Checks and diagnosis

The thought of an internal examination of the rectum doesn’t fill one with enthusiasm, and for several nights I woke at 3 or 4 worrying about the possible outcomes. Eventually the appointment time arrived on the 11^th and having changed into the inevitable hospital gown, I was shown into the theatre where the examination was to take place.

A lady Dr introduced herself and asked whether I minded a student Dr being present during the examination. I said I didn’t, as long as they didn’t speak too much about my situation in words that I would understand. The Dr examined my notes and said that in view of the various previous examinations, she expected the findings to be a healthy rectum. As soon as the probe entered my body I could tell that her concern rose, and when I heard her ask the student to take 6 biopsies I knew that my worst fears were confirmed. After several minutes, the probe was over and I turned to the Dr and said “You have found something haven’t you.” She replied “Yes, but I will talk to you later”. With that I dressed and returned to the waiting room to await her report.

My first thought at that time was that I wanted Masha to be there when the Dr explained what they had found. She had dropped me off at the hospital and then gone to the shops in Poole. So, I immediately phoned her and for once both mobiles worked. I explained the situation and she said she would come immediately.

The waiting room where I was sitting was separated from the main waiting area by a partition, so I walked through to the other half and asked the receptionist to tell Masha where I was when she arrived. I just hoped she would arrive before the Dr called for me. The journey from the shops should have only taken 10 minutes, so when she hadn’t arrived after half an hour I became anxious and decided to ring her again. As soon as the phone rang, I heard her voice from the other side of the partition. She had been waiting there for 20 min wondering what had happened to me.

We met just in time as the Dr and 2 nurses called us and led us into a small room. The Dr wasted no time, and explained that she had discovered a growth at the top of my rectum, which had stopped the colonoscopy from probing any further. She said that the biopsies would confirm the situation, but that she was sure that the growth was cancerous. She explained the likely outcomes in a factual but sympathetic way and then went to carry out further sigmoidoscopies.

We were left with the 2 specialist cancer nurses, Caroline and Georgie. Both were exceptionally caring but professional in their approach. They had clearly been well selected and trained for their role as cancer nurses. They described in detail the various tests that I would need to undergo in the next couple of weeks and explained what the outcomes would be, depending on the results of those tests.

They then told me that I needed to eat a fibre-free diet. This was almost the hardest news of all because it involves cutting out all the foods which I most enjoy, including nuts, seeds, hot chilies, vegetables and anything else containing fibre. What was left is mainly white bread, cheese, most meats and pasta, which sounds OK until you try to think of what to go with the pasta that has no fibre. At least beer and wine were not on the list.

The real irony was that Masha and I had gradually moved us towards a diet containing high fibre and low meat intake over many years because we believed that it was good for our health.

Before we left the hospital. Caroline explained that I would be called for MIR and CT scans in the next couple of weeks. The following afternoon we were due to attend a neighbour’s funeral, and minutes before we left, the hospital phoned to ask if I could come in for an MRI scan that afternoon. Since the appointment wasn’t until 4.30, we could go to the 3pm funeral and still make the appointment.

The lady on the phone asked a series of questions to ascertain that I had no metal objects such as joint replacements, which can cause problems with the scan, and finally asked if I had had any recent operations. I told her that I had a hernia repaired about 10 years before.

After the funeral, we made our way to Poole hospital in a downpour, and a few minutes after we arrived, the nurse called me to the reception and began to go through the same questions that I had been asked on the phone. I explained that I had answered the questions on the phone, but was told that the nurse had to go through them herself, as any metal object could cause me real harm. When I mentioned that I had had a hernia operation 10 years previously, she enquired whether they had used any clips in the repair. As I wasn’t sure, she tried to find my notes, but when she was unable to track them down she told me that the scan would have to be postponed. I was disappointed, but more surprised that hospital records are still kept on paper files. At least those of a certain age are. 

The nurse said she would phone me during the next day, and true to her word, she called to make an appointment for the following day, which was a Saturday.  Not all nurses seem suited to the job, but “Lizzie” whom I was to meet again during the year was outstanding.

An MRI scan comes as a bit of a shock if it is your first. Having changed into a hospital gown, you are laid onto a moveable slab. The nurse explains that the process will be noisy and gives you earplugs and offers earphones and music of your choice. I chose 60s pop, and with that I was moved into the cylinder chamber which gives the MRI scan. The nurse who has withdrawn from the room can communicate with you through the earphones and after a few moments warns you that the process will begin. Years ago, before university I worked in a wire product factory, where a number of noisy machines produced a series of bangs and screeches. The MRI scan reminded me of a combination of those sounds of the past, combined with those made by the Tardis in Dr Who.

The nurse had told me that the scan would last about 20 minutes, but in fact I was in for double that time as she had to repeat some of the scans. The whole process was a bit claustrophobic but otherwise not too unpleasant. I was then able to go home, and wait for the results on the following Thursday, when the cancer group would meet to discuss the next step. This is a group of all the Drs and nurses who are involved in your case.

For the next few weeks, it was the waiting which was the most difficult thing. During the day, I tried to get on with my normal life, but when I woke at 3 in the morning, it was hard not to dwell on all the possibilities that might lie ahead. I probably averaged only 4 or 5 hours sleep during those few weeks.

Despite, or perhaps because of all this I had to keep reminding myself how lucky I was in several respects. Firstly, I have Masha as my ever-present companion and support. It is in her nature to be positive. She always encouraged me to think positively, and supported me throughout in every way including: accompanying me on my hospital visits, looking after my dietary requirements and putting up with my downtimes. I often needed to remind myself that these days must be almost as difficult for her as they are for me.

My 2 children Lena and Steven were also supportive throughout. I decided to tell them as soon as I knew, and although they were clearly shocked, they too remained positive.

Sadly, one of my best friends of 40 years was diagnosed with cancer just a week after me. Steve was told that he had between 3 months and a year to live, and he died in August, just 7 months later. Steve was a great guy who was a fitness and health fanatic. In his 60s, he ran marathons in under 4 hours, and took part in a variety of sporting and gym activities. He was just 66 when he died. There is no justice in life and death matters.

 I had taught with Steve back in the 1970s, and he and his wife Jill devoted much of their lives to looking after their severely disabled son Michael. Masha and I kept in touch with all the family because Mike’s favourite event is coming to the Purbeck Gateway club for people with learning difficulties which we help to run on a Thursday evening.

Thursday of the next group meeting eventually arrived, and late in the morning nurse Caroline phoned. She said she had generally good news. Firstly, she confirmed that the biopsy showed that it was cancer, but that the MRI scan indicated that the cancer was contained in the lining of the bowel and hadn’t spread into the surrounding tissue and lymph glands. She said that this would mean an operation in the next few weeks but that first they needed to do a full body CT scan.

This was arranged for the following day, which was a Friday. The CT scan was less onerous than the MRI scan. Having donned the now inevitable hospital gown, you are laid in a table and a moveable scanner passes over your torso to scan the organs inside. You are injected with a liquid dye through a cannula in your arm to highlight the vital organs. After only about 20 minutes I was told that I could go home.

The wait for the results on the following Thursday was worse than for the previous week. Somehow, I sensed that all was not well and that I was in for a shock. The nurses had given me a booklet on rectum cancer and I had noticed that the cancer could spread through the blood as well as via the lymph glands. The fact that my close school friend Bas had died from liver cancer just a year before didn’t help me to sleep well. Bas had only become aware of the cancer a few weeks before he died. I even dreamt being told that there was a problem with my liver on the Wednesday night.

Sure enough, the phone rang and Caroline answered. Having exchanged pleasantries, she explained that there was “one small blip” on the previous plan. They had discovered an unexplained patch on my liver. My heart sank despite her reassuring words that all the rest of my organs were clear. She then told me that I would need to go for another MRI scan, this time on my liver to ascertain the extent of any growth. Another week of waiting.

Within an hour of Caroline’s call, the phone rang again. It was from the hospital inviting me for a further MRI scan on the following day. So far, the NHS is proving its worth in times of real need. Everyone I speak to has nothing but praise for the NHS when dealing with serious illness. At least that is the case here in Dorset. Minutes later, Caroline phoned again to check that I had received the appointment time. Another kind step beyond the call of duty.

Like most things in life that you don’t relish, when they come around a second time, they seldom seem so bad. I knew what to expect of the MRI scan, and this time I was only in the cylinder for about 20 minutes. Then it was home for another week’s wait.

The following Thursday, Caroline phoned earlier than usual. Her news was much as I had expected. The MRI scan showed a single blot on my liver. Caroline explained this meant that I would now need to undergo chemotherapy, both to kill the cancer in the liver, and to reduce the rectal cancer before they will be able to operate. She said that the growth may not in fact be cancerous, but if it is, and they try to remove it, then it could cause it to spread. She arranged for me to see the oncologist (cancer specialist) in 10 days’ time, and said that I would need to have another blood test to decide on the most effective treatment. She said that I could have this done in the pathology department at any time and that she would leave the relevant form in reception after 12noon.

As ever, Masha had driven me to the hospital, but when I enquired at the pathology reception, the form had not arrived. The receptionist didn’t know who Caroline was, and suggested that I went to the oncology department to see if they could deal with me.

My first visit to oncology was a bit scary. I guess it is something you hope you will never have to do. However, everyone there was pleasant and helpful, and within a few minutes they had managed to locate Georgia (Caroline’s partner) and she immediately came down with the relevant form and explained that they could do the blood test in the oncology department, as they were experimenting for a week to see whether they should offer blood tests there on a permanent basis. Luck was with me because the whole procedure was over in 5 minutes. Judging from the queues in pathology it might have been a long wait there.

A quick phone call to Masha and she arrived to pick me up and off to lunch at the Wareham golf club. What a tremendous support Masha has been throughout. I dread to think what it would be like without her backing, and I am very aware how difficult it must be for people to face this situation on their own.