Die Freie und Hansestadt Hamburg

In the summer of 2004, shortly after the Edinburgh marathon, I moved to Hamburg with two bikes, some clothes and not much else.

It was a wonderful eighteen months, living in the quiet suburb of Groß Flottbek and working only a short cycle away at the DESY laboratory on the ZEUS particle physics experiment towards my DPhil. Protons and electrons from the 6.3 km long HERA accelerator were collided at every few nanoseconds at the centre of the ZEUS detector, and we observed the jets of particles thrown outwards by the high energy collisions. It was mind boggling stuff, though we did spend most of our time nursing the rather complicated electronics of an ageing detector or writing code to sift through the millions of different collisions for ones of interest. The particular focus for my thesis research was using a statistical analysis of the ionisation of particle tracks through the gas filled tracking detector (which I stumbled upon only recently in the foyer of a building on the Harwell site that I was visiting for a work meeting!) to identify electrons coming from the semi-leptonic decay of beauty and charm mesons (over ten years later and I would struggle to tell you much more about it than that now…).

Away from the physics I, along with a good group of colleagues (Catherine, Philip, Billy, Paul et al), made the most of our time in Hamburg, exploring the local sights and sounds, as well as taking trips further afield – a Schönes Wochenende ticket would take up to four of us anywhere in Germany on local trains for the bargain price of €30. Hamburg was a great place to live: everything worked. The public transport was cheap, clean, punctual and integrated (across the bus, U-Bahn, S-Bahn, train and ferry network); the cycling provision was excellent; and the city was full of trees and water. Hamburg also knew how to enjoy itself, though in a very organised, north-German way. There were always plenty of food and drink festivals, including the sprawling Christmas market; whenever a big cruise ship came into port there would be big gathering and fireworks display; and the kitsch Dom funfair would come a couple of times a year. Nothing as raucous as an Oktoberfest, but all very enjoyable (though the Fischmarkt early on a Sunday morning was a sight for sore eyes!) and it was good to live there for over a year to see these things come round again. Claire would also come out to visit regularly and we would explore Hamburg together, as well having some longer haul trips, including Paris, Berlin and even Sydney and Perth!

As well as being memorable for all of these reasons, my Crohn’s disease inevitably played a part in defining some of my memories in Hamburg, particularly shortly after I arrived. Prof Jewell, my consultant in Oxford, had referred me to a Prof Rädler, a well respected gastroenterologist specialising in IBD. Prof Jewell wrote to Prof Rädler summarising my condition and treatments, and I also wrote to him on my arrival in Hamburg. The hope was that I should just be able to continue my treatment (infliximab every few months) as before and so I waited to hear back from Prof Rädler. Time passed, the effects of my last infliximab infusion were starting to wear off and I hadn’t heard anything. Starting to get worried about how I was going to get in touch with Prof Rädler and where my next infusion was going to come from, I spoke to our liaison officer, Susan, who knew everything and everybody, and got everything done with ruthless German efficiency: she was an absolute angel. We soon discovered that my letter to Prof Rädler had been returned owing to the hospital having changed its name! Susan worked out what the correct address was but also telephoned the hospital and managed to arrange an appointment for me in the next few days – my relief was palpable. She also signed me up with a local GP.

Upon meeting Prof Rädler, once we had worked out quickly that his English was superior to my broken German, his first question was did I have insurance. Erm, no… I cannot stress how lucky we are to have the NHS in this country: health treatment free at the point of use and no compulsory health insurance (it has been pointed out to me that as healthcare insurance in Germany is compulsory, universal healthcare is effectively available for all German citizens – it was only because I was a UK student on assignment to Germany that I didn’t have a German health insurance card). It is a brilliant thing that we should strive to maintain. I have always had faultless treatment on the NHS; yes have I always had to wait a long time to get seen, but the doctors and nurses could not be better.

I cannot remember exactly how I resolved the stumbling block of insurance with Prof Rädler. I think I managed to convince him initially that I needed some infliximab badly and quickly, and that we could sort out the paperwork later. I went back to speak with the angel Susan, who discussed things with the hospital and we worked out (legitimately or not, I don’t know) that we could use my E111 (as it was in those days) to pay for my infliximab (so the costs were probably charged straight back to the NHS). All I cared was that it turned out that I simply needed to phone the hospital whenever I wanted some infliximab and they would give it to me! So while there were some worrying struggles to get things sorted in the first place, it all worked out quite well in the end.

When I first moved to Hamburg, infliximab was working well for me and so kept me well for a couple of months, following which I would deteriorate and then need some more. Over the course of my time in Hamburg, the drug started to lose its efficacy, to the point that I could barely hang on the minimum eight weeks between infusions. I therefore started to look for other options but these were few and far between, particularly because my main point of contact for discussing things was the GP, who was not a specialist, although he seemed to know more than most about Crohn’s disease.

For a while I had been eliminating foods from my diet that I was pretty sure caused me problems, such as stringy vegetables, onions (particularly raw or lightly cooked) and anything more than mildly spicy, as well as tea and coffee. Although identifying which foods were causing problems was tricky owing to the number of different foods I (or indeed anyone) ate, I was pretty sure that after eating these foods I felt worse than if I avoided them. I also tried to limit my alcohol intake – not that it was particularly high to start with – because again I was convinced that any non-negligible amount of alcohol was deleterious to how I felt. Like with the various problem foods, I think it was more that these things made me feel generally rubbish and gave me more pain in my bowels than actually causing my symptoms to flare up. As a very non-scientific explanation (somewhat owing to it not being known particularly why different foods cause different people with Crohn’s problems), I can imagine that if your insides are inflamed, putting food through them that irritates the inflammation isn’t going to make you feel any better.

Although avoiding certain foods wasn’t a particular problem (other than I missed having quite a few tasty dishes), eliminating alcohol was harder. Again, it wasn’t because I was a big drinker (far from it(!), though I did enjoy sampling the excellent bier that Germany had to offer), but rather that the scientific collaboration I was part of was based heavily on socialising (most of my time out of the office was spent with the people with whom I worked), mostly with people that I had only met since I had moved to Hamburg. It wasn’t anyone’s fault in particular (probably more a feature of our society), but I found having to defend my choice not to drink when it is the norm, pretty much every time someone offered me a drink, difficult (particularly because I didn’t feel comfortable telling someone that I had just met that I had some serious bowel disease). Some times it was just easier to accept the drink, though I always regretted it. This changed when I moved back to Oxford because I was back among people who knew about my Crohn’s and so were more accepting of me not drinking. Even so, there would always be one person who would refuse to buy a non-alcoholic drink: “surely just one won’t hurt?”. It hurts already; the drink is going to make it worse… Fortunately such people are far and few between.

In December 2005, when I had finished my stint in Hamburg (though I visited a few times a year until the end of my DPhil), I moved back to Oxford to write up and into a flat with Claire in leafy north Oxford, and we were engaged by Christmas! Again, while this was a very happy time, my Crohn’s disease continued to cause problems: I had a feeling that the infliximab was no longer working well enough for me and my treatment needed to change. Fortunately, I was back in the care of Prof Jewell, who would sort things out for me, for the next few years at least.

Mark

A good week’s training: four runs with a total distance of 55 km. Some hard runs but feeling fitter and stronger than this point in my training last year – I’m probably running about 10s/km faster (which equates to 7 minutes over the course of a marathon!).

Monday: 11.8 km in 54 minutes

Wednesday: 13.7 km in 60 minutes

Thursday: 9.9 km in 45 minutes

Saturday: 19.5 km in 90 minutes

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s