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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 Thirty-Seven

Summary

While undergoing medical treatment, the author continues to push ahead with his writing. Now well into chemotherapy, he is experiencing a degree of fatigue. Also, the occasional small problem with memory. He reads about memory loss in association with the aging process. Life is undramatic but the fear of the future is there in the background.


        Friday 8 April 2005.
        Two articles touching on the subject of brain surgery caught my eye in The New Zealand Herald today. One, on page A4, is about the funeral of a Mr. Paul Jeffreys, who "died unexpectedly on Friday night at Auckland City Hospital after surgery for a benign brain tumour".
        Another, on page A2, about a lack of neurosurgeons in New Zealand, quotes Auckland District Health Board meeting papers as saying that a surgeon shortage is "seriously impacting" on waiting times for non-urgent operations for neurosurgery patients. Which prompted my mother to say I was lucky to have my brain biopsy when I did.
        Apparently one of the root causes is that, internationally, there is quite simply a shortage of neurosurgeons.
        Anyway, I had the good fortune to have my own brain surgery in a timely and thankfully uneventful fashion, and today I feel pretty good. Another perfect day with matchless autumn weather.
        Have been working well on the BAMBOO HORSES novel. Have just been going over new inputs with my spell checker, which suggests changing "Towadafudaishi" to "Quaaludes" (I have to say I don't quite follow the logic here), "Namie" to "Name" and "scamming" to "scramming". As for "Ujizuno", that should become "Jinn" and "splodging" should become "pledging". And "Hessawatari" should become "Wastier". And "Voyoska" is taken as being a misprint for "Toyota".
        It's now 10:29 in the morning and my father has just come home bringing fresh mussels in their shells from the supermarket. That's one thing that, for some reason, I haven't seen on sale in Japan: mussels. I can't imagine why, since the seafood section in a Japanese supermarket is really big compared to the meat section (in New Zealand, it's the reverse, with the fish selection limited and generally expensive).


* * *


        Saturday 9 April 2005.
        Since coming down with cancer I've naturally noticed a constant trickle of newspaper articles about cancer. In today's issue of The New Zealand Herald there's a Reuters article credited to a Maggie Fox in Washington which says in part that, according to a recent report from the American Cancer Society, "More than 60 per cent of all cancer deaths could be prevented in Americans stopped smoking, exercised more, ate healthier food and got recommended cancer screenings".
        The article comes with a sidebar which looks as if it has been added by the Herald, and which says in part that "In New Zealand, cancer causes about a quarter of all deaths," mostly in people aged sixty-five or more, who account for seventy per cent of all people who die from cancer.
        Before my own illness I'd vaguely been aware of cancer as a kind of bogeyman disease, one of life's monstrous possibilities lurking in the shadows, but I had no idea that it was, statistically, a commonplace disease.
        This even though I probably had my own first brush with cancer some years back: I went to a doctor, a general practitioner, to have her take a look at an odd little growth on my nose, and, having decided that there was a good possibility that it was a case of skin cancer, she burnt it off with liquid nitrogen. It never came back.
        Today my own life with cancer was quite simply boring. I was up at 07:00 and was at my computer from 08:00 to 12:00, working on the BAMBOO HORSES novel. Work went reasonably well but got steadily slower and slower as I ran out of steam, and by lunchtime I had to acknowledge that there was no option but to give up.
        My stamina levels seem to vary from day to day but are definitely low, and today four hours of deskwork brought me right to my limit. So after lunch I went to bed and had an early afternoon nap, having decided on principle that I'm not going to try to force myself past whatever my current limits happen to be.
        But it's definitely frustrating just to run out of steam like this.
        I don't know why I'm so short of energy. Maybe it's the cancer itself, or maybe, as noted earlier, the effects of chemotherapy or the effects of tapering my steroid dose from eight milligrams of dexamethasone a day to two.

* * *


        Monday 11 April 2005.
        This morning I kept a 10:00 appointment at Auckland Hospital to find out how my chemotherapy has been going. At this stage I've been through four cycles of chemotherapy (four of a projected six) involving the chemotherapy agents methotrexate and vincristine, and, additionally, I've had six lumbar punctures involving injecting a third chemotherapy agent, Ara-C, into the spine. So how am I going? Well, it's a good news bad news situation.
        Good news: I am done with lumbar punctures. No more needles into the spinal area. All finished. The last samples of cerebrospinal fluid have been clear: there is no more lymphoma left in the spine.
        Good news: the latest MRI scan of my brain shows that the lymphoma tumor which was conspicuously evident earlier has shrunk away to leave only, as far as I can follow the explanation, a skeleton of itself and some kind of permanent residual damage (the brain does not revert to its original pristine state), and that this response is a "first step" on the way to a cure (assuming we are going to get a cure.)
         Bad news: my latest lab tests (both blood tests and a urine test for something called creatinine clearance) indicate that my kidney function has taken a fifty percent hit (compared to what it was earlier). This raises the possibility that there may be methotrexate crystals in my kidneys, but that's just a possibility.
        Today I had a fresh blood test and the results of this will determine whether the remaining projected cycles of chemotherapy, cycle five and cycle six, do or do not proceed. If the methotrexate is in fact threatening the kidneys, then cycles five and six will probably be canceled, and we will probably skip ahead to the next step, which is radiotherapy.
        On the other hand, depending on what today's blood test shows, it's possible that I could still be admitted to hospital on Thursday, as originally planned, for another five days or so of chemotherapy: cycle five.
        Subjectively, today I feel fine, so the news that my kidney function is down (on a temporary basis or a permanent basis I have no idea) does not alarm me. It's like the news that there's residual battle damage left in my brain: if I'm functioning okay then I don't see that I should be fussed about it.
        However, there are days on which my energy levels are conspicuously down. I just run out of steam and feel exhausted. Why? The answer that came back was that it's probably the cumulative effect of the chemotherapy, and that I should expect to continue to quite possibly have energy level problems during the projected radiation therapy, too, since fatigue tends to be one of the consequences of radiation therapy.
        Anyway, having received both the good news and the bad news, my mood on this bright sunny autumn day (magnificent blue skies weather!) is relaxed and optimistic.

* * *


        Wednesday 13 April 2005.
        Content of this account of my daily life as of April 13: living with chemotherapy: my own low-key experience. Context: I am being admitted to hospital once in every two weeks for five days of chemotherapy, and the fifth of a projected set of six such five-day chemotherapy cycles starts tomorrow, Thursday.

* * *


        One of the things that I've learnt during my illness is that I cannot accurately gauge my own intellectual function. There have been times at which I have felt crystal clear but when, in retrospect, I was misperceiving things, or getting a rather blurred perception of the world.
        Of course, everyone experiences little mental glitches from time to time, but, now, when these things happen, I don't know whether it's just life as usual or a symptom of structural brain damage.
        Yesterday, for example, I was waiting at home for Dr. Porter to phone me to tell me if I would or would not be going to hospital tomorrow Thursday for the fifth of six projected cycles of chemotherapy. But he didn't phone.
        Then, after 10:00, my father told me, no, at Monday's meeting he didn't say he would phone you. He said you were to phone him.
        That was completely the reverse of my understanding. I had a very clear memory of Dr. Porter saying that he would phone me. However, my father was at the meeting. And what I've learnt from past experience is that if my father's memory or my sister's memory conflicts with mine, then they are right and I am wrong.
        So I phoned Dr. Porter about 11:00, apologized for calling in late and asked what the situation was. He found the results of my latest blood tests on the computer, and apparently they're fine. Kidney function seems to be normal. So I'm to show up tomorrow at 10:00 to be tethered to a drip stand for another five days.
        Emotionally, I'm neutral about this. On the one hand, I don't want to spend another five days as a prisoner of the hospital system. On the other hand, my longterm survival chances are presumably greater if I can complete all six scheduled chemotherapy cycles.
        Felt tired yesterday and went to bed before 21:00. Woke about 04:30, felt rested and so started my day. As the Immunologically Compromised Man, the first thing I did was to take my temperature with my high tech digital thermometer, and it came in at 36.4 degrees Celsius, which is pretty much normal for me in the morning.
        Then I dropped a capsule of an antacid called Losec, one of only two medications I'm taking on a daily basis. The other is dexamethasone: I'm still taking two tablets a day, a one-milligram tablet after breakfast and a second one-milligram tablet after lunch. And I'm still having nosebleeds and a little internal bleeding (currently I have a purplish bruised patch on the right elbow) as a consequence of the dexamethasone.
        Anyway. Today's plan is to push ahead this morning on the BAMBOO HORSES novel, taking advantage of the fact that I feel rested and ready to work. At twelve noon I'm scheduled to show up at sister Catherine's place for lunch, my big social event of the day.
        I've nothing planned for the afternoon. When I became ill, one of the very first decisions that I made was that I should vow to do less, to slow down, to take things easier. And my practical experience has shown that this is necessary: my stamina levels are not what they are.
        So. Let's get into the working day and push ahead with BAMBOO HORSES. While I do, I'll listen to Tchaikovsky's Sixth Symphony. (I'm not a big classical music fan, but my parents' CD collection is mostly classics, everything from the standard encyclopedia composers like Mozart to guys I've never heard of before.)

* * *


        A little later: cancel the symphony. A bit too much at this early hour of the morning. Too much energy, blaring and thumping. I'll go with Bach, the Brandenburg Concertos. Or maybe this oddball CD, TIBETAN CHANT.

* * *


        This morning I hit a little memory problem while working on the BAMBOO HORSES novel. Ken's wife, Valencia, has been getting drunk, and to authenticate the moment I give her a specific wine to drink, this being cabernet sauvignon blanc.
        Then, checking with my computer's resources (encyclopedia and dictionary) I find that no such wine is possible. It seems that "cabernet sauvignon" designates either a specific type of red wine or the black grape used to make that wine. It follows that "cabernet sauvignon" cannot be "blanc." And "sauvignon" is a kind of grape that is used for making white wine.
        This is not a major intellectual disaster. It's not as if my encyclopediac knowledge of wine has suddenly been wiped out, because the truth is that I've never known much about wine except that it's a liquid which comes in bottles and which is comprised of water plus alcohol.
        However, even so, the truth is that I have a distinct memory of having recently bought, from the supermarket, a bottle of wine labeled "cabernet sauvignon blanc".
        Obviously a false memory.
        When I took a break from writing and sat down with a cup of tea I had a range of books to choose from. (I'll usually read a book while taking a break.) And the book which took my eye was "Ourselves Growing Older". And the section in the book which attracted my attention was section 28, "Memory Lapse and Memory Loss".
        Which contains, amongst other things, the statement (page 530) that "Diseases and physical disorders can be accompanied by emotional distress that can lead to increased forgetfulness, especially when treatment in an unfamiliar place, such as a hospital or nursing home, is required." Yeah, I've been there, done that - my first admission for chemotherapy ended with me pretty much completely collapsing intellectually, and losing track of the date by two days.
        The quote above is from the Fontana Paperbacks 1989 British Edition of "Ourselves Growing Older", a version of an American original by Paula Brown Doress and Diana Laskin Siegal with some chapters -- not the one quoted from -- rewritten for the British edition by Jean Shapiro.
        The target market for the book seems to be women, with the material on the cover mentioning Doress and Siegal and then saying "and The Midlife and Older Women Book Project". However, it's a book I might read more of myself. A body growing older is a body growing older, and section 24 is titled "Cancer".
        I don't spend a lot of time thinking about my own deterioration, actual or potential, but my thoughts do drift back to the topic now and then.
        At this stage, with the original tumor having been reduced to a defeated skeleton of itself, it seems that I'm still functional. I do suffer the occasional mental glitch, but, then, who doesn't? And, if I have at this stage suffered a slight degree of irreversible damage as a consequence, my judgment would be that it's no big deal.
        As things are, I can still handle my daily schedule, write, update my web site, install new software and figure out how to use it, and so forth. And, subjectively, I feel fine, except for the times when I hit a wall, intellectually, on account of exhaustion, pure and simple.
        However.
        Up ahead, I have the radiotherapy. And, in terms of intellectual function (and potential damage to the eyes, and so forth) that's a lottery. So I am conscious of the fact that, later this year, I am going to be spinning the roulette wheel, with one red chip sitting gleaming on the wheel, with that one red chip being my life.
        I won't say that this thought is dominant, but, yes, the question of potential intellectual disintegration does arise now and again.
        So.
        Today's bad news is that I got a bit glitched about wine. The good news is that, in the course of rummaging around in my computer's resources, I thought to check up on the "brut" versus "sec" question.
        A few weeks ago, I and my father and my brother Charles were trying to figure out the difference between "brut" and "sec". The verdict was that probably "brut" is dryer than "sec", but this wasn't entirely clearcut because one of the dictionaries we were consulting Englished French "brut" as something like "wild" or "rough".
        However, the dictionary I looked at today unambiguously says that "brut" is used to designate wine which is "extremely dry", which I take it as meaning that we were correct in concluding that "brut" is a significant step dryer than "sec".
        Focusing on the day's good news, then: if I get out of this alive, I'm going to end up knowing more than I did about wine, classical music and (maybe) Tibetan chant.
        A statement which may seem to trivialize the situation. But the reality is that my life has settled into something of a routine, and the words "mundane" and "quotidian" apply. I assume that I'm on the path to survival, but, even if I'm dying (which, statistically, is still a possibility at this stage) my days are pretty uneventful.
        Events in the life of a cancer patient, today: open a packet of green peas; add green peas to boiling water; add instant noodles to boiling water; open a tin of tuna (for a change, not the usual tomato and basil flavor but a can of the sweet Thai chili flavor); eat breakfast; wash the empty tuna can with detergent and boiling water (because the inorganic rubbish is only collected once a week, and any uncleansed fishy cans will start to stink).
        It is, one has to say, a quiet and singularly undramatic life, particularly since I don't get any systematic feedback from the disease process. I do know that (erratically) on some days I feel fine and on other days I feel pretty lousy, with really low energy levels, but this inconsistent pattern of "okay days" and "stamina depleted" days doesn't give me any picture of how I'm faring internally.
        For the outcome, the result, I'm reliant upon the medical system, and the verdicts delivered by blood tests and MRI scans and so forth. My kidney function is down? Well, maybe, but I don't feel any different. The tumor has gone, leaving just a skeleton of itself? Well, I've never had any "having a tumor" sensation (the brain, of course, does not send out any sensory signals about itself.)
        What becomes dominant, then, is not the cancer itself (which sinks into the background) but the daily routine. The question: so what am I going to do today? Today's day-specific answer being (a) to push ahead with BAMBOO HORSES as far as I can today; (b) to go to sister Catherine's for lunch; and (c) to do nothing in the afternoon (well, that's the plan, but, in fact, I'll probably spend more time with "Ourselves Growing Older," maybe the section on cancer).

* * *


        Post mortem on the day (toward the end of the day):
        Looking back on my quiet and simple day, I'd say it was a success, but, at the same time, it did bring home to me the limited nature of my physical resources.
        To start with, I had to abandon work on BAMBOO HORSES in the morning when I hit a wall, feeling exhausted. I set my alarm clock, lay down for an hour and actually went off to sleep.
        Having volunteered to provide lunch, I'd allowed myself an hour to wander down to the shops and pick up some simple provisions: fruit, garlic bread, marinated mussels and some eggplant-based babu ghanoushi spread. That proved to be the right amount of time.
        Lunch with my sister went very well, the two children (Miss Two and a Half and Master Almost Five Years Old) behaving very well, and we decided that later in the year, after my sixth round of chemotherapy, we will have a celebratory meal at Sigdi's, a local Indian restaurant that we've been meaning to dine at for some time.
        After lunch, I sat in the sun for a while reading the newspaper and chatting, then said goodbye and wandered home. Feeling good but tired.
        I laid down and slept a bit, and woke with my pulse racing along at 92. Sick? I took my temperature, in case it was elevated, but it was an acceptable 37.1 degrees.
        In summary, then, my baseline state is that I generally feel okay. If I'm idling in neutral then, physically, I'm relaxed and comfortable. But, once I start to push the limits mentally (keyboard work) or physically (going out and doing stuff) I pretty soon run up against restrictions.
        I guess the answer is just to accept the decisions that I made at the outset: to do less, to slow down, to take things easier. To acknowledge my limits and live within them.
        I'm assuming that the fatigue, at this stage, is primarily due to the cumulative effects of the chemotherapy. (If I remember correctly, Dr. Porter affirmed that assumption at our last meeting.) And I know that the planned radiotherapy can also cause fatigue. So the prognosis seems to be that I can expect to live with fatigue issues for some months yet.
        Which is okay.
        My attitude at the moment is one of fatalistic acceptance. Very early in my treatment - pretty well right from the begining, in fact - I saw myself as being like a rocket launched on a set trajectory, with no decision junctions. That's still my feeling. There aren't really any options.
        I don't really want to go to hospital for another two chemotherapy cycles, but, given that it seems that my kidneys are equal to the test, it would be foolish to say no. Completing the six cycles is the best way to kill the cancer.
        And I don't like the idea of the damage potential of the radiotherapy. But the theory on which my treatment is based says that having the radiotherapy that having the radiotherapy is the best way to make sure that the cancer stays dead. And, while I don't like the idea of having radiation into the eyes, my radiotherapists have raised the issue of the eyes possibly being a sanctuary site for cancer, difficult to deal with effectively by chemotherapy.
        So I'm launched on this trajectory, with no options. But, although I'm living within strict limits, I can still accomplish things by working steadily, on a daily basis, within my limits. While at home I've been working on the BAMBOO HORSES novel, and, during the next five days, in hospital, I'll be working on my poetry, and also, possibly, on short stories and novels.
        And I may do some thinking and planning for the OOLONG MORBLOCK project, a big, messy fantasy fiction project which has already absorbed some years of effort, and from which I hope, at some stage in the future, to produce a string of actual finished books.
        The status of the OOLONG MORBLOCK project, incidentally, is that, at the moment, I've produced a few short stories set in the Oolong Morblock milieu, I've finished an elaborate map of the area, and I have incredibly messy drafts of various partially conceptualized plots amounting, in total, to something in excess of a quarter of a million words.
        ("Roughly a million words", says a note somewhere on my web site, but the truth is that right now I don't have an accurate idea of just how much text I have, so any figure I might give would be just a wild guess.)
        My basic problem with the OOLONG MORBLOCK project is that I let my ambition get way out of hand at the planning stage. What I need to do now, initially, is pull back and focus on plotting and writing just one self-contained novel to get the series rolling, otherwise I'll be floundering around in a world of false starts for the rest of my life.
        So working on plotting a first OOLONG MORBLOCK novel (at this stage I'm toying with ideals for something provisionally called POWERS OF OOLONG MORBLOCK) is something I may work on in my upcoming five days in hospital.
        I'll also be taking some large print library books to hospital, and I anticipate spending at least a little of the time writing letters.
        That said, the reality is that lying in a hospital bed for days at a time with an intravenous drip running into your arm is no fun at all. Assuming I go on to complete not just the fifth chemotherapy cycle but the sixth as well, then I will end up having spent over thirty days in hospital, which is quite a substantial chunk of time.
        Well, that was today. I didn't write down absolutely everything that happened, but today's account of my daily life does, I think, a good job of capturing the flavor of life now: a very low key routine. Living in an alternate reality (goodbye job, goodbye Japan) which is not of my choosing but which is survivable.
        And, all going well, if I come through the trip round the radioactive roulette wheel in good shape, I will get my life back. I will get through this, perhaps a bit damaged and bent out of shape, and carry on where I left off. That's what I'm working for.
        I still don't have a firm schedule, but, provisionally, I can expect to finish up chemotherapy early in May. There will be a break between chemotherapy and radiotherapy. I'm not sure how long, but perhaps as long as six weeks. Then there will be a month of radiotherapy, on a daily basis. And then, I guess, some kind of fingers-crossed post mortem stage, at which point, maybe round about June or July, I would expect to get a clearer idea of exactly what the future holds.
        As to when I might realistically get back to Japan, I don't really know, but I'm hoping for later this year, or early 2006 at the latest.
        Sitting here writing this at the end of the day to the strains of Johan Pachelbel's canon and gigue. Content, for the moment.

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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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