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
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.
Morning begins with what has become a daily ritual: combing out the hair which the scalp is discarding. Radiation therapy continues. The cancer patient meets with a cancer doctor and discusses his petechiae and the "woolly feeling" in his toes, the strange feeling being the consequence of nerve damage caused by chemotherapy. On the last day of radiation therapy, the author assesses his physical condition and the experience of radiation therapy. In the case of this particular cancer patient, not too bad, really. The author discusses the long-term effects of radiation therapy, some permanent, some unpredictable. It is seemed he is destined to be a cancer patient for life.
* * *
The day cheered up when I got to the hospital, where, after my radiation therapy treatment, I had an appointment to be medically reviewed by a Dr. Anna Bashford in the oncology department.
We discussed my petechiae, my rapidly-fading dots of internal bleeding, in the light of the results of my latest set of blood tests, done on Friday. The results of the blood tests were perfect, everything in the normal range. Platelets at 211, for example, and hemoglobin at 136.
In the light of these perfect results, it seems that the petechiae can be comfortably dismissed as what my family doctor thinks they probably are, an inconsequential sign of some kind of allergic reaction, rather than an extremely ominous sign of far worse things yet to come.
Happy to be reassured on the petechiae front, I tried to describe the nerve damage I've noticed in my toes since the end of chemotherapy, damage that I attribute to the chemotherapy itself. I still feel pressure, heat, cold and pain in the normal way, but when I crinkle my toes there's an odd fuzzy feeling. Dr. Bashford came up with the happy term "woolly feeling", which captures it rather well.
The prognosis? The nerves may recover over the next year or so. But perhaps they won't. If they don't, I'm not fussed. The damage is something I can live with. I simply needed to be reassured that it's a known element, something that other people have suffered from. (My father, incidentally, says that my Aunt Joyce, who tragically died from the disease -- non-Hodgkin's lymphoma - that I'm planning to recover from, suffered from the same kind of woolly toes feeling as a consequence of her own chemotherapy.)
Somewhere down the track, I'll probably have physiotherapy to tune up my muscles, particularly my wasted thigh muscles, which have suffered badly from steroid use. But physio is something I'll probably discuss with my radiation oncologist next week, at the end of my radiation therapy.
Also, at some stage yet to be decided, once my brain has had a chance to settle down in the aftermath of the radiation, I'll have another magnetic resonance imaging scan to see how things look. But, at the moment, all I have planned with the oncology department is another medical assessment in six weeks time. (I came away with yet another form for blood tests which I will take to a local laboratory the week before the assessment, so the results will be on the hospital computer by the time I show up.)
Dr. Bashford approved of the decision which has been taken to defer, for the moment, the vitrectomy which is planned for my right eye. Removing the jelly in the eye to get rid of the cancer junk is something which can happily be left until I have properly recovered from chemotherapy and radiation therapy.
As measured on the oncology department scales, my weight, fully clothed, was 73.5 kilograms, down perhaps half a kilogram since I started radiation therapy. Not bad, all things considering.
Anyway, I came away happy to have dismissed the petechiae from my imagination, and generally pleased at the way things are going.
* * *
Monday 18 July 2005.
Once again, the descent to Treatment Room Six. The table. The application of the mask. The alignment by green lasers. The radiation.
As always, at the moment at which the mask is lifted free, I feel the dampness of my own perspiration, a fragmentary hint of a humid microclimate. Then I'm on my way out into what passes, these days, for normality.
Today will be the last day. I will have completed all twenty fractions -- five days a week with one rest day during one week because of machine maintenance.
I feel ... flat.
I've been receiving cancer treatment now for an improbable number of months, and what is becoming dominant is the sheer accumulation of time. I'm trudging through the days pretty automatically, doing the same or similar tasks each and every day -- studying Japanese, working on this cancer memoir, and putting the final touches to my "Bamboo Horses" novel as I proofread my way through the final draft.
Physically, at this end of the radiation therapy I'm doing more or less okay. I haven't needed to go on dexamethasone. I've had the occasional very slight touch of headache. My scalp and forehead feel a bit hot. Most of my hair has fallen out but I still have some left -- I don't yet fall into the "bald" category, though I am expecting the remaining hair to fall out in the weeks ahead.
Early on, on about the fourth day of radiation treatment, there was one moment at which I thought I was going to throw up, but Maxolon tablets three times a day have done a good job of controlling nausea, and I've been able to boost my food intake by deliberately snacking through the day rather than by trying to eat everything at three set meals.
Sleeping has been a bit of a problem. I've had trouble getting to sleep and, sometimes, I've woken up in the night and have had difficulty in getting back to sleep again. However. Day by day, I have been able to get enough sleep, even though ideally I would have liked to have slept more.
There are still some unknowns about the aftermath of radiation treatment, but at this stage I'm feeling calm and confident. But flat. Very flat. I'm living, yes, and I'm slowly grinding ahead with my projects. But, even so. This doesn't quite qualify as a life.
* * *
Tuesday 19 July 2005.
And so today I came to the end of my radiation therapy, receiving fraction number twenty. For this final session, I went across the harbor from Devonport to Auckland by ferry, accompanied by my mother, then took the bus up to the hospital, which sits up on a ridge overlooking the harbor. My mother accompanied me downstairs to Treatment Room Six.
"It's like death row," said my mother. "Where they take you into the room and give you the lethal injection."
I had my doubts about the accuracy of this comparison. To the best of my knowledge, my mother has never been on death row. She has, however, read a John Grisham novel which touched on the subject of capital punishment.
I went alone into the depths of Treatment Room Six, where I received not a lethal injection but a sublethal dose of radiation.
"Do you want your mask, Hugh? As a souvenir?"
I did, so I walked out of Treatment Room Six holding it, a clear plastic mask, a kind of death mask for the living. White rather than black: appropriate for Darth Vader's evil albino twin.
After the treatment session, I had an appointment with my radiation oncologist, Dr. Gill Campbell, at which we talked about the future.
The end of radiation therapy is a kind of beginning. The territory of the unknown starts here: the cumulative effects of radiation go on making themselves felt after treatment ends, with, for example, marked fatigue being one standard possibility. And the loss of what's left of my hair being another.
What is known is that, as a consequence of the radiation delivered into the eyes, I can expect that in three to five years from now I will need an operation to remove cataracts from each eye. (All going well, the treatment of a cataract involves a fairly straightforward operation under local anesthetic, the damaged natural lens being removed and replaced by a permanent plastic lens.)
Additionally, to think further about the future, the irradiated area -- my forehead in particular -- is going to need to be protected from the sun by sunblock or a hat.
"Is this temporary or permanent?"
"It's permanent. The risk of sunburn or skin cancer is heightened forever."
Other effects of the radiation therapy should be transient, particularly the nausea. I was advised to continue taking my anti-emetic tablets, Maxolon, as usual (three times a day, before meals) for another week.
The effects of the radiation therapy (such as fatigue) may reasonably be expected to peak in the next week to ten days, after which I should start experiencing some improvement.
I will have an assessment six weeks in the future, and at some stage I will be seen by a physiotherapist to be assessed. And, of course, at some stage in the future, maybe in September, I will have a vitrectomy, a jelly-removal operation for the right eye to clean out the cancer junk.
I don't like the thought of being, in a sense, a cancer patient for the rest of my life, living with the possibility that the radiation may come back and bite me years from now, inflicting brain damage or malignancy. But, overall, having survived both chemotherapy and radiotherapy, my dominant mood is one of quiet optimism.
I think I'm going to get out of here alive.
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.
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.