Friday, 8 November 2013

Me, a dilatory old doctor... and cancer

AS we settle into the biorhythms of Movember - the month dedicated to defeating the devil that is prostate cancer - it may be time to challenge the dictum that all doctors know best.
So, come with me to a West of Scotland National Health consulting room and an incumbent who was so overtly friendly that he might have been an old school buddy rather than a general practitioner. This was only my second appointment with him, but I was immediately put at ease in what normally constituted an alien environment.
He revealed that my PSA (prostate-specific antigen) blood test was slightly aberrant. He further emphasised that no alarm bells should be rung. Now, I’d leant fairly enthusiastically towards hypochondria all my life, but I reckoned that this surely was a no-sweat situation. And hadn’t the medical profession previously insisted that my prostate was small going on miniscule?
I was told to return for a further test in a few weeks. Similar consultations took place over many months. Each time the PSA count increased, but my doctor insisted that he was relaxed about the situation. So I convinced myself to join him in that laid-back posture. Besides, how could you argue with someone who had medical qualifications?
To be strictly fair to him, he did send me to the local hospital, where an ultrasound test was performed. This apparently was inconclusive.
When my PSA reached 7.5, my locum was not noticeably unnerved: he simply unfurled another comfort blanket by telling me he had patients still walking around with quotients of 20 and over. This was reassuring. Well, almost.
Surely, there must be a more definitive test, I asked? The word ‘biopsy’ was mentioned, but my doctor shuddered as if he had seen Christopher Lee converting to Dracula mode. ‘You wouldn’t want that,’ he told me. ‘That’s a very nasty procedure. Very nasty, indeed.’
To be fair, I can’t say I was ever a proponent of nasty procedures. I’d committed myself to the cause of cowardice all my life, so I didn’t really want anything that would inflict pain or indignity on this sad, old relic of a body. I thus proceeded to go with the medical flow. It was a decision that would ultimately prove hopelessly flawed.
One day - we were now approximately two years down the line - the alarm bells began to ring so stridently that you might have thought my doctor had become a convert to campanology. Surrendering to agitation, if not wholesale panic, he divulged that my PSA was now 13.9 - and that I might have to subject myself to the procedure that provided the fabric of my nightmares.
My mind initially concentrated on recrimination. Of course I was fuming with this silly, old fool, his function being to save lives, not endanger them. However, I directed the greater proportion of my anger at myself. Why hadn’t I learned more about prostate cancer and PSAs? Why didn’t I use the Internet to familiarise myself with the situation? I mean, there was enough information about the disease on Google to keep Holby City in production for years.
I knew why I’d resisted any opportunity of transparency, of course: I was old school and almost endorsed technophobia. I didn’t like or understand computers, and sought education from the mouths of experts, not from the electronic media. There again, perhaps I was happy with my ignorance. Maybe I didn’t want to know. How infernally stupid was that?
It was time to address the reality of the situation, I had private medical insurance, which previously I’d been reluctant to use as it sent the premiums soaring. But, cost be damned, this now had all the hallmarks of emergency.
Within days, I was in a consulting room and the surgeon was strongly recommending biopsies. He couldn’t quite understand why someone with a PSA of 13.9 was demanding his attention at this late stage. ‘I operate when the figure reaches four,’ he admonished.
As my Adam’s Apple performed an impromptu break dance in my throat, he inquired as to the age of my general practitioner. He was not surprised when I told him that he was very probably in his late fifties/early sixties. It was time for an alarming revelation. The consultant surgeon told me that doctors in middle age upwards were not always conversant with the vagaries of the illness. I silently wished I had been privy to this information a couple of years back.
An appointment was made for the biopsies. Faced with the inevitable, I was uncharacteristically calm. There were no Christopher Lee moments. Sure, I experienced minor discomfort but strangely no real pain. You suspected the GP’s prediction of nastiness belonged to hyperbole. I considered myself lucky.
That luck deserted me almost immediately when the prognosis was delivered, however. They told me there and then: it was cancer and a most aggressive one at that. If I remember, four of the five tests prove positive. The remedy was simple and brutal: a radical prostatectomy - which meant the removal of the gland and the end of my life as fully-functioning man.
That night, sleep promised to be problematic. I should have been in a ferment. Instead, I was seized by an almost disturbing tranquillity. Tears would come to me, all in good time, but not then. This was the moment for prayer and pragmatism. I was 63, had reached the top in my chosen profession of sports journalism, had a beautiful wife, lovely children and five adorable grand-daughters. No-one could say, least of all me, that I’d been in deficit. If this was my fate, then so be it.
But something was gnawing at me: I wondered how, in hell’s name, had I managed to contract this awful illness. Had it been genetic? There was no history of it in the family, as far as I could ascertain.
Then it hit me: could it have been the notorious Index Finger Test? It provides the alpha male with a psychological jungle to explore, even when it’s conducted with sensitivity. Let’s have it right: having your backside antagonised in such a fashion is scarcely appealing.
But the sensitivity was conspicuously absent when I arrived at a private clinic in London in 1999. I’d had the procedure before, so I knew what to expect. What was unexpected was the force behind the finger on this occasion. It promised to fillet me like a North Sea haddock.
I chastised the young doctor, sarcastically suggesting that he could have taken a longer run-up in the manner of England fast bowler Darren Gough. He was not amused, but then neither was I. My insides throbbed with pain and that pain lasted many weeks before the natural healing agents prevailed. Could that have been the reason for having to undergo radical surgery? Maybe. Maybe not. Perhaps it was attached to my destiny.
Whatever, the operation took place on a Saturday afternoon in March 2008. The delay in discovery had led to the tumour growing exponentially. It was out of prostate and there were legitimate fears that it might endanger the lymphatic system and bones.
Here, Lady Luck visited me again. A bone scan, further tests and agonising delays ultimately proved that this was not the case. And when the surgeon told me he had managed to remove all the diseased tissue and later that my PSA was showing zero, my happiness could not have been purchased for a million quid.
Life had regained the threads of a silver lining but, unfortunately, not for long. Signs of the cancer began to reappear two years later and I was referred to an oncologist. This time, a course of radiation was recommended. Side effects were obligatory but you were obliged to take them in your stride. Once again, the cancer scurried into a corner and made out a surrender was in the ether. But once again it returned - almost furtively at first, but forever becoming bolder.
I’ve just turned 69 and I suppose in many ways I live from appointment to appointment. The oncologist told me ostensibly at our last meeting that, having had the radical surgery and the radiotherapy, there were no more cures available - only a series of delaying tactics. That, of course, doesn’t signal imminent disaster. These tactics can offer a formidable resistance to the malignancy of this disease.
So, I’m waiting - and it may not be long - for that renegade PSA to reach the figure four. Then, it’ll be time for some hormonal therapy, the side effects of which include hot flushes and weight gains. Well, everything comes with a price tag.
I’m sorry to report that the narrative does not have a happier conclusion. But, hey, it’s not as if I’m incapacitated. I’m still standing. Still working. I look around me, witness life’s carnage and acknowledge that it could be
far, far worse.
The fact, is however, that save for the ineptitude of a general practitioner (I never received as much as an apology from him) and the crass stupidity of someone who should have known better (that’s me), it didn’t have to be like this.

In this significant month of Movember, just be sure you don’t make the same mistake.