Consultant counselling psychologist Colin McGuiness usually listens to the patients and provides support. However, McGuiness felt the need to provide support for himself earlier this year.
Previously fit and healthy — he cycled and ran two or three times a week — he’d been told that without treatment, a worsening back problem would leave him paralysed from the chest down.
Colin, 65 years old, noticed mild symptoms for the first time in December 2013.
‘When I tried to run, I couldn’t get my right leg to move when I wanted it to,’ he says. ‘It was as if someone had taken out the batteries on my right side.’
He put it down to lockdown and ‘old age’ but in February this year, his wife Jan, 67, a retired medical secretary, noticed that when he walked, he threw out his left leg to compensate.
Normally, Colin McGuiness, a consultant psychologist and counselor to counselling psychologists is responsible for listening and offering support to patients. He felt the need for support earlier in the year.
Colin is a specialist in post-traumatic stress disorder and had been locked down in Warminster (Wiltshire) for several months, looking into a screen that he was using to counsel his patients. He not only continued to see clients via Zoom but also volunteered to help a charity named Frontline 19 that provides psychological support for NHS employees.
‘I counselled intensive care nurses who’d seen more dying patients in one week than in their entire careers,’ he says. ‘It’s my job to absorb all that trauma and help people process those dreadful images, so it was a very tense time.’
Colin, who has two sons, Nick, 32, and Adam, 29, was convinced the problem was to do with the way he’d been sitting for work — back hunched, legs crossed, a notepad balanced on one knee.
‘I thought I might need a bit of physio,’ he says. However, he was worried about his condition and went to see his GP late in February. He referred him for further tests. ‘But he also mentioned motor neurone disease (MND) — Jane and I were so scared we both broke down outside the surgery,’ he recalls.
Colin was covered by private insurance so he could see the specialist in a matter of days.
An MRI of his spine revealed that, thankfully, he didn’t have MND — the muscle weakness in his right side was caused by a disc that had slipped out from between the vertebrae.
Normally these discs, which act as shock absorbers for the spine, have a spongy interior — but Colin’s had become hardened, or calcified, and was now compressing his spinal cord, causing numbness and a gradual weakening of his right leg.
The problem was the unusual position — most slipped discs occur in the lumbar or lower back: Colin’s was in the upper thoracic region of his spine at about the level of his lungs.
Without surgery to remove the disc it would continue to compress the spinal cord and he’d be paralysed from the chest down within months, losing bowel and bladder function.
Normally these discs, which act as shock absorbers for the spine, have a spongy interior — but Colin’s had become hardened, or calcified, and was now compressing his spinal cord, causing numbness and a gradual weakening of his right leg
But due to its position, surrounded by vital organs and vessels — operating carried enormous risks. Colin was informed that only a handful of surgeons would attempt this.
‘The consultant I saw at my local hospital in mid-March said he’d done a few of these operations and “had very bad outcomes”, by which I assumed he meant death or paralysis, so he’d stopped doing them,’ says Colin. ‘He couldn’t think of anyone else who would do it either. I felt vulnerable and utterly devastated.’
There seemed little hope for Colin until a physiotherapist friend mentioned Rodney Laing, one of the world’s most eminent spinal surgeons, based at Addenbrookes Hospital in Cambridge — and, it emerged, the only one brave enough to take on his case.
The procedure features in a new series of BBC Two’s Surgeons: At The Edge Of Life. In each episode both doctors and patients balance extraordinary risks — in Colin’s case the chance of paralysis — with possible, but not guaranteed benefits.
Viewers will see doctors pushing the boundaries of their abilities and seeing patients who have been bravely faced with fear and the unimaginable.
Colin knew there wasn’t any other option. ‘If I didn’t have the operation, I’d be in a wheelchair anyway,’ he says.
‘I was losing more muscle tone in my right leg every day and beginning to lose function in my left leg.
‘By June, I couldn’t flex my right foot at all, it was like a flipper. At one time, I felt so terrified that I almost thought I would die.
‘My son took me to A&E but there was nothing wrong with my heart — I was just terrified of what was happening to me.’
After his initial consultation with Zoom Mr Laing, he felt instantly more relaxed.
‘He was incredibly down to earth,’ says Colin. ‘He just inspired confidence. When he told me he’d take my case on, my only question was: “When can you do it?”. Mr Laing performs just two or three of these highly risky operations every year.’
A disc surgeon is normally able to access the spine through an incision on the back. Mr Laing spent hours honing his skills on cadavers, teaching himself how to approach a thoracic disc through the patient’s side, which means there is less risk of permanently damaging the spinal cord.
‘All surgeons need to be obsessive, but neurosurgeons more than others because there is no such thing as a straightforward spinal operation,’ says Mr Laing.
‘Because we operate so close to the spinal cord, which carries messages from the body to the brain, they all carry significant risk.
‘Courage to attempt these comes from training and experience, learning from others and getting the right team together on the day.’
In an 11-hour operation on July 7, Mr Laing cut through Colin’s ribs and deflated his lung, carefully manoeuvring through healthy tissue to reach the damaged disc.
It took him and his assistant Jibin Francis, five hours just to reach Colin’s spine.
He spent the remaining six hours drilling a ‘trench’ around the disc before removing it in tiny slivers, working millimetres from Colin’s spinal cord, where even the vibration of his drill could potentially cause damage and paralysis.
It’s physically and mentally very demanding.
‘Just as you’re getting tired, the stakes are getting higher,’ explains Mr Laing. After eight hours, his hands and arms ache and yet he knows he is always just a millimetre from ‘wrecking’ his patient.
He can recall the names of the people he treated who were worse off than him and admits that he wouldn’t have had the same experience today.
‘Much of surgery is about knowing when to operate and when not to,’ he says. ‘It is about weighing up the pros and cons; risks and benefits.
‘When things go wrong there is always something to learn. But I try to foresee all the possible difficulties — a very big advantage of [a long career] is that you have mostly seen everything before.’
With this ahead of him, Colin was ‘shaking and nauseous,’ the night before his operation.
‘But as soon as I got to the hospital, I felt completely calm.’
He could feel his feet when he woke up, which was a good sign that there wasn’t nerve damage. ‘And that’s all that mattered,’ he says.
He is still in recovery: he’s had several falls — when, as he describes it, ‘the power goes off’, but in the past few weeks, he’s felt almost back to normal with his walking and Mr Laing expects his progress to continue. ‘A gift’, Colin says. ‘Which I am grateful for every single day.’
It is not difficult for patients suffering from severe symptoms to want treatment. But it also means finding the specialist who can — and will — help.
As a little girl, Ekpemi Irune, a gifted head and neck surgeon, who later in the series operates on cancer survivor Nancie Raby, 75, used to flip through her uncle’s anatomy books, sketching the images of bones and tendons and sinews.
‘He was a thoracic surgeon and those textbooks were the reason I became intrigued by the structures on the inside of the body,’ she says.
Nancie, who has been married to Harry, 81, a Cambridgeshire farmer for 50 years, was diagnosed with oesophageal cancer two years ago and ‘sailed through’ 20 sessions of radiotherapy.
Although her cancer was successfully treated, her voice box at the top her of her oesophagus was severely damaged and her stomach which is responsible for food and liquids to the stomach was also affected by scar tissue. She was not able to swallow fluids.
A self-confessed foodie and keen cook, she missed eating with Harry terribly — particularly roast potatoes and her beloved puddings — and she’d lost around two stone in weight.
Before she was referred for surgery by Miss Irune, she was already receiving liquid nutrition through either a tube of PEG or a PEG. [percutaneous endoscopic gastrostomy]For 18 months, you can insert directly into your baby’s stomach.
It was possible for her to continue as she is or have this extremely dangerous and major surgery.
Nancie’s is a hugely complex procedure, involving head and neck and plastic surgery. In order to repair her oesophagus, her damaged larynx — the voice box — needed to be removed, leaving a gap at the top of her airway as well as a hole in the front of her oesophagus.
To reconstruct the area so Nancie could swallow again, Miss Irune performed a myotomy — a series of shallow cuts to the muscle around the oesophagus, allowing it to expand.
The team of surgeons removed the skin from her forearm and also removed millimetre-thin arteries and veins. They then replumbed her neck in order to preserve the newly formed skin.
It now covers her front oesophagus making it more wide. Another piece of skin taken from Nancie’s chest was sewn on top, to ensure the reconstruction is watertight.
‘It’s a very beautiful sight!’ Miss Irune declares during filming, as she peers into the abyss of Nancie’s neck and throat.
It’s a difficult operation to watch, let alone endure and there were multiple risks for Nancie — including heart attack, stroke, bleeding and infection as well as complications connected to the sheer length of the anaesthetic in someone of her age — surgery lasted a total of eight hours.
And recovery will be long: removing Nancie’s larynx means her airway is no longer connected to her mouth so she now breathes through a stoma (hole) Miss Irune created in her trachea or windpipe at the base of her neck.
But six weeks after surgery Nancie ate her first meal in nearly two years — a sandwich. Since then, she hasn’t looked back. In a few months, a voice valve will be installed in her trachea. For now she speaks through a series whiteboards in each room.
Nancie is naturally stoic and doesn’t dwell on the physical and emotional impact of what she’s been through. When I ask her what made her go ahead with such long, painful and risky surgery, she writes on her board: ‘I just wanted my life back.’
Is it worth all the effort? She smiles as she nods. She’s now enjoying simple dinners with Harry, Sunday lunch with their friends and the thing she looked forward to most, salted caramel Magnums with her five grandchildren.
Surgeons at the cutting edge of the world are motivated by their patients’ happiness and gratitude. Never far from Miss Irune’s mind is ‘the responsibility to bring much-loved patients safely back to their families. Life is precious and short’, she says.
‘To restore a patient’s quality of life is unique.’
Starting this week, surgeons will be featured on BBC 2’s At the Edge Of Life (at 9pm)
The microscope
Singer-songwriter Katie Melua
Singer-songwriter Katie Melua, 37, takes our health quiz
Are you able to run up the steps?
Yes, I can. My running runs are two to three days a week. I’m able to run 10K. Since the Covid pandemic started I’ve also had weekly ballet lessons with an ex-Royal Ballet dancer, which I’m really enjoying.
What has the Pandemic done to you?
Although I had mild symptoms, Covid was something that I contracted in Georgia. I’m sad about having to cancel tours but since I was 18 it’s just been making records, touring, promoting — and repeat, and I’ve recalibrated. I’m not sure I want things to return to how they were.
How about five for a daily breakfast?
I do, I’m not religious about it though. My mom lives near me, and the Georgian cuisine she makes is simply amazing.
Ever dieted?
My 20s was a time when I got mad at my thick arms. But looking back, they looked great. I’m 155 cm [just over 5 ft] and I’m about 57 kg [8 st 13 lb] which I’m happy with.
Are there vices?
I’m not into alcohol as I just don’t like not feeling fresh and alive. I procrastinate my most serious vice.
Worst illness?
I was in hospital for six weeks in 2010 with a breakdown, but physically I’ve been fine.
Take any pill?
I also take vitamins to maintain my nails and hair, and lipoic acids which helps break down carbs.
Was anything taken out?
I had some moles on my back and side removed — they were benign, but the doctors didn’t like their shape.
Are you considering plastic surgery for yourself?
I’ve always said never, but when I had the moles removed — in a cosmetic clinic — I saw they can extract fat from your arms. Now I ‘never say never’.
Do you know how to cope well with your pain?
I’m average. Because my father is a physician, I used to look up strange things in his surgical books as a child.
Have you tried other remedies?
I’m quite trusting of mainstream medicine, though I do meditate.
Ever been depressed?
It’s not true. When I had the breakdown I wasn’t diagnosed with depression. My psychotic episode was due to too many pressures, such as work and travel. Since then I’ve been OK, although as a writer, I do explore the sadness in me.
How do you stay awake at night?
It’s the age question. I’m 37 and would like a family, so I’ve frozen my eggs as a back-up. The other night I woke up thinking, ‘Oh my God, when it is going to happen?’.
Any phobias?
For me, frogs seem very frightening.
The Acoustic Album No. 8 will be released November 26th by katiemelua.com