Wednesday, December 21, 2011


Another pic that comes from the wonderful Underpaintings site.

I want to start this post with a disclaimer. I'm not sure what we make of ideas like "intuition" as Catholics, but right up front, I want to make it clear that I don't believe in ESP or any of that quasi-occult/parapsychological stuff. I think somehow intuition is a real thing, though. I think sometimes God will give you a little hint about some things sometimes, for His own reasons that even those who are given these little hints don't know.

I know my stepfather Graham knew without a doubt that he would die young, and he did indeed die at 48. For many years, at least since my early 20s, I have had an equal conviction that I would die of cancer. I don't claim to have any sort of divinely inspired knowledge, but it's there very firmly and has never gone away. When I was diagnosed, I was horrified and almost blind with fear, but not surprised.

Yesterday, we a very comprehensive and fruitful meeting with one of the Gemelli's oncologists and things are settled for surgery to be booked in the week between Christmas and New Year's. Which is next week, now that I think of it. I got to ask all my questions and have, I hope, cleared up the communication problem by getting the cell phone number of the doctor who speaks English.

She was very surprised to hear that I had been left alone with no followup after chemo and said that this is certainly not normal practice. There was some speculation that this was the fault of the oncology secretary who does not speak more than two words of English and who therefore may have been avoiding dealing with me, a common Italian habit.

Nevertheless, things are cleared up for the moment. I got the doctor to fax my medical records to my GP here in Santa Marinella, got her assurance that I can call or text her with questions or problems any time. I also now have a back-up oncologist now who works in Civitavecchia who answers his phone, speaks English and has agreed to help if there are problems. So we hope that the difficulties with communication and support will be cleared up.

But the gist of what she told me was not very encouraging and it has set me thinking about things. As we know, the last surgery showed that there were still cancerous cells in the area around the tissue they removed. the chemotherapy was only partially successful, with the tumour reduced in size but not as much as they had hoped and the cells still active. This means we have to go ahead with the large surgery. I will have all my reproductive organs out next week and they will be sent to the lab for more detailed examination. They are hoping that there will be no more evidence of cancer in the margins but there will be no way of knowing anything until they've taken it all out and had a look cell by cell.

If the cancer has spread into the organs past the uterus or in the lymph nodes in the parametrium, I will be facing more "procedures," whatever they may be. But this isn't so hopeful, because they weren't expecting to find cancer in the margins from the last surgery, and yet, there they were.

There is no way to tell without surgical removal of the suspect tissue whether the cancer has spread into other organs and systems. Micrometastases are too small to be detected by scans and can easily be missed by biopsies. In fact, they can only be found by removal of entire organs. I asked if there was a chance that there were micrometastases hiding anywhere else, and she admitted that the possiblity certainly exists. The only way that scans can tell is after the tiny single cells have started dividing and growing tumours and there is no predicting when or where that will happen.

The surgery back in May showed there were no cancer cells in the lymph nodes around the affected area and the PET scan I had showed that the metabolic activity surrounding the tumour is reduced since chemotherapy. Chemo's effects last for some time, (as I am reminded daily) so it is likely that the cancer is not developing or developing very fast. The doctor said it was "probably" safe to wait until after Christmas but said it would be unwise to leave the surgery any longer.

If there is cancer found in the margins after this surgery, the only thing left to do for the time being is more chemotherapy or radiotherapy. The cancer, however, has already shown itself to be chemo-resistant so if this surgery doesn't remove it entirely, there isn't a great deal they can do but dose me and wait for it to emerge somewhere else. Or not, as the case may be. If the cancer spreads to organs that I can't live without, there is only chemo, and as we have seen, there is only so much that can be expected of that.

Truth to tell, I am becoming less and less confident as we go along. Each time they have told me that the initial signs are positive, the actual examination has shown things to be worse than they had hoped.

A friend of mine has said "it's just fear" but I disagree. It is certainly an idea that I'm afraid of, but the idea itself was there first. I can't help thinking that I'm on a path to the end of my life.

For the first year after I was here, I was under the impression that I had been brought here by God to start a new happy life, possibly with marriage in the offing. But even then, I remember thinking that maybe it was not that I was here to start a nice new life, but to get myself safely to the end of the old one.

From the start, I never really thought of any plans to leave Italy. There has never been any exit strategy or end-date to my stay here, and no pressing reason to ever go anywhere else. And despite its infamous aggravations, this country is growing on me. It has taken me a while to get to the realisation, but I have no intention of ever leaving as long as it remains possible for me to live here legally.

I don't know when I started thinking I would probably die here, but it was fairly soon after I came. Really, it is hard to imagine a better place to do that and to live the last part of life. Beautiful Italy, by the seaside, surrounded with friends and upheld by the Church in a Catholic country.