Saturday, January 28, 2006

The Consequences of Having Cancer

So what are the consequences of having cancer? Well, to start with, I've started to reach for the soy sauce, a salty condiment which has absolutely none of the health benefits of soy-based products such as tofu and natto ("natto" being, if you don't know, rotten soy beans eaten by some Japanese people, but not by all).

Many years ago, when I was part-time military in New Zealand's peacetime army, I did an advanced medical assistant's training course. Not all that advanced, but we did get to do interesting things such as to go to the morgue and watch an autopsy. And one otherwise unfilled gap in the timetable ended up getting filled by a video on dietary salt.

This video convincingly made the case that moderating your lifetime intake of salt will reduce the risk of having high blood pressure in old age. It convincingly linked salt to high blood pressure, giving the Japanese as an example.

There is too much salt in the Japanese diet, the worst offender being a very popular soup called miso soup, which is absolutely laden with salt, and which some people eat on a daily basis. Although Japanese people tend to live long, part of the problem of high blood pressure in old age seems to be directly attributable to dietary salt.

Freedom fries (or, in traditional British English, "chips", not to be confused with "potato chips") were a regular feature of the messhall diet, much to my pleasure. (I spent two years of my youth living in a student hostel where the food was even one step down from hospital food, which takes quite some doing, and, having survived that experience, I never had any complaints about army food.)

Up until that day, it had always been my habit to load salt onto my fries, but, having made a decision, I didn't.

Bereft of salt, my meals initially seemed a bit tasteless, but, after persisting for some days, I found (truth in advertising) that the flavors of the food started to come through.

I gave up putting salt on my food entirely, used no salt in cooking and shunned soy sauce, which is basically liquid salt.

This most certainly did not result in me being deprived of salt, because the modern diet is saturated with the stuff, and it typically turns up in, amongst other things, bread, which I eat on a daily basis, often in large quantities.

During my first encounter with cancer, I cleaved to a healthy diet and maintained my salt-moderate approach to diet.

But now, when the cancer seems to be coming back for a second shot at me, I find myself thinking, ah, what the hell, and reaching for the soy sauce.

My mental metaphor for my first round with cancer was that I was strapped into a rocketship and launched on my trajectory, and that the trajectory was out of my control. The arc of flight would take me where it would, and I had no option but to go along for the ride.

My metaphor this time is different. I'm in a burning airplane, with no way out, and it's coming in for a crash landing, the survivability of which is uncertain.

So what does it mean in practice?

Well, in the short term, it means I get to dine more often with family members, drink more wine than usual and buy more chocolate than usual, a lot more chocolate, not the little bars but the really bit ones which have been scientifically designed th meet the needs of middle-class famine relief.

At one of these family meals, which took place at my sister's place, the invited guests included Helen, who was one of my superior officers in those long-ago years when I was a member of a military unit.

It was a medical unit, first called One Field Hospital, and then, having been downsized and combined with a field ambulance, retermed a medical battalion, an odd beast which I don't think you will find in any standard dictionary of military terminology.

I never got to go to war with this unit, but I did get to go on a medical mission to Tonga (one task of the mission being to do a survey on some kind of disease, I think possibly typhoid), and I did get to go to Fiji to provide medical cover for an infantry unit doing jungle warfare training, and I also got a trip to the Solomon Islands, the mission being to inject the local population in a certain area with long-life penicillin to eliminate yaws.

(Yaws is a disease which spreads by social contact, such as the skin-to-skin contact of kids playing together, so it spreads very easily through a society, and the medical wisdom of the times was that, after the incidence reaches a certain percentage, the correct approach is go give everyone the one-shot penicillin cure, without worrying about who is or who is not infectious, which made it a suitably mindless exercise which could be successfully be completed by a part-time military unit going out to the Solomons in two waves of, if memory serves, two weeks each.)

Anyway, Helen was looking at a copy of CANCER PATIENT, the medical memoir I wrote about my first encounter with cancer, and she was surprised to come across the passage on the big fire near the Waiouru military base.

I remembered the fire during my first stay in hospital because, having been pressed into service as a radio operator in the employ of the fire chief, I came down with hypothermia during a long night ride in the uncovered tray of a four-wheel-drive vehicle, heading back to an improvised camp.

That was my first identifiable brush with death, though fortunately my condition was not too bad by the time I reached the improvised camp, and, after a few hours in a sleeping bag in the back of an ambulance, I started to warm up.

Helen was also at the Waiouru army base at the time of the fire, and what she told me, what I had not realized until then, was that a number of soldiers ended up in hospital being treated for hypothermia.

Waiouru is up high and it gets cold, and these troops were drenched with water from the monsoon buckets that the helicopters were using to douse the flames.

(I have no recollection of having seen any helicopters that day, though it may be that we had rations delivered by helicopter and that I have simply forgotten about it. Such was the huge scale of the fire that, even though I was with the fire chief, and was, theoretically, in the middle of the burning area, I could see nothing on fire and could not even see rising smoke anywhere in that hilly landscape.)

Out of curiosity, I asked Helen if that was the Waiouru camp at which a certain number of the higher-ranking members of the unit went and raided a rival medical unit.

(I did not get involved in this kind of mischief, because I was a member of the lower ranks, which were, I think, somewhat more disciplined. I never got higher than sergeant, a rank I held only very briefly, right at the end, not very long after reaching a major decision junction in my life: do I become full-time career military, or do I not?

Even back then, I was long in the tooth by military standards, but I was an army medic, I had done courses, had worked in military hospitals, had been on overseas trips, and, of course, could do the standard stuff like shoot rifles and throw grenades, and they were short of medics so, after I had applied, they came back with an answer, which was, yes, they had a job for me, if I wanted it.

Instead, I turned it down, and, some months later, quit the military entirely, and, the next year, 1989, took a year off and traveled: Singapore, Malaysia, Thailand, Nepal, India, Greece, Turkey, Hong Kong and Japan.

Being, then, low in the ranks, I never got involved in the trouble that the officers did.

(I have no idea why, after one parade during our Tonga deployment, the commanding officer chose to march the officers away and bawl them out when they were some distance away from us, and we could not overheard what was being said. But I understand that they did get a good chewing-out, and I presume they deserved it.)

I ran the second-hand version of the story I'd heard. Allegedly, some of the senior members of our unit had raided the tented hospital encampment of our rival, a military hospital under canvas, very much, in outward appearance, like the Korean War tented hospital featured in the American TV show Mash.

The tented hospital was treating real patients and one of the patients woke up late at night and, very perturbed, called out, "Nurse, nurse! There's someone under my bed!"

And so, according to the story I had heard, it was, and it was a certain warrant officer, whose name I have conveniently forgotten.

And apparently this warrant officer wriggled out of it by giving name, rank and serial number, but not his name, not his rank (the rank he gave was an air force rank) and not his serial number, either. (You don't get to be a warrant officer unless you're competent.)

But the story Helen told me was different. No, the people under the beds did not get caught, because the idiots at 2GH never thought to look under the beds.

Then Helen told me the story of a certain officer -- I don't recollect that she pinned a name on the woman during our conversation -- who was in on the raid.

This female officer, who I'll call Captain Boadicea, was at a very formal military function in her best uniform, splendid and immaculate. And, having got splendidly drunk (a habit which, I believe, the New Zealand army was at the time trying to moderate, with partial but obviously not perfect success) they decided to go out raiding.

The target was 2GH, Two General Hospital, based down south, at or near Wellington, New Zealand's capital city.

The 2GH people had used mechanical diggers to dig a huge hole about ten feet deep (that is, roughly three meters deep) in the land on the western side of the Desert Road which runs through the Waiouru military training area. They had set up their entire tented hospital in this formidable military stronghold and were feeling very, very proud of themselves.

So. They were fair game, right?

To infiltrate to the enemy encampment, Captain Boadicea and her comrades crawled on their hands and knees through what was described to me as "a place with radios", which I can only presume to have been the top-secret electronic spying base which the navy maintained on the land to the east of the Desert Road. (Not so top secret because you could see it from the road.)

Having crawled through a lot of wet grass on a very cold night, they easily penetrated the 2GH security cordon and got inside the hospital.

Then a couple of them got discovered walking round the hospital, and were challenged, and, in the confusion, an over-excited sentry discharged a rifle, which, fortunately, was loaded only with blanks.

Those under the beds, true to their military training, reacted to gunfire by hugging the ground and staying quiet, very quiet. Mice don't come any quieter.

And, because the 2GH mob were ignorant of the guile, the military tenacity and the sheer numbers of the invading force, they, having caught a couple of the culprits, congratulated themselves on having achieved a magnificent victory. And the survivors crept uncaught once everything had settled down.

There was, apparently, a BIG fuss about it all the next day, the fact that a rifle had been discharged without proper authorization elevating the profile of the incident. But Captain Boadicea and most of her companions got away with their mischief.

This is the kind of incident that military training can involve you in, so you can see why George W. Bush was wise in sensibly avoiding most of his.

Helen's big news of the night was that she had her long-standing female companion had chosen a propitious date for their upcoming marriage, the provisional date being February 10. (My mother, getting a little bit technical, says they're going to "enter a civil union", but, as far as they're concerned, they're getting married.)

So these, then, are the consequences of cancer for me, the immediate consequences of cancer (possibly) coming back: I get a little reckless with the soy sauce, hit the wine when it's on offer (but not as hard as members of the officer class -- I've never had a hangover in my life, and those I've written about are modeled on reports I've received from survivors of the Alcohol Front) and eat quite a bit of chocolate.

And start thinking about going back to hospital for more chemotherapy.

If it does work out that way, then I figure I can afford to splash out for an iPod (my culture does not require me to buy my own coffin, so I don't have to save money for that) and I'll load a few talking books on that (my eyes are messed up and the spectacles I have aren't much good, so, while I can read, I can't really read for pleasure), and I'll sit in my hospital bed, listen to my iPod, and write poems on whatever topics come into my head, such as, perhaps, the character-forming influence of military discipline or about George W.'s glorious wars on cancer and poverty.

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