THURSDAY is not over. A little more than one hour after my SOS to LSS 72, I am thrown a lifeboat via the telephone, by Kuldeep Singh Sidhu. Kuldeep is one of my friends in Sydney and one of the LSS 72 alumni. He runs a medical practice in Hornsby, in the north-west. The physical distance between us means we meet rarely, and he is not my family doctor.
Dr Sidhu, as he is known at his practice, says: “William, what’s this you just wrote to the group? I’ve read the message, but tell me again, tell me everything you know, what’s happening over the next few days. I want to help if I can.”
At this point, I am shell-shocked, probably deep into some form of PTSD. I know I have a very, very bad condition. Bloody hell. Let’s not beat around the bush, it’s most likely cancer. It’s the pancreas. I am petrified I am going to die. All I want is to get the tumour out of this body of mine as soon as possible. The referral from Magar is like a once-in-a-lifetime golden pass.
I tell Kuldeep all I know, in all the detail that my by-now tender disposition allows — diagnosis, prognosis, lack thereof, referral for imminent surgery, name of surgeon. I like the sound of his reply as soon as I hear it. “Have you confirmed surgery yet?” Hope goes up a notch. No, I say. “Don’t. Don’t book yourself in. Don’t pay the deposit. Give me some time to explore all this.” Straight to the point, Kuldeep goes on: “William, any kind of surgery on the pancreas is very complicated. Forget about whether or not cancer has been confirmed. When they cut you up, you want to be certain your surgeon knows exactly what he’s doing. Pancreatic surgery is a very, very specialised area.”
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| My LSS saviour in Sydney, Dr Kuldeep Sidhu: "No promises". |
Kuldeep is unrelenting in his attempt to discourage, if not prevent, a pit-stop at the first available station. “You will most probably undergo Whipple’s Procedure, am I right?” At this time, I don’t know very much at all about treatment or surgery. I tell Kuldeep so. “What will happen is more involved than removing a brain tumour, or a multiple bypass. I’m not saying anything about this guy you have been referred to, but you don’t want someone who may be more used to stomach banding and common gastro-intestinal surgery. I’ll see who else there is, from what I know, from my network. Then, at least, you’ll have a choice, and we can take it from there. I’ll do my best.
“Willie, sit tight. I’ll get back to you tonight. You sound like you’ve got the right frame of mind for this. You’re already fighting. I can tell by your message. Don’t let go of that spirit. Your attitude is the most important thing in this situation. We can throw the best treatment at our patients, but if their frame of mind is not right, it’s not going to work very well.”
A few minutes later, my phone pings for an SMS. It’s from the surgeon’s office. The man I have been referred to for urgent surgery will need to re-schedule due to a “family emergency”. The message asks me to call the clinic first thing the next day. I am immediately apprehensive about this surgeon. In my mind, I make the judgment call: No matter what Kuldeep has to say about this guy, I do not want to go under his scalpel while he’s got a family emergency on his mind. Helen feels the same resolve. It’s decided then.
Kuldeep calls back. “Look, Willie, no promises, but I’ve reached out to another Punjabi in town. His name is Jaswinder Samra. He’s a professor and pancreatic surgeon. He’s among the top in the world. His clinic is understandably busy. I’ve spoken to his registrar. They will see if they can fit you into his patient book. Like I said, no promises.
“Just one thing — his consultation clinic is in North Sydney and treatment will also be there. A bit far for you. Hospital recovery will take several days if not weeks. It all depends on how the operation goes. It will be a long drive for Helen when she visits. Are you guys prepared for that?”
I don’t hesitate to say, yes, of course. “Kuldeep, it means a lot to me that you have reached out like this. I mean, we only met up twice in all the years the both of us have lived in Sydney. That’s more than 20 years.” Tears form as I talk. I start to choke on my words. The relief is powerful, the wonder of a Malaysian friend like magic. “Willie, what are friends for? We go back a long way, man. If we don’t step in like this when one of us is in trouble, who are we?”
Helen’s on the internet like a predator, jumping on anything she can find on Prof. Samra. As it turns out, Samra is among the best in the world in a highly specialised field. In Australia, he performs the most number of operations among his peers, by far. His clinic and surgery share data with other specialist centres in Britain, Ireland, Canada and the US. Collaborators include the top hospitals in these countries. Samra also has a doctorate in philosophy. “White Light” burns more brightly. Hope springs. Hello Punjabi Warriors. God doesn’t play by religion.
That night, before we sleep, for the first time in our lives, we speak the words aloud when we pray together. The throat squeezes with each declaration of faith, hope and belief. My prayer is also the first step towards telling my wife that I can take this, I will fight this bastard, because I believe God is walking with me, and He will give me strength. God has given me life. My wife will help me with the living. There will be blood. And there will be redemption.
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| With Errol in his Sunway home. |
In his later years, my brother Errol stopped saying “goodnight” after our evening phone calls between KL and Sydney. Instead, he would say, “White Light”. May the grace of God be with you and give you strength. That night, after we pray, White Light flares fiercely in my heart and I put Kris Kristofferson’s From Here to Forever on the mini-compo in our bedroom.
In my eulogy for Errol, at Assumption Church in Petaling Jaya, I read out the entire lyric to that song, and directed it especially to my brother’s wife, Alice, and their four children, Christopher, Brendan, Kathleen and Kimberley. That night, the song becomes an anchor, bringing a calm-water stop after everything that has happened to me since Magar’s diagnosis. Poignant, sad, deeply moving, uplifting, From Here to Forever is what I need, it helps me sleep, and it sends Helen the message she needs to hear from me.
*****
Early Monday morning, the phone rings, Nigel B Jamieson is on the line and he introduces himself as Samra’s registrar. I frantically motion to Helen, first finger at my lips. After the niceties, he says, “Dr Sidhu referred you to Professor Samra. As it is, we have an opening and we can register you as a patient.” I punch the air. Helen goes from “freeze” to a big smile. “Hello, Dr Jamieson. I can’t tell you how grateful I am to hear this.” He chuckles. “Please call me Nigel, Bill. Can I call you Bill?” I’m thinking, hey, buddy, you can call me Al.
“Look, I know how you must feel with news like this. Professor Samra’s one of the best, if I may say so. We’ll do our very best to get you through this. All I can say is, try not to worry too much.” There it is again, “don’t worry”. It’s only been three days, but that’s plenty long enough for the utter sense of those two words to be sculpted in my mind. Nigel continues, “Let us take care of things from here on.”
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| Dr Nigel Jamieson: "Try not to worry." |
He’s got a definite accent, Scottish, I think. I always hear a similarity in the Indian, Scot and Irish accents, in the melodic, sing-song intonation. I've always felt a kinship with the Irish and Scottish for what I interpret as the musical link in how we all speak. Today, the accent is music to my ears.
The way Samra works, he says, “We like to put you through several tests at the hospital. Then, we’ll talk about if and when you need to go into surgery. I understand your condition has been discovered early. That’s a good sign.” Nigel and team have taken the liberty of booking several medical tests at Royal North Shore Hospital, where Samra performs. “You’ll have to prepare to stay a few days in the hospital.” Nigel explains that there’s usually a queue for these tests, but he’s managed a bypass. “Samra performs surgery here, so we have… some influence, you might say. Are you free to come in and get admitted for tests tomorrow morning, Bill?”, the lovely accent comes through like a lyric, the music rises ever so gently. I don’t say, “Are you kidding?”.
And so it begins. I am supposed to have gone under the knife in five days — straight from my consultation with the GP and into the hands of a surgeon performing under the weight of a family emergency. A couple of phone calls by Kuldeep and it’s “Cancel that, thank you very much.” I am now in the hands of one of the world’s best pancreatic surgeons. Samra is part of a world-wide team that shares data on pancreatic surgeries, efficacy of before-and-after chemo treatments, new drugs, drugs still in the trial stage, successes, failures, the business of living and dying and saving lives.
My Punjabi Warriors and the Scot are eventually joined by a south Indian cardiologist and Sri Lankan anaesthetist. I have the start of my migrant army, my best shot at giving the boot to the unwelcome bastard that has forced its way into my life. There is no running away from this, and I shall never resile from saying it again and again: I owe my life to Kuldeep and Samra, and this able band of soldiers.
Nearly three years later, when Kuldeep and I relive these hours, we talk of how far I have come. Kuldeep remembers it was a Thursday, because it’s his weekly day off. His recall of the message I had sent is uncanny. He just had to call me, he says. It’s very unlike him because he almost never adds to the chats. “I wouldn’t have been able to sleep if I didn’t call you lah, Will.” He reminds me that I said, “Bro, I’m in your hands.” And he tells me now, “God tells us what to do. He’s in control. My hands are his instruments. That day, he told me to call you, that I had to help you.” In time to come, I will also hear versions of this refrain from Samra, my oncologist at St George Hospital, other GPs and specialists; all these men of science saying they’re only instruments of a higher power, that I have God to thank.
*****
By the time of the tests at Royal North Shore, Peggy has passed on. I go through about three tests every day, and I am a patient for less than a week, but it’s a full-on stay. Before each test, I am made to feel like a stupid, bloody idiot. The intentions and manner of the staff are beyond question, the fault is all mine. They have an SOP, and a questionnaire has to be completed before each procedure. Do you smoke? Yes. Do you consume alcohol? Yes. Do you take drugs habitually? Bang! I admit to my foolhardiness at least six times and each time I close my eyes in profound regret. My repeated answer is softer and softer, as if I can change my health history if I whisper.
It is perhaps my fifth day in hospital, the middle of a hot afternoon, and I am napping in my hospital bed. Jenny Arena, the cancer co-ordinater, bless her soul forever, gently wakes me and takes a seat by my bed. We have been expecting the results of the tests by this time. I remember Jenny as the only medical officer who tells me to use her first name. Like she means it. I have come to see Jenny as that mysterious, mostly unseen presence that organises all my tests in proper sequence, and she knows every detail like the back of her hand. Her entire demeanour says, I am here to help and to ease the journey. The Catholic connects with a Holy Mary-like presence.
Once again, the idea that I am so very fortunate to be in Australia in this time of dire need takes hold and offers a special comfort. Jenny is officially the ‘cancer co-oprdinator’. Man! Who would have thought such a position even existed? It’s been more than 30 years since we left Malaysia as migrants, I don’t know how it is back ‘home’ on the medical scene, I knew Australia would be different, but this is all beyond the most wonderful imaginings.
Bak to the reality of the moment. Jenny doesn’t like what she has to say. I can tell. I see and register the empathy of a woman who has to break the news to someone who probably has about 30 years over her. Helen is pacing the corridors, or on the phone to some family member. She is not in the room, and I feel alone, deserted and desperate for the reassuring presence, my comrade in arms. Of course, Helen is simply away from the room for a few moments. I am just feeling sorry for myself, and Helen is the only human being who sees this side of me.
I am still blinking into wakefulness when Jenny says, “Mr de Cruz, as you know we have done a series of tests to determine what your condition is.” It’s excruciating. Jenny has not started with a big, charming smile. No “Good news, mate!” She pauses. It’s not easy for her. There’s no way the news is anything but bad. But I have to say, “And…?”
“I’m afraid there is no doubt now. The tumour in your pancreas is malignant.”
She then proceeds to tell me, in gruesome detail, what could be ahead. Pancreatic cancer is deadly, vicious, quick to metastasise. The rate of relapse is very high. We have to move quickly. I snap. “Stop,” I tell her. “You’ve just told me I have cancer, and I’m hearing all this and it’s just too much information. I’m really sorry. I don’t want to be rude and I know you mean well. Can we do this some other time?” Until now, I have been a very amiable patient, “thank you very much” every time someone does his or her job, smiling my way through an ongoing process that is horrendous, mind-numbing, even belittling, because the smoker and drinker has done all he can to bring this upon himself, and they keep asking, “Do you smoke? Do you drink? How much? How many?”
But Jenny has been that vital link between patient, carer, a retinue of specialists, a mind-boggling testing regime, through my entire stay at Royal North Shore. She has held my hand through it all, helped me understand the results, why I need a stent in my bile duct, helped us re-schedule consultations. Incredibly patient. Jenny, a professional, entirely human and empathetic cancer co-ordinator, does not deserve this. She is in a difficult situation, she is actually aceing her job. I should know better. She is visibly shaken and moves to leave. “I’m sorry,” I say, “I just need a bit of time. There’s a lot to take in. I know you’re doing your job. You’ve been very kind. Thank you for all your help.” It sounds so feeble as the words come out. Of course. I don’t mean it. I didn’t want this news, and now it’s been delivered to my doorstep.
About two minutes later, I get up and walk out of my room, looking for Helen. And there she is. One of the doctors who has seen me regularly, reporting back with every test, huddles in front of my wife with Jenny. They are speaking in hushed tones. Helen has her back against the wall. She is ashen, she looks like she is pleading, “Please tell me this is all not true.” I notice for the first time that my wife has visibly lost weight. Desperation is in her eyes as she looks directly at the doctor, then to Jenny. Her fists are clenched and they are hitting the wall she leans against. I nearly break down and cry. But I can’t. I’ve got to look after her. It takes a lifetime for me to take those few steps, move from my room door to Helen.
I am physically weak, my head is swirling and I feel as if I could faint. I go up to Helen. In front of the doctor and Jenny, I take her face in both my hands, push stray wisps of hair behind her ears. “Hey. It’s ok. I will be ok. Don’t forget it’s early discovery. I can do this. We can do this.” I can see the nurse nodding as I speak softly. “These guys know what they are doing. And we have Samra. I’ll be ok, nee. We can do this, nee. We’ll get through this.” Then I make the sign of the cross on her forehead, with my thumb, and kiss her gently there, to seal it in.
Later, Helen tells me, she was very agitated with them. She was almost angry. The doctor and nurse had reported that more time was needed before decisions on surgery were made. She had said to them, “Do you realise you are telling me this days after my sister passed away from cancer?
“Sorry,” Helen says she told them “I need to know what’s what now. I can’t be told you’re not sure what to do next, or anything like that.” The nurse and doctor are stunned and full of empathy. Of course, it is all to no avail. The science has determined more information is needed. The truth hurts, sometimes more so because you can’t change it.
The next day, a stent is inserted into my bile duct, because the tumour on my pancreas has narrowed the passage. It is inserted through my oesophagus. That evening, the hospital team having been assured the stent is doing its job, I am given my walking papers and Helen and I drive home.
*****
Things begin to happen very quickly now. Within days of leaving the hospital, I have a consultation session with Samra, to discuss the results and plan how to proceed. David has arrived from London. My family is with me at Samra’s consultation clinic in Crow’s Nest, to the north of Sydney’s CBD. It’s not a big room, more chairs are brought in to accommodate the retinue. Sara is perched on a table across from Samra, her legs crossed, very ladylike. Ben has a chair to the side of her. I seem to recall David stands. I notice he’s wearing a white business shirt, black pants, shoes, a slim black tie. It’s the teacher in him. Ben has come from work, and is similarly dressed. Sara is as pretty as ever. I could die for these kids, but now I must fight to live. The three of them are just behind Helen and I, sitting directly across the desk from Samra.
This surgeon Kuldeep has found for me offers the best chance of coming out of this in the best condition possible, but I have dreaded this day, this appointment. It's probably one of the most important moments in my life right now, but I don't want to be here. I don't want these moments, this “now”. I don’t know yet if I am a candidate for surgery, or palliative care. I am about to be told how my life will unfold in the next few weeks. “Early discovery” has kept me going all this while, now it’s crunch time. I have already set a certain tone in how I am handling it, and I can feel that Helen and the kids are expecting me to keep holding it together. Whereas I just want to break down, cry, give in to frailty, go to sleep till dinner in three days’ time. The Sydney summer is punishing, traffic on the trip across the bridge has been as congested as you can get on a working day afternoon. Samra doesn’t look at all like his online photographs. He cuts through the fog with the ease of a seasoned player. He breaks this sort of news every day in his clinic.
Me, I'm a man who’s been frightened out of his skin by an ugly medical diagnosis, who nevertheless continues to portray a character who can take anything. It feels like I've just about had enough of this play-acting. I just don’t want to be strong anymore. It’s exhausting. Helen and the kids are as kind as anything, and they must be going through their own private journeys, enduring their own pain, one bad scenario building on another just passed. The look I give Samra is inscrutable. This afternoon, I’m too tired of making it easier for others. I have no energy but for myself.
Then, none of all that matters as Samra begins. “William, as you know, you have been diagnosed with pancreatic cancer. I will be your surgeon.” Ah! It’s not palliative care. “I want you to know that we will take very good care of you. We have the best facilities at Royal North Shore and we are going to do everything we can to bring you out on the other side the best way possible.” Samra then takes hold of a notepad, holds a pen and turns the blank sheet to face us. He then proceeds to roughly sketch the main parts of the chest, abdomen and pelvis. From where he sits, he's looking down at the paper that faces away from him. Finally, he draws a little object that looks like a groundnut shell. “This is your pancreas,” he says. “It’s a complex process to reach it. The operation is called Whipple’s Procedure and it can take up to nine, 10 hours. I will be the one to call Helen as soon as it is over, to report back.”
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| Prof. Jaswinder Samra: As Mum would have it, "good bedside manners". |
Then he explains the process, using his own peculiar power-point sans computer. Clearly, a seasoned traveller. I think to myself, He’s very good at this. He has had a lot of practice drawing such an intricate diagram on a sheet that faces away from him. What do you call this art form? Post-modern Da Vinci Anatomy? My mind is racing, and I can’t control it. Pointing with his pen, he backtracks on his drawing, and says, “In order to get proper access to your pancreas, which is to the back of your stomach, I will have to make an incision from below your chest bone to below your navel.” The pen draws a line downward. He points to the stomach, and marks out a section with parallel lines. “Then I will remove a section of your stomach.” What? What? He pauses. Looks at me. Kind eyes. He’s really good at this. “Next, I will remove your duodenum, here at the top of your intestinal system.” What? What the hell is going on? I don’t even know what a duodenum does. I’m already feeling like I might as well come out of this a cripple. But the blood and gore bits are not over.
“I will also remove your gallbladder.” I will also be relieved of my appendix. Hey man! When does this stop? Stop, for God’s sake! And Samra does stop. He does. It does stop there, sort of.
“Then I will be able to see your pancreas properly. I won’t really know how much the tumour has grown until I see it. I may be able to save the pancreas, if the tumour is small, and the pancreas has a good chance of functioning. It depends greatly on how you respond to the chemotherapy, how much the treatment will shrink the tumour. After I operate on some people, I find it’s too far gone, I can’t save them at all. I am duty-bound to tell you this.” Again, in less than one month, another doctor is clearly implying, Settle your affairs, young man.
“Bill, you are very, very lucky, my friend. Most people find out they have pancreatic cancer too late for anything to be done. It rarely presents with symptoms. You had very clear symptoms. And we discovered it early. Also, the tumour is at the top of your pancreas, which makes it easier in surgery.
“Your vital signs are also very good for someone your age. This means you are in good shape to withstand this sort of invasive surgery. I am very pleased to see that you have brought your entire family with you. That’s very good, your children are all adults, and you are all hearing this together. Any questions so far?” I look at each of them, giving them the chance to say whatever is on their mind. No takers. “No, doc, please go on,” says Dad.
“Surgery will take six-to-eight hours, maybe 10. You will need to prepare yourself well for this surgery, my friend.” Samra looks at me again, holding me with his eyes. Somehow, the use of “my friend” doesn’t come across forced, or false. This eminent surgeon is actually reaching out in a friendly, empathetic way, and I will come to know Samra as just that — a medical professional with that rare quality, what my mother used to refer to as “good bedside manners”. He tells me I will need to take brisk walks every day, and begin lifting light weights. “If you feel like you can run, then run. But don’t push yourself to exhaustion. Heavy breathing, not panting. Maintain a balance between resistance training and building your endurance. The cardiologist in our team will track how you are doing and keep us posted. He is the main guy, who will confirm to us that you are ready for your surgery.”
“What’s the success rate?” I ask.
“Out of one hundred surgeries, one does not survive,” Samra says. “This is also about the patient’s endurance level. A lot of strain will be put on the heart. Then there is blood loss, if anything goes wrong. It’s a minefield of veins and arteries.”
“If only one out of a hundred doesn’t make it, those are pretty good chances,” I say. “No, no, my friend,” Samra replies quickly. “That’s not a very good rate at all, medically speaking. If it was one out of a thousand, those would be good numbers. But one out of a hundred actually represents a high mortality rate.
“But we are all very, very experienced at this. I will also have a cardiac surgeon on standby. You should focus on knowing that we have found this early. Given your pathology results and your health history, you are a patient with a very good chance of beating this.
“Now, the other good news is, as far as we can tell, the malignancy is contained within the pancreas. It has not spread. Everything else is clean as a whistle.” The smoker’s wife asks: “What about the lungs?”
“The lungs are clear,” Samra says, and Helen whispers, “Oh! Thank God.” More details of the test results follow.
There is not much more we can think to ask about, and Samra hands over a stack of information brochures and fact sheets. I already know that I will leave this information-perusal exercise to Helen. It has been too much for me since a few days ago, when they confirmed the malignancy. Today, it feels like a TKO after the rapid-fire assault of facts, numbers.
Samra also hands over an appointment card for the oncologist’s centre. “Professor Stephen Clarke is my partner in the pancreatic treatment program,” Samra says, “and I would trust him with my mother.” The plan is for a three-month, pre-surgery program of “intensive chemo, with a new, very strong cocktail” that will be administered intermittently, orally and intravenously. Three months? Isn’t that a risky wait? “We’ll monitor your progress, my friend,” he says.
Following this first stage of treatment, I will have to clear my system of the chemo, rebuild, renew, recover, and prepare for surgery. The daily exercise is essential. If I make it through surgery, I will have to repeat the recovery program, until I am strong enough for another three-month course of chemotherapy.
As Samra explains it, “If any cancer cells show up in the PET scans after surgery, or if we find it has spread to other organs, I cannot operate again. This is a once-in-a-lifetime chance. Our treatment strategy tries to ensure, as far as possible, that as much of the cancer cells are killed by the chemo before we perform surgery.” My first dose of chemotherapy is to begin in days at Prof. Clarke’s treatment centre, also in North Sydney.
I am thoroughly depleted of energy as we leave Samra’s consultation rooms. We all troop into the elevator and I ask for a sweet to suck on. Of course they all say, “No.” It’s sugar. “It’s bad for you, Dad. Sugar feeds cancer cells.” Everybody’s been on Google. It will be some time before we all learn to separate fact from the conventional wisdom of the layman that has no basis in science, and which is freely available over the internet.
Downstairs from Samra’s clinic, Ben takes over. He is a tragic devotee of Australian rugby league, and plays the game as well. He goes into coach mode and gets us all into a huddle. Then, he says,“Now, family, we will get through all this.” With that attempt at rah-rah, the kids go into their car and Helen and I drive back in ours across the harbour, to Oatley. Dad and Mum have no idea what the kids are saying to one another on their drive back, but it leaves us quiet, wondering how they are taking it.
The next day, Helen and I return to North Sydney for the appointment with Clarke. He is past middle-age, very affable, not out of place at all if he were to be cast by Peter Jackson as one of Gandalf’s men — exuding a gentle, comforting wisdom, not so gentle as to gloss over the seriousness of my condition, not so harsh and unrelenting as to strip me of hope.
Clarke’s bedside manner ultimately puts me at ease, and it adds to the growing notion that I am very, very lucky to be in Australia, and eligible for all the assistance the public health system has to offer. It does not matter that I have elected to seek out my own medical team, rather than go the nearest hopsital and sign up for the next available spot in the next available specialist’s calendar. Private or public — this is a system geared to serve, provide, treat and heal. We could all do much worse.
I am again grateful to Kuldeep for setting me on this path.
Clarke assures me Samra is the best in Australia, one of the most highly regarded in the world. My therapy will be intensive, the cocktail of drugs will include a new type of chemo that is very effective, necessarily strong. I know the information brochure will read like a horror story, and again I will leave it to Helen. I don’t want to read it. I’m just the soldier. You tell me where to go, where to point the sword.
Then, Clarke delivers that silver lifeline: “There is hope that in seven, eight years, we will find a cure to this dreadful disease.” For now, he goes on, they will do their very best “to get me over the line and looking at a good and productive life”.
Clarke tells me he is very confident that I will do well with surgery and treatment. “Apart from the cancer, your health is excellent for someone of your age,” he says. “Your heart is very good and you don’t have blood pressure, diabetes or cholesterol issues. We would not recommend this drug to you if your general condition were not this good. It is very strong but we believe you can withstand it.
“I believe we can cure you of cancer.” Clarke is the only professional on the team to use that word.
Clarke shakes my hand, then moves to clasp Helen’s in both his hands in a wordless reassurance, and gently hands me over to a nurse who will take us through all the information on medical care we shall need in the months ahead, the chemo sessions, the surgery. It feels like I am going to war, and there’s a strong sense that I am on the side most likely to win. Optimism, belief, hope, it’s all exhausting and draining. Already I want to go somewhere and just fall asleep.
Some practical information is delivered directly to Helen and me by the nurse in attendance for Helen and me and I can’t avoid it. She begins by saying, “I've been through all this before, I've had chemo, so, trust me, you have to follow all this strictly.”
She has my full attention. Once you begin chemo… Flush the toilet twice after use, with the lid covered. Wash your hands thoroughly every time you go to the bathroom. Brush your teeth before and after each meal, immediately before you sleep and after you wake. If you nap, brush teeth after you wake. Avoid public transport, or wear disposable gloves and a face mask if you must commute on trains or buses. No cinemas, or shopping centres. You’re Catholic? Do not attend mass. Do not visit anyone who is mildly ill. Sick people cannot visit you. Yup, your immunity is shot to bits. And the poison in your system is so deadly you have to protect others from it.
They will check on me periodically for five years, counting from the time of diagnosis. In the first three years, the checks and tests will be conducted every quarter. For the last two years, tests will be done every six months. Five years is that magical time period, after which I may be told I am free of cancer. I could have a framed picture hanging on a wall at home. “Five years” in blazing, iridescent, magical hues and tones of colour. Fifty shades of the rainbow of hope and life.
Clarke tells me he is very confident that I will do well with surgery and treatment. “Apart from the cancer, your health is excellent for someone of your age,” he says. “Your heart is very good and you don’t have blood pressure, diabetes or cholesterol issues. We would not recommend this drug to you if your general condition were not this good. It is very strong but we believe you can withstand it.
“I believe we can cure you of cancer.” Clarke is the only professional on the team to use that word.
When I get home, I send a broadcast message to my cousins, and to Jerry, who will pass it on to LSS 72. This is the gist of it:
“Sorry I did not send this message earlier. It’s been an intensive series of tests and appointments, and an avalanche of info to digest and absorb. When I got home from hospital after the news, the last thing I wanted to do was, dwell on the illness. My focus now is the treatment (chemo) and surgery, both in the hands of the best professionals we know of.
“The good news: PET scan and all other tests done in hospital show cancer has not spread to any other organ; no evidence that it has metastasised. Tumour marker very low at less than 500. Patients with pancreatic tumours have presented with markers above 20,000. Even with the tumour size being only 3cm, there is every chance that microscopic cancer cells are lurking in nooks and corridors of the abdominal cavity. Hence, the plan of action: Start with three months of chemo to blast away any cells that cannot be seen on the scans. At the same time, the chemo will hopefully shrink the tumour prior to surgery. My first shot will be 13 Dec.
“Then major surgery, date undecided, and two months to recover. We hope this chemo schedule will allow our planned Sri Lanka holiday in late Feb. Both my surgeon and oncologist think it’s important we go on the holiday before surgery. Then, three more months of chemo.
“My oncologist, Prof Stephen Clarke, is the leading pancreatic cancer man in Australia. Possible important advancements in cell immunology treatment, in the next two-to-three years, will most likely be granted to his team to trial — IF it comes to that. We had our first consultation with Clarke today. He, the surgeon Prof Jaswinder Samra and my GP/school buddy Dr Kuldeep Sidhu are very hopeful that I will be able to walk away from this in about six months. My general health, diagnoses and results so far, early discovery, a relatively small tumour etc. make me a good candidate for eventual cure.
“It’s a nasty cancer, chemotherapy will be intensive, with potentially awful side effects (‘unfriendly visitations’ as Leonard Cohen said) and surgery will be quite complicated. Whole family was at the consultation with Samra and we all came away feeling good, and actually happy, because, while he didn’t pull any punches, he told us about the strong positives on my side. Having just wrapped up consultation with the oncologist, we all feel we are in very good hands and we are very, very positive with this holistic approach. That’s basically it. Having said all that, I don’t want to keep talking about the illness. I am focusing on the treatment and surgery and getting to the other side of all this strong, healthy and normal.
“I have three marriages to see to, grandchildren to look after and spoil and an ex-girlfriend who wants to go places with me, as luck would have it. I feel more and more that God is on my side. A lot of people with pancreatic tumours show no symptoms and then it’s too late. Mine blocked the bile duct and showed clear and present danger.
“I’m usually a private person, but I told everybody about my condition, which is so out of character for me. And if I had not, my school mate/GP would not have known, and I would not have been referred to Clarke or Samra. My original GP’s referral would have meant I would have been rushed into surgery two weeks ago. Thank God they themselves cancelled the pre-op consultation. Then, all the positives that have come out of this ugly mess. I think The Man has work for me to do yet. Feel free to call, and if I can, I will answer. I would prefer it to texting."
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| LSS in Sydney: I'm with, from left, Andrew Reddy, visiting from Melbourne, Kuldeep and Raymond Ng. |
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