About the piece:
This was one of several creative readings delivered at our April 2024 Literary Evening with the NBM Lab.
This is an excerpt from Chapter 15 of Cancer Confidential: Backstage Dramas in the Radiation Clinic (University of Toronto Press, 2022), reproduced by permission of the Press.
The book intertwines stories drawn from my practice as a radiation oncologist with the story of my father’s death from metastatic prostate cancer. In this chapter, I have just received the news that my father’s cancer has progressed, and he is now in kidney failure from a large mass in his pelvis. I travel from my home in the east of Canada to Calgary, where my father is in hospital.
An Excerpt from Cancer Confidential
By the time I arrive in Calgary, it’s too late.
My father has fallen into the clutches of a urologist — not the senior Brit who gave him his hormone treatment, but a young hotshot who, without explaining other options, has stabbed his back and thrust rubber tubes directly into the kidneys to bypass the blockage by the cancer. My father’s kidney function has improved, and he’s become more alert.
Damn. I hate this reflex behaviour of performing a technical procedure in a dying cancer patient without considering the bigger context. The drainage tubes are only a stopgap measure. They will buy my father time, but sooner or later some new crisis will occur — then another, and another. Crisis will follow crisis on a stuttering downward slope. Death patiently waits at the bottom with open arms. Time spent on this rickety one-way roller coaster is rarely good quality time.
Medical students and residents — mesmerized as they are by technological wizardry – are always keen to do procedures, but I always caution them that just because a procedure can be done, that does not mean it should be done. In a dying patient without hope of cure, the option of masterful inactivity should always be put on the menu.
So quick and reactive were the urologist’s actions, my father was given no chance to review the menu. In any case, it turns out he and my mother have never discussed his wishes around medical intervention. Like me, they have long known this moment was coming but have chosen to ignore it, like it’s some distant mirage. The scrim of silence descended again.
By the time I arrive at my father’s bedside in a small, dark room in a remote corner of Calgary General Hospital, the drainage tubes are a fait accompli. I see no point in stirring things up. It’s far easier to prevent an intervention than reverse it.
He lies under blankets on the bed, sleeping, an IV dripping in one arm, an oxygen mask flopping at his jaw, murky amber liquid coursing through tubes from his flanks to drainage bags slung under the bed.
My mother sits at his bedside in a wheelchair — all the stress has made her lupus act up. She rolls forward and pats my father’s arm.
“Look who’s here to see you.”
He rouses, raises his head from the pillow, and looks at me. Through the rectangular frames of his glasses, his eyes are clouded, dull. His lips curve in a weak smile.
“Oh. Hello,” he says, in a chirpy matter-of-fact tone, like I’ve been gone only a few hours on some errand.
For the first time since his diagnosis, he looks truly sick. Cachexia, wasting, is underway. His cheeks have sunk to dark pits, and his once-thick black hair is thin and streaked with silver. Purple-grey blotches mottle his arms. A film of sweat glistens on his broad forehead.
These features are those of a hundred dying cancer patients I’ve attended to. This time, it’s my father. He spots something on the wall behind me.
“There’s that woman again.”
I turn to a faded framed print depicting a forest with a row of bright red poppies in the foreground. A typical example of hospital art that’s meant to cheer you up, but instead provokes queasiness.
“I don’t see any woman.”
“She’s there. Hiding behind that tree. She’s looking at me! Go away! Go away!” he shouts.
The renal toxins are still affecting his brain. I take the picture from the wall, flip it, and place it on the floor. My father’s head falls back, and within a few minutes he’s asleep again.
My mother and I spend the next couple of days at my father’s bedside. We watch him sleep. We wait, wait, and wait some more for something to happen. For me at work, hospitals are busy, frenetic places, where I constantly scurry here and there to perform a never-ending list of tasks. Now, from a patient’s point of view, everything seems to unfold in the slowest of slow motion. I understand the frustrations of families waiting to see me.
Visits by a nurse to take his vital signs or check his tubes punctuate the long periods of inactivity and waiting. Occasionally, his urologist — a curly-haired, boyish-faced man who turns out to be a former medical school classmate of mine – pops his head around the edge of the door like Mr. Punch peering around the wings of a puppet show. “Everything okay?” he asks peremptorily, then immediately disappears. His manner recalls the evasive behaviour of surgeons I’d first witnessed with Sam.
. . .
On the third morning I decide to chase Mr. Punch into the corridor outside my father’s room.
“Hey, Jake. So how do you think my dad is doing?”
“Temp’s normal,” he says with a bright smile. “His creatinine’s come way down.”
Creatinine is a marker of kidney function.
Yeah, I think, his creatinine’s better, but the cancer is worse. I recognize a common phenomenon, of which I’ve sometimes been guilty: focusing on improvements in technicalities, such as lab data, to provide a false sense of optimism in a dire situation.
Obviously proud it’s his plumbing work that’s led to the improvement, he gives me a satisfied smirk and turns away.
“Uhh . . . Can I ask what the plan is?” The word “plan” catches him short. He stops and turns.
“Plan?”
I take a big breath. “It’s pretty clear his cancer’s getting worse.”
“Oh, yeah, that,” he says, like I’ve reminded him of some trivial detail. “We’ll get the med onc to see him about some chemotherapy.” He scurries away.
At the time of my father’s illness, chemotherapy for advanced prostate cancer is next to useless, an opinion confirmed by the medical oncologist, a middle-aged woman with an aristocratic demeanour, adorned with a stylish dress and pearls like she’s ready for a night at the opera.
As I expected, she punts the situation forward.
“He’s in no shape to get chemo now, my dear,” she says, laying a bejeweled, manicured hand on my arm.
“I’ll book him to see me again in a month. We can revisit the situation then. Have a wonderful day.”
There’s a slim chance my father will be alive in a month. It’s that Catch-22 again. Too sick to get treatment that might help the disease causing the sickness. Her delay is just a tactic to disengage without appearing to disengage. She releases my arm, gives me a sort of curtsey, and slides away.
I watch her receding figure disappear. As I stand alone in the corridor, brushed by passing nurses, surrounded by the familiar hospital cacophony of beeps, blips, buzzes, moans, and shouts, anger at her abrupt, disinterested manner – and that of my father’s urologist – rises inside me. Why the hell don’t they care? Why are they running away? Why are they writing him off? Why aren’t they doing more to help my father? To save him?
My logical, scientific doctor’s approach to my father’s situation suddenly crumbles against a tide of desperation. How can my father be allowed to die? At sixty-six, he’s young enough to look forward to a few more decades of active life. To enjoy his retirement. To travel back to his birthplace, India. To see parts of the world he hasn’t visited. To see his grandchildren, grow up.
I want to shout help. Help. Why isn’t anyone doing anything? Can someone please do something?
Surely, there must be something, somewhere, to rescue him, bring him back, give him more time — time for me to achieve that reconciliation I crave.
About the author:
Charles Hayter is a radiation oncologist, writer, award- winning playwright, and medical historian who identifies with the 2SLGBTQI+ community. He was formerly Associate Professor of Radiation Oncology at the University of Toronto.