PET-CT and Philosophy

I have wrestled a bit with this blog entry, as I did with the last. To what extent should I trouble my readers with the tough news? I've had Catherine here for the last fortnight, a great chance to discuss matters important and unimportant. But in discussing this particular matter, we both agreed that part of the purpose, indeed the primary purpose of the blog, was to let friends know about the state of my health. So let's get the "information part" sorted first.

Yesterday I had a PET-CT scan. Catherine drove me, at 7-15 am, just down the road to the Bowen Medical Centre where Pacific Radiology have a new facility. I am treated like a regular customer by Pacific, placed first in the queue for the 18F-labelled glucose produced that morning in the Wellington cyclotron. In the past, when the isotope was produced in Melbourne and flown over, decaying through a a couple of half-lives at least, I used to ask if I could go early in the queue, figuring that I would get more sensitivity with highest activity. Now that it is locally made, it really doesn't matter. But, rather than protest that my idiosyncrasy no longer applied, I accepted their insistence that "we know you like to be early in the queue", along with the early morning rise that it implied, two hours of advance water drinking being specified.

The scan was quite an ordeal this time. It is necessary to stretch both arms back behind the head during the 20 minutes of the gamma ray detection as the gantry steps through successive slices. This is quite a painful position for me now, and as the scan started, I wondered if I could sustain myself through it. I did, partly through counting breaths, about 70 per slice as it turned out.

By the afternoon my surgeon had already rung me to discuss the results in broad terms, though I hadn't by that stage seen the report. This morning the hospital rang to advise me of an appointment with my oncologist in two days. I was impressed with the speed. Today I received the report in the mail. It was a hammer blow against hope, the final conclusion reading,

"There is evidence of quite widespread recurrence within the peritoneal cavity involving peritoneum, liver, bowel, mesentery and anterior abdominal wall. There is also more extensive involvement of the xiphisternum and increase in size of the right lower (lung) lobe mass."

In short, I have extensive disease now, which has definitely spread to the lung and liver. The various tumours cause me quite a bit of discomfort. The xiphisternum tumour causes me to have to sleep in a sitting position since lying on my side or back compresses the chest resulting in a buildup of pain. I am being well served by the health system with extra support from the district oncology nurses and occupational therapists. Where I go next in terms of treatment, perhaps radiotherapy to reduce my largest tumour mass, or some further chemotherapy for systemic reduction, will be decided in a few days. It is essentially palliative.

So to the matter of philosophy. How am I to deal with the next phase? It is different because optimism is harder, time horizons more immediate, and my body continuously reminds me of its concerns. To be frank, I have not yet worked this philosophical problem out, but I expect that I will.

Down at the radiology clinic there was an older man from Hastings who had travelled by bus the day before, and stayed in a Johnsonville motel overnight, so that he could follow me into the PET-CT machine. Catherine chatted to him after I had been called. His condition was considerably more painful than mine, he was alone, and he was worried because he had needed to spend his limited financial resources on taxi fares and part of his motel bill, the health system having not fully provided.

I have no money worries. My daughter was able to be there with me in the clinic. My essential medical services are but a short drive away. I am not alone. More than that, I am blessed with having the exceptional love and support of Miang. I have the care of family and friends.

The truth is that I am very fortunate in almost every aspect of life, and what I face now is part of what we all face in this journey, in our own peculiar and individual ways. As regards this blog, what I will try to do, dear reader, is to write more about my thoughts and hopes, than about the rather self-absorbing details of my physical condition. And if there is good news, I promise to let you know!