopathy, acupuncture and psychotherapy. Yet these kinds of approaches are frequently derided by conventional doctors, who reject them because they can’t be understood in our current scientific terms.

If there is one thing that can be said with confidence about our understanding of the human organism today, it is that, like all bodies of scientific knowledge, it will be shown to be woefully inadequate over the next 50 years. The provisionality and partiality of our knowledge should serve to keep our minds open to other ways of thinking.

I can now direct patients with anaesthetic-related back or neck injuries to someone who can help them. My regret is that I didn’t have this understanding when David needed help. I can still see him, clamping and pressing his hands to his scalp, trying desperately to communicate what he was going through but being met with the incomprehension and impotence of his physicians. That has been one of the defining lessons of my career and I try to remember it whenever a patient presents puzzling problems that defy a conventional diagnostic approach. 

This article first appeared in the 20 August 2014 issue of the New Statesman, What the Beatles did for Britain

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Why Philip Green's fall should bring down the honours system – but won't

Sir Shifty may fall in disgrace, but our ridiculous system will endure. No matter what's happening in the rest of politics.

Sir Philip Green’s Efficiency Review (2010) is his Das Kapital and it is still, happily, online. You can, if you wish, smirk at his recommendations to the government, which were solicited by David Cameron, I imagine, because when he stood next to Green he looked not like a 17th-century woodcut but like a tall, handsome semi-aristocrat.

“There is no motivation to save money or to treat cash ‘as your own’,” Green grumbles, before complaining, “There are inconsistent commercial skills across departments.” I am weeping with laughter at the whole report. But I’m not one of those BHS employees watching their pension ­vanish as the hideous cushions, throws and bedspreads pile up on the Green family yacht Lionheart. I instantly rename the yacht 14-Day Return Policy No More.

The days when Green could write efficiency reviews for people to ignore are gone. It is said that he could lose his knighthood, because that would be exciting and pointless. If so, I hope the ceremony features the formal rending of a garment from the BHS sale bin – perhaps a torn sock will be flung at his head? The Queen will not be happy, because de-knighting makes the ancient system of patronage look as ridiculous as it really is. Do intercessors between man and God make mistakes? Would they raise a man the Daily Mail now calls “Sir Shifty”? (I checked whether there was a Sir Shifty among the knights of the Round Table who flogged the Holy Grail to a passing tinker. There was not.)

Lord Melbourne advised Queen Victoria not to attempt to make her husband, Albert, a king, for if the people knew that they could make kings, they might unmake them. Green will discover this in his tiny way. But the elites should not hide their baubles. One fallen knight will not destroy the system (and I cannot think that Green will take £571m from his Lionheart cushion budget to save his knighthood by replenishing the BHS pension fund, because a knighthood is, in essence, just a tiny Bentley Continental that you wear over your nipple). One fallen knight should destroy the system but it won’t, because human conceit and docility are without end. Green will be shunned. Nothing will change.

One might have hoped that the Brexit vote would have alerted Cameron to the abyss between the electorate and the elected. (Even Alastair Campbell, chomping against Brexit, seemed to forget that he was as complicit in the alienation of voters as anyone else: government by sofa, teeth and war.) The response was glib, even for Cameron, a man so glib that I sometimes think he is a reflection in a pond. Brexit hit him like someone caught in a mild shower without an umbrella. He hummed at the lesson that history dealt him; he hummed as he left his page. It was the hum of the alpha Etonian caught out in a mistake, yes, but it was still a bloody hum.

His next act was to increase pay-offs to favoured courtiers against civil service advice and at public expense; then, it was reported, he nominated his spin doctor Craig Oliver and his former spin doctor Gabby Bertin for peerages, because the upper house needs more PRs. He has learned nothing. I wish him a relaxed retirement in which he will, apparently, write his four-page memoir, David Cameron: My Struggle (sub-subtitle: Eton Mess?). I hope he does not attempt to deny “the prosciutto affair”, because there is no need. It was not true. It was too pure a metaphor.

So the honours system, an essential part of our alienating politics, alongside dodgy donors, duck houses and George Galloway, endures in its worst form as conventional politics fails. It is a donkey sanctuary for political friends and Bruce Forsyth. I am not suggesting that everyone who has been honoured is dreadful – some lollipop ladies deserve to be patronised with an OBE (when there is no E any more), I am sure, and the lords, some of whom are excellent, are the functional opposition now – but the system can no longer be defended by the mirth potential of watching politicians ponder what light-entertainment celebrities might swing a marginal before being posthumously accused of rape. We must find something better before the house burns down. Perhaps a robust parliamentary democracy?

The problem is best expressed by the existence of a specialist consultancy called Awards Intelligence, which engages in “VIP brand-building” by soliciting awards. It sells “awards plans” from £795, which I could well imagine Philip Green perusing as he bobs about aboard Lionheart, were it not too late. The Awards Intelligence website tells us so much, though obliviously, about the narcissism of modern politics that I am tempted to reproduce it in full. But I will merely report that it asks:

"Did you know that you can join the House of Lords on a part-time basis as an Independent Crossbench Peer or a political peer affiliated to one of the main politial parties – even if you have ongoing work, family or community commitments!"

The message from Awards Intelligence, which boasts of a 50 per cent success rate, is clear: the legislature is part-time, it exists to “instil trust, add credibility and provide a platform for you to have your say” – and it can’t always spell “political”.

Sir Shifty and Awards Intelligence do not constitute the worst crisis in the history of honours, dreadful though they are. During the First World War the royal German cousins were stripped of their garters, so that British soldiers would not have to kill men of higher rank. But it is time for the Queen to stop pinning toys on nipples. They are part of a political system sweeping us, swiftly, towards the night.

This article first appeared in the 28 July 2016 issue of the New Statesman, Summer Double Issue