Friday, 4 January 2008

The Regimen

July seventh, 2005. The haematology outpatient clinic at Royal Cornwall Hospital, Treliske. There are about sixteen patients, all hooked up to electric pumps. Half are getting blood transfusions; the rest, myself included, are having chemotherapy. But because of the news broadcast that is panicking us all -- clinicians, patients, nurses and auxiliaries, some of whom have relatives in London, some, like me, who have spent half their lives in the city and could walk that fateful bus route through Tavistock Square with their eyes closed, we seem to have blurred the boundary that usually marks off sufferers from non-sufferers (or those who may long-suffer us). We are all equal today, uniformly terrorised by the pressing understanding of our own mortality which has jumped out of the TV set in the treatment room and shaken us all to the teeth.. As the decimated bus in Tavistock Square is framed up close, we are all, this minute, entering an even playing field of fear and horror. This doesn’t make it any easier, of course; but it does seem to make our situations less exclusive, at least for today.
When I received my diagnosis, two weeks after Cara and I returned from the annual trip to the spa, and a mere twelve days after the GP had referred me to The Mermaid Centre (‘a one-stop shop,’ she said, ‘so at least if there’s anything nasty under there you’ll know the same day’), I thought I was falling off the edge of the world. The world hadn’t ended -- far from it; it was rather that I was being thrown out of it, and not with a bang but a whimper. At the same time, I had the slightly more uplifting thought that all this was an illusion, like the series of tests I had had that morning at The Mermaid Centre: mammogram, ultrasound, needle aspiration, cone biopsy. A series of illusions, one after the other. Throughout these tests, I was thinking of the work I had brought with me: a series of creative writing assignments done by external students at Exeter University, mostly of indifferent quality, and almost as tedious to endure as all these clinical procedures. But, increasingly, I grew all too aware of my surroundings (grounding, I think, is the pop psychologists’ term). I became aware of the radiographer’s blank expression and increasing taciturnity, contrasted with the warm touch of the clinic nurse who came in to assist the kindly, German radiologist who performed the ultrasound. ‘You are right,’ she told me, ‘moving the sensor to the top of my right breast, beneath the collar bone. ‘It’s nothing to do with these superficial skin infections.’
Then the surgeon arrived. ‘I’m Alistair,’ he said. ‘And this is going to hurt you, sweetheart. When I was a junior doctor, I never hurt anybody – but I didn’t get enough material and then the consultant had to go and hurt them. Now that’s me.’
He punched a fine needle into the area below my collar bone identified by Kirsten, the radiologist, and drew out his material. It didn’t hurt a bit, and I told him so. I liked his utter frankness and his Sean Connery-esque Scottish burr.
‘I’ll be back in half an hour,’ he said, grinning at me in a non-committal fashion. The Mermaid Centre has a cytologist on site – which is helpful to those lonely women in the consulting rooms, cowering in fear and anticipation. Needless to say, it was a long thirty minutes, in which I was hyper-aware of the white walls, the half drawn blind, the light breeze blowing in the through the window, the basin on the wall, the MRSA-fighting hand-wash, the needle mark on my chest, which was starting to throb a little, though still it did not hurt.
Alistair came back into the room with a woman dressed informally in a soft grey sweatshirt and trousers. It’s bad, I thought, because they’re bringing in the counsellor.
Alistair sat down next to me on the consulting couch and put his arm around my shoulders. ‘You don’t need me to tell you what it is, do you?’ he said. ‘You know what it is?’
I nodded. ‘The thing is,’ I said, ‘I’ve got a daughter. She’s ten. I’m a lone parent.’
‘And have you any relatives near by?’
‘She has,’ I said. ‘She has her father’s relatives in Hayle. Her father isn’t with us. He isn’t well.’
‘Are they decent people?’ Alistair said. ‘Can you trust them?’
I didn’t know what to reply. I had never had to trust them before – I had never had to trust anybody with Cara’s care. There had been only me and her: a symbiosis.
‘Well this is our problem now,’ Alistair said. ‘My problem, as well as yours, for the next five years. I’ve been to see my colleague, Duncan, just down the corridor there.’ He pointed through the window to what appeared to me as a blank wall. ‘The way we’re going to treat it is to give you some chemotherapy, over eighteen weeks. Duncan will tell you about all that. Then we’ll give you a month off in August before doing a mastectomy. I’d want my wife to have it,’ he added defensively, as though anticipating some protest on my part.
‘And who will do that operation?’ I asked. ‘Will you do it?’
‘Who the fuck else would do it?’ he said. I laughed.
‘You’re a four-letter man,’ I said. ‘I like that.’
He nodded. ‘Then we’ll give you some radiotherapy. You know, when I first came to this hospital, I had to send my fucking patients up to Plymouth for their radiotherapy. Couldn’t be doing with that. This is Janet, the breast care nurse,’ he said, indicating the lady in grey and getting up. ‘She can fill you in. Duncan, will see you tomorrow, nine o’clock, at The Sunrise Centre.’
‘Clinical Oncology, just down the corridor there. That’s where you’ll have the radiotherapy.’
I stared through the window at that blank wall. Alistair went out and Janet hovered. There was a box of tissues on the chair at the foot of the bed. I think she was waiting for me to cry.

Duncan drew me a diagram on a piece of paper and referred to the dots and dashes on it as ‘zapping the buggers’.
‘I’ve got plenty of weapons in my armoury,’ he said. ‘There’s a drug called Taxotere, one of the nastiest poisons we’ve got. We might start with that, although it might make you feel really rotten for a bit. The idea is to shrink the tumour down so we can operate.’
‘Alistair, you mean?’ I said. ‘Why can’t he do it now?’
‘The tumour’s too close to the chest wall,’ he said gently. ‘I’m proposing six doses of chemotherapy to see where that takes us. But before we start, I want to send you for a couple of tests – a chest X-ray. A CT scan and a bone scan, just so I can see what I am dealing with from the very outset. I wouldn’t want to get six months down the line and find we’ve missed something.’
‘OK. And when will this chemotherapy start?’
‘Next week probably.’ He smiled. ‘Oh, and if you agree, we’d like to send some of your biopsy tissue away for testing. It’s for a clinical trial we’re running, to see if you might be suitable for it.’
‘That’s fine,’ I said. ‘It’s no good to me.’
So I signed the consent papers, went for the scans, and looked forward to having a few days’ off from all this, over the week end, before Duncan zapped me with his monstrous regimen.
But he wanted me back before then. He had left a message with the bone scanner to call me over to The Sunrise Centre again. I knew why – not where, exactly, but why.
This time, Duncan had both his research nurse, Thea, with him and another breast care nurse, called Josephine. It’s bad, I thought. Very bad.
‘The bone scan was clear,’ Duncan opened. ‘But unfortunately, the CT scan showed some spots on your lungs.’
‘Metastases,’ I said, smugly citing the clinical word, because words are my job. My whole life, I thought, I’ve been obsessed with what Alistair might qualify as fucking words. And what are words, anyway? Just fancy parcels of received meaning.
‘You mean it’s spread? You told me before that with these drugs – this Taxotere, for instance, and all the rest, the surgery and the radiotherapy, that you could eradicate it, more or less, and I’d have the same chances as any other woman my age, I mean for living to old age…’
‘We can’t cure it,’ Thea said. ‘But we can treat it.’
‘Alistair can’t operate on my lungs?’
‘No,’ said Josephine. ‘It wouldn’t be possible.’
I looked Duncan in the eye. ‘I’m not bothered for myself,’ I said. ‘I mean, I’ve had an interesting life.’ A rich and exciting life by anybody’s standards. Running round the world like a headless chicken, interviewing people for American TV, so that people in the red-necked mid-West could switch on and gawp at those backward Europeans. I had a much more important life now, here in Cornwall, a life that was all my daughter’s.
‘Will I live to see my daughter grow up?’ I asked Duncan, rather fiercely.
‘Yes,’ he said, emphatically. ‘Yes. We’re talking years, not months.’

Years with cancer. I tried not to think how many. I had had forty six years without it; the number I had to look forward to with it was an unknown quantity. But then so is any calculation pertaining to the future, an unknown quantity rubbed in hard on 7 July 2005, in front of the TV set in the haematology clinic. Hooked up to drips, we patients are as desperate to hang on to life as the healthy people caring for us, terrorised by the news broadcast. I am hanging onto life by a line containing the product of outstanding medical research: the monoclonal antibody, trastuzamab (Herceptin). It costs twelve hundred pounds a dose, and Duncan, to whom I am eternally indebted, has put it into my treatment regimen, a mixture of three cytotoxic chemotherapy drugs, a hefty dose of steroids, which send me up high as a kite, and something the nurses in here call ’your cover’ – which has so far stopped me from being sick. I am hanging onto life here in the clinic in Cornwall, while up in London, a group of deeply disaffected, morally moribund, and mortally stupid young Islamo-fascists are blowing themselves to pieces and destroying, willy-nilly, innocent bystanders who happened to get in the way. A bit like cancer cells, really, spreading out in an undercover crab-like motion, seeking parasitically to block out and destroy all that is life-enhancing and life-affirming – all that is life. An anti-culture, a terrible blight.
But I have survived it – up to this point in time, which is the only point any of us really have. I am equal to it.

I am still here.

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