Monday, 29 August 2016

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 30th August for Surgery on 31st August.

Tuesday, 23 August 2016

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.

Wednesday, 17 August 2016

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.

Tuesday, 9 August 2016

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