Wednesday, 29 September 2010

Dr Waldenström will see you now

The story has now reached Tuesday 7 September 2010 and I am writing this almost exactly three weeks after the event.

Even bad days are a mixture. Maybe it is the inner knowledge we have that this is so that enables us to rise at all from our beds each morning. So it was that I awoke to the prospect of a gentle morning’s work at home, to be followed by a quiet drive in the early afternoon into the leafy Surrey suburbs, rather than to the usual torrid hack into the bowels of the City followed by the increasingly effortful climb up the ramp out of Bank Tube and into the rushing masses on Lombard and Fenchurch Streets.

I wish I could report to my bosses that my morning was more than usually productive as a result of these auspicious circumstances, but this turned out not to be the case, as every intuition told me that my appointment this afternoon was likely to be of an unusually serious nature. Nevertheless, clinging to my waning hope that iron pills would be the order of the day, rather than any other more potent remedy, I was able to do some work before the time inevitably arrived for a snack lunch and departure.

As I was driving to an unfamiliar place, I relied on sat nav, which I succeeded eventually in bending to my will, that being the normal pattern of my working relationship with the device. The hospital car park is (as I have since discovered) constantly full and so I was slightly late for the appointment, which was at 2pm. I telephoned from the car park to make sure that the doctor would know I was at least in the grounds, but need hardly have bothered as it appeared, when I reached reception, that I was the only person on the list that afternoon, my mood having by that time been further subdued by seeing the label on the wall identifying the clinic by its actual title of “Haematology-Oncology”.

After the tiniest of intervals the specialist ushered me quietly into her consulting room, which was pleasant and spacious enough, containing several chairs and her desk (with inevitable computer) as well as an examination couch. We shook hands, sat down and she proceeded to deliver her uncomfortable news with admirable skill, swiftness and clarity. After briefly confirming that my haemoglobin was indeed low—9.8, whereas 13 would be normal, thus confirming that I was anaemic—she moved to mention of my white cells, at which point I lost full control of my feet, which started to shuffle restlessly back and forth across the pleasant green carpet.

I said, “I don’t like the sound of this" but the good woman would not be deterred by my obvious distress from the admirable directness of her ensuing communications, which were to the effect that the white-cell counts and the presence in significant amounts of a particular protein pointed in the direction of a rare, specific, but treatable, condition. At this point, I calmed down somewhat, although it was clear by now that my normal foundations were sliding beneath me and that my inner world was tilting at such a strange angle that its landscapes would never now appear as they had before and that I would soon be in search of new vantage points and places of safety.

I asked whether treatment would be sufficient to eradicate the disease and she wasted no time in making it clear to me that a pattern of remission and recurrence would be the norm, as we were dealing with cancer. Before this the only forms of “liquid” cancer I had known of were leukaemias and the three cases known to me personally, one in a particularly dear friend, had all been fatal. With the speed and lucidity that was eliciting my growing admiration, the doctor assured me that my condition was not that ‘L’ word but another: lymphoma. To give it its full name, the diagnosis was Waldenström Macroglobulinaemia, so we will with a measure of relief call it “WM”, one of 20 so-called non-Hodgkin lymphomas. Slow developing, it had probably been building up in my system over the last five years to the point where it was now declaring itself in symptoms such as: exhaustion, breathlessness, night sweats, blurred vision, dizziness, mental confusion and impaired concentration. Although she seemed slightly surprised that the extent of my symptoms had not led me to seek advice some months before, rather than leaving detection to the random timing of a routine blood test, she told me that now was the stage at which treatment would normally be started.

She said that a bone marrow biopsy would be needed to confirm the diagnosis, which she should be able to confirm in a couple of days and so we would meet again then. For the moment, she would need to take more blood and give me a brief physical examination for swollen glands. So for the second time in five days I felt a needle go into the skin of my inner elbow as I clenched my fist to make the giving vein palpable, this time giving two samples, each rather larger than the little offering I had so blithely donated to the system on the previous Friday. The specialist’s cool, calm hands swiftly identified an enlarged spleen as well as some palpable glands under my left armpit. Some time within the next 10 days I would be having a CT scan, which should reveal the full extent of swelling in my lymphatic system, a circuit whose vital importance remains in inverse proportion to the meagreness of my understanding of its activities and functions. She assured me in the meantime that my liver and kidneys did not appear to be compromised and that my blood platelets were showing no signs of disease.

My business at the hospital that day was indeed far from over (bone marrow biopsy needed, remember?) but I am going to continue the narrative in another entry, which I will begin very soon. In the meantime, what better company for me to leave you in than that of the good Doctor W himself?

Dr Jan Gosta Waldenström (1906-1996)
Seen here in 1944, he identified the common elements of WM from two similar patients he encountered that year. To think I had imagined a Professor Calculus-type lurking behind pebble spectacles!

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