You die the first time when you get the initial diagnosis. Cancer. That’s it. Out of nowhere, unexpected, inexplicable for the most part. One day you’re healthy, with a few curious issues maybe that you don’t take too seriously, but healthy. Nothing that requires medical attention, and it’s been like this for a while, but you finally go have these curious issues checked out. A couple of days later you sit in the hospital and chat with a doctor with a serious face who says, I’m sorry, just a few times too many. I died my first death last week on Wednesday. Adenocarcinoma of the colon.
Today, I died a second death. The results from the PET-CT and the final histology were ready in time for the tumor board to discuss my case. My new doctor, a junior chap with the dour demeanor, repeated the story about the malignantly thickened colon wall and the suffering lymph nodes. This I knew. He said that the lung was most probably and the liver most definitely clear (at least for the moment). Flucha perked up and could hardly contain her excitement. It’s all good, it seemed.
The doctor’s summary of my condition continued. There were a handful of sizable metastases in the peritoneum, a lining of the abdominal cave that holds things together in there. The term was peritoneal carcinomatosis, and there was no way of putting a positive spin to this. The doctor spoke of a slim chance of a cure and the focus on quality of life instead of survival. It was a brutal comedown for Flucha. I remained in a daze. What am I doing here?
The doctor continued with a bit of cautious optimism. It’s highly unusual to have metastases in the peritoneum and nowhere else. I’m a bit of an odd case, in the company of a few others who had surprising success with a rather harsh surgical treatment followed by aggressive chemotherapy. The surgery removes the primary tumor and the afflicted lymph nodes and then scrapes out the larger metastases identified during the PET-CT and the smaller ones discovered in situ. Directed chemotherapy might then be able to curb or kill remaining cancerous cells. This is called hyperthermic intraperitoneal chemotherapy (HIPEC). It doesn’t sound like my kind of pleasure cruise, but there’s a slim chance things would work out fine in the end.
There’s also a chance, and this will be the topic of a consultation with surgeons that I have at the hospital tomorrow, that this kind of treatment is not applicable or sensible after all. Tomorrow I might die a third death. If the visible manifestations of my cancer cannot be removed completely or if they’re simply inaccessible, HIPEC might not be possible. In this case, I’d just be sitting around waiting to die in the most painless way the doctors can manage to cook up.
For the moment, I live in honest disbelief. This cannot possibly have happened to me. Someone must have exchanged the names on all the samples and files that are circulating in the hospital. Maybe there’s someone else with my name and birthday, a guy with a cancerous gut and little time to live. I’m healthy and happy and fit and ready for decades to come. I want to see my children grow and mature. I feel all right.
I’m definitely not all right. My body is fucked up. A little part of it betrayed me, subverted the peaceful order, and is on an inexorable path towards mayhem. I will have to accept that - but if I do, what do I do with that acceptance? Can I use it to draw extra strength to fight the cancer? Can I use it for energy to avoid despair and self-abandonment? The downward slope is still gentle. I will need to figure out how I can keep myself mentally in shape when my body falls apart. Screaming fuck this off the top of my lungs and shaking my head violently is not going to be enough.
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