Infection

So I was ready for chemo. My holiday was cancelled, my sperm banked, and the operation distant enough for me to be healed. Or so I thought on the latter.

The night before I’m due to go to the chemotherapy ward for a run-through of what to expect, I’m getting ready for bed when I notice a small wet patch on my boxer shorts. I go through the possibilities: have I done a little wee wee by accident? Nope, too old for that. Or not old enough. Have I got a little excited at something or other? The sight of a pie maybe? No, it’s not quite in the right place.

I took off my boxers and had a look at my scar. There at the bottom of it was a small area that was a little gungy. The rest of the scar had healed perfectly, but right at the bottom was a small patch of sticky clear liquid. It was hardly worth talking about. Just a tiny bit of seepage. But I instantly knew it was going to be a big problem.

I saw the chemo nurse the next day. She was Mediterranean-looking, thick accent, short and pudgy. She wittered away like a bird, constantly repeating herself. She was nervy, worried she was going to forget something. But I don’t think she was new. She seemed to know what she was doing, just that if she didn’t keep going over it, it was going to escape from the clutches of her memory never to return. She drove me mad.

She went over everything Dr Laurence had told me already, enhanced with much of the stuff I’d read in the leaflet he’d given me. She’d even go over stuff that was only relevant if I was having more than one dose of chemo, ending it with “But that’s not the case for you so that’s okay.”

Just when I was about to scream at her that I knew all this stuff already what the hell was the point of this you mad bitch, she would give me a nugget of information that was useful. Like I should use a baby toothbrush when cleaning my teeth as my gums were likely to bleed from vigorous brushing. “So I can’t use my electric toothbrush then?” I joked. She laughed but looked horrified. “No!” she squealed. “Just a baby toothbrush.”

Eventually I managed to get a word in edgeways and asked her about the puss oozing from my scar. She put on her serious face but failed to cover up the fact that she had no idea what to say to me about it. She didn’t even ask to look at it. She just said I should speak to my oncologist.

I phoned the nurse practitioner, Nurse Kathryn, and left a voice mail, trying to make it sound as innocuous as possible. I had thought about not saying anything. The last thing I wanted was to delay the chemo; I needed to get it over and done with as quickly as possible so I could get back to normality. But that need also fed my decision to ’fess up and ask them about it. If I had chemo and it made what was looking like an infection worse, then my return to full health could be delayed even further. It wasn’t worth the risk.

It was an infection. I saw Dr Laurence the next day – the day I was due to have chemo. He looked at it, took some swabs, and put me on antibiotics for a week. I was going to have to wait a whole week. He confirmed my fears – if I had chemo then there was a risk that my dilapidated immune system would allow the infection to fester and grow worse.

A week. A whole fucking week. I was angry. Angry and frustrated. To add insult to injury it looked like the day I would now have chemo was the day we were supposed to be going away. It wasn’t the holiday itself as such - we could go down to Cornwall any time, although it would have been nicer at that time of year. What made me angry was the demanding, unreasonable, inflexible nature of this illness. You dance to its tune, not the other way. There’s no give at all. I’m not used to being properly sick I guess. But if I want to beat it then I have to play by its rules. I can’t take it on and still live my life exactly the way I want it. I’ve had to put certain aspects of my life, bits that make it fulfilling, enjoyable and, if I’m honest, manageable, on hold a bit while I take care of it. And I hate it for that. I really hate it.

Yesterday I went back to the hospital for them to check my infection. It looked like the antibiotics had made little difference to me. It doesn’t seep as much I guess, but it’s still infected. Dr Laurence was more positive however. He felt it had improved enough for us to go ahead with the chemo, but he wanted to get a second opinion just to be sure and called in a urological surgeon to have a look.

It wasn’t the guy who operated on me, thank god. This guy was unexpected – a big burly man, very muscular, his hair cut in an army style. With his thick Eastern European accent he could have been a bad guy from a Bond movie. It was hard to imagine him doing something as delicate as surgery, but I trusted in Dr Laurence that this was the man to give a second opinion.

I lay back on the bed again, trousers dropped and boxers down enough to reveal the scar. I wasn’t getting my dick out again for anyone, that was for sure. He asked me some questions about the surgery and how long I’d had the infection then bent over to take a look. He pressed his meaty fingers onto the scar and pushed into it. It was very uncomfortable. He pushed some more. And more. He kept pushing until I thought my pelvis was going to snap. I cried out in agony and pushed his arms away.

“What the fuck are you doing?” was my immediate response. He responded apologetically, saying he was trying to squeeze any remaining pus out. He bent over to have another go. I sat up and pulled my shorts up. “No fucking way, you’re done mate.” He looked a bit mortified. He started jabbering away, saying he was just trying to see how much of the infection was left. I said I didn’t care what he was doing, but he should at least give a bit of warning.

He kept apologising and trying to get me to let him look at me again. I wasn’t having any of it. I’d been so upset by my last run in with a registrar that somewhere in the back of my head was a voice going, ‘Never let that happen again.’ I wasn’t a piece of meat he could manhandle however he liked and I let him know it.

He got me to try and push some pus out of my scar but nothing really came out. Either I wasn’t doing it hard enough or there wasn’t much there. I did my trousers up but he wouldn’t go away. He kept apologising, at which I would just stare stonily at him. Then he started asking me questions about children and sperm banking. Unbelievable.

“Do you have any kids?” “No.”
“Do you want kids?” “I’ve already sperm-banked,” I cut in, not wanting to get into the conversation with him. I wanted him to go.
“Did you give a few samples?” “No.” I stared at him. He put his hand on my shoulder. “You’ll have plenty of kids.” Wanker.

He apologised again and I nodded. This seemed enough of an acceptance for him to finally leave. Dr Laurence had tried to mediate a bit during this exchange, to no avail: he’d been determined to apologise and I’d been determined to let him know he was out of order. He sat me down and said some soothing words. I told him about the first registrar and he conceded that there was a certain type of personality drawn to that job, and that they saw so many patients that in a way they lost sight of them as people.

But down to business. He reckoned the infection had cleared up enough now that by the time my immune system started to be affected by the chemo, it would be long gone. It was time to book me in. He had no spots free today – imagine that, all those people needing chemo – so tomorrow it is. Just one dose then I’m done. Sounds easy right? How hard can it be?

Banking

Did I need to bank any sperm? Probably not. From the professionals’ surprisingly non-judgemental point of view they offered me the opportunity as a precautionary measure. They knew I had no children and they knew I was gay and when they asked me if I wanted to have children I said probably not, but they still offered me the chance. They told me that although my fertility level would be lowered somewhat by the chemotherapy most patients saw it return to normal afterwards and went on to have children normally, and I would probably be the same given I was only getting one dose. But they still offered me the chance. And I thank them for that.

From my point of view, given my sexuality and where I was at in my life right now, I thought it unlikely that I would want children of my own in the near or distant future. Add into this the thought that if I did want children I would think it better to adopt, then it’s increasingly unlikely. But why take away the choice? I decided that, though I probably wouldn’t have any use for my sperm in the future I envisioned for myself, I still wanted it there if I changed my mind.

Plus I wanted to experience what sperm banking was like.

Turns out it’s quite amusing.

So I left work in my lunch hour and headed to the hospital, this time to yet another new department – the Assisted Conception Unit. It was a little awkward at the reception as there were people stood behind me but I eased the situation by using medical euphemisms: “Hi, I’ve come to give a sample.” Much more appropriate than: “Hi, I’ve come to wank into a pot for you.”

A nurse showed me to the room. She explained the procedure: I’m to lock the door twice so the red light is switched on and people know not to disturb you; I’m to produce the sample into the pot, screw the lid on tight, place in the plastic bag, and place into the plastic container to be sent up a shoot (as it were) to the laboratory. She then showed me how to work the shoot (as it were).

She left me to it and I shut the door behind me. I fiddled with the lock for awhile, unsure whether it was locking twice or not. I realised I was nervous and told myself to stop pissing about and get on with it. The room was small with a leather recliner and foot stool in one corner, a sink and mirror in the other and a desk with a TV and DVD player.

I decided to peruse the ‘materials’ they’d kindly left to stimulate you. I was sorely disappointed: all the magazines and DVDs they had were aimed squarely at the heterosexual market. There wasn’t even the odd cock to look at – it was exclusively girl on girl action. I had to rely on the old ‘wank bank’ instead.

(For those not au fait with the term ‘wank bank’, it merely means a collection of sexual fantasies or previous excellent sexual experiences that are stored in the head for the use of stimulation as and when they are required.)

The harsh glare of the hospital light added to the clinical nature of what I was about to do. But they’d thought of that. Between the desk and the sink was a lamp with which you could create ‘mood lighting’. I did just that.

When I was done (I’ve got to tell you I aimed well, not a drop was wasted) I screwed on the cap and had a look at what I’d produced. I was pleased with it. It looked pretty, you know, spermy. I wrote my number on it, put it in the bag and container and went outside to stick it up the shoot (as it were). I braced myself as I opened the door, expecting to have to look someone in the eye who would know exactly what I’d been up to. There was no one there.

I was told I had to wait to see a doctor before I could go so I settled in the waiting room. It was all young couples. I got the odd questioning look. I was kind of wondering why I was here as well.

I waited forever. I filled out some forms they gave me. It was pretty heavy stuff. I had to give consent for embryos created with my sperm to be stored, fair enough, but I also had to decide whether I would allow my sperm or embryos to be used for training (I did) and what would happen to my sperm or embryos in the event of my death or mental incapacity (sperm got rid of, but embryos could be used by my partner, I decided). I wasn’t sure that any of it was the right decision. The enormity of it overwhelmed me a little. It was the kind of ethics I never thought I would have to contend with, yet here it was getting right in my face.

I flicked through a massive book of photos of London to distract myself. I got through the whole thing. I was getting antsy as I’d not told them what I was doing at work, I’d just mentioned blood tests as I couldn’t be bothered to explain this one, and I didn’t want any questions when I got back. I went to reception.

Everyone had seemed to have gone to lunch. I eventually got someone’s attention and reminded them of my existence. I was cajoled by the receptionist, who assured me she would get someone to see me. It took another 10 minutes but she eventually came good on her promise.

A lady doctor saw me. She was pretty and gently direct. We discussed the forms and she told me I didn’t have to worry about the questions of embryos and using my sperm for training. It was more just to get my permission for storage. We talked a little about what would happen if I needed to make a withdrawal (as it were) on what I’d banked. She told me about IVF. It all seemed totally irrelevant to me. What was I doing there? All she knew was I was single with no children, so she was giving me all the information she felt I needed. I made out like it was more important to me than it was.

She told me I may have to bank some more. This wasn’t so appealing. The novelty was totally gone now. But if the sample I’d given them didn’t have enough sperm in it for the IVF process then they would need more, i.e. if it wasn’t good quality they needed more quantity.

Despite my long wait and the chat with the doctor, the lab hadn’t yet analysed my sample. So I made a tentative appointment to return. A couple of hours later the lady doctor called me at work. I retreated to a quiet room where no one could hear me discussing the quality of my sperm. Turns out it was pretty good stuff. The doctor told me it was up to me if I wanted to come back and give more, just to be on the safe side. I said I’d go with her advice: did I need to go back or would there be enough sperm there for the IVF process? She told me it was good enough.

I may be firing on one cylinder, but I’m still firing well.

Decision

Nine days after my operation I went into hospital to get the results of my biopsy. My oncologist was Dr Laurence Krieger, henceforth known as Dr Laurence. He’s a nice guy, well-dressed – not elaborately exactly but certainly with an eye for detail. He’s quite earnest, softly-spoken, with a wry smile that says: “Isn’t the world a funny place? Oh well, let’s get on with things as best we can.”

With him was Kathryn Elwis, my nurse practitioner – the person assigned to me to be my point of contact with the hospital should I have any questions or issues to raise outside of my appointment times. She’s a tall Scottish woman with a friendly face and practically-cut short hair. She struck me as unflappable, someone who could face down any stroppy or temperamental customer just by continuing to be incredibly nice.

I liked them both.

Dr Laurence checked my wound and told me it looked fine, healing nicely. Then he sat me down and started doling out the news. First he asked me if I’d done much reading. I hadn’t. I’d decided not to delve too deep into the information available, especially into the panic-mongering that I thought I might find on the internet. I didn’t want to wallow in this experience. I wanted to be pragmatic and get it over with as quickly as possible. To me this meant just listening to the doctors and nurses and taking on board their advice and information, nothing more.

My tumour was a seminoma – the classic testicular cancer tumour that they enthusiastically told me is easily curable. It was roughly four centimetres in diameter. While the x-ray and scan had revealed that I was clear of cancer in the rest of my body, and there were no what they call tumour markers in my bloodstream, there was evidence of ‘lymphatic vessel invasion’.

This means they found that cancer cells had moved around in the vessels of the testicle. It followed therefore that cancer cells could have moved on to other parts of my body. The emphasis was on ‘could’. It was unlikely given all the other evidence, but it was still a possibility. Therefore they wanted to give me one dose of chemotherapy, to be on the safe side.

They were adamant it was my decision whether I had chemo or not, but made it quite clear that it was sensible to do so. I was given odds of 40/50% of it coming back if I didn’t have chemo, 5% if I did. They were hard odds to ignore. I made the decision to have it then and there, but played along with their game that I had time to think about it. What was there to think about, really?

They gave me something else to think about: sperm banking. Chemotherapy works by breaking down the fast-producing cells in your body, as that is how cancer grows. But this also includes things like white blood cells (which form your immune system), hair, and sperm. As such there is a risk of infertility from having chemotherapy. Given that I was only having one dose this was unlikely, but the risk was still there and they advised sperm banking if I thought I would ever consider having children in the future.

I’m given a week to think about it, though I don’t need to do much thinking. My own opinion and that of everyone I speak to is that the sensible option would be to have it. As Maz put it: “Of course you should have it. What’s to think about?”

When I went back, this time with Mark, Dr Laurence - flustered and tired-looking this time as he juggled three doctors’ work due to illness - once again went over the side effects of chemotherapy so I was aware of the possibilities of what I was letting myself in for. He didn’t paint a pretty picture.

I’ve already mentioned the possible effects on the various bits of my body that are made up of fast-producing cells, although Dr Laurence was happy to admit that I was very unlikely to lose any hair given that I was only having one dose of chemo.

The main side effect would be nausea, but this would be treated with anti-nausea pills given before the treatment and for some period after. The effects on my gut may also cause diarrhoea or constipation or, most importantly to me, loss of appetite. If I can’t eat to make myself feel better then I was in for a rough ride.

I was warned I could bruise easily and that my gums may bleed, particularly after I clean my teeth. I may get mouth sores, dry skin, or flaky nails. I was told there would be an increased risk of blood clots, both from having had cancer and then chemotherapy as well.

I may find myself overly tired, lethargic, even breathless. This is due to anaemia caused by the red blood cell count being diminished: less red blood cells means less haemoglobin which means less ability to carry oxygen around the body. This may also cause dizziness or aching muscles or joints.

A more unexpected one was the possibility of getting the pins and needles feeling or numbness in my fingers and toes. They call it peripheral neuropathy. Other symptoms included headaches, changes in how well my kidney works, effects on my hearing; it didn’t sound like much fun at all.

The other main effect though was to my immune system. As my white blood cell count would be dramatically diminished by the chemotherapy I would be at increased risk of infection. If I was to get sick in the recovery period after having chemotherapy it would be a matter of heading into hospital to recover, not just heading to bed.

But it was inevitable. Despite this onslaught of gently discussed possible side effects I never really wavered in my decision to have the chemotherapy. It was just a matter of when.

Mark and I had organised some time away to Cornwall. It was an important holiday. Mark would finally meet my parents for the first time. I would spend some quality time with them and my godchildren for the first time in some three years, having been away for so long. Mark and I would travel around Cornwall as tourists as well, me getting to see my homeland through his fresh eyes. But the week we were heading down was the week Dr Laurence wanted me to have the chemotherapy.

There was a certain period after the operation that needed to be left so that I could heal properly, before exposing my body to chemotherapy. But there was only a certain period after the operation where they knew chemotherapy would have some effect on any remaining cancer. If we delayed the treatment until after our holiday, Dr Lawrence said regretfully, there was no scientific evidence to say it would have the desired result.

It was yet another inconvenience. That’s how I saw it: an irritating thing that was causing much inconvenience and bloody well ruining my summer. I’d already had to give up weeks of kickboxing training so as not to risk a hernia after the operation, now I was going to have to give up my holiday.

Again Dr Laurence gave me time to go off and think about it, but again I felt I didn’t really have much choice. It was either treat this sensibly and go with the doctor’s advice, or carry on living my life how I want to regardless of the risks to my health.

This week I went in for more blood tests. This time I found myself in the Nuclear Medicine Department. Dr Laurence wanted me to have what he called ‘EDTA creatinine clearance’. My understanding of it is that it’s an injection of a small amount of radioactivity in your arm, followed by a series of blood tests every hour for a few hours. With the results they can assess how well my kidneys will respond to the chemotherapy. I may have that wrong, but that’s the general idea. I did well anyway so I’m good to go for chemo in that respect.

I tracked down Dr Laurence and gave him the go ahead to arrange a session of chemotherapy. I need to get this sorted, get it out of the way. Only then can I go back to doing the things I want to do and living my life properly.