Radiation Oncologist 2

This morning Al drives me to South Brisbane where I have my planning meeting at Southern Radiation Oncology Services.

I had a deep but unfulfilling sleep last night and wake feeling very dizzy.

In the car, I realise I am exhausted and wonder how I am going to get through the rest of the day. I'm meeting my sisters later, for a movie, maybe lunch but I feel disoriented and I'm having difficulty keeping my eyes open.

We arrive on the dot and Al drops me off as there is no point him being there.

This place is to become very familiar to me over coming weeks and is located in a street where roadworks are in progress so it all looks a bit crazy.

People receiving treatment and their taxi services receive free parking as part of the deal so I suppose that is one good thing.

I present myself at the front counter and am directed downstairs to Level c where treatment facilities are located.

At another counter, I'm given some paperwork to fill in and ask the lady how long I'll be. To my dismay, she says 'one to two hours'.

I repeat "One to TWO HOURS!!" and she clarifies, "Just over an hour." Okay that's better.

Then I'm directed to the nurse named Bronwyn who obviously doesn't remember me (I'm just another bald head in the crowd) and says exactly the same thing she said last time: "Bronwyn, spelt the same... there aren't a lot of us around."

She's lovely and friendly and, to be honest, a little disheveled like a lot of these wonderful hard working nurses I meet. She is hard not to like.

I'm handed another form and dutifully go and sit in the waiting room. I make myself a cup of tea and fill in the paperwork. I've brought my Kindle so bury myself in Keith's life story.

About 40 minutes since I arrive, I am called in and am taken through a sliding door immediately abutting the waiting room. I have no idea what to expect.

There are two nurses who lead me through, an older one called 'Mary' and another whose name tag I can't read, but she's young and pretty.

They are friendly and engaging and lead me into a room where there's a huge machine. I'm told I'm to have a CT Scan, something I've never had before but I think Harry had one years ago when he had a bad infection.

The first thing they do is produce a small digital camera and they take a picture of me.

Next I have to undress. I'm wearing a dress which is the wrong thing to wear as the bit they need to scan, obviously, is my chest.

There's some argy bargy as I learn there are no changing rooms here so they just hold up a sheet while I disrobe and take of my bra. It really feels odd because I'm standing in a room with two strangers under an unforgiving neon light.

Part of the CT Machine is a bench on which is a white sheet. As I'll discover, the sheet assists the nurses in making the small adjustments they need in positioning you correctly.

I lie down and I have to say, it's really quite uncomfortable as my neck is arched over this hard bit and my bum is wedged against another hard bit to stop me sliding down.

I have to take off my gold necklace but can leave my gold earrings in.

All through the process, the nurses do a good job of telling me exactly what is happening, although I have to ask questions to find out why.

Once I am properly positioned, they go to either side of the machine and read out some measurements indicating, I suppose, where the geographical positioning of my torso.

As if by magic, my radiation oncologist, Dr Cox materialises. I give her a warm greeting but there's no small talk as a green marker is produced and I feel her making some marks on my chest. She draws a dotted line marking a parallelogram, ending with a flourish.

Just as quickly as she materialised, she dematerialises and then the younger nurse is placing a piece of clear plastic over the area. I'm told they are tracing the marking.

I ask why and it's explained that this provides a templated outline for some gel material that's to be fabricated and will be placed over that area so it matches the shape.

Then the nurses place stickers on the area, marking entry and exit points I guess.

There's a lull in the activity as we're waiting for this gel stuff it seems, so I ask Mary what the difference is between "radium" treatment and radiotherapy as I hear a lot of older cancer patients talk about this "radium".

While we wait, Mary explains that radium used to be the treatment they used in the old days. They were part of what was known as 'live materials' treatment involving either radium or cobalt. She says it used to be very laborious and time consuming for the ladies, especially when the substances were approaching the end of their half-lives. Interesting.

A few minutes later, the said gel material is brought in from a room I can't see - it's like magic, abracadabra! - and it's placed over the area that Dr Cox has marked out. Mary shows it to me and I see the shape is quite thin.

Now I'm ready to be scanned and the bench moves slowly under the white arch of the machine.

"You must work with some large women," I observe.

"Oh yes, and some big men. You're a lightweight by comparison," the younger nurse says.

"Has anyone ever got wedged here?" I joke and Mary says she did. We have a laugh over that one.

Now I'm all set and the two nurses leave the room, telling me not to move and that the procedure will only take a few second.

They're right. It does actually only take maybe one, maybe two minutes.

The bench I'm lying on moves slowly back and forth under the white semi-circle that arches over me. There's a kind of glass strip on the edge and it looks like little laser lights are chasing each other over this.

Unlike the MRI scanner, the machine is quiet.

"All done!" I hear as the nurses re-enter.

The last step in this process is that I am to be tattooed! Mary says I'll feel four pin pricks

"Can you tattoo a heart saying Mum?"

"No, I'm not that artistic," says Mary. "Now the first one will hurt the most because it's near your sternum."

She's not kidding! I feel four sharp jabs.

"I can't believe people put themselves through this on purpose." I say. "The only tattoo worth getting is the one you regret."

And so it is done. Another plastic drawing is made of the area and I can now get changed.

Soon I am speaking to Dr Cox in the waiting room (Yes, it's odd isn't it? She'd discussing my medical details in a public place.)

My first radiation zap will be on March 19th.

She goes through the kind of cancer I have (multi centric, lobular - she describes it as "the insidious kind")

She goes through all the side effects I can expect - in my case mainly skin irritation and fatigue.

At this point I receive one piece of good news. I thought I would be radiated from the front, but Dr Cox says she's going in from each side (sounds like a battle manoeuvre doesn't it?)

This means that my heart will not be affected.

Dr Cox also says that, as I have a small frame, the treatment will not be as toxic to me (a smaller area is involved) So you see, there's another good thing about being on the slimmer side.

Because I'm not that fat, it means she can get access to the area without affecting my ticker. It also means I don't get wedged in CT Scanners!

I ask her if it's likely I'll be able to undertake any sport during treatment and explain my desire to return to refereeing.

And now I get the second piece of good news. She strongly encourages me to get back to my normal routine as quickly as possible and, if that involves activity, all the better.

After Dr Cox, I am then lead into another room by a lady called Narelle who has to tee up my appointments. I have to pick a timeframe, rather than a specific time slot. The mornings are not available as they're left for ambulance, Gold Coast and other entries. So after some discussion, I choose the 12 noon to 3 pm time slot.

Keep in mind, I have to drive in EVERY day, for treatment that goes for 15 minutes and allowing some time for sitting around.

It's kind of depressing, the way this treatment will suck time. But I suppose, I am giving time so I can buy some time. That's one way of looking at things.

Now I'm all done! My sister, Nicky picks me up and we drive to the Dendy Cinema at Portside.

We have to wait for Fiona who has gone to the wrong cinema so we buy ourselves some groovy shoes that are on sale.

My sister Fiona joins us and we end up just going out to lunch. It's one of life's pleasures going out with my sisters. Really, we can talk about anything.

So by the end of the day I have pepped up because, at the back of my mind, I'm focusing on the positives.

My heart will not be affected! I can referee!

Really, how much better can it get?

Radiation Oncologist

Exactly four months since my initial diagnosis, with my rescued and nicely manicured wig in place (thanks to Maria and her sleight of hand), Al and I drive through a rainy Brisbane afternoon to meet my 'radiation oncologist' for the first time.

I've rescheduled this appointment no less than three times so I'm glad to finally be meeting her.

The Radiation Oncology Mater Center (ROMC) is directly opposite the Mater Mothers, and I can't help observing the juxtaposition of birth against a process generally associated with dying.

Located in a fairly old red-brick building, I present myself at the front counter and afterwards, go to sit in a virtually empty waiting room. I don't know how long this is going to take so look around for some reading material.

I am quietly amused to note the stack of novels on offer. Just how long do people have to wait here? A cursory inspection reveals that, thankfully, it's more a 'Mills and Boon' rather than a 'War and Peace' kind of waiting period. The tea urn, microwave and television also do not augur well, suggesting one should get comfortable.

It isn't too long though before I'm called in by Dr Judith Cox. She's older than I had imagined, a lady with a trendy short cut who immediately strikes me as being open, kind and friendly.

In what passes for her office, there's a little bit of a kerfuffle as we realise that several pieces of information are missing from my file and she's not 100% on the details of my case.

She doesn't know I've had a mastectomy, and then, I can't remember if I had one or two lumpectomies.

As we wait for the missing paperwork to be recovered, I launch directly into my pressing concern: whether I can wheedle my way out of radiation.

I talk about all my other friends with radiation, Kim who hasn't had chemo and I don't think she's had radiation either, Chrissy who didn't have radiation, Cathy who didn't have chemo, Mary who didn't have a mastectomy. Why do I have to have all four, including the hormone treatment? I'm going to have the other breast off. I'm pitching as hard as I can with Al also offering up any arguments he can.

You see, if I'm to have radiation, that will add weeks to my treatment.

But most vexingly, it will mean that I will have to wait six months until I can have a reconstruction and then, my options will be severely limited because of the extent of damage radiotherapy can do to your breast tissue.

The business of getting on with my life will be severely retarded.

As it is, initially, Dr Cox thinks I've only had one lumpectomy and she leads me to believe that perhaps radiation is unnecessary.

I can't believe my luck!

But when Dr Cox says she needs to see the results of all my procedures before she can provide a definitive answer, my hopes are quickly dashed.

I am interested in what the pathologist had to say about the results of my mastectomy: "The sections show residual classical lobular carcinoma in situ... There are three foci of residual invasive lobular carcinoma in this area measuring up to 2mm. There is extensive lobular carcinoma in situ throughout all quadrants of the breast. Further 2mm focus of invasive ovular carcinoma is present in the lower inner quadrant. The invasive and in situ carcinoma appear well clear of margins of excision. There is no lymphovascular invasion. There is no invasive ductal carcinoma identified. No lymph nodes are identified..."

To a layman, it would appear that surely, all is good? The margins are clear. The lymph nodes are not involved.

But Dr Cox is concerned about the occurrence of carcinoma in the inner quadrant which is the area closest to the sternum.

She produces a pen and starts writing in my file. She adds up the findings in the pathology report for each procedure I've had so far and it's close to five centimetres when she's finished.

I've already been through this with Dr Lambley so I'm not surprised.

Dr Cox says that my breasts are not particularly big (really!) which means the occurrence of carcinoma closer to the chest wall is a concern.

The verdict, alas, is that she strongly recommends radiotherapy. In fact, the look in her eye suggests I'd be a fool not to go through with it.

At this stage, it looks like five weeks with around 25 shots to be given in that period although this is still to be confirmed.

I ask her about side effects and she mentions skin changes in the treated area.

I ask her about fatigue and, apparently, if you've had chemotherapy, you won't notice any difference. (The fatigue can be chronic if you only have the radiation).

Dr Cox says I'll need to present next month for a 'planning meeting' and then, I'll commence radiation three weeks after my last chemo.

Apparently there is presently a 6-week wait for access to this service but I'll be sweet as I've come in to see her early enough so I'll be in the queue.

I can't say I'm excited. In fact, I feel as flat as, well, half my chest. It sucks.

That's five more weeks of being treated like a 'patient'. Five more weeks of hospitals. Twenty five more days of sitting in waiting rooms. An extra 50 hours minimum of travelling.

I know I should be grateful. Yesterday I spoke to Eddie who is doing some landscaping for us. He wanted to know about my bald head so I explained my situation.

Eddie used to be a bodybuilder. But he was also a smoker and you can tell from the raspy voice and the cough. (It's funny imagining him pushing weights and stopping in between sets for a drag on a Winfield Blue). Eddie had radiation and chemotherapy for both thyroid and pancreatic cancer he tells me. He received his treatment at the Atomic Research Centre in London. As a result of his chemo for thyroid cancer, the poor bugger lost all of his teeth. They fell out one by one. He was in his early 50s at the time.

He showed me his teeth and tapped them with a finger. "All false," he announced.

"Well, here you are live and kicking so I guess it's all worth it," I said.

"Yup," said Eddie. "I've got nothing to complain about."

"Yeah, we're really lucky, Eddie," I replied.

I'm lucky I have such great support - from medical staff, from family, from friends.

I'm lucky in so many ways.

Today my race simply got a little longer.

I'm just going to have to dig deeper for that second wind and hope like hell that when I cross the finishing line I won't be completely cactus.

What is there to do but buckle down.

Diagnosis 3

It's Sunday morning in Melbourne and I'm just about to enter a packed little cafe for breakfast with Lyndal and Garry. (We're down here in part to see Lyndal's exhibition - she's a wonderful sculptor and I'm one of her biggest fans.) After breakfast, we are due at the Tutankhamen Exhibition at the Melbourne Museum. Al's a great Egyptophile and this is the "most impressive collection of Tut artefacts ever assembled" out of Egypt.

The night before was a lame endeavour in kicking up my heels - three glasses of wine and relatively early to bed. There was no strip poker. No wild orgies with AFL Footballers. And no tattoo to regret in the morning. Al didn't even moon anyone.

Then my cellphone rings. It's a 'blocked' number and turns out to be Dr Lambley. I suppose there's a small part of my brain that is a little alarmed. After all it's a weekend. What's so urgent?

Dr Lambley explains that the results of my second lumpectomy have revealed further progress of the cancer. He says that with my type of carcinoma, unfortunately, lumps are generally not present. In other words, these suckers are hard to detect.

He tells me that he would like me to have an MRI to determine just how advanced my situation might really be. He says further surgery may be needed and immediately, I know he means a mastectomy.

I explain my chemo starts on Thursday and can I wait until after all of that if I need surgery.

He says that he's pleased I'm having chemo soon - it sounds like his preferred option - but it's important the MRI is done before treatment so that we can get a good picture.

By the time we arrive at the Tut exhibition, dark thoughts are palpating at the edges of my consciousness.

When I learn that King Tutankhamen died suddenly (and inexplicably) at 19, of course, I think about the lifespan of a man, the time we have on earth, the contribution that we might make.

King Tut's father, Akhenaten died at 17 but his grandfather made it to the ripe old age of 30. Look at what this dynasty achieved. 3200 years later, humankind marvels at their achievements.

As I stare at the vessels that once contained the mummified organs - stomach, lungs, intestines, liver - of Tutankhamen, I think about what I have achieved in my life. I think about becoming a part of ancient history. What sort of lousy legacy have I left? Some amateurish artworks, some second-rate poetry and a manuscript. I can't see Howard Carter getting too excited about that lot.

After the Tut exhibition, we walk down to the National Gallery of Victoria to see an exhibition called 'Vienna'. It's educational. I hadn't known about the "Viennna Seccession", including Gustav Klimt (who died at 56), and an artist I've never heard of, Egon Schiele (who died at 28).

While I am taking it all in, the exquisite works, that's all I'm processing: when they were born and when they died.

After we leave the exhibition, I find my conversation returning to Dr Lambley. The issue he has raised, about the need for a mastectomy, is a hound at my heels.

You see, even though they're somewhat large and flabby, I'm rather attached to my breasts. It's a lot to get my head around quickly - the idea that Nicky and Paris (as I call them) may be wrenched from my bosom and replaced by Silicon Sally and Saline Samantha.

Still, already, I'm working out the timing of things. When my chemo will finish, when my breasts will come off, how long before I can get back to my beloved soccer field? I'm trying to be practical, visualising my life over the coming months.

Al can't work out why the operation should not happen before the chemo. We argue about the logic of it.

We go to the airport where I'm mindful of having promised myself some shameless lush-like behaviour. I didn't even manage the Margarita I had wanted. As a last ditch effort, I buy myself a packet of Maltesers.

On the plane, I make the mistake of reading a book on Post Cancer Nutrition. Alas, it seems that even sugar has been demonised by those who believe diet is at the root of everything - and I feel guilty about those Maltesers. Damn it.

After we return to Brisbane it is evening and I decide to call Dr Lambley back to clarify my situation.

Al asks him why I can't have the operation first as isn't the chemo done to just do the mopping up.

But my surgeon is adamant that is no evidence to suggest that doing things in either order is more effective. However, if I have the mastectomy first, it may be 2-3 weeks before I can start chemo.

You know what the subtext is: I don't have the luxury of time.

So my thoughts return to Tutankhamen. I may not be a Pharoah or a Living God, but I nearly 30 years on him. Surely, that has got to be a plus.