On the Tuesday, December 21st, I ended up seeing a doctor in Devonport, Dr. Grant Smith. My parents made a half hour appointment for me. He ran me through a bunch of tests, including hitting parts of my leg with a rubber hammer, and then got on the phone to Auckland Hospital and arranged for me to see a neurologist the very next day.
By this time I had the sense that things were moving very fast. On the one hand, my medical problems had abruptly hit the crisis stage, and I had the impression that I was tobogganing toward the Chasm of Doom. On the other hand, I also felt that my medical treatment was beginning to move quickly.
Very soon afterwards, on Thursday 23 December, I went to the hospital together with my wife, my sister and my brother-in-law. I had an appointment to see a neurologist by the name of Hutchinson, but expected to be seen by a subordinate first. Instead, the man himself showed up, and put me through what would have to be one of the most thorough neurological tests ever.
This test, observed by my wife, sister and brother-in-law, went on for almost two hours. Disconcertingly, Dr. Hutchinson would occasionally pause and say, "Strange ... hmmm. Very strange." As my brother-in-law says, that is not what you want to hear your doctor say. Preferably, you would like to hear something along the lines of, "Oh, yes, we've been seeing a lot of this lately!"
The tests, as I remember them, were individually pretty simple, as simple as walking, standing and balancing. But, in combination, they allowed Dr. Hutchinson to deduce that, yes, the problem could be lymphoma.
The next step was a magnetic resonance imaging scan of the brain and spinal cord, which I ended up having at Auckland Hospital that evening. It was the same as the MRI that I had experienced in Japan, only dye was injected into a vein to provide contrast.
A small pedantic note: think I can pinpoint the date of the MRI exactly, because I have a written record showing that it took place on Thursday December 23rd, but I find myself confused about exactly when I saw Dr. Hutchinson. In the scramblebag of memory, I seem to remember the appointment with Dr. Hutchinson and the MRI being on one and the same day, but it's possible that I saw Dr. Hutchinson the day before. Or maybe my record of the date of the MRI is wrong by one day.
Before I had my MRI, the staff at the MRI center had some basic questions to ask me. For example, did I have any allergies? They needed to ask this because they planned to inject a dye to enhance contrast, and some people prove to be allergic to the dye. I was able to respond that, no, I did not have any allergies. Furthermore, at one stage, iodine had been injected into a vein for a CT scan, with no ill effects.
While I was answering these questions, I was sitting comfortably in a chair talking to someone who was sitting behind a desk. It was a safe and comfortable environment. We hadn't yet gone anywhere near the MRI machine, and, besides, having had an MRI in Japan, I knew it was a totally painless procedure, and I had no apprehension about it.
Even so, it was there at the MRI center that I had my most terrifying experience. As I was speaking, answering a question, my voice began to run down like an exhausted mechanical clock getting slower and slower. I knew exactly what I intended to say. I had formulated the relevant sentence in my mind. And I was succeeding in producing the sentence, as planned. But the words were coming out more and more slowly. My speech was slowing down and there was no way for me to stop this happening. I could still speak, but I had lost control over the speed at which I was speaking.
This was a moment of absolutely appalling horror. This was the very worst thing that happened to me during the entire course of my disease and treatment. Suffering partial paralysis had been bad enough but I had always known that, of course, people do sometimes suffer paralysis. But nobody had ever told me that you could lose control of how you spoke. Being unable to speak, yes, I'd heard of that, but I'd never heard of any condition that forced you to speak more and more slowly, willpower no longer sufficient to control communication.
Losing my velocity control in this manner was terrifying because nothing in my entire life had prepared me for it. I had no script for this. My willpower was thwarted. I was trying to speak at a normal pace but my voice did not respond to my attempt to command it. The other thing which was truly horrifying was the speed with which this problem came on. I answered a couple of questions normally, with no problem at all. And then, on the next question, my voice betrayed me. Mutinied. Became no longer mine to command as I would.
The thing which is the most terrifying is something which is absolutely unknown. Blindness, paralysis -- these were threats for which I had been imaginatively prepared.
Suffering partial blindness was a big negative, as was suffering partial paralysis, but I'd been trained to deal with such problems. Not formally, true, but my imagination had confronted those possible outcomes.
But having my voice run down like a bit of machinery driven by a clockwork spring which had unwound to a point near that of total exhaustion -- that was not in my repertoire of imaginative scripts.
Maybe the fact that I've always been supremely confident of my verbal skills is relevant to my extremely negative reaction to losing control over my own voice.
Fortunately, the "slow voice" problem only manifested itself that once, at the MRI center's reception desk, and the problem had gone by the time I reached the chamber housing the MRI machine itself.
My wife had come to the hospital with me and accompanied me into the room housing the MRI machine. I already knew that I would have to divest myself of all my pieces of metal (keys and so forth) because I was going into the MRI machine itself. To my surprise, my wife, who chose to accompany me into the machine room, was also asked to leave all her pieces of metal outside the room housing the MRI machine. Apparently the whole room becomes a big magnet.
Additionally, my wife, like me, was given ear-protecting headphones to wear during the MRI.
Apart from the presence of my wife, the MRI was exactly the same as the one that I had earlier undergone in Japan, except that a dye was injected into a vein.
While the MRI that I had undergone in Japan had proved to be negative for lymphoma, I had read on the Internet of cases where an initial MRI had proved negative and a later MRI (six months or so down the track) had proved positive. So I was not particularly surprised when the news came back that the MRI indicated that I was suffering from lymphoma.
Or, in the language of the report produced by the expert who analyzed the MRI scan, there was "Extensive cerebral abnormality typical of lymphoma".
I received a copy of the report in December of 2004, but was so overloaded that I didn't end up sitting down to study it until June of 2005. I quite simply forgot that I had it in my possession. Since I accumulated quite a bit of paperwork, everything from a stack of appointment details to a pamphlet on proper nutrition, it easy enough to lose track of the report on that first New Zealand MRI.
The report begins with an "Indication", which I take to be the reason for doing the scan, which says:-
"Posterior uveitis left > right. Weight loss. Motor neurone deficit left leg ? intracranial cause."
The "Findings" seem to indicate that there is no conclusive evidence of anything being seriously wrong in the spinal area but, with regard to the brain, the "Findings" say the following:-
"There is extensive T2 hyperintensity in the right frontal centrum semiovale, around the frontal horns of both lateral ventricles, crossing the anterior corpus callosum, in the peritrigonal regions and extending along the periventricular white matter of the right temporal horn. These areas of T2 hyperintensity are associated with multiple enhancing foci in the same distribution including crossing the anterior corpus callosum. Enhancement is also seen in the left optic nerve and to a lesser extent in the optic chiasm in the right optic nerve. No areas of haemorrhage or calcification are identified."
The ventricles are structures which are filled with fluid. The corpus callosum is a band of nerves dividing the forebrain, the cerebrum, into two halves. Having written that, I have to confess that I don't really have more than the fuzziest sense of the anatomy, and I'm reluctant to invest the time and effort that would be needed to rectify my ignorance. (I guess that comment sounds lazy, but this "reluctant" statement is being made at a time when I've entirely lost track of the hundreds of hours I've spent thinking about my condition, talking about it, reading documents about it and doing research on the Internet.)
My crude (and possibly erroneous) interpretation of the "Findings" is that in context (in this particular case, for this specific scan taken at this stage of my disease) the words "hyperintensity" and "enhancement" are both indicating the presence of cancer and the term "enhancing foci" means something approximately like "areas of distinct damage caused by disease" and may be roughly equivalent to "lesions".
As of December 2004, the cancer (if I read the "Findings" correctly) seems to have gotten into the left optic nerve ("Enhancement is also seen in the left optic nerve"), and, to a lesser extent, seems to be messing with the wiring connecting the right eye to the brain.
After my MRI scan had been analyzed, the next step was for me to return to Auckland Hospital to have a lumbar puncture (a spinal tap) to extract a sample of cerebrospinal fluid for analysis. This involved me lying on a bed with my back curved while a female doctor stuck a needle into my spinal area. She also inserted some kind of gadget which was designed to measure the fluid pressure in the spine.
I was frustrated at not being able to observe these interesting procedures, and asked my wife, who had come along, and who had brought our digital camera with her, to take some photographs. But she declined.
On the basis of the analysis of the fluid extracted from the spinal area, a provisional diagnosis was made: non-Hodgkin's lymphoma of the large B-cell variety (the option, apparently, being cancer of the T-cell variety).
My dictionary, Chamber's Twentieth Century Dictionary, defines a "lymphocyte" as "a kind of leucocyte found in the lymph-glands and spleen". So what is a leucocyte? It's a "white corpuscle of the blood or lymph". A "corpuscle" is not usefully defined but seems to be (in this context) the same as a "cell".
As far as I can make out from my reading, lymphocytes are cells which form part of the immune system. B-lymphocytes are one particular type of lymphocyte, and what I had was cancer of the B-lymphocytes. The term "cancer" can be conveniently defined as an inappropriate multiplication of cells, a multiplication process which is capable of spreading. (In other words, not only are the cells multiplying inappropriately, but this process can invade other parts of the body.)
So it was that toward the end of December, I got a provisional diagnosis.
So there I am. I have become the cancer patient. The long siege of uncertainties is over. This is it. The challenge is here. Now to live or die, to survive or go under. One or the other. And I find that I am ready. I have had, after all, many months to prepare for this diagnosis. Dr. Lux did warn me, right at the outset, that cancer was one of the branches of possibility. And the known is, in a sense, easier to deal with than the open-ended threat of a disease which so many tests and so many shiny bright machines have previously fail to clarify.
Yes, I am prepared for this.