Mind Tricks

Oh, the mind plays tricks, when you’re recovering from surgery, having uncomfortable, sleepless, or at least wakeful nights, constantly aware whenever you move or turn over of the catheter and the tube going down into the bucket that holds the night bag…

And in the moments of sleep, the dreams that come are dreams of strange anxieties, harping back to things that used to be major parts of your life, but now: well, not so much…

I dreamed I was taking a Holy Communion service for the nuns. In my pyjamas. Just when it was time to begin, I noticed that my catheter leg bag was full almost to bursting. With some difficulty I found the toilet at the far end of the dark cloister, but just as I was doing the business a family of about 27 tourists (including a dozen children) burst in…

Then I was half-awake for the longest time, reconstructing old proverbs. “If you rob one end of a person’s grave, you’re gonna have to rob the other.” OK, if you don’t like that one, let’s make it a party game or exam question: Complete this sentence: If you rob one end of a person’s grave…

Just the same last night. My anxiety dream was about conducting a wedding in a church I didn’t know, for a couple I’d never met. I arrived late and unprepared, just as all the other massed robed clergy (and why wasn’t one of them taking the service, anyway?) were already processing into church, and saying, “Come on, hurry up!” And when we got inside, I found myself in the AGM of something like the Esperanto Association of Britain, which went on and on, and I’m saying, “But what about the wedding? They won’t want to be waiting all this time, and anyway, I still don’t know who or even where the bride and groom are.”

Still, I must be getting a bit better. There weren’t any ghoulish proverbs last night.

Prostate Story: Part 1

If you google “How many men suffer from prostate cancer?” (which turns out to be a common query), the answers you’ll get include:

“All men are at risk for developing prostate cancer. About 1 man in 9 will be diagnosed with prostate cancer during his lifetime, but only 1 man in 39 will die of this disease. About 80 percent of men who reach age 80 have prostate cancer cells in their prostate.”

Does it run in families?

“Prostate cancer seems to run in some families, which suggests that in some cases there may be an inherited or genetic factor. (Still, most prostate cancers occur in men without a family history of it.) Having a father or brother with prostate cancer more than doubles a man’s risk of developing this disease.”

If you get prostate cancer, are you going to die? (Well, yes… the mortality rate for life is 100%… But the answer the WWW actually gives is:)

“The 5-year survival rate for most men with local or regional prostate cancer is nearly 100%. Ninety-eight percent (98%) are alive after 10 years. For men diagnosed with prostate cancer that has spread to other parts of the body, the 5-year survival rate is 30%.

I’m sceptical about the figure of 1 in 9 men getting this diagnosis (or 1 in 7 according to another source). Most of the older men I’ve spoken to about my recent experiences say, “Oh yeah… been there… done that…” (I’ve yet to see a T-shirt…) “You’ll be OK.” So the message seems rather: It’s very likely; it’s very survivable. And, as some of those friends almost evangelistically continue, when talking to other men: “If you’re over 50 or 60: get your PSA tested.”

My own ‘prostate pathway’ began after we moved to Thame. I’d been noticing one or two of the symptoms that are well-known indicators, and mentioned them to my GP when I went for our first meeting. She proposed an internal examination as the first step. Well, they say you should embrace new experiences as you get older…

(She: “You can have a male doctor do this, if you prefer?” Me: “If someone’s going to be sticking their finger up my bum, I’d rather it was a pretty young woman.” — No, I didn’t actually say this; and since she was an intern I got her male supervisor looking on anyway.)

The result was, my prostate gland did feel enlarged on one side, so the next step was for one of the practice nurses to take a blood sample and send it for PSA (Prostate Specific Antogen) testing. My level came back as slightly elevated so I was sent an appointment for an MRI scan. In all sorts of ways, this had been one of my nightmares. I’d only ever seen it on TV, where the patient disappears into a noisy, narrow tube, and so often suffers some disastrous reaction. For someone who is slightly phobic about medical dramas, and very phobic about being shut in confined spaces, this represented a challenge. But the reality was that strangely comforting – almost womb-like, you might say.

The literature tells you that, after the MRI scan, you may be called back for a biopsy. I got the distinct impression that around here this is not a ‘may be’ but a ‘will be’. Another new, and much more unpleasant, experience. The TRUS (Trans-rectal ultrasound) biopsy involves having a probe inserted in your back passage, with needles which stab you in the prostate 12 times, taking small tissue samples for analysis. The kindly women who inflicted this on me, in a kind of “Hail fellow, well met” manner, promised me that it would be possible for me to get a printout of the ultrasound picture of my prostate, which I could have shown off to my nearest and dearest in the manner of newly pregnant mums with their antenatal pictures; but alas, they forgot to do this. Their offer to reinsert the probe and have another go, I politely declined.

The biopsy showed that there were indeed cancerous cells present in my prostate, and you get this information in the arcane formula of a Gleason score, which is a mixture of the most common grade of cancer present, and the highest other grade in the samples. It’s a bit like being read a page from Wisden, so if you like that kind of thing, I’ll leave you to read all about the scores on one of the link pages. I was in the ‘low risk’ category, however; so the proposed action was: No treatment, but active surveillance. Sounded good to me.

Trouble was, after a year of quarterly blood tests, my PSA level didn’t do what I hoped it would: hover about around the same level. It continued to go up, indicating that whatever cancer was present, was growing. At this point you embark on the next step of the pathway: a second MRI scan, and a second biopsy: this time a trans-perineal biopsy which allows for more samples to be taken, and greater accuracy in selecting where they are taken from. I hoped that trans-perineal biopsy would be less unpleasant than the TRUS. It wasn’t, really. And, it was done by the male surgeon, rather than the hearty women.

It also revealed that I had transitioned from low to medium risk — only just — so it could be desirable to do something about it. The NHS is a lot about choice, these days — which is all a good thing! But it does involve a lot of the professionals’ time, explaining stuff to people who don’t know much about it and may well not want to know anyway. The main thing anyone needs to know is, that around here, they are brilliant at it. In the case of a man of my age and general health, there were two courses of action which are thought to be equally effective and successful: radical prostatectomy surgery, and radiotherapy. You get to meet the consultants in both areas in an event that is reminiscent of a fresher’s fair, with different interests setting out their stalls and trying to get you to sign up. The advantages, the disadvantages, the possible outcomes and side-effects, and so on.

The surgery option begins encouragingly with, “Well, we have to tell you that in rare instances, surgery can result in death…” After that, it does get better. For various reasons, we decided to opt for the radical surgery. One, if the cancer does return, you can have radiotherapy after surgery, while surgery after radiotherapy is often not possible, because of tissue scarring that can be caused by the earlier radiation. Two, it seemed at the time that surgery would be less intrusive on our lives, than having to travel to the hospital for daily radiation treatments. But what really clinched it for me was that the radical prostatectomy available around here is robot-assisted! keyhole surgery! It almost makes you want to become a surgeon, so that your work is like a computer game, shooting down prostate glands like space aliens. (This may not quite do justice to the procedure, though the short video clip we sat through that showed the procedure was pretty exciting.) I couldn’t find the exact video we saw online, but this (presumably, promotional) video gives an idea of it.

Having opted for surgery, we were told the waiting list was 10-12 weeks. As the weeks went by, we began to wonder whether this was a figure based more on aspiration than on the reality of staffing levels in the operating theatres. We prayed the surgery would take place before Christmas — and here’s why you should always be careful what you pray for — a letter arrived ‘confirming’ the date of my surgery as December 24.

(To be continued…)

There are lots of online resources about prostate cancer, among which the most extensive and helpful I’ve found is Prostate Cancer UK. The NHS site has lots of excellent helpful information. A starting point might be to watch this video. And there is, in fact, even a T-shirt:

Missing: Victorian Librarian

Somewhere high in the Austrian Alps there may lie the body of a librarian, for that is where Robert Proctor was last seen, at the head of the Taschach valley, on the morning of Sunday, 6 September 1903.

How could anyone resist an article with an opening sentence like that? The article, by C. J. Wright, entitled The Missing Librarian, appears in the latest issue (no.59) of Slightly Foxed, which subtitles itself ‘The Real Reader’s Quarterly’. If you have never read Slightly Foxed, or are not yet a subscriber… WHY EVER NOT? Of all the publications I subscribe to or have ever subscribed to, this is the only one – the only one – that I read, without fail, from cover to cover. It describes itself as:

The independent-minded quarterly that combines good looks, good writing and a personal approach. Slightly Foxed introduces its readers to books that are no longer new and fashionable but have lasting appeal. Good-humoured, unpretentious and a bit eccentric, it’s more like a well-read friend than a literary magazine.

And it is just what it says on the tin. It’s a constant source of discovery and delight. I used to think I would need to search out and read every single book its contributors write about, which would have proved a challenge when so many are now out of print. And yes, it has introduced me to lots of previously unknown books and writers I have since enjoyed. But that’s no longer essential: it’s often sufficient to eavesdrop on the enjoyment of the article writers, some of whom have indeed come to feel like fascinating friends. (If I have one small niggle about them, it’s that so many do seem to be the product of a private school, or at least a boarding school, education. But we can’t all be State-school kids, I suppose.)

And for this particular retired vicar, in whose breast still beats the heart of a librarian, how could I not be intrigued to read of a colleague who met such a mysterious fate over a century ago? According to Wikipedia, one of Proctor’s friends thought the missing librarian may have committed suicide up there above the Taschach valley. But C. J. Wright leaves the mystery much more open. Perhaps in the far future, a few thousand years hence, his frozen and preserved body will be found, like that of Ötzi the Ice Man, and the mystery of his death be finally resolved. But perhaps it’s more fun that it’s not.

38 years a priest

38 years ago today, I was ordained as Priest in the Church of England. In my morning prayers today, I looked up the Ordinal in the Book of Common Prayer to read the exhortation in The Ordering of Priests. These are not quite the words we heard in that service, which I suspect had been brought in line with Series 3 or some other revised form of service. But these words express the same sentiment. And they are scary…

YOU have heard, brethren, as well in your private examination, as in the exhortation which was now made to you, and in the holy Lessons taken out of the Gospel and the writings of the Apostles, of what dignity and of how great importance this office is, whereunto ye are called. And now again we exhort you, in the Name of our Lord Jesus Christ, that you have in remembrance, into how high a dignity, and to how weighty an office and charge ye are called: that is to say, to be messengers, watchmen, and stewards of the Lord; to teach and to premonish, to feed and provide for the Lord’s family; to seek for Christ’s sheep that are dispersed abroad, and for his children who are in the midst of this naughty world, that they may be saved through Christ for ever.

Have always therefore printed in your remembrance, how great a treasure is committed to your charge. For they are the sheep of Christ, which he bought with his death, and for whom he his blood. The Church and Congregation whom you must serve, is his spouse and his body. And if it shall happen the same Church, or any member thereof, to take any hurt or hindrance by reason of your negligence, ye know the greatness of the fault, and also the horrible punishment that will ensue. Wherefore consider with yourselves the end of your ministry towards the children of God, towards the spouse and body of Christ; and see that you never cease your labour, your care and diligence, until you have done all that lieth in you, according to your bounden duty, to bring all such as are or shall be committed to your charge, unto that agreement in the faith and knowledge of God, and to that ripeness and perfectness of age in Christ, that there be no place left among you, either for error in religion, or for viciousness in life.

Forasmuch then as your office is both of so great excellency and of so great difficulty, ye see with how great care and study ye ought to apply yourselves, as well that ye may shew yourselves dutiful and thankful unto that Lord, who hath placed you in so high a dignity; as also to beware that neither you yourselves offend, nor be occasion that others offend. Howbeit, ye cannot have a mind and will thereto of yourselves; for that will and ability is given of God alone. Therefore ye ought, and have need, to pray earnestly for his Holy Spirit. And seeing that you cannot by any other means compass the doing of so weighty a work, pertaining to the salvation of man, but with doctrine and exhortation taken out of the holy Scriptures, and with a life agreeable to the same; consider how studious ye ought to be in reading and learning the Scriptures, and in framing the manners both of yourselves, and of them that specially pertain unto you, according to the rule of the same Scriptures: and for this self-same cause, how ye ought to forsake and set aside (as much as you may) all worldly cares and studies.

We have good hope that you have well weighed and pondered these things with yourselves long before this time; and that you have clearly determined, by God’s grace, to give yourselves wholly to this office, whereunto it hath pleased God to call you: so that, as much as lieth in you, you will apply yourselves wholly to this one thing, and draw all your cares and studies this way; and that you will continually pray to God the Father, by the mediation of our only Saviour Jesus Christ, for the heavenly assistance of the Holy Ghost; that, by daily reading and weighing of the Scriptures, ye may wax riper and stronger in your ministry; and that ye may so endeavour yourselves from time to time to sanctify the lives of you and yours, and to fashion them after the rule and doctrine of Christ, that ye may be wholesome and godly examples and patterns for the people to follow.

Clearly no one is worthy, or can fully live up to that high calling. (God knows how any priest could physically or spiritually abuse any person, if they at all remembered those words about causing any hurt or hindrance to any member of the body of Christ, by their negligence…) The ordinary harm we cause by the ordinary negligence of ordinary sinners is a hard enough burden to bear, with words like ‘horrible punishment’ hanging over our heads. The only comfort is that Jesus called some pretty unworthy people to be his disciples and apostles (see the Gospels, passim); and that the Everlasting Mercy is always greater.

How did I dare to do it for all those years? And how do I still dare, when I’m asked to? Because somewhere, and sometimes it seems against all experience and evidence, I do believe that Mercy always triumphs over Judgement.

New Zealand: 16. We stand on the Misty Mountains

The next day was the hottest day so far, with temperatures reaching 37° C. This is supposedly unheard of in those parts of South Island: I’ve already mentioned that the hotels down there don’t have air conditioning, on the grounds that they don’t need it.

And we finally got our promised helicopter flight, from Queenstown Airport to the top of the Remarkables. I wasn’t the only member of the group who had been feeling some trepidation about this, even though (very fortunately) it was the day before four British tourists were killed in a helicopter crash at the Grand Canyon, and not the day after… But it was actually a great experience. A short one – which is probably also a blessing.

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The thing that surprised me was that it didn’t feel like we were travelling fast, though it only took a few minutes before we were landing at the top. Yes, there was a slight moment of “Aargh! There’s a mountain side just a few yards to our right…” And here we are:

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Enjoying spectacular and beautiful views of Queenstown and Lake Wakatipu

View of Queenstown and Lake Wakatipu

Safely back on land and boarded the coach, we continued to Arrowtown, a quaint old gold-mining town, near the river where I had tried my hand at panning for gold a couple of days earlier. It feels like some kind of old cowboy town, with its old-style clapboard houses and street furniture.

Arrowtown Post Office

Arrowtown post box

After lunch we had another long drive on to the Kawarau Gorge, Cromwell and the Lindis Pass – at 965 m above sea level, the highest road we drove over in New Zealand, and so on to the junction town of Omarama, where we were to spend the night at the Heritage Gateway Hotel. There weren’t many places to eat in town (it’s not much of a town) so we all ate together in the hotel restaurant. It was good to share a more communal meal, which hadn’t been a frequent event during our stay. It was also a pleasant summer evening to sit outside with pre- or post-mealtime drinks. Some of our fellow-travellers stayed up to see the stars of the southern hemisphere, including the Southern Cross. I didn’t manage it: after all the early starts and long coach rides I couldn’t stay awake long enough, especially as it didn’t get dark until very late.

Shame. It would’ve been quite a sight.

stars of the southern hemisphere

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