The Cancer Diaries, Part 11

Three Stooges, nyuck, nyuck, nyuckAnaesthetic must be one of the most remarkable inventions of the 20th century. While various forms of anaesthesia have been used since the ancient Egyptians (with varying degrees of effectiveness), it really wasn’t perfected  until the last century. It’s difficult to imagine the horrors of surgery before it became commonly used and as effective as it is today.

Here I was, lying on a table in the operating room, Thursday morning, being covered with a warm blanket by one nurse, while another nurse held a mask over my face to breathe from, and a third prepared to administer my anesthetic via the IV drip (that spelling is for my American readers). The latter nurse said, “In the next thirty seconds you’re going to drift off to sleep…” And then I did. Lights out, like flipping a switch.

Sleep. Mercifully deep and absolute. No dreams, no tossing and turning. No having to get up to pee three or five times. No pushing the cat or dog off my legs. Don’t feel a thing as I am poked and prodded internally. Just sleep.

And then I awoke. Just like that: bang the shutters of the eyelids popped open and I was awake. No slow rise to consciousness, no lingering dream state. No memories either, just a sort of ellipsis between the operating table and the recovery room. And just like that, my surgery was over. Amazing stuff, anaesthetic. Where was I? Ah, yes, my latest surgery.

I know there are readers in the world, as well as many other good people in it, who are no readers at all, who find themselves ill at ease, unless they are let into the whole secret from first to last, of everything which concerns you.

That’s from Chapter IV of Laurence Sternes’ delightful 18th-century novel, The Life and Opinions of Tristram Shandy, Gentleman, more commonly simply referred to as Tristam Shandy. I’m reading it right now, among other books, and this bit amused me. He continues, apologetically, 

It is in pure compliance with this humour of theirs, and from a backwardness in my nature to disappoint any one soul living, that I have been so very particular already. … [I] therefore must beg pardon for going on a little farther in the same way: For which cause, right glad I am, that I have begun the history of myself in the way I have done; and that I am able to go on, tracing everything in it, as Horace says, ab Ovo.

From the egg, that Latin bit from Horace’s Ars Poetica; means from the beginning. So to follow in Shandy’s (or rather Sterne’s) literary footsteps I must go back a bit and explain for those who have not read the previous ten pieces on my cancer, why I was on the operating table again. Put it all in perspective, as it were. I do recommend you read the previous entries, however, to get a more robust story than this precis.

Continue reading “The Cancer Diaries, Part 11”

The Cancer Diaries, Part 9

Good news/bad newsWell, I suppose it’s a good news/bad news story for this post, although I dearly wish it was better. Would that I could have put it all behind me, finished my recovery, and moved on. Not to be: I receive comfort like cold porridge (to quote from The Tempest). Still, I came away from my consultation with at least some sense of relief: after all, it might have been much worse. The anxiety of waiting for the results was far more stressful than actually hearing them.

My recent PSA blood test showed a greatly-reduced number (less than 1, which is very low, considering it was over 8 before my surgery), which is a relief, but it’s still higher than the doctor says I should have returned two months later. So I have another blood test booked for the end of the month. If it goes up, it probably means the cancer is still gnawing away at me.

Whilst rank corruption, mining all within,
Infects unseen.
Shakespeare: Hamlet, Act 3, Sc. 4

The doctor reiterated that the cancer had been very aggressive, and the surgery difficult, and had already spread outside the prostate before my surgery, hence his “going wide” to remove my diseased organ (and taking with it some nerves that had once helped me rise to the occasion of sexual performance). On the positive side, the pathology for my lymph nodes after surgery came back positive (no cancer, which was a relief; lymphoma is a particularly nasty cancer).

Plus, while I am emptying my bladder, I do so too slowly; slower even than some weeks back. The stream is too weak for my stage of recovery, so the urinary tract may be thickening or be suffering some blockage (was I too enthusiastic in doing my Kegel exercises?).  And for that he wants to stick a camera into my penis and snake it down to my bladder to see what’s happening. What he can do about any problem he encounters, I don’t know.

I’ve had the procedure before, and while it wasn’t particularly painful, it sure wasn’t any fun. Not the least of all because it was done with a local anæsthetic, so I could see everyone looking at my tackle (are they smirking?) while the doctor threaded the scope through my urinary tract. And I could look down and see what seemed to be a golf ball on a tube being inserted into my penis. Had I wished to entertain myself, there was a small screen showing the view as it travelled within me. Netflix it wasn’t. 

Not that I have much dignity or self-respect about my private parts being on display at this point. Inhibition is an early victim of this cancer. And after the surgery, well, it’s not like it’s worthy of proud display any more. But still…

Continue reading “The Cancer Diaries, Part 9”

The Cancer Diaries, Part 6

I’m sitting here, on my back deck, in the late Friday afternoon, beside Susan, trying to take stock of my life over a glass of wine, and read a bit while the light’s still good. I’m 30 days past my surgery and recovering reasonably well, but still three weeks away from my next set of tests, and almost four until I sit down with the urologist and learn if I still have cancer. And what happens next. All the rest of my life is on hold until that meeting.

My father lived to 92, and died of esophageal cancer, caught too late. He might have lived longer, otherwise, although he also had prostate cancer that might have caught up with him instead.  It was a horrible death, one that I also saw take my dear friend, Bill, many years later (fall, 2019). My mother died at 95, living long despite her stroke in 1960. Her father died at 94. I always thought I’d live into my 90s. My genes promised it. But of late, I am not sure I’ll even see 75. My father’s mother also lived into her old age, but his father died younger than her of prostate cancer. Maybe I have his genes.

Sure there may be treatment: radiation and chemotherapy, neither of which is appealling. They have nasty side effects. To what end do I go for treatment if it involves a steady decrease in the quality of life and only saves me a short snippet of time? It’s a bit like the Roadrunner and Coyote cartoons. Cancer is the Roadrunner that the Coyote never catches, and gets himself blown up in the process of trying. Sometimes I think of it like the Red Queen’s Race in Alice in Wonderland: you run as fast as you can simply to stay in the same place. I can’t even make up my mind about how I see it  until that next meeting.

I sit here with a pile of books beside me, trying to read as much as I can to get through all the to-be-read stacks that litter my house. Every day I sit outside with a small stack, sometimes the same books, often changing one or two. Never less than six, never more than ten, each with a bookmark to guide me back the next time I pick it up. There’s a pile or two beside the bed for my nighttime reading, too. Sometimes I augment them with books from my daytime reading.

I don’t know why it matters, but I just don’t want my life to end with so many unread books. Will I ever finish reading Proust? Or Casanova’s diaries? Will I even get to read the latest Murakami, so recently received? I keep wanting to re-read Chandler’s Campaigns of Napoleon, a tough enough task should I live to 90. Now it seems so much further from my grasp. I’m pretty sure I’ll never learn to read Latin, either, despite the shelf of textbooks to teach me.

Last year I read Will Schwalbe’s book, The End of Your Life Book Club. In it, he and his dying mother form a “club” to share and compare how they felt reading the same books together. She had cancer and they spent many hours in waiting rooms, in hospitals, in her palliative bedroom discussing their books. His book is a combination of her story, his, and their views on literature, and about shared memories. It’s very touching. I didn’t really appreciate it as much when I read it as I do now.

Continue reading “The Cancer Diaries, Part 6”

The Cancer Diaries, part 5

The resilience of the human body is truly amazing. Here I am, three weeks after major surgery, and much of my daily life is back to normal. I can drive, walk the dog, unpack the dishwasher, cook meals, pour the wine, feed the cats, walk upright… a far cry from my crabbed old-man style of a week or two ago.

Not that I am fully recovered. I have several weeks or even months ahead of me for that. My incisions are still tender, in particular the spot where the Hemo-vac tube had been inserted. The main incision from my navel to my pubes remains a bit raw and ugly (to my eyes, but I have no Goth sensibilities, I suppose), and the bruising hadn’t quite gone away. I can’t walk or get up from my chair as quickly as before surgery, but I am still ahead of my post-surgery days. Bending or twisting requires some fore-thought to avoid pain, and if possible the inevitable squirt of urine. Sneezing still makes me leak, too (and hurts the scars). Regardless, I try to get up and move about, walk the dog, go upstairs, do my chores, and get my limited exercise, as often as possible.

Yes, I’m still incontinent, but much, much less than the days immediately following the catheter removal.  My nights are dry, although I get up two or three times to empty my bladder. I graduated from a diaper to a stick-on pad, too. 

Incontinence is humiliating and frustrating. We associate it with either the very young or the very old: infancy or dementia. And maybe extreme drunkenness (although I’ve never been quite that drunk, myself, I’ve known others who have).

For a relatively healthy, normal person to suffer from incontinence can be embarrassing and emotionally stressful. Continence is an early milestone when you start to grow up. It says you have control, you’re a big person now, you gained some independence. You’re on the path to being an adult. And suddenly you’re off it, standing in the drug store aisle trying to decide which sort of pad or diaper you need, while other shoppers mill around you. And it’s not like I can ask for advice from the 17-year-old stock clerk.

Losing that control is a downward slide on the snakes-and-ladders game of life. It means we have lost the control that identified us as adults. There’s little more deflating than thinking you have finally regained control only to stand up and feel the squirt of urine that says you still have a long way to go. A long, slow way because there’s nothing that signals you’ve reached the plateau of control. You just keep exercising and hoping tomorrow it will be okay.

No one wants to talk about it because incontinence isn’t a sexy, fun topic like religion, politics or what’s on Netflix, so you have to figure out how to deal with it by yourself. But when I suddenly leak, especially after I’ve been exercising and think I have gained some control, it’s like a personal failure; my inability to control a basic bodily function that I was able control before age five, but can’t at age seventy.

There’s an inevitable sense of shame. All the intellectualism I muster can’t help that. I can tell myself it’s just temporary, it’s the inevitable result of prostate surgery, it’s something thousands of men go through, that it will get better. It doesn’t make me feel better when I squeeze a drop of urine into my pad (the pad is a constant reminder I have limited independence). It erodes my sense of eudaimonia, as the ancient Greeks called it — that feeling of wellbeing I have tried to cultivate all these many years.

As I wrote in a previous post, there really is no one to talk with about the cancer, the surgery, and the recovery. There isn’t a support group either, at least none locally. Sure, the doctor gives you some basics, but no one at any stage of the process even told me to bring a pad or a diaper to the office when I had my catheter removed. I was fortunate to have had that experience previously, so I knew enough to do that. But there is so much more I had to learn on my own.

Continue reading “The Cancer Diaries, part 5”

The Cancer Diaries, Part 4

A home is not a sterile environment. Not mine, anyway. With two cats, a dog, numerous houseplants,  rooms full of books, and my sometimes lackadaisical attitude toward cleaning, our home will never be sterile. Not to mention the microbiome we all carry around with us: 100 trillion microbes live on or in each one of us: only 10% of the cells we carry around are our own. Most of these colonists are benign, but a few species are opportunistic and will invade our territories when they can. Plus there are viruses around and on us, too.

Coming home after surgery with a catheter and fresh incisions meant thinking about infection. In the weeks leading up to surgery, I had been reading a lot about microbiology and the colony creature we call a human being (start with 10% Human, by Alanna Collen if you want to know more). Fascinating, sometimes a bit scary, but also a great incentive to wash your hands a lot — particularly good advice during this pandemic that I hope I remember to carry through afterwards.

Having pets who were used to sleeping on the bed with us made me cautious about my own sleeping arrangements post-surgery. Last thing I wanted was a cat or dog scratching at my night bag, or the catheter tubing. Not to mention the highway for their bacteria the catheter would be. And then there was the prospect of an animal sleeping on me, or against me when I had limited mobility and a lot of very tender areas.

We decided I’d sleep in one of the spare rooms — Susan’s room with the pull-out couch-bed where our few guests stay. My own work room was, of course, made even smaller by the large collection of books that both lined the walls and covered a fair percentage of the floor. Sleeping in another room would also mean that I would not wake her if I tossed and turned at night.

While I was in hospital, Susan made up her room and the pull-out bed, ready for my arrival. For at least the next few weeks, this would be my sleeping quarters. She thoughtfully made a place for the inevitable pile of bedside books, and placed a reading light nearby.

*****

I left the hospital shortly after noon. The drive home was, itself, rather trying. Every pothole or sharp bend brought a protest of pain from my innards, or along the tender line of flesh held together by metal staples.  But Kevin got me back in one piece. I was relieved to be able to walk into my own home again.  Susan and Bella were glad to see me; the cats I’m not so sure. Such is their nature.

First order of business when I arrived was to get the kettle on and a cup of hot tea brewing. Damn, but I missed good tea. I slowly walked around the house, making my glacial way upstairs as Susan carried my bag into our main bedroom to unpack. Going up and down stairs tended to aggravate my urethra, so once I got into the bathroom I applied a liberal coating of Polysporin to the catheter tube and around the urethra to both protect it from infection and to help lubricate the tube. It helps, but frequent re-applications are recommended.

I got a chance to look at my scars in the mirror, too. Ever seen any Frankenstein movie? My abdomen might have made a good model for some monster’s reconstruction. I could count about 18 (16?) staples in my abdomen along a puckered red line. I had obviously had my groin shaved around the incision, too, which looked a bit odd but didn’t bother me otherwise. There were other inflamed scars to see: where the laparoscope and the Hemovac were inserted, as well as some odd bruising and marks from unknown machinery. I gently dabbed some Polysporin on the reddest parts.

I already had two future medical appointments booked: one in a week’s time to have the staples removed locally, the other in two weeks with the urologist to have the catheter removed and discuss whrogpat to do next. I didn’t anticipate much distress from the former, but the latter made me anxious. I’d had a catheter previously and the removal was a rather unpleasant memory. Like having a golf ball dragged through your urethra. plus there was the question of “did you get it all?” I wanted to ask.

By now, I had shed my anxieties about immediate mortality if not about my future prognosis. But since that had to wait for at least two more weeks, I concentrated on how to live day to day under these new and challenging conditions. I had to be careful and conscious of every step, every movement. Where my collection bag was and to be sure it was firmly attached had to always be foremost in my consciousness.

My experiences, of course, may not match your own if you go through any of this, but perhaps they will provide some guidance. As Catullus wrote,  diversae varie viae reportant (different and varied are the roads that carry us back: Poem 46)

Continue reading “The Cancer Diaries, Part 4”

The Cancer Diaries, Part 3

offThe operating room was cold. Not merely cool: winter cold. In my thin hospital gown, I felt the chill and shivered a bit. The nurse told me it’s kept cold to help discourage bacteria from thriving. I wanted to ask her about this, to chat about bacteria and their lives. I’d been reading about microbiology and the microbiome a lot of late, so I’m curious. But this was not the place or time.

I was helped onto the table, and a warm blanket wrapped over me. Very comforting. My arms were splayed out from my body on small side panels. I wanted to make a joke about crucifixion, but couldn’t find the words. Didn’t matter, because my mouth was covered with an oxygen mask. Someone I couldn’t see told me to breath. A nurse told me she would remove my underpants and return them with me to my room. Sigh. There went my last shred of dignity.

On my left, the anesthesiologist was putting something into my IV. I tried to look around, to see what’s happening, and then…

.

.

.

I woke up. Suddenly. It’s like that: you fall asleep without warning on the operating table and wake up abruptly sometime later in another location. I fell into the black hole of consciousness and came back on its sharp edge.

I hurt. A lot. This must be what it’s like to be gut-shot. My body, my abdomen was so very sore, so deeply sore. I tried to breathe slowly, measuring the pain by breaths. My walnut-sized prostate was gone, but for such a small organ, it made a big pain in leaving.

There were nurses and the doctor around me. I might have spoken, asked questions, said something, they may have spoken to me, too, but I don’t recall much of that initial period. They may have given me painkillers. The anesthesiologist had warned me there might be a gap after surgery, a time when I would be lucid, but not forming memories. I vaguely recall being wheeled from the recovery area along a corridor to my room. The pain dimmed to a dull discomfort, no doubt thanks to the pills.

Doctors and nurses will ask you about your pain somewhat frequently. They have a scale of 1 to 10, where 10 is the most unbearable. It’s entirely subjective, but that’s how they determine what medication to give, or perhaps what additional medication, since they already have a regimen of painkillers and anti-inflammatories scheduled. I was around 4-5 after the surgery, but gradually the sharpness subsided so most of the time I was 2-3. Sometimes, when I was relaxed and reading in the hospital bed, I hardly noticed it at all. If I forgot and tried to move,  or shift in the bed, however, I got a sharp reminder in the 3-4 range to be careful.

Continue reading “The Cancer Diaries, Part 3”