Heidi Swart. Picture: Gareth Smit
There’s a train coming at me. I can do nothing about it. I’m just watching it. I’m strapped into a chair, which is tied to railway tracks. my family, friends and vague acquaintances are standing next to me, telling me not to worry. It’s not yet the time to worry.
But I’ve seen what trains can do. They fragment. Obliterate. End.
I remember the emergency worker, picking bloody pieces of that boy up off the tracks. the only way they could identify him was through a college ID card tied to his backpack. he was 19 and a student at Northlink College. Everyone blamed the broken fence around the track and the railway parastatal, which blamed the government, which blamed the departments within itself, which blamed the recession. But that train was coming for him. it always was.
Right now, I’d say it’s coming for me at full speed – for dramatic effect. But the truth is it wouldn’t have to move very fast to make mincemeat of me. if a car travels at 36km/h and crashes into the back of a truck, then the car’s driver and all the passengers will be decapitated. it only takes 36km/h. That’s what a coroner once told my uncle, who was a chief medical technician at Wits. She had the heads to prove it. Four of them.
So here comes the slow train.
The doctor cut a mole out of my back. he did so with great care and wide eyes. “That definitely has to go. we cannot be too careful. it might be nothing.”
Five days later, I got an e-mail from him. it wasn’t nothing. it was melanoma. he attached the report. I s**t myself.
I’d only ever read about this type of cancer in you magazine. happy person lives a happy, healthy life. Finds lump/spot/ thing somewhere in or on body, thinks it’s harmless, then dies a slow/fast death. Grief-stricken family are left behind. and now, thanks to the efficient distribution of toilet magazines, there’s always an element of panic in it for the rest of us.
We, the general public who make up the general statistics, don’t just get to mourn some poor sucker we’ve never laid eyes on. we also get to be an inch more paranoid about the 1 001 things out there that could kill us.
So when I first saw the big black mole staring at me in the mirror, eye-balling me from my left scapula, I got a You-sized fright. I’m going to die. it was a particularly bad time to have cancer.
So it wasn’t until three months later, when my dad threw a hissy-fit, that I decided to have the little f****r lopped off. good thing my dad had that fit.
Melanoma is a particularly aggressive cancer. once it takes hold, it can metastasise quickly. it doesn’t respond well to chemotherapy or radiation. the standard treatment is surgery, surgery, and more surgery. They have to cut pieces out of you until they get it all. if they can find those pieces. and if they can get it all. Fragmentation. That is the cure for melanoma.
Not happy with my doctor’s vague gestures regarding prognosis, I do what many doctors will expressly order you not to do – hit them interwebs running.
My melanoma is only just thick enough – by 2mm – to warrant panic. That’s good. But it has also penetrated deeply into the skin – Clark level IV. This means it has penetrated the epidermis, and dermis and has reached the lower dermis. This is bad. But it is still a lot better than Clark level V, the highest Clark level, which means it has reached the tissue below the skin.
It is near a hair follicle. I have no idea what the significance of that is, but it bothers me that they would even mention that. I somehow imagine the hair follicle as a porthole into my body through which the cancer can secretly invade me. I keep forgetting to ask the doctor about it.
There’s another scale, based on the extent to which the cancer has spread. I’m classified as a T2b, according to one site. This is good. there appears to be an 85 to 99 percent five-year survival rate. better than stage 4 (anything) in which you are pretty f****d.
I wonder in what stage it was when I first saw it? Could I have prevented all of this? Perhaps. likely. I don’t know. But I’m disappointed in myself.
But mine is only a preliminary diagnosis. They need to cut some more out to know. To almost know. To sorta-kinda know for sure.
What frightens me about death is that it will turn me into an object. A body without me in it. A thing. A something. which is the same as nothing. Lot’s wife. I don’t want to be something. Or nothing. Hell. I have expectations.
One night, a few weeks before the diagnosis, I wrote down exactly what I wanted. I was in a somewhat manic state following sex with a stranger and a lot of expensive whisky, but I’m pretty sure it was a fair summary of my aspirations.
“if I had one wish, it would be that I could transcend space and time, and be everywhere and everything and inside all times at once. if I had one wish, it would be to encompass the universe, and at the same time to move through it without limit or trace. To be it, to see it, to own it, and to never, ever let it go. I want to be forever and always, everywhere and everything.”
The melanoma does not fit in with my plan. it brings the prospect of being a single, solitary, lost object ever closer. it allows me to practise getting used to my worst fear.
When you enter the continuum of medical care, you turn into an object even before you die. you have to do this to save your own life.
First there are the follow-up examinations. Naked in a pool of light while a doctor and a nurse comb your skin for anything else suspicious. I insisted on this. Especially when he told me the chance of having more than one melanoma simultaneously is 4 percent.
“we once had a lady with three. Her son had two.”
I stripped down faster than a teenage boy who is about to lose his virginity.
Luckily they saw nothing. Or unluckily. the role of luck is never clear.
The doctor explains to me what will happen. the procedure itself is relatively simple. You’re out under anaesthetic. A plastic surgeon cuts out a circle of skin with a 4cm diameter with the original location of the melanoma as its centre point. This piece of skin gets tested for cancer. during the same operation, a general surgeon removes a lymph node. But not just any lymph node: the Sentinel Lymph Node.
To find this lymph node, you lie incredibly still inside a tunnel-shaped X-ray-type machine. you are injected with radioactive isotopes which, theoretically, travel the same route as the lymphatic fluid draining from the mole affected by melanoma. the reasoning is, if cancer cells escaped from the mole and took a ride in the lymphatic system, they would land up in one specific gland. the Sentinel Gland.
You lie still in the scanning machine so they can take pictures of the path the radioactivity takes along your lymphatic system. it shows the doctor exactly where the lymph gland is. the radiographer doing the scan makes two big marks under my armpit. This is where they’ll cut. “Don’t wipe this off,” she says.
The sentinel gland is the one they remove and dissect to find any traces of cancer. if they do not see any melanoma in the sentinel lymph node, you’re good to go. it is an “indicator” that you are, in all likelihood, cancer-free. A proxy. A “controversial” diagnostic method, one site called it.
The surgeon explains the “theory” behind the operation. he is clean-cut, neat, compulsive. he wears chinos and a pin-striped shirt. his shoes shine. his office is clean, neat, air-conditioned, and pastel-colour co-ordinated. Nothing is more predictable than a surgeon’s office. except perhaps death. and the surgeon himself: “But if we find anything in the gland… then we talk again about what we do next.”
The sentence is curiously phrased, as if I am part of the team that can save my life. as if there is something to do next. as if there will be control beyond that point.
“so if you find something, what do you do next?” I ask. I know what they do next, but I want to double-check. I want to know for sure.
“then we remove all the glands surrounding the gland we found the cancer in. It’s a big operation and it can leave a scar. it has side effects.”
I know about these side effects. Swelling. Restricted movement. Scars. Ugliness. being repulsive to others. Even now vanity and the need for acceptance at any cost is a prevailing factor. it hovers like a fly around old shoes. Or sharks around chum. I’d compare it to blossoms in the springtime. But I’m not that optimistic.
I haven’t found the right combination of drugs and honesty yet. so it remains an irritating basic human need that just won’t go away.
I’m sure if someone brought out canned intimacy, they’d be instant zillionaires. I’d buy it. I’d have it next to the omega-3 capsules, multi-vitamins, Prozac, and mood stabilisers. the label would read: “once opened use within two days. Contents are harmful in excessive amounts. keep out of reach of children.”
I am 33 and I am single. Not entirely by choice. if I have cancer and die, I’ll never get over my cynicism. This worries me. It’s the one thing I really want to fix. Cancer is a lot like love. it either hits you or it doesn’t.
Next week: the operation
Help, I’ve got cancer, I’m going to die