"He was a dreamer, a thinker, a speculative philosopher... or, as his wife would have it, an idiot" - Douglas Adams
I’ve booked an appointment tomorrow to see my GP to talk about the pains I’ve been having while away in Durham last week. In the meantime, I’ll think I’ll just see what Dr. Google has to say about my condition. None of those dodgy natural health websites though, I’ll stick with the good old NHS Direct. I select my cancer type, my tumour grade and my Fuhrman score and see what sage advice they have to offer me. The website bluntly states that 96% of patients with my type and grade of cancer are no longer alive five years after the initial diagnosis. I therefore have a mere 4% chance of surviving five years or more. Shit. Shit. Shitty Shit McShitpants. These odds are even worse than the ones Mr Campbell gave me, and I wasn’t overly fond of them. I don’t think I’ll bother googling my illness anymore.
I explain my symptoms to my GP a few days later in the surgery. She listens patiently as I reel off my list of miserable maladies. Abdominal pains, hot sweats, shortness of breath, at which point I notice she scribes the letters SOB on her note pad, that must be a worrying one I guess. She asks me when my next CT scan is due. It’s still not for another 3 months, but I’d rather like one earlier to put my mind at rest. She agrees. She acknowledges that I am an infrequent visitor with valid concerns and she will thus be happy to arrange an early scan for me. Her phrasing suggests that she is constantly plagued by bemoaning hypochondriacs darkening her door and demanding CT scans for non-valid reasons. I may also be a bit of a hypochondriac, but it appears that she suspects I may at least have a very good reason to be so.
An appointment for my next CT scan at Salisbury General hospital is scheduled for the following week. By which time I’m feeling a little better. Perhaps all that pain and shortness of breath was just the lingering after effects of my operation after all. Still it’s six months now since my operation and a six month all-clear would give me a bit of a boost, so I’m quite relishing this next scan. This will be my fourth CT scan and it has become quite a run of the mill experience. I now know the best place to park, the best route to the radiology department and how to quickly check myself in on the computer without any assistance. The scan itself is quite routine and I go home to anticipate no further correspondence from the hospital indicating that all is well and I’m just being a bit neurotic.
I notice on Facebook that my friend Milton is celebrating his ten year all-clear. After my last six months I think I may have a small inkling as to what he and his family have been through. I send him my heart felt congratulations via a Facebook like and look forward to being congratulated myself in a few weeks' time when I can officially announce my six-month all-clear. Milton’s good news puts me in a rather chipper mood. All seems well at the moment, it’s Friday morning and I’m meeting my friend Phil for lunch, then as I’ve already done more than my hours this week, I’ll finish work early for the weekend. Just as I’m activating the screen lock on my computer and getting ready to go for lunch Tori rings me. I step outside the office to take the call in private. She says the hospital have rang and I need to go in ASAP to talk about my scan results. This is clearly not good news. When the scan was clear they didn’t bother contacting me, what else could they possibly want to talk to me about apart from my cancer returning? I take the number so I can call the hospital back and they can hopefully tell me what it’s all about. I get through to Mr Campbell's secretary who confirms that Mr Campbell needs to talk to me urgently and suggests an appointment on Monday morning. I ask if I can just speak to Mr Campbell now. I can’t. I ask if she can tell me the results of my scan. She can’t. I ask if she can look at my scan results and see if there are any notes written on them. She can’t, in fact the only thing she can do is make an appointment for me on Monday morning. I have no option but to spend my weekend pondering all the possible unfavourable scenarios. I’m really not in the mood for lunch now so I ring Phil and postpone our lunch date.
I can’t envisage a good scenario where Mr Campbell needs to talk to me urgently. I doubt very much that he needs to talk to me pressingly to ask what I think about the latest David Gilmour album. I also doubt that he is ringing up to invite me to his next dinner party. It’s even unlikely that he just ringing up to say all is tickety-boo and not to worry, he clearly has some less favourable news for me. I can therefore foresee just two possible scenarios. Either the cancer has come back as a single tumour close to where my kidney used to be and can be operated on again, or it has snow-stormed up in multiple locations and is inoperable. Of the two, a reoccurring single operable tumour seems to be my best bet.
Tori has a cunning plan to try and take my mind off things this weekend. There are thirteen white horses carved into the chalk hills of Wiltshire, her plan is to visit each one in turn this summer starting this weekend. She drags me to Alton Barnes to have a look at the first one. I really can’t be arsed to get out of the car though, I have far too much pondering to be getting on with at the moment. After a little coaxing however, I’m lured out of the car and we start the trek up the hill to view the white horse from above. The view was actually far better from the road but I’m here now and I collapse on the grass exhausted and drained. I place my hat on my face to deflect the sun and muse once again what Mr Campbell has to tell me on Monday morning. The more I cogitate, the worse the abdominal pain becomes and the more convinced I become that the cancer has spread everywhere. Tori comes up with a few positive scenarios to try and cheer me up, but I find them highly implausible and quickly return to my darker deliberations.
After the longest weekend of my life Monday morning eventually arrives and Tori and I drive to the Salisbury General for our appointment with Mr. Campbell. The urology department seems eerily deserted when we check in on the computer system. At least I shouldn’t have long to wait. Nonetheless a lengthy wait ensues, or at least it feels like a lengthy wait. We are eventually summed into Mr. El Saghir’s office and he explains that Mr Campbell is actually in Greece today. Very nice. Thankfully Mr El Saghir doesn’t beat about the bush and he promptly tells me the results of my CT scan. My cancer has indeed returned and I now have tumours in my right lung, my tummy and the place where my right kidney used to be. He quickly confirms that the cancer is now inoperable and that it is terminal.
Buggering arseholes.
I’m not sure what questions to ask, so Tori asks some instead. My mind is reeling, I’m unsure what Tori asks and I’m unsure what Mr El Saghir’s responses are. I do however remain calm and relatively collected. The obvious question to ask is “How long do I have?” Shaken as I am, I do however understand that this is a rather nuanced question. It will clearly depend on how well I respond to any treatment that they may be able to offer me in order to prolong my life. Also cancer is a complex family of diseases that may have quite different responses in different patients. It may be unrealistic to expect an accurate prediction on my life expectancy until further data has been gathered. I chose therefore not to ask the question. Mr El Saghir is however presumably used to being asked that particular question and has a pre-prepared response waiting for me which he submits without prompting. “Eighteen months”, he surmises before adding the standard caveats. Aware of the massive possible variances on Mr El Saghir’s early estimate and the limited data on which it is based I nonetheless think it may be interesting to make a note of the date. I count exactly eighteen months forward from today’s date and put a brief note on the calendar on my iPhone. I’m curious to see how arcuate Mr. El Saghir’s prediction is. Being quite competitive, I’m also quite keen to have a target to beat.
The next step apparently is to transfer me to a specialist oncologist at Southampton General who will put me on a course of chemotherapy with a view to extending my life as long as possible. I am told in no uncertain terms not to expect the chemotherapy to be a cure. Mr El Saghir explains that I will probably be put on a course of Tyrosine-Kinase Inhibitors (TKIs). Mr El-Saghir has written to Dr Wheater at Southampton General and I can expect a letter with my first appointment directly.
Finally Mr El Saghir asks if we have any children and upon confiding in him that we do we are advised to put our affairs in order. Yes, he just used those actual words, “put your affairs in order.” It’s a common phrase that I am quite familiar with, but not one I expected my consultant to use verbatim and it sounds quite uncanny when spoken in the correct context. I ring work when we get back home and arrange to take the rest of the week off so that I can indeed put my affairs in order.