449 lines
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Plaintext
449 lines
24 KiB
Plaintext
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File: gutted.txt
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Cont: 6 days post-op.
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I arrived at the hospital at 6:30am, went up to the ward, dumped my stuff
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in the cupboard, hung up my clothes (black beanie, black Cave Clan shirt,
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black trousers, and some gleaming white sneakers I found a couple of weeks
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ago). I put on one another of those arse-baring white gowns, and did the
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pre-op checklist... did I want anti-anxiolytics, asked the anaesthetist,
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and on hearing the name of the benzodiazepine I decided I'd rather go in
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with a clear head. They put on some fetching white compression stockings
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on my lower legs, these are meant to lower my likelihood of getting a
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venous thrombus while I'm not moving around. I chucked my spectacles and
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watch in the bedside drawer. The staff clipped some ID tags to my left arm
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and leg. They thought what I wrote on my abdomen was pretty amusing.
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Mum and dad were there, and mum was surprisingly cool about it, but she
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looked edgy when they both left. I rang her up a little while before I was
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taken down to the OR, and she answered the fone in the sort of voice you
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expect is going to tell you someone's just died. I could hear the bloody
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*dog* moaning sympathetically in the background. I told her, look mum, I
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appreciate the concern mum but would you please just bloody relax? I'm ok,
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I'm not gonna die yet, I'll be out of here in a few days and this'll all
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be over. Dad told me later she appreciated the call, but it didn't stop
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her angsting.
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Some dude named Alex wheeled me down to the roomful of other trolley-bound
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patients who, like me, were stashed there awaiting to be knocked out and
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chopped open and so forth. I got caught up in a conversation with him and
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forgot to do Professor Derrida Deconstructs. The ceiling tiles were there
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to farewell me, as was the anaesthetist, who expertly cannulated a vein in
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my left arm, asked me to identify myself and then, injecting a load of
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some crap with too many z's in its name to be identifiable by its IUPAC
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chemical formalism, popped me off into unconsciousness. Dad told me later
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I was too doped out to say anything intelligent as we passed each other in
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the corridor outside of the theatres, he on the way to do his ops and I on
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the way to do mine.
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One of dad's mates, Greg (for whom I did a Playstation mod' a while ago)
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popped in while I was on the table, for a lookie. I was very lucky. When
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they did the initial incision, they decided they need not do the ugly
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lungbusting transthoracic gash I had expected them to do. Nevertheless,
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Greg still got more than a worthwhile eyeful. Natch, when they open you up
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(skin, muscle, peritoneal lining) the first layer of actual guts they have
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to get through is coils of intestines. Generally the surgeons locate the
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mesenteric attachments which hold them in position in your abdomen, and
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cut 'em off the inner back wall of your bod, then pull the whole lot out
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and dump it on your chest, so they can get at the kidneys, main arterial
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supply, and lymphatic networks involved in the op. So that your guts
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doesn't dry out while you're being worked on, they chuck a couple of wet
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towels on top of 'em. High tech, man.
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The arteries feeding the mutant freakshow are small and difficult to tie
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off without tearing and subsequently bleeding everywhere, so these days
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they just staple 'em closed a couple of times with a few stainless steel
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staples, between 6 and 11 mm wide, then chop 'em off at the occluded end.
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If I fly anywhere now I'll be setting off metal detectors at customs. They
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lifted the kidney/tumor out entire, then went to work on the lymph stuff.
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Once that was done, someone shovelled my guts back into my peritoneal
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cavity, sewed the two sundered halves of my abdomen back together, and
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closed me up with a long, subcuticular stitch from sternum to mound. I'm
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glad I didn't know a damn thing about it.
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First thing I remember when I woke up was more ceiling tiles, mostly
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obscured by the face of an intensive care nurse telling me I had to stop
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swearing so much, tho I wasn't actually aware I was saying anything to
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begin with. Someone had been a bit rough with the air tube, I noticed, I
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had bruised lips on the right side of my mouth, tho maybe this was due to
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someone smacking me one in the gob for being unacceptably rude while my
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anaesthetically drugfucked brain was in the gradual process of rebooting.
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I woke up a bit more later on. My throat was dry. There was something
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stuck up my nose, which I figured out was a nasogastric tube, which made
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it hellish to swallow properly, though that didn't matter since I was on a
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nil-by-mouth regime. For some perverse reason I'd also had a long blue
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urinary catheter fed into my dick while I was out. I discovered it when
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I wanted to take a piss and couldn't feel it happening, but did it anyway
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and wasn't immediately swimming in a warm puddle of my own urine. It went
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all the way into my bladder and was held there by a hydrostatically
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inflatable balloon. Hmmm. Must.... Think .... Pure .... Thoughts. I didn't
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want to mess up my reproductive plumbing by getting a hardon while this
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thing was embedded in it. A tube from the catheter went into a bag hung on
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the side of the gurney and was watched hawk-like by nurses for blood,
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cloudiness, and general volume.
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There was an IV stuck in my arm, and I also had a central line plugged
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into my right jugular vein, stuck onto my neck with sticking plaster. I
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half wanted to puke but something was stopping me, which I later found out
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was some or other anti-emetic which was being fed in through this central
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line along with my delicious, nutritious intravenous saline, potassium,
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glucose, antibiotics, and my new best friend, morphine, which is an
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awesome pain-destroying alkaloid derived from opium poppies, and next
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chemical cousin to thebaine and heroin.
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I had control of how much analgesia I got: very simple, if it hurt, I'd
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press this button pinned to my hospital smock, and the pain went away,
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since more morphine was fed into my veins. I chewed through quite a lot in
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the first couple of days. I watched dreamily as I was given jabs of
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anticoagulant into the flesh of my thigh every 12 hours and didn't even
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feel the needle go in. I spent wednesday night in the ICU and came out on
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thursday. An ICU nurse, I think his name was Gray, cleaned my teeth
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for me with a cotton swab soaked in mouthwash, which felt like going to
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the dentist after a week of eating basalt grit topped with sawdust.
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It felt like I was vomiting when they eventually yanked the NG tube out of
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my head, and aside from a faintly pukey remnant tang in my turbinates, it
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was a great relief to be rid of it.
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Intensive care sucks but I think I had a relatively easy time of it, the
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old dude in the next bed along, who had also had a kidney out the same day
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as I did, was moaning with pain 'cos he couldn't find his morphine button.
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Across the room a patient was throwing stuff at one of the nurses,
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paranoid that the nurse was stealing his possessions.
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My olds came and visited me in the ICU on thursday. I remember the visit
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only vaguely.
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A physiotherapist asked me to cough for her, and I told here there was
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just no goddamned way I was gonna do that 'cos it'd hurt too much. I was
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breathing fine, though. She passed me this clear plastic toy with three
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lightweight plastic balls in it, each of which would rise up when one
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inhaled 600, 900 or 1200 cc's of air per second through an attached
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mouthpiece. I could pull all three of them up with a good drag, and hold
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them there for long enough to suggest my lungs hadn't filled up with
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too much crap. I was very glad, again, that they hadn't slashed my thorax.
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I made it back to the regular north ward on thursday night. Everything was
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still a bit of a blur. Trev Hyde came along for a visit, and I can't
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remember what I said to him. Paul Cozzi came in and mentioned that they
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got the kidney all out cleanly, but we all had to wait for the pathology
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report to come back in a few days to see if we've really succeeded. I
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slept on my back, morphined up to the maximum extent that the patient
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controlled analgesia (PCA) machine would admit.
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"Drugs are fuckin' fun, pal." -TISM
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Yeah. I had some weird dreams, but at least I was asleep.
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I was very, very glad I packed the earplugs. Aside from the proximity of
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my room to the ward reception and nurse's desk (very loud conversations
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when the door was open) I had to deal with the accursed, Pythonesque,
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Machine Which Goes BING - a peristaltic pump mounted on an intravenous
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drip stand, which had the responsibility of forcing the contents of a
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suspended bag of electrolytes and assorted pharma into my veins at a
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predetermined rate. While it worked I could hear its internal gears
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grinding away faintly, which was quiet enough to suffer and still get to
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sleep.
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However, for reasons related to running out of fluids to feed me, or the
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occurrence of a kink in the lines, or a vein in my arm going awry, it
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would chime, BING BONG... BING BONG... BING BONG... for hours if
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necessary, and loudly enough for staff in the corridor to hear it so they
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could come and attend to it. I found out where the SILENCE button was
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fairly quickly but that only gave a minute of respite. Unplugging the
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bastard didn't shut it up either, since it had battery backup. But it
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dawned on me, in my opiated daze, this demonic item was responsible for
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keeping me hydrated and doped up. Arrrgh. And it was plumbed into my
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circulation, too. Captive audience. I hoped whoever designed this thing
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died and went to a customised hell where an infinity of these things
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stretched from horizon to horizon, were cannulated to 'em by an
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inescapable web of PVC tubing, beeping furiously, no earplugs in sight,
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and nobody came, ever, to turn them off.
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On Friday I stood up, got out of bed, and walked around the ward a bit,
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slowly, with the help of a physiotherapist, i.v. drip stand functioning as
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a kind of walking support. I couldn't stand up properly, I was bent over
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since the abdominal stitches still hurt.
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I gingerly peeled the long adhesive dressing off my wound. If you buy a
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steak at the supermarket you'll notice there's a bit of absorbent padding
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stuck to it on the bottom side of it, sodden with blood. Mine was like
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that, longer, crustier, more colourful, but clean - didn't look infected
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at all. I was impressed that none of it stuck. The pattern intrigued me
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for a few seconds before I tossed it in the bin. Whoever sewed me up knew
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what they were doing with a needle but I'm stuffed if I know where they've
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hidden my old belly button. I had a shower, sitting down, for the first
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time in some years, and felt a lot better, and went back to bed, into the
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waiting arms of the nicest drug I'd met all week.
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Frank came along and dropped off a load of roses chopped from his wife's
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garden. They smelled very nice. A couple of my ancient rellos, Mon and
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Paul, dropped in to say hi, also bearing a load of flowers. I'm such an
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ungrateful bastard about such things... I think of them as more stuff to
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take out when I leave the ward. Trev Hyde came in and told me the
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condensed version of his life story, which was interesting. He's pretty
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old now, considering retirement since the insurance situation is insane
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these days. We got to the bit about dying. He's afraid of the judgement
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which he thinks will come after he dies. I think religion has shortchanged
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him - he's lived a life in fear of god, and will die acutely terrified of
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the impending sentence. I was like that once. I ditched god and started
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living a decade ago. My death is a cleaner one, where my metabolism shuts
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down; my personality submits to the implacable grip of thermodynamic
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entropy, and dissolves irretrievably into the molecular noise which my
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organism fought so hard against for three decades. There's no succour,
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though. Trev thinks he will survive death. I know, in the very neurons
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thinking this thought, that I will not. But at least I'm not scared of an
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eternity of anything.
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Since I was on nil-by-mouth I couldn't drink, or eat, or swallow oral
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painkillers. By friday night I finally became tired of having paracetamol
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suppositories jammed up my bum and told the nurse I was not gonna have any
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more of 'em, which was probably as much of a relief to me as it was to
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her. I was gonna miss the morphine when it eventually went away. I also
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finally decided to toss the oxygen prongs which had been stuck up my
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nose ever since the NG tube came out. The gas came out of the feeder
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tubes anhydrous and cold, and gave me recurring bloody snotty nostrils.
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They fell somewhere behind the bed and gradually oxygenated the whole
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room, hissing quietly in the dark and doing the job anyway. One less piece
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of equipment to tie me down.
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Stupid little things became important... wether or not I was farting, for
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instance. On friday, I took my first crap for a couple of days. I had to
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unplug myself from the wall sockets, and carry a bagful of my wee with me,
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in order to go to the bathroom. Cozzi was happy about this shitful event
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when I told him, since it indicated my reshuffled cabinet o' guts hadn't
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adopted some strange kinked or knotted topology not conducive to pushing
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partly-digested dinner through it. It surprised me, since I hadn't eaten
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anything since tuesday, that anything remained to be discarded.
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Simple things scared me. A person came in with a vacuum cleaner. She asked
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if I wanted the room vacuumed, and I pulled the bed covers over my face,
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shaking my head and pathetically moaning "NOOOOOOoooo!" ... I was in
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terror of the agony of any sneezing which might be provoked by whatever
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dust the vac' might exhaust into the air in the room. Thankfully she
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retreated into the corridor with her allergen aerosolisation weapon in
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tow.
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A nurse named Nadia walked in and told me she was gonna take my catheter
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out. Holy shit! Want a bloke's undivided attention - threaten his rigging.
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She plugged a syringe into a port on the protruding end and evacuated the
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balloon which held it inside me, then before I could even say "be careful"
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she rapidly removed the thing in about one second of blistering urethral
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agony. It was great to take a leak normally again but I had to remember to
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pay attention when I did it again, having not had to do so for the past
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few days.
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Saturday came, and with it, finally, a clear fluids diet, so Cozzi asked
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me if I wanted to lose the drip, and oh, hell yesssss, I did. So I was
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finally freed of that blasted BING generator by the evening. With it,
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alas, went my beloved narcotic.
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Coz' mentioned that I wasn't allowed to eat any fat for two weeks, since
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one apparently tends to get problems with chylomicron accumulation
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immediately after lymphatic resection when on fatty diets. Oh, cruel...
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the cannabis cookies in the 'fridge at home, built around a fatty,
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butter-laden biscuit mix, were now off my list of things to eat, just when
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I needed them. This is apparently more problematic with the longer chain
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fatty acids, so it'd be sorta-ok to eat fish. Someone had sent up a large
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box of chocolate thingos which I hadn't opened. Once the news about the
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no-fat diet arrived, I decided to give the chocolates away to the nursing
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staff, and they had gobbled 'em all by sunday morning.
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On Saturday, Raffo and Tee also showed up and we had a chat, though I
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dunno if I mumbled anything especially intelligent. Stuff was still
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painful. I'd been on my back for consecutive days, since rolling over
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caused pain as my detached guts sloshed about inside my abdomen under the
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influence of gravity. Tee understood the significance of what was on the
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MRI scan, since she's a nurse, but really, one could suss this out fairly
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straightforwardly with the untrained eye. They held it up to the window
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and had a gawk at my previous tennant, and were suitably impressed.
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Sunday was the first day I got any solid food. My guts rumbled as if not
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quite sure what to do with this unfamiliar manna coming down from a
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long-empty oesophagus, but oooh, it was good to eat actual food again.
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Digesting it was a different matter. I felt the coils move around,
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painfully trying to decide how to pack themselves, and my dinner, in my
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abdomen. They made lots of noise. They haven't they figured out there's a
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load of new space to live in, now half my renal system's gone, but then,
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they're guts, not brains, I suppose, so one can forgive them of this
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learning deficit. Pack in, dudes, shut up and chow down. Do yer job. Keep
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me alive.
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Several people came on Sunday. Most of the geek crew from cat.org.au
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ventured out on the train. It was good to see 'em.
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I got out of bed on Monday morning and walked the ward unassisted,
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unemcumbered. Aslan (geez, I'm already misspelling his name, can't
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remember if it ends in m or n) came in and told me the histology report
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had finally come back. They got all the kidney out and its margins
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suggested it hadn't invaded anything nearby, which was reassuring.
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However, all but one of the lymph nodes which Coz' resected was
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_involved_, which is pathology-speak for invaded by tumor cells. It's
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already spread. What this op has achieved is to push me back along the
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exponential growth curve exhibited by uncontrolled, proliferating cells,
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but not to get me off it.
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Aslan said I could go home. I called mum, my long-suffering taxi. I put on
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the same clothes as I wore when I came. Black. I had spent the whole time
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in a hospital gown so nothing in the pack had been used, adding subtle
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idiocy to the ruckus which went into controlling what went into it. I
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slung it over my shoulder and walked slowly down the corridor. I checked
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out with the sisters on the desk, and suggested there were two jars of
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cut-off plant sex organs in my room for which I had no further need and
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which might look good on their counter top.
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I sat in the lounge and awaited mum's arrival. A man and woman in their
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seventies were chatting about their cancer. It struck me I could just as
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well be having the same conversation, but they were less bleak about it,
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being twice my age, and less clued into its molecular biological nature.
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Maybe ignorance is bliss, but in general I find it just leads to one being
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bitten on the arse more often than not.
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Its formal name, by the way, is renal clear cell metastatic carcinoma. It
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will re-emerge. Somewhere, sometime, as surely as night follows day. This
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is the way of living things, the logic of cells gone mad. The game is
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afoot, and I am it. All your cell are belong to us.
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The oncological cat is out of the bag, running loose in my vascular and
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lymphatic systems, the intricate fractal ducting which has served me for
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so long now subverted to facilitate my destruction. Unlike normal cats
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with nine lives, this cat is immortal, clonal, malignant and predatory, as
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one might expect.
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"I am Locutus of Borg.
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Resistance is futile.
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You will be assimilated.
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Your life as it has been is over.
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From this time forward, you will service us."
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-Picard.
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Well, fuck you, pal.
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I was gonna say to it, you'll never take me alive, but then, it *has*
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already done so. After all, it *is* me. So the game changes to
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scorched-earth.
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I know where the azide is, where the ropes are. I have a half-kilo of AN
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prill somewhere, too, if I feel the need vapourise my head faster than the
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nerves inside it can possibly process the experience. Yeah. Fuck you, pal.
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_I_ live here. I'll burn the house down with you in it, if needs be, to
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get you out.
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I type this with a curling upper lip, snorting air through flared nares,
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not quite sure of my own vehemence but rapidly becoming convinced.
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Mum drives me home. My guts jiggles as we drive over cracks in the
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highway. I don't tell her about the metastatic nature of the thing till I
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get there. I am a pretty grumpy guy all day, thinking about this
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situation. Chemo and radiotherapy are pretty much useless for this
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disease. It has to be fought immunologically. Maybe some recombinant
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chemokines would help at this point, but I don't know anything about their
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effectiveness yet.
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Another option, which I know a little bit about, is the construction of a
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DNA vaccine against this thing which has taken me over. We kept some of
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the tumor, in order to extract from it some short segments of its DNA
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which encode for proteins unique to the surface of the cells which make it
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up. Using the usual restriction enzymes and DNA ligases, one splices this
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into a mammalian expression vector - a hoop of DNA which is constructed so
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that cells injected with it read the DNA and synthesise the protein
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encoded thereon. There's a sting engineered-in, however: the hoop of DNA
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containing the tumor protein sequence is arranged so that another bit of
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DNA, encoding another protein with which the immune system already has the
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shits, is spliced in adjacent to the segment codifying the tumor protein.
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This hybrid is called a chimaera, or a fusion protein. When the cells
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injected with this engineered hoop of DNA make the protein, they'll carve
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it up into fragments 9-16 amino acids in length, serve it up on the major
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histocompatability Class I and Class II systems to various surveilling
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lymphocytes, which will then learn to recognise these fragments, hopefully
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go clone themselves up, distribute themselves and attack any cells bearing
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any parts of this unnatural molecular construct. From what I read five
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years ago in '98 when I was doing honours, this sort of strategy works
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well on some viruses, some proteinaceous venoms, and in certain
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immunocontraceptive roles. People were only starting to think of
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vaccinating themselves against their own tumors back then.
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Nobody does it in Oz, but fortunately, labs exist in Deutschland and
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Nippon which do this sort of stuff to order, and once fabricated, can send
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it back via airfreight. It might work, it might not, I'll have to go trawl
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medline to see if it's worth a shot. I am not feeling especially hopeful,
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but five years is a long time in molecular biology. Particularly in mine.
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It's monday night, no, 3am tuesday morning, and I cannot sleep. I didn't
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sleep again last night, I lay there trying to figure out which position
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would let me conk out into blessed unconsciousness but none of them did.
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I'm a bit hiccough prone, which makes my guts hurt. I'm producing bloodied
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phlegm, but not by coughing it up. Panadol isn't a rat's arse on morphine,
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but I figured I'd better wean myself off the opiate. I do these strange,
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uncharacteristic muscle twitches when I am drifting off to sleep.
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The score at the moment:
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-1) I have cancer, but not so much of it. This process will
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progress, and eventually cancer will have me. When this happens, I
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will die.
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0) I lost five kilos in four hours with this uh, amazing kidney-free diet,
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but I only had 65kgs to begin with.
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1) I have a big slash up the middle, which hurts when I try and stand up
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straight. It leaks blood a little bit. My belly button has disappeared,
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which probably means I have Joined The Unborn 8-)
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2) My intestines are playing musical chairs with themselves, which
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|
also hurts. They're rather like an unruly room of schoolkids; take 'em
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|
out for an excursion and they muck up for the rest of the month. I'd
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smack 'em if I thought it would improve matters, but that'd hurt too.
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3) right 'nad occasionally painful, OW. I hope this is referred pain.
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4) I'm shooting blanks. Obviously I did not Think Pure enough Thoughts
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|
while catheterised, or I was damaged when it was fed in, or removed.
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Bummer.
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5) Bordered by lines of incredible adhesive which refuses to come off with
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soap, are several rectilinear patches of hair missing from my arms,
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adjacent to bruises where needles were wrongly inserted or pinpricks
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|
where they went in OK. Small black pocks dot my legs where the
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|
anticoags were administered.
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It has finally sunk in that I am actually alive, despite all this stuff,
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|
but I'm not out of the shit, not by a long way, and may never be.
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Tuesday.
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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.
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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
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molecular biology.
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<predator>
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(the next in the series is now at conway.cat.org.au/~predator/hunting.txt)
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(It is long, and unlikely to be an enjoyable read. You've been warned.)
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