On a hot day in February
2019, I consulted a dermatologist in Hermanus. A thin woman in her fifties, she
wore a strapless dress that was so flimsy and loose-fitting it occurred to me she
might be wearing a nightie. I asked her to take a look at some skin blemishes.
She said the one on my cheek next to the left ear lobe appeared suspicious and
should be investigated. A few days later she phoned to say that the biopsy had
revealed the presence of a squamous cell carcinoma, which could be surgically
removed by a plastic surgeon colleague of hers. He was 80 years old but, she
assured me, his eyesight was still keen and his hands were as steady as a 70-year-old’s.
The procedure took
place at the Hermanus Mediclinic, where, in 2016, I had undergone two separate
operations on my cancerous prostate gland. (See The Lead Cylinder and thePlastic Urine Sieve.) Although this facial surgery was of a minor nature,
it also had to be done under general anaesthesia and I again experienced the
sudden and total loss of consciousness that had surprised and delighted me
twice before. This time, however, the anaesthetist must have brought me round
prematurely, because I was aware of the surgeon still swabbing the side of my
face. I was also filled with a vague sense of embarrassment, suspecting that I
had been talking a lot of confused nonsense as I returned to consciousness.
Back in the ward, my doctor
called in to express his satisfaction with his scalpel work, having
successfully avoided severing any facial nerves. He also assured me that he had
‘got it all out.’ I went home in the afternoon, thinking that the man must know
what he was talking about and there was no reason to doubt him, even if he was
in his eighties.
More than three years
later, after surviving the Great Pandemic of 2020/21, I became aware of a
swelling on my lower abdomen. On finding that it disappeared into my groin when
I lay down, I concluded that it was probably a hernia. How the fuck had I ended
up with a hernia? I had not been aware of any recent activity that had involved
violent exertion sufficient for me to bust a gut. There had been no tell-tale
sharp pain or the sound of abdominal wall ripping open.
Searching for a
possible explanation, I looked back over the events of recent weeks and came up
with three prime suspects. Firstly, I had spent two weeks coughing and sneezing
with a heavy cold. Maybe I had strained myself then? What about the storm that
brought down the big rooikrans? (Link) I might have overdone it chopping
up those heavy logs. Finally, there was the anniversary lunch. Lifting that No
4 pot out of the fireplace required more effort than was good for me? Or maybe
it was a combination of factors that had caused the rupture.
At the beginning of August
2022, I saw my GP in Gansbaai. When I exposed my pubic area to her she
immediately diagnosed a right side inguinal hernia and wrote a letter of
referral to Dr S, a general surgeon in Hermanus. I also asked her about a lump
on my neck just below the left ear lobe. She said it could be an infected lymph
node, which Dr Esse would be in a better position to investigate. An
appointment was made and K took me in five days later.
Of average height, Dr Esse
was a thick-set man in his mid-forties. He had a superficially jovial manner
and did not seem to be in a hurry. Having asked me some standard questions
concerning my medical history, he got me to lie on the examination bench and
began prodding my groin. No doubt about it: a right-side inguinal hernia. He
could cut me open and repair the tear with some surgical mesh if I gave my
consent. I said that would be in order, and asked him to look at the facial
lump. He palpated it and then said a biopsy would determine what was going on.
This could be done in the morning after the hernia op and before I was
discharged.
Meanwhile, K had been
running a discerning eye over the office furnishings. She had noticed a
glass-fronted cabinet containing a collection of miniature cars, and mounted on
the wall two model trains in glass cases. She commented on them, saying that
our son collected model aircraft. Dr Esse became animated at this non-medical
diversion and, for a few minutes was happy to talk about his hobby, and how his
interest had been encouraged by his father, who had been a Railways man.
Because K was working
full-time for the next two weeks, G delayed his return to Joburg in order to
help out in pearly Beach. It was right at this time that our 13-year-old
Ridgeback was reaching the end of her life and, in my condition, I would not
have been able to pick her up.
At 5 AM on Tuesday 16
August G drove me to Hermanus and it was still dark when we walked into the Mediclinic
reception area. After checking in we were led to a general ward and two male
nurses took charge. I changed into hospital garb, got into bed, and one of them
gave me an ECG while the other recorded my clinical details with assistance
from G before he made it back to Pearly Beach. K needed the car by 8.30 in
order to get to work by 9.
About an hour elapsed
and then Esse, already in his theatre attire, showed up. With a blue marker he
drew a line on my lower abdominal area where he intended to make the incision.
I assumed he did this in order to be certain of giving me a right and not a
left-side repair. Another hour or so went by, and then two nurses appeared.
They lowered the bed’s landing gear and hurried me feet first down a long
draughty corridor through two sets of swing doors to the operating theatre. As
expected, an anaesthetist soon approached, asked me the usual questions about
blood thinners and allergies, and set up the IV catheter in my left arm. I was
wheeled into theatre, told to move over onto the operating table, and was once
again being instructed to take a deep breath prior to departing for an unknown
destination.
I came to in the same
semi-private ward where I had been on my previous visits. This pleased me
because I liked the view to the east where the sun came up. The ward was
cleverly designed to accommodate three patients separated by cupboards that
served as room dividers. All three beds had access to a window and were of the
same proportions. The dividers and curtains provided visual privacy but the
otherwise open layout meant that one could lie in bed and overhear what was
happening a few meters away.
I was pain free and
did not have a urinary catheter to inconvenience me, and it was not long before
I was enjoying lunch. Pleased with my progress, I very carefully got out of bed
and stood at the window for a while. I could hear that there was one other patient
in the ward. He was 85 and required some sort of surgery. However, his surgeon
was concerned about the condition of his heart and wanted advice from a
cardiologist. I became aware of the arrival of a female visitor, who must have been
his daughter, because she called him Dad. She spoke slowly and clearly and
began to explain how to use the cell phone she had just brought him. For more
than half an hour she took him through the basic functions again and again
until he seemed to get the hang of it. I did not discover what was wrong with
his old phone, but she said she would take it with her lest he become confused.
I was struck by her unhurried manner and the complete absence of impatience and
condescension in her voice. This, I thought, must surely signify a mutually
respectful and affectionate relationship between father and daughter. It gave a
lift to my spirits.
At around 3 Dr Esse
called in, still in his scrubs. He sat down next to the bed, saying his head
was swimming. These medics make good money, but they certainly work for it. He
said he was happy with the way the op had gone, and I could go home the next
morning after the biopsy on my neck.
Supper had just been
served when a patient was wheeled in by three paramedics who looked like
ambulance people. They transferred their charge to the vacant bed and departed
with the empty stretcher. A sister and nurse got to work and they were soon
joined by a male doctor. I could not see what was going on but was soon able to
begin constructing a picture. The patient was 66 years old and had been
admitted in a state of extreme dehydration. This accounted for his delirium,
which rendered him disorientated and unable to put together a coherent
sentence. (In fact, I was struck by the similarity of his speech to that of a
brain damaged acquaintance of mine in Pearly Beach. I have never been able to
communicate with that unfortunate fellow, and it hasn’t been for a lack of
trying.)
Apart from being
dehydrated, there was a lot wrong with him, as I soon heard when his wife
arrived. A consequence of urinary incontinence and immobility was a pressure
sore that was not responding to treatment. He suffered from epileptic seizures
as well as schizophrenic hallucinations. Osteoporosis had resulted in multiple
fractures in recent years and he was unable to walk without assistance.
Furthermore, he had of late become increasingly uncooperative, refusing to eat and
drink; hence his current state of dehydration and collapse.
This woman had an
assertive manner, and I imagined her to be self-employed and used to giving
orders rather than taking them. I listened to her going through all the meds she
had brought with her, explaining to the sister what drug was for what and when it
should be given to her spouse. Christ, I thought to myself, what a mission it
must be having to care for this physical and mental wreck!
With the patient in
bed and IV rehydration underway, the nurses withdrew. There was silence for a time
and then she spoke on her phone. Something to do with her house alarm and the
security company. Again, there was silence for a while before I heard her say
she would be going soon. Her voice sounded totally different, now that she was
talking to him in private. The tone was softer and more subdued, as if she no
longer felt the need to appear strong and in control. She told him not to
fiddle with the drip, that he was now in hospital and it was all because he
refused to drink.
I was shaken, not by
the content of her words but by what I could detect in the flatness of her
voice. She was exhausted, had given up hope that he would ever be anything more
than this vestige of the man she had loved, and was resigned to continue caring
for him until death decided it was time for them to part. I could have done
without having to witness first hand such misery and pathos. It unnerved me,
probably because I feared it was a preview of the suffering that was almost
surely coming my way.
Well, not only was I
plunged into a state of mental and emotional distress, but was condemned to an
almost sleepless night. The man became more restless and confused. A nurse was
assigned to sit at his bedside and every few minutes she told him to stop
trying to remove the drip. Increasingly agitated, he kept insisting that he had
to get to a meeting, and that ‘they’ were waiting for him.
“No, there is no
meeting. You are in hospital and you must lie still.”
This went on until
well past midnight before either she convinced him the meeting had been
cancelled, or I succumbed to fatigue and managed to doze off.
After breakfast I was
eager to get moving. I was informed that the biopsy was scheduled for 11 AM. At
10.30 I dressed, packed my things and sat in a chair waiting for a porter to
come and take me to Radiology. At 11.30 they told me there was a backlog and I
would have to wait until after one.
Seething with
irritation and impatience, I stood at the window and phoned G once more. As I
updated him, I noticed that squalls of rain were being blown across the
carpark. I asked him how Ruby was doing, and if he had been able to let her out
to relieve herself. He said he had and she was contentedly chilling on the back
seat, so I should not worry. And he had plenty to keep him busy on his laptop
until I was finally discharged.
At around two o’clock
a porter arrived, I got into the wheelchair and he pushed me down a corridor to
the Radiology department. A tired looking radiographer told me to lie on a hard
bench next to some equipment and a monitor. She placed a hand-held device
against my neck where the lump was located and moved it about to focus the image
on her screen. Then she told me to remain motionless while she called the
radiologist. A woman in her forties arrived, sat down next to me and, without a
word of greeting or introduction, took up the device and moved it about while
looking at the monitor. I asked her if she was the radiologist and she said she
was. I thought of saying something conversational like, You must be very busy
and working under pressure, or, I understand Radiologists are very highly
renumerated, but decided against it.
She said she would
first give me a local anaesthetic injection before using a large needle to
aspirate the tumour. Aspirate the tumour? Yes. Remove fluid by suction.
Once she had finished
aspirating the tumour, she rose to her feet and left the room, never to be seen
again. I later learned that for performing this procedure and reporting on the
results from the pathology lab, she charged R3147.69.
Once discharged, I
waited at the entrance for less than ten minutes before G pulled up outside. He
took my bag and I lowered myself into the passenger seat, careful not to put
strain on the repair job. Then it was back to Pearly Beach in time for a dop
and supper.
For the next few days,
I took it easy, avoiding physical activity like housework, cutting the grass or
chopping wood, and definitely not lifting anything that weighed more than 5kg,
as per the surgeon’s instructions. Each morning I took Ruby for a walk around
the block. It was gentle exercise because she was very slow and unsteady. In spite
of tempting her with tasty variations to her normal diet, she was now eating
hardly anything, and her ribs and skull were showing through her skin. We
agreed that her days were numbered but that we would keep her going for as long
as she was not in pain and still able to walk a short distance to relieve
herself
.A week
after the hernia op and biopsy, on Wednesday 24 August, Dr Esse phoned to tell
me that the lymph node in my neck was being colonised by cancer cells. To
ascertain whether anywhere else was under attack I should undergo a CT scan.
This I did two days later on the Friday.
That night after
the scan and at the usual hour when I let her out to do a wee, we found that
Ruby could no longer get to her feet. We made the decision to take her to the
vet the following morning.
When she
left for work, K never failed to say goodbye to Ruby, and she always made a
fuss of her when she returned. On this final parting of ways, she knelt beside
the old dog stroked her head and tried to whisper something before hurrying
down to the car.
Ruby lay in
her basket until 9 AM and then surprised us by getting up and walking unaided
down to the Venture. G lifted her into the back and we drove to Stanford, where
the vet was expecting us. Ruby recognised the familiar surroundings, sat up and
looked like she wanted to get out. G helped her down and, although just a
feeble old bag of skin and bone, she showed she still had some of her youthful
spirit left in her, and I felt a twinge of guilt. Should we have kept her going
for a while longer?
G put her
back in the vehicle and the vet came out and administered the IV injection.
Within seconds, Ruby lowered her head and lay still.
The drive
back to Pearly Beach was an emotional one. As we entered Gansbaai the bells of
the NG Kerk began to chime, and I was reminded of John Donne’s admonition not
to ask for whom they tolled. On our return, G immediately set to work digging
the grave in the sandy soil next to our other two dogs. He dug it deeper than I
would have and it took him over two hours. We brought up the lifeless body in
the wheelbarrow, and it made me think of refugees fleeing before an invading
army. It was late afternoon by the time he finished filling the grave and had returned
the tools to the shed. I told him that without his help we would have been in
trouble. This was a foretaste of what it would be like as K and I became frailer
and more dependent on him and N. I hoped he wasn’t thinking of emigrating any
time soon?
On Sunday
we began the process of getting used to no dog. On Monday K took me into
Hermanus to hear the results of the scan. While in the waiting room before the
appointment we heard Esse ushering out a patient. As he approached, we were
astonished by the sound of his feet on the tiled floor. Each step he took was
accompanied by a loud squawk of protest from a rubber sole. He was wearing
expensive-looking black ankle boots that we later guessed to be orthopedic
footwear or a birthday present from his wife.
He followed
us into his office, and once we were all seated he gave us the good news and
then the bad. The radiology report confirmed the presence of cancer in the
lymph gland but there was no sign of it having spread further. That was the
good news, he said. The bad news was that the lymph node would have to be cut
out and then be followed up with some radiotherapy. So be it, I said. It
sounded the logical course of action to take, and it was covered by Medical Aid,
wasn’t it? Then, as we were about to leave his room, He made what sounded like
a casual remark. “And remember never to give up hope.”
On the way
home I thought about this piece of advice. What lay behind it? Had this
sonofabitch already concluded that I was now on my way out and would soon be
pushing up the daisies, give or take a year or so? He was telling me to
continue deluding myself that all would be well in spite of incontrovertible
evidence to the contrary. Did he think I was a simpleton?Or a religious nut who believed in
miracles and the power of prayer?
A week
later, on Tuesday 6 September, I was back in my bed at MediClinic. A plaster
was stuck to the side of my face where the cut had been made but I did not feel
any discomfort that could be called pain. Lunch came, I got up and pissed in
the toilet, stood at the window for a time and went back to bed.
Around 4
o’clock there was the sound of distant squeaking. It grew louder and only
stopped when the surgeon came to a halt at my bedside. He did not seem his
usual breezy self and I soon learned why. He had been unable to remove much of
the tumour, it being harder and more dense than he had expected. It was like
chipping away at concrete, he said. There was nothing more he could do for me,
apart from referring me to an oncologist
K picked me
up and we got back to Pearly Beach in a slightly subdued mood. G had returned
to Joburg, Ruby was gone and the house felt empty. It was beginning to sink in
that this cancer story was far from over.
To view my longer work as an author, you can find me on Smashwords here.