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Went to Oncology in late July to hear the results from the CT scan I had many weeks before that. Short summary is there was no good news. It’s still progressive, which is bad, but then there’s nothing new or catastrophic to report either. Most of my tumours are increasing in size. For example, the largest area of soft tissue on my upper left lung went from 37mm to 46mm and continues to obstruct the left upper lobe. It’s pushing against my left pulmonary artery and I must hope that it doesn’t push through to trigger the La Traviata outcome. There is more soft tissue in the pelvic area, in something called the presacral space, which tends to cause pain in the lower back and hips.

Also on the agenda was my suitability for the drug trial. The genetic screening result came back negative – I’m not in the 20% minority and don’t have the right wrong gene. Therefore there’s no place for me on the amusingly-named “STARTRK” trial, and I won’t be boldly going anywhere.

One interesting revelation was I could still opt for more chemotherapy, if I so desired. I said that I didn’t think I wanted to do so. I now regard chemo like the “dead cat bounce” they talk about in stock markets. The poison kills enough cells and pauses growth to make a short term impact, but it isn’t lasting. It may even provoke my over-eager genetic triggers to produce even more cancerous cells as a response. I left enough wiggle room so the consultant could tell me what a fool I was, and that it was best for me, but generally he agreed that my decision was “right for me”.

At least the Thoracic Park adventure continues. I was there just after for a spot of injecting, cutting and general vacuuming of the lung tissues. They’d left it a while since my last visit, and I think they’d forgotten me until I reminded them. But they did a tidy, neat job, and I’m better for it. Unlike the Piss Factory, who seem to have finished with me now, without so much as a farewell night out.

So, where does this leave me, Doc? I’m a bit of a conundrum to them. When I first appeared on their horizon in 2009 I was something of a classic “type 4” – advanced cancer, diagnosed late, wonky stem cells, poor prognosis, etc. But (with their help and treatment) I’m turning into more of a “type 2” where the decline is of the slower variety. Just another reminder that any specific cancer is really many different forms of disease hitting the same organ, and any cure has very many targets to pursue, with all the excitement and frustration that entails. They can’t do very much, but at the same time not much is going badly. Remember I’m supposed to be on a “two years, probably not five” countdown and that timer started 20 months ago. I have to say I don’t feel like I’ve used up >80% of the allotted time. Maybe it feels more like the 33% option.

This is clearly a good thing. The longer, the better. But at the same time there is no certainty. I’ve just read Paul Kingsnorth’s novel “Beast” about a would-be hermit, alone on the moor and probably unhinged, who stalks and/or is stalked by a mysterious big cat (very Beast of Bodmin). There’s a sentence in it that makes me think of cancer: “I am in the presence of something that does not know time“. Michael Faber’s short book of poems “Undying” tries to make sense of it all while watching his wife Eva die from cancer over a six-year period. He calls it “a harmony of dark biology“. On the one hand, more time is good. On the other hand, who doesn’t want to wake from a nightmare where you are being stalked by the dark beast? To quote Umberto Eco: “is this not a death undying?“. Yet I know that I am definitely no Tithonus, doomed to get older without ever dying.

I am fairly sanguine about it all. I am equally concerned about putting some vivification back into my life. We went away twice in July, which can be a big deal for me and my personal medical supplies mobile apothecary. It all went pretty well. I connected with as much of the wildness in man and nature as I wanted. The pleasures required are small and simple – a type of bird or butterfly will do it. Maybe my role now is just to get on with it, smile a bit, and not be too much of a cancer bore. “To be a rock and not to roll”, as the song says. You’d think that under the circumstances one would want to gorge on life’s pleasures before time runs out, to take in all the sapori e saperi that is to be had. But the appetite is weak.

Meanwhile, the Exterminating Angel smiles, and moves along.

Have finished reading “The Prague Cemetary” by Umberto Eco.

It’s a tough read, mostly because it’s main character is an anti-hero called Simonini who doesn’t like much apart from fine dining. He’s especially anti-Semetic, and the intensity of anti-Jewish comment never lets up. The storylines concern his exploits working as a forger in the employ of various Secret Service agencies from European countries including France and Russia. The timing of the novel is late 19th Century and it’s leading up to the struggle between imperial powers that was WW1.

The ‘life work’ of this anti-hero is the creation (i.e. forgery) of the infamous “Protocols of the Elders of Zion” which you’ll find even today quoted as a real document on far Right websites propagating the myth of Jewish dominance and emergence of a new world order. In the words of Rabbi Joseph Teluskin, “Thousands, perhaps even tens of thousands, of Jews have died because of this infamous forgery.” I think he may still be under-estimating it, so if you ever need an example of a dangerous book, this one will meet the criteria. It was a favourite book of Adolf Hitler’s, so this is also a backdrop to WW2, the Holocaust and the Final Solution. The title is taken from the ‘fact’ that these protocols are a record from a meeting of Rabbis in the Jewish Cemetary in Prague. The Rabbis discuss how they will corrupt Gentile society and culture for the benefit of Jewry and Zionism.

Eco finishes with a message that “they” are still among us. Given the deeds of far-right maniacs in Norway (for example), he isn’t wrong.

Most of what comes from the mouth of Simonini  is pure vitriol. The beginnings of conspiracy theories start with an actual book published by a French Jesuit named Abbé Augustin Barruel who reckoned that Philosophers, Freemasons and the Illuminati were plotting the overthrow of all European heads of state and religions. Of course, at the time  there were actually Jacobins behind the French Revolution and other radical movements, so like in any good conspiracy the seed was watered and fed. You might laugh, but when I was passing through religious-taught schools in 1970s Ireland, there was still a deep and vocal distrust of Freemasons and Communists  among the priests (Orwell’s “1984” proved it all, you see). Later I became aware of the existence of Catholic Secret Societies such as Opus Dei.

Life is really stranger than fiction. One quotation I’d hear from communists during my student days was that people would never be free until “the last of the kings was strangled by the guts of the last priest”. This is actually a quote from Jean Meslier, a 17th century Catholic priest of 40 years service who (it turned out upon his death) wrote the first book recommending Atheism as a philosophy.

It’s a bit of a jump, but the attribution by footnotes style of the opening chapters of The Prague Cemetary put me in mind of Brian O’Nolan (writing as Flann O’Brien) in “The Third Policeman”; and especially the way he uses the fictional polymath of the de Selby character. These footnotes ramble on, appearing to provide an anchor to the increasingly surreal elements of the main book, but in reality doing nothing of the sort. Just like conspiracy theories…

It’s a very 19th Century device. By using it so well Eco shows that he understands how novels are constructed, and in his time Brian O’Nolan had the same ability. There’s one wonderful example where he starts a footnote on one page and finishes it eight pages later having completely wandered off the original topic. A genius.

Another infamous anti-hero is that of Jean Des Essientes who appears in “A rebours” (“Against the Grain”or “Wrong Way”), a novel by Joris-Karl Huysmans. It was written in 1884. It’s said to be the “poisonous” novel that Oscar Wilde references as the one that corrupts his character, Dorian Gray, and leads to his downfall. The book was cited during Oscar’s trial by the prosecution as evidence of sodomite leanings. The Des Essientes character has also tired of life, and seeks solace in the sensual. It’s the book where he covers his tortoise in jewels, leading to the allegorical death of the unfortunate creature. One of his few remaining pleasures is Gastronomy, and that reappears with Eco’s Simonini. I like the story where Oscar Wilde and Aubrey Beardsley went on a sort of pilgrimage to meet Huysmans in Paris, only to find that he had become a Trappist monk who refused to meet them and encouraged them instead to abandon their wicked decadent ways. Beardsley must have took him seriously – he later converted to Catholicism and wanted to burn his erotic drawings before he died.

What links Huysmans, Brian O’Nolan and Umberto Eco is they all possess an encyclopediac knowledge that they can unleash upon their novels. It’s as if they have rummaged in a library of classic texts until every word was jumbled up inside them in a seemingly useless mess. O’Nolan and Huysmans also shared the dubious distincton of working as bored Civil Servants in Dublin and Paris respectively, but as far as I know Eco has only ever been forced to become an Academic.

Nothing surreal happens in my life. However, I did return from my holiday in Ireland to find two letters waiting. The first was from the President of Ireland wishing me a recovery from my Cancer (sincere thanks, Michael D, it lifted my spirits big time). The second was from the British Army containing a medal for my voluntary service. Before the big bad bogeyman (aka Gerry Adams) gets the wrong idea, I’d like to put it on record that I have never served the British Crown nor furthered her interests (apart from paying tax, like). Like John Lennon before me, I’ll be returning the medal.

Damien Rice – The Blowers Daughter

And so it is. Just like they said it would be.

It’s been an action-packed few weeks. I made a good recovery from the Left lung operation and they decided to do an ultrasound-directed biopsy of the tissue around the left bronchus. They’d taken a piece during the operation and it was not malignant, but they wanted more to be sure. It’s a day procedure involving some anaesthetic, swallowing a camera and piercing by a very thin needle with a tiny claw stuck into the lung via the esophagus. If I were doing a review for a travel advisory web site I’d mention the wonderful service being met at reception and escorted to ward; the sun-filled room with pale wood floors, and the personal attention from the surgeon in charge of the whole unit. In theatre they showed me the scans on the computer monitors. Pointed out the specks they were after. Mentioned that they did a 1000 of these procedures every year but until they do one, they can’t predict the outcome.

And that was the problem. Once they got the needle into position they found there was an artery blocking further access. I like to think of it as an oil drum lying on its side with a half-full black bin bag behind it. They just couldn’t get to that bin bag. Apparently going through the vein to take a grab isn’t a major no-no but it depends on the angle of entry and this angle wasn’t right. So they abandoned it. I was ready to go home again at around noon having been admitted at 08:00.

Their parting advice (to me and to my consultant surgeon) was to take the pragmatic approach. Keep a very close eye on it in case it changes. The only ambiguity is what constitutes the least risk option? Do they zap it with radiotherapy just in case?

So, then it was back to the Right lung. I’ve had two “offers” on the table for this. The first was to hook me up with UH London for a blast of RFA. The second was from the Thoracic people to remove the lesions using keyhole surgery (a VATS resection). First one to get to me gets the gig, was my response. It was the second option. I got a call on a Thursday asking me if I wanted a quick course of action, and that turned out to be show up for surgery on the following Monday. Like Stella lager, I’ve been triple-filtered but with a smooth outcome.

I checked-in at 8.30 on the Monday and around noon I was sent down for surgery. I stayed in surgery for around 3 hours and everything went as planned. By that I mean the surgeon was able to successfully perform keyhole surgery and it didn’t require a full-scale thoractomy. It left me with two 1-2″ holes for each of the keyholes, and two 1″ holes for the plastic tubes (the drains). The pain was minimal and there were no major complications except perhaps the next morning when I vomited blood, and there was a question whether this came from the lung (normal, under the circumstances) or the stomach (bad). It was enough to keep me there until the Wednesday. Then it was a battle of wills between the doctors (send him home) and the nurses (keep him in) that eventually culminated in a very grudging release of me at the last possible minute (8pm) on Weds. I was very pleased to get home to my own bed. By the next morning I was well enough to start reading work emails and getting stuff done.

Today, just a week later, I had the stitches removed from the drain wounds.

Soon I’m off to Ireland for a short break. I shall be walking longish distances to see how much lung capacity I’ve lost and whether exercise will get some of it back. I will remind myself that the sea is a good place to think about the future. I will be drinking large black pints of Guinness because I am reliably informed that it is good for you. I will be finishing the book I started in hospital: “The Prague Cemetery” by Umberto Eco. If you recall “The Name of the Rose” you’ll know that Eco is a master of novelist technique and mechanisms, and subverts the whole idea of who is the writer/who is the reader? I will also bring some lovely little books I was given in May describing the prehistoric sites in the Burren area where we’ll be. Finally, and with the help of Arthur Guinness, that wonderful 18th century Irish Protestant who ran a small brewery in Dublin, I shall be contemplating whether Cancer offers the best pathway we have to understanding immortality. It knows how to twiddle with your proteins and your chromosomes so that it never grows old, and it knows how to divide and reproduce without constraint. It truly is something to admire. I can’t take my mind off of you.