One Thing Leads to Another

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.

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