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Authors: Kate Hardy
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for the last six weeks and it hasn’t touched the pain; and she tells me she’s taken them properly, not treated them as if they were painkillers, so it isn’t that either. I’m referring her to the neurology department for tests. She’s a bit nervous about hospitals, so I wanted to know what the procedures are so I could run through them with her beforehand and give her an idea of what to expect.’
‘Without actually seeing her myself,’ Amy said, ‘I can’tsay what kind of treatment I’d recommend, but the neurologist will send her for an MRI scan to check if there’s an obvious cause for the pain—a tumour, or pressure on the nerve from a blood vessel—and run some tests to rule out any other diseases.’ She set her glass down and shifted in her chair so that she was sitting cross-legged. ‘Do you know if she’s had shingles?’
‘It wasn’t in her notes,’ Tom said.
‘It’s worth checking, because that’s a possible cause,’ Amy said. ‘Poor woman. I’ve known cases where the pain was brought on by brushing teeth, or even by going outside on a cold night.’
This was something Tom had missed deeply; he and Eloise had studied together as undergraduates, and he’d loved discussing medicine with her. He’d still been able to discuss things with his colleagues, but it wasn’t the same as relaxing after dinner and talking about medicine.
Amy must have enjoyed doing something similar at one point, he guessed, because right at that moment she looked more animated than he’d seen her before, even than when she’d been baking with Perdy.
‘So would we be looking at treating with a rhizotomy or microvascular decompression?’ he asked.
Amy grinned. ‘Did you look it up, or do you know the stuff already?’
‘Looked it up,’ he confessed. ‘I’ve only come across one case of TGN before.’
‘The condition’s not that common. It affects roughly one in a thousand men, and two in a thousand women,’ Amy said.
‘As you told Perdy you were a neurologist, specialising in pain management, I assume you’ve seen a few?’
‘Yes.’ She looked thoughtful. ‘So your patient is nervous about hospitals. You might have trouble persuading herinto microvascular decompression, then, because it’s open surgery under a general anaesthetic.’
‘So she’d be in for a few days afterwards.’
Amy nodded. ‘It can be a good bet because it works for around ninety-five per cent of patients, and ten years later three-quarters of them are still pain-free—though they do get headaches and nausea for a few days after surgery. The operation’s still a pretty big deal.’ She shrugged. ‘Mind you, so’s the pain. If she wants to know exactly what happens, we make a cut behind her ear, open the covering of her brain to expose the trigeminal nerve, and then move all the blood vessels and arteries that are compressing the nerve and making it hurt.’
Tom could’ve listened to Amy all day. She knew what she was talking about, got straight to the point, and didn’t try to dress things up to make herself look important. ‘What other options are there?’
‘A nerve block. We can do that as a day case, and it’s much lower risk than microvascular decompression.’ She pulled a face. ‘But it’s still not going to be a pleasant experience. It’s done under sedation, so she won’t remember much about it afterwards, but the op itself is a bit scary.’
‘How scary?’
‘Basically I’d put a needle through her cheek under local anaesthetic so it’s just inside the skull by the nerve, and then wake her up just enough so she can tell us when the needle touches the nerve in the place where it corresponds to the pain site.’
Tom could imagine explaining that to Mrs Cooper—and he knew she’d hate the idea. ‘And it’s going to hurt.’
‘Briefly, yes. Otherwise I’d work on the wrong part of the nerve and she’d end up still having the pain as well as having to deal with numbness in her
‘Without actually seeing her myself,’ Amy said, ‘I can’tsay what kind of treatment I’d recommend, but the neurologist will send her for an MRI scan to check if there’s an obvious cause for the pain—a tumour, or pressure on the nerve from a blood vessel—and run some tests to rule out any other diseases.’ She set her glass down and shifted in her chair so that she was sitting cross-legged. ‘Do you know if she’s had shingles?’
‘It wasn’t in her notes,’ Tom said.
‘It’s worth checking, because that’s a possible cause,’ Amy said. ‘Poor woman. I’ve known cases where the pain was brought on by brushing teeth, or even by going outside on a cold night.’
This was something Tom had missed deeply; he and Eloise had studied together as undergraduates, and he’d loved discussing medicine with her. He’d still been able to discuss things with his colleagues, but it wasn’t the same as relaxing after dinner and talking about medicine.
Amy must have enjoyed doing something similar at one point, he guessed, because right at that moment she looked more animated than he’d seen her before, even than when she’d been baking with Perdy.
‘So would we be looking at treating with a rhizotomy or microvascular decompression?’ he asked.
Amy grinned. ‘Did you look it up, or do you know the stuff already?’
‘Looked it up,’ he confessed. ‘I’ve only come across one case of TGN before.’
‘The condition’s not that common. It affects roughly one in a thousand men, and two in a thousand women,’ Amy said.
‘As you told Perdy you were a neurologist, specialising in pain management, I assume you’ve seen a few?’
‘Yes.’ She looked thoughtful. ‘So your patient is nervous about hospitals. You might have trouble persuading herinto microvascular decompression, then, because it’s open surgery under a general anaesthetic.’
‘So she’d be in for a few days afterwards.’
Amy nodded. ‘It can be a good bet because it works for around ninety-five per cent of patients, and ten years later three-quarters of them are still pain-free—though they do get headaches and nausea for a few days after surgery. The operation’s still a pretty big deal.’ She shrugged. ‘Mind you, so’s the pain. If she wants to know exactly what happens, we make a cut behind her ear, open the covering of her brain to expose the trigeminal nerve, and then move all the blood vessels and arteries that are compressing the nerve and making it hurt.’
Tom could’ve listened to Amy all day. She knew what she was talking about, got straight to the point, and didn’t try to dress things up to make herself look important. ‘What other options are there?’
‘A nerve block. We can do that as a day case, and it’s much lower risk than microvascular decompression.’ She pulled a face. ‘But it’s still not going to be a pleasant experience. It’s done under sedation, so she won’t remember much about it afterwards, but the op itself is a bit scary.’
‘How scary?’
‘Basically I’d put a needle through her cheek under local anaesthetic so it’s just inside the skull by the nerve, and then wake her up just enough so she can tell us when the needle touches the nerve in the place where it corresponds to the pain site.’
Tom could imagine explaining that to Mrs Cooper—and he knew she’d hate the idea. ‘And it’s going to hurt.’
‘Briefly, yes. Otherwise I’d work on the wrong part of the nerve and she’d end up still having the pain as well as having to deal with numbness in her