In 1978 the American writer, Susan Sontag described in her book ‘Illness as Metaphor’ the language people at the time used in relation illnesses, particularly cancer and earlier TB.
When I was young, several of my parent’s friends died prematurely of cancer (Sidney, Leslie, Ivor, I remember you guys). At the time, the stigma associated with cancer was such that it was only passingly referred to as ‘The Big C’ – to say cancer was to somehow denigrate the individual as if it reflected a moral or existential failing on their part to have acquired such a thing.
Subsequently, in 1989 Sontag wrote ‘AIDS and its Metaphors’ applying the same analysis to the condition at that time.
What is the theme?
It was incurable, potentially inexplicable illness that given the fear, allowed a cult of stigma to arise. As if dying of cancer or AIDS was a reflection of your character, reflecting a shortcoming not in your genetic or lifesyle choices (possibly) but your morality.
I vividly remember, it was 1986, my friend Jake at school in Israel showing me his water bottle.
In those days, during the very hot late spring and early summer, the schoolchildren would run to the taps after lessons or perhaps following a game of basketball, to rehydrate.
The taps were a long line of outside taps, maybe 10 in total where we would drink, mouth to spout, supping the over-chlorinated water.
Jake announced that given the risk of AIDS, his parents didn’t want him drinking from the taps.
I didn’t understand, I continued drinking.
A few years later, I remember someone telling a joke about pizzas and the way they were delivered to people in hospitals.
I never understood that either, which was at the time and now looking back, an offensive and stigmatising interpretation of illness.
If you had to ask me what the bogey man in today’s healthcare metaphor it would be mental health in general and dementia in particular.
For a year or two Covid was the spectre, less so now.
TB has treatments (if you can get them) and cancer, depending on the type and the stage is also very often curable. HIV/AIDS has become a chronic condition – someone recently told me that the life expectancy of someone with HIV/AIDS was longer than the average population as the patients are so closely monitored and have such good healthcare (in the UK) – I don’t know if that is true (I can’t find the evidence).
We understand so much more these days about health and disease, some of us, although not all, take an approach to the news ‘I have cancer’ as being another of life’s challenges, for others, it things fall apart.
I don’t have cancer.
As far as I know.
This is the story I wanted to tell.
I tried writing about it a few weeks ago but did not manage.
It is a question of my age, my lifestyle and my veganism.
A month ago I contacted my GP to request some routine blood tests.
I am 50 and it felt the thing to do.
Those of you familiar with the Bromiley ‘Just a Routine Operation’ will sense the Chekovian device.
And so, my bloods.
I was pleased to see that my last year of regular exercise, abstinence from alcohol and all animal products (except honey, sorry bees) had lowered my cholesterol and kept my Hba1c significantly under the diabetes threshold (a family risk factor).
From work at home, I know my blood pressure is normal.
Great.
My thyroid is even ticking-over as it should, maintaining my metabolic homeostasis.
My blood count, that is haemoglobin was however a little low. Something like 125 instead of 126.
Being one-off normal is not the end of the world although for an otherwise healthy guy who runs, swims, cycles a lot as well as consuming lots of food it gave me pause. Even being on the lower limit of normal might have been a surprise. Shouldn’t all this activity be boosting my Epo levels, elevating my haemoglobin (Hb)? (A 140 or 145 would have made me happy)
It caught my GPs eye.
‘Your blood count is low,’ She said.
She actually, like me, started off with my cholesterol and Hba1c, using the same strategy I employ – reassure the patient before you tell them the bad news.
‘I am a vegan,’ I said to her.
She didn’t appear to hear me. I repeated.
‘You see, I have not had any meat for almost a year. I can be lazy with my diet. Not enough leafy vegetables.’ She didn’t hear any of this.
‘I think you need some tests,’ we agreed.
And so.
Here I am.
Before I go on, I’ll apologise for over-sharing.
I did think to keep this to myself. I also thought, writing tends to help me process, so it is beneficial to me, also, I suspect some of my readers have had or will have a similar experience.
What’s the big deal?
As I doctor, I know the statistics.
I am not very old therefore cancer is less likely although we are programmed by evolution to see the dark shaded rope as a snake, we tend to go to the worst case scenario first.
Other tests are pending.
It could be an ulcer. Maybe a polyp. It could be a spurious sample.
I have been focusing on this being a dietary failing.
Regular readers will know I have been on a health-kick for a while, to get my weight under control.
I’ve lost around 15Kg.
I’m losing weight.
For the most, at least in my experience, people with cancer tend to lose weight from two components, first, cancer itself causes anorexia – a medical term that means you don’t want to eat, you lose your sense of hunger, foods nauseate you, second, the cancer itself which is highly metabolic or catabolic (breaking down your body) uses lots of energy that might otherwise be stored in fat cells.
My appetite remains healthy. I don’t know about super-charged mutant cells.
My weightloss has been intentional – the diet, intermittent fasting and so on.
There are lots of variables.
And so, I am waiting.
More tests.
I have started to eat green-leafy vegetables – Cavolo nero, broccoli, spring greens, spinach and kale have all been on the menu this week. I bought some iron supplements (which I know might skew future results, but why not – I thought, if I could boost my Hb, I might run better; I was running better until last Sunday and the slippery path (see last week’s blog).)
I ordered some multi-vitamins from the Vegan Society ‘Veg1’ they are called.
I am doing what I can.
Yesterday two people at work said, ‘Have you lost weight?’ Previously when I had been asked I took this as a complement – my hard work paying-off, now I wasn’t too sure. Is this cancer chic? Am I wasting?
What are my metaphors? Uncertainty.
Recently, a patient told me that he was very worried, waiting for the result of a scan.
I informed him he had cancer.
Strictly I should have kept him waiting for the multidisciplinary or the requesting team to tell him at his as yet to be arranged appointment (this is one of the things doctors still do face-to-face, >breaking bad news< rather than the age-of-Covid phone consultations, ‘How much chest pain? How much does your arm shake? Where does it hurt?’)
At the time I was split.
Do I tell him or do I pretend I don’t have access to the result.
He was with his family and was asking me directly. It felt wrong to pretend.
Breaking bad news is never easy.
Two weeks ago I watched a short lecture from breast surgeon, Liz O’Riordan who described her own breast cancer journey.
‘When the doctor comes into the room with a specialist nurse, you know it is bad news,’ one of her patients had told her. At the time of her appointment, she saw the specialist nurse and all was clear to her, like those lines from Robert Frost’s Out, Out -.
She foresaw the next steps, the tests the pre-ops, the nights in hospital, chemo, radiotherapy and so on.
Knowing too much can be bad.
Likely, not as bad as knowing too little. Information is supposedly power.
And yet.
My patient’s grand-daughter asked him if he could see the results on the app, ‘We don’t have internet he explained,’ (I was surprised the grand-daughter even suggested this – perhaps it was the shock.)
This was another part of the health and social care jigsaw. Digital exclusion.
I am digitally included which I suppose is good (these days in the UK you can get the results of tests direct to your phone before the doctor has seen them).
And I blame the Tories.
They are an easy scapegoat.
I am reading Kate Atkinson’s , ‘Started Early, Took My Dog’ – she has a recurring motif, ‘for want of a nail,’ this is an allusion to the poem. For want of a nail the shoe was lost…
For want of a decent government, there was a failing health service, for want of a failing service there were not enough doctors and nurses, for want of enough doctors, there was a delay in diagnosing and operating and recovery…
I will keep you updated.
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