That Monday morning, the morning of January 17th, my sister arrived at the hospital early in the morning. She got to my room at 0700, having negotiated her way past the hospital's unobtrusive (but real) security. (At a certain hour of night the doors giving access to the areas containing the wards were locked, and they were not unlocked until the morning was well underway.)
Sister Catherine arrived before official visiting hours began, but my brother-in-law had advised the staff to expect her. He himself, having worked late and slept little, was in the car with his two children, Miss Two and a Half and Master Almost Five Years Old. He was on his way out to Auckland airport to meet his sister, who was arriving from Canada for a New Zealand holiday.
Doctors whirled through my room at 0730, moving really quickly. That was the ward round. Breakfast time came and went (roughly speaking, breakfast could be expected to arrive at about 0800 or shortly afterwards) but I, being scheduled for an operation, did not get any breakfast.
At 0830, a man showed up, an orderly.
"Mr. Cook?" he asked.
I acknowledged that I was Mr. Cook, and he told me that he was there to take me down to the magnetic resonance imaging facility on my bed. It felt extremely strange to be moved on a bed when I was perfectly capable of walking but I didn't argue about it.
I was pushed along corridors and into elevators and arrived at last at the MRI facility. There, some dye (containing, I think, a rare earth called gadolinium) was injected into a vein to provide contrast for the scan, which, on this occasion, was to be of my brain only, as opposed to my brain and spinal cord. My scalp was still adorned with the various adhesive dots which Sheik had stuck to my scalp shortly after midnight, and these dots would show up on the scan.
The brain scan was scheduled to take eight minutes, but the machine froze at the six minute point. I was extracted from the chamber so more contrast (more dye) could be injected. The machine was successfully rebooted, but by that time the machine had gone and lost my data, so a new scan had to be done from scratch. Then all the data was put on a CD-ROM which went in with my notes.
This procedure, then, resulted in the hospital ending up with a copy of my brain scan on a CD. The dots which landmarked my scalp were visible on that brain scan.
Back in my private room, I waited for the operation, which I thought would be at 1130.
My sister was perfect company, letting me chat or snooze as I wished.
One of the things that I reflected upon was the fact that the role of writer, in a very real way, alienated me from the social world for a significant number of years.
In my notes I wrote:-
"In a bizarre way, the role of cancer patient, imposed by circumstances largely outside my control, integrates me into my family, my society, my world. Whether destined to live or to die, I am, for the moment, socially optimized."
I understand that some people apparently experience a cancer diagnosis as being extremely isolating, but for me my medical crisis was, at least in the days and weeks immediately after diagnosis, a kind of homecoming experience.
My sister and I talked about things that had nothing to do with the operation, such as the nature of parenting -- when it comes to the business of parenting, every single thing is simple but the process just goes on and on, relentlessly.
I talked about being a parent in Japan, me alone for an afternoon with baby Cornucopia, and I go to the toilet, and she crawls to the door of my disappearance and screams. (It seems that at a certain age kids do suffer from separation anxiety, and will scream if they're left alone in the universe.) This screaming is really intolerable, and what am I supposed to do about it?
"You open the door," explained sister Catherine.
"I thought of that," I said. "But the idea was grotesque. Me sitting on the toilet with my daughter watching."
At the time, I imagined the wider universe censoriously observing the grotesque spectacle and so could not bring myself to take the logical, obvious step and open the door.
"At her age," said Catherine, "she probably doesn't have a concept of you as a separate human being."
That sounded plausible, on a theoretical level. But, even so, I couldn't quite bend my brain enough to accommodate the thought.
The day before, I had met the female half of the anesthetic team. Monday morning, the second anesthetist dropped by, a friendly South African guy whose name, unfortunately, I have forgotten. He also talked to me about the operation.
I was glad to have met with both anesthetists in advance of the operation, as the anesthetists are the people who actually keep you alive on the operating table.
Once, in the Solomon Islands, I was present at a time-consuming operation on someone's hand. The operation had been going on for a long time and the surgeon was getting a bit tired, so the anesthetist invited the surgeon to go awake, take a break and get a bite to eat. The anesthetist would be perfectly comfortable sitting with the patient until the surgeon got back.
As it happened, the surgeon declined the offer, but the incident rammed home a fact that I already knew in theory: when you're under a general anesthetic, your life is in the anesthetist's hands.
To the South African anesthetist, I made one point that I was at pains to make to every single member of the medical staff that I encountered before the operation: the pupil in my left eye was not reacting properly to light.
At that stage my left eye was still close to being useless and I didn't have any great hopes for it, but, at the same time, I was conscious of the fact that I was definitely seeing a bit more with the left eye than I had been a week previously.
It was important to me to make absolutely sure that everyone knew that my left eye was not reacting normally to light. One simply method of checking someone's level of consciousness is to shine a bright light into their eyes and see how the pupils react. If one of the pupils fails to react normally then it may suggest a problem with the brain. In this case, as I was keen to explain, the problem was with the optic nerve, not with the brain.
I figured then (and still believe now) that there's no harm in checking things like "Do the staff know about my eye condition?" Even if something is documented somewhere, there's no guarantee that everyone has read the notes. And mistakes do happen, even in well-run hospitals. During the course of my various admissions I noticed a number of small glitches, the (potentially) most serious involving a "Mr Hughs".
What happened (months after my brain biopsy operation) was that a doctor who was in the hematology department looking for a patient called "Mr Hughs" glanced at the name tags slotted into the name tag holder outside one of the wards and saw a name tag for "Hugh Cook", in bed C. The eye tends to see what it expects to see (which is what makes proofreading so difficult) and she misinterpreted "Hugh Cook" as "Mr Hughs". She came to my bed, the name tag having told her which bed it was, and, without any preamble, launched into a conversation by saying "I'm sure you know why I'm here".
That was the one occasion on which I was actually misidentified (albeit temporarily). It reinforced my belief that, from the point of view of self-defense, it's smart to stay in touch with what's going on, and, on occasion, to make sure that other people are properly in the picture.
At some stage, either on Sunday or Monday, someone did an informed consent procedure with me, but I can't remember who. In fact, now I think about it, it's possible that there were two informed consent procedures, one for the brain biopsy and a second one for the general anesthetic.
What I do remember is that at some stage I signed a form agreeing that if it was absolutely desperately necessary for me to be given blood then that was okay by me. I didn't like the idea of having a blood transfusion but it seemed preferable to bleeding to death on the operating table.
Then there was nothing to do but wait.
By 2 p.m., the patient was becoming distinctly impatient. Also, my sister had not been fed. Her plan was to wait until the hospital people came to take me away for the operation, but that could be hours yet.
"Go and get something to eat," I said.
"But, if I leave, they'll come for you," she said, joking.
"They may," I said, seriously. "So take your stuff with you."
She picked up her stuff and left, and I went into my private room's big ensuite chamber (shower, toilet, wash basin) to take a leak, and a voice outside said, "Mr. Cook?" Yes, they'd come for me. And very shortly afterwards I was lying on my back on my hospital bed and was being wheeled down a corridor with a little voice wailing silently in my head saying "I want my sister!"
That was the one point at which I was conscious of being scared.
I was wheeled into a kind of waiting room, a room holding beds on which various patients were lying waiting for their operations, and a nurse asked me a question.
"Did you pee?" she asked.
"Ten minutes ago," I said.
I was still wearing my spectacles and asked if I should take them off. The answer was no. Standard operating procedure was for patients to wear their spectacles into the operating theater. In the theater, someone would take the spectacles away from me, and they would be available to me as soon as I came round after the operation.
At that stage (that is, when I was lying on my bed in the waiting room) I was wearing a surgical gown and a kind of nappy (that is, a kind of diaper) which the night nurse had helped me into after I had taken my morning shower, which I had finished at about 0630.
I was under the impression that I had been told that immediately before my operation I would be in a room containing just people who were waiting for brain operations, but, evidently, an overload from elsewhere had spilled into the neurosurgery department.
A couple of beds away, there was a confused old woman who had smashed her shoulder, and who was going to need a bone graft to fix it. A doctor was going through an informed consent procedure with an old man, who was presumably the old woman's husband, and it seemed that the old woman's prognosis was less than ideal.
That put things in perspective for me, and I was conscious of how lucky I was. I, after all, had enjoyed (if that's the word) over twenty-four hours in which to get briefed and prepared. These old people, however, were having to face a crisis as short notice, presumably only shortly after having been rescued from a car smash or some similar catastrophe.
After waiting for about ten minutes, I was wheeled into the operating theater, which was big -- much bigger than I'd expected -- and white and very bright with lights, and which contained all the standard operating theater stuff that you see on TV. The whole thing seemed to be set up to do just one operation at a time.
I had been told that, before the operation, I would meet the surgeon who would do the actual cutting, and that he would explain the operation to me and go over any questions. But I never met him. Later, when I received from the hospital a "clinical summary", a written report detailing what had happened to me, the name of the surgeon was on the report, but it was not a name I recognized.
I guess something came up, making it impossible for the surgeon to visit me, and I have no regrets about that. By the time I was wheeled into the operating theater, pretty much everyone else had dropped by to give me part of the picture, and I had built up an image of the operation which satisfied me.
The skull. That's the starting point. In the skull, the brain. In the brain, in the front central area, a node of lymph density. Aim of the operation: to put a needle into the node and take a sample to send to pathology so pathologists can tell the oncologists exactly what kind of cancer they're dealing with so the oncologists can optimize my chemotherapy.
Risks: infection, death, stroke (five percent) and, additionally, (one percent), maybe the pathologists won't be able to analyze the sample, in which case we have to come back and do this whole thing again.
Asset: MRI scan of brain showing target node plus images of dots which are glued to my real physical skull and (this is my not-properly-informed and possibly counterfactual guess) on a computer screen, a virtual needle. The computer screen, as I visualize it, displays my brain (as mapped by the MRI and recorded on CD) and a virtual needle.
The operation (again, this is my conjectural version) goes like this: I go under, I get morphine, a hole is drilled in my skull and a real needle goes into the hole. The real needle somehow communicates with the virtual needle on the computer screen and the virtual needle models the movements of the real needle.
Thanks to the virtual needle which is displayed on a computer screen, the surgeon is able to see where the real needle is in the brain, allowing for accurate surgery with a bare minimum of hacking and cutting. (No chainsaws are used in this operation.) When the needle is in exactly the right place, it is used to extract a tissue sample. The node which is being sampled is (perhaps) the size of a kidney bean.
That, then, is the concept of the operation that I have in my mind as I'm wheeled into the operating theater. The procedure is known as a stealth biopsy, and allows a tissue sample to be taken with a minimum of fuss. Instead of hacking the brain open to get a look at what's inside, the surgical team can judge what they're doing by watching the progress of the virtual needle on the computer screen.
As I'm wheeled into the operating theater, I'm not really worried about the operation. Rather, what's uppermost in my mind is the business of the urinary catheter. Once I'm under the anesthetic I'm going to be catheterized, and when I wake up the catheter will be in, and I really don't like that idea one little bit. Still, there's nothing I can do about it.
Overall, however, I feel upbeat and confident about the operation, and what really cheers my spirits is to see both members of the anesthetic team. They recognize me, and, smiling, have a few words with me. The fact that they know who I am means that I'm definitely in the right room for the right operation, not in the wrong room where they're going to experimentally swap a man's brain for a chimpanzee's brain.
(Bad things do happen even in good hospitals. Like, for example, your breakfast failing to arrive.)
When I was wheeled into the operating theater, I already had a cannula (a hollow needle-shaped tube) in a vein in my left arm. Or, more exactly, to use the lingo of the hospital system, a lure: a cannula with a short length of tubing attached to it. The cannula had been used that morning to put in contrast dye for the MRI and had subsequently been flushed clean with sterile water. The first thing the anesthetists did was to check that the cannula was still working, which I assume they did by injecting some more water into it.
Presumably at some stage someone took my spectacles away, but I have no recollection of that happening.
At some stage, possibly before the lure was checked, I was asked to move from the bed onto a narrow operating table. Then the anesthetists put an oxygen mask on my face then started shoving in drugs, using the lure to do this.
I was about to go under the general anesthetic.