Part two of two of my blog on this journey. I pay tribute to all my friends and family who have encountered the tiger – those who have met it and have defeated it, those still battling, and those who were sadly defeated by it. Many friends laughed with me on reading my first blog (Tiger Cancer 101) that looked at my prostate cancer; others seem to have found it less than amusing and have not responded. 

A long-time friend responded:

• I take a lot of comfort knowing that you now have family close by. I would hate to think of you dealing with this in faraway Thailand.

Readers and friends who have endured their own battles with cancer may perhaps understand or empathise with this blog … or may just think I am crazy. Of course this is not a unique condition: prostate cancer is one of the most frequently diagnosed cancers in men over a certain age. But this one is unique to me and another good friend said:

•  But Chris – most men who get prostate cancer die of something else (*)

The brilliant poet Dylan Thomas died too young, but his delicious 1950s play Under Milkwood will live forever with its luscious lines and its incredible characters inhabiting the fictional Welsh town of Llareggub – or for those who can read backwards – Bugger all.

I have enjoyed the work of this writer for many years, and when some loved ones were dying of cancer years ago, I recalled Thomas’ poem Do Not Go Gentle as I watched them just fade away.  I really wanted them to rage against the dying of their days:

• Do not go gentle into that good night,
• Old age should burn and rave at close of day;
• Rage, rage against the dying of the light.

I resolved that I would not just fade away … so my writing about this cancer is my way of “raging” against whatever the future may bring.

Rage or rave …?

But I am not really much of a rager … or a raver.  I have always wanted to follow the simple path and have avoided confrontation whenever possible – You want my wallet?  Take my watch as well! – but in another life I might have been a bit of a raver.  The idea appeals to the ancient and deeply buried hippie in me.

After the various scans and tests mentioned in an earlier blog I returned to my urologist:

• Yes, Mr Chris, I am sorry, but the news is not good.  I am afraid the cancer in your prostate is rather advanced and has spread beyond the prostate.  The scans show that it is also now found in your lymph glands and …
• Sorry? How can that be?  How can a cancer escape my body and go into the Enchanted Forest?
• What on earth are you talking about?  I said …
• Lymph glands?  Oh.  I thought you said nymph glades …

I had rather lovely visions of scantily clad faeries skipping through boughs of orange blossom in deep emerald forests somewhere … but perhaps that was the after-effects of the Valium I had taken to allow me to stay reasonably calm while the MRI machine whirled and hummed and thumped about my head.

The lymphatic system and the lymph glands are scattered throughout the body in the neck and back, in the groin, stomach, armpits and in the chest.  As far as I have been able to discover, their purpose is to filter out the baddies and produce the goodies to destroy those baddies … such as cancer cells …

I am somewhat at a loss to understand how the guardians of the universe themselves can be battered by intergalactic forces.

After all, as Juvenal once jovially enquired:

• Quis custodiet ipsos custodes?   (**)

The urologist suggested that a course of HRT (Hormone Replacement Therapy) would be preferable to chemo or radiation therapy or any surgery.  I was not sure I was happy to hear this – or if this indicated a greater degree of severity of advanced cancer than I had contemplated, but I happily popped off to my local pharmacist for the first course of HRT tablets and injections. 

I glanced at the booklets that Dr A had given me, warning of trivial side effects of HRT:

• Loss of libido
• Erectile dysfunction
• Night sweats
• Osteoporosis
• Loss of muscle and an increase in body fat
• Breast enlargement

I am happy to report that while I have woken occasionally in the middle of the night sweating heartily and that what few muscles I have ever had have not yet become totally invisible, I have yet to become eligible to audition for RuPaul’s Drag Race Down Under … or for the part of Dr Frank N Furter in Rocky Horror Show.

Show me da money

I do not really understand how the Australian Government works, or how the public health system Medicare works, but so far, I have bought two batches of medications.  The first, for the HRT, cost me just over AU$7.00 and the second, to help with high blood pressure, also cost just over AU$7.00.

The actual cost of these two batches of pills was AU$1133.51, so I am not sure who is paying the other $1118.91.  I also wonder how any drug company can calculate to the nearest one cent the cost of their product. 

I was brought up by rather conservative parents and it was never considered quite proper to discuss money.  However, I am now finding that such an idea is ridiculously old-fashioned.

Every specialist and every hospital and every consultation I have had has involved long emails with reception staff telling me that the consultation will cost $xxx and that I might get $yyy as a rebate from my private health insurer, and instructing me to ensure that the full payment for the upcoming procedure is remitted at least four days before my surgery / meeting / consultation.

• I have never been to a fine dining restaurant and asked to pay in advance.  I find this practice in the medical world rather sad … and rather grubby …

It seems that a patient must pay up front before the first Cunnamulla (I really wish that this was its correct name) is inserted into the crook of an arm and before the first drop of anaesthetic flows through the Cunnamulla into the bloodstream.  If the procedure results in death or contamination from cross infection or from anaesthetic abnormalities, all those involved would still be ensured of receiving their full fees … and would of course, be free from any likelihood of litigation. 

• And the Outback Queensland Cunnamulla Shire Council would soon be chasing the patient to retrieve that cannula from his arm …

For many years I worked in schools in Australia and overseas.  Only once did I have a parent say to me:

• But I paid your school thousands of dollars!  Of course my son must graduate with honours and be accepted into a leading world university!

How I wish I could have said to that parent:

• Yes sir … and had your bone-idle son ever done any work he may well have done so …

Another former student, a boy who became a man with whom I worked in amateur theatre in Hobart, heard of my faltering first footsteps along the road with cancer. 

He sent me a warm email that reduced me to tears for the first time as I faced the TIGER.  As educators we never really know the impact we might have on people in our charge.  This young man suggested that I had made a significant impact on his life and on his world … and that somehow made all that I have done to this point worthwhile.

• Thank you, David

We all live in a yellow submarine …

Since then I have had the dubious pleasure and the excitement and the thrills of having just a dozen close and personal friends and strangers staring at my bare bottom and my naked genitals as I snoozed under a general anaesthetic.  I hope there were no selfies taken during my prostate biopsy:

Can you imagine it? 

• Hi guys!  This is me in front of some scruffy old guy’s scrotum.  We are about to shove things up his bum and chop a few bits out.  Where are we meeting for drinks this afternoon?

During a Trans Perineal biopsy, an ultrasound device rather like a miniature submarine sails up the rectum to provide images while the surgeon pokes sharpened needles through the perineum into the prostate and chomps out delicate little samples of tissue for testing. 

The tissues, it seems, are stored forever in a frozen laboratory somewhere, so they can be used not only to advise current medical practitioners on likely treatments for the patient (me!) but will also be available for researchers and practitioners somewhere beyond the rainbow.

• I think I am okay with the thought of having bits of my body stored in some refrigerator somewhere and that someone sometime in the next hundred years may defrost them to make an omelette … or something …

 The TP biopsy was all over quite quickly.  The ham-and-cheese sandwich and orange juice provided in the recovery room made it all almost worth-while, but I really would have preferred a glass of wine and a meal from a fine dining restaurant.

Tomorrow

A glance at my calendar for the days ahead shows:

• 10 August:  Oncology specialist
• 15 August:  Cosi Fan Tutte at the Queensland Performing Arts Centre
• 18 August:  Patsy’s birthday
• 07 September:  Rocky Horror Show, Star Casino Gold Coast (see above)
• 10 September:  Replace cockroach baits

I met my oncologist this week to chat about the biopsy and his first urgent statement was to remind me to replace those cockroach baits. 

Specialists are SO good these days.

He showed me the images from the scans and biopsy I had had done:

• The red bits are supposed to be red and the green bits are supposed to be green, but the other bits just aren’t supposed to be there at all …

The onconolgist confirmed that while my cancer is just “of the garden type” and not particularly aggressive, it had spread through the lymphatic system and that traces were present in my liver and in my lungs and elsewhere.  I am so glad I am no longer a smoker, although I do wonder if a good puff on a KOOL menthol cigarette may have sorted out all these little buggers.

I asked what causes cancers. 

Of course he equivocated and mentioned hereditary factors, environmental factors, obesity and perhaps the phases of the moon. It is no longer the Age of Aquarius, after all … but I may soon be heading off to the former hippie capital of Nimbin in NSW to find some medicinal foliage if all else fails …

As this cancer has apparently dashed about my body like a sailor on shore leave waving his wooden leg in the evening air and checking out all the bars and all the brothels, we discussed options for the future, including chemotherapy.  For the moment, we have decided against chemo, although it may be an option at some stage in the future. 

He also told me that modern treatments are far less invasive than those of just a few years ago, when he may have recommended orchiectomy … a lovely sounding word … but meaning the removal of one or both testicles.

Tomorrow and tomorrow

My days of enjoying a sunny naked afternoon on a nudist beach may be long-past, but the idea of going to the knacker’s yard did not fill me with much excitement.

Testosterone does not cause prostate cancer … but it drives it … so to work against the cancer I have to limit the production of testosterone either by surgery or by the new medication he prescribed.  I am, effectively, to be chemically castrated.

• So, Doctor, my balls will shrink and my breasts will grow?
• Yes

I rather wish he had been less honest, but he did tell me that the procedures will ensure many years of active life yet to come.  I am, however, doubting the wisdom of buying tickets for the closing ceremony of the 2032 Olympic Games in Brisbane. 

Opening Ceremony – yep! 

But the other one may just be that one bridge too far away.

Treatment

I have a couple of blood tests scheduled, and follow-up meetings with the oncologist.  I am due to start the new tablets in a day or two, with possible additional MRI scans and biopsies in the future to see if all the nasty little buggers here and there are behaving themselves and have gone home to mother.  Apparently there is no cure – but the current situation is far from terminal – and the treatment is designed to slow things down, to shrink or prevent future developments

Had surgery proved to be the best option, it is reassuring that I could have gone shopping for replacement bits, and that I could have chosen any one of five standard sizes for testicular prosthetic implants.

• Perhaps the XL ones, doctor (do they come in a range of colours?), and can you also remove the bags under my eyes and give me a full head of hair again …?

Rage on …

Of course, again, none of this is a unique condition … but it is unique to me … and although I am not enjoying every element of it, the challenge of writing about it all and finding some humour wherever possible is its own form of therapy, so I will continue to try to

• Rage against the dying of the light … and to laugh whenever possible …

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Journey May – August 2023

Text and photographs © Christopher Hall August 2023

Illustrations marked thus * from the Internet

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*      I mentioned this to the oncologist who readily agreed with me … but added that it is only true if the cancer is detected very early … and not at a later stage, like mine …

**     Quis custodiet ipsos custodes:  Who watches the watchmen …

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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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