A twenty-year-old car starts to develop problems.  The grommets start leaking, the tappets stop tapping and the gaskets often give up the ghost.

I have no knowledge of motorcar engines – they go … or they do not.  If they do not go, I call in a specialist who will tap the tappets and grease the grommets and gas the gaskets.  I don’t know what any of these bits are or what they do or how they make the car go, but I believe they are all important enough to make sure the car trundles on for a few more kilometres.

A seventy-year-old body also starts to develop grommet problems.

A local mechanic may start to talk about elevated PSA levels, Good HDLs and Bad LDLs, Stool FOBs and other exotica such as cancers and heart conditions and Atrial Fibrilation and hypertension and ingrown toenails.

I don’t know what any of these medical bits are … but I am told by my various mechanics that this old sack of bones is in a bit of a mess and seems to need a bit of a grease and oil change, a sand-blasting of the arteries, a biopsy here and there, a PET scan and a MRI scan … and perhaps a quick trip to lie naked on the sand somewhere in Crete.

Suzanne Chambers is an Australian writer and apparently an expert in the psychology of cancer.  Her book, Facing the Tiger, was given to me by the consulting urologist who told me that I probably have prostate cancer, and it seemed like a good title for this blog – or this series of blogs, depending on time and treatment and the elephants – or tigers – in the room.

It is, after all, likely to be a fascinating journey of a different kind.

Laughter is the best medicine

There are lots of cancer-related cartoons on the Internet and several feature a masked horseman proudly stating:

• Nope, buddy, I am not the Chemo Nurse, I am Kemo Sabe and I wonder if you have seen Tonto recently …?

I know that some will find this blog offensive figuring that cancer – or the potential threat of cancer – is no laughing matter.  But I believe that laughter is the best medicine.  I have several friends who have faced the tiger and who have survived it, and several friends and family members who have met the tiger … and been consumed by it.

Flashback

For many years I lived in Chiang Mai, in northern Thailand, and as part of my time there I had regular medical check-ups at the Chiang Mai Ram Hospital – an internationally accredited facility.  In 2017 my normal “grease and oil change” checkup revealed a slightly elevated PSA reading – and perhaps an early indicator that all was not well with the prostate.  My consultant (with a soft pack of Camel cigarettes in his shirt pocket) suggested I pop down to see the in-house urologist.

• Yes, Mr Chris, the PSA is a little bit high – let me do a physical check

In clinical terms, a “physical check” is called a digital rectal examination – or DRE – but in layman’s terms it is more commonly called AFUTB – a finger up the bum.  Neither phrase really covers the thrills of having a stranger become intimate in the cold confines of a consulting room.

While that FUTB revealed that my prostate was smooth, glossy and clear (rather like a crème caramel) he did detect that there was a minor haemorrhoid nearby:

• Yes, Mr Chris, I can give you some creams for this and it will disappear in a few weeks, or I could snip it off now and you will be good to go almost immediately.

As I was flying off to Croatia in three days’ time, I took him at his word, saw the gleam in his eye and heard him pulling out his butcher’s steel, snicker snackering his scalpel, muttering something that sounded like “Yesss … my preciousss …” and lunging with anaesthetic syringes for my tender nether regions.

A FUTB is not very pleasant … but it is far more jolly … than having a needle shoved repeatedly into one’s rectum, of snickering and snackering knives chopping and shaving … and medical lint pads Cellotaped in place with enough adhesive power to block any bodily function for several millennia.

Fast forward

I found myself in Chiang Mai again a few weeks ago and decided to treat myself to another full body check-up – one that revealed that the PSA had jumped from a norm of about 4 … to about 17 in 2017 … to about 189 in 2023.

• Sir – your blood pressure is very high …
• YES!  And it is getting higher every time you measure it and tell me that it is very high!
• Sir – you need to see our urologist …
• YES!  And will he tell me that my blood pressure is …

I returned to Australia and chatted casually to my GP – a former student from many years ago.  How strange it is to have a boy to whom you once taught a tricky badminton serve now practising as a doctor, and serving you life truths:

• Your PSA is astonishing and worrying and WAAY off the scale.  Please go NOW to have another blood test and see me again TOMORROW!

• Your PSA is now 200. Go see a urologist NOW.  Do not pass GO and do not collect $200.00

Really – doctors and specialists are drama queens and seem to treat minor problems as if they are life-threatening … which I guess, unfortunately, they may be … but with the costs of various scans coming up, I really could have done with that $200 from passing GO.

Urology 101

• Please get undressed and lie on this chilly, wrinkled-paper-covered examination bench.  I am going to examine your penis and testicles …

Over the years I have quite enjoyed having people toying with the wobbly bits but to then hear:

• Oops – sorry Mr Chris – I am out of lube.  Wait a minute.

Where was I likely to go?  No trousers, wobbly bits waving in the breeze, crinkled-paper examination bench creaking under me …

• Right!  (An impressively cheerful tone of voice)  I am about to put my FUTB … some gel here (why is gel ALWAYS so cold?) … Ummm .. Thank you
• No sir, thank you!  I really enjoyed having ….

The urologist then pulled from a shelf a model of the male reproductive system but as he did, plastic bits of penises and prostates fell to the floor.  He picked them all up and re-assembled it all and explained that the prostate is located HERE – and cancers usually develop HERE – oops – this bit is meant to go here … Bright pink and dark brown bits of the plastic penis and prostate fumbled here and there, with a shiny silver dot I figured must be the main source of all cancers – if not of all mankind  – but was in fact a tiny magnet supposed to hold my plastic prostate together. 

Wouldn’t it be wonderful is surgery was as simple as chopping out a bit of shiny silver from a rosy pink bit of plastic …?

Dr A instructed me to have a PET scan. I will have to see my niece and her husband to borrow their lovely Boston terrier to have that PET scan.  I will also have to find out how many G&Ts I will need to be fully sedated

Scan 1

Hello, I am Chris and I have an appointment for an 11.00 PET scan. 

• Yes – Do you have your dog with you?
• Huh?
• How can we do a PET scan if you do not have a dog?
• You need to go to the Q Scan desk.  Turn right past those statues, go all the way down the corridor and take the steps to the lower floor.
• Hello – I am Chris and I …
• Yes.  Do you have your dog?  PET scans are on the next floor.  Go down the corridor … and see them on the LG floor
• Hello – I am Chris …
• Does your dog bite?  That is not my dog.  
• Hello I am Ninni your nurse. I am from Bangkok and my husband is from Rayong.  We met in Perth at a medical conference.  Where did you have your test?  Thailand.  Oh – so you speak Thai:
  • Yes.  Please Thanks You
  • Hello Goodbye
  • Now, although I believe Emmanuel Kant was perhaps the greater theorist, one of the earlier Chakri dynasty kings may have had …
• Please come this way, take off your clothes and put on this robe – I will tie it for you as we do not want wobbly bits falling out as you walk about

I finally found that PET scans were not about dogs at all, but were Positron Emission Tomography and Computed Tomography scans.  I think I preferred it when I thought they were all about dogs.

Ninni shoved a needle into my arm and some sort of radioactive goop was fed into my system:  I wonder if a quick trip to Chernobyl would have been less painful?

I had been told that the PET scan was quick and easy and that a giant doughnut would do all the work.

It did not.

Although there was a cheery illuminated ceiling featuring pretty autumnal trees in golds and reds and greens, another line of radioactive material or indigo dye or shiraz wine was tapped into my arm and the euphemistically named “bed” slid into the doughnut as lights and sounds swirled about me, as claustrophobia threatened to destroy my calm, my cyclic ten-second breathing patterns (Breathe in two three four …. Nine ten, Hold, Breathe out eight nine ten) and as Dalek-toned voices bellowed at me

• DO NOT BREATHE DO NOT SWALLOW

After a while I croaked out “How much longer will this take?” and got an informative non-response from the Dalek scanning my body.  Eventually I was told to sit up and a nurse took the tubes from my arm, told me to get dressed and asked me if I would like a cup of tea and a sandwich

• Do you have G&T?

Scan 2

I was terrified of the second scan – an MRI – as I had heard so many tales of the agonies suffered by claustrophobes enduring this procedure.  My excellent GP had prescribed some Diazepam / Valium for me.  I gladly scoffed a handful before going off to the machine room.

Oh yes.

Before the machine room was the WC.

• Hello Mr Chris.  As this scan will be looking at your prostate, located just above your back passage (Back passage?  Sounds like an area in a cheap backpackers’ hostel), we want to make sure your back passage is as clean as it can be.  Take this tube, twist the end off the spout … insert the tube up your back passage and squeeze the gel in.

At least the gel was not too cold, and at least it was not a bottle of creaming soda.

The MRI machine looked formidable and frightening.  My ankles were taped together (“To stop you from running away”) and a heavy SatPad was draped over my body.  I was asked if I had any metallic bits and pieces in my body – pace makers, hip replacements, metal plates in my skull – but could only imagine the ancient amalgam fillings in my teeth being yanked out by the strong magnetic forces and fired like shrapnel all around the treatment room.

• What sort of music do you like, Mr Chris?
• Classical, please. Do you have Cosi fan Tutte?

Earplugs and earphones were clamped on, Diazepam was kicking in, and the noise started.

Borodin’s Polovtsian Dances pumped through the headphones … but the music was soon outmanoeuvred by building site industrial jack hammering and Brisbane City Council rubbish collection truck back-up noises of BEEP BEEP BEEP and the assorted thuds and burps and belches and deep-sea submarine thuds and depth charge blasts made it pretty hard to recognise what I was listening to.

It may have been the latest Pink album … but my Valium allowed me to welcome even her.

• Ah, Mr Chris – It is all finished now.  You were very brave. 
• Nope – the drugs helped

Results

Tomorrow I return to my urologist for the results of these scans and tests and pokings and probings and manipulations of my penis and testicles and prostate. 

I guess there are three or four possible results:

• Ho ho ho – it’s all been a big mistake!  Those oysters you ate and the masturbation you reported all totally bewildered the incredibly complicated electronic and electromagnetic and X-ray machines. Oscar Wilde once told US Customs officials that he had nothing to declare – except his brilliance.  All my machines all found nothing to report except a deep-rooted and rather ironic sense of humour. Yes!  You are totally free of any prostate cancer, your liver looks ready for a steak and kidney pie and the electromagnetic radiation from this machine and that big red one over there have cleared all your veins and arteries of any arteriosclerosis, your heart is that of a vibrant sapling of just 22 years and your IQ has just racked up another 23 points – so welcome to MENSA! 

• Yes, Mr Chris, there is some cancer here, but if you take three Aspirin and have a good lie down, all will be well.

• Mr Chris, we have a problem here …

And so …

This is all a bit of a problem, as I am going to Sydney in a couple of days to watch the Wallabies play Argentina, and as I am cooking a Northern Thai Khao Soi Gai for my family in a day or two.

My main concern at the moment is where can I find some fresh mustard leaf pickles to accompany the khao soi …

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Journey July 2023

Text © Christopher Hall June 2023

Illustrations from the Internet

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In my blogs I try to present a snapshot of the places I have discovered during a brief visit.   I am not trying to present a detailed picture of the whole city or the whole region or the whole country.

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If a man ascended into heaven and gazed upon the whole workings of the universe and the beauty of the stars, the marvellous sight would give him no joy if he had to keep it to himself. And yet, if only there had been someone to describe the spectacle to, it would have filled him with delight.

• Attributed to Marcus Tullius Cicero – On Friendship

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