File: gutted.txt
Cont: 6 days post-op. 

I arrived at the hospital at 6:30am, went up to the ward, dumped my stuff
in the cupboard, hung up my clothes (black beanie, black Cave Clan shirt,
black trousers, and some gleaming white sneakers I found a couple of weeks
ago). I put on one another of those arse-baring white gowns, and did the
pre-op checklist... did I want anti-anxiolytics, asked the anaesthetist,
and on hearing the name of the benzodiazepine I decided I'd rather go in
with a clear head. They put on some fetching white compression stockings
on my lower legs, these are meant to lower my likelihood of getting a
venous thrombus while I'm not moving around. I chucked my spectacles and
watch in the bedside drawer. The staff clipped some ID tags to my left arm
and leg. They thought what I wrote on my abdomen was pretty amusing.

Mum and dad were there, and mum was surprisingly cool about it, but she
looked edgy when they both left. I rang her up a little while before I was
taken down to the OR, and she answered the fone in the sort of voice you
expect is going to tell you someone's just died. I could hear the bloody
*dog* moaning sympathetically in the background. I told her, look mum, I
appreciate the concern mum but would you please just bloody relax? I'm ok,
I'm not gonna die yet, I'll be out of here in a few days and this'll all
be over. Dad told me later she appreciated the call, but it didn't stop
her angsting.

Some dude named Alex wheeled me down to the roomful of other trolley-bound
patients who, like me, were stashed there awaiting to be knocked out and
chopped open and so forth. I got caught up in a conversation with him and
forgot to do Professor Derrida Deconstructs. The ceiling tiles were there
to farewell me, as was the anaesthetist, who expertly cannulated a vein in
my left arm, asked me to identify myself and then, injecting a load of
some crap with too many z's in its name to be identifiable by its IUPAC
chemical formalism, popped me off into unconsciousness. Dad told me later
I was too doped out to say anything intelligent as we passed each other in
the corridor outside of the theatres, he on the way to do his ops and I on
the way to do mine.


One of dad's mates, Greg (for whom I did a Playstation mod' a while ago)
popped in while I was on the table, for a lookie. I was very lucky. When
they did the initial incision, they decided they need not do the ugly
lungbusting transthoracic gash I had expected them to do. Nevertheless,
Greg still got more than a worthwhile eyeful. Natch, when they open you up
(skin, muscle, peritoneal lining) the first layer of actual guts they have
to get through is coils of intestines. Generally the surgeons locate the
mesenteric attachments which hold them in position in your abdomen, and
cut 'em off the inner back wall of your bod, then pull the whole lot out
and dump it on your chest, so they can get at the kidneys, main arterial
supply, and lymphatic networks involved in the op. So that your guts
doesn't dry out while you're being worked on, they chuck a couple of wet
towels on top of 'em. High tech, man.

The arteries feeding the mutant freakshow are small and difficult to tie
off without tearing and subsequently bleeding everywhere, so these days
they just staple 'em closed a couple of times with a few stainless steel
staples, between 6 and 11 mm wide, then chop 'em off at the occluded end.
If I fly anywhere now I'll be setting off metal detectors at customs. They
lifted the kidney/tumor out entire, then went to work on the lymph stuff.
Once that was done, someone shovelled my guts back into my peritoneal
cavity, sewed the two sundered halves of my abdomen back together, and
closed me up with a long, subcuticular stitch from sternum to mound. I'm
glad I didn't know a damn thing about it.

First thing I remember when I woke up was more ceiling tiles, mostly
obscured by the face of an intensive care nurse telling me I had to stop
swearing so much, tho I wasn't actually aware I was saying anything to
begin with. Someone had been a bit rough with the air tube, I noticed, I
had bruised lips on the right side of my mouth, tho maybe this was due to
someone smacking me one in the gob for being unacceptably rude while my
anaesthetically drugfucked brain was in the gradual process of rebooting.

I woke up a bit more later on. My throat was dry. There was something
stuck up my nose, which I figured out was a nasogastric tube, which made
it hellish to swallow properly, though that didn't matter since I was on a
nil-by-mouth regime. For some perverse reason I'd also had a long blue
urinary catheter fed into my dick while I was out. I discovered it when
I wanted to take a piss and couldn't feel it happening, but did it anyway
and wasn't immediately swimming in a warm puddle of my own urine. It went
all the way into my bladder and was held there by a hydrostatically
inflatable balloon. Hmmm. Must.... Think .... Pure .... Thoughts. I didn't
want to mess up my reproductive plumbing by getting a hardon while this
thing was embedded in it. A tube from the catheter went into a bag hung on
the side of the gurney and was watched hawk-like by nurses for blood,
cloudiness, and general volume.

There was an IV stuck in my arm, and I also had a central line plugged
into my right jugular vein, stuck onto my neck with sticking plaster. I
half wanted to puke but something was stopping me, which I later found out
was some or other anti-emetic which was being fed in through this central
line along with my delicious, nutritious intravenous saline, potassium,
glucose, antibiotics, and my new best friend, morphine, which is an
awesome pain-destroying alkaloid derived from opium poppies, and next
chemical cousin to thebaine and heroin.

I had control of how much analgesia I got: very simple, if it hurt, I'd
press this button pinned to my hospital smock, and the pain went away,
since more morphine was fed into my veins. I chewed through quite a lot in
the first couple of days. I watched dreamily as I was given jabs of
anticoagulant into the flesh of my thigh every 12 hours and didn't even
feel the needle go in. I spent wednesday night in the ICU and came out on
thursday. An ICU nurse, I think his name was Gray, cleaned my teeth
for me with a cotton swab soaked in mouthwash, which felt like going to
the dentist after a week of eating basalt grit topped with sawdust. 

It felt like I was vomiting when they eventually yanked the NG tube out of
my head, and aside from a faintly pukey remnant tang in my turbinates, it
was a great relief to be rid of it.

Intensive care sucks but I think I had a relatively easy time of it, the
old dude in the next bed along, who had also had a kidney out the same day
as I did, was moaning with pain 'cos he couldn't find his morphine button.
Across the room a patient was throwing stuff at one of the nurses,
paranoid that the nurse was stealing his possessions.

My olds came and visited me in the ICU on thursday. I remember the visit
only vaguely.

A physiotherapist asked me to cough for her, and I told here there was
just no goddamned way I was gonna do that 'cos it'd hurt too much.  I was
breathing fine, though. She passed me this clear plastic toy with three
lightweight plastic balls in it, each of which would rise up when one
inhaled 600, 900 or 1200 cc's of air per second through an attached
mouthpiece. I could pull all three of them up with a good drag, and hold
them there for long enough to suggest my lungs hadn't filled up with
too much crap. I was very glad, again, that they hadn't slashed my thorax.

I made it back to the regular north ward on thursday night. Everything was
still a bit of a blur. Trev Hyde came along for a visit, and I can't
remember what I said to him. Paul Cozzi came in and mentioned that they
got the kidney all out cleanly, but we all had to wait for the pathology
report to come back in a few days to see if we've really succeeded. I
slept on my back, morphined up to the maximum extent that the patient
controlled analgesia (PCA) machine would admit.

"Drugs are fuckin' fun, pal."  -TISM

Yeah. I had some weird dreams, but at least I was asleep.

I was very, very glad I packed the earplugs. Aside from the proximity of
my room to the ward reception and nurse's desk (very loud conversations
when the door was open) I had to deal with the accursed, Pythonesque,
Machine Which Goes BING - a peristaltic pump mounted on an intravenous
drip stand, which had the responsibility of forcing the contents of a
suspended bag of electrolytes and assorted pharma into my veins at a
predetermined rate. While it worked I could hear its internal gears
grinding away faintly, which was quiet enough to suffer and still get to
sleep.

However, for reasons related to running out of fluids to feed me, or the
occurrence of a kink in the lines, or a vein in my arm going awry, it
would chime, BING BONG... BING BONG... BING BONG... for hours if
necessary, and loudly enough for staff in the corridor to hear it so they
could come and attend to it. I found out where the SILENCE button was
fairly quickly but that only gave a minute of respite. Unplugging the
bastard didn't shut it up either, since it had battery backup. But it
dawned on me, in my opiated daze, this demonic item was responsible for
keeping me hydrated and doped up. Arrrgh. And it was plumbed into my
circulation, too. Captive audience. I hoped whoever designed this thing
died and went to a customised hell where an infinity of these things
stretched from horizon to horizon, were cannulated to 'em by an
inescapable web of PVC tubing, beeping furiously, no earplugs in sight,
and nobody came, ever, to turn them off.

On Friday I stood up, got out of bed, and walked around the ward a bit,
slowly, with the help of a physiotherapist, i.v. drip stand functioning as
a kind of walking support. I couldn't stand up properly, I was bent over
since the abdominal stitches still hurt.

I gingerly peeled the long adhesive dressing off my wound. If you buy a
steak at the supermarket you'll notice there's a bit of absorbent padding
stuck to it on the bottom side of it, sodden with blood. Mine was like
that, longer, crustier, more colourful, but clean - didn't look infected
at all. I was impressed that none of it stuck. The pattern intrigued me
for a few seconds before I tossed it in the bin. Whoever sewed me up knew
what they were doing with a needle but I'm stuffed if I know where they've
hidden my old belly button. I had a shower, sitting down, for the first
time in some years, and felt a lot better, and went back to bed, into the
waiting arms of the nicest drug I'd met all week.

Frank came along and dropped off a load of roses chopped from his wife's
garden. They smelled very nice. A couple of my ancient rellos, Mon and
Paul, dropped in to say hi, also bearing a load of flowers. I'm such an
ungrateful bastard about such things... I think of them as more stuff to
take out when I leave the ward. Trev Hyde came in and told me the
condensed version of his life story, which was interesting. He's pretty
old now, considering retirement since the insurance situation is insane
these days. We got to the bit about dying. He's afraid of the judgement
which he thinks will come after he dies. I think religion has shortchanged
him - he's lived a life in fear of god, and will die acutely terrified of
the impending sentence. I was like that once. I ditched god and started
living a decade ago. My death is a cleaner one, where my metabolism shuts
down; my personality submits to the implacable grip of thermodynamic
entropy, and dissolves irretrievably into the molecular noise which my
organism fought so hard against for three decades. There's no succour,
though. Trev thinks he will survive death. I know, in the very neurons
thinking this thought, that I will not. But at least I'm not scared of an
eternity of anything.

Since I was on nil-by-mouth I couldn't drink, or eat, or swallow oral
painkillers. By friday night I finally became tired of having paracetamol
suppositories jammed up my bum and told the nurse I was not gonna have any
more of 'em, which was probably as much of a relief to me as it was to
her. I was gonna miss the morphine when it eventually went away. I also
finally decided to toss the oxygen prongs which had been stuck up my
nose ever since the NG tube came out. The gas came out of the feeder
tubes anhydrous and cold, and gave me recurring bloody snotty nostrils.
They fell somewhere behind the bed and gradually oxygenated the whole
room, hissing quietly in the dark and doing the job anyway. One less piece
of equipment to tie me down.

Stupid little things became important... wether or not I was farting, for
instance. On friday, I took my first crap for a couple of days. I had to
unplug myself from the wall sockets, and carry a bagful of my wee with me,
in order to go to the bathroom. Cozzi was happy about this shitful event
when I told him, since it indicated my reshuffled cabinet o' guts hadn't
adopted some strange kinked or knotted topology not conducive to pushing
partly-digested dinner through it. It surprised me, since I hadn't eaten
anything since tuesday, that anything remained to be discarded.

Simple things scared me. A person came in with a vacuum cleaner. She asked
if I wanted the room vacuumed, and I pulled the bed covers over my face,
shaking my head and pathetically moaning "NOOOOOOoooo!" ... I was in
terror of the agony of any sneezing which might be provoked by whatever
dust the vac' might exhaust into the air in the room. Thankfully she
retreated into the corridor with her allergen aerosolisation weapon in
tow.

A nurse named Nadia walked in and told me she was gonna take my catheter
out. Holy shit! Want a bloke's undivided attention - threaten his rigging.
She plugged a syringe into a port on the protruding end and evacuated the
balloon which held it inside me, then before I could even say "be careful"
she rapidly removed the thing in about one second of blistering urethral
agony. It was great to take a leak normally again but I had to remember to
pay attention when I did it again, having not had to do so for the past
few days.

Saturday came, and with it, finally, a clear fluids diet, so Cozzi asked
me if I wanted to lose the drip, and oh, hell yesssss, I did. So I was
finally freed of that blasted BING generator by the evening. With it,
alas, went my beloved narcotic. 

Coz' mentioned that I wasn't allowed to eat any fat for two weeks, since
one apparently tends to get problems with chylomicron accumulation
immediately after lymphatic resection when on fatty diets. Oh, cruel...
the cannabis cookies in the 'fridge at home, built around a fatty,
butter-laden biscuit mix, were now off my list of things to eat, just when
I needed them. This is apparently more problematic with the longer chain
fatty acids, so it'd be sorta-ok to eat fish. Someone had sent up a large
box of chocolate thingos which I hadn't opened. Once the news about the
no-fat diet arrived, I decided to give the chocolates away to the nursing
staff, and they had gobbled 'em all by sunday morning.

On Saturday, Raffo and Tee also showed up and we had a chat, though I
dunno if I mumbled anything especially intelligent. Stuff was still
painful. I'd been on my back for consecutive days, since rolling over
caused pain as my detached guts sloshed about inside my abdomen under the
influence of gravity. Tee understood the significance of what was on the
MRI scan, since she's a nurse, but really, one could suss this out fairly
straightforwardly with the untrained eye. They held it up to the window
and had a gawk at my previous tennant, and were suitably impressed. 

Sunday was the first day I got any solid food. My guts rumbled as if not
quite sure what to do with this unfamiliar manna coming down from a
long-empty oesophagus, but oooh, it was good to eat actual food again.
Digesting it was a different matter. I felt the coils move around,
painfully trying to decide how to pack themselves, and my dinner, in my
abdomen. They made lots of noise. They haven't they figured out there's a
load of new space to live in, now half my renal system's gone, but then,
they're guts, not brains, I suppose, so one can forgive them of this
learning deficit. Pack in, dudes, shut up and chow down. Do yer job. Keep
me alive.

Several people came on Sunday. Most of the geek crew from cat.org.au
ventured out on the train. It was good to see 'em. 


I got out of bed on Monday morning and walked the ward unassisted,
unemcumbered. Aslan (geez, I'm already misspelling his name, can't
remember if it ends in m or n) came in and told me the histology report
had finally come back. They got all the kidney out and its margins
suggested it hadn't invaded anything nearby, which was reassuring.

However, all but one of the lymph nodes which Coz' resected was
_involved_, which is pathology-speak for invaded by tumor cells. It's
already spread. What this op has achieved is to push me back along the
exponential growth curve exhibited by uncontrolled, proliferating cells,
but not to get me off it.

Aslan said I could go home. I called mum, my long-suffering taxi. I put on
the same clothes as I wore when I came. Black. I had spent the whole time
in a hospital gown so nothing in the pack had been used, adding subtle
idiocy to the ruckus which went into controlling what went into it. I
slung it over my shoulder and walked slowly down the corridor. I checked
out with the sisters on the desk, and suggested there were two jars of
cut-off plant sex organs in my room for which I had no further need and
which might look good on their counter top.

I sat in the lounge and awaited mum's arrival. A man and woman in their
seventies were chatting about their cancer. It struck me I could just as
well be having the same conversation, but they were less bleak about it, 
being twice my age, and less clued into its molecular biological nature. 
Maybe ignorance is bliss, but in general I find it just leads to one being
bitten on the arse more often than not.

Its formal name, by the way, is renal clear cell metastatic carcinoma. It
will re-emerge. Somewhere, sometime, as surely as night follows day. This
is the way of living things, the logic of cells gone mad. The game is
afoot, and I am it. All your cell are belong to us.

The oncological cat is out of the bag, running loose in my vascular and
lymphatic systems, the intricate fractal ducting which has served me for
so long now subverted to facilitate my destruction. Unlike normal cats
with nine lives, this cat is immortal, clonal, malignant and predatory, as
one might expect.


"I am Locutus of Borg.
 Resistance is futile.
 You will be assimilated.
 Your life as it has been is over.
 From this time forward, you will service us."

-Picard.



Well, fuck you, pal. 

I was gonna say to it, you'll never take me alive, but then, it *has*
already done so. After all, it *is* me. So the game changes to
scorched-earth.

I know where the azide is, where the ropes are. I have a half-kilo of AN
prill somewhere, too, if I feel the need vapourise my head faster than the
nerves inside it can possibly process the experience. Yeah. Fuck you, pal.
_I_ live here. I'll burn the house down with you in it, if needs be, to
get you out.

I type this with a curling upper lip, snorting air through flared nares,
not quite sure of my own vehemence but rapidly becoming convinced. 

Mum drives me home. My guts jiggles as we drive over cracks in the
highway. I don't tell her about the metastatic nature of the thing till I
get there. I am a pretty grumpy guy all day, thinking about this
situation. Chemo and radiotherapy are pretty much useless for this
disease. It has to be fought immunologically. Maybe some recombinant
chemokines would help at this point, but I don't know anything about their
effectiveness yet.

Another option, which I know a little bit about, is the construction of a
DNA vaccine against this thing which has taken me over. We kept some of
the tumor, in order to extract from it some short segments of its DNA
which encode for proteins unique to the surface of the cells which make it
up. Using the usual restriction enzymes and DNA ligases, one splices this
into a mammalian expression vector - a hoop of DNA which is constructed so
that cells injected with it read the DNA and synthesise the protein
encoded thereon. There's a sting engineered-in, however: the hoop of DNA
containing the tumor protein sequence is arranged so that another bit of
DNA, encoding another protein with which the immune system already has the
shits, is spliced in adjacent to the segment codifying the tumor protein.

This hybrid is called a chimaera, or a fusion protein. When the cells
injected with this engineered hoop of DNA make the protein, they'll carve
it up into fragments 9-16 amino acids in length, serve it up on the major
histocompatability Class I and Class II systems to various surveilling
lymphocytes, which will then learn to recognise these fragments, hopefully
go clone themselves up, distribute themselves and attack any cells bearing
any parts of this unnatural molecular construct. From what I read five
years ago in '98 when I was doing honours, this sort of strategy works
well on some viruses, some proteinaceous venoms, and in certain
immunocontraceptive roles. People were only starting to think of
vaccinating themselves against their own tumors back then.

Nobody does it in Oz, but fortunately, labs exist in Deutschland and
Nippon which do this sort of stuff to order, and once fabricated, can send
it back via airfreight. It might work, it might not, I'll have to go trawl
medline to see if it's worth a shot. I am not feeling especially hopeful,
but five years is a long time in molecular biology. Particularly in mine.


It's monday night, no, 3am tuesday morning, and I cannot sleep. I didn't
sleep again last night, I lay there trying to figure out which position
would let me conk out into blessed unconsciousness but none of them did.
I'm a bit hiccough prone, which makes my guts hurt. I'm producing bloodied
phlegm, but not by coughing it up. Panadol isn't a rat's arse on morphine,
but I figured I'd better wean myself off the opiate. I do these strange,
uncharacteristic muscle twitches when I am drifting off to sleep.

The score at the moment:

-1) I have cancer, but not so much of it. This process will
    progress, and eventually cancer will have me. When this happens, I
    will die.
 
0) I lost five kilos in four hours with this uh, amazing kidney-free diet,
   but I only had 65kgs to begin with. 

1) I have a big slash up the middle, which hurts when I try and stand up 
   straight. It leaks blood a little bit. My belly button has disappeared,
   which probably means I have Joined The Unborn 8-)

2) My intestines are playing musical chairs with themselves, which
   also hurts. They're rather like an unruly room of schoolkids; take 'em
   out for an excursion and they muck up for the rest of the month. I'd
   smack 'em if I thought it would improve matters, but that'd hurt too.

3) right 'nad occasionally painful, OW. I hope this is referred pain.

4) I'm shooting blanks. Obviously I did not Think Pure enough Thoughts 
   while catheterised, or I was damaged when it was fed in, or removed.
   Bummer. 

5) Bordered by lines of incredible adhesive which refuses to come off with
   soap, are several rectilinear patches of hair missing from my arms,
   adjacent to bruises where needles were wrongly inserted or pinpricks
   where they went in OK. Small black pocks dot my legs where the
   anticoags were administered.

It has finally sunk in that I am actually alive, despite all this stuff,
but I'm not out of the shit, not by a long way, and may never be.


Tuesday.

This fat-free diet sort of sucks. It's not like I have a lot of it on me
anyway. Milk with no fat, which is called "Shape" instead of "Taste" for
good reasons, is an insipid, transparent, runny waste of effort, showing
up a bowl of cornflakes as the uninspiring foodstuff it is. I eat toast
with honey for breakfast, with a banana. Mum excelled herself tonight and
cooked up a steamed lemon and pepper barramundi so fiendishly delicious
I'm sure I'd swap it for a kidney again if I had a spare one to donate.

I'm off to an oncologist on Thursday to clue in about the options.  A chap
named John Hunter said, in the eighteenth century, that surgery was like
an armed savage who attempts to get that by force which a civilised man
would get by strategem. I've done the armed savagery, but I'm not feeling
especially civilised at the moment. Perhaps when I awake tomorrow I will
be when I chat to the cancer heads. I hope, whoever they are, they speak
molecular biology. 



<predator>


(the next in the series is now at conway.cat.org.au/~predator/hunting.txt)
(It is long, and unlikely to be an enjoyable read. You've been warned.)