A cancer scare: peering over the edge

Up close and personal: my  high grade dysplasia
Up close and personal: my high grade dysplasia

The only previous occasion that having one’s bowel examined got a mention on this blog was in relation to Jack Straw’s nickname of “the human colonoscopy“. That being so, The Knife was not expecting to be undergoing that procedure a few months ago – one reason why blogging has been relatively light for a while.

Even though I’m a surgeon, and on a daily basis see all sorts of terrible clinical problems, I did have that rather naive attitude that it somehow wasn’t going to be me. Despite a negative bowel screening test – as a routine procedure – I had a bit of bleeding, tried to dismiss it, failed, and ended up phoning a friend for a ‘scope.

I wasn’t too bothered about undergoing it, although I would have been at one point, for no good reason. Hence one morning I sneaked into the endoscopy department of my own hospital, and had my ‘scope. As I didn’t have any sedation – no need to with a skilled endoscopist – I spotted a polyp right away. In fact several polyps. Now, I know that they can usually be removed there and then, but one in particular looked a little too flat and too big. My colleague – who is a terrific doctor – was bullish on the way in about taking it out, but 5 minutes later, on the way out, had changed his mind: “It’s a bit too big, the wrong shape … and I’m not quite sure about that one”.

These were not reassuring words, although the poor fellow had no choice, and I appreciated his candour. Once changed, 5 minutes later, he came through to speak to me “I’m really sorry, but you’re going to need surgery”. We both, I think, thought the same thing: bowel cancer.

So, one MRI scan and one CT scan, and one “promising” but not definitive biopsy result later I was getting another ‘scope, by the surgeon, another very skilful and highly regarded colleague. Three polyps out, one – the big flat brute – left behind. “I think I can get that out with surgery, but it’s not safe to do it endoscopically as we might not get it all out.” So we had a brief chat about the options. When these potentially include a colostomy, radiotherapy and months out of action – if everything goes well –  you tend to focus, albeit in a dry mouth, unreal, fuzzy headed sort of way.

The plan was to cut it out locally and see if it was indeed highly dysplastic, but not yet an invasive malignancy, so that’s what happened. Only not right away, because, of all things, a hospital holiday on the relevant operating day. I’m not complaining, but I do now have a finely tuned empathy for my own patients who end up waiting, and I had a (strangely fulfilling) opportunity to ponder it all, over the week’s delay.

The surgery was a success, everyone was quite brilliant: surgeon, anaesthetist, pathologist, radiologist, nurses, cleaners, friends, the many genuinely kind visitors, my family, everyone. I have no complaints, quite enjoyed the time off, and got back to work four weeks later, as I felt fine. The pathology was ultimately OK, as these things go, the tumour fully excised.

However, I realise that many people don’t have such a happy ending. I’ll need regular colonoscopies in the future, which I’m actually delighted about, small beer compared to contemplating cancer. So what did I learn? In particular, are there any lessons for anyone else who is in the same situation – who might have found this post via Google – or indeed any lessons for me? Well here are a few:

1. No-one should worry about having colonoscopy. It’s a fantastically accurate investigation. It’s not really embarrassing – even if you know everyone there – and most colonoscopies will  be reassuringly normal. But you do need to know. Uncertainty is a miserable thing. Don’t ignore symptoms.

2. When you’re contemplating the worst, you rapidly adjust to the real priorities: family, faith, basic needs, getting your “affairs in order”. A couple of miles running in the country was a major pleasure. In a strange way life seemed very simple.

3. Reading was very therapeutic and enjoyable, for reasons unclear to me, music wasn’t. I just couldn’t be bothered, though I can now.

4. Readers of this blog – there are a few – may have twigged that The Knife is a catholic. Not a good person, particularly, but a believing catholic nevertheless. This was a wonderful help. I chalked up plenty of masses, prayed, thought a lot and read a lot. Everyone’s religious practice is different, but catholicism provides certainty about the big issues, albeit with no guarantees. Recommended reading includes: St Therese of Lisieux’s extraordinary Story of a Soul – a unique mix of fervour and ordinariness that completely captivated me; Richard Challoner‘s Meditations for Every Day in the Year – which teems with Challoner’s advice on just about everything, based on very orthodox scripture and belief – you alternately smile and shudder with the home truths on display; the Divine Office of the church, which is based on the monastic hours – lauds, terce, sext, prime, nones, vespers and compline. This fits perfectly into the rhythm of the day – these guys aren’t daft – and is available on several phone apps, notably the very reliable Lectio Divina.

5. Following on from 4, get a Kindle.

6. It really was an opportunity to recalibrate. I changed a few things at work, spent whole days doing not much. When I was waiting for surgery, this was a very intense time, but not as bad as I’d expected. Afterwards it was great. Now back at work, my approach is different in all sorts of small ways, and hopefully better.

No doubt there’s more, but the above gives a flavour of what it was like. Hopefully it doesn’t come across as self indulgent to write about this, but I’ve done so partly because it’s my blog and I can do what I like on it, partly because there are some universal experiences that people might relate to, and partly because cancer and the precancerous conditions – of which this was one – are so common that there will be people Googling it all the time, looking for some sort of advice/comfort/insight, or whatever.

Overall, I can’t say that I regret that it happened to me. I’m already a better doctor in some ways, and whatever happens in the future, it does feel like some sort of watershed in my life.

That’s enough for now. Back to ranting about politics,  non-existent global warming , the NHS, books and so on. Normal life, in fact.

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