中Radiotherapy was in full swing. Meanwhile, the conundrum around the biopsy report remained unsolved. What’s the main reason for radiotherapy? Was the ninja really “minimally invasive” to the nearby tissues? By then, I had reached a state that I would rather not speak at all if I could, but I couldn’t wait for the upcoming chat with Mr J. A few days prior to the call, the hospital sent me an appointment reminder about a face-to-face consultation at the ENT outpatients clinic. As I read more carefully, I noticed the date and time were the same as those for the telephone consultation. The reminder didn’t specify who in the clinical team I was going to see.
“Isn’t this a bit strange? How come I’ll have a telephone consultation and a face-to-face one at the same time? What’s going on? Is there a mix-up somewhere?” I wondered.
To find out, I called the hospital department responsible for managing patients’ appointments. I was told that the face-to-face appointment was valid, so the reminder I received wasn’t sent in error. Still, I had no idea who I was supposed to see. In hindsight, why didn’t I enquire with the ENT outpatients clinic directly? I don’t know, perhaps I was too unwell to think straight......
The scheduled consultation was at 3pm, quite a few hours after the radiotherapy session in the morning that same day. Instead of hanging around at the hospital after the session, I had to first go back home, get some lunch (whatever that meant......), take a break, and visit the hospital again.
Face-to-face consultation —— that’s probably with Mr J? I really hoped this ad hoc trip to the hospital was worth my last few drops of precious energy.
I half slumped on my seat in the ENT outpatients waiting room and waited for 45 minutes. Even slumping on a chair was tiring when compared to lying in bed at home. I sipped water while waiting, as the dry mouth and sore throat would make speaking difficult.
Finally, it’s my turn. Who’s calling? Not the nurse, but Mr J himself.
“It’s great to see you again, Mr J. I thought we’re going to speak over the phone only.”
“Yes, I changed the appointment to face-to-face because I knew you must have loads of questions for me. I’m really sorry I couldn’t have seen you sooner due to COVID.” Mr J put himself in my shoes and figured out what’s troubling the scientist in me.
I cut the chase, “I really want to know about what you saw exactly when you opened up my neck. The pathologist drew his conclusions about invasiveness of the tumour from the burst remnants, but he didn’t get to see the tumour in situ. That’s why I am very keen to hear your first-hand experience.”
“The tumour was completely sheathed. The bursting happened while I was transporting the excised tumour away from your body. Tissues in the tumour bed looked normal, with no sign of local spread at all. With the spillage, we flushed quite a few times and that should have cleaned it up.”
Ah! Now I had his word, I was relieved. “Flushing” often reminded me of a similar procedure when I was handling cultured cells in dishes in the lab; I just hadn’t anticipated one day that it would be done to the tumour bed in my neck. With his rich clinical experience, I trusted Mr J’s judgement, even though his eyes weren’t equipped with lenses of a microscope. Any residual, invasive cancer cells the naked eye couldn’t see must have been pretty early stage metastasis, and were being obliterated by radiation anyway, so they weren’t of concern.
From what you just said, tumour spillage isn’t really the main reason for radiotherapy. What is, then?
“Insurance. You see, for other cancers, such as those of the breast or liver, usually we would remove a margin of healthy-looking tissues at the periphery of the tumour, just to be on the safe side. However, given the location of your tumour, all tissues around it have crucial functions and can’t be removed. So instead we use radiation to destroy any cancer cells which may be hiding just behind the tumour bed. This reduces the chance of relapse, which usually takes the form of multiple smaller tumours scattered around. That’s bad news because they are tricky to remove cleanly by surgery, which complicates treatment.”
I see. Finally I know what all this suffering was for.
Why were the other surgeon and oncologist so fixated on the tumour spillage incident when introducing me to radiotherapy? Ummm......
“I got it now. Sigh, this radiotherapy is like nuclear warfare going on in my mouth. It’s really a mess.”
“Yes, I know. The operation was like a walk in the park, in contrast. Radiotherapy is barbaric, but that’s the best we could offer in medicine right now. Immunotherapy is the future, and I really hope that radiotherapy will be made obsolete soon to stop the suffering. Let me have a look inside your mouth......”
I slowly opened my mouth, conscious of touching or stretching any wounds inside.
“Ah, yes, this is quite typical, it’s unpleasant, I know.”
After the examination, I discussed with Mr J the extent of mucositis and the trajectory of recovery. He said the severity of the side effects and speed of recovery differ quite a lot between individuals. From his experience, the side effects one gets have more to do with genetics than with age, which means me being younger doesn’t necessarily mean I suffer less or recover faster. Who knows, some patients who could still eat curry during radiotherapy could be much older than me?
At this point, Mr J switched to a deeply caring tone, “try not to be too stoic with the side effects and pain, don’t be too hard on yourself. Use painkillers when needed —— it’s just temporary, it’s safe. Oh, also have a word with the dietician, so you can get some energy drinks. Each 125ml bottle provides 300 kcal and is easy to consume, much more comfortable than eating.”
He continued, “ ‘cancer’ is an emotive word and many people would immediately relate that to mortality, but it doesn’t have to be that way. Please reassure your family that your condition is curable.”
The worst of radiotherapy will be over one day, you’ll definitely get better.
As he brought up the subject of painkillers, I shared my amazement at my pain-free post-op days. It’s only then that he revealed the secret, how he severed a few minor nerves to numb the region near the wound!
OK, last question: “what happened to the left submandibular salivary gland? Why was it excised? Was it showing signs of cancer or what?”
“Oh, that’s purely for access —— to access the tumour. But it’s OK, you still have the parotid gland working on the left.”
“Really? I thought the parotid gland was destroyed by the tumour, since the tumour originated from it?”
“No, the parotid gland is still there. Look at this MRI image, the tumour was only pressing on the gland, but the gland itself was intact.”
“Oh!!!”
Lost, and found —— my left parotid gland, that is.
End of consultation. The physical exhaustion and pain remained, but Mr J’s answers lifted a heavy cloud above my head.
“You’ll definitely get better”: a simple message delivered with conviction, sincerity and credibility. That calm voice and reassuring gaze are still with me, to this day.