Saturday, March 29, 2008

Herpes Zoster - and a journey home

Herpes Zoster, better known as 'shingles', is a very painful condition affecting peripheral nerve endings in the skin. The first symptom is severe pain, like being stabbed by hot needles in the affected area, commonly the back and chest wall, but sometimes on the head and scalp, or one of the limbs - and almost always on one side of the body. The cause is a virus that attacks the nerves, a virus that in a slightly modified form also causes chicken-pox, so that people who have had chicken-pox are generally immune, unless their immunity is compromised by old age, disease, or debility. As the disease progresses we see the unmistakeable tell-tale sign: a string of angry blistered wheals, conforming to the distribution of the affected nerve. The lesion or 'wound' looks for all the world as if the unfortunate sufferer has been struck with a cat-'o-nine-tails, and even a light touch will cause them to flinch in pain.

When I visited my Mum in Bartley Green, Birmingham, on Thursday afternoon, this - shingles - is the picture that greeted me. Mum is 91, and generally in good health, with a robust constitution and a lively mind. When I found her slumped in a chair in her flat it was clear something was wrong, and I could see her hand was swollen and discoloured. She thought she had pulled a muscle in her shoulder carrying her suitcase on to the train from Euston, and a visit to A & E had supported this, because the rash still hadn't 'come out', and she came home with codeine tablets for her pain.

With the kettle on for a cup of tea, I got her into the kitchen where the light was better and looked at her hand and arm. Not a pretty sight. Up her arm I could feel the swollen nodular nerve-endings, and in the palm of her hand and up her ring finger the angry blistering was apparent, an open-and-shut case of herpes zoster. Nurses aren't really supposed to 'diagnose' disease in the absence of a doctor. But it is generally accepted in medical circles that diagnosis is not a skill exclusive to the medical man, and I was confident enough to tell Mum what was wrong, and knowledge - as they say - is power. Knowing what was wrong reassured her it wasn't something dreadful, just dreadful enough! And occasion for a visit by her GP. Although Mum is pretty fit, she's not so young, and it's as well -living alone and unsupported by social care agencies - that her GP knows how she is and keeps an eye on her.

Working in Zambia during the early 1990s I saw a lot of herpes zoster: the locals called it "God's burn", and it was an early sign of HIV/AIDS, because of the disrupted immunity caused by the virus. Our clinic there was regularly visited by young people with very severe shingles, and of course you didn't need to be very highly qualified to know what it signified for them: a virtual death sentence. All we could do was supply pain killers, give advice about keeping the lesions protected from abrasion, drinking plenty and taking appropriate rest, and recommend a visit to the local hospital for a blood test. At that time specific anti-virals weren't available; even now they're only available to the few who can afford to buy private medicine.

While waiting for the doctor to make a home visit to see Mum, I did a little shopping for Mum and took a walk along the dam at Bartley Green reservoir, stopping to gaze at the stand of ancient beeches that crowns a low promontory a mile away over the water - Frankley Beeches. This has been a local landmark for centuries past, on the Western fringes of Birmingham, offering a view over the "Black Country" towns of Dudley, Halesowen and Oldbury. I used to cycle here as a child, and here I got my first sense of there being a 'world outside' away from my mother's apron-strings. The familiar topography, the low hills and little valleys, still with ancient damply winding lanes and overarching oaks, the introjected horizon and the memory-soaked planes and smells of the fields all spoke deeply, achingly, to me of home. Home. How complex, rich, bittersweet, challenging, wonderful and human is this sense of home. How blessed, yet how complex, this human existence, this mortality of ours.

Earlier I had spent a wonderful couple of hours with Peter Gilbert and some of his colleagues at Stafford University, in conversation about our shared interests in 'engaged' spirituality. Peter Gilbert is Professor of Social Work and Spirituality at Staffordshire University and NIMHE (National Institute of Mental Health Excellence) Lead on Spirituality. A strong supporter of the hospice movement, Peter leads intimate retreats for hospice staff (one is upcoming in July and I will link to details soon, so readers can find out more). Peter explains: "The retreat is about creating a safe space to share at a deep level and take comfort from each other, and also take time to step back and reflect on what is happening to us and around us".

More about this conversation, and about my discussions with Mark Savage, Peter Gilbert's Buddhist colleague, on a later blog.

The image above is the view from Frankley over South West Birmingham looking towards the city centre. This to me is home.

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