A form of life saving

 

At one level it is a startlingly personal story, revealing a person light years from the Tommie Gorman we saw chasing Pβdraig Flynn, then an EU commissioner, into a lift in Brussels, demanding information about a £50,000 cheque. We see a sometimes hesitant, nervous, regretful man standing by his beloved parents' grave in Sligo; in a hospital bed smiling wistfully at a photograph of his wife and children; begging a surgeon to be honest about whether he is going to live or die.

At another level, it is the Gorman we know, this time forced to ask tough questions of himself and the health system. He could have kept the answers to himself, but they turned out to be a matter of public interest. "It's only fair that if the answers you're getting are important, that you should share that information, even if it involves yourself. That's just paying your dues," he says.

What makes this eerily watchable, almost voyeuristic television is Gorman's personal story: his battle with a rare cancer; the scene when he asks a consultant for his prognosis, not knowing what the answer will be; the emotional farewells to the medical staff in the Swedish hospital that probably saved his life.

What makes it of public interest is the way he funded his treatment in the hospital's world-renowned endocrine-oncology unit. "I am alive now not because I was in some way a public figure with a range of important contacts. I'm alive because the services I received were mine by right. And they're yours by right, too."

He is alive, he says, for the simple reason that he is a citizen of the European Union.

The first warning shots came in 1994. After Christmas in his native Sligo with his wife, Ceara, and daughter, Moya, Gorman headed back to his Brussels base, putting the "very rough stomach cramps" that were assailing him down to the conditions of the job. His Belgian GP suspected a ruptured appendix.

In hospital in Belgium, a surgeon looked closer and found "small lesions compatible with metastasis of the liver" - which is to say, a secondary cancer site. Looking around, he found the primary site, "a small nodule in the small bowel", about a centimetre in size.

He left it in place. As Gorman was waking up, he would hear the word "cancer" for the first time from the Burundian nurse. "That was the worst, the very worst. Ceara came bouncing in to see me with Moya in her arms, nine months old at the time and a little head of red hair. And I had to tell her."

In the following days, he would take refuge in the hospital's oratory, "listening to the most positive pieces of information, filtering those." Time took on a new meaning.

For the next four years, he kept the worries at bay by staying busy, returning to hospital for six-monthly check-ups, knowing the lesions were still on his liver and the nodule still in his small bowel. But the hospital's strategy was to "monitor, monitor", and the slow-moving disease appeared to be behaving in character.

News of his condition was confined to a tight circle of friends, one of whom was "this guy I met in a bar in Budapest", called Frank Gannon.

Nearly everyone who has had a brush with cancer has an "if only" story, and Gannon is the catalyst in this one. Apart from being a Sligo man, Gannon happens to be one of Ireland's best-known scientists; he runs the European Molecular Biology Laboratory in the German city of Heidelberg.

He researched Gorman's condition and got a shock. "When I read what I read, instead of finding things like 'minor', 'benign', 'it will go away', 'nothing to do', I was reading things with statistics like 'on average, a five-year lifespan . . . immediate surgery recommended'. And I was seeing statistics that didn't stretch very far because they hadn't been gathered very far, because the disease was one which didn't have a long lifespan following discovery," Gannon says.

Time to switch strategy. Gannon's research led Gorman, via the Internet, to Dr Kjell ╓berg of the endocrine-oncology unit at Uppsala University Hospital, in Sweden. Though only 20 years old, the unit, with its unique therapeutic options for hormone-produced tumours, has become a worldwide referral centre.

╓berg was puzzled that the nodule had not been removed when discovered four years before. Without treatment, he said, the tumour would be constantly progressive, with symptoms becoming more severe, along with further secondaries in the liver and, then, the bone and the brain. The heart would also probably be affected.

Gorman was prescribed interferon to arrest the disease, and he injected himself three times a week. The tumour, by now an unknown quantity, was to be tackled in a delicate operation.

After the surgery, Gorman is filmed emerging from the anaesthetic to see the surgeon standing beside him. Eyes suddenly wide open, he implores: "Look at me. Honestly. Tell me, how does the prognosis look?"

"It's good", the doctor replies. "You have the type of tumour that grows very slowly when we have taken away the risky parts which are connected to the gut. And the treatment you can have for decades and decades, to keep the tumour as it is." True to his Sligo roots, Gorman responds with a groggily exultant: "Up the Rovers!"

So how does an ordinary Irish Tommie access such a state-of-the-art service? Most who have holidayed in Europe are familiar with the €111 form, which entitles EU citizens to the equivalent of medical-card treatment anywhere in the zone. What Gorman uncovered, however, was its much bigger brother, the €112.

This document grants EU citizens "open sesame" access, as a right, to sophisticated tests or operations in any EU country where it is deemed cost-effective and useful.

Gorman's health board, the North Western, his VHI membership and Irish social insurance came into play. But the main condition for the €112 is that the patient's local consultant must vouch that he or she has no better treatment to offer. Gorman achieved this by arming himself with wads of uncontradictable information and presenting it to his consultant at Sligo General Hospital. With the support of Dr Peter Morrison for his €112 application, he now had a document that was akin to "an internationally recognised chequebook".

How do places such as Scandinavia, Germany and France manage to develop and support such a first-class public service without any tradition of private practice? First, we need to know what the Swedish health authorities pay a man like Dr ╓berg, one of the world's foremost authorities in his field, for his services.

The answer is about £70,000 (about €89,000) a year. And that's the height of it; there is no private practice. "Charlie McCreevy has said it a few times - that enormous sums of money are being pumped into the Irish health service - but where is it all going?" asks Gorman. "It's going into a black hole, that's where. It's going to pay people who are getting three, four, five times more than their equivalents in Europe."

In Sweden, you see doctors and nurses "who can work in a team environment and there is not one single mention of money. I talked to a Swedish doctor, Barbro Eriksson, one of the leading endocrine oncologists in Europe, about this and what she said really struck home: 'Like oil and water, medicine and money do not mix. We're here just to try and sort you out' ".

As a result of his experience, Gorman has taken a hard look at the Republic's health service. The proposal that more public money should be pumped into the private sector appals him.

"It can only reinforce the desperately degrading two-tier system we already have and which is insulting to us as a race. Our unhappiness with this country is crystallised in the health service; it's tearing at our very soul," he says.

There is another context to Gorman's crusade. He is a man with a profound reverence for his parents' generation. He saw how worried his increasingly frail mother and father were after having to deal with the health system, so the first thing he did when he got a job was to enrol them in the VHI.

That an old person, or anyone, approaching a hospital admissions office has to face such "dirty questions" as to whether they're with the "in" crowd - the VHI - or "out", before being treated accordingly, grieves him deeply.

Why, he wonders, when the Republic is so much closer to Berlin in so many of its attitudes, does it seem much closer to Boston in healthcare? He has a theory. Traditionally, because of its English-language culture, our best and brightest doctors have headed for the US rather than Europe for further training.

So when they return to practise here, they bring back the US model of patients' money - and lots of it - up front rather than the European social-democratic model of service on the basis of need. "And the great irony is that it's the taxpayers here who have put these doctors through college," Gorman says.

But his €112 discovery gives him hope. Some health boards, notably the North Western, have already tuned in to the fabulous array of services available on our European doorstep. If the Republic's healthcare system cannot or will not be changed from within, then perhaps the "notion of patient as consumer in the European single market might run a blast of fresh air through it. That kind of collaboration between Ireland and Europe can only help to purify the Irish system".

As for himself, he is back in Ireland, as RT╔'s northern editor, "fighting to stay healthy, fighting to stay alive". He has learned the familiar lessons, such as how fragile life is, how vulnerable we all are and yet how resilient we can be. He remains on interferon. The tumours are still in his liver. But Dr ╓berg is alert.

"There is this new radiotherapy treatment that could take them off. We may try that," Gorman says.

Europe, Cancer And Me is due to be screened on January 8th, as part of RT╔ 1's True Lives series