Intermission 3: The Growing Groin Saga.

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Posted January 26th, 2018

 

By Glenn Ward  

 

     When one is diagnosed with recurrent colon cancer, health problems that arise are often ones that no longer warrant medical intervention. Because it is recurrent, the cancer has already shown itself to be resistant to treatment, and so it’s only a matter of time before it defeats all efforts to fight it, and the goal of treatment is often to “keep the patient comfortable”. However, what happens when the health problems are ones indirectly related, or unrelated, to the cancer? In the Fall of 2016, several months after the recurrence diagnosis, I underwent dental surgery for painful facial abscesses caused by problems associated with root canals done over a decade ago. Fortunately, I found a dental surgeon who agreed to remove the molars closest to the site of the abscesses and thereby reduce the pain that I was having. He did an excellent job of removing the molars, and the pain that resulted only lasted a couple of days. However, when we discussed cosmetic repairs to fill in the gaps left from the surgery, it was a different matter.

 

    “And now what?” I asked, visualizing replacement of the removed molars.

 

    “Well, there will be some residual discomfort for a week or two, but it will eventually subside,” he replied.

 

    “What about the spaces in my teeth?” I asked. After all, two missing molars had left quite a gap in what were once models of modern dental reconstruction.

 

     “There won’t be anything done with those spaces,” he answered with the finality of someone who had had this conversation many times before. In other words, it wasn’t so much that my teeth weren’t worth fixing, but that I wasn’t worth fixing. I was asking him to put new Michelins on a car with several hundred thousand kilometers on it.

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     I’ve also developed fractures in my vertebrae (likely due to weakening of the skeleton by the chemo meds) that leave me in chronic severe pain that is (effectively) treated by opiate painkillers. However, the amount of opiates I take every morning and evening leave me feeling intoxicated most of the day and prevent me from driving, and so I’ve become totally dependent on others to go anywhere. If I lived in town, I could rely on public transit to take me places but I live at least ten km from the closest bus stop, and so I keep myself busy at home while asking my daughters to pick up groceries when they are out (I can still prepare meals for the rest of my family) as well as other sundry items (we always seem to need batteries and light bulbs of various sorts). Otherwise, my life has shrunk to an existence constrained to my home office (where I compose most of these blog entries), our kitchen, and our living room. Fortunately, we underwent a major renovation project the spring before my original diagnosis in 2014, and so I find that our post-reno house is a cozy and efficient one.

 

     And then, of course, there are my books — hundreds if not thousands of books — and little nooks and crannies in which to read them. Many of my books are in our sunroom but, with it’s 12-foot high ceilings, it’s a room too cold for comfortable reading on most winter days unless I light a fire in the woodstove at least an hour or two before I plan to read, and I find that my strength is barely adequate for chopping kindling and firewood, and for keeping the fire well maintained, for more than special occasions. I also keep many books in my office, although I really must get some more shelves put up so that I no longer have to rummage through mountains of books when I’m trying to find one I’d read several decades ago. I also keep books in our master bedroom, although my wife keeps pressure on me to not to build a mountain range of books in our bedroom or, heaven forbid, our en suite bathroom. I also store books in our living room, my favourite room for reading, although I do most of my reading there during the day when no one is home to watch TV, a terrible distraction when one is trying to read in the same room. I keep most of my books in the basement, where I send them to die, although I often grant one a reprieve and release it back into the living book society on the main and upper floors. And, finally, I have books on my e-reader (one hundred and one at last count), reserved for books I don’t need to annotate (and yes, I know that e-readers allow the reader to annotate freely, but it’s just not the same as putting sticky notes on the relevant pages).

 

     So I have books by the hundreds or thousands to keep me occupied for most of my exile from society, and books that will guide me through the last years or months of my life.

 

     The worst thing about my condition is that it slowly changes, and that it changes in one direction only: my condition worsens. This means that most changes herald the beginning of the new normal. Aches and pains don’t go away but rather become part of the life I must adjust to, either through prescription drugs or some adaptive change in my daily routine. In some cases, such as my spinal fractures, there are surgical interventions that could lessen the severity of the pain, but neurosurgeons are very busy and never return calls from my wife inquiring into the possibility of surgery on a 60-something-year-old male with a terminal illness. Reading is difficult when one is in pain, and my greatest fear is that the pain will worsen to the point that I can no longer enjoy one of my last pleasurable indulgences.

 

     Thus, when I woke up in terrible pain early on a recent Sunday morning, so terrible that the pain itself woke me up, I was alarmed. The pain was in my groin area and was so severe that I feared that it was due to pressure inside the groin caused by the growth of lymph nodes in the region. As always when I experienced a new source of pain, I imagined that it was the beginning of a new phase in my cancer, a phase of chronic pain that could not be relieved by even the most powerful drugs.

 

     Furthermore, I quickly discovered that I was having great difficulty reading or, more accurately, that I was unable to focus on what I was reading. It had finally happened. My greatest fear had materialized. I could no longer read. I stared at my piles of books and realized that I may never again be able to enjoy the last real indulgence I had left. Yesterday, they were pages of some of the best writing in the English language. Today, they may as well have been pages of Sanskrit. Perhaps I could increase my daily dose of opiates to overcome the pain, but then what? I already was on a dose that rendered me barely able to hold onto the content and meaning of what I could currently read. If I increased the dosage, would I be able to get anything of value from my books?

 

     As always when I awoke to a new pain, I waited for my wife to wake up. When she did so, I described the new pain as best I could. She had me lie down on my back while she palpated my groin area and tried to find the source of the pain.

 

     “Does that hurt?” she asked as an excruciating pain shot from the groin area into my testicles.

 

     “Ow, ow,” I answered. I imagined lymph nodes inflamed and swollen, squeezing the testicles from all four sides. Can lymph nodes exhibit malice? These ones certainly seemed to do so. After all, they had murdered my books.

 

     “What about here?” The pain in the area my wife was palpating was even worse.

 

     “That’s very painful,” I informed her. “What part of me is that?”

 

     “It’s called the inguinal canal.” I recalled the name from reproductive anatomy and tried to recall if it was a necessary organ for a man of my age. Perhaps if a surgeon cut it out, the pain would end.

 

     “Tell me if you feel pain in the testicles when I push down hard.”

 

     “Ow ow ow!” I yelled and pushed her hand away.

 

    “I haven’t started to push down yet.” I wasn’t sure but I thought I detected a bit of a suppressed giggle on her part.

 

     “Do you think it’s the lymph nodes?” I asked. “At least, if it was the lymph nodes, a surgeon could cut them out, right? Or at least we could kill them with radiation?”

 

     “I can’t say for sure,” she mumbled absently while she focused on investigating the source of the pain. Would my being unable to read and comprehend the content of my books be seen as justification for surgery? Surgeons liked to read, didn’t they? They would understand that reading was a fundamental right, like eating and drinking, wouldn’t they?

 

     The pain lasted through the day and spread from the right to the left side of my groin. A friend had emailed me the day before to see if I would still be up for a visit from her and some friends next weekend. I struggled to compose a response and, although I had difficulty forming the sentences, I now emailed her back to let her know that things had taken a turn for the worse and that I didn’t think I could handle a social visit next weekend.

 

     “Our thoughts will be with you,” she replied.

 

     As this was the last day of my current round of chemo, the home care nurse from CCAC was scheduled to come by that afternoon on her routine home visit to disconnect me from the chemo line. When she arrived, I tried to describe the pain to her. She listened for bowel sounds through her stethoscope but could barely hear anything. She asked for a detailed rundown on everything I’d eaten over the past two days, which I thought was a no-brainer given that I’d barely eaten anything at all. I was often not hungry following a chemo session.

 

     “That’s all?” she asked when I was done.

 

     “Pretty much so,” I answered.

 

     “When was your last bowel movement?” Their favourite question.

 

     “During chemo on Friday afternoon.”

 

     She and my wife compared notes and failed to come up with a reasonable diagnosis so, as usual in cases where they can’t agree on a likely diagnosis, they decided that the best thing would be to wait until the next day and, if the pain hadn’t subsided by then, then a trip to emerg was warranted. There was the distinct possibility that this was the beginning of a "new normal" for me, a period of groin pain that would make me miss the earlier condition where the only real pain was coming from my spine. It would mean new drugs, and new side effects of those drugs, and less independence, less mobility and, most importantly, less ability to indulge meaningfully in my books.

 

     I woke up on Monday shortly before my wife awoke and I suddenly realized that I was pain-free. Completely pain-free. Absolutely and utterly absent any pain whatsoever except for the hint of pain I felt every morning that lasted until my morning pain meds kicked in. Furthermore, I was able to read and comprehend again. My books sent messages of welcome to my hungry brain, and my brain responded eagerly. Come and open us, the books teased seductively, alluringly. Come and see what pleasures await you. And my brain responded willingly, without constraint. Where to begin? The collection of essays by George Orwell? But which ones? The ones describing his time as a colonial policeman in Burma? His essays about politics and the use of language? What about Cormac McCarthy’s Suttree? It was there at the top of one of the piles in my home office, the title attracting me. I’d heard that it was darkly funny and I was in the mood for humour, and the darker the better. What about Marilynn Robinson’s essays? Too demanding until my mind — or my concentration — sharpened a bit, I decided? I could try them later.

 

     When my wife woke up, she was relieved and, to a lesser extent, amazed, as she had feared that we would have to spend the day sitting in emerg, waiting to see some young doctor who wouldn’t know what to do other than send us home with instructions to see my family doc if the pain wasn’t gone within another day or so. I was in my home office, catching up on the emails I didn’t answer on Sunday because of the severity of the pain in my groin, a pain that had completely subsided overnight. My wife came in to check on me one last time before heading to work, and she noticed an empty Licorice Allsorts bag on my desk. I hadn’t noticed it until that very moment and it took me a few seconds to register just how it got there.

 

     "What’s that?" she asked.

 

     “Oh, it’s empty,” I answered as I crinkled it up and tossed it into my waste basket.

 

     “Were those the ones you got last summer for your birthday?”

 

     “Yes, they’re the ones the girls bought me.”

 

     “When did you eat them?”

 

     The air in the room had changed. Outside it was below freezing and it felt as if the window was open, but the cold chill wasn’t coming from the window. It almost seemed to be coming from my wife’s voice. I had to think, and think fast, not an easy thing to do at the best of times but especially when I was under the influence of the pain meds. “I ate most of them last summer.”

 

     “I didn’t see the bag on your desk until just now.” Where was that cold breeze coming from?

 

     “I finished them off a few days ago.” She said nothing but stared at the crumpled up bag.

 

     “A few days ago?” she repeated my answer and kept staring at the empty bag.

 

     Silence filled the room. It demanded a response other than the one I’d given. “Um, I think it was Saturday”.

 

     "How many did you have?” Yes, I confirmed it: the cold breeze was definitely coming from her words.

 

     “Just a few leftover ones from last summer?” I answered as if I was asking a question. A bad sign that gave my wife a certain power over me. A malevolent power.

 

     “How? Many? Were? There?” Each word came across the room as if carried on a cold breeze. She’d warned me years ago that licorice could be hard on bowel motility, and I’d always paced myself when I ate it. At least I thought I was pacing myself.

 

     I wasn’t going to get away with this and so I realized that I’d better just come clean. “About 10 or so…” My wife stared at me so hard I had to look down to avoid the glare, like a student who hadn’t done their homework and was being called on by the teacher. “… maybe 20”. Still, she said nothing but just kept staring. "… 30 at the most?"

 

     "And they were the solid licorice ones, not the ones with the sugar candy segments?” She knew that I always left the solid licorice ones to the end.

 

     “They were really hard and dried out.” That was true even if it wasn’t an answer to her question. "It took a while to eat each one. I had to suck on them as if they were hard candies, so I couldn’t eat them all at once."

 

     "So you ate 30 licorice candies on Saturday night before you came to bed?”

 

     “Yes?” Again, I was answering with questions, as if I was trying to find out which answer was the right one. Which was what I was trying to do.

 

     “Maybe it wasn’t quite as much as I said? You know, I think 30 was a bit of an exaggeration.” She stared and said nothing. “Maybe it was only 27… 28 at the most?”

 

     “So, you ate a bunch of licorice, then went to bed, then woke up at 6 AM with terrible bowel pain which moved down to the groin area throughout the day.”

 

     “Yes?” My voice sounded meek, even to myself. 

 

     "We had the CCAC nurse look you over to make sure that you didn’t have a perforated bowel.” 

 

     "I mentioned that I’d had some candies the day before,” I answered honestly.

 

     “Maybe I should palpate your bowel to check things out.”

 

     Somehow, I just knew that that would be a bad idea. “I think if I just wait a bit, things will get completely back to normal.”

 

     “Maybe I should check it anyway.”

 

     “No, no, it’s okay. Really.”

 

     "Let me know if you change your mind," she replied. She said it in a way that sounded like a victory lap rather than as a sign of the caring caregiver she usually was.

 

     “I will," I said, and she left me relieved that she had to go to work and didn’t continue with the inquisition.

 

     Thus was the end of the saga of the growing groin pain. I was not going to suffer from a new ache and pain, and there was going to be no new normal, at least not yet.