A Wander in Vetland

by John Hicks

  In my opinion, the entrepreneurs driving the change to ever-larger dairy herds are strangling the spirit that so convinced me of the vitality of New Zealand agriculture. Leveraging on capital gain, they have become the new land barons, buying farm after farm. Some are solely investors with few ties to the land. As vets we were tending to deal more and more with disgruntled and exploited staff who, lacking job satisfaction, regularly moved on. It was becoming more difficult to establish trust and develop satisfactory working relationships in this environment.

  It would be wrong to paint a totally negative picture. We still had a tremendous amount of work with sheep farmers and their dogs, and there were some motivated and considerate dairy farmers, but the more intensive dairying took over, the less it appealed to me. My mindset about being a practising vet, the only career I had ever considered desirable, was changing.

  There were other factors in my change of heart. For several years I had been under treatment for recurring bladder cancer. On top of this, another seriously malignant form of cancer had erupted in my mouth. When I first felt the small pea-like lump catching on my tongue, and peered in the mirror to see what it was, I was horrified. It looked, to me, suspiciously like a squamous cell carcinoma (SCC). I had quite often seen similar growths in the mouths of dogs and cats. They were highly malignant and the prognosis was invariably grim, with the probability of euthanasia just round the corner. But, for myself, I thought it prudent to seek a second opinion.

  Within weeks I was admitted to Dunedin hospital for removal of what had, indeed, been confirmed as a SCC, and a radical resection of the surrounding tissues inside my mouth. The surgeon also planned to remove the lymph nodes draining the area. This would involve delicately dissecting past the rich nerve supply to my left arm and he warned me that there was a chance that I would wake up to find it partially paralysed. What choice was there? I signed the consent form without hesitation.

  It was with some relief that I awoke several hours later with nothing more than a numb cheek and a sore mouth. I was lucky, we had caught the tumour early and there was no evidence, from the lymph nodes they had analysed, that it had spread. But the immediate relief that I felt, and was reassured to see that Viv also felt – never having taken her affections for granted – was tempered by the warning from the surgeon as he took her aside and looked her in the eyes: “This is great news for you, but I have to be realistic. It may be seven months; it may be seven years, but it will be back.”

  It was certainly time for us to reassess our life plans. By this stage both Emily and Morwenna were undergoing tertiary education and well on the way to adult independence. The prime motivation for the working fifty year-old male is supposedly to grind out, during the years when he has the most earning potential, the wealth required to support him and his wife through the years of their retirement. Somehow it didn’t seem so important any more. I wrote to my partners, advising them of my wish to drop off the after-hours roster. For much of my working life I had been on duty every third or fourth night. I proposed to trade a substantial cut in income for the opportunity to work a normal 8.30 am to 5.30 pm day. Generously, and in the same spirit they had carried me through frequent hospital absences, Giles and Sid (Daryl had by this stage retired to his farm) acceded to my request.

  Soon after this I passed blood again. My bladder cancer had returned in a more invasive form and I realised that, once again, there was a reasonable chance that I would not be able to achieve all I had intended in this life.

  ~

  It took two long months to recover from my bladder and prostate surgery. Two months of general listlessness, two months of pissing fish hooks, and at last I felt the stirrings of energy to get into the garden, to resume my work as a vet, perhaps even head into the mountains or the bush. But the histology report revealed that it was possible that not all the cancer had been removed. There was a thickening of the bladder wall on the CT scan. It was not something to ignore. The oncology specialist recommended a combined course of radiation and chemotherapy.

  Even after eleven years of repeated monitoring and surgery for the occasional cancers thrown my way, this was the first time that Viv and I had had to face this dreaded prospect. Surgery had at times been scary, at times painful, but surgery is the clean solution if your cancer is in a suitable spot. As long as a tumour can be completely removed before it spreads and colonises other parts of your body, you have a great chance. Chemo- or radiotherapy suggests that the dogs of cancer have slipped the leash, and the dice are loaded that much more against you.

  ~

  At the oncology department the initial waiting room impression was daunting, but I cannot deny a certain Pepysian curiosity. It was new territory for me. How would I cope? Could I rise to the challenge serenely and with dignity? Thank goodness Viv was with me.

  Other patients engaged in desultory conversations. We lounged in our practical grey gowns. There was occasional laughter, occasional exhibits of anxiety and things you’d rather not see or hear. “…I was OK last time until I started on chemo, and then it was like living with the worst case of flu you’ve ever had. After ten days I couldn’t even be bothered to hold a conversation.”

  A sticky island of magazines occupied the centre of the room. In such situations men and women seek the non-challenging comfort of the women’s weaklies, their limp pages pulped by the passage of a thousand sickly fingers. There were alternatives. Perhaps the pristine red covers of The Fourth Labour Government: Radical Politics in New Zealand? Who on earth would want to read that as their fate hung in the balance? Imagine the consternation: being called for therapy just as you were about to discover Geoffrey Palmer’s views on constitutional proportionality.

  Feeling disgustingly healthy, I set off for my first dose of radiation. The team of radiotherapists positioned me according to coordinates pre-determined by an earlier CT scan. The massive rotating head circled the hard bed on which I lay – no time for idle chatter as they retreated to the leaded-glass safety of their control room: they had another thirty patients to process that day. I had spent my whole working life juggling with lead aprons and gloves to protect myself from the cumulative effects of radiation, yet here I was, voluntarily consigning myself to another thirty-two repeats of a massive overdose. The radiographers were unconcerned by my questioning; it’s mostly concentrated in a very small area. They warned me of tiredness, and other possible side-effects: diarrhoea, hair loss (oh well!), impotence (it won’t happen to me!). And so with that age-old optimism, that enables soldiers to “go over the top”, we accept our fates. Back then there was no choice. You got shot if you lingered. Death by cancer would be less humane.

  When the buzzer sounded, did I really feel a wind of deadly beams pierce my flesh and shrivel my bladder? The mind plays games that scientific logic can’t dispel. I chose to regard their risky passage favourably and willed them on. Blast away at the walls of my bladder! Eliminate every dividing cell!

  So much for radiotherapy: chemotherapy is the one that really knocks you. Chemo damages all the cells in your body to some extent. Luckily, rapidly dividing cells, such as cancer cells, are the most susceptible.

  Before starting, the nurse gave Viv and me a thorough pre-amble. Don’t be alarmed when we approach you with full gown, mask and gloves. We don’t know what the long-term effects of repeated exposure to even minute amounts of cisplatin could be to the nursing staff, so we can’t afford to take risks. We ask you to consider all your body wastes as toxic. Flush the toilet twice after using it. Refrain from sexual intercourse for 48 hours, we can’t even be sure that condoms are safe – so be careful! A fleeting thought – not even a careful act of unselfish conjugal charity with the protection of industrially reinforced gardening gloves? We grin at each other knowing, after thirty-three years of marriage, what each is thinking. Part of this is bravado: hair loss, diarrhoea and impotence feature as potential side-effects for chemo as well as radiotherapy. My immune system was going to be stuffed up. We were to a
void contact with sick people and pay strict attention to food hygiene. I was going to feel nauseous. Drugs would be given to alleviate the worst of these symptoms but some of these would also have side-effects.

  Some of the same patients we had seen waiting for radiotherapy were already splayed out in reclining chairs in the chemo ward. As some dozed listlessly others, perhaps earlier in their courses, were more alert. They read, or chatted to friends and relatives. All the while they were hooked up to bags of fluid – often saline first, to lessen the noxious effects on the kidneys – then whatever chemical was being used for their type of cancer. By the end of the day, over seven litres of alien fluids had flushed through my veins, I’d wheeled my drip stand at least a dozen times into the toilet (my apologies, Nancy Mitford, chemotherapy is very non-U and they were not designated “lavatories” on this ward) and my kidneys would ache from their tough work-out. The mere thought of gardening gloves made me feel nauseous.

  It started badly. The student nurse, poor girl, missed my vein a couple of times. Viv gripped my sweating palm in sympathy. Her support reassured me, but this was as much her ordeal as mine. Over the next few weeks she oversaw the gradual deterioration of my body into what we hoped would be a cancer-free zone. How far would I sink? Some of the patients – bald, jaundiced and enfeebled – bore witness to just how low you could be dragged. But it wouldn’t happen to me of course, I just couldn’t contemplate it.

  We walked back to our motel. Many of the patients attending the oncology unit were outpatients, like us. With our home so far from the hospital we had few alternatives but to stay in a motel – subsidised accommodation. During the night I was up several times to eliminate fluid from my over-hydrated body. Being a law-abiding citizen I double flushed each time, as per instructions. Eventually it was too much for Viv: “Do you have to make that fiendish racket every time you get up? What about the poor people in the unit downstairs?” she hissed (in the nicest and most loving manner, of course).

  “I was only obeying my nurse,” I responded. “We wouldn’t want to wake up in the morning and find the toilet bowl had been dissolved by my toxic emanations, now would we?”

  From then on we flouted these particular rules in the interest of harmony in the motel community. If only the drunken louts in the street, the car door slammers and loud, late laughers had been as considerate. St Patricks Day in the student quarter of Dunedin: we cursed St Patrick and his drunken followers.

  For the next few days I was conscious of what I dubbed “the pink smell” – something noxious pervading my deepest essence, so almost unnoticeable yet so very unpleasant. It reminded me of the slightly off-tainted pink juice from a long-thawed joint of beef. It was the faintest essence of nausea. After a while it did get to me. Its constancy wore me down. The gentle persistence of water torture is the closest parallel I can draw.

  Sometime before my bladder cancer decided to spread its wings, a thoughtful friend lent me that book by Lance Armstrong (It’s Not About the Bike: My Journey Back to Life). This mighty competitor, who has won the Tour de France a record seven times, bounced back from a serious bout with testicular cancer. Assertive from the beginning, he took control. He chose his treatment and his specialist. He came out on top. Is this the model to which cancer sufferers should aspire? Can cancer sufferers really fight their way out of it? If they then fail is it due to a lack of moral fibre?

  Lance Armstrong chose a line that suited his character but, in my opinion, no one course is the right one. He was a statistic. A certain percentage of people with his type of cancer, given appropriate treatment, will recover and a certain number will die no matter what their attitude. The same applies to all those who disdain conventional medicine and place their lives in the hands of charlatans, radically change their diets, lifestyle, or religious beliefs. As to the appropriate attitude, there’s a statistical bias. Not many people who fight and fail are motivated, still less able, to record their demise.

  Living in a small country, we haven’t Lance Armstrong’s luxury of choosing from such a large range of specialists. I prefer to assume that, in the main, New Zealand practitioners act in good faith and within professional guidelines.

  Lance Armstrong got the right treatment and was lucky. I say this for all the people who lose their battle with cancer and feel guilty that their failure is for want of a fighting spirit, or for failing to top up with the latest panacea or diet fad that their nearest and dearest tried to foist on them.

  At a more naive stage in our lives Viv and I had briefly flirted with the unpalatable Pritikin diet. However, Pritikin’s basic premise – that if we restricted ourselves to vegetables only (ideally grass), we would massively extend our life-spans – didn’t ring true for me, dealing as I was with farm animals. Ruminants, I had observed, were far from immortal: even without human intervention. Besides, Nathan Pritikin himself died of leukaemia – an inconvenience for his adherents and those who extolled his diet, which had been expressly promoted as a preventative for such embarrassments.

  In the face of recurrent tumours, I have tried to plot a course of serene acceptance, as far as possible. I will not complain, blame and become embittered. If, in the end, I win: so much the better. If I lose, I hope to do so with dignity.

  Week two followed the same format: daily radiotherapy, with Tuesday the dreaded chemo day. One afternoon I heard groaning from a changing cubicle. An old man was hunched over, a picture of misery. He didn’t hear me asking if he was all right. I touched him on the shoulder, amazed at the soft flesh, and asked if he needed help. He looked up, and by way of explanation pointed to the urethral catheter snaking to a collecting bag on his leg. “It’s too painful to move now. Thanks,” he whispered, “I’ll be all right after a short rest.” The accent was heavily Central European: a refugee? A Second World War survivor? Very likely he would have known greater suffering in his past. To see him so sadly reduced towards the end of his life gave me pause for thought. Over the years I could lay claim to more than a passing acquaintance with urethral catheters and the niggling pain and discomfort they cause. My depictions, earlier in this book, of Liston’s tocolosi and Hollier’s itinerarium, were not there by chance – such interferences, for obvious reasons, hold a special resonance for me. Likewise, for my fellow sufferer, I felt deep sympathy. He didn’t look like moving. He looked close to death. I informed the nurse and minutes later Viv saw him being slowly walked back to his ward. A few days later we saw him looking happier, the catheter removed. Where is the balance between pain and gain?

  Amongst the reading matter I had been kindly lent for my medical internment was Shackleton’s Forgotten Heroes (Lennard Bickel). This is a moving account of the team who lay food depots for Shackleton for the final leg of his attempt to walk across Antarctica. They accomplished the task heroically in conditions of great privation. Equipment was inadequate. Lives were lost in appallingly drawn-out circumstances. Men risked their lives for others. This was noble suffering for a cause, fruitless as it eventually proved: selfless suffering that inspires the human spirit.

  In the cancer ward similar prolonged suffering, endured with great bravery, was part of everyday life. For the most part pain and mental trauma was met with humour and good grace by patients and relatives alike. For many there was an end in sight: the hope that one day they would be restored to normal use and function, or perhaps the chance that a few weeks of suffering would buy a few months to support a loved one, or see a grandchild born. For others there seemed no prospect of restoration to a life of purpose and dignity.

  I resolved that should the balance, in my case, tip this way, I would sooner float free, than drag on in the state of prolonged misery to which modern medicine and legal thinking – life at any cost – condemns many.

  The pink tongue of nausea returned and gently lapped at every cell of my being. I developed angina: more tests and monitoring. I was in good hands. I could expect complications. The cisplatin was inhibiting DNA synthesis and denaturing the double hel
ix in every cell of my body… but it hadn’t dissolved the toilet bowl yet.

  Deep down I felt optimism about the future. Viv squeezed my hand under the table. I had a lot to live for.

  ~

  Week three, day five. The greeting card said, “Hang in there, John”. This night I was doing just that. What positives can be taken from suffering? By enduring and overcoming such challenges, we have the chance to grow and become more appreciative, more feeling and more human. There seems little opportunity for most of us living our cocooned Western lives to come to terms with these things until it’s too late. I wrestled with severe indigestion and, in attempting to sleep and take myself away from my discomfort, I repeated a mantra. Slow breaths: inhale… “as I suffer”… exhale… “so I grow”. It seemed to help, and in the morning I was able to adjust my medication to alleviate this side-effect: one of many.

  Gruelling days were to follow, but when I was halfway there and home for the weekend, I picked up a pen. Feeling listless and too debilitated to move from my chair, I lived for the moment, wrote of the moment… “I survey the sun-bathed garden through the window, much as childhood sicknesses encourage endless and detailed examination of ceiling cracks and wallpaper misalignments: endlessly, endlessly. But now I see the richly verdant bay tree, vigorous against the newly painted cream walls. It likes the position I gave it three years ago. Vibrant dark green leaves, in lanceolate perfection, alternate and dance up the stem, packed with the wonderful biological life-force of chlorophyll – the very essence of life on this precious planet.