The Rectal Verge is not a grassy bank close to the Vicarage. It is unlikely to be the scene of an untimely and mysterious death in Midsommer Murders. It is though, a rather difficult to survey and access area of the bottom, where the anus joins the rectum. And where my cancer has decided to live. And from where, today a biopsy was taken.
I say taken, for as the Nurse Endoscopist explained, they were not able to collect as much tissue as they would have liked. If they have not, then there will be a rematch, this time using general anaesthetic. This procedure is called a ‘flexible Sigmund Freudoscopy’, possibly.
So, what was todays adventure all about? I will write a crib sheet for all the examinations, scans, and biopsies that I have had as a later essay. A couple of weeks ago, I had a CT colonoscopy (bottom inflated with CO2, bloodstream dyed with iodine and moved in and out of a special x-ray machine – believe me, it’s not as much fun as it sounds) and this identified the primary site of my cancer as being my rectum. Yes, I have the very definition of bottom cancer! And from today’s experience it may well prove to be a pain in the a**e in every respect.
The Colorectal team’s response to this was to refer me for an MRI scan to help identify the stage that the cancer is at; it is definitely in at least one lymph node but has not been spotted anywhere else. And to refer me for today’s procedure, which I think is to collect tissue so that appropriate drugs can be chosen for chemotherapy. The nurse also explained that at this stage they are not considering surgery and used the term palliative care.
PALLIATIVE CARE! WTF. To me, and possibly many non-medical people, that’s what you give to the soon to die in a hospice. It’s all rather peaceful and caring and ends quite soon. In a box.
I exclaimed my concern to the nurse, and she explained that what she meant was that my cancer would be treated with chemo and radiotherapy and not surgery. At least that’s the plan at the moment. The position of the cancer in my bowel makes surgery difficult, my personal medical adviser thinks that this could result in a stoma (which I think is a stick-on bag that you pooh into rather than using your own bottom) and the groin lymph node is quite close to big arteries. So, crap in my own version of a dog pooh bag and have a big bleed on the operating table? I think we will give the palliative care a go.
Bloody hell, what a fuss and after this we have to sort out the dodgy heart valve.
Today was a very early start. My appointment was for 9.10 at the rather nice new cottage hospital on the outskirts of Bridgwater. This is 25 miles from home on the A39. Allow an hour. But not today. Today the A39 is closed for resurfacing. Better allow another hour.
And allow another hour post ‘bowel prep’ and allow another hour to have some food and to allow 30 minutes between food and prep. 9.10am appointment = get up at 5am. Quick breakfast of cornflakes with milk and honey and a coffee. Wait 30 minutes then bowel prep. This is not so bad. Lay on the bathroom floor and squirt an enema up your bum. Wait a few minutes and then sit on the toilet. Hang around in the bathroom for a while, shower and ready to go just after 7am.
The A39 skirts the beautiful Somerset coast, curving around the foothills of the Quantock Hills Area of Outstanding Natural Beauty. The official diversion is out to the M5 at Taunton. We cross Cothelstone Hill and enjoy an early morning drive through the woods. Allowing nearly two hours and arriving in very good time, despite several vans traveling in the opposite direction and enjoying the same side of the road as us.
Inside the hospital I am booked in and on time taken through to get ready for the procedure. Identity checks and consent forms are completed. There are actual risks to all these procedures. But not tackling the cancer is really not an option. I opt for gas and air rather than an injection. Five years ago, I had a routine colonoscopy and gas and air was just fine.
Then I change into an ‘open at the back gown’ and ‘dignity pants.’ My first time in these and I rocked the fetching blue and plus fours style. I don’t remember these from five years ago and they would also have been good for the recent CTC. They have a convenient rear access for the Nurse Endoscopist to work through and help keep your accoutrements out of sight.
Goodness me, the staff doing this work are super professional and kind. In short, a camera and a biopsy needle go up your bum, find the cancer and scrape some tissue off. Suck on the gas and air when it gets a bit uncomfortable.
But, we have a but. Where is the cancer? The camera goes for quite a long journey, up to the ‘Splenic flexure,’ and has a sneaky peak around the next bend (suck quite a lot of gas and air). Back in the target area, the ‘mass’ (all 2cm of it) is found parked on the verge, facing the wrong way for the camera to see it properly and inconsiderately close to the vegas nerve.
If you have a camera colonoscopy, and are not too squeamish, you can watch the procedure on the same screen as the endoscopist. I saw my own pink and quite healthy looking insides, a corrugated illuminated tube (maybe just a spec of pooh here and there). Then the needle went in, suck the gas and air, and in again, more sucking, and again. I started to feel quite warm, and the team decided I was having a VASO VAGAL ATTACK! And bring the procedure to a close. I have subsequently been told that this simply means I may have fainted. However, lets stick with the dramatic medical terminology and ! marks.
All I have done is lie down for a while and be looked after by caring professionals, but I feel wiped out and very vulnerable. The Nurse Endoscopist explains how difficult the cancer was to see and her decision to look further inside. The recovery nurse provides biscuits and tells me that most of the bowel is nerve free, except the ‘verge’ where the vegas nerve helps tell us when we need to pooh. Bloody stupid cancer sits in the most awkward place.
So, more waiting. Has enough tissue been collected to work with?
Tomorrow is the MRI scan. I don’t think they will be disturbing my vegas nerve, so should be a walk in the park.
Postscript, not enough material was collected.
(9th August 2023)
