Cancer 52
Posted on June 11, 2023 Leave a Comment
I have been talking about my reactions to cancer throughout these blogs, but I have not really said what the problem is. At one level I suppose this does not matter. I have cancer, it is going to kill me, I am not sure when. The health service has not yet established all the facts (sorry, Mr Gradgrind). We are still waiting for the results of further biopsies, and I will have a CT scan later today to determine the extent to which the cancer has spread over the last couple of months. We also do not know how well or badly I will respond to the chemotherapy, and whether the chemotherapy will need to be changed as a result of these awaited tests.
What do we know? After various signs and symptoms followed by tests I underwent an open Hartmann’s procedure. The post-operative histology confirmed a poorly differentiated mucinous carcinoma of the sigmoid colon. The biopsy confirmed the tumour deposits, meaning I have N1 disease (cancer in nearby lymph nodes), and there was also evidence of extra mural venous and lymphatic invasion, but no evidence of perineural invasion. pT4a means my cancer has grown throughout the layers of the colon, but not attached to other organs or structures. pN2b indicates the cancer is in nearby lymph nodes.
While there are overall survival rates for this type of cancer it cannot of course be specific to an individual. The consultant, when asked, gave an estimate of 50% survival rate at 24-30 months. We haven’t started treatment yet so it will help when we see how I respond to that treatment. While I am happy that the people in the NHS will do their best perhaps the most important thing for me is to stay positive and to eat a reasonable diet.
The treatment plan. I have my PICC line fitted tomorrow (in the vein, from my upper arm to above my heart: covered ith a dressing when not in use) and chemotherapy starts on Tuesday. I will be sitting in hospital with a drip for about 4 hours on Tuesday, and then sent home with a bottle attached for a further 48 hours. On Thursday the district nurse detaches the bottles and cleans the PICC line. I am then free for 6 days. On the following Thursday the district nurse takes a blood sample and recleans the PICC line. On the Friday I see the consultant to see how things are going, and then the following Tuesday it starts all over again.
Assuming I respond well and can cope with the side effects (I have decided not to have any) this will be repeated every two weeks for three months, and then a further CT scan will indicate whether it is working. If so, then I will probably have another three months and then take a break from treatment to go and spend a month or two somewhere warm. If things work out well this will be my life between Tuesday and death, however long or short that may be.
I am going to have combination chemotherapy with FOLFIRI +/- Cetuximab depending on my further results. I can look forward to the possibility of a range of side effects, including skin toxicity (stay out of the sun, use moisturiser!), sore mouth and ulcers, cardiac toxicity (due to heart failure), bowel problems, high stoma output, risk of low blood counts, risk of infection, and life threatening neurotropenic sepsis – it is funny how ‘life-threatening’ only comes up at that point. I had the vague idea that the cancer itself is somewhat life threatening (stay positive…).
Right, I am off to fix some skirting boards. Stay tuned for updates on the side effects of chemotherapy.
Cancer 51
Posted on June 11, 2023 Leave a Comment
I suppose reaching fifty blogs on the subject of cancer is something of a milestone. I have had quite a few positive comments so I must be doing something right. I am probably repeating myself at times but I don’t care, the blog is more about a stream of consciousness than an attempt to write a logically constructed account of the process of living with and dying from cancer. It is the same with grammar and spelling. I don’t tend to go back and review or revise anything that I am writing. You get it as it is. I should perhaps do more research when I start blathering about books or people but I can’t be bothered. I am not attempting to write a logically constructed and empirically informed account of the process of living with and dying from cancer. If there are errors then blame my comprehensive school education.
I have written about, and I think about, the meaning of life. As I have said before, I see life as essentially meaningless. Any meaning attached to life is the meaning you as an individual attach to it, whether that relates to relationships with others, the acquisition of knowledge, admiring natural beauty, or even believing in fairy stories about a badly dressed beard god sitting on a cloud called heaven. That is all there is, and once you are dead those meanings die with you. That is not to say some of these meanings are not shared between many members of the human race. I have no empirical evidence (see above), but I suspect that if you ask everyone in the world about what meaning their lives have, most would mention relationships with others. It is probably top of the list.
While I like to think of myself as a – usually – reasonably kind and nice person (apologies for the ego) there is a part of me, especially now, that is incredibly selfish. I want to live. I want to be alive. I want to breathe. I want to be in my home. I want to travel to places. I want to smell grass. I want to smell cattle shit. I want to listen to birds and insects. I want to be with other people. I want to sit in the dappled sunshine under a tree. Me, me, me. It is all about me, not you.
Nevertheless there is also the selfless element. I don’t want to upset people. I want them to be happy. I want them to get on with whatever they want to get on with. If they have a relationship with me I want them to continue with it. So truthfully it is not just me, it is you too.
But on the scale of things this is all meaningless. In the end none of it matters. In 100 years we will all be dead. We will all be forgotten, so what if I am dead this year or in 30 years? It makes no difference in the end.
Cancer 49
Posted on June 7, 2023 Leave a Comment
I have just developed a new fear. It happened while I was scrambling down a vertiginous slope while walking at Hadrian’s Wall. I realised that if I fell, and it was rather precarious, especially with my aching bones, I may well break a leg ir two and spend the rest of my foreshortened life in hospital, in traction, in pain unrelated to any rapidly spreading cancer. To be in hospital with cancer is a nightmare, to be in hospital because of my own stupidity when I could be at home dying of cancer is a worse nightmare. I don’t think I will walk anywhere ever again just in case I get injured. I had better not drive in case I am in an accident. I had better not stay at home in case Libyans decide to blow up an airliner somewhere above my house – sorry, that is in bad taste. We have just driven past Lockerbie. I drove past it 36 hours after the plane crashed there and there were bits of aeroplane everywhere, especially lining the sides of the road.
The problem with black humour is that while a lot of modern folk disapprove (how can you make jokes about race, sex, the Holocaust, pet cats, etc?), when you are sitting dying black humour is one of the best ways of staying cheerful. I have heard some good cancer jokes while I have been ill. I can’t remember them partly because I never remember jokes – my humour is spontaneous folks! – and partly because for the last few months the part of my brain critical for inputting new long term memories, the hippocampus, seems to have metamorphosed into a cancerous lump. I can’t remember new things in the way I could. Actually I have no idea if I have cancer in my brain if anyone is worried.
If anyone knows any good cancer jokes, the sicker the better, please send them to me. Perhaps they could become a blog.
The part of Hadrian’s Wall we were visiting is near to that part that is somewhere between where Robin Hood Prince of Thieves landed on the south coast and Robin’s Dad’s castle presumably in Snottinghamshire. If anyone isn’t aware ofnthe basic geography of England you don’t need to go via Hadrian’s Wall to make this trip.
The story of Robin Hood (not the Prince of Thieves version) has always inspired my basic socialism. I realise that many people do not think Robin existed, but of course he did. Who else wouls fight against the basic inequities extant in the feudal system sometime in the (probably) 13th Century? I know he existed. My Aunty May made me a Robin Hood suit when I was little. Armed with a Dad-made bow and arrows (a bit of a plastic downpipe for a quiver, baling twine for a bow string), I conquered our woods and extracted a toll from all comers to give to the poor.
And don’t give me this nonsense about Robin coming from Nottinghamshire. He was from Loxley on the disputed Derbyshire-Yorkshire border. He holed up in the Peak District when not robbing ruch people on the Great North Road, in both Yorkshire and Nottinghamshire, and the Sheriff of Nottingham at the time was a Peverill from Castleton in Derbyshire. The two counties, Derbyshire and Snottinghamshire were a unitary council at the time.
I just thought I had better make that clear.
What kind of punctuation mark am I? A semicolon cancer.
There, those random jottings might convince you my brain is addled (riddled?). I will just sit here quietly.
Cancer 50
Posted on June 7, 2023 Leave a Comment
A few years ago a very good book on traumatic stress was written by Bessel van der Kolk, who works in Boston (Massachusetts, not Lincolnshire). It is called The Body Keeps the Score, and is well worth a read. The fundamental point of the book is that when negative things happen to you these are remembered by the mind/body, and these can be then expressed as traumatic stress or PTSD. Van der Kolk discusses the techniques that can be used to effectively deal with these problems.
The body keeps the score in many ways. We all know this. It is certainly not just about traumatic stress. The old phrase life fast die young has meaning, not that I would claim to have lived fast, though I think the latter is a near certainty (yes, I am saying 60 is young. Deal with it). I used to smoke in my teens and twenties. I used to drink more alcohol than I should. I love red meat, bacon and sausage, along with black pudding, haggis, and most other forms of processed meat. I have never been a drug taker apart from in my teenage years the odd bit of cannabis (about five times in total perhaps) and a few years of seasonal magic mushrooms, where I tended to double up with each dosage, so fortunately the season was short. I have never, to my knowledge, seen cannabis or heroin. As with most people there have been a number of other risky activities in my life. Nevertheless, my risk count seems to have added up and indicated that it is time for me to have cancer (and heart disease). The body keeps the score. Inevitably there are other factors, such as genetics and personality, but the score probably matters.
I have always known about the risks involved with some of these activities, but as a youngster I was, like most people, immortal, and by the time I realised I was mortal all the bad habits had set in. There is often a disjuncture between when we know and what we do. It is probably a problem associated with the way the mind works. How would I know, I am just a psychologist? Why do so many people (traditionally mostly men) know what they should eat and how they should behave but do the opposite? What is wrong with us? Presumably the common assumption is that it will happen to others, otr that it will happen in a distant future when it won’t matter. There is also plenty of evidence that we are poor at using risk and probability in everyday life. And bacon is delicious.
This talk of body and mind suggests a classic Cartesian dualist perspective, where the body functions independently of the mind, and the mind itself has separate elements. Dualism is at one level utter nonsense because the brain – generally acknowledged to be the seat of the mind (I said I was a psychologist) – is just another bodily organ like the liver or the heart; but at another level the body and the mind appear to be functionally distinct, with the mind being partially conscious and, it appears, partially non-conscious, and there is often conflict between various elements, which may explain risky behaviour.
As a glass half full person my conscious mind is largely concerned with the positive aspects of life and the non-negative aspects. I try to live my life in a satisfactory and enjoyable way, taking an interest in what I and those around me do, reading good books, and admiring the countryside. I sometimes fail. I am sometimes anxious, I am sometimes depressed, but it rarely lasts for long. A good rule of life is to enjoy the positives for a long time and ensure the negatives are brief. Football is a good example for me. As a fair weather supporter of Derby County and England, as I watch a match I will be suitably enthusiastic, and if they win I will enjoy the pleasure of that for a day or two. If they lose, then I will be down for about five minutes, and then forget about it. It doesn’t matter, and what is the point of negative thinking? It is a good strategy for football and it is a good strategy for life. Unfortunately, it does not always work this way.
The other day I drove through the Highlands of Scotland, which has two fundamental pleasures for me (apart from being with the wife), being in a beautiful place and driving; but cancer got in the way. As I was driving I started thinking that this is likely to be the last time I drive here because I will soon be dead. This stopped my enjoyment of both the scenery and the driving. This sort of thing is usually momentary, but on this occasion it lasted for minutes before I knocked it out of myself. I do wonder if this is going to be an increasing problem, like the growth of my tumours. I will have to fight it.
The body might keep the score, but I don’t have to constantly take notice of that score, especially as the world is such a beautiful place.
Cancer 48
Posted on June 4, 2023 Leave a Comment
Neville Shute’s On the Beach is a great book, if somewhat flawed about the impact of radiation after a nuclear war. If there is anyone out there who hasn’t read it (and that should be rectified immediately) then it is based around a set of characters living in and around Melbourne – the Australian one, not the Derbyshire one (the former was named after the latter, as Lord Melbourne, from Melbourne in Derbyshire, was Prime Minister to Queen Victoria at the time Victoria became a state). Radiation from a nuclear war in the northern hemisphere has been gradually heading south. It has killed every living thing in the north and is doing the same in the south.
The book follows a number of people who are dealing with the inevitability of death, some coping well, some less so. One person drives in a no holds barred race where several drivers are killed. Others turn to alcohol (for some there isa a cellar to be finished off). Some, including the hero’s wife, are in extreme denial. As the cities of northern Australia go silent and the people die, they are said to be ‘out’. Throughout the book there are frequent reports about how the radiation is gradually but inexorably heading south, how it will inevitably kill everyone. A submarine is sent north to see if anything has changed. The Golden Gate bridge is down, there is random radio chatter from Seattle, but it turns out to be a window banging in the wind. The submarine checks the far north to see if the radiation is decreasing and there is any chance for humanity. It isn’t, and there isn’t. It is the end of the world.
Having cancer which is going to kill you has some of the same qualities of the book, the knowledge of certain death, the wondering what to do with the remaining time, learning to cope, being unable to cope. No doubt some people turn to alcohol – I haven’t, though I have started drinking alcohol free alcohol which, due to my neurotic turn of mind, I believe is getting me pissed. Some people go into denial. I don’t. I am fully aware that in a relatively short time I am going to be dead. Unlike the characters in On the Beach I have no certainty about the timing, but currently I have rotten backache and I now assume all pains are associated with the growth of tumours. The only treatment available in On the Beach is drugs for suicide. I hope I will have access to something similar when the time comes – as I have said before, I have a fear of pain, not death.
The main difference between On the Beach and terminal cancer is that the rest of the world will carry on once you are dead, and will quickly forget you. That is a good thing, both carrying on and forgetting, and I am happy that the world will continue rather than be ravaged by the radiation resulting from a large scale nuclear war. There is one small problem though. In the back of my mind, and the back of my mind has many ugly compartments nowadays, hoarding thoughts and feelings that are not altogether positive, though it is better than having them in the front of my mind. In the back of my mind there is a jealous thought. I am jealous that you will all continue to live after I have died. I also have a selfish thought. Why can’t we all die together as in On the Beach? Of course, I do not mean these things. I am not really jealous (not much anyway), and I am not that selfish – not at all. The thought just passed through my head as I was writing this. It just goes to show that while analogies may be a useful tool when examining and attempting to explain the nature of the world, they can be wrong.
Still, On the Beach is a good book. Read it, even though I have given the end away. They all die, just as we all do in real life.
Dr Nigel Hunt 