Navigating cancer – with all its gifts and challenges

In this first of four podcasts, Biznews writer and news curator, healthcare journalist Chris Bateman, shares his recently-begun cancer survivor's journey as his contribution to destigmatizing the disease, giving us an intimate insight into the challenges and gifts it offers. The series was first published by HASA.

I'm Chris Bateman, a 63-year-old freelance and career print journalist, much of it covering healthcare as the news editor at the SA Medical Journal. I'm also a husband and father of two pre-teenage daughters, an avid fly-fisherman – and a relatively recently-diagnosed cancer survivor.

This initial 3-episode podcast series is about my cancer journey, which began early last November (2019).  I want to share it in the hope that it will inform and support newly-diagnosed fellow travelers and their families and help them navigate what can sometimes be tricky and challenging terrain. Most of all I want to talk about what is an intensely human and vulnerable experience that's busy teaching me an important overarching lesson; Gifts come wrapped in unexpected and strange packages.

I was covering an international emergency medicine conference at Century City outside Cape Town last year and about to go into a session on Resilience and Burnout among emergency care workers, the latter all too common in our trauma-ridden society. My phone pings. It's an SMS from my sister's golfing buddy, who also happens to be a semi-retired gastro-enterologist at Tygerberg Hospital in Cape Town's northern suburbs where we live. My heart sinks upon reading the words; 'call me urgently – Estelle".

Actually, let me back up a bit; a month earlier I was at a family braai with my sister and brother-in-law and suffered a severe attack of reflux on swallowing a juicy piece of steak. I wasn't too worried because it had been happening occasionally, several months apart, for about two years. Each time I'd get a constricted, painful feeling around my sternum and begin hiccupping, often unable to swallow or eat further. The episode would create thick saliva, the kind you get when you're about to throw up, though I wasn't the least bit nauseous. It would pass and I'd forget about it. I had my anti-reflux pills… Until the next time. My sister, who's a bit of an intuitive sangoma, told me she had a gastro enterologist, golfing friend. She said enough of this nonsense – she was going to call her friend so I could make an appointment.

I capitulated, knowing it was overdue. The following week, the gastro drove around to my doorstep, (she happens to live around the corner), picked me up and helped me book into Tygerberg Hospital, medical aid form-filling included. Once in her department, she put me under and performed a gastroscopy and biopsy. Later when I came to, she sketched for me the various potential outcome scenarios, then drove me home. To say I felt special would be an understatement.

OK… so fast forward to the Emergency Medicine Conference and her SMS.

I called her back and sure enough, she apologetically told me that the biopsy tested positive for esophageal cancer which had developed on what I knew was previously a 2mm hiatus hernia. She referred me to a bariatric surgeon at Blaauwberg Netcare Hospital whom she assured me was among the best. I felt numb but strangely calm, my thoughts moving to how I could break this gently to my family and elderly parents. Somewhat surprisingly, I engaged fully with the ensuing conference session on resilience and burnout, taking copious notes on my laptop.  Not only was this now doubly important income-generation, it was deeply fascinating and directly pertinent to my life-context which just minutes ago had fundamentally changed. Call the conference session subject matter graceful timing.

Talking of grace; last year I spent several months interviewing cancer survivors, nearly 20 of them, plus oncology care providers of all shapes and sizes, from surgery, symptomatic and palliative care, to psychologists. Little did I know I'd soon join the survivor ranks and be gifted with direct empathy.

My client was Discovery Health and I was populating their prospective oncology website whose purpose is similar to this podcast. It's a very valuable resource and will be well worth visiting. What I learnt from those 20 interviews goes directly to the contradictions we experience in life, the ironic wrapping of gifts we so often fail to recognize. It also speaks to how opposites literally define one another. To really live, it helps to contemplate the inevitable; death. Every one of the fellow cancer survivors I interviewed spoke about how their diagnosis was the biggest gift of their lives, providing new context, perspective, faith and gratitude. I kid you not. If it struck me forcibly then, it's bowled me over now.

So, how did I tell my nearest and dearest that I had 'the Big C?'  That was my biggest fear from the outset. My kids are nine and eleven, my folks are 90 and 89, both in good health but prone to the varying maladies of old age. I decided to adapt the learnings shared by my fellow-survivors. For example; take somebody with you when first you speak to your oncologist or surgeon. Often the shock of the diagnosis is so fresh that you don't absorb everything (permission to record the consult is readily granted by most doctors for this very reason). My adaptation in disclosing my cancer diagnosis to my family was simple; use key, easily understandable words – and repeat them. Often. My five words were these; treatable, curable and Stage One, localized.

The reaction of my daughters and wife, whose voices you'll hear in the next podcast, were totally different, unexpected and completely endearing. My Dad, whose KwaZulu-Natal, near-colonial upbringing and love of people have left him with an astonishing memory that can link almost any surname mentioned in his province to a school, university, family or town, listened deeply.

My Mum, a former nurse whose memory is the polar opposite, sobbed and then temporarily forgot.

My chemo treatment began in December, my bariatric surgeon opting for the conservative approach to shrink the tumor which had grown from a mere 2mm hernia in the six years since a long- forgotten gastroscopy, to 5mm. He wants good cutting margins for what will be unavoidable 4-6 hour keyhole surgery to remove my esophagus and most of my stomach, now scheduled for anytime between July and September 2020. I asked my oncologist why such radical surgery is necessary – because I want to avoid having a truthful, universal cop-out in future when using the expression; I don't have the stomach for this!

She paused and then fixed me with a steely glare before replying," Chris….that would be palliative. We're going for a cure!"

Doctors titrate (as in drip-feed) you information, I've discovered. It's not intentional or confined to any single physician. My experience is this; my generous-hearted gastro-enterologist told me they'd cut some of the stomach out and pull it up to create a new oesophagus. My oncologist said I'd lose a lot of my stomach. My bariatric surgeon said I'd lose most of it, but that with Vitamin B injections and totally new diet with many more small meals, I'll lead a virtually normal life. Fly fishing would still be very much still in the picture. I have a bucket list that includes a week on one of the world's best trout streams in the sweeping valleys of Barkly East.

But the road will have many more twists and turns, like unexpected pulmonary emboli (that's blood clots on the lung) that my first post chemo CT scan revealed in mid-February. Unexpected by myself, but common in oncology literature apparently. I spent a week in hospital on blood thinning injections and oral Warfarin. Warfarin is better known as rat poison but it's a highly-effective medicine for blood-thickened human health conditions. I'll spare you the obvious jokes involving men and mice. My esophageal tumor has neither visibly shrunk nor grown, but there's some inflammation. Only time will tell, though my surgeon believes the inflammation is masking some shrinkage. By the way the esophagus is the tube linking the throat to the stomach, just in case, like me, you didn't exactly know.

So, as I put this podcast to bed, my regular visits to the path lab to have blood drawn have increased in number. This is so that they can adjust my daily Warfarin home dosage in addition to the full blood count which reveals the state of my immune system prior to each week's chemo session. To be honest, I'm not looking forward to a repeat of three months of the fatigue that accompanied my previous nine chemo sessions. But I got off lightly – just speak to some of the friends I've made and spend several hours with in the chemo room every week. It does mean that I can generate better income as a freelancer in the extra time I'll have. Last year, while interviewing 10 of Discovery Health's top brokers, I spurned the opportunity to take Dread Disease and Income Protection cover, in spite of numerous glowing accounts of clients being awarded millions with cancer diagnoses within months or a few years of taking out policies. The subs were just out of budget reach, I decided, though of course that's a worm-hole down which I refuse to dive now! It is as it is.

We'll need this extra op-waiting time for me to generate extra income and get us through my inability to work when the op and three-month recuperation come. There's always an upside. In my next podcast you'll hear more from my family and how all this has impacted them, the amazingly upbeat and crazy chemo nurses at Blaauwberg Netcare Hospital and some more tips on overall self-care. Their nursing professionalism is echoed at private hospitals country wide, not to mention most hard-pressed public sector tertiary hospitals. I look forward to having you on board again. Until then, this is Chris Bateman signing off.

Click here for Episode 2.