Yuletide

I hope you all have had a lovely Christmas. And if it hasn't been lovely, I hope it hasn't been too difficult. I know exactly how it feels not to have a happy Christmas. Indeed, last year I was in hospital after major abdominal surgery.

This year T and I have had a very happy and relaxed time at home. We ate duck, turkey and gammon with chestnut stuffing. We drank mulled wine and champagne. We scoffed mince pies, Christmas cake, Baklava, dates, chocolate and nuts. We sat around our large tree and enjoyed plenty of good presents from family, friends and neighbours. And we slept in, often not rising until noon.

It has been a time of indulgence and celebration: giving thanks that I am not where I was a year ago; giving thanks that I have come through two recurrences of my cancer.

In-between all the sleeping, eating and relaxing we managed a few local walks, giving Rex, the farm dog, a present of extra biscuits. He was happy to see us, as usual, and rolled over in the farmyard to get his throat, ears and belly rubbed.

We got so relaxed that we almost forgot that we were going away for Hogmanay. So we have been frantically packing.

Wishing you and yours a healthy and fruitful New Year.

I'm wishing for a cancer free 2017.

Paul xxx

Dear Friends,

Thank you for following my blog. Your support and encouragement has made a real difference to what has been a very difficult year for me.

As you may recall, after four years of being all clear I had a recurrence of my cancer and this time last year I was admitted for major abdominal surgery. Due to some complications I ended up staying in hospital until Boxing Day. T decorated my bed with Xmas lights and tinsel, the nurses called it Santa’s Grotto!

Unfortunately, they didn’t remove all of the bad cells and six months later the tumour had regrown in the same place. In early September I went back into hospital for more surgery and have been recovering well since. I had a scan a month ago and that was all clear, but you need a series of them to be sure.

T and I have exchanged rings and have set up home together. She has been great throughout these hard times. I don’t know what I would do without her.

While recuperating from the two periods in hospital, I’ve continued to write poetry and my weekly blog. I’ve also managed to become active again, walking and cycling regularly. And I’ve rejoined the Sing for Life choir.

I very much hope your troubles have been few.

Wishing you and yours all the very best for Xmas and the New Year.

Paul xxx

Speed Dating

T and I have never been car enthusiasts. We can’t stand Jeremy Clarkson or Top Gear. All we really want from a car is for it to start reliably, drive well and not cost us too much to get through the MOT. Due to a series of unfortunate events, T has become the owner of two cars. But neither of them works. And we have been forced to enter the murky world of automobiles in more depth than we ever wanted.

For years T had driven a German car with a reputation for its engineering. She never really liked the car that much. The seats weren’t comfortable and it drove badly in winter, needing two sacks of sand in the boot to keep it on the road. But it was very reliable, until one day a couple of weeks back when the engine failed and it rolled to stop on the motorway. The car was dragged away at some expense and then taken back to her garage. After some delay we were told the timing chain had broken and had seized the engine. The options were to fit a new engine for £3000 or sell it to a breaker for £500. As the car was nearly seven years old, the latter was the only realistic option.

Fearing the worst, we had already started looking for another car. I sought the weekly magazine called Auto Trader, but was told that it was now all online. Checking through the site we realised it was a little like computer dating. You surf the possibilities, look at their shining photos, read the description of their best qualities and make a short-list. Then you arrange to see them. But this often leads to disappointment, as you find they weren’t quite what you expected. And when you test them you can encounter some unsavoury features.

Car salesmen are also very much of a type, whether at a main dealer or on a small lot somewhere on a country road. They are full of blather and would say almost anything to get you hooked. Despite wearing sharp suits, they would be fully at home at a country fair selling horses with nods and winks. You can well imagine them spitting in their palms to seal the deal.

In the end, we bought a Fiesta from a main Ford dealer; it was three years old with a Powershift automatic gearbox and low mileage. The car cost £7500 with a year’s warranty. We picked it up on Saturday lunchtime, just before they closed. On the way home the car began to judder and rattle alarmingly, this got worse on hills.

We rang Ford and complained. They asked us to bring the car back in for a check. We did so the next day. They confirmed a fault with the automatic transmission. We asked for our money back.

A manager came over and spoke to us gushingly. He offered us our money back, but pleaded for an opportunity to fix the fault at no expense to us. As T liked the car in every other respect, we agreed. He also promised that if the fault was not fixed then we could have our money back. I asked him to put this agreement in writing and gave him my email. He looked at me uneasily and gave me a half nod, then shrugged.

I drove T home and waited for the email. When it didn’t come, I summarised the agreement in an email to him. The next day, I had to take T to her local appointments in my car. At the end of the day I got a call from the manager, he said he agreed with my email. I again asked him to put this in writing, he replied to my email but carefully avoided confirming the agreement. The day after I took T to the Belfast bus and picked her up on her return. Then we had a call to say her car was fixed.

Again we picked it up on Saturday lunchtime. For a wee while it seemed to be going better, then the juddering and rattling began again. Exasperated and unhappy, we returned the car to them. They said that they would fix it for good this time and offered T a hire car for the week. As T still liked the Fiesta, we decided to give them a second chance.

This car problem really bothered me. It was the same week that I was waiting for my scan results. I didn't need another significant stress. I was afraid that we had bought a lemon and that Ford would do their best to avoid refunding us. Might we end up being stuck with it? 

The following Saturday we again collected the car, hoping against hope that the fault might be fixed. But the car juddered and rattled, just like before. We raged and railed. It was over. We had reached the end of an unhappy road with this car. With regret at all the time we had wasted, we returned the car to Ford and asked for our money back.  

Several managers gathered around us with serious expressions. At first they told us that the juddering was a characteristic of the automatic transmission. We refused to believe them, shaking our heads with disbelief. Then they offered to take the Fiesta back, but only if we traded it for another automatic from the lot. We flatly refused to have another Powershift car. Eventually they agreed to take the car and give us our money back.

We shook hands on the deal. It would take some days to process the documents and our refund. We walked away from Ford with deep relief. We were back on the dating scene again.

The Scans

I’ve had three scans over the past two months. The first two took place during my second stay in hospital in early September. The third was last week. My first CT scan was routine, on my admission as a new patient. It identified a suspicious spot on my tenth rib, which could be an early indication of a bone tumour. This scared me very much. My tenth rib was near where I’d just had a tumour removed.

The radiologist said I needed a bone scan to check this out. Three worrying days later, a radiographer appeared at my bedside with a small metal container with radioactive materials in it. This was injected into my bloodstream. She seemed very casual in handling the wee container, so I asked her how much radioactivity had just been pumped into me. Put it this way, she said, you’re exposed to more radioactivity than this when you have a CT scan.

In the scanning room I lay down on a raised bed. I had to be very still for half an hour as a large camera on a metal arm followed the contours of my body very slowly. The radioactive materials highlighted spots where your body was making new bone and the special camera recorded them. These hot-spots could be places where you had a new fracture or a tumour.

I spent a terrible night on the ward, waiting for the results. And when I got them I wasn’t put out of my misery. ‘It’s not positive,’ said the doctor, ‘and it’s not negative’. I looked at him perplexed. ‘There’s no evidence of bone-making going on in your tenth rib,’ he said, ‘but the type of cancer you have can be present without any bone-making going on’. I shook my head in disbelief. ‘We’re discharging you,’ he said, ‘and sending these results to your Oncologist.’

This mental distress was on top of my recent surgery. I was in a lot of pain and still disorientated from the anaesthetic. Three very difficult and fraught weeks later I got to see the Oncologist; or rather the Oncologist’s ‘Reg’ (Registrar), the most senior of the junior doctors, who seemed to end up doing a heavy workload.

‘I’ll be frank with you,’ he said, ‘we don’t know what the spot on your tenth rib is.’

‘Oh,’ I said, ‘but what might it be?’  

‘It could be nothing, a false reading, or it could be some damage connected to the surgery you recently had,' he paused, ‘or it could be a new tumour.’

‘Oh dear,’ I said, ‘so what are you going to do about it?’

‘Wait and see,’ he said. ‘We’ll scan you again in six weeks and see if anything has developed.’

‘Six weeks,’ I gasped, ‘aren’t you going to test it now?’

‘Not at this stage,’ he said, ’a biopsy would have to be done under general anaesthetic, almost the same procedure as to remove the rib itself.’

‘And what would you do if it was a bone tumour?’ I asked.

‘I couldn’t speculate,’ he said, ‘but when we see a tumour in the bone, that’s usually a sign of more widespread recurrences’.

I went home with a dense black cloud hanging over me. I was still recovering from surgery. My body was sore and complaining. My head was full of dread. I hoped against hope that the spot was caused by some damage from the surgery. The surgical table in an operating theatre is narrow and your body must be pulled and pushed around when you are anaesthetised. However, the suspicious spot was on the inside of the rib. I imagined the surgeon cutting away at my rear abdominal muscles with heavy pressure and tearing the attachment to the rib, like when I was carving up a chicken for Sunday dinner. Equally well, I could imagine the tumour cells, that had been just a few inches away from the rib for the best part of eighteen months, spreading there and then throughout my body.

The wait was interminable. I was irritable, moody and couldn’t concentrate. I went for walks, watched TV, surfed the internet. Friends called. Nothing seemed to distract me from the black cloud for very long. Not even the always patient and considerate T, who did her very best to help me.

I returned to the dilemma again and again. Night was always the worst. In sleepless hours I weighed the scant evidence repeatedly. I became my own jury. And often I was my own hanging judge.

The day of the CT scan came. I headed to the Cancer Centre, like I had done so many times before, and went through the machine.

Back home, I waited for days for the call. It normally came from my GP, who would access the scan report online.

The mobile rang. My heart leapt. It was the GP. The hospital intranet was under repair, so he couldn’t get the report. I begged him to try again. I just couldn’t wait the two weeks until my next hospital appointment.

Two terrible days later, another call. Breathless, I listened. The scan was clear.

I gasped. Relief flooded through me, then deep exhaustion.

The Surgeon

I returned to the Mater Hospital for a review appointment with the surgeon who did my operation. He examined my wound and said it was healing well. I told him about the pain I was experiencing in the lower part of the wound. I pointed to a raised patch of skin that became irritated when I slept on my side and by the waistband of my trousers. So much so, that I normally went around with my waistband undone, my zip at three-quarters height and my trousers only held up by a loosely fastened belt. I’m sure if I bent over, which I don’t do because of the wound, there might be an episode of workman’s bum.

He explained that this surface pain was from a fold of skin that protruded because of some of the stitches underneath. He described this as a corrugation and told me the surface layer of skin would soften soon because the stitches underneath would break down and become fully absorbed. I also asked him about the deeper pain I experienced in my lower abdomen. He said that this came from my rear abdominal muscles and nerves that he had to cut into to remove the roots of the tumour. He felt it ought to settle in time. He described this part of the operation as tough work, for he had to ‘hack away’ at the muscle and then ‘haul out’ the tumour which was very reluctant to be dislodged. As he spoke I imagined some nineteenth century surgeon on the battlefield, removing a wounded soldier’s leg. Thankfully, I hadn’t been given a piece of wood to bite on.

He then talked me through the pathology report on the tumour. The good news was that the tumour was fully encapsulated by healthy cells, although in places the clear margin was rather fine, at 1mm. Further good news was that the tumour had abutted onto, but had not invaded, any of the structures of my liver or my small bowel. It seems that it had just been caught in time.

I was extremely relieved and thanked him for his great skill and judgement. He smiled but advised caution. I would have a CT scan shortly and this would be the first real test of whether there was any evidence of spread. After all, cancer cells had been active inside my body for the eighteen months prior to this surgery. I needed to be vigilant.

T and I held hands and walked out of the consulting room with a much lighter step than we had entered. We called in to Ward F; where I had been for a week, two long months ago. I thanked the nurses and gave them presents of chocolates and biscuits. Then I noticed that the young man who had been in the bed next to me was still there. I went over and commiserated with him. He had been discharged but had then relapsed and had been back in hospital for the past month. He had no idea when he might get home. I wished him well with his treatment and left the ward thankful that I had come so far on my journey of recovery.

The Corner

I feel as if I am turning a corner. It is now seven weeks since my surgery and five weeks since I left hospital. The pain of my wound is diminishing and my digestion is improving. I’m putting on weight and I’m able to walk further. There is still some way to go, but I feel that I’m approaching a more normal life; that strange mix of fears and reliefs that punctuate the life of a cancer patient.

My good friend Philip, who I have known since I was eleven, came from England to visit this week. We went to Murlough and did some birdspotting in Dundrum inner bay. But the most unusual bird we saw was actually on the way there, a Merlin flying ahead of us, scouting the hedgerow along a country lane. On another day we went to Castlewellan and walked around the lake. The autumn colours of the beech trees were just turning, and should be at their best in a week or so. Later we went to the Norman castle at Dundrum and surveyed the coast from the top of the keep. Climbing up the narrow spiral staircase was okay, going down was much harder and I was glad of the handrail as my legs got a bit tired and wobbly. We then had a good meal at Maud’s Cafe in Newcastle, finished off by Graham’s excellent ice cream.

I’ve been able to reduce the painkillers I take each day, from four to three grams. But night is still the worst and I often wake up with a throbbing pain in my right side after I have been lying on it awkwardly. I’ve been able to eat more at each meal and to take a more normal range of foods. I tend to try only one new thing at a time, as I can then gauge if there is a reaction in my digestion. Unfortunately both chocolate and marzipan have led to bad reactions, so I have to make do with cake.

T and I are involved in a competition. She is trying to lose weight and I am trying to gain it. The competition began a month ago. She was in the lead at first, but this week I’ve gone ahead by three pounds. I’m sure she will win in the end. The prize is a celebratory Mars Bar.

Next week, I have a review appointment with the surgeon who did my operation. I’ve been noting down questions to ask him, as and when I think of them. I always prepare a list of notes to take in with me, as it is hard to remember what you want to ask when you are in the room with the consultant. And you only get one chance to cover all the issues that you are concerned about. I know some of them don’t like being quizzed in this way, but it is my right as a patient to have my questions answered. It is far worse to be on the way home and then to remember a question that you should have asked.

I’ve not yet restarted any of my normal weekly groups. I do miss going to the Sing for Life Choir and the Queen’s Writers Group. I am becoming more robust, week by week, but I don’t quite feel ready to return yet.

David Hockney and the Flu Jab

I needed to go to Belfast to get the annual flu jab. I wasn’t looking forward to it. ‘You should add in a treat’, suggested T. After some pondering, I decided on the Hockney exhibition at the MAC. It had been recommended by a friend of mine. In the end, I was very glad that I went.

One of the advantages of being a cancer patient, indeed, it may be the only one, is that you are given the annual flu jab free of charge. Despite feeling under the weather, T drove me to Belfast for the jab. And a jab it certainly is; the vaccine is delivered by a broadish needle that the doctor forcefully inserts into the deltoid muscle of your upper arm. Thankfully, it was all over quickly and I was soon on my way to the MAC.

The exhibition space was on the third floor. It was free, but you still needed a ticket. So like many others, I went up to level three, down to the box-office in the foyer and back up again in the lift. The exhibition was billed as the first major show of Hockney’s work on the island of Ireland, surprising given his worldwide recognition. I thought back to the last time I had seen an exhibition of his work. It would have been twenty years before in Salt’s Mill in Bradford, Hockney’s home town. Salt’s Mill had been built by the Victorian social entrepreneur Titus Salt at the centre of his industrial village of Saltaire (like the Richardsons and Bessbrook). At that time I was living in a village in the Yorkshire Wolds, an area that Hockney had recently begun to paint in landscape.

Drawings and canvasses from throughout Hockney’s long career as an artist were crammed into a space that was subdivided into several smallish rooms. My initial thought was that the exhibition would all have been so much better shown in the Ormeau Baths Gallery, but, hey-ho, that was closed down in a political row over the opening of the MAC. But then I began to concentrate on the work.

Hockney is a very skilled draughtsman and drawing has been at the centre of his art since he studied in Bradford during the 1950’s. There were some early streetscapes from Bradford, then a roomful of portraits. Hockney is particularly good at capturing facial expression and bodily aspect. The portrait I liked best was of two men in bathrobes on easy chairs; the older man was looking at the viewer and the younger man was looking at the older.

The next room was dominated by two large pieces. The first was one of his large Californian pool paintings: sunlight, dappled water, a splash, a wobbly pink torso. On closer inspection it was made of coloured papier-mâché, which powerfully augmented the dappled effect. The second, was a series of 16 lithographs called The Rake’s Progress. These were inspired by Hockney’s first trip to the USA and were a reflection on Hogarth’s originals. Although witty and well made, they seemed a little dated in their critique: Bedlam was a row of identikit young men in jeans and T shirts with Sony Walkmans in their back pockets.

The final room was an assemblage of pieces from across his career. There were several of his recent Yorkshire Wolds' landscapes, drawn on Ipad and colour printed. The outcome was more like painting than drawing. I liked a large treescape the best. On the other walls were two very interesting series of lithographs inspired by Surrealism and Expressionism. The first series provided some witty pastiches of Picasso. The second series, called ‘The Boy who Left Home to find Fear,’ was largely expressionist in style. The series was inspired by Grimms’ Fairy Tales. I looked at the dozen or so plates again and again. This series, drawn 1969-70, was, I felt, the best piece in the exhibition.

In the car on the way home, I began to feel groggy. My body started to ache and my throat became sore. The side effects of the flu jab were kicking in. I went to bed and slept for thirteen hours. The next day I was little better, but I still felt groggy, weak and feverish.

The Hockney exhibition is on at the MAC until 16 October. It is well worth a trip. The flu jab is unpleasant in the short term, but hopefully worth it in the long run.

Halfway House

Recovering from surgery and a couple of weeks in hospital is not easy. Progress is slow and seems imperceptible, as you have few accurate measures. You are not ill enough to need nursing care but you are not well enough to lead a normal independent life. You are on a passage between these two states. The defining characteristics of this journey are disorientation, discomfort and frustration. Your passage contains elements of what you are losing and what you are gaining. You are inching your way in-between.

My wound remains sore; less so than before, but I am still taking my full allowance of painkillers. I can walk further and more easily, but I still need help putting my shoes on. I continue to wear jogging bottoms as I can’t bear trousers because the hard waistband catches my wound. I’ve just started driving short journeys in the car; operating the controls isn’t difficult but the holes in the road still jog the wound painfully. I have to wear a pillow between me and the seatbelt. The guts are still very sensitive and I’m continuing to eat soft food and small meals, but I have gained a couple of pounds.

Rex the collie dog is my regular companion on walks down the lane. He’s always pleased to see me and is ready for a walk. He rushes on ahead and often diverts into fields to follow scents or to chase a rabbit. He’s curious about the world but seems to be afraid of sheep and cattle (a bit of a disadvantage for a farm dog). He has two most unsavoury habits. He loves to roll in fox shit. It is black and very smelly and makes him honk something terrible. And he loves to chase cars. When I hear a vehicle coming down the lane I have to grab his collar or he will be after it in a flash trying to bite the wheels. I shout and whistle to try and divert him, but he only stops when the vehicle outpaces him.

I’ve become frustrated with daytime TV, but I haven’t yet got back into reading. My latest diversion is internet surfing. I’ve been watching old episodes of classic programmes such as Steptoe and Son, Spike Milligan and The Two Ronnies. I imagine that a serial about the humorous co-dependency between a father and son, who are rag and bone men, would not get very far with commissioning editors these days. I noticed that Leonard Rossiter appeared in several of the early episodes.

My journey of recovery continues and I am doing my best to find a good way forward through the confusion. I researched rites of passage in organisations for my PhD, so I should know a good bit about this topic. The key source was the anthropologist Victor Turner, who also wrote about drama and performance. On my desk I have a figurine of a man with a red and yellow striped body and a black, red and white striped face and headdress. He is the Mwengo, a shaman who leads the boys out of the bush after they have completed their tribal rite of passage; he takes them back to the village as young men. I got him in Zambia.

I’m not sure who will be leading me out of my discomfort and into normal life. I have a review appointment with the Oncologist next week. Somehow, I don’t think it will be her.

On the Up

My surgery was three and a half weeks ago and I’ve been home from hospital (the second time) for a week and a half. I’m recovering slowly but steadily. Home is peaceful and T is looking after me very well.

My wound is still sore and I take my full allowance of paracetamol and co-codamol each day, but the skin has fully closed over and is looking healthy. I now possess four large scars on my torso and would have no trouble being a body double for a pirate. I already have the accent. Although swinging through the air on a rope with a cutlass in my teeth might be a bit much for me at present.

After the bowel surgery and the dramatic relapse my guts are very sensitive. I lost ten pounds during my two bouts in hospital. And I’ve been finding it difficult to eat enough to put weight on. I tend to eat little and often. I also have to take soft and easily digestible food. I’m only able to manage a half to two thirds of what I would normally eat at any one meal. I seem to get full up fairly easily. At the same time, T is on a diet and has to watch me munching through full-fat yoghourts, digestive biscuits and organic chocolate bars each evening.

I go for gentle walks a couple of times a day. I amble along, my wound twinging, down the lane from the house. I’ve made friends with the collie dog who lives at the first farm. He now accompanies me on my walks and escorts me back to the house. I reward him with a biscuit before he returns to the farm. I asked T to give him a name. She called him Rex. I saw the old farmer a few days ago and asked him what the dog was called. Strangely enough, he said Rex.

I’m also sleeping a lot, ten to twelve hours each day. Every afternoon, whether I feel tired or not, I close the bedroom curtains and lie down. I usually wake up an hour or so later. My habit is then to watch daytime TV. My favourites have been the reruns of ‘Sherlock Holmes’ with Jeremy Brett as Holmes and Edward Hardwicke as Watson, and ‘Time Team’ with Tony Robinson.

I’ve caught a few matinee films. I saw ‘The Producers’ for the first time for decades and was struck by how politically incorrect its humour was, with a series of jokes about Jews, Nazis, women, gays and so on. It featured the recently deceased Gene Wilder but the star of the show was undoubtedly Zero Mostel. I found myself happily singing along to ‘Springtime for Hitler’.

I was much less impressed with ‘For Whom the Bell Tolls’, starring a wooden Gary Cooper and a vivacious Ingrid Bergman, with little onscreen chemistry. It was a sort of Spanish Western with plenty of action on horseback and the blowing up of a bridge across a canyon. Location shots were impressive but the sets were rather tacky.

‘The Mouse that Roared’ was a curiosity. A vehicle for Peter Sellers (who played three roles) and a weak satire on the nuclear arms race. It was a cross between ‘Passport to Pimlico’ and ‘Dr Strangelove’, with few of the merits of either.

I’m still unable to concentrate very well. I can manage a newspaper article but I’m not yet ready to read a book. The print seems to swim before my eyes quite quickly and my head seems to have plenty of cotton wool inside. I hope the anaesthetic disperses soon.

The Alien Reappears

Dear reader, I am continuing to go to great lengths to survey the healthcare system of NI. Over the past week, I’ve been inside two ambulances and been treated in two different hospitals.

My recovery from surgery at the Mater had been going very smoothly. I went up to Belfast last Friday to get the staples out and the nurse told me my wound was healing well. But on the way back I began to feel unwell and went to bed when I got home. I was having difficulty breathing. In the evening I got worse. T rang the out of hours GP who asked her to check me over and said she should ring them back later. My breathing got worse and I began to have pains in my chest. Then I started vomiting. T called an ambulance.

After getting lost on the way here, they arrived about 10.30pm. Big Arthur escorted me into the ambulance, strapped me into a chair and hooked me up to a heart, pulse and breathing monitor. I was breathing fast and shallow, my chest was very sore right in the centre and I was vomiting up foamy saliva. ‘Can’t you breathe normally,’ complained Big Arthur, ‘you’re stopping the monitor reading properly.’ I panted and moaned. He spent a long time filling in my details on a form, and then we got started.

It was the worst journey I’ve ever had. Even worse than the day I spent on the back of a flat-bed truck in Laos with high fever. Every bump on the road jolted me. The pain in my chest got worse and worse. My blood pressure was through the roof. I was retching with the cold sweats. And it seemed to take forever. After half an hour or so Big Arthur said, ‘we’re in Banbridge, won’t be long now.’ Dear God no, I thought, that’s only ten bloody minutes from my house. The monitor was bleeping out its readings straight in front of me. I gritted my teeth, grasped my knees and rocked myself side to side. I just had to keep going, gasping through the pain. From time to time I glanced over at Big Arthur. He was asleep.

Eventually we drew up outside Craigavon Hospital. The journey had taken the best part of an hour (a drive I had done myself in half the time). Big Arthur helped me down the steps into a wheelchair. ‘You’ll soon feel better with a bit of fresh air,’ he said cheerily. Thankfully A&E took over. They wheeled me into a room called ‘Resuscitation’ and took an Xray of my chest with a portable machine. A young doctor with a Southern accent appeared. ‘You’ve got a 90% collapsed left lung,’ he said, and threaded a tube up my nose and down the back of my throat. ‘Swallow,’ he said. Not easy to do when you are retching. Then a huge rush of air, like a balloon deflating. He had got the tube down into my stomach and was relieving the pressure on my lung. I started to feel a lot better very quickly. ‘That was a big lung collapse,’ said the young doctor, ‘you won the prize for the Xray of the night.’ I gave him a weak smile. ‘You’ll be fine now,’ he said.  I was hooked up with a drip and moved into the main A&E room. Only then was T allowed to come and sit beside me.

We spent the rest of the night in A&E: me on a trolley, T beside me in a chair. In the morning I was admitted to the ward and given a CT scan. I was feeling much improved, my lung volume was already at 75% of normal. But the medical staff decided to transfer me to the Royal Victoria Hospital in Belfast. They were worried that I might need emergency surgery on my diaphragm. Another ambulance journey, but a much more comfortable one this time: they knew the way and Big Arthur was now off duty.

The following day I was examined by two medical teams at RVH. The thoracic surgeons were keen to do surgery to repair my diaphragm and pencilled me in for theatre on Tuesday. I was very concerned to be going in to another big operation less than two weeks after the last. The general surgeons reckoned that the bloated stomach had been caused by either a blockage in my small intestine or late-onset ilius (when your digestive system freezes after surgery). Both of these are common after bowel surgery. They recommended that I be monitored for several days instead of being given more surgery. Thankfully this last counsel was accepted. The next day, they detected bowel sounds and I began to pass wind. The day after, they took the tube out of my stomach and I was allowed to try food. Soon my guts returned to normal and after more tests and scans I was allowed home yesterday.

I’ve spent thirteen nights in hospital out of the past sixteen. It certainly feels great to be back home. I’m very much hoping that I will be recuperating here without any dramatic interruptions for a good while.

The Return

I’ve returned home from hospital with some things and without others. I have a sore foot-long wound from the centre of my belly to my right side that is closed by a line of staples, a very upset stomach, a pervasive feeling of bewilderment and an inability to concentrate. I have left behind the tip of my liver, six inches of my small intestine and a tumour.

My surgery was more extensive than planned because the scans taken beforehand hadn’t shown the full extent of the problem. What the surgeon found was that the tumour had regrown from my rear abdominal wall into my liver and it was attacking my small intestine. Fortunately, before he had become a liver surgeon he had been a bowel specialist. He first removed the tip of my liver, then removed a section of my small intestine that had been weakened by the tumour and finally he dug through my abdominal wall into the muscles of my side to try and remove all traces of the tumour. This meant that the procedure was more complex and took more than twice as long as planned. I was in theatre for two and half hours, then in recovery for two hours being given morphine and finally on the ward later in the evening (when this picture was taken).

This surgery was in effect rectifying the deficiencies of the surgery I had in Dec 2015 which removed the tumour but had left cancer cells behind at the margin. Since then the tumour had regrown at the same site. Worryingly this local recurrence had not shown up on the scans, which only registered a problem in my liver. On the plus side, this surgery was completed by an expert surgeon and it was also very timely as the tumour was set to spread into my bowel. You have around twenty feet of small intestine, so losing six inches does not make a difference. Amazingly, after being cut and rejoined the bowel tissues repair in twenty four hours.

I received excellent care in the specialist liver and pancreas unit at the Mater Hospital. If I was comparing Belfast hospitals on Trip Advisor, which I am now in a position to do, I would be giving the Mater five stars. The unit had fewer patients per nurse, as they did mostly very complex surgery. They also provided innovative pain relief, pioneered in Australia. I arrived back from surgery with a small tube sewn into the wound that pumped in local anaesthetic. This line stayed in for the first three days and made a huge difference. On the first morning after surgery the nurses always force you to get out of the bed and sit in the bedside chair. In December I was so sore I managed to sit for just five minutes. This time around, after more extensive surgery, I was able to sit out for three hours. On the second day I was able to do a short walk with a nurse holding each arm. On the third day I was able to walk on my own with the support of a frame. On the fifth day I was able to walk entirely unaided.

My recovery was also promoted by not getting ileus after surgery (when your bowels stop working). This had happened on both of my previous major surgeries. To some extent it is a bodily reaction to the trauma of surgery. It is also a side effect of morphine. Aware of this, I was sparing in my use of morphine over the first few days. But this was only possible because of the local anaesthetic in the wound. As my bowels were working (I was able to pass wind) I was allowed to sip water on the first day of recovery, then to try and eat soft food on the second day. By the third day I was eating half of the small portions that were provided. By the fourth day I was able to eat normally. But despite regularly passing wind, nothing solid emerged. At least I was only constipated.

On the fifth day I was told by my specialist that there was no medical reason for me to remain in hospital. The only issue was that my bowels had not opened. When this happened I would be allowed to leave. That day I had six sachets of laxative and walked up and down the corridor repeatedly. But nothing came. On the sixth morning I asked for an enema. Sister took me into the toilet, inserted a large plastic syringe into my back passage and squirted in a viscous fluid. I was instructed to sit on the toilet and try to hold in the fluid for as long as I could. The fluid stung my anus then cramps began.  As I closed the door of the toilet, Sister looked at me enquiringly. ‘My bowels have moved,’ I confirmed. She smiled and turned to a Staff Nurse, ‘this man is ready to be discharged.’ T called for me in the afternoon. All the way home my guts were grumbling. T helped me from the car into the toilet and the diarrhoea began. Not surprising, given all the laxatives and the enema. But a small price to pay for the delight of getting home.

The Surgeon

We were called in to see one of the surgeons in the specialist unit for liver and pancreatic surgery at the Mater Hospital in Belfast. He sat at a desk with a large monitor; beside him was a nurse in blue uniform. The surgeon turned the screen towards us and called up the MRI of my liver. As he scrolled through the scan, a small shadow appeared near the lower edge of the liver. ‘That’s it’, he said, pointing at the screen with his pen.

Next he asked to examine me. I took off my shirt and lay on the couch. He perused the long scar down the centre of my torso, which had come from my first cancer operation in 2011 and was again employed for the operation last December, and shook his head. ‘I’ll need to make a fresh incision,’ he said. Using his finger like a scalpel he drew a line across my belly that followed the edge of my ribs on the right side. He paused at the bottom of my ribs and prodded my right side with his finger. ‘That’s where the tumour is,’ he said. ‘But I’ve not felt any pain there,’ I said. ‘You wouldn’t,’ he replied, ‘it’s too small at present.’ I nodded and gave thanks to the radiologist who had noticed that small shadow and alerted my doctors to the problem. The tumour would have been so easy to miss.

Back at the desk the nurse produced a one page colour diagram of the liver and pancreas. The surgeon inked the tumour in the diagram; it was near the lower tip of the liver. ‘It’s a reasonably straightforward procedure,’ he said, ‘I’ll remove the tip of your liver.’ He took his pen and drew a line across the diagram above the black dot. ‘I’ll need to leave a drain in for a few days,’ he said, ‘sometimes bile accumulates and that can lead to infection.’ I nodded, noticing that the nurse was writing notes below the diagram. ‘The liver is very resilient,’ he said, ‘what I’m going to remove should grow back in three months.’ T gripped my hand. ‘Thank you,’ I said, ‘’you’re making it very clear.’ The nurse smiled at us.

‘I’ve got a slot in theatre available on Wednesday afternoon,’ he said, ‘do you want it?’ I gasped; I wasn’t expecting anything to happen so soon. He looked at me quizzically. ‘I’ll take it,’ I said, my heart racing. ‘The sooner the better,’ said T, squeezing my hand

‘You’ll need to be admitted tomorrow afternoon,’ said the nurse, ‘for your pre-op.’ ‘Okay,’ I said, with a sharp exhale. The nurse took the one page diagram and wrote down the ward and phone number, ‘they will ring you to make arrangements for your admission.’ Then she handed us the page with the liver diagram, it had a label with my name and a barcode at the top. As we left the consulting room she handed me a document titled ‘Patient Information for Consent’ which listed all the risks associated with the surgery I was going to have. The first page included the names of each of the surgeons, she pointed out her name, phone number and email at the bottom of the page.

‘I’ve now been in each of the hospitals of the Belfast Trust,’ I said, ‘and this is the best patient information I’ve seen.’ She smiled, thanked us and returned to the consulting room. T and I paused in the corridor. The green walls and fluorescent lights began to whirl around me. ‘You alright?’ said T, clasping my arm. ‘It’s all happening so fast,’ I said. ‘You’re bound to be feeling the shock,’ said T, holding me tighter. ‘Thank you,’ I said, steadying. ‘The good thing is that it will all be over quicker,’ she said, and hugged me.

Ward F

Level 3, McAuley Building

Mater Hospital

Admission 30^th August for Surgery on 31^st August.

The Oncologist

I was due to meet the Oncologist to discuss the results of my MRI scan. We waited uncomfortably. Then a letter came giving me an appointment, but it was cancelled the day before by telephone. A couple of days later another letter arrived. It called me in to the Chemotherapy Suite for an assessment.

Anxiety surged through me. I looked up tumours in the liver and found that the usual treatment was either surgery or ablation. Oh no, I thought, this means my tumour wasn’t treatable in the normal way. Then I looked up chemotherapy for Renal Cell Carcinoma and found that the drugs they currently had didn’t eradicate it, they only slowed down the tumour’s progress. I felt very depressed.

I tried to keep myself busy and went on long cycle rides, so that when night came I was very tired and slept. After all I didn’t feel unwell. If the routine scan hadn’t found a problem I wouldn’t have known anything about it. One of the rides I did was up to Spelga Dam via the highest road in NI at 1350 feet. It was a real struggle but I managed it. I was delighted; I hadn’t done that steep climb since before I had cancer. I suppose I was also trying to challenge myself to prove that I was really alright. 

I hadn’t been to the Chemotherapy Suite before. It was a large comfortable waiting room with easy chairs, magazines, free tea and coffee. You were given a bleeper and when this went off you had to head down one of three corridors to the treatment rooms where the heavy business took place. We sat and waited in this ante-chamber along with many others. A good number were pale and gaunt: some in wheelchairs, some with no hair. I was very afraid that I would soon be joining them.

Finally we were called. At the end of the corridor a room and a different Oncologist to the one I’d seen before. She said the lump in my liver was confirmed as a tumour. It was small, 1.8 cm in diameter. I nodded, my pulse was beating faster. She told me that my case had been discussed at a multi-disciplinary team meeting and the recommendation was that I should have surgery. I gulped. She said that I would shortly be called to the Mater Hospital to meet the surgeon.

‘And what about chemotherapy?’ I said, hesitantly.

‘We wouldn’t be recommending that’, she said.

‘But your letter said I should come here for an assessment,’ I said, showing her the letter.

‘We were really worried,’ said T.

‘It’s just words on a page,’ said the Oncologist dismissively. ‘Surgery is the first treatment option and you’ll soon be called in to the Mater.’

We walked out of the Chemotherapy Suite with a spring in our step. The letter was, of course, only words on a page. But which words were placed on the page did matter. I imagine the problem was caused by a mistake or laziness in the office. Surgery was a known evil. And despite its threat, it somehow felt more manageable.

First Aid

To help relieve my worries about the lump in my liver, I went for a relaxing cycle ride along the tow-path yesterday afternoon. The good weather had brought out many more people than usual on their bikes. Returning from Newry, I was surprised to meet a boy running towards me shouting for help. I stopped.  

‘He just collapsed and fell,’ he screamed. ‘It could be a heart attack.’

‘Where is he?’ I said.

He pointed up the road. ‘I’m ringing an ambulance,’ he gasped, ’please help.’

I nodded and cycled the short way to a younger boy who was pacing around a man lying in the road. ‘Daddy, daddy,’ he shouted.

The man was flat on his back, a patch of dark blood on the tarmac behind his head. Three bikes were scattered across the road.

‘I think he’s gone,’ said the younger boy.

I gulped and stared at the man beneath me. I was afraid, what could I do?

I glanced up; the young boy looked at me pleadingly.

I slowly bent down to feel his neck for a pulse. Suddenly, the man coughed but didn’t open his eyes, his face was purple

‘Daddy, oh daddy,’ howled the young boy.

Desperately trying to remember the first-aid course I’d taken forty years ago, I turned him into the recovery position and began to press his lungs with my palms to help him breathe. He coughed a couple more times but then stopped. I kept going with my rhythmic pressing.

‘Where are we?’ shouted the older boy, phone to his ear.

‘A mile south of Poyntzpass’ I said, having been up and down the route countless times.

He relayed this to the 999 operator, who then began to ask questions about the man. The older boy spoke them to me. I answered and he relayed my responses to the operator.

‘She says we need to put him on his back’ said the older boy. We rolled the man over and the younger boy took off his T shirt to support the man’s head. The older boy, phone wedged to his ear, put his hands together and with the heel of his palms began CPR – press one, two, three, four, pause.

After a short while I took over. Then a couple arrived on their bikes and began to help. They were Polish and trained in first-aid. Taking it in turns we kept the CPR going until the siren of the ambulance sounded down the road.

The two paramedics jumped out, each with a kit bag. One worked at his side and injected him with something; the other began to work on his airway, pressing a large balloon to work his lungs. The Polish man continued with CPR.

I stood up and looked at my watch. Twenty minutes must have passed. Standing a discreet distance away up the road was a group of cyclists and walkers.

As they worked, the paramedics had lots of questions about the man. The youngest son answered. It seems his father had been having pains in his chest for several weeks. They were cycling and he had complained of feeling faint, then he collapsed.

Attaching a lead to his chest and side the paramedics told us to stand away from him. One convulsive shock and a pulse started. I could see the jagged line on the monitor. They gave him another injection and told the Polish guy to continue with CPR.

The man had been dead for twenty five minutes, but now he was resuscitated. Soon he was in the ambulance and away.

I turned to the Polish man. We shook hands. ‘I hope he survives,’ he said. ‘I hope so too.’

‘I’m going to take another course in first-aid,’ I said, mindful of the terrible feeling of exposure I had being first upon the accident. ‘It’s something everyone needs to know’.

The Polish man nodded. We both picked up our bikes and set off. We were heading in different directions.

I had about nine miles to ride to the car. I cycled slowly. For me this was another powerful lesson about how fragile life is; the latest in a line that stretched back decades. Yet I would still habitually rush around with hardly a thought for how easily my life and the lives of those around me could be snuffed out.

Driving home, cars sped past me, overtaking on the other side of the road. ‘Hold on there,’ I shouted, ‘slow down’. Here I was with a potential tumour growing inside me, and I didn’t want to die in a car accident.

Sixteen Tons

The routine CT scan showed a small lump in my liver. ‘It could be a capsular deposit or a metastasis’, said the oncologist. I looked quizzically at her. ‘A tumour’, she said, helpfully. I nodded. She smiled, ‘so I’m sending you for an urgent MRI scan’.

At the Cancer Centre, I filled in the MRI questionnaire. They wanted to know whether I had any metal in my body. I could safely say no to the questions about body piercings and shrapnel wounds, but I had to acknowledge the sternal wires and surgical clips from previous operations.

I took off my clothes, then my necklace and bracelet and put on the hospital gown. I sat in the cubicle and waited, naked apart from my underwear.  A knock on the door and I was called.

The MRI scanner is a long slim tunnel surrounded by a huge magnet. I lay on the narrow bed in front of the machine. A curved panel was strapped around my midriff. Then headphones were put on me. Because MRI scanners are very noisy, the radiologist speaks to you through the phones. But most of the time music is playing very loudly.

Move closer...

I began to slide into the scanner feet first.

Move your body real close...

I was right inside the scanner; its grey walls just a few inches away.

Feels like we’re really making love...

I was entombed. The scan started and loud pulses roared around me. My midriff began to get warm. But, despite Phyllis Nelson, I wasn’t feeling a great deal of love.

‘Hold your breath’, said the radiologist. And the pulses began again. They sounded like a deep thumping siren.

People say a man is made out of mud.

A poor man’s made out of muscle and blood...

Again I was told to hold my breath. The pulsing reverberated around me.

 

You load sixteen tons and what do you get?

Another day older and deeper in debt...

I was trapped, like at the bottom of a coalmine. I panted, allowed to breathe again. Tennessee Ernie Ford boomed on.

St Peter don’t you call me because I can’t go

I owe my soul to the company store.

My mind raced ahead; what would the scan show? A third bout of cancer?

When the night has come

And the land is dark

And the moon is the only light we'll see

‘Nearly finished’, said the radiologist, cheerfully. ‘You alright?’

No I won't be afraid
Oh I won't be afraid
Just as long as you stand, stand by me

Good Weather for the Garden

The past month has been pretty wet hereabouts. Barely a day seems to have passed without rain; payback perhaps for the long dry spell we had earlier. The ground has been saturated and combined with a little warmth most plants have flourished. My garden seems replete with moist, green fecundity. Five weeks ago my mower broke down and the lawn has retaliated by becoming a meadow.

We live on the side of a drumlin and have about half an acre of grass around us dotted with trees and shrubs. When I moved here the house hadn’t been lived in for months and the grass was over three feet high. A farmer friend of my neighbour's was enlisted to cut the grass with his tractor and disc mower. Afterwards I had to manually rake the grass and pile it into stooks which were then picked up and carried away by the tractor. This was an insight into the agricultural labour that my forefathers had done for generations. The haymaking was very hard work over several days which left me with an aching body that took days to recover.

I was advised to get a ride-on mower to keep the grass in check. I bought a second-hand Honda but it couldn’t manage the steep slopes of the garden. So they took it back and sold me the toughest mower they had, a Snapper, made in Georgia USA to a 30 year old agricultural design. It was red and chugged up and down the steep slopes munching the grass as it went. Over the years my Snapper has proved to be very robust until it stopped suddenly five weeks ago.

I took the mower to the repairers, they already had a backlog to fix and said they would try and do it in two weeks. At the end of this time I rang to find it still wasn’t fixed. They had first ordered the wrong part and then, because it was an old mower, the part they needed wasn’t in stock. Two more weeks passed and the grass grew and grew. It was about a foot high and meadow flowers had begun to proliferate in it: yellow vetch, ox eye daisy, white and purple clover. Without trying I’d got a very large bee garden.

I rang the repairers again, they had fixed one problem and the mower was operational, but they were still waiting for several parts to finish the job. We agreed that I would take it back to cut the grass and then return it to them when the parts they needed had arrived. My obliging neighbour took me to pick it up with his trailer which had a ramp at the back. The trailer was littered with sheep shit from its previous occupants, but no matter the mower slid in nicely.

I pondered how the mower would manage to pick up the grass when it was over a foot long. It won’t, said another neighbour, what you need to do is to mow the grass and blow it back out onto the lawn. Let it dry for a few days and then you’ll be able to go around again and pick it up with the mower. Seemed like a good plan.

I waited for a dryish day and late in the afternoon I set about the cutting. Even the trusty Snapper laboured through the long grass. The engine grumbled but the grass was sprayed about fifteen feet into the air, landing in heavy green clumps on the lawn, the mower and me. Then the mower ground to a halt. The grass was only dry at the top and kept clogging up the blades. I had to keep stopping to pull handfuls of matted wet grass from its innards. Slowly the Snapper did its job. I didn’t feel good chopping through the wild flowers, so I left a strip along the edge of the garden for the bee meadow.

It rained solid for two days and then it was dryish for the next two. On the first day I raked the clumps of grass to help them dry. On the second I got out the mower to pick up the old grass. Trouble was the lawn had also grown a couple of inches so it was a mix of dry and fresh grass which took double the normal time to cut and pick up. T helped me dump the grass into the field at the back hedge. And to add insult to injury there was a torrential downpour for the last ten minutes of our work. But we just kept going and flopped indoors: drenched, covered in grass cuttings and knackered. Even with labour-saving machinery, a country life isn’t easy.

History Repeating Itself

We seem to have been reliving our past. There are so many points of connection between the national politics of the past six years and the 1980’s. To begin with: austerity. Or as this was known in the 1980’s ‘the cuts’. Then, Margaret Thatcher led a government which made deep cuts in public spending year on year. As have Cameron and Osborne. And what is more, the electorate kept voting for these cuts, then as now. Indeed, it was Mrs Thatcher who coined the phrase ‘there is no alternative’.

With rapid falls in public and private investment, poverty, inequality and unemployment all massively increased during the 1980’s. Since then high levels of unemployment have become normal. In recent times this pattern has repeated and levels of poverty and inequality have spiked again, as the national need for food banks has shown.

In the 1980’s there was widespread opposition to austerity and this was focussed around metropolitan local authorities, such as in London and Manchester (where I was a PhD student). But perhaps the greatest emblem of this opposition was the Miners’ Strike, which the Thatcher government managed to successfully undermine through union constraining legislation and politicised policing.

Recent public opposition to austerity in Britain seems to be relatively cowed. Perhaps it has become refocused around single issues, like benefits for the disabled or funding for the NHS or environmental protest. In contrast to the 1980’s, the highest profile union struggle in recent times has been between the government and the BMA, an elite professional union.  

Throughout the 1980’s the Labour Party was riven by struggle between right and left. At first Michael Foot and Tony Benn were in the ascendancy and led the political opposition to Thatcherism. This undoubtedly implacable opposition did not lead to success in any general election and the party’s manifesto for 1983 was called ‘the longest suicide note in history’. So is Jeremy Corbyn a new Michael Foot? And is Momentum the new Militant, yet to be proscribed by a new reforming leader? Might there be a putative Neil Kinnock about to emerge on the scene or is Jeremy going to change his spots?

During the same period the Tories were split over Europe. Under Thatcher the Euro-pragmatists were in the ascendancy and she used this, and the rise in poverty, to negotiate a large rebate on the UK’s annual payment to the EU (which still remains). During the 1980’s the migration problem was in the other direction, conditions in the UK were so harsh that more people chose to leave than stay. And this unremitting harshness eventually told on public opinion.

In the run-up to the 1992 election Thatcher was deposed by Tory MP’s scared of losing their seats. The reformed Labour Party under Neil Kinnock was in the lead in opinion polls, but the tabloid press came to the Tories aid. The front-page headline in the Sun on election day was ‘If Kinnock wins today will the last person to leave Britain please turn out the lights’, with a caricature of his face on a light-bulb. And the Tories under John Major scraped back in.

The tabloid press played a similar role in last week’s referendum. The Daily Express front page had a Union Jack backdrop with the headline ‘Your Country Needs You: Vote Leave Today’. And when this war was won, the Express (like the Sun in 1992) crowed that they had played the decisive role in this xenophobic victory.

So now there is to be a new Tory leader and PM. Apart from Cameron, the Tories have a recent tendency to choose those who have been cut from the common cloth and made good: it reinforces notions of social mobility and disguises their patrician power base. Thatcher and Major both fitted this bill, as do all of the current candidates. The Bullingdon boys have decided to hold fire until the dimensions of the mess that we all have been left in become clearer.

And what happens next? Well, who knows? Leaving the EU is definitely dangerous, uncharted, territory. And I still hope that this can be avoided somehow. Whatever path we take we will surely need to work through the confused mix of nostalgia, prejudice and protest that has brought us to the current predicament. I think it was Santayana who said that ‘those who fail to learn from their history are doomed to repeat it, first as tragedy and then as farce’.