“Its an ill wind that blows nobody any good.” ― English proverb
Having fixed a date for my operation (March 15th 2012), the usual procedure in the UK is to proceed with some cycles of chemotherapy, in my case three cycles. A cycle is a period of 21 days, starting with one day in the hospital as an outpatient attached to the relevant chemical drips, and followed by the remaining period on cytotoxic (cell-killing) tablets. The side effects vary with the patient, but in my case were minimal. Unfortunately, the effects on the tumour were apparently minimal too, with no discernible reduction from its original large size (10 cms) at the end of the treatment. But it gave some guarantee of removing any outlying seeds of malignancy (metastasis). For example, some baso-carcinoma spots on my face – a very mild and non-lethal type of wart, seemed to disappear. But as my oncologist (Professor Hochhauser of UCLH) remarked, this is rather like a by-product of the NASA Space program producing a Teflon frying pan.
The actual operation, performed at St Marys Hospital by a 12-person team including 4 surgeons led by Professor George Hanna, lasted 11 1/2 hours. The operation was the venerable (1946) Ivor Lewis Oesophagectomy procedure which involves using part of the stomach to remodel the oesophagus. This was completely successful. I then spent some 3 days in Intensive Care, plus a further similar period in High Dependency and finally after about 9 days left for home.
It is normal practice in the UK to follow – at a decent interval! – the operation by a further series of adjuvant chemotherapy, just in case the surgeon has missed something, much to his annoyance but presumably suggested by the oncologist to put the surgeon in his place. I tolerated this series much less than the earlier pre-op series, being somewhat debilitated by the effects of the operation. And due to a depressed food intake – a gourmet appetite with a Gandhi capacity - I was not replacing good cells, such as blood haemoglobin, as rapidly as the chemo was killing them, and this necessitated blood transfusions.
One accidental effect of the operation was incidental bruising of a vocal cord which left me with a hopefully temporary but fairly long-term voice problem. But with my sinister gruff voice, bald pate and newly acquired black leather jacket, I now resemble mafia godfather Don Corleone, finally eliciting overdue respect, nay fear, from my family.
So it is an ill wind that does not blow some good.
Friday 10 August 2012
Thursday 9 August 2012
Cancer Ward II: Analyses
“Everybody has got to die, but I have always believed an exception would be made in my case.” ― William Saroyan
After the first tentative diagnosis, “probable malignant tumour”, the National Health Service burst into frenzied action like a newly-mobilized panzer division. Consultation followed test followed consultation as surely as day follows night, but with greater frequency.
First test after the gastroscopy was a CT , or computerized tomography, scan. Just as a single radar sweep can detect all the aircraft in a plane, so a single X-ray can detect the suspect objects in a plane of the body. By mathematically integrating a series of such planes – a process called tomography – a three-dimensional image can be built up revealing tumours within the body. Pure mathematicians often like to boast that their subject is essentially useless – but quite the opposite is the case.
A similar tomographic technique is used in the more sophisticated PET (positron emission tomography) scan. Recently the Large Hadron Collider (LHC) in Geneva has been in the news – especially regarding the search for the elusive Higgs particle, which – if it exists – may go some way to explaining how particles get their mass, and the asymmetry between the numbers of particles and anti-particles in our world. An anti-particle is, roughly speaking, the opposite of a particle; if the two should meet – they would mutually annihilate in a burst of energy. That is why we do not come across anti-particles in the ordinary course of events – they have to be produced artificially in accelerators like the LHC. However, the Institute of Nuclear Medecine at University College London Hospital (UCLH) has its own accelerator – in which I was placed while positrons – the anti-particles of electrons - bombarded my body, annihilating themselves against the electrons which were preferably excited chemically in tumours by injection of a glucose derivative. The energy bursts – in the form of photon pairs (light particles) are then detected and integrated by the same tomographic technique as in the CT scan to get a 3-dimensional image of the tumour.
This combination of mathematics, physics and chemistry is truly an impressive achievement of modern science.
Various further analyses followed, including an EUS (endoscopic ultra-sound) – which is essentially a small camera which when swallowed uses sound waves to map the extent of a tumour. But surgeons are never really happy until they explore your interior visually – and this soon occurred with an abdominal laparoscopy – or keyhole surgery – used to get a human’s eye view on a TV monitor of the interior.
After all these tests there seemed little doubt about the diagnosis, cancer of the oesophageal-gastric junction, but it seems that its operable, and at the very least, the scientific approach adopted by modern analytic techniques is something that appeals to me, after a lifetime working in science.
However, as Woody Allen said, “I don't want to achieve immortality through my work…I want to achieve it through not dying.”
(To be continued)
After the first tentative diagnosis, “probable malignant tumour”, the National Health Service burst into frenzied action like a newly-mobilized panzer division. Consultation followed test followed consultation as surely as day follows night, but with greater frequency.
First test after the gastroscopy was a CT , or computerized tomography, scan. Just as a single radar sweep can detect all the aircraft in a plane, so a single X-ray can detect the suspect objects in a plane of the body. By mathematically integrating a series of such planes – a process called tomography – a three-dimensional image can be built up revealing tumours within the body. Pure mathematicians often like to boast that their subject is essentially useless – but quite the opposite is the case.
A similar tomographic technique is used in the more sophisticated PET (positron emission tomography) scan. Recently the Large Hadron Collider (LHC) in Geneva has been in the news – especially regarding the search for the elusive Higgs particle, which – if it exists – may go some way to explaining how particles get their mass, and the asymmetry between the numbers of particles and anti-particles in our world. An anti-particle is, roughly speaking, the opposite of a particle; if the two should meet – they would mutually annihilate in a burst of energy. That is why we do not come across anti-particles in the ordinary course of events – they have to be produced artificially in accelerators like the LHC. However, the Institute of Nuclear Medecine at University College London Hospital (UCLH) has its own accelerator – in which I was placed while positrons – the anti-particles of electrons - bombarded my body, annihilating themselves against the electrons which were preferably excited chemically in tumours by injection of a glucose derivative. The energy bursts – in the form of photon pairs (light particles) are then detected and integrated by the same tomographic technique as in the CT scan to get a 3-dimensional image of the tumour.
This combination of mathematics, physics and chemistry is truly an impressive achievement of modern science.
Various further analyses followed, including an EUS (endoscopic ultra-sound) – which is essentially a small camera which when swallowed uses sound waves to map the extent of a tumour. But surgeons are never really happy until they explore your interior visually – and this soon occurred with an abdominal laparoscopy – or keyhole surgery – used to get a human’s eye view on a TV monitor of the interior.
After all these tests there seemed little doubt about the diagnosis, cancer of the oesophageal-gastric junction, but it seems that its operable, and at the very least, the scientific approach adopted by modern analytic techniques is something that appeals to me, after a lifetime working in science.
However, as Woody Allen said, “I don't want to achieve immortality through my work…I want to achieve it through not dying.”
(To be continued)
Wednesday 8 August 2012
Cancer Ward 1: Diagnosis
The philosopher Woody Allen, who will probably be remembered more for his bons mots than his films, essays or clarinet playing – once remarked that the three most beautiful words in the English language are not “I love you” but “It is benign”. This thought occurred to me most recently after having been persuaded by my daughters to visit the local doctor. I had triumphantly told them that at long last my strict diet seemed to be paying dividends. Instead of congratulating me, they replied almost in unison - a difficult feat as Nathalie lives in Lausanne while Annabel lives in London - as follows: “Daddy, you have been dieting for over thirty years without success, there must be something wrong”. But how could I visit the GP without any positive symptoms – other than a successful regime – to report. Apparently my diet of whiskey, crisps, nuts, fish and chips – but cut out the deep-fried Mars bars – was at last paying dividends. Reluctantly I made the visit to the local surgery, and told our GP that of course at my age – I had just turned 75 – troubles with the plumbing were to be expected, and I did have two cousins who died recently of colonic cancer.
“At what age?” he asked.
“Well, they were in their mid-eighties.”
As my oncologist later remarked this, clearly, did not represent a significant family history. (However, somewhat more so than when some time ago I reported to a French doctor that I feared arterial problems as my father-in-law had suffered from this.)
Nevertheless, my doctor, with wisdom and surprising sympathy, booked me into University College London Hospital for a colonoscopy (insertion of a small camera to investigate the colon) and an endoscopy (ditto for the gullet and upper stomach). These were booked with almost no delay – a National Health Service policy dictates that such investigations be made within 14 days – and were preceded by consultation with the relevant specialists, who seemed rather impressed by my seeming all-round fitness.
The colonoscopy proved negative. However, as my daughter Annabel and I were preparing to leave the ward after the tests, a rather young and presumably under-briefed nurse handed me a letter addressed to my GP which contained the endoscopy report and which I, of course, immediately opened. The phrase which leapt to the eye was “probable malignant tumour” – not, as Woody Allen would have agreed, the three most beautiful words in the English language. On taking leave of the assembled nursing staff, I could not resist the following bit of repartee.
Me: “Well, I am on the way out.”
Staff: “No, no, please don’t say that.”
Me: “Why not, I just meant we were going home”.
(To be continued).
“At what age?” he asked.
“Well, they were in their mid-eighties.”
As my oncologist later remarked this, clearly, did not represent a significant family history. (However, somewhat more so than when some time ago I reported to a French doctor that I feared arterial problems as my father-in-law had suffered from this.)
Nevertheless, my doctor, with wisdom and surprising sympathy, booked me into University College London Hospital for a colonoscopy (insertion of a small camera to investigate the colon) and an endoscopy (ditto for the gullet and upper stomach). These were booked with almost no delay – a National Health Service policy dictates that such investigations be made within 14 days – and were preceded by consultation with the relevant specialists, who seemed rather impressed by my seeming all-round fitness.
The colonoscopy proved negative. However, as my daughter Annabel and I were preparing to leave the ward after the tests, a rather young and presumably under-briefed nurse handed me a letter addressed to my GP which contained the endoscopy report and which I, of course, immediately opened. The phrase which leapt to the eye was “probable malignant tumour” – not, as Woody Allen would have agreed, the three most beautiful words in the English language. On taking leave of the assembled nursing staff, I could not resist the following bit of repartee.
Me: “Well, I am on the way out.”
Staff: “No, no, please don’t say that.”
Me: “Why not, I just meant we were going home”.
(To be continued).
Sunday 25 December 2011
Christmas- a season for moral cowardice?
In his Christmas message, Archbishop Vincent Nichols sees fit to criticize Israel for constructing a security barrier in the West Bank to protect Jews against terrorist attacks. No mind that dozens of Egyptian Coptic Christians are still warm in their graves after being killed by Islamists. That warrants no mention. No matter that dozens of Nigerian Christians have been killed by Islamists on the very Christmas Day when the good Archbishop’s speech was being delivered – while they were peacefully celebrating their Holy Day in their Churches. That is of no consequence to the Archbishop.
No, that does not warrant any mention. The criticism of a civilized democracy like Israel for trying to protect its own citizens from precisely that sort of Islamic terror carries no dangers for the Archbishop and his flocks. And he knows that this type of moral cowardice is a no-lose stance. One would have thought that the ethnic cleansing by the Palestinian National Authority of Christians from the once majority Christian town of Bethlehem – the focus of today’s ceremonies and whose population constituted 60% in 1990 to less than 15% today! – would have given pause for thought, especially when compared with the exponential growth of the Christian population within Israel.
No, for the good Archbishop the only game in town is criticism of Israel, the one state in the region where Christians do have full protection and equality.
But he is mistaken if he feels that this approach will curry favour with the Islamists, and will help to remove Christians in the Arab lands from danger, especially after the Arab Spring returns even more Islamists to power. No, Archbishop. You are considered a Dhimmi, an inferior person in Islam, and they expect this sort of subservience from you, as they expect you in trembling to distance yourself from anyone they consider willing to stand up to them.
In his Christmas message, the Pope too made no mention of the murder of Christians around the Islamic world, only “even-handedly” praying for a resumption of Israeli-Palestinian peace talks – as if that would do anything to alleviate the situation of Christians across the Arab world.
Until the Roman Catholic Church realises that the only steadfast ally they have in the region is the Jewish state, I fear that Christians will continue to be murdered in their hundreds around the Middle East, while the the Church leaders glibly condemn Israel.
No, that does not warrant any mention. The criticism of a civilized democracy like Israel for trying to protect its own citizens from precisely that sort of Islamic terror carries no dangers for the Archbishop and his flocks. And he knows that this type of moral cowardice is a no-lose stance. One would have thought that the ethnic cleansing by the Palestinian National Authority of Christians from the once majority Christian town of Bethlehem – the focus of today’s ceremonies and whose population constituted 60% in 1990 to less than 15% today! – would have given pause for thought, especially when compared with the exponential growth of the Christian population within Israel.
No, for the good Archbishop the only game in town is criticism of Israel, the one state in the region where Christians do have full protection and equality.
But he is mistaken if he feels that this approach will curry favour with the Islamists, and will help to remove Christians in the Arab lands from danger, especially after the Arab Spring returns even more Islamists to power. No, Archbishop. You are considered a Dhimmi, an inferior person in Islam, and they expect this sort of subservience from you, as they expect you in trembling to distance yourself from anyone they consider willing to stand up to them.
In his Christmas message, the Pope too made no mention of the murder of Christians around the Islamic world, only “even-handedly” praying for a resumption of Israeli-Palestinian peace talks – as if that would do anything to alleviate the situation of Christians across the Arab world.
Until the Roman Catholic Church realises that the only steadfast ally they have in the region is the Jewish state, I fear that Christians will continue to be murdered in their hundreds around the Middle East, while the the Church leaders glibly condemn Israel.
Sunday 31 July 2011
After the Arab Spring, now the Israeli summer...
Anyone watching the series of uprisings in the Middle East could only surmise that it was just a matter of time before the Israelis rose up in revolt against the oppressive regime that rules them. We marvel as the Libyan ruler Gaddafi mows down his subjects by the hundred, standing up bravely against the combined superpower forces of NATO. And the Syrian leader Assad attacks the city of Hama, where due to his restraint the death toll in the current campaign is only in the hundreds and has yet to reach the glorious total - reputedly 40,000 dead - achieved by his father in the same town in 1982. No, the Israelis have surely more reason to protest than their Arab neighbours.
Inspired by earlier protests in Israel against the price of cottage cheese, the oppressed proletariat have massed in their dozens in the main towns. And do not mock at cottage cheese; I myself am partial to the odd dollop on my breakfast crispbread. This, I consider, is one of the basic Human Rights, hitherto ignored by the United Nations (but not now by the British media). Any government which permits the price of cottage cheese to rise above a level which allows it to be purchased by the most impoverished citizen is surely guilty of - at the very least - a Crime Against Humanity. Count me among the protesters; today, I am with you - Israeli Cottage Cheese Protesters. We in the West owe it to the downtrodden cottage-cheese-less masses in Israel to mount flotillas, filled with cottage cheese, if that vile regime will allow them to approach their shores.
And it is not only cottage cheese - although that is bad enough. After having spent 6 weeks in a luxury three-bedroom apartment in Tel Aviv, I was disgusted to learn that there are even more luxurious 6-10 bedroom apartments being built in the plusher quarters of that city. Ten bedrooms! Why should any capitalist - with the requisite capital - be able to afford such a flat in Rothschild Boulevard (now that's an appropriate name) and not me? I am with you, Oh Israeli protesters, Luxury Flats for Everybody! is our slogan.
And what about the cost of raising children - another of the issues being raised? I assure you, anyone with kids will tell you that this is no laughing matter. Especially, with Jewish children who adamantly refuse to leave the parental home until they are themselves married with children. We demand free creches and kindergartens for all in Israel. (Oh, they do have State Kindergartens in Israel already? Well surely not enough. And so what if in the UK we don't have any; since when do we judge Israel by our standards?)
And it was only to be expected that violence would be exhibited by the police of that illegitimate entity. The Guardian published a photograph of a police officer discreetly standing behind an activist. It is highly possible that the activist had been ticked off really harshly by that policeman.
So stand by our Israeli protesters: Proletariat of the world unite! we have nothing to lose but our cottage cheese.
Friday 15 July 2011
Our Two Minutes' Hate
I am exhausted, yet peculiarly refreshed. I have just finished my daily Two Minutes' Hate.
In George Orwell's novel, Nineteen Eighty-Four, the Two Minutes' Hate is a daily period in which Party members of the society of Oceania must watch a film depicting The Party's enemies (notably Emmanuel Goldstein and his followers) and express their hatred for them and their principles of democracy.
At last we have a demonic Goldstein figure, the embattled press baron (the adjectives and nouns are de rigeur) Rupert Murdoch . The media, TV , radio, newspapers have non-stop devoted every loving minute to expressing venom for this eater of babies, this cannibal, this mass murderer, this.. I am lost for words.
No matter that the United Kingdom is descending into economic misery, that our armed forces build aircraft carriers with no aircraft to carry, that our Parliament has been shown to be a den of corrupt expenses cheats. No matter that the Eastern Mediterranean is aflame with revolutions in Tunisia and Libya , as well as Egypt and elsewhere in North Africa and the Middle East; that a thousand have been murdered in Syria, that the Sudan is approaching ominously to a war after partition,..we can forget all of this.
We have at last a focus for our frustrations, our hatred; poor Rupert.
Don't worry, Rupert. If it wasn't you it would be someone else. We need you; and in serving as an outlet for the outpouring of our venom, you provide a greater service to our great nation than your newspapers ever did.
Tuesday 12 July 2011
Green Jews
The other day we were invited round to lunch by a Jewish couple who had recently moved to our neighbourhood. As it was a lovely day, one of those rare English summer days when you have to take advantage of every minute of sunshine, we spent some time in their garden. My wife and I could only gaze in awe and wonderment at the sight. Lush greenery, exotic flowers and plants, bushes and trees, reminiscent of the Brazilian rain forest, or possibly more accurately of the tamed naturalness of a Capability Brown. Not, I thought unkindly, your typical Jewish garden. The hostess - the gardener in question - kindly offered us some cuttings.. "Cuttings, noch", I thought, echoing the Manchester writer Howard Jacobson's Yiddish self putdown.
And yet, and yet. The Jews' ancient history depicts them as agriculturists extraordinaire, well ahead of their time with respect to ecological questions. The Torah itself is strong on sustainable agriculture, ordaining every seventh year (Shmitah year) as an annual rest for the land. The Roman historian Publius Cornelius Tacitus, writing around 100 C.E., rather scathingly refers to this practise among the Jews as due to their love of indolence[1]! He otherwise notes the fertility and cultivation of the soil; as does the Romano-Jewish historian Titus Flavius Josephus, who wrote in 75 C.E., referring to the Jews of the Galilee, “their soil is universally rich and fruitful, and full of the plantations of trees of all sorts, insomuch that it invites the most slothful to take pains in its cultivation, by its fruitfulness; accordingly, it is all cultivated by its inhabitants, and no part of it lies idle.“ and of Samaria, “They have abundance of trees, and are full of autumnal fruit, both that which grows wild, and that which is the effect of cultivation"[2].
Perhaps the destruction of Jerusalem and the subsequent dispersal, depriving Jews of their own country, and involving centuries of persecution and moving from one temporary host country to another, militated against the traditional Jewish love of land and cultivation.
But the more recent history of the Jews shows that since their return to their homeland they have once again become world leaders in cultivation and fruit and vegetable production. Due to the ever-present problem of water resources, agriculture has become a less important element of the GDP, but now Israel is discovering innovative techniques for growing more produce with less water[3].
And continuing the ancient Jewish ecological tradition.
[1] Tacitus, The Histories, Volume V, 5.4.
[2] Flavius Josephus: The Wars of the Jews or History of the Destruction of Jerusalem, Chapter 3.2 and 3.4.
[3] See the excellent Wikipedia article , Agriculture in Israel.
And yet, and yet. The Jews' ancient history depicts them as agriculturists extraordinaire, well ahead of their time with respect to ecological questions. The Torah itself is strong on sustainable agriculture, ordaining every seventh year (Shmitah year) as an annual rest for the land. The Roman historian Publius Cornelius Tacitus, writing around 100 C.E., rather scathingly refers to this practise among the Jews as due to their love of indolence[1]! He otherwise notes the fertility and cultivation of the soil; as does the Romano-Jewish historian Titus Flavius Josephus, who wrote in 75 C.E., referring to the Jews of the Galilee, “their soil is universally rich and fruitful, and full of the plantations of trees of all sorts, insomuch that it invites the most slothful to take pains in its cultivation, by its fruitfulness; accordingly, it is all cultivated by its inhabitants, and no part of it lies idle.“ and of Samaria, “They have abundance of trees, and are full of autumnal fruit, both that which grows wild, and that which is the effect of cultivation"[2].
Perhaps the destruction of Jerusalem and the subsequent dispersal, depriving Jews of their own country, and involving centuries of persecution and moving from one temporary host country to another, militated against the traditional Jewish love of land and cultivation.
But the more recent history of the Jews shows that since their return to their homeland they have once again become world leaders in cultivation and fruit and vegetable production. Due to the ever-present problem of water resources, agriculture has become a less important element of the GDP, but now Israel is discovering innovative techniques for growing more produce with less water[3].
And continuing the ancient Jewish ecological tradition.
[1] Tacitus, The Histories, Volume V, 5.4.
[2] Flavius Josephus: The Wars of the Jews or History of the Destruction of Jerusalem, Chapter 3.2 and 3.4.
[3] See the excellent Wikipedia article , Agriculture in Israel.
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