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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:-

Table of Contents

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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-Nine

Summary

The author writes about his thoughts on radiotherapy, that is, on the risks of radiation therapy and his fears about the process. The author supplies a radiotherapy poem.


        2005 April 15 Friday. 09:33.
        With time on my hands, my thoughts slide forward, in an evaluating way, to the topic of radiotherapy. This will be carried out, further down the track, at Auckland Hospital, with extremely modern high-tech machines which are at the cutting edge of the possible. However, when I received a briefing from my two radiographers last month, I had the briefing itself at Greenland Hospital.
        The briefing was very long and leisured, relaxed and honest: it seems that there is a debate in the medical world about exactly how to balance the use of chemotherapy and radiotherapy, and I'm left with the impression that any choice is going to involve an unavoidable element of speculation.
        That being said, it seems to be the case that:-
        (a) Assuming I have the radiotherapy as planned, the probability of the cancer coming back will drop, but
        (b) the radioactivity involves the possibility of damage, including brain damage (confusion and memory loss and so forth). Part of the bad news is that damage of one kind or another may not show up immediately. It might show up ten or fifteen years into the future.
        Nobody has been able to quantify the precise risk of brain damage for me, but I have seen some statistics relating to the outcome of a small experimental trial involving a particular combination of chemotherapy followed by radiotherapy.
        The disease treated in the experimental trial was the same as mine (non-Hodgkins lymphoma of the central nervous system) but the drug combination was different and the number of people involved was small. Given the slippery nature of the statistical situation, then, I can't legitimately expect these statistics to reliably predict my personal outcome.
        But, in the absence of anything else, it's these statistics that I'm personally using to get a kind of vague ballpark guide to the risks I'm facing in going through with radiotherapy.
        Of the (small) number of people in the experimental trial, twenty-two percent of those aged sixty or over suffered something severe enough to be described as "brain damage." For the group as a whole, the "brain damage" rate was fifteen percent.
        As I see it, then, though nobody has been able to precisely quantify the risks I'm running, it seems reasonable to presume that I have roughly an eighty-five percent chance of coming through the radiotherapy without a significant degree of cognitive deficit, which is good enough for me.
        Still, I do have a kind of looming awareness of the unknown consequences of radiotherapy, these including, possibly, cognitive deficit, damage to the endocrine function (since the pituitary gland gets irradiated), and, since the plan is to irradiate the back portion of each eye, possible eye damage.
        When it comes to chemotherapy, I have, for some reason, a confident feeling that my basic physical good health will help me deal with any chemical insult. But in the face of the prospect of the radiation, I don't have any such feeling of countervailing strength. Subjectively, I feel vulnerable to the imperial lordship of the radiation. It will do whatever it does and I will not be able to resist or modify it.
        Even without the upcoming radiotherapy, I've already soaked up quite a bit of radiation in the last twelve months, starting with a chest X-ray in Japan in May last year.
        Adding together what I had in Japan in 2004 and what I've subsequently had in New Zealand, inside of twelve months I've already had three CT scans (each of which involves a hefty belt of radiation), five chest X-rays and a gallium count (a procedure which involves an intravenous injection of a radioactive isotope).
        And I do believe that this stuff can come back and bite you.
        The above is the background to the radiotherapy poem which follows, a poem called, simply, RADIOTHERAPY:-


RADIOTHERAPY


Silence waits on my schedule,
Bright with invisible needles.
At the cutting edge of the possible
The clinical machines are waiting,
The statistical spin is waiting:
A white space and an outcome.

Radiation.
The internal probe.
The deep destroyer.
Igniting
The brain,
Burning
The cancer,
Incinerating
Some part of my intellect.

I will sacrifice
For the chance of a happy outcome,
Propitiating a god
Who gives no refunds,
Who carries no insurance,
Who gives no guarantees.

The actual process
Will be credit card painless.
Silent as bankruptcy.
An action
With no audible hammer,
With no banner of outcomes,
The first results a blankness,
A disconnect,
Initially truculent, nonconfessing,
Mute as the uncut wire.

I imagine myself then,
At the outset.
Committed to the process,
I am a lottery ticket
Tiptoeing across the cymbals of consequence
Into the mousetrap future.

I imagine the first days.
Some done, much more still to do.
Two and two is still more than three and a half.
But damage must have become,
And damage, more,
Must be inevitable.
And how much damage?

A world away from kisses,
The open mouth of my outcome:
Human, still, and competent,
Or a maimed broccoli,
Uncertain of rodent versus rabbit.

Reality is no longer a sugar lump.
Instead,
I am walking on shadows,
Never quite knowing
Which shadow might possibly collapse.

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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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