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This is part of the full text of the medical memoir "Cancer Patient" written by Hugh Cook. The full text has been published online on a free-to-read-online basis. This autobiographical non-fiction account deals with the author's initial health problems, diagnosis, and treatment with chemotherapy and radiation therapy.

The complete text of "Cancer Patient" is here on this web site but is also available for purchase from amazon.com as a proper printed paperback book. The full text may also be purchased as a download (a PDF file) from lulu.com for US $5. Go to lulu.com/hughcook

For a chapter-by-chapter breakdown of what's in the book (in its online version, in the PDF version and in the paperback version), see:-

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CANCER PATIENT is a medical memoir which deals with the author's autobiographical experiences which involve, amongst other things, chemotherapy, radiation therapy, a brain biopsy, a lumbar puncture (and then some more lumbar punctures), treatment with Ara-C, treatment with vincristine, treatment with methotrexate, treatment with radiation from a linear accelerator, and a vitrectomy (an operation to remove the jelly from an eye). This is a non-fiction account but it does contain a couple of fictional stories, clearly identified as such, and it also includes some poetry.

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Chapter Eighteen

Summary

Confronted with the possibility of dying, the author goes through a period of ceaseless mental activity, reviewing the present, the past and the future. He thinks back to, amongst other things, an occasion on which he had a brush with hypothermia while on military service. Now, faced with the active possibility of death, the author thinks about his life and concludes that he is satisfied: he has lived a good life.

         At this time, my head was always whirling with thought. A process of virtually non-stop mind activity began with the diagnosis of lymphoma (or, more melodramatically, which was how I sometimes ended up thinking about it, of "brain cancer") and continued for some months, perhaps right through to May.
        I kept thinking about the past, the present and the future, and usually ended up being satisfied, in the sense that I thought, "Well, I had a good life."
        Initially, I tended to think that I was probably at the end of my life, and was playing out the final act. But my confidence steadily rose as a whole bunch of good things happened to me. First, I came through the vitrectomy on my left eye okay. Later, I survived the brain biopsy in good shape. And, later still, I came through the chemotherapy with only the most nominal amount of nausea and vomiting (and that only in the first of six cycles).
        What exactly did I do in those five or so months of feverish non-stop thinking? I guess, in a way, I reviewed my life. And one of the things I reviewed was the incident in which I almost died. (Almost? Well, maybe not "almost". But I was definitely drifting happily in the direction of death by the end of it, in dire danger and completely oblivious of the fact.)
        The memory of my brush with death was something I processed shortly before being admitted to Auckland Hospital for a brain biopsy. This is part of my cancer patient story: this journey back through my own history, back through my own life. The journey is part of what happened to me as a consequence of my medical condition.
        I didn't deliberately choose to meditate on death, but, as mentioned above, one thing I ended up thinking about was how I almost died. How I almost died without noticing that I was in any danger at all. How I almost died despite being well-equipped and superbly trained. How I almost died because I failed to recognize the thing I had been trained to recognize, Enemy Number One. How I almost died, feeling happy and warm, of a danger on which I could have comfortably (and competently) lectured without notes.
        What undid me (what made all the training fail in practice) was the context shift. The implicit context of my training was the hypothetical Someday Maybe war, or the very real training cycle associated with getting ready for that war.
        But we didn't go to war. Instead, we went to something about which I knew next to nothing. We went to a fire. A big fire burning through farmland to the south-east of Waiouru, whipping quickly through dry tussock and light scrub, leaving more than half the fuel unburnt, so the fire could come burning back over exactly the same ground with a shift of the wind.
        Waiouru is a location roughly in the center of the North Island of New Zealand. It is in an elevated area dominated by the volcano known as Mount Ruapehu and it contains a large army base. At that time I was a medical assistant, someone trained in the basics of first aid and the like, in the part-time section of the army known as the territorials. And, on the day of the big fire, I ended up with the fire chief.
        The fire chief had no need for a medic so ended up pressing me into service as a radio operator. At his command post, there was just him and a few other guys with a couple of four wheel drive vehicles sitting in the middle of nowhere, trying to command unseen arrays of untrained troops (since Waiouru was a major training base, untrained troops were available in quantity) plus a handful of helicopters against a fire that was bigger than ... bigger than what? Maybe bigger than Singapore. Too big to see at a glance, put it that way.
        Although I was with the fire chief in a location which I think was somewhere in the middle of the fire, I couldn't see anything burning. All through the day, I didn't see any smoke and I didn't see any fire. I could see a fair bit of hilly countryside but I couldn't see anything burning. It was not a photogenic fire. From my point of view, it was more of a radio show, and since my job was simply to pass the radio's handset to the fire chief when necessary, it was a pretty easy day.
        I remember the fire chief talking to someone who had been requesting a helicopter with a load of water, urgently, now, and saying "Is your need greater than a fifty kilometer front?"
        Or maybe it was only forty kilometers ... these fire fronts have a way of getting longer as you age.
        The whole day I felt happy and also felt warm enough, though the day could not really be described as warm. Rather, it was a bit on the cool side. The Waiouru military base sits at 815 meters (2,674 feet) above sea level, high enough for altitude to come into play as a cooling factor, and I think the land where the command post was located was higher.
        However, I felt warm enough. I was wearing a shirt (a woollen shirt, if the change from cotton shirts to woollen shirts had been made by then), a woollen jersey and a plastic parka. I was at ease with the military radio, which was pretty simple to use, and which I had become familiar with because I had carried those brutes (ten kilograms or so of electronics and battery) of ten enough on exercises (do that only two or three times and you'll get the feeling it is "often enough".)
        So my day passed. Then it was night, and the fire which was too far away to see, the fire we were supposedly fighting, had died down as the wind died down, and it was time to head back through the cool night air.
        I traveled back in a four wheel drive vehicle. There was no canopy on the vehicle. The canvas cover had been removed because of the fire risk. Consequently, I lay on the cold steel of the tray with no shelter from the elements. I felt cold but happy, satisfied with what had been a long but interesting day, something different, something out of the ordinary.
        The vehicle moved slowly through the night, eventually joining up with other vehicles and becoming part of a convoy grinding over rough tracks that led through hill country dominated by tough tussock grass. For a long time I was uncomfortably cold and shivering, but felt relaxed. And, finally, felt myself growing warm.
        "So," I thought. "So, you're getting used to it."
        That was my thought, my languidly snoozy and totally complacent thought. That was the point at which my training (convection, conduction, radiation, yes, I knew all that) failed me totally. That was the point at which I began to die in a very well-known well-described manner.
        And I, for all my training, for all my intelligence, for all my gung ho can do, will do, want to do spirit, I failed.
        Midnight or thereabouts we got back to our improvised base (field kitchen, field shower unit, medical unit and associated ambulance and so on) half way between the fire disaster area and Waiouru military base.
        Before being assigned to work with the fire chief, I had come to the improvised base as part of a medical team, and the other members of the medical team were still awake and working. I very naturally went to help the other members of my team. I was conscious, after all, of the fact that I had enjoyed a very easy day (sitting on my backside on a hillside beside a four wheel drive vehicle) and had been given plenty of time (hours of time) to rest on the drive back.
        But, when I went to help the other members of the medical team, they were shocked at my condition, and, to my bafflement, ordered me to get into my extremely nice warm sleeping bag (my personal purchase) in the back of the ambulance.
        I thought they were nuts, but, like the good soldier I was, obeyed orders. And was soon solidly asleep. Waking much later, at about four in the morning, I realized that, after four hours in the protection of the vehicle, after four hours in a sleeping bag good enough to have preserved human life above the snowline (had that been necessary), I was only just starting to get warm.
        Only just.
        It was only then that I figured out that I had been suffering from hypothermia by the time I got back to the improvised base.
        When we get cold, the first things that cool down are the peripheries -- expendable things such as ears, noses and fingers. The blood circulation in the peripheries shuts down as the body tries to conserve warmth in the vital core, which contains the brain and the heart. If your fingers get too cold then you may end up losing a few of them to frostbite, but if your heart and brain get too cold then the probable outcome is death.
        Hypothermia is a condition in which the body's vital core starts to cool. The temperature of the core, which includes the brain, begins to drop. And, as the body's core temperature drops, judgment goes, and, finally (and this is a screaming danger signal that should throw you into a state of red alert) you start to feel extremely comfortable and warm. As you start to die.
        I began the dying process, and it's not unreasonable to think that, given a few more hours on the road, I could have completed it.
        And, as I lay awake at night, contemplating the hospital admission and brain biopsy which lay ahead, thinking about my chances of survival, I thought back to that day in Waiouru, many years earlier.
        Of course, there were other occasions in which I put my life in hazard, other moments when I ended up in a danger zone because of stupidity or recklessness or just a sheer failure to recognize the obvious.
        One occasion that came back to me was an evening in Gaya, a town in the state of Bihar in the north east of India. I was on a railway platform late at night. I was sitting on my backpack, waiting for the train which would take me on to Calcutta. And, as I was sitting there, a group of four policemen quasi-military uniforms came wandering along the platform, each of them carrying a rifle.
        The policemen looked obviously surprised to see me, and I wondered why. As far as I could tell, my behavior was both logical and lawful: sitting on a railway platform waiting for a train. And, on top of that, I'd never before noticed anyone in India being surprised at anything.
        Some weeks later, another tourist told me that Gaya was notorious for having the highest murder rate in India, at which point I realized that perhaps parking myself on an unpopulated railway platform round about midnight had possibly not been the safest thing to do.
        Anyway, that night in Bihar I came to no harm. Eventually the train arrived and I got on it. I did wonder, during the journey to Calcutta, why there were more policemen on the train, each armed with a rife. Only much later did I find out that the reason for the police presence was that the train was sometimes stopped by bandits.
        That was the kind of thing that went through my head in those early weeks of my life as a cancer patient, my mind constantly busy, thinking of the past, the present and the future. I was not happy about the prospect of quite possibly dying. But, as far as the past is concerned, I was satisfied. The risks I took, the adventures I had and the experience I accumulated. Dawn in the Nepal Himalaya at close to 5,400 meters, for example, high on the pass of Thorung La -- for me, a peak experience.
         I am glad I took my opportunties when I had them. I had a good life. I regret nothing.


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The text on this page is part of the cancer memoir "Cancer Patient" which has been posted online. All the chapters of this book are on this website and can be read for free online. However, the text is copyright - all rights reserved. For permission to use this text or any portion of it contact Hugh Cook.

Disclaimer

        This personal memoir of the writer's encounter with cancer (non-Hodgkin's lymphoma of the large B-cell type) attempts to cleave to the truth. However, the text may contain information that is wrong, outdated, incomplete or otherwise misleading.
        This memoir has been written in a time of illness by a cancer patient who, though he feels sharp enough, must admit to sometimes misinterpreting things, forgetting things, or, on occasion, quite simply not hearing things.
        This memoir is designed to communicate the writer's personal experience and is not intended as a source of medical information. Got a medical question? Ask your doctor.

Cancer Patient Copyright © 2005 Hugh Cook.

Hugh Cook

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