This is a diary of my experience as an outpatient at a specialist cancer hospital in Cardiff, where I began a course of radiotherapy for prostate cancer in July 2008. I shall try to describe not only the treatment itself but my emotions. Since prostate cancer treatment is continually evolving, this will be something of an historical document before long. I hope it will provide a useful record of one man’s experience of a particular phase in the war against The Big C.
27 July 2008 (Sunday)
I begin my course of radiotherapy tomorrow but I’m not looking forward to it. I don’t like either the look or the feel of the place, which I’ve visited twice for consultations and once for an open evening. This is an entirely personal reaction, as it has an excellent record. But the big white machines that blast the cancer with radioactive rays remind me of a nuclear power station. I find it hard to grasp that anything so mechanical can play any part in healing. I’ve a good mind not to take up the treatment. But if I don’t I may regret it for I’m told this is the only way forward for me. We shall see.
Today’s the day. Even last night I was still in two minds whether to call it all off. Now I know I’m going ahead. It’s 6.20 a.m and we – that is, wife Dorothy and myself - are drinking our early morning cup of tea.
5 p.m. We’ve just returned from the hospital. Not an auspicious start. I was 25 minutes late going in for my treatment and then there were more delays because one of the spots tattooed on to my body to enable them to line up the machine properly had mysteriously disappeared. ‘We’ll have to give you an x-ray and then there’ll be a two-minute wait while we look at it,’ said the radiographer in charge. I was by then lying flat on my back on the bed – which looked and felt more like a stretcher – with my hands across my chest, my raised knees resting on something and my trousers and pants pulled down, with a thin sheet covering my groin. How degrading.
The huddle of radiographers –three or four of them, all female – disappeared. ‘Lie perfectly still,’ commanded one of the retreating voices. The machine – consisting of three or four large parts, all moveable and coloured white or cream – begin doing its business. The parts moved slowly around before stopping. A prolonged humming was accompanied by a dentist’s drill in counterpoint – or so it sounded – and the business continued with various realignments of the parts. And this was just the preliminary x-ray! And what do you know, they had to do another. All because of the missing spot.
At last the treatment began, and it was very like the x-ray – myself lying supine, those big white objects moving about, the unseen rays penetrating my abdomen and beginning the slow destruction of my prostate cancer (I hope). There was no pain, no sensation of anything entering one’s body, my only distress the increasing urge to urinate – for the instructions had been to drink half a pint of water an hour before the time of the appointment, and with all the delays that meant I’d been holding it back a very long time indeed. ‘Oh,’ said a radiographer afterwards, ‘if you just drink the water 20 minutes before coming here that will be alright.’ If only I’d known! The missing spot has been restored, and tomorrow should be plain sailing. We shall see.
This morning I felt headachy and low in spirits. I wonder if I am doing the right thing after all. I didn’t explain that the reason I had to drink all that water was that the bladder has to be ‘comfortably full’ for the treatment to be effective. Yesterday it was uncomfortably full, no question. I did not sleep well but this morning I had a far better flow of urine when I went to the loo. Must be a coincidence – a single session couldn’t achieve that, could it?
‘Have you brought your card?’ the receptionist asks when I report for duty. No, I hadn’t. ‘Should I have?’ I ask brightly. She smile a ‘yes’ and checks my name, address and date of birth. We sit down – Dot is with me, as she was yesterday and will continue to be until one of us reaches the Pearly Gates. We’ve been married 53 years – 54 come November. ‘Wonder if they’ll be on time today?’ I muse. ‘I wonder,’ says Dot, not committing herself. It’s ten to three – we are ten minutes early. We sit, read, look around and wait. And wait. It’s a pleasant enough room, if any doctor’s, dentist’s or hospital waiting room can be said to be pleasant. Some patients chat to each other. I become disgruntled, for no good reason. ‘They’ve probably been in hospital together,’ Dot points out. ‘It’s natural they should talk to each other.’ ‘I hate this place,’ I respond. Luckily I didn’t drink the compulsory water till 2.30 so there’s not much fear of busting to go to the loo. Time passes, as someone once said (OK, I know who). But I’m called in soon after, half an hour late. There’s a nice welcome from Jenny (I spot her name badge) and her colleague (didn’t spot her name, sorry) and I lie down on the bunk – yes, that’s the best word for it – and the action begins. No messing around today – it’s on with the motley right away. I lie very still, the machine moves around, it makes the noise that tells me it’s blasting me with x-rays, and I stare up at the ceiling. There’s a cut-out shape of a small cross in the ceiling just above my head – nothing to do with religion, I’m sure, but what’s it doing there? – and a large painting of blue fish with a yellow streak above and a white streak below, swimming in an impossibly blue ocean. They haven’t moved since yesterday and I don’t suppose they’ll move before tomorrow. A pleasant distraction all the same.
After four or five minutes, Jenny and colleague emerge from the room where they’ve been hiding from the death rays (got to have my slice of gallows humour, haven’t I?) .
It’s all over. Bye-bye. Ta-ra. See ya.
Two down. Only 35 to go.
Pause for reflection.
It’s just over a year since I was diagnosed with prostate cancer. ‘It’s inoperable and incurable,’ said the consultant. ‘That’s nice,’ I replied. The only treatment they could offer was hormone implants into my abdomen, which destroy the testosterone off which the cancer feeds. In so doing it destroyed my sex life, which was then still active. Tough on my wife. I wrote a poem about it.
A few months ago I was told that although the hormone treatment had been doing its job, it wouldn’t be so effective much longer. That’s when I was offered radiotherapy, which had been discounted before. The hormone implants – injected every month or three months – would continue alongside the radiotherapy and go on afterwards. The radiotherapy involved five sessions a week, Monday-Friday, for seven weeks. ‘It’s the best way of keeping control of the cancer,’ the doctor who would be supervising my treatment assured me. ‘It should give you a few more years.’
I shall be 76 in September. I have to die of something anyway. It’s said that people often die with prostate cancer, not from it. But 35,000 new cases are detected in the UK every year, and the annual death toll is 10,000.
There’s a danger of the cancer escaping from the prostate gland and invading other organs, such as the lungs. But even if it affects the lungs it’s still prostate cancer, not lung cancer. Weird.
They think my radiotherapy will lessen the chance of the cancer spreading elsewhere. Let’s hope so.
Monday 4 August
My first week’s sessions ended last Friday. They went ‘as well as can be expected,’ as the saying goes. They weren’t a barrel of laughs but I didn’t expect them to be. The radiographers made them as comfortable as possible. By the end of the week we were sharing a few jokes, especially about my querying the late start to every session. ‘I wouldn’t mind if it wasn’t for all that water I have to drink beforehand,’ I assure them. Again I was told that 20 minutes was enough – ‘If you find we’re running late when you arrive, you can go to the loo here and then drink the water.’ The unpunctuality is obviously not the radiographers’ fault, as I was amazed to find that officially only 10 minutes is allowed for each session. Since they have to line up the patient with meticulous accuracy before the machine begins its work, that doesn’t sound enough. But there appears to be a heavy workload and it’s not easy organising this place. I’m lucky to be offered this expensive treatment at my age and am grateful for it. Whatever my emotive reactions might be, this is a top hospital allied with a highly skilled urology department.
Tuesday 5 August
9.30 a.m. I had the runs over the weekend, and that worried me a bit; this wasn’t supposed to happen until the third week of the treatment. I mentioned it to one of the radiographers yesterday and she said dubiously, ‘Maybe you’ve got an infection, but I’ll give you the name of something you can take anyway.’ The treatment was a low-key affair, nobody saying very much: no jokes about late starts, like there’d been on Friday. Maybe it all gets to them now and then, as they confirmed that each of these sessions was scheduled to last only 10 minutes. ‘That’s quite impractical,’ I said. ‘We know,’ was the reply, ‘but you try telling the management that. It means we’re always on overtime.’ So why does it go on like this? All to do with meeting targets, it appears – getting as many patients through the system as quickly as possible. Sounds batty to me. What would the legendary Physicians of Myddfai have said? And what would they have made of all this space-age technology, I keep thinking. Probably have run back to their health-giving herbs and potions crying ‘Witchcraft! Save us from the future!’
I have discovered that the small cross cut out of the ceiling enables the linear-accelarator machine (LA for short) to line up exactly in the right place. So now I know.
Since we’d been warned they were running 30 minutes late – a notice at reception said so when we arrived – I dared to sneak into a loo beforehand, empty out and top up with water from a plastic cup. It worked! I felt heaps better, the bladder was obviously full enough for the dreaded machine not to cry out ‘Cheat! Cheat! Away with you!’ and everyone was happy (up to a point, Lord Copper).
As for the runs, I was advised to buy some capsules called Imodium. A box of six cost me £3.29 at the chemist’s. They seem to have worked. If it goes on like this I’ll ask for a prescription.
That was yesterday. Today…?
© Herbert Williams