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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 Forty

Summary

The author's latest chemotherapy session is aborted because his blood count is down. The author resists the suggestion that he should have a blood transfusion. The author attends the hematology department as a daypatient. The author's "battle with cancer" is mundane and undramatic, as when, for example, he eats raisins for extra iron. Having reduced his intake of the oral steroid dexamethasone, he finds his sense of taste returning to normal.


        Friday 15 April 2005. 11:48.
        At 11:40 today had today's second blood test, the first having shown an apparent drop in my hemoglobin and white blood cell count. Also provided another urine sample (everything in the plastic jug, nothing down the toilet) to get a new pH level as we come up to twelve noon, theoretically methotrexate hour.


* * *


        Friday 15 April 2005. 1215.
        The lab results on the second blood test have come back and, yes, hemoglobin is down, and my white blood cell count is also down. So: proceed with methotrexate? We're waiting for a decision from a doctor who is in a meeting.

* * *

The Outcome


        By 12:25 I got the details. My hemoglobin was down. Also down was the count for my neutrophils, neutrophils being (I had to look this up) one of the two main kinds of white blood cells, the white blood cells being the ones that fight infection.
        It was suggested that I should have a blood transfusion, so I asked if this was vital. Vital? No, but if I didn't then I might become "symptomatic", meaning I might get short of breath, I might get dizzy or I might get pins and needles in my fingers.
        I tend to find every new medical procedure stressful, and I'd never had a blood transfusion before, so I was happy when I was permitted to escape from the hospital without having a transfusion, it being understood that I would come in for a transfusion if I did in fact become "symptomatic".
        I also promised to monitor my temperature zealously in case my reduced white blood cell count resulted in me being hit by some kind of infection.
        I took away from the hospital two forms for blood tests at my local branch of Diagnostic Medlab, the first scheduled for Monday and the second for Wednesday. I will phone the hospital Thursday morning, by which time the hospital will have the results of both blood tests. And, depending on how my body is doing in recovering from the hit that the blood counts have taken, I either will or will not go in on Thursday for the second attempt at my fifth chemotherapy cycle.
        Apparently the hit that the blood counts have taken can reasonably be attributed to the impact of methotrexate on my body, and this kind of hit is not unusual. All going well, my body will recover naturally.
        In the face of this unexpected development, I have a kind of "c'est la vie" feeling. Them's the breaks. What happens : that's basically my feeling about my treatment.

* * *


        Sunday 17 April 2005.
        Having cancer continues to make me aware of the trickle of cancer news in the media, most recently something I've noticed in the issue of "New Scientist" dated 25 March 2005. It's on page 20 of the Australian edition in an article entitled "Tea Trouble" which mentions that people who drink green tea have a lower rate of stomach and throat cancer.
        It says in part:-
        "The researchers found that the anti-cancer compound in green tea, epigallocatechin gallate or EGCG, works by blocking the enzyme dihydrofolate reductase, which is essential to the growth of tumour cells. This mechanism is similar to that of the anti-cancer drug methotrexate, but EGCG has far fewer side effects."
        Good to hear about the "far fewer side effects", because the list of the potential side effects of methotrexate is pretty extensive.

* * *


        Tuesday 17 April 2005.
        Today I received my latest "what happened to you" letter from Auckland Hospital, a letter which, because it's designed not so much for the patient but for any medical people who need to see it, is written in technical language. The story of my latest hospital admission is tersely shorthanded as "HD MTX -- cancelled due to neutropenia", with "HD MTX" presumably standing for "high dose methotrexate".
        Earlier in the story, I had to look up "neutrophils", these being a kind of white blood cell. Today's challenge is "neutropenia", which I fail to find in any database that I have immediately available to me, but which presumably means something like "a shortage of white blood cells".
        One thing about becoming a serious client of the public health system is that it certainly encourages you to expand your vocabulary.
        [Later, while editing my way through my old diaries, I found that back in January a doctor had explained "neutropenia" to me as meaning "low white blood cells", but I had totally forgotten this explanation.]

* * *


        Thursday 21 April 2005.
        My fifth cycle of chemotherapy has been cancelled for the second time. The first time it was cancelled because my neutrophils (a type of white blood cell) were down.
        Now the neutrophils are fine. In fact, the nice doctor who explained the cancellation news told me "the neutrophils are fluffy". (This "fluffy" probably derives from the traditional Kiwi expression "just like a box of fluffy ducks", meaning "feeling fine".)
        However, while the neutrophils are fine, according to a blood test done in hospital today my hemoglobin level is down to 87, down from a level of 93 on April 14th. Apparently the norm for a man would be 120, and at about "70-odd" they would give me a blood transfusion.
        Rather than just bung in blood now, they want to figure out what has happened. Most probably the manufacture of red blood cells has been knocked back by the chemotherapy agent methotrexate, in which case time is the cure, but there are other possibilities, including a viral infection of some kind or (worst case, and I'm told the likelihood is low) cancer in my bone marrow.
        So this evening I had blood tests. The hospital will be my hotel for the night, and tomorrow I'll get feedback on the blood tests, I'll get a kind of "management plan" and I'll get to go home.
        My feeling about this development is pretty neutral. I'm still in my "accept it as it comes" mode for the simple reason that the medical variables are out of my control.
        What I can control is my food intake. This evening I ate the hospital meal, which was roast beef (reasonably well done, I must concede) but elected not to chase it with any of the sweet stuff I'd brought to hospital.
        By late last year, my weight had dropped from a lifetime high of 75 kilograms to 62 kilos, but today it was back up to 72.8, and a significant proportion of that has started coagulating around my belly, so I've decided it's smart to cut back on which might be called excess food.
        Still, regaining the lost weight has given me a reassuring sense that life is coming back to normal. Since my daily dose of the steroid dexamethasone has been cut from eight milligrams to two milligrams, my sleep patterns have more or less normalized. Also, my sense of taste is normalizing: before, the dexamethasone had skewed my sense of taste so red wine became undrinkable, impossibly dense and foody, but last night, at a dinner party, my first evening out for some weeks, I drank a glass of merlot with no problems at all.
        When I was on eight milligrams of dexamethasone I had a ravenous appetite and wanted to eat and eat, but dropping the dose has brought my appetite back to normal.
        Anyway, my day today was this: admitted to Auckland Hospital at 11:00; fluid loading started at 14:00 with benign fluids in preparation for chemotherapy with methotrexate tomorrow; nice doctor arrives at 17:30 with news that the fifth cycle has been cancelled because of my low hemoglobin count. Drip is then stopped and blood is taken for fresh blood tests, and I phone home with the news that I am to be discharged tomorrow, and then I eat my hospital meal.
        Up to a point I'm living in a world of outcomes which are unpredictable and sometimes feel a little arbitrary, and maybe this conditions the "playing with images" poem I finished off today while lying in my hospital bed, a cryptic poem called "Cryptic":-

CRYPTIC

In the room with the five green armchairs
The redesign of red
Has been postponed.
The mattress sits cross legged on the floor
Ignoring the jawbone.

The retired mongoose
Winks at the stolen key.
In retirement he keeps busy,
Renting the blue teats of Jupiter,
Marketing the tears of the Buddha,
Hosting the hologram.

Posing on a somnolent table
The cleavage of the copper peach
Is wet with dandelions,
Oiled with spiders,
Building an outbreak with watermelons.

An eviscerated kilogram
Melts in the butter pan.
Baklava drools.

        Being at a bit of a loose end after dinner, I wandered into the TV room and got updated on today's news. Which includes the revelation that a bunch of New Zealand police officers have been using the police e-mail system to circulate pornographic images, to the point where at one stage twenty percent of the storage space occupied by e-mail police images was taken up by porn pics.
        This story, I'm sure, will run and run.

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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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