Cancer 14: talking dirty
In the last few days I've found myself having to talk in far more detail than any of us would normally want to about bowel output. Although with my literary education I probably have a bigger vocabulary than many, I've been having to dig through options for the right combination of accuracy and delicacy.
For the most part we routinely talk of "stools" and "movements". "Stool" strikes me as a particularly strange one. It seems to have developed over the 16th century, referring first to the place of evacuation, and then by extension to the object itself. There is of course no shortage of more vulgar and expressive terms, which also feature unsurprisingly and less specifically among our milder swear words.
That notion of the vulgar versus the genteel, how it manifests itself in language, is what's interesting here. I suppose historically poorer people really did have to live with shit, in ways that wealth could always shield you from. And if you've just recoiled from my use of the word "shit" (which hasn't come up in any of my medical discussions) you're confirming my point, that we regard this most basic of human functions with immediate disgust, while that disgust is actually a luxury.
Being ill it's been said is a great leveller, and nowhere more so than in bringing our most private functions into a kind of public realm. The patients in the three beds opposite me on my colorectal surgery ward all had stomas (popularly known as colostomies, though as I've learned there are different types). One of the happiest outcomes of my operation is that I don't need one, but it's important to say that two of these three men (the third was a special case, which I'll come onto) were quite philosophical about it, saying you quickly got used to this new appendage and way of doing things. Seeing them occasionally standing with their bags visible this seemed all the more difficult to accept, but I imagine it's very true, not least because of the way we all come to uneasy terms with our production of food waste (I have recurrent unpleasant dreams of somehow trying to talk to people while sitting among them in the open on a toilet, and I don't think I'm unique in this).
Is it possible to see it differently? I know there are some who have a sexual interest in excrement, but it seems likely that this is fundamentally still about disgust. The influential art critic Herbert Read followed Freud in suggesting that having a poo was a child's first conscious creative act, the first time he or she would see that he or she had brought something out of themselves into the physical world. Or you could say this explains why art is so easily so much crap (a cheap joke but still true).
A remarkable few days
All this is on my mind because I've been in hospital for the removal of my tumour. It has to be said it wasn't a typical experience, because I've recovered so quickly, but perhaps in the future this will become more normal. That would be good. As past blogs in this series bear witness, it's only human to imagine the worst case, and those images are fed by the way the preparatory hospital information will tell you the worst case. Explaining how you'll be in control of your own pain relief only emphasises how much pain you're about to face, while my anxious mind couldn't help but pick up on the possible horrors of what happens if your bowels fail to start working again (vomiting, tubes down your throat, possible stoma).
All this is on my mind because I've been in hospital for the removal of my tumour. It has to be said it wasn't a typical experience, because I've recovered so quickly, but perhaps in the future this will become more normal. That would be good. As past blogs in this series bear witness, it's only human to imagine the worst case, and those images are fed by the way the preparatory hospital information will tell you the worst case. Explaining how you'll be in control of your own pain relief only emphasises how much pain you're about to face, while my anxious mind couldn't help but pick up on the possible horrors of what happens if your bowels fail to start working again (vomiting, tubes down your throat, possible stoma).
I expected to be dealing with all this for at least four days, and probably six. But I was out of hospital 48 hours after the operation, my bowels beginning to work again, looking and feeling essentially well. For this much credit must go to the surgeon Mr Anwar, who was able to perform the operation though keyhole incisions. A doctor in attendance later told me it had been "textbook". We wait on the histology to know whether I'll need chemo, but Mr Anwar seemed optimistic that he'd got everything out. It's a weird feeling: it was nothing personal but this man (and his team) just saved my life. I think I'm going to have to talk about the NHS in a later blog.
I was expecting an extended hospital stay. Peter, the patient opposite me said that when he was working as a nurse in the 60s that kind of operation would have meant three weeks in hospital. So quickly did everything happen that it now seems faintly unreal. Some memories though will stay with me.
The operation
The day of the operation I was in the hospital at 7.45, and told I was second on the operating list, after a day patient. I settled myself down, in a bed that was happily next to a window at the end of the bay, looking out over trees and a pond, wondering what would happen next. I had eaten nothing solid since the previous lunchtime, and was nil by mouth from 6am. I was beginning to feel hungry. The anaesthetist and a registrar came to talk to me about what was going to happen. The registrar answered my question about how the two ends of the severed bowel would be joined: they use a glorified titanium stapler, pushing the anvil up through your rectum and then staple via the keyholes around the outside to create a secure seal. It seems the bowel tissue does not heal itself like flesh, so the fixture is permanent (unless you get a leak, which is catastrophic and happily rare, though for now and the next few days I remain in the danger zone).
The day of the operation I was in the hospital at 7.45, and told I was second on the operating list, after a day patient. I settled myself down, in a bed that was happily next to a window at the end of the bay, looking out over trees and a pond, wondering what would happen next. I had eaten nothing solid since the previous lunchtime, and was nil by mouth from 6am. I was beginning to feel hungry. The anaesthetist and a registrar came to talk to me about what was going to happen. The registrar answered my question about how the two ends of the severed bowel would be joined: they use a glorified titanium stapler, pushing the anvil up through your rectum and then staple via the keyholes around the outside to create a secure seal. It seems the bowel tissue does not heal itself like flesh, so the fixture is permanent (unless you get a leak, which is catastrophic and happily rare, though for now and the next few days I remain in the danger zone).
The operating theatre was directly opposite the ward. We walked there across the corridor, and I was ushered into an ante room set up for the initial anaesthetic. The anaesthetist had decided to use an epidural injection as his primary tool, because it would have the fewest after-effects. The needle went easily into my spine and the lower half of my body disappeared. As I lay on my back I was looking up at a light panel painted with an image of clouds in a blue sky. I laughed about this and the nurse cheerfully agreed it was supposed to be calming. I realised this but had first thought it was welcoming me to heaven via my approaching death.
The anaesthetist pushed something through the cannula in my hand, and the day went away. The next thing I remember I was having vivid ordinary dreams, and then I realised I was awake in an unknown place, a couple of nurses in attendance, feeling something like astonishment that it was over, and more than this the relief of being still alive, and as far as I could tell, not in any great pain. They gave me an ice pole to suck on. I don't think I've had one since I was a child. It did taste very good.
I was attached to an IV paracetamol drip, and given a morphine button to top things up if the pain got too bad. I didn't feel the need (that's the morphine machine in the header, which my friend Jem described as a "cyberman's phone box"). My head was relatively clear, though my voice was croaky with phlegm. I called Mary to tell her I was okay. I don't think she could believe it was me.
I was expecting to deal with a new level of pain, the result of the keyhole wounds and internal trauma. It's just not been like that. Yes the keyhole wounds are sore, but no more so than other flesh wounds, and easily managed with paracetamol. I had to wear a nose cannula till the following morning to bring my blood oxygen up to a better level. I didn't need the morphine so my hand cannula was freed from any tubes. While unconscious they had inserted a catheter in my penis, so they could monitor my urine output. Because it seemed to be functioning properly I asked them to remove it on that first morning after the op, which the nurse did as kindly as she could. It was every bit the ouch moment you might expect, but once done I could move freely.
On his rounds Mr Anwar looked at me with satisfaction, and said that if my bowels showed signs of life I could be out the following day. They did and I was.
Other lives
There were six beds in our bay, of which four were occupied at night. I bonded quickly with the older man Peter opposite because he ordered a copy of The Guardian. Small things, and we laughed because the young nurse who'd volunteered to get him a newspaper hadn't heard of it. Of course there's no reason why such a thing would feature in her life. Peter was recovering well, having come to easy terms with his colostomy, and was discharged at the same time as me. Ian on the other hand though reassuringly cheerful had endured a much harder time over the last few years with recurrent cancers and organ failure. He was a little younger than me, with all the warmth and exuberance that comes with a certain camp manner. His operation, the day after mine, had gone well and left him much more comfortable, but he said at one point he'd been given eleven months and was determined to make the most of it. I know from my own recent experience that when you're faced with such things all you can do is accept them and live your life, whatever's left, but Ian's refusal to give in to despair seemed a true courage all the same.
There were six beds in our bay, of which four were occupied at night. I bonded quickly with the older man Peter opposite because he ordered a copy of The Guardian. Small things, and we laughed because the young nurse who'd volunteered to get him a newspaper hadn't heard of it. Of course there's no reason why such a thing would feature in her life. Peter was recovering well, having come to easy terms with his colostomy, and was discharged at the same time as me. Ian on the other hand though reassuringly cheerful had endured a much harder time over the last few years with recurrent cancers and organ failure. He was a little younger than me, with all the warmth and exuberance that comes with a certain camp manner. His operation, the day after mine, had gone well and left him much more comfortable, but he said at one point he'd been given eleven months and was determined to make the most of it. I know from my own recent experience that when you're faced with such things all you can do is accept them and live your life, whatever's left, but Ian's refusal to give in to despair seemed a true courage all the same.
Then there was Bob, an older Scouser. Bob had already been on the ward for eleven weeks, while they tried to get his stoma functioning properly. Things had been improving in the last week so perhaps there was light at the end of the tunnel for him, but in the meantime he'd come to haunt the ward, more than familiar with every routine, wandering forlorn with his drip machine on wheels beside him like some dazed soldier with a shattered flag, to gaze out of the window at the foot of my bed, an outside world that for the moment had passed beyond him.
On the second morning Mr Anwar came round again. I was dressed in my own clothes now and sitting with a laptop in my chair (getting you up and mobile as soon as possible is an important part of the Enhanced Recovery Programme). Although I'd yet to pass any stools I'd enjoyed some Flatus (these words you see!) and that was good enough.
Sparkling eyes
The staff had been wonderful, but I couldn't wait to leave. While they completed the final paperwork I walked down to the ward entrance, where Mary was waiting in the corridor beyond (because of Covid she wasn't allowed on the ward). She was wearing a mask but the look of relief and joy in her eyes when she saw me walking upright and with a healthy pallor was another thing I'll never forget. It's been a hard few months.
The staff had been wonderful, but I couldn't wait to leave. While they completed the final paperwork I walked down to the ward entrance, where Mary was waiting in the corridor beyond (because of Covid she wasn't allowed on the ward). She was wearing a mask but the look of relief and joy in her eyes when she saw me walking upright and with a healthy pallor was another thing I'll never forget. It's been a hard few months.
So now I'm home, wandering around the house like a muppet in my elasticated trousers and support stockings, having to think more than I'd like to about my bodily functions, but they are at least functioning. My sleep patterns are all over the place (I've written a substantial part of this blog at three in the morning) but I imagine that will settle down. I'm taking a daily walk to fend off the risk of thrombosis, but mostly avoiding other people because much as though our idiot prime minister seems to think it doesn't matter there's a lot of Covid out there and this wouldn't be a good time to pick it up.
The clips on my wounds will be removed early next week. At that point too I can be more and more confident I won't suffer the daunting leakage (which would mean redoing part of the operation and possibly fitting a temporary stoma). I should also hear round about then whether I will need chemotherapy. I can dare to hope not though I know it remains a distinct possibility.
If I do need chemo I'll continue this account as it happens over the next few months. If I don't I can begin to wrap things up, with the feeling that much as though I've been through a pretty serious (four hour) operation, in my brush with the dreaded cancer I will have got off pretty lightly.
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