30
October

Is that a bag of piss in your pants or are you just pleased to see me?

Well, the deed has been done and I am now sans prostate.  The last thing I remember before surgery was the anaesthetic being administered at 1pm and thinking about my late parents.  It was upsetting to think of my mother and father dying from cancer as I was about to be operated on for the same disease.  So I had to make a conscious effort to not think about my parents at the most vulnerable time of my life.  That was hard.

When the welcome oblivion of general anaesthetic lifted, I noticed the time: 10pm.  I was initially troubled about the length of time I was out – it should not have been nine hours.  Apparently there was some issue with my pain management: I vaguely remember regaining consciousness briefly and being in some distress in the recovery room but quickly going back under again.  When I came to at 10pm I felt no pain but I was disorientated.

I had always imagined that coming out of a general anaesthetic must be very disorienting and I was right.  Losing several hours is disconcerting, not that I would want to have gone through them.  After spending a couple of hours under observation in the recovery room, I was brought back to the ward, where I had the best nights sleep in weeks!

On waking the next morning, I was pleased to find I had a patient controlled analgesia attached to my arm – the means by which I would treat myself to frequent doses of morphine for the next day and a half. I had heard great things about morphine and was not disappointed.  As well as being an effective painkiller, it gives you a pleasant ‘high’ – the silver lining of major surgery!

The next thing to check was my abdomen and, of course, Horace.  Poor Horace!   The catheter was in place as expected.  What I was not ready for was the sight of a 6mm diameter tube sticking out of his one eye!  It looked awful and Horace was horribly bruised and swollen.  Surprisingly, though, the catheter did not feel as intrusive as I had expected (probably due to the painkillers).

The day following surgery was okay, thanks mainly to my new best friend: morphine.  Getting in or out of bed demanded herculean effort but apart from that there was no pain.  I mostly spent the day stoned and drifting in and out of sleep.  The medical team was around early and Dr. Galvin told me the surgery had gone well.  He managed to remove all that he needed to while leaving nerve endings to the right of my prostate largely intact.  It is these nerves I will rely on to achieve an erection, eventually.  I needed a lot of pain medication during surgery so that accounted for my feeling so out of it now.  Dr. Galvin said I would be coming off the intravenous morphine the next day and switching to an oral version.  Apparently the good stuff can cause constipation and the next signs of recovery the team will be looking for are farting and shitting!

Grace was to come in to the hospital to see me the next day so I was happy enough to abandon my NBF in the interest of having a clear head for my daughter’s visit.  I was a little worried that she may be freaked out by seeing me laid up, with tubes sticking out of me and me carrying a bag of my piss around like a macabre handbag.  As always, though, Grace was cool about everything.  There is an old head on her 6-year-old shoulders and she seemed barely even curious about my condition, thankfully.

I started walking around the hospital more, on Dr. Galvin’s advice.  I’m a bit shaky on my feet and get weak and dizzy easily.  So trips are kept short and close to the hand rails that are everywhere in hospitals. I’m also to drink as much water as I can, to flush out the system.  Luckily, I can drink quite a bit so the nurses are kept busy emptying my catheter.  I have to say, I really do not like wearing one!  While it wasn’t particularly uncomfortable at first, it is starting to get so now and I am counting the days to Friday 10th November, when I get it removed.

I said it before and I’ll say it again – you’d be amazed what you can be grateful for.  Even something as routine as taking a piss is a thing of great beauty when you can’t do it!

What seems most unfair about a catheter is, contrary to what I expected, I still fee the need to ‘go’ all the time, even though the urine is constantly draining out of me.  I can spend the day watching my bloody urine filling a bag but I don’t get the sensation of relief from having a normal slash.  At one point, I tried applying a little pressure, to see if I had any control at all.  It hurt like hell so I won’t be trying that again in a hurry!

Another inconvenience of the catheter is the tube gets airlocked.  So I have to keep lifting it up to allow the urine to drain.  A few times, the flow went the wrong way – a very unpleasant sensation!  The catheter I go home with will be different and designed to be mobile.  So hopefully I can have a relatively normal life while I have it.  I don’t think the other diners would thank me for sorting out my airlocks in the restaurant!

Overall, despite considerable discomfort, my sojourn in The Mater is pretty good.  It is a relief to have the first phase of my treatment behind me.  The recovery is next and I’m looking forward to it.

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26
October

Under the Knife

My radical prostactomy looms as the countdown transitions from days to hours.  I am being admitted to the Mater Hospital at 2pm today, with the surgery to take place about the same time tomorrow.

I still feel very fortunate that I was diagnosed at all.  Were it not for my high blood pressure, I would still have cancer anyway.  However, I would not have been be aware of it and it would still be growing – and probably spreading – inside my body.  This would have had the attendant impact on my chances of survival.  So, all things considered, I am a very lucky man indeed, especially given my family history of cancer.

To any man reading this I say: Get Yourself Checked Out!  I was only 43 when the bombshell dropped.  Since then, I have heard of men as young as 33 being diagnosed with prostate cancer.  The perception that you have to be over 50 before you start thinking about the threat of prostate cancer is a mistaken one.  You have nothing to lose by going to your GP for a blood test and you have everything to gain.  This applies to women too.  You won’t get prostate cancer, obviously.  But cancer can start in any organ of your body, at any age, and it is utterly indiscriminate.

I was lucky to have a good GP who ticked the PSA box in a routine blood test.  But luck is not something to be taken for granted.  So get it checked out: you owe it to yourself and to your family, not least your children.

On D-Day, when Prof. FitzPatrick broke the news, my attitude was that I only wanted to live and the side effects of treatment – urinary incontinence and erective dysfunction – would be trivial in comparison.  At the time, I said I would “cheerfully” accept them. While still grateful for a second chance, I’m not sure that I can say I’m still “cheerful” about the side effects.  Resigned or stoical would be more accurate.  Perhaps this is a product of complacency, from learning that my cancer has not apparently spread beyond my prostate gland.

Among the preparations I have had to make for surgery and its aftermath are pelvic floor exercises, to strengthen the muscles pertaining to urinary functions. They mostly involve clenching muscles in the pelvic region and are pretty tedious.  I was never one for exercises, as a small fortune in wasted gym membership fees over the years will testify.  But the emphasis put on them by the medical team and prostate cancer patients I have spoken to makes me think it is actually about more than just going through the motions.

At my yoga session in the ARC Cancer Support Centre on Monday, one of the guys in particular told me how much yoga and the exercises have helped him to recover.  A year after the surgery, he is making good progress, largely thanks to these exercises.  So I am now faced with an inconvenient truth: that physical exercise and real effort reap benefits that I will have to work at to realise. Feck!

One of the main benefits of ARC is meeting other patients.  I am definitely the ‘baby’ of the class and I almost feel like a pretender as a result.  But in conversation with two of the lads, before hitting the mats, one thing that was said, which I hadn’t appreciated before, was that the younger you are, the more aggressive your cancer is likely to be.  Oddly enough, this made me feel better (now that I have my favourable MRI and bone scan results under my belt), enhancing my right to be a member of this exclusive club, so to speak.

At the end of the yoga class, the guys were fantastic, wishing me luck with my surgery and giving me phone numbers to ring for moral support.  There is a sense of community among cancer patients that is beyond compare.  The support from the medical professionals, the Irish Cancer Society and ARC is excellent.  But it is your fellow patients – the people who have gone or are going through what you are – that means the most.  These are the guys who have stared the prospect of imminent death in the face, pulled through and gone on to live life with renewed vigour.

There is an observation that I am bound to make at this juncture of my experience.  In Ireland, we are regularly told about crisis in the health service.  While there are undoubtedly issues, I have to say that my experience so far has been entirely a positive one.  Having been diagnosed on 16th September, I am having curative surgery six weeks later.  That’s not bad, considering a necessary wait between biopsy and MRI/bone scans.

This makes me wonder what I paid VHI for in the years before I quit about six months ago, due to the unsustainable rising cost of private health insurance.  I would not have been seen or treated any sooner had I had VHI cover.  In some countries I would be turned away if I didn’t have private insurance.  So, with all the problems we have in Ireland, including the health service itself, it is reassuring to realise that there actually are some things that do work in spite of all the bad press.

My main point-of-contact with the HSE is my prostate nurse, Mary.  She has been absolutely fantastic.  Talking to anyone – never mind a woman – about urinary incontinence and erectile dysfunction is difficult.  But Mary has a professionalism and sensitivity that makes it easier.  In fact, she was way ahead of the curve than I was, foreseeing the emotional issues I’m only beginning to come to terms with now.  I was blasé about ED in particular, in the beginning.  But Mary, due to her training and experience, was good enough to know that the impact at my relatively tender age would be yet to hit me.  The cavalier attitude I have admittedly had up to now is ebbing somewhat.  The good news is that my prospects of a full recovery are good, though it will probably take months rather than weeks.

Mary assured me that the plan is to:

  1. Cure the cancer
  2. Get me “dry”
  3. Recover my “erectile function”

I am all for this order of priorities so no problem there.  The difficulty I have is that I am only now beginning to realise that the issues of urinary incontinence and ED are going to affect me more than I had at first chosen to believe.  It is not that TLC and I have a particularly rampant sex live.  It is probably average, at best.   But even going from average to zero is disappointing.  So there is a body of work ahead of me over the next several months (image of Sylvester Stallone in training as Rocky Balboa, complete with background music!).

The 24 hours between admission and going to surgery will be long.  I was given the option of a sedative at my pre-operative assessment yesterday but I declined.  I reckon I’m going to have enough pharmaceuticals in my blood as it is and a bit of anxiety won’t kill me.  I have plenty of reading material to keep me occupied and if I don’t sleep, it might zonk me out for longer during the day when I will need it more.

I hope to duck out of the hospital in the morning to vote in the presidential election and get back in time for surgery.  Hopefully I will be sufficiently recovered on Friday to follow the results online.  Election counts are my Cheltenham (sad, I know) so I’d be disappointed if I don’t get to watch the results coming in for my preferred candidate.  Thank God for the single transferrable vote – you can’t buy entertainment like that!

Anyway, it’s time to sign off and go under the knife.  Wish me luck!

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14
October

Lucky, Lucky Bastard

It really is amazing what you can be grateful for, when you have the right perspective.  I was diagnosed with prostate cancer four weeks ago today.  But the disease has not spread beyond the gland itself.  That’s the wonderful news I got this morning, after four long, anguished weeks of waiting.  And gloriously grateful am I to receive it!

With a PSA level of 9.5 and a high Gleason score of 9, I had pretty much convinced myself that my cancer was bound to have spread throughout my body, with the attendant impact on my chances of recovery.

The nurses had given me an unofficial heads up that the MRI and bone scan results looked good.  But the results had yet to be reviewed by the medical team and there was always the risk that they would spot something untoward.

This morning my mind was put at ease in the Rapid Access Prostate Clinic.  If I won the Lottery it couldn’t top the feeling I have now and my prospect for a full recovery is now far better than I dared hope when I was diagnosed four weeks ago.

Of course, once you are diagnosed with cancer, you are never completely out of the woods and there is always a chance that it could rear its ugly head elsewhere in my body, at any time in the future.  But I could also be hit by a bus before that happens.  So life goes on regardless and the spring in my step that eluded me on D-Day has finally materialised.  In a peculiar way, being diagnosed with cancer has given me a new lease of life.

I also, finally, have a date for the surgery to remove my cancerous prostate gland (and a few other bits and pieces) – I go under the knife on Thursday 27th October.  The tumour in my prostate measures 1cm x 1.9cm.  Given that a prostate gland is about the size of a walnut, that seems quite large, not that it will bother me after the 27th.  While the surgeon is in there, he’s going to remove lymph nodes in the pelvic area, as there is a chance that cancer can spread to these.  So the surgeon’s instructions on the day will be “if in doubt, whip it out”!

Apparently, the consequences of losing my prostate gland may not be as severe or as long lasting as I had feared.  I will certainly have to cope with some urinary incontinence and erectile dysfunction following surgery.  But the extent of these side effects varies greatly from one patient to another.  I could be back to my old self within weeks or it could take a year or more.  There is no way of knowing at this point.

Urinary incontinence may not be quite as bad as I’d feared.  I had thought I would have no control whatsoever, pissing myself all the time – not cool!  However it is, apparently, likely to be only when there is pressure on the bladder, such as when standing up from a seated position or bending over, stuff like that.  The silver lining is that it gets me out of many of the household chores I hate.

Urinary control is based on two sphincter muscles: one behind the prostate and one in front.  I will lose the rear one in the surgery but it’s the front sphincter that matters most.  I can prepare for this over the next couple of weeks by stopping a slash in mid-stream.  It’s not the most edifying of exercises but hardly the most arduous either.  So I can live with it (“live” being the operative word).

I’ll be wearing a catheter for two or three weeks after surgery and it is when this is removed that I’ll know what I have to deal with.  I’ll be wearing ‘pads’ (an awful word) to soak up the (hopefully) odd dribble for a while.  I have only discussed this with one other prostate cancer patient so far and he was still having problems since his surgery in January.  I’ll be talking to many more before my date with the scalpel.  So hopefully I’ll learn of others who have had a better experience.  Either way, it’s inconvenient but not the end of the world, all things considered.

Of course, the second major side effect of radical prostatectomy is erectile dysfunction (ED).  Similarly, this may not be as long lasting as I’d first feared.  There is no real pattern in the experiences of previous patients.  So, again, it’s a case of ‘wait and see’ (the traditional ‘suck it and see’ seems hardly appropriate, under the circumstances).  The Lovely Colette (TLC) can be assured of undisturbed nights sleep for quite some time following the surgery.  It can take weeks, months or years before normal service is resumed, if at all.  There is hope though.

One option is to take a quarter of a Viagra tablet six out of seven days.  This does not mean I’ll be walking around with a stiffy all the time (sorry ladies!).  To achieve the desired state, a full tablet at the weekend should do the trick.

Funnily enough, it is important to achieve erections in the first year following surgery, if only chemically induced.  If this doesn’t happen, the tissues involved effectively form a kind of scar tissue that reduces the probability of being able to get it up naturally.

There is also the option of using an injection into the base of the penis, which would definitely perk Horace up (‘Horace’ is how TLC and I affectionately address my cock).  The thought of sticking a needle into Horace seems kind of cruel.  But if tough love is what he needs that’s what he’ll get – and he’ll bloody well like it!

Overall, today has been one of the best days of my life.  The cliché that “today is the first day of the rest of your life” takes on renewed meaning after you’ve been diagnosed with cancer.  So many clichés like “life’s too short” and “don’t sweat the small stuff” assume new meaning that you had previously taken for grated.

When you are faced with the cold, up close and personal prospect of imminent death you undergo a life-changing transformation that is utterly irreversible.  Having being diagnosed with a life-threatening condition is not necessarily the end.

Blessed as I am with the beautiful family, friends and colleagues I have, I now realise what a lucky lucky bastard I am!

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6
October

Radioactive Man & Birthday Boy

Radioactive Man & Birthday BoyI was never one to get overly excited about birthdays.  Since turning 40, in particular, each passing year was not something I relished celebrating.  That was before D-Day.  My 44th birthday yesterday was quite different to all the ones that preceded it.

Someone asked me what I wanted for my birthday.  I replied, joking (but not really), that all I wanted for my birthday is another birthday.  It seems strange to me now that I used to regard birthdays with mild annoyance.  It was as though their sole purpose was to reiterate how far removed I was from the full flush of youth, when health and optimism were in abundance.

It’s funny how it takes something like a diagnosis of cancer to shake you out of the drudgery of mundane, everyday routines and to understand your place in the universe.  I now value birthdays for what they really are – a celebration of another year of life – not a countdown to old age and death.  Indeed, it now seems to me that when we moan about getting old, we completely miss the point.  Old age is a gift, not to be taken for granted.  I used to joke that what I wanted to be ‘when I grow up’ is a dirty old man.  That is still my goal but it’s not so much a joke as it used to be.

In an effort to establish whether my cancer has spread and to what extent if it has, I had my bone scan today.  This is of paramount importance to me.  The initial diagnosis of prostate cancer is one thing but this and the MRI will quantify it, giving me a better indication of my chances of survival.  The scan itself was quite straightforward.  My appointment was for 08:30 and I was back out on Eccles Street at 08:42, so no problem with long waiting times there.  I was given an injection of radioactive material and this needed two hours to be absorbed by my bones.

There were no side-effects and I was free to leave the hospital for the couple of hours.  Breakfast called so I had a thoroughly unhealthy full Irish (cholesterol is the least of my concerns these days), followed by a visit to the Irish Cancer Society kiosk in the foyer of the hospital.  I picked up a few more booklets about radiotherapy, the emotional effects of cancer and talking to children about cancer.  The ICS nurse was very helpful and told me about a Prostate Cancer Conference in Croke Park on 5th November.  I will be attending that if I am not in hospital for surgery at the time.

Karma demands that if I get through this I must give something back.  So my plan for the conference is to learn as much as I can about the available supports for prostate cancer patients and their families, draw what I can for my own case and to find out how I can make my contribution later.  It is a pity that it takes a diagnosis of my own to get me off my arse and doing something proactive.  I have a new found respect and admiration for people who freely give of themselves for the benefit of others, in whatever cause.

Now that my bones were nice and radioactive, it was time to return to the Nuclear Medicine Department for the scan.  I have to say that I found it very efficiently run and I did not have to wait long before finding myself lying in the scanner.  It was not as intimidating as the MRI machine, being smaller, less confined and relatively silent.  The scan would take about twenty minutes, as the machine moved slowly from my head to my feet, seeking out concentrations of radioactivity in my bones, where it would indicate a presence of cancer cells.

Out of the corner of my eye, I could see my skeleton being progressively revealed on a computer monitor.  With my layman’s untrained eye, I strained to discern anything that looked like a hot spot.  Head, shoulders, rib cage – so far so good.  The abdominal area looked brighter than I would have expected and I could clearly see my kidneys.  As this was a bone scan, I was concerned about seeing my kidneys lit up like Christmas trees and I have recently been feeling some mild discomfort in the area.  I imagine that the kidneys could be ‘riddled’ and the thought of a potential regime of dialysis or waiting for a transplant is unsettling.  There isn’t anyone in the room with me at the time so it will be the first thing I ask about when the scan completes.

The staff who appeared were all very pleasant and my question about the prominence of my kidneys is answered.  It’s perfectly normal and nothing to worry about. The kidneys are supposed to show up like this and it is why I will have to drink as much fluid as I can over the next 24 hours, to flush out the radioactive material.  The nuke med staff were at pains to stress that they are not doctors nor trained to interpret the scan result – that is Prof. FitzPatrick’s job.  However, they see hundreds of these scans and as far as they could see, my bones look normal.

Oh Happy Day!  Medical professionals can be infuriatingly non-committal so it was encouraging to hear this opinion, albeit with a disclaimer.  There is a risk that the medical team who will officially analyse the scan may take a different view.  But after waiting this long for more details, I will grasp with both hands any lifeline that’s thrown my way.

I have been feeling ‘odd’ in my abdominal area recently and actually very worried indeed about what the scans may reveal.  There is a danger when you have a serious illness that you attribute undue significance to every little ache and pain.  With middle age now upon me, I have to remind myself to be circumspect and not jump to conclusions.  I am still awaiting with bated breath an appointment to meet Prof. FitzPatrick and discuss my treatment in greater detail.

In the meantime and for the rest of the day, I am to avoid pregnant women and young children because I will be emitting radiation to a radius of about two metres.  I have never been radioactive before and wonder if I will acquire superhero powers or whether my piss will glow in the dark.  Probably not.  I consider myself to have already received my share of good fortune today!

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1
October

Dial M for Magnetic Resonance Imaging

It’s now been two weeks since D-Day and there are still no outward signs of any symptoms of prostate cancer.  As welcome as this is in itself, it is a mixed blessing in a way.  Feeling physically normal makes it harder to truly accept that you have cancer.  Maybe there has been some mistake?  No. I was never one for clutching at straws and it is highly unlikely that both the PSA test and biopsy got it wrong.  If life has taught me anything, it is that knowing a thing and feeling it are two very different affairs.  So, I must accept the diagnosis and keep preparing for the worst, like hearing a tsunami warning and bracing yourself for the tribulations to come.

Having finally completed reading the Understanding Prostate Cancer booklet, I now have some figures to quantify the likelihood of post-surgery issues.  There is a 70% probability of urinary incontinence during the year following surgery, dropping to 10% thereafter.  The likelihood of erectile dysfunction (ED) is also 70%, dropping to a less encouraging 30% a year after surgery.

Urinary incontinence is pretty much something to be coped with but there are some well known drugs for treating ED, like Cialis and Viagra.  Another drug I hadn’t heard of before is Caverjet.  According to booklet, Caverjet is “injected into the penis using a small needle to cause an erection”.   I’ll have to take their word for that because I cannot conceive of any cause/effect relationship between ‘needle’ and ‘erection’!  On the other hand, the most memorable sentence in the whole booklet, also about Caverjet, is: “a prolonged erection longer than 3 hours needs urgent medical attention”.  Intriguing!  I dare say, if I had a stiffy like that, it’s the lovely Colette who would be in need of medical attention. Ha Ha!

At a yoga class for men with prostate cancer on Monday I met John, who had his radical prostatectomy in January.  He still has problems with his waterworks now and you can tell from his demeanour that he’s fed up with it.  But John is happy to have survived and talk among the men is mostly about check-ups and comparing notes about doctors and treatments.  I was by far the youngest there and felt a bit like an interloper, with my week-old diagnosis and yet to commence treatment.  But it is an exclusive club and I will be fully inducted soon enough.  There is a common misconception that prostate cancer only affects men over 50.  So I wondered if my presence made my senior fellow patients feel a little bit better, by reducing the average age profile.

Yoga is something I had not tried before and I did find it relaxing.  Being the new boy in the class meant I kept glancing around me to see what everybody else was doing.  Connie’s verbal instructions were clear enough but I’m a visual kind of person and tend to understand what I see better than what I hear.  I will keep going to the weekly class, not least for the sense of camaraderie and mutual support that only fellow cancer patients can provide.

The strain of the impending treatment and uncertainty about the outcome is starting to show in Colette.  My wife is being exceptionally nice to me and, as every married man knows, this is cause for concern!  Colette has not read as much as I have about prostate cancer, its treatment and their consequences, both inevitable and potential.  She needs more time to get her head around it all and she feels a need to await the MRI and bone scan results, to know exactly what we’re faced with.  I have tried to convince her to avail of supports from the Irish Cancer Society and the ARC cancer support centre in Eccles Street.  But everybody is different so I don’t push it, trusting that Colette will find the inner strength to deal with this in her own time and her own way.

Colette has told Grace that I will be spending some time in hospital soon, without going into detail.  At just six years of age, I don’t expect that this will mean very much to Grace.  She has not mentioned anything to me about it so I wonder how much she will understand.  At some stage, we are going to have to explain to Grace why I am ‘not myself’ and not going out to work.  But before we can do that, Colette and I need to understand more about that lies ahead ourselves.

The highlight of this week was having my MRI scan yesterday.  This and the bone scan are the great swords of Domacles hanging over my family.  Everything is on hold pending the results of these tests, which will establish whether and to what extent the cancer has spread.  At risk of being melodramatic, I see these tests as indicators of whether I am going die of this cancer or survive it.  Concerns about incontinence or ED pale into insignificance in comparison with a literal matter of life or death.

I had not had an MRI scan before and it was more or less what I expected.  On exchanging my clothes for a most unflattering gown, Frances went through the obligatory checklist to make sure I didn’t have any metal in or on my person and whether I suffered from claustrophobia.  The scan would take twenty minutes and there would be a lot of noise so I’d have headphones on with the radio station of my choice.  It was tuned to Lyric FM but, as much as I like classical music, the choice seemed a bit clichéd for the task at hand.  So I opted for Newstalk, which I would normally be listening to in the car on the way home from work about now.

All prepped and ready, Frances left me alone in the room and the sounds from the headphones changed from classical music to Newstalk.  At this point, it occurred to me that I was about to be scanned for signs of the spread of cancer throughout my body.  I would be unable to move for twenty minutes inside a giant magnet and I’d have George Hook in my ears.  Oh well, in for a penny in for a pound, there’s going to be far worse than this to contend with later.

The first thing that struck me on entering the MRI scanner was how much more confined was the space than I expected, the top of the chamber no more than a couple of inches from my face.  I imagined how much like being in a coffin it must be, without the cheap wood and frills.  Not the most comforting of thoughts when you’re being scanned for a spread of cancer through your body.  It also confirmed my wish to be cremated when the time comes. But, being something of a science fiction nerd, I also found it a curiously interesting experience, wondering how magnetism ‘sees’ inside the body and making a mental note to Google it later.  When the scan started, it was indeed very noisy and I was glad of the company of George Hook for twenty minutes.

When it was all over, Frances returned and had checked up to find out whether there was any progress on my bone scan.  I had mentioned earlier that I was still waiting for an appointment for one.  To my surprise, there is an appointment in the system, for next Thursday, and Frances surmised there is probably a letter in the post for me.  She gave me a number to ring on Monday to confirm it.  My appointment is with, of all things, the “Nuclear Medicine” department, much to the titillation of my inner nerd.  I mean, “nuclear” medicine – how cool is that!

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