However, each time I return to the Centre of Excellence for a follow-up consultation I find that I feel quite unreasonably frightened. This is rather nonsensical in view of the fact that I had absolutely no sense of fear at all before the operation itself. Although there are no symptoms of any recurrence of the tumour locally, and nothing in a range of blood tests to suggest any distant spread, it is with a sense of rather childish dread that I enter the consultant's lair. As we now live some 160 miles west of London it is quite a day out keeping the appointment. This lends it an even greater sense of occasion than the 20 minute train journey from Essex before we moved to rural Devon.
It is a curious sense of fear though: within the few minutes of examination and chat, it evaporates to be replaced by an overwhelming sense of gratitude that makes it difficult to restrain tears of relief. Whether 'ordinary' patients (rather than doctor patients) go through the same series of emotions had never struck me before. I think, on the whole, it is harder knowing the statistics (and I'm already well ahead...) and the possibilities for the future. The three-year survival rate appears to be well under 50% for oesophageal cancers; but though mine must have been very slow-growing, it had already spread to surrounding structures in the neck. With everything between chin and sternal notch removed except for the major vessels, the anterior surface of the spinal column is just under the skin... a curious sensation on palpating the neck. The whole area was subjected to 25 days of radiotherapy - a procedure which hopefully stopped any remaining tumour cells in their tracks.
I know I ought to be entirely reassured by this follow-up business, but realism dictates otherwise. Cancer is like that: it hangs over every little episode of 'ordinary' illness ever thereafter. "Is this it?" springs to the forefront of the mind when anything out of the ordinary crops up. The difficulty lies in distinguishing between realism and pessimism here... Of course I believe the specialists when they tell me all is fine; yet... the knowledge that there may be remnants of the cancer still there with its cells still busy dividing chaotically and spreading themselves around the body, preys on the mind somewhat. Every little ill can be ascribed to its relentless progress.
Most days, like most people, I am perfectly well. I still climb Cornish cliff paths faster than my wife; in the manner of a 'tubed' racehorse there is a much reduced 'dead-space' with a tracheostomy which has a striking effect on respiration under the stress of exercise: and having the ability to sink a pint of beer without the effort of having to swallow, I actually have some advantages over mere mortals. I can also speak non-stop without having to pause for breath - it makes no difference whether I am breathing in or out.
Do I miss my voice? It's curious, but when my wife asked me this very question, it took me but a moment's thought to answer 'no'. It is far less of a handicap than I had originally anticipated. Use of the 'Servox' speech buzzer gadget is almost entirely satisfactory - so long as the ambient noise level is reasonably low. I bumped into the only other patient in this part of rural Devon with a similar history to mine, in the midst of a local agricultural show. Others in the crowded marquee must have thought they had come to a Dr Who convention as we two buzzed away at each other. Our respective wives thought it was hilarious.
Surprising embarrassments do happen as well. A nice luncheon party hosted by an ex Eton Dame (we have people like her in our little village in Devon...) got increasingly hilarious as the wine flowed. Then there was some commotion with her dogs and she let out a most extraordinary whistle. Completely without trying, I almost did the same - not really possible with a tracheostomy - and was so astonished that the little filter on the trachy-tube flew out and landed with supreme accuracy in the sauce Mornay being served with the salmon. Nobody was particularly bothered: I ate most of the sauce anyway.
A columnist in one of the weekend supplements writes eloquently and with good humour of his experiences with cancer. I find that I share many of his sentiments about the disease. There is the fatalistic thought when buying anything: "...do I need these new shoes for only a couple of months, or shall I make the old ones last out." And: "...is there any point in making arrangements and marking this in the diary for three months ahead?" Again, this is the perpetual argument between realism and pessimism. It's very difficult to draw the line...
It helps to write about it all. It is curious indeed that this disease has shades of taboo which until recently were only accorded to venereal disease and its 'Special Clinics'. The experience of being 'a cancer patient' colours relationships with everyone: although old friends express their sympathy in cards and letters, somehow, face to face, the subject is skirted around; almost as if not mentioning it will make it disappear.
But again: it doesn't disappear. "How long will we keep attending for follow-ups?" "For ever..." leaving unspoken the thought which hangs in the air - "until you die."
All is not pessimism though: this particularly slow-growing tumour may have been growing for many years before the symptoms made themselves known. It may therefore be many years more before any remnants surface: so I may yet shuffle off this mortal coil without untimely haste.
I trust that this series of articles, written from the perspective of suddenly finding myself a 'doctor patient', may have been of equal interest to those of my colleagues who find themselves in the same predicament, and to those who, like me, always considered themselves immortal.
After all: "Doctors don't get ill do they?"
Dr Alan G. Gray