A story, an anniversary and a moral

In early 1996 my father Fred fell from his motorbike on the farm and cracked a rib. He had blood in his urine, which the doctors called haematuria which means bloody urine in Greek. The doctor told him that the indicated procedure for haematuria was a cystoscopy to check the bladder for tumours or other conditions. This is a nasty procedure in which the patient is put under a general anaesthetic and the doctor inserts a camera up the urethra (up the penis) and into the bladder and has a look around.

Because the procedure is unpleasant and not completely free of risk especially for a man in his mid-70s, and because the diagnosis seemed obvious, Dad decided with the doctor’s blessing that he’d not bother with it. About four months later with ribs in fine fettle, the symptoms recurred. On performing the cystoscopy the specialist told Dad as he woke up ‘You’ve got a nasty tumour in there’. And so he had. During his long illness, one of the specialists asked him if he’d ever worked with aniline dyes. Dad had worked for a printer for a year or so when he was 19 in England. Smoking till his mid-forties probably didn’t help but working for the printers probably gave him the cancer over half a century later.

Dad didn’t fancy having the surgery and had always thought he wouldn’t. But he decided to go ahead, perhaps to please others. He ended up with a stoma and urostomy bag but this failed to stop the cancer. Metastases spread to the rest of his body (some of the nastiest medical conditions have some of the most beguiling names).

Just a few months after Dad died, I noticed blood in my own urine. I thought it was very unlikely I had bladder cancer the whole period had been pretty stressful and the symptoms appeared after some vigorous exercise. Still I was anxious and so I hightailed it down to the doctor and asked to be checked out as soon as possible. It was a Thursday and I asked him if it was possible to get me seen the next day. The answer was yes I could have an ultrasound for the urological system above my bladder (kidneys), but that I’d have to wait till the middle of the next week for the cystoscopy of my bladder.

Off I went to the ultra-sonographer who was a friendly fellow who talked to me about what he was up to. He didn’t keep his cards close to his chest as they are all trained to do these days and told me that, though he could see a cyst on my kidney (and he pointed it out on the scans) it was benign and things were fine.

I asked him if, given my circumstances, he might have a bit of a squiz below the kidneys into my bladder. I said that I realised that doing so would not be as reliable as a cystoscopy but I’d be grateful if he could tell me anything he could discover. No worries. He had a good decko around showing me while he was doing it. He said, “you’re clear”. No bladder cancer there! I was dumbfounded. I asked why I was having a cystoscopy if he could be sure that there was no tumour there. He said that the cystoscopy might be very slightly more accurate, and that I should go have it, but that he was thoroughly confident that I didn’t have bladder cancer. (He may have said that the cystoscopy might be better at detecting abnormal pre-cancerous cells, but this is more me trying to use my commonsense now, rather than a clear memory).

So there you have it. Dad could have been checked out for bladder cancer non-invasively with almost complete confidence of accuracy four months before he was. Even if it was not as accurate it was the obvious thing to do. There’s a fair chance it wouldn’t have saved him as the cancer was slow-growing and had probably been growing for many years. But since they thought they had a reasonable chance of catching it (from memory around 30%) when they did operate, had they done so another four months earlier the chances would have been better. Who knows how much?

In any event, the experience has led me to think that we make surprisingly little use of ultra-sound. It may not be perfect and there are some things it can’t tell us, but it’s a very powerful, non-invasive and very safe procedure. People tell me that doctors in Germany have ultra-sound machines in their surgeries and that they use them a lot. Sounds sensible to me not that I know enough to be sure.

In any event, when I get a checkup it bemuses me to be poked and prodded to detect problems in a way that can’t have changed much since the 19th century. Now I go and get an upper and lower abdominal ultrasound every couple of years. It may be entirely appropriate that our medical system doesn’t encourage this. It is probably appropriate that you need more than a checkup to get an ultrasound on Medicare. But while I like to think my tastes in lots of things are reasonably modest, I’m happy to part with a couple of hundred bucks every couple of years. It seems cheap to me for the good it just might do.

I reckon you should consider doing the same, or some variation of it maybe once every five years?

If you do, spare a thought for Dad. Even now, people tell me how much they liked him. I was introduced to the founder of the CIS, Greg Lindsay the other day at a CIS function. He mentioned he’d known Dad and added how gracious he was. He was indeed.

He died aged 76 in ward 76 of the John James Hospital nine years ago today.

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anon
anon
15 years ago

My father was diagnosed with lung cancer on Friday. I’ve just returned from spending the weekend at my parents house in the Dandenongs. At this stage, they’ve got to do more tests before they know the best course of action, though it’s going to be chemotherapy or radiotherapy of some kind – surgery is not possible. So I’m trying to come to terms with the possibility that my father (aged 58) may only have a few more years left.

I’m not sure if I’ll ever write about this on my own blog, but your post seemed like a timely place to let this little bit out. Thanks.

skepticlawyer
15 years ago

Don’t really have anything to add, Nick. Great post, that’s all.

Jonno
Jonno
15 years ago

The download has gone but this might be interesting:

http://www.abc.net.au/rn/healthreport/stories/2006/1711788.htm

I have borrowed the book from the local library, but am yet to read it.

The science of cancer is very much being developed – this is one man’s exploration of using the latest means to fight cancer and challenging practitioners constructively.

Tony Harris
Tony Harris(@tony-harris)
15 years ago

Great post Nicholas.

Last week a colleague at work described a publicity program that was run in the UK to alert people to the symptoms of an impending stroke. Rapid action can save a life and/or avert serious and permanent disability. John Newcombe had a near- death experience with stroke and a chapter in his autobiography describes how it happened with emphasis on the need to take preventive action, and to know what to do when the emergency arises.

Chris Lloyd
Chris Lloyd
15 years ago

Fred was indeed a gracious man. He was also my Dad’s best mate. As a kid, I found Fred hard to fathom because he was on such a different intellectual level to me. But he was not at all threatening. And I recogised the discussion and arguments that he and Dad had were a kind of sport. Between the two of them, they planted the idea in my impressionable mind that it might actually be cool to be an academic.

Gaby
Gaby
15 years ago

Hey Nicholas, really nice post. And thanks for the prudential advice. Food for thought there.

Joshua Gans
Joshua Gans(@joshua-gans)
15 years ago

A good way to celebrate the anniversary, Nicholas, with some practical lessons.

Chris’s comment reminded me of something that doesn’t seem to attract as much comment as it deserves, namely the chance influence – mostly positive – that adults can have on children who come in contact with them. Not parents or teachers or relatives, but friends of your parents and parents of your friends. These people start dying en masse when you get to my age, and with each one that goes, I remember something he or she taught me, some colorful phrase they used , or something they said set that sent me into spasms of laughter. In some cases, as in Chris’s, they can be important role models, though you don’t realise it until the funeral forty years later.

michael dillon
michael dillon
15 years ago

An evocative post, redolent of “what might have beens” and “what might be’s” for us all. Thanks Nick. My father shared an office with Fred at the NSW Department of Agriculture, I think in the late fifties. Certainly Fred’s name was regularly mentioned in our household as i grew up, my father explaining how he had arrived on the Dunera with nothing, the difficulties which followed, and the huge contributions he had made to the discipline of economics in Australia. On a lighter note, your post reminded me of John Cassidy’s recent article in the New Yorker (September 18 2006)on developments in neuro-economics, essentially exploring recent work which points to the continuing role of emotion in our decisions. While your advice on five yearly ultrasound scans makes sense, it wont do much to prevent a brain tumour , or being hit by the number fifteen bus. My father died of melanoma, possibly initially contracted during field visits to farms in outback NSW while working for the ag department. I am now much more careful about wearing a hat and rolling down my sleeves. But what can we do about that number fifteen bus?

Peter Fuller
15 years ago

Nicholas,
I’m pleased to commend your post also. Fred was my lecturer in Agricultural Economics in the late ’60s at Monash, and everything that others have said about his fine intellect and gracious manner rings very true for this very minor pilgrim who happened across his path. Your cautionary advice about medical checks is spot on.
I hope that the memories inspired by the anniversary are predominantly happy ones, even if the wistful note of the post is unmistakable and entirely valid.

Bannerman
15 years ago

The real moral being not to trust the word of medicos or place one’s faith in medical science. If you want to know something and are prepared to pay for the service, then you have every right to have your demands met, in my view.

Tom N.
Tom N.
15 years ago

Yes, a great post. And within what is a serious piece this brilliantly simple yet wonderfully amusing line: “He had blood in his urine, which the doctors called haematuria

Colin Campbell
15 years ago

My Grandmother, a Scottish miners wife from Kirkcaldy put off seeing a cancer specialist for two years because he was Pakistani. She couldn’t bear the thought of having a black man look up her bum. By the time that she got help it was too late and the cancer was well developed and untreatable. She died an agonizing death doped up with morphine. Sad but true. At least the next generation in Scotland is a little more tolerant of other races in the community (except the English of course).