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I get knocked down, but I get up again

I get knocked down, but I get up again.’ That was the tune that was playing in the sound-defending headphones inside the MRI machine. It was my first experience of ‘riding the white doughnut’ and I found it curiously soothing.

I was having an MRI of my neck, because I had been experiencing pretty severe right shoulder pain for a few weeks. I have always had trouble with my neck from poor posture, bruxism and general ‘holding-in-the-terror-while-on-call’ stress-ness.

It was seven months after the birth of my third baby and I had been back at work for a month. I started losing weight unintentionally, which I had done with my other two babies, but this time it kept coming off; 2kg, 4kg, 6kg. I also started having night sweats, which was something entirely new for me.

(Those of you who are particularly keen diagnosticians are going to try to start piecing this together now. Let me give you a few relevant negatives: I had no cough, no change in bowel habit, no headaches, no vomiting. I had two, maybe three episodes of bright-red blood PR during my pregnancy. And this shoulder pain.)

I got my bloods done; very slight anaemia, slightly-raised alkaline phosphatase. Everything else normal. I had a normal chest x-ray. No sign of lymphoma. Super.

Then the shoulder pain got worse and I began to have right upper-quadrant pain. Excellent! Gallstones! Sorted.

I had an ultrasound.

I had a call that evening from my GP (I’m showing off what a good doctor I am. I have always had my own GP).

She said there were some masses, probably haemangiomas, and that I would need to have an MRI.

I collected the report from her a few days later to bring to the MRI people. “Multiple heterogenous masses,” it said.

(The diagnosticians are getting very excited now.)

My brain scrambled to find a perfectly reasonable, non-lethal pathology that would fit with this.

It failed.

In the nine days that I waited for the MRI, I had my bloods done again. Now my LFTs were through the roof. None of this was looking good.

I had the MRI on a Thursday, because I don’t work on Thursdays. We were due to travel to Paris for a romantic weekend on Friday. Just as well I had already booked the locum.

The phone call from my GP that came just an hour or so after I left the scanner was, and remains, the worst moment of my life. After she told me I had multiple liver metastases, I had to ask her to tell me that I wasn’t imagining the conversation. That this was really happening. That my world had really just collapsed.

In a whirlwind of efficiency, due to the kindness of multiple colleagues, I was in a scan machine again 15 hours later. This time there was nothing soothing about it.

I had colorectal carcinoma, with at least 16 metastatic deposits in my liver.

I was 37 years old.

Within 10 days I had had a colonoscopy, a portocath fitted, my first dose of chemotherapy and my first emergency admission due to pyrexia. I was inwardly terrified, but continued with the Christmas shopping, the school pageants, the laundry. I stopped working, because I assumed that was the right thing to do.

I was to have six cycles of FOLFOX chemo, but I only managed five because of side-effects (neuropathy, neutropaenia). The next scan showed about 50 per cent reduction in my liver tumours. Woo-hoo!

I went on to have selective internal radiation therapy (SIRT), twice, in Cork. I was one of the last patients to receive this here before the ‘Powers That Be’ determined in their wisdom to cease its funding.

That SIRT is, I reckon, the reason I am still here now. A PET scan following it showed my liver lesions were now tiddly, although one of them did happen to be clutching my portal vein, which was unfortunate.

I had an anterior resection about a year after my diagnosis. No stoma, which was bloody fantastic news.

More chemo to see what we could do with the ‘portal-vein-clinger’. He’s a determined little fella and the chemo didn’t shift him. The rest of the liver was pretty quiet at this stage, so we went ahead with a liver resection, removing about 60 per cent of it. Seven weeks of recovery with a very uncomfortable drain.

More chemo.

Then, just to make sure I got to have a go off all possible treatment options, I had stereotactic body radiotherapy treatment (SBRT) to the ‘clinger’.

Last known clinger status — fuzzy, but still there. Currently waiting to hear if he’s finally released his grip.

So that is the story of me and my ‘journey’ so far.

I think I need to get a better travel agent; it’s been a circuitous route.

But the destination remains the best place on earth.

Here.

Now.

Alive.

(You can follow my meanderings at www.adventuresofasickdoctor.blogspot.com)

Dr Sarah Fitzgibbon is a GP in Gurranebraher in Cork city. Her current interests include integrated care, health inequality and staying alive.

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