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  • nbrightside 10:04 am on July 13, 2013 Permalink | Reply  

    a chat with a clinical psychologist 

    August 2012

    I was back at home. The London Olympics was on. The sun was shining. The flurry of post-discharge activity and regular visits from district nurses had slowed. Life was good – not quite normal but definitely good. I looked in the diary ‘Thursday 9 August – clinical psychologist@RMH, Sutton’. Shit – why did I book that appointment ? Why did I weaken when I was in hospital ? I’m fine now. There’s nothing wrong with me. Of course, I felt down in the dumps in the hospital. Who wouldn’t – being cooped up in there for 7 whole weeks, feeling like crap and unable to walk.

    I immediately thought about cancelling the appointment but thought better of it. What harm could it do ? What else had I planned for Thursday – nothing ? Maybe it would help.

    So I went along to the Royal Marsden Hospital in Sutton and navigated to the Psychological and Pastoral Care Unit which is adjacent to the Children’s Day Unit (I always find rather upsetting to see young people with nasal drips in being wheeled around in wheelchairs). Anyway, a young lady introduced herself to me and our session began. I did most of the talking, taking her through my medical history from diagnosis through chemotherapy followed by radiotherapy, surgery and up to the current phase of ‘post surgical recovery and recuperation’.

    She occasionally interjected and asked a question or provided some reassurance. I faltered at the normal sections (telling my kids, telling my folks, how supportive my wife had been). She seemed mildly interested in my coping strategy. I told her that I found inspiration and hope from people who had battled cancer and won – or at least were in remission. I also told her that, whenever I felt sorry for myself and could feel myself feeling down, ‘you only have to walk around here or look next door [Children’s Day Unit] to find poor people much, much, worse off than yourself’. The lady gently replied, almost in a whisper; ‘So you find it helpful to look at people who have conquered this illness and you also look at people in less fortunate positions to give yourself a boost’. That sounded rather callous, cold and unfeeling which really wasn’t what I meant. I never meant ‘Hey I may have my problems but, look, I’m much better off than that poor sod’ and felt mildly ashamed when she appeared to interpret my words in that way.

    At points, our session did feel worryingly reminiscent of a comedy sketch that sort of reinforced some of my worst fears and preconceptions about ‘counselling’. For example. when I was trying to describe the mental anguish of sharing the news with our teenage children, I just dried up. I paused, I couldn’t get the words out. I knew what I wanted to say but I couldn’t utter the words. I leaned forward in my chair – ‘Sorry, I’ll be OK – sorry’ and put my head in my hands. Finally, I gathered my composure and muttered ‘The TV advert gets this bit right – the worst moment, in all of this, was telling my children’ and, as always, just as in hospital, just as I knew they would, the emotional floodgates opened, triggering yet more meaningless apologies to a lady who looked young enough to be my daughter.. Once again, she leaned forward, looked sad and waited patiently while I took a few moments to dab my eyes, have a sip of water and get my shit together for the next section. Before I could do so, she helpfully observed ‘Yes – now I can see that telling your children was a very emotional and harrowing event for you. Even the memory of it, a year afterwards, is still very emotional and raw for you. Why do you think that is ?’

    Well – the answer is bloody obvious. The exchange reminded me very much of the legendary doctor program in Emacs; M-x doctor

    I am the psychotherapist.  Please, describe your problems.  Each time
    you are finished talking, type RET twice.

    I just keep crying all the time

    Why do you say that ?

    I feel so unhappy

    Are you unhappy often?

    Yes. Every day

    Earlier you said you felt unhappy?

    Yes. I have a serious illness.

    Maybe your life has something to do with this.

    Possibly. I do love pork pies and beer

    Do you drink a lot of beer?

    Yes

    Can you elaborate on that?

    I like a drink when I’m watching football. What of it ?

    And so on and so forth. Repeat as necessary.

    Our session ended rather abruptly. I had finished my tale, reached the present day and my 50 minute session was up. But, hang on, wait, she hadn’t really talked yet. I hadn’t received the miracle cure. What was I supposed to do now ? Were these feelings of low self esteem and survivor guilt normal ? Did I need prozac to numb the pain ?

    ‘Well, you seem to be in a much better state of mind than when you made the appointment. Now you’re on the system, you can make another appointment and you will be seen much quicker. But unless you feel strongly, I’d say we don’t need to schedule a regular, ongoing appointment’.

    So that was that. I had been man enough to accept I needed help. I had had a session with a clinical psychologist.

    Did it help me at that time ? Not really.

    Would it have helped seven weeks earlier when I was on the edge of despair in hospital ? Possibly.

    Did I learn anything new ? No.

    Would I seek help more readily next time ? Yes.

    Would a session with fellow bowel cancer sufferers with real-life experience have been just as beneficial ? Probably.

    Would I run across to the ward asking for details of the next Bowel Cancer Support Group meeting ? No, of course not.

    Of course, I think deep down, my resistance to obtaining help (or even medication) was really related to the fact that I was already taking a plethora of pain-killers, antibiotics, assorted pills as well as blood thinning injections. My main aim in life was to wean myself off all of this medication in an effort to gradually make a return to some sort of normality. Having a regular, scheduled meeting with a clinical psychologist – even if it was helpful – would simply have been another emotional crutch, another dependency which I would inevitably have to sever myself from in due course. Subconsciously, I think, I didn’t want to establish such a precedent and leave myself with more baggage that I would surely and inevitably have to discard and learn to live without.

     
    • Matthew Davidson 12:52 am on July 20, 2013 Permalink | Reply

      Personally I have no problem with seeing a psychologist every month or so, and all things being equal, would recommend it to most people. I’ve seen a few over the years, of varying quality, and even the best are not much use until they get to know you pretty well, by which time they’re able to drop the Turing test responses. I certainly don’t see them as keepers of any hidden profound knowledge about the human condition, with the power to cure anything; rather they’re just a reasonably intelligent person who I respect and can talk to without having to wory about upsetting them with an unguarded opinion or personal revelation. More than once I’ve noted an upcoming appointment and thought “thank Christ for that.”

      Probably in centuries gone by this would be a role filled by a somewhat distant relative, and we should bemoan the necessity to contract it out to a professional. Though I can’t see that entering my top 100 social welfare anxieties any time soon.

  • nbrightside 11:48 am on July 5, 2013 Permalink | Reply  

    going under the cyberknife 

    I had radiotherapy prior to surgery and because the ‘margins were slim’, I also had radiotherapy after surgery, shortly after being discharged from hospital. The second bout of radiotherapy was quite different though – it was. wait for it, Cyberknife. I had already seen an excellent BBC program all about this innovative, new treatment which featured my oncologist, Dr. Nick van As.

    The first stumbling block was that Cyberknife treatment isn’t currently a recognised treatment available on the NHS. Consequently, the insurance company wasn’t guaranteed to fund the treatment which is essentially undergoing clinical trials in the UK. I knew Cyberknife was expensive. While still in hospital I asked Dr. van As how much the 3 sessions would cost. The answer – ‘£40k’. A lot of money, a sum I’m not sure I could raise without selling my house and moving my family to a trailer park in Aberyswyth. Still, what price can you put on life or prolonged life ? And, anyway, my Dad had frequently offered financial help should I need it which was more welcome than his unforgettable advice to ‘Keep your chin up’. Dr. van As reassured me that ‘There will be some to’ing and fro’ing with the insurance company but I am confident they will agree in due course’.

    A couple of days later, he reappeared in my hospital room with the glad tidings that the insurance company had agreed to fund the Cyberknife treatment and he wanted to kick things off by booking the planning scan. When I expressed surprise at the speedy turnaround, he explained ‘Professor T (the surgeon) wrote to them stating that ‘If Mr. Brightside should re-present to me with recurrence of his colorectal carcinoma, after Cyberknife treatment was denied to him, then we will be seeing you in court’. After that, he said smiling, they had received approval via FAX within 25 minutes. What fantastic news – my savings were safe and my Dad’s inheritance would also be fully intact.

    The Cyberknife treatment is quite different to conventional radiotherapy. Instead of a single beam radiating the affected area, a complex computer model is created which allows the radiographer to dispense tens of different beams of varying strengths to the area. For example, a strong beam might be used to radiate the central core of the tumour while lesser doses administered to the peripheral areas which reduces the risk to adjacent organs and tissue.

    I has some difficulty picturing exactly what they were to target in my case – there was no tumour and there was no central core. I knew this because it was in a jam-jar on my bedside cabinet. I had this vision of my backside being a bottomless, empty void but I guess they were just radiating the area in the bowel close to the pelvis trying to eradicate any residual, microscopic cancer cells to give me the best possible chance. Which was fine by me.

    Bizarrely, the planning scan for the Cyberknife treatment was done using a CT scanner which allows the team to create the computer model and 10 days later, I was in the basement of the Royal Marsden in the sterile, white, clean, shiny and very expensive Cyberknife suite. Unlike, the conventional radiotherapy which lasts a couple of minutes, Cyberknife sessions are much longer (40 mins for me) and you have to lie motionless and perfectly still for this period. so you lie on a sunbed, you stare at the ceiling which is adorned with a lovely high resolution photo of spring blossom and get to choose your musical entertainment – Now That’s What I Call ’70’s, 80’s or 90’s.

    The Cyberknife treatment is delivered by a robot – do you remember the famous robot that painted the Citroen car in the factory – well Cyberknife shares a lot of the same technology and the robot base uses a similar hydraulic system to position itself and then dispense the X-ray beams. It is a little disconcerting at first as the robot whizzes and whirrs all around you – in fact sometimes I thought it was looking inquisitively at me before it lost interest and accurately re-positioned itself by my knees and then promptly withdrew high above my stomach.

    After 25 minutes, the robot paused for longer than normal. In fact, it stopped completely by my feet. The senior radiographer came and explained ‘The robot wants to go where your feet are. Because we do the planning scans using CT, it doesn’t cater for people who are over 6 foot with size 10 feet’. I offered to twist my feet flat but it was no good – the session was aborted and they would have to recalculate the entire computer model – omitting the areas around my feet. I suspect this was a ‘Version 1.0’ type software problem that would be fixed in the next maintenance release.

    Anyway, Dr. van As was summoned to re-jig the model and, within 4 hours, I was back on the sun bed with the Cyberkinfe robot doing its bizarre dance around my body.

    Some people ask ‘Does it hurt ? What does it feel like ?’ No, it doesn’t hurt at all – there’s no burning sensation, discomfort, any faint warm glow or even any feeling at all. In fact, you’d be hard pressed to know you’d been subject to a leading edge medical treatment that costs as much as a semi-detached house in Burnley.

     
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