Cancer 4
Posted on February 5, 2023 3 Comments
Perhaps the worst aspect of the internet is the availability of information, some of it accurate, some of it less accurate. When someone gets a nasty disease it is common for them to search the internet and try to understand what is happening to them. I get it. I do those searches just like everyone else. We want to become knowledgeable so that we know what we are facing, have some idea of how to behave, and perhaps to have a reasonably intelligent conversation with our doctors.
While this may work to some extent it is not possible to become an expert in an area by reading a few webpages. The illusion of knowledge is a dangerous thing. We all know this implicitly. It is just that when we are faced with something difficult personally we somehow think it is different for us. It isn’t.
I am a professional psychologist, a trained scientist. I have at least 36 letters after my name. I have three fellowships. I work in a School of Medicine. I teach trainee medics. I read academic articles all the time. I can interpret theory and method. I have access to all the main academic journals and articles on cancer and bowel cancer. I can theoretical read them all.
What I cannot do is become an expert in bowel cancer in a matter of days, weeks or months.
The articles I have read have suggested many positive and negative aspects of the disease. I read one indicating that bowel cancer spreads much earlier than previously thought. I have read articles which suggest most people with bowel cancer die quite quickly (this was an easy one to interet as most people with bowel cancer are already old so they are going to die quite quickly anyway). I have read that most people with bowel cancer live for years. I have read about temporary and permanent colostomy bags, cutting out parts of the bowel, information about the right and wrong things to eat (I am pretty good at eating the wrong things), chemotherapy, radiotherapy, and so on. There are many words I have to look up as I don’t understand them. Sometimes when I look them up I still don’t understand them.
My point is that, even though I have all these qualifications, I am not going to become an expert on cancer, I am not going to know more than the people treating me. I might get to a point where I can have a half decent conversation about a particular treatment, but when I say half decent that is from my perspective, not the perspective of the person with years of education, training and experience who is having the conversation with me and is probably rolling his or her eyes, at least inwardly, and wishing that the internet had never been invented.
Michael Gove was wrong. I have not had enough of experts. I want more of them. I want to listen to them and take their advice. If I do this then hopefully I will receive the best treatment, become cancer free, and can stop writing this blog.
Of course there are exceptions. Experts sometimes get it wrong. Amateurs sometimes make surprising discoveries (usually in astronomy). But these are not the norm.
To be continued, hopefully.
Cancer 3
Posted on February 3, 2023 1 Comment
Briefly, some pretty good news. I spoke to the cancer nurse today. The cancer is confirmed. OK, that isn’t entirely positive, but only one node found outside the bowel. I don’t know where it is, but presumably near the bowel. All organs clear except two small nodes on the right lung, which may or (probably) may not be cancer. So, it looks like surgery and chemo. The only complication is my heart failure, but that is going to be checked out. Next stage meet the surgeon. More to follow.
Cancer 2
Posted on February 1, 2023 1 Comment
The NHS is doing a good job so far. I went to see the GP just before Christmas, who after an appropriate examination (not really my thing but I did find out that I don’t have a prostate problem) sent me for a sigmoidoscopy (for those not in the know it is a tube with a camera and various implements for snipping off lumps for biopsy, needles for tattooing and so on. A wonderful yet rather unpleasant invention. As we were just about to head off for Provence for three weeks the procedure was arranged for the New Year. I had the test last Tuesday, which indicated a 7cm growth 31cm up in my colon. The live visuals were mostly fascinating, including the colourful item that turned out to be the tumour. At least I have seen my own living cancer. I was immediately recommended for a CT scan, which I had on Saturday evening. I am now waiting for the results.
My experience so far with the NHS has been almost entirely positive. The people who have dealt with me have been kind and caring, yet practical and skilled. Obtaining this kind of diagnosis is not pleasant, nor are the procedures for obtaining the diagnosis. The nurses acknowledged my fears and dealt with them in a caring way. I was more frightened of the procedure than the potential outcome. I am officially less frightened of driving through a minefield than having something stuck up my backside. At least minefields are exciting.
The only problem I have experienced is the inability of people to tell me in a straightforward manner what they have found. After the sigmoidoscopy the two people who carried it out said – twice – that they would like to phone my wife so she could come along to the discussion about what they have found. That gave me a clue. Then, at the subsequent discussion (no, they didn’t get to phone the wife), instead of telling me what they suspected the problem was they asked me if I had thought about what the possible outcomes might be. I said that I had, and waited for them to employ that word. No chance, it was left to me to suggest that they had found a tumour, for me to mention the word cancer. They finally acknowledged it, and the look on their faces suggested they thought I was going to break down in tears and smash up the room, which I didn’t. It wasn’t until they left (quickly!) that I was given the letter that suggested a 7cm malignant tumour, so I was unable to ask for more details.
I understand that they were trying to be caring, to let me know gently, but that is not possible. In the end there is a single transition point. At one moment you do not know you have cancer, at the next moment you do. There is no breaking it gently. That transition from not knowing to knowing is fundamental. It is a life changer. It cannot be said gently.
I don’t like people faffing around with the truth. Just say what you mean and then I can deal with the consequences. Stress arises from ignorance.
To be continued, hopefully.
Cancer
Posted on January 30, 2023 2 Comments
This is rather an awkward subject for many people, presumably because it is about life and death and many people have an awkwardness about death. I have just found out that I have bowel cancer. I have had the tests and now I am waiting for the results to see whether it has spread and if so, how far. It is an odd feeling, knowing that there is a malignant growth inside you. I have a (dis)advantage in that I have seen it. The camera showed it attached to my colon very clearly. It is 7cm long, and that is about all I know at the moment. I have had biopsies and a CT scan and I am waiting for an appointment with the consultant.
I don’t know whether this is going to kill me, and if it does whether it will do it quickly or slowly. I might live for three months, I might live for 30 years, but just knowing that I have cancer means that I am at present confronted with death. On the positive side my main thoughts are so be it. I am not afraid of death. Why should I be? I agree with Bertrand Russell and others that my ego is a temporary phenomenon that appeared when I was born and will disappear when I die. The best we can hope for is to have some self-constructed meaning in that short time we are alive. The individual is the only one who can give meaning to life. In Sartre’s terms authenticity, or from being to becoming.
We are not remembered for long. Once you die everyone gets on with their lives. They might think of you occasionally, they might experience sadness, but in the end their life is more important, along with the lives of their family and friends. A very few people are remembered for what they did. People such as Hitler, Pol Pot, Churchill, George Orwell, Edward I, Florence Nightingale, Charlemagne, Orville Wright, Alan Turing, Napoleon, Piers Gaveston, Cleopatra, Oscar Wilde or William Gladstone, but they are not remembered for who they are but for what they did. It is a tenuous link between the famous person remembered and the actual person known to friends and family.
I really do not mind dying. I am pleased that at the first threat of death I didn’t give up on a lifetime of beliefs and start praying to a ridiculous non-existent bearded fairy who lives on a cloud. The culture of religion and belief is strong. It is not surprising because people want the world to mean something. Unfortunately it doesn’t mean anything. The universe has no beginning that we understand, it has no end that we understand. The only true beginnings and ends for our egos are birth and death. The only meaning is the meaning we place on life. Placing a religious meaning on life is inauthentic. It means taking other people’s ideas (which are usually about the subjugation of the masses) and internalising them as your own. That is essentially inauthentic. It demonstrates a person who has not thought about what their life means.
Am I authentic? I like to think I am but I don’t really know. I tend to behave consistently in certain ways (including being inconsistent), often to the annoyance of others, but hopefully mainly positively, eg challenging the way people unthinkingly think. I hope that in my career I have helped a bit, done a bit of good. I have been closely involved in the education of many people from all around the world. I hope some of them at least have become slightly better (whatever that means) in some way because of my influence. I hope that overall my influence on and interactions with friends and family have been positive. I hope I have made their lives a little better. I have written a few books and a lot of academic articles. In some ways these are a more permanent contribution but do they really mean anything? It is the same as my other interactions. I hope they have helped some people in some ways.
In the end it is not for me or for anyone else to judge my contribution. I have done what I have done and that’s it. I have broken moral codes but I have generally lived by what I hope is a fairly reasonable moral code. I am imperfect, ok very imperfect, but aren’t we all? With free will we are bound to make the wrong choices at times. That makes trying to be authentic in life all the more important, because authenticity is not just about the self it is about the way we are with others.
Of course, this experience of the potential for fairly immediate death may be somewhat premature, then I might look a bit daft talking like this. I hope I do get a bit longer because I still have things to do, particularly post-retirement (write books, read books, go to places, talk with people); but if it isn’t that’s fine.
My other thought is that the usual perception is that family and friends should be supportive of the person who is dying. Sometimes it is the dying person (I am not saying I am dying but you know what I mean) who does a lot of the supporting. ‘It is ok, I am fine about dying, it doesn’t worry me.’
To be continued – probably.
Ukraine: What the media doesn’t tell us, Part Two
Posted on March 8, 2022 Leave a Comment
Last time I looked at some of the background issues regarding Ukraine and the current war. Now I would like to look at the military situation, which is very difficult as no one seems to know what is happening, and few people are even reporting the military situation beyond a few bland statements. Much of what is happening must be guesswork, and reliant on what we know about the military strengths and weaknesses of the two sides, and the (very) limited reporting from the front lines. The media focuses more on the (important) human stories of misery to the exclusion of informing us about the military situation. This is in contrast to Western reporting of other wars in Afghanistan, Iraq and so on, where journalists are working closely with, and often embedded with, the military.
Most of what we hear about the Ukrainian and Russian military situation on the BBC and in the newspapers is based on what the Ukrainians are saying, which is inevitably biased and probably largely wrong. If we believe Western media then we should think that the Ukrainian forces are holding their own against the Russians, that their equipment is equal to the Russians’ and that they are inflicting more harm on the Russians than the Russians are inflicting on them. The truth is unknown, but the Russians are advancing, and there are a number of things we should consider, for example armour and air forces.
Before the war started the Ukrainian air force had around 225 aircraft. Of these, fewer than 100 are combat aircraft, mainly Mig-29s and Su-27s with a few Su-24s and Su-25s. These aircraft are not far from obsolete. Actually compared to some of the Russian planes they are obsolete. The better ones, the Mig-29s (which Poland is purportedly going to provide more of to the Ukrainians if they can find a way of getting them across the border without getting drawn into the war) and the Su-27s were introduced in the 1980s. They are Soviet aircraft. They have been upgraded but they are no match for the Su-35s of the Russian air force.
Since the 1930s, ground invasions have usually been preceded by air bombardment, often lasting several hours or days, designed to reduce the defences of the attacked country. This did not happen in the current war. We don’t know why, though it was perhaps thought that the Ukrainian forces would collapse quickly and the Russians wanted limited destruction so they could quickly rebuild the country. Nevertheless, there have been air battles, though these are rarely reported in the Western media, presumably because it is usually the Ukrainians that have lost planes. We saw a video of a presumably Russian helicopter shot down, and a Ukrainian pilot reputedly shot down 6 planes in one day, though this is likely to be a myth. What most media outlets did not tell us was that Russian planes (presumably) shot down four Ukrainian Su-27s in one day, while ground-based missiles shot down an Su-25, a drone and a helicopter on the same day. Military Watch magazine has a picture of several Ukrainian Mig-29s shot up while on the ground somewhere in Ukraine.
It appears that though Western media generally does not report significant Ukrainian losses, the Ukrainian air force has possibly been largely destroyed or has to confine itself to Western Ukraine. The best hope for the Ukrainians is having a good supply of Stinger ground-to-air missiles, which are highly effective at bringing down aircraft.
Turning to armour, the Ukrainian army has the largest European tank force outside Russia, perhaps 850 tanks. This substantial force should be able to meet most threats. Unfortunately most of it (around 90%) consists of outdated Soviet vehicles, particularly the T-64B, which was introduced in the 1970s. While some have been upgraded, they are no match for Russian armour. The T-72B3 and the T-90M are better armoured, have more modern firepower (rounds and ranges), and have a greater operational range.
The Russians have not yet, apparently, deployed their best tank, the T-14, which is superior to any other tank in the world, with a greater range, a gun which can accurately fire 12km, very strong armour to protect the crew – and it probably not worth employing in Ukraine given the superiority of the Russians’ other tanks.
The best hope for the Ukrainians regarding stopping Russian armour is probably hand-held anti-tank weapons that are being shipped to Ukraine from the West. Another example of asymmetrical warfare which endangers the operator.
The most significant problem the Russians might face, and we do not know the details here, may be logistical. Do they have enough fuel for their armoured columns, their resupply trucks, their aeroplanes? Do they have sufficient spare parts? How is resupply affected by the sanctions?
It remains to be seen whether the Russians can succeed in their war aims using their current approach, or whether they will need to employ their superior weaponry in greater numbers. Presumably they do not want to destroy the infrastructure of Ukraine any more than is necessary, but given the will of the Ukrainians, the desire to fight and kill the Russians, they may have bitten off more than they can chew, particularly if the West can continue to resupply the Ukrainians without being drawn into a wider war.
We should not think that the Russians are bogged down, that their advances are not going to plan. Ukraine is a big country, and it is likely to take a long time to subdue. And even if the Russians do succeed in taking over the country will it be safe for them to walk the streets at night?
Some of the above is speculation, some is known, but I would like to see more journalists in this war doing their job, which involves reporting what is happening as objectively as possible, and then conducting analysis in the same way.
Dr Nigel Hunt 