Vol. 41 No. 8 · 18 April 2019

Instead of shaking all over, I read the newspapers. I listened to the radio. I had my lunch

Colm Tóibín

8529 words

Listen to this piece read by the author

It all started​ with my balls. I was in Southern California and my right ball was slightly sore. At the beginning I thought the pain might be caused by the heavy keys in the right hand pocket of my trousers banging against my testicle as I walked along the street. So I moved the keys into my jacket pocket. The pain stayed for a while and then it went away and then it came back. I was doing readings every day, selling my melancholy stories to the people of Orange County and places south. I wondered, some days, if there might be a doctor in the audience who, if I made a suitable announcement at the end of the reading, could make this pain in my right testicle go away. But I didn’t want to make a fuss.

When the readings were done, I went to LA and ignored my balls. Then I went to London and looked them up on the internet. It was clear what I had. The right testicle was painful but not swollen. But the veins around it had decided to swell up a bit. The internet made clear what this condition was called:

A hydrocele is a type of swelling in the scrotum that occurs when fluid collects in the thin sheath surrounding a testicle … Older boys and adult men can develop a hydrocele due to inflammation or injury within the scrotum.

A hydrocele usually isn’t painful or harmful and might not need any treatment … Adult men with a hydrocele might experience discomfort from the heaviness of a swollen scrotum. Pain generally increases with the size of the inflammation … A hydrocele might be associated with an underlying testicular condition that can cause serious complications, including infection or tumour. Either might reduce sperm production or function.

I wrote stuff during the day and then attended a few parties and wandered in galleries in London and went about my business in the pretty sure knowledge that I had a hydrocele. Had I been sure how to pronounce it, I might even have started to boast about it. Sometimes, however, my ball was sore, and the swelling became more significant. One evening, I made my way to one of the London hospitals and was put in the line for accident and emergency. They took blood samples and a urine sample. When a doctor finally saw me, because she was a woman and it involved my balls, she had to have a nurse with her while she was inspecting me. As the doctor looked at my testicles, the nurse looked at me and at the doctor. I looked at the nurse or at the floor.

The doctor said there was nothing in the blood or the urine that pointed towards a clear diagnosis. For that, I would have to get an ultrasound; the hospital would contact me to arrange that. She didn’t think it was cancer, she said, as there was no sign of a lump anywhere. So that was good news. The bad news was that the pain in my right ball grew more annoying. I managed to make an appointment with a urologist in Dublin and flew home one morning in late June. As soon as he examined me, the Dublin urologist seemed concerned, though he said nothing. He arranged some blood tests and an ultrasound, telling me that, unlike with kidneys and livers, a biopsy on a ball is rarely a great idea.

The ultrasound was done by two young guys filled with kindness and sympathy. Both seemed fully aware that taking your trousers and underpants down and lying flat on your back and then having some sort of gel poured on your junk before a type of prod begins to zoom around the outside of your balls is no fun, and they outdid each other in being nice to me. When they had performed their magic, they told me they would have to go further and this meant that the little towel they had put over my dick, such as it is, would have to be removed. ‘I know this is shaming for you,’ one of them said. I sat up, rested on my elbows, and looked at him. ‘When you get to my age,’ I told him, ‘nothing is shaming.’

It was decided that I should go on various antibiotics for a week and then they would see what to do. In that week, the swollen veins disappeared, but the ball itself got harder and bigger. When I came for the next appointment, the urologist asked me if I was fasting. I hadn’t bothered to have breakfast so I told him truthfully and innocently that I was. ‘In that case,’ he said, ‘I can fit you in today.’

I knew what he meant; he meant to remove my ball. I went home and packed a small suitcase and presented myself at the hospital. As the afternoon waned, dressed in a gown with no back, I was wheeled down the corridors. Soon, with the help of the anaesthetist, I was fast asleep. This was just as well, since during the time that followed, the urologist, with efficiency and speed and skill, removed my right testicle.

As I recovered in my hospital bed, I was told that it would take a week for a laboratory to report back on the intricacies and inner workings of what had been removed. I also got a CT scan so that my insides could be examined by another group of doctors. I was asked if I had a problem with being told the result on the phone rather than waiting for an appointment. I said I had no trouble with the phone.

A week later the phone rang and I was told that I had a cancer of the testicles that had spread to a lymph node and to one lung. Instead of seeing the urologist, I would now need to see an oncologist. For a few days I comforted myself by pretending that, because of my abiding interest in the mysteries and niceties of Being, I had to see an ontologist. Nobody except one of my fellow Irish novelists thought this was funny. The oncologist showed me the scan of my insides on his computer. At first I could not work out from what angle these images had been taken. Then I understood that the scan was a sort of carpaccio of the middle and lower parts of my torso, a slice of the inside of the self. While I saw some well-known organs clearly, the cancer as it appeared on the screen seemed nothing more than a smudge, a few faint grains. If the doctor had not pointed them out to me, I would have given myself a clean bill of health and gone to play tennis.

To get rid of this cancer, the oncologist told me, I would need chemotherapy. Four week-long sessions of it, with a break of two weeks between each session. He told me I could stay in the hospital while getting the chemo, which seemed sensible. If something went badly wrong in the middle of the night, I thought, I would be in the belly of the whale rather than at home wondering what to do. ‘It’s curable,’ he said, his voice low and reassuring, his tone modest and reserved. ‘We have not lost anyone to it yet.’

I had looked the whole business up on the internet and was concerned that the chemo would cause deafness and also a thing called ‘chemo brain’, when a patient starts not to be able to remember things after treatment. The oncologist directed me to a nurse who arranged for me to have a hearing test so that they would have a baseline from which to judge, should there be any deterioration. She seemed less sure about ‘chemo brain’. Her response was the sort I became accustomed to over the coming months: it depends on the person, it’s hard to predict, everyone is different. It seemed, as Mrs Cadwallader in Middlemarch says, that ‘everything depends on the constitution; some people make fat, some blood and some bile.’

The nurse noted a great number of details about me before asking me if I drank much alcohol. I thought it wise to respond that I was sober in all my habits, a quiet-living person. The nurse did not seem fully reassured by this. And then she told me that people who drank a good bit of alcohol found chemo easier, since chemo was, like alcohol, a sort of distilled liquid with a poisonous edge that could change your mood and cause you aches and pains and generally damage your system. The more alcohol you had drunk in your lifetime, the less shock chemo would be to your system. In Ireland, there are people who have taken a pledge not to drink ever; they are often members of the Pioneer Total Abstinence Association of the Sacred Heart, founded in 1898. When I was growing up they were simply called Pioneers. You don’t hear much about them now, except in the deepest countryside. Nonetheless, the young nurse now invoked their presence. ‘Among those who have chemo,’ she said wistfully, ‘it is the Pioneers who suffer most.’

Both she and the oncologist were oddly unalarming. They spoke calmly and sympathetically. Neither of them was interested in spelling out all the terrible things that could happen. They made the future seem manageable and bearable. It was arranged that I would present myself in the hospital the following Sunday afternoon. The Irish poet Patrick Kavanagh has a poem called ‘The Hospital’, which begins: ‘A year ago I fell in love with the functional ward/Of a chest hospital.’ This did not happen to me, but it was surprising how quickly the routines of the hospital became comforting and absorbing. They had a way of filling the day, which was long. It was hard to sleep because of the intravenous steroids that were part of the treatment. On one of the first nights, something began to bang and clash in my head. It was not made up of words, but it was like words, or like sentences; it possessed the shape of a sentence or two that seemed to be violently seeking an outlet. Every so often, a break would come and a single word that had nothing to do with anything would suddenly emerge.

All this happened in the silence of my head, but it was like sound, and loud sound. I supposed it was the unconscious taking an opportunity to make itself heard, or perhaps it was what happened if you began to go stark raving mad. When I called the nurse and told her about it, she offered me a sleeping pill. I took it and fell asleep. The next night I had a notebook ready to write down any sentences and words that might come banging into my head, but nothing happened. I never got that strange visitation again. Soon a routine began. A sleeping pill every night gave me rest from about 1 a.m. to 5 a.m. I woke knowing it wouldn’t be long before I heard noises in the corridor; a nurse would come to check my blood pressure and take my temperature. Then someone – often a very glamorous Asian woman – would arrive to take blood that would go to the laboratory. Then – usually between 6.30 and 7 – the oncologist would arrive, turn on the light, and ask me in a soft voice how I was. Early on, I decided that unless I was fully falling apart, I would tell him I was well. I enjoyed adding that there were ‘no issues’. I had never used the word ‘issues’ before. I had heard it used most memorably by an English novelist at a foreign literary festival when he told his publisher that he ‘had issues’ with his bedroom. Now, I could use it every morning if I wanted. It was one of the small compensations for having cancer.

On one​ of those mornings in that first week, the oncologist told me that a more recent scan had shown a tumour on the liver as well; this meant that the chemotherapy would have to stick rigidly to schedule. In other words, there could be no more than two weeks between each five-day session. He said all this very calmly. After his visit, breakfast came, and the newspapers. Sometimes, I had a drip putting water in my system through the night. And then steroids in the morning, and something else too to stop nausea. All this before the holy ceremony of chemo, also known as the juice.

Two senior nurses would arrive in the room with the chemo on a trolley. They would ask me my name and my date of birth. They would check the number on my wristband. Then one nurse would read out the details of the chemo to the other. This would be done with such seriousness and sense of sombre occasion that, the first time, I presumed there would be some response from me when the first drops of liquid went coursing through my veins. Maybe I would shake all over or let out an unmerciful cry. (I later learned that another nurse was waiting outside the room in case I had a bad reaction to the juice.) Instead, nothing happened, nothing at all. The juice was neither cold nor hot. It caused no pain. I wondered if all the talk about it wasn’t exaggerated. Instead of shaking all over, I read the newspapers. I listened to the radio. I had my lunch. When the chemo finished, I had a shower and put on my dressing-gown and slippers and did a tour of the hospital corridors to see if anything was going on.

In those first five days, I also read a long and difficult novel. When I went home, it looked like there was going to be no problem. I was able to go to the supermarket, and go up and down the stairs in the house. They had given me anti-nausea pills so that not once in all the time I was on chemo or afterwards did I have any desire to vomit or suffer any stomach problems. The steroid pills became a problem. Once I’d taken them in the morning, I could feel them grinding away inside me all day. In the early evening, they gave me a sort of energy which faded quickly enough, but also meant that I could not sleep without sleeping pills, and the pills only guaranteed sleep for four hours.

I lay on the sofa in the house in Dublin and thought about things. I read a bit, but not much. I found that I had no interest in listening to music. For the next three months, I would not need to shave. My eyebrows would thin out but not disappear. The hair on my head would more or less go. The hair on the rest of my body remained in place until towards the end of the chemo, when it faded away. It took a long time to grow back. In that first week after chemo I lost any desire to eat or drink, and I lost all sense of taste. Instead, my sense of smell became acute. For the next few months, on the street, I could smell everyone’s perfume or aftershave or deodorant. It became confusing and surprising. In the house, when I was upstairs, I could smell any food in the kitchen even when there was nothing cooking. I could smell the soot in the chimney.

I wanted to be on my own in the house in those two weeks between chemo sessions. Friends offered to come and stay, or look in every morning, and Hedi, my boyfriend, wanted to come from LA, but I found the possibility of company oddly alarming. It was easier just to lie on the sofa and think about nothing than have a friend offering drinks of water or checking to see whether I was still alive. It wasn’t as though I was enjoying a period of inwardness and introspection. There was no inner self to examine or get in touch with. There was a surface self and all it could do was stare straight ahead. Over the months, I got used to a few friends who came regularly and looked forward to their visits in the evenings. But I needed, for the most part, to spend the days alone. People often talk about their ‘battle’ or ‘fight’ against cancer. It was really hard to know what this meant. I was sure that the nurses and doctors were involved in some battles, as were the cleaners and the kitchen staff, but I just lay there not thinking much. All I really wanted to do was fall asleep and not wake up until it was over.

What​ I never want to hear again is the screeching of seagulls. Dublin, I discovered as I lay on that sofa for much for July and August and September and October and November, is awash with them. They peak in early August and fade somewhat by late October. They would sail towards the house in groups and start to shriek in the upper air. Then they would move lower and shriek some more. They are scavengers and they love the fact that the centre of Dublin has so many new restaurants. They get fat on garbage.

As soon as there was the faintest glimmer of sun in the eastern sky, the gulls began their ghastly cries, and they went on screaming even after night had fallen. Even worse, they would breed. Their little ones found rooftops, where they perched, seeming to be immobile, but moving an inch or two back and forth on their claws. All summer, they did this incessantly on the roof over my bedroom; they made their irritating little noises against the slate of the roof through the night until I came to believe that they and their parents had been sent by some force of darkness to mock me.

Not being able to taste brings with it dreams of tasting. On days when I was at my worst and could be cheered up by nothing, I imagined a large grilled lobster and then I thought about a boiled lobster. And then I dreamed of a steak cut into strips and marinated and then put into the pan to fry. The strange thing about this is that, in the normal course of events, I wouldn’t know marinade from toilet duck. But now, in this time of chemo, it was much on my mind. Food had no taste, none at all, but it had texture and it had colour. Sometimes, I was sure I wanted something – a duck breast, for example, or a piece of fruit, or some yoghurt – only to find when it was in front of me that I didn’t want it at all. I liked really thin, cheap, white sliced bread. I found that I had an interest in making a sandwich with plenty of butter and two grilled rashers. I can’t think why I could eat this when I could eat nothing else. I could also eat a sandwich of tinned salmon. A few times I made a big fry-up and added a small tin of baked beans. I ate it all down, even though it could have been sawdust or deadly poison. A few times I gorged on a banana sandwich. I could not drink water. Since I had no taste, my mouth treated it as a foreign object. No other drink was better.

Often, especially early on, I went online to explore my ailment. There are chat rooms where people with cancer share their experiences. For many of them, after a week of chemo, the two weeks afterwards came with much variety. Bad side effects one week; better the next weeks. But I felt the same way all the time. The internet also mentioned a difficult operation that could take up to eight hours for people like me, whose cancer had spread to a lymph node. When I brought this up with the oncologist, he said he hoped that we wouldn’t have to do it.

In the end, I found nothing on the internet that was of any use to me. Except ginger ale. One patient in a chat room mentioned in passing that when he or she could not drink anything, they found they could drink ginger ale. Ginger ale saved his or her life, or at least his or her kidneys. I tried it and it was better than anything else but still not easy to swallow. Then I asked one of the nurses if she had a solution and she said that I should add elderflower cordial to the ginger ale. That became my drink of choice. Food was much harder. Since I was not hungry and since I could not taste, I could go a long time without food. I went from 79 kilos down to 66. My waist went from 36 to 30. Since all my trousers started to fall down, I had to buy some new ones.

Since I didn’t have to shave, I didn’t look in the mirror. This was a mistake, since it allowed me to believe that I looked like a normal person. The illusion was broken one day when I was coming out of a pharmacy with a small bag of drugs and needed to get a taxi to the hospital for a test. I hailed a taxi and it stopped. As I was about to open the door to sit in the front passenger seat, the driver saw me close up and spotted the pharmacy bag. He quickly drove away. Since there is a methadone clinic for heroin addicts close by, he must have thought that I posed some sort of risk to him or his taxi. In any case, he did me the great favour of making me realise that I looked like a bad Egon Schiele drawing.

After the first five days of chemo, I began to get sores in my mouth. Each day they got worse. When I went for a blood test, it was discovered that some of the cell counts were very low. The hospital phoned and asked if I was all right. When I showed my mouth to a nurse and a doctor I was given some liquid morphine – which I liked – and was told that this problem could be prevented next time by having an injection of some high-tech material that created white cells in some very modern and artificial way.

When my friend Catriona Crowe inspected my house at the beginning of the chemo regime she declared that it would not do. On the floors or on cluttered surfaces there were many items that had lingered there for years. Old keys, old underpants, old Chinese takeaways, old banana skins, half-finished short stories written out in longhand in notebooks, beginnings of novels, books, pamphlets, old mandarin oranges, old apple cores, condoms still living in hope. Catriona made clear that this would all have to go; the house would have to be made hospital-clean. No dishes could be left in the sink. Food would be thrown out when it had reached its sell-by date. The inner reaches of the fridge would be cleared of dried-up food. Smelly socks were not to be left on the floor in the kitchen. Since I did not have a washing machine, bags of stuff had to be sent to the launderette, all of whose machines, it seemed, were now working full-time for me.

Catriona phoned every morning and came most days with news of the wider world and often with food she thought might be palatable. She was judging the Irish Theatre Awards at the same time. As she dropped by on her way back from a performance, I loved asking her if there was a big crowd at the play. This was what you did in Enniscorthy, where I’m from. If anyone has been out anywhere – at Mass, a football match, downtown, in Dublin, to the pub – you asked them: ‘Was there a big crowd?’ When other friends came to visit, they could also be asked if there was a big crowd at any event they had attended. Once the steroids kicked in, I could talk and pay attention. I don’t know why asking about the ‘big crowd’ gave me such satisfaction. The answers tended to be generally the same.

In that first two-week period after chemo, a pattern established itself. I would wake early to the sound of the seagulls and lie there as the room brightened. I would then call my boyfriend and we would talk on the phone. Then I would take some pills and open the curtains and get back into bed, often half-listening to the radio. Then I would turn off the radio and lie in bed for a few hours without thinking. Then I would decide to get up. The rest of the day would be spent on the sofa. It was not merely that the chemo left me fully thoughtless so that as time went on I could not even read; the effect of the drug darkened the mind or filled it with something hard and severe and relentless. It was like pain or a sort of anguish, but those words don’t really cover it. Everything that normally kept the day going, and the mind, was reduced to almost zero. I couldn’t think. All I could do sometimes was concentrate on getting through the next five minutes because contemplating any longer stretch of time under the pressure of the chemo and the steroids (and perhaps some other drug) was too hard. At about six o’clock in the evening I would feel OK for a while, but by nine or so a real lassitude had set in again. When I decided to go to bed I would find that the decision made no difference. Two hours later I would still be lying on the sofa. I spent the time staring straight ahead. No watching films; no TV; no radio; no books; no magazines or journals. No memories; no thoughts; no plans for the future. Nothing.

Each day passed like this in pure blankness, punctured by pangs of depression that were almost unbearable and which made going back into hospital for the second five days of chemo easy. I liked packing my case and getting a taxi across town and settling down in the familiar space of the cancer ward. In the hospital, my mouth became an object of some interest, but otherwise it was the same routine: intravenous water overnight, then steroids and anti-nausea drugs and then the juice itself. And then a shower, a walk around the hospital and visitors and then a few hours lying there and then some sleep.

The day after​ my second session of chemo ended I went back to the hospital and got an injection in my stomach. It felt like nothing. I looked through the list of possible side effects, but without concentration. This treatment was going to be good; it was going to produce or provoke into being essential white cells. That was a Saturday. A week later, at about six in the morning, I was woken by the most excruciating pain in my pelvic area. It felt like something throbbing; with each throb the pain became more intense until it felt that it could not become worse and then it did and did again. And then it died down only to start again. White cells are made in bone marrow: it felt as though the cells were being produced too fast and were getting ready to crack the bone. I called the hospital and spoke to a nurse. Taking note of what I said, she asked me if I could come to the hospital, if someone could drive me over. I reminded her that the pope was in Dublin. He would be appearing the next day in the city, which was now divided in two for security reasons. A car would not get through. The nurse said she would call me back in ten minutes.

In those ten minutes, as the pain became so intense that I actually believed I was going to have a baby, I imagined appealing to the pope to let me through. I would apologise for all the rude things I have said about him. I would take back the assertion that he doesn’t mean a word he says. I would withdraw my view that at least we knew where we were with the previous two. With Bergoglio, no one knows where they are. I would tell him that I was sorry I had said this and would promise to be even more emphatically and eternally sorry if he let me through. This kept me busy as the throbbing pain became more and more unbearable. Finally, the nurse called back and told me to get the oral morphine I had used before. She told me exactly how much I could take. If the pain was still there in an hour, she said, I was to call back.

I drank the morphine and lay back. Then I called my boyfriend. I took him through the pain as it rose and fell. Soon, we got talking about other things, our conversation peppered with high screams from me. The pain continued for almost an hour. I was ready to phone the hospital back. Slowly, however, it began to die down until, without my noticing exactly when, it disappeared. What it left in its wake was one stoned man. I spent the weekend looking at the pope on my laptop. I was both high and low and sorry I had not had that encounter with him in the middle of Dublin. I had, in fact, got tickets for his event in Phoenix Park, thinking that I might be well enough to trudge across the city and stand in the park while he preached to us all.

Slowly, as the chemo went on, things got worse. There were a few hours, especially in the early evening, that were almost OK, but the rest of the time was grim. There was no pain again, just increasing weakness, continued lack of appetite and growing depression. Nonetheless, the hospital was almost fine, filled with distractions and things that amused me. I liked everybody there and that helped. It was the time at home that was hard. One morning, a few days after I had finished the third week of chemo, I knew that I couldn’t go on. I found it difficult to stand and could no longer leave the house. I hadn’t eaten anything for three days. I was determined, however, to follow the agreed schedule, which included a blood test the following day. If there were any real problem the blood test would show what it was. But I found myself sitting in the middle of a room in real distress. It wasn’t just the lack of energy, or the inability to think, or the sense of some vast shadow wandering in my head: it was much more active and present than that. I tried my five-minute trick. I imagined that this would last only for five minutes. All I had to do was concentrate on the next five minutes, keeping at bay the certain knowledge that there would be many such five minutes and that would include today, all day.

In the end I phoned the hospital. The nurse could not have been kinder, but since there was no pain, no precise problem, she did not seem to know what to say. Feeling bad was part of chemo, so the fact that I felt bad was not news. Eventually, I found that I couldn’t explain what I felt and we ended the conversation. A few minutes later, she called back and said I should come over to the hospital and pack some things with a view to staying for a few days. Up to now, admission to the hospital had been quick and simple. This time it was slow and cumbersome. Waiting there in the middle of all the bustle and busyness was difficult. I tried to get someone’s attention so that I could let them know that I really needed a bed now. My problem remained that I had no pain, no obvious dire predicament. When they finally told me I could go to the ward, I found that I couldn’t walk and needed my wheelie suitcase to lean on as I made my way along. When I was spotted doing this, they told me to wait for a wheelchair, but I was too cranky, too desperate to find a bed. I remember a nurse whom I didn’t know coming with a list of questions. They included a query about my bowels. Had they moved that day? In hindsight, this seems like a perfectly normal question. At the time, I thought it was funny and I told the poor bewildered nurse that I believed the question to be rather too personal. In fact, I said, I could not think of anything more personal. Then I gave in and told her that, as far as I was aware, my bowels had not moved that day.

I’d got it into my head that the last five-day session of chemo was going to be easier to tolerate. My body was getting used to this poison, I thought, though I had no evidence at all for this conclusion. One day I tried it out on one of the most senior nurses. She looked at me sceptically. Once more, the chemo as it went into the veins could easily have been a relaxant. It was all peaceful. On that last Friday, as the last bag of juice emptied out and the cannula was removed from my arm, I felt like a free man. All we would have to do now was wait a few weeks for another scan to see how much of the cancer was still there and how much had gone.

One night the following week as I tried to go to bed, I knew that I was worse than I had ever been. It was like mixing a major hangover with a major flu. I had not been able to sleep for a few nights in a row and I still was not eating. Lying down brought no relief. In the middle of the night I knew that I could not go on like this. At about seven in the morning, I phoned the hospital. The same problem arose: I was not in pain. I had no complaint that had a name. It took some time before the nurse said that I should come to the hospital. They would find a bed for me at some point.

It was clear to me and to everyone at the hospital that I looked awful, but I began to think that maybe this was standard, something all the medical people had seen before. The next day, however, a doctor and nurse came to see me and assured me that lots of blood tests were going to be done. One of these tests showed that my neutrophil count was very low. When I asked the doctor if it could be lower he shook his head. When I asked how it might go up, he said blood transfusions might help and then it might rise of its own accord, now that there was no more chemo. I would have to have my temperature taken every half-hour, he said, including through the night. If it went over a certain point, a big dose of antibiotics was waiting for me. My platelets were also down, he said, and would have to be watched too.

It was in the middle of the night two days later that the nurse, having taken my temperature, whispered: ‘It has spiked.’ Quickly, quietly, she left the room and returned with liquid antibiotics that I was to take intravenously. That meant that I was grounded in the hospital for about a week. I could look at the newspapers in the morning and see visitors, but I still had no desire to read or listen to music. One day a friend came in with a bottle of apple juice from his orchard. I was still living on ginger ale mixed with concentrate of elderflower and whatever scraps of food I could manage to eat. When he had left, I was about to put the apple juice aside when it struck me that I should try some. I found that I could taste it. Not fully, but enough. Over the next few days I found that I could taste blueberries and lemon juice, but not orange juice, not strawberries, not raspberries.

Slowly, very slowly, the blood counts started to go up. Once the antibiotics were over, I thought I would be able to go home, but I was told I would have to wait until there was a real upward trend. One Sunday at about four in the afternoon I was feeling especially unhappy. Catriona was in the US; Hedi was in LA. It occurred to me out of the blue that I should tell the nurses I wanted to go home. When I tried this, I was told that going home on a Sunday was unusual but not unheard of and that my request would be put to the oncologist. After a while, the nurse returned to say that going home would be no problem. I could leave this very second, if I wanted to, as long as I knew to call if I had the slightest problem.

My problem, not so slight, was that I couldn’t really walk. I had been disguising this in the hospital, going to the bathroom only when there was no one around, leaning against walls, moving slowly and gingerly, sitting on a plastic chair to have a shower. Now, I sat down on the floor of the room and tried to pack a suitcase. Then I sat on a chair and attempted to dress myself. I found that, since the suitcase had four wheels, I could lean on it and, bent almost double, move along. I knew, however, that if I passed the nurses’ station using this method someone would notice and wonder if I was really fit to go home. I remembered that there was another corridor that led to a smaller lift. I made my way furtively down that corridor and then, via the lift, to a corridor below, where I met a nurse from my ward coming back from her break. Having taken one look at me, she stood back. ‘Are you all right?’ she asked. When I told her that I was perfect, I watched as she assessed the moment and concluded that she should wish me well and move on.

I made my way to the lobby, where I finally got to sit down, feeling that I would never have the strength to get up again. I looked around in the vain hope that I would see someone I knew. After a long wait, I moved slowly towards the door, keeping close to the wall. Once out on the street, I could lean against the wall as I edged along without worrying about being caught. I nodded to the taxi driver who was first in the queue. He came and helped me into the car. When I told him where my suitcase was, he went into the lobby and fetched it. Then he drove me home and helped me into the house.

There were​ many people I could have phoned, but most of them, I felt, would take the view that I should be in the hospital. Also I didn’t want to disturb people on a Sunday evening. I made my way to the sofa, where I battled against cancer once more by lying there staring straight ahead. I had such great resistance to thought that I didn’t even worry. Past midnight, I went to bed. In the morning, I realised that I had no food and no fluids in the house. I slowly got up and took my steroids and dressed. I found walking to the supermarket at the bottom of the street quite easy. I put what I needed in my basket. When the basket was almost full, as I stood in one of the aisles, I realised that again I could not walk. If I tried to move, my knees would buckle. I supported myself against the shelves until a man, I supposed a manager, approached. I asked him for a chair and a glass of water. I didn’t actually want a glass of water but I thought the request would make me sound more plausible. When I was sitting comfortably, I asked him if he could get someone to take my basket to the checkout and then bring my purchases back to me so I could pay. I tried to look like someone who would not spend the day annoying him.

I managed to leave the supermarket with my groceries and cross the road, but once at the bottom of my own street, I realised I could go no further. I sat down on the steps of an office building. I had, of course, come out without a phone. Anyone passing would think I was part of the city’s homeless crisis. I didn’t feel I could safely stand up. It wasn’t cold. If I remained here all day, I thought, something would be bound to happen. I studied the busy office people going by. If I was to accost one of them, I thought, I would have to get it right the first time. It would be too much to have to sit here as person after person ignored pleas for assistance. When I saw a tall, sporty-looking guy in a suit come towards me, I caught his eye and told him what the problem was and pointed to my house at the top of the street. I could stand up, I said, but I would probably need help walking and would need to rest along the way. This guy, who was South African, agreed to help. He was very cheerful. He thought my bag of groceries a bit ambitious. We stopped a few times when I needed to sit down on the steps of buildings. He deposited me, like a little frail old lady, at my door.

After a few days, when my walking had improved, the hospital called to say that it was time to do another CT scan. First I had to do some blood tests. These made it clear that I needed to get water intravenously, so I went into hospital for a few days. The CT scan people were cool, but they couldn’t understand why I didn’t want a needle in my left arm. The reason was simple: many, many needles had gone in there, including cannulas, which allowed for the chemo to go into the veins. Most people who work in hospitals don’t know how to put in cannulas. Nurses tend to be better at it than doctors. What doctors lack in skill, they make up for in confidence. The younger they are, the more certain they become that they know how to put in a cannula. This means that they often put the needle in where it least needs to go, and they put it in badly. Often, they have to do it two or three times. In my hospital, there was one nurse who could put in a cannula sweetly, simply, painlessly, perfectly. But she was often busy. Nonetheless, I asked for her when I thought she might be free. In the meantime, my left arm felt like a Francis Bacon painting.

The CT scanners must have thought I was someone who liked making a racket. When they stuck the needle into me, I started to yelp. I yelped my way through the little tunnel as my insides were scanned. I yelped as the scan returned me to civilisation. I yelped louder as they took the needle out. The scan, despite all my yelping, turned out to be good, with much of the cancer having disappeared. I did not need any more chemo for the moment, but I would have to be checked regularly. I was on parole. The news coincided with the arrival of my boyfriend from LA. I couldn’t drink alcohol; I still had no appetite for food; I was skinny and miserable and bald; I couldn’t sleep; I found walking hard; I had only one ball. But there really was nothing to complain about.

A week or so earlier, I had begun to work with a physiotherapist. He brought news from the outside world. He went to Vegas on his holidays. He and his girlfriend enjoyed going to restaurants. This meant that I could ask him: was there a big crowd in Vegas? Was there a big crowd in Fallon & Byrne? He made me sit on a chair and then stand up, and do this twenty times. He made me walk up the stairs without touching the bannisters and do this twenty times. He had lines of tough material, like the stuff that makes balloons, that I had to stretch out with my arms. He had many more exercises. He made me walk for miles. I felt better after sessions with him.

Now, as I prepared to leave hospital for what I hoped was the final time, the physio was going to work with me some more so that I could, by Christmas, have some of the characteristics of a real person. And when I got home, my boyfriend was going to be there and we could talk and make jokes or sit opposite each other on the sofa. I could watch him reading a book while pretending to read one too. We could watch a movie, like ordinary people. An hour after I got home, when the phone rang, I recognised the number. It was the hospital. Could I repack my suitcase and come back over, they asked. And do it now, without any delay at all?

The scan, on closer examination, had revealed blood clots. I needed injections to thin my blood and I needed to stay in the hospital while this was being done. That evening my boyfriend and Catriona came to see me. And then they went to dinner together. I would have liked to have gone with them. This was one of the five or six things I would like to have done last year and didn’t: a friend’s wedding in Glasgow; the pope in Phoenix Park; Patricia Bardon in Mahler’s Second Symphony at the National Concert Hall in Dublin; the Wexford Opera Festival. As I lay there, however, I could not take the blood clots seriously. I knew that they were potentially dangerous, but that knowledge still didn’t make me worry. In bed, I identified the difference between cancer and blood clots. In a tennis match, blood clots would be all smashes, aces, double faults and disputes with the umpire. Cancer would be more steady and stealthy, keeping calm on match points, returning the ball accurately – low, cross-court strokes – rather than hitting big winners. In literature, blood clots were Christopher Marlowe, violent, restless, brilliant, while the cancer would be Shakespeare, coming in many guises, dependable, sly, fully memorable. In painting, the blood clots would be Jackson Pollock, the cancer Barnett Newman. In Tory politics, Boris Johnson would be a blood clot; William Whitelaw, if anyone remembers him, the cancer. In Dublin, Malahide is a blood clot, Monkstown the cancer. In Europe, Macron is a blood clot, Merkel the cancer. In other words, instead of battling cancer I was becoming foolishly respectful of it. Like Shakespeare, Newman, Whitelaw, Monkstown and Merkel, it would not respond well to being underestimated.

A rumour spread in the hospital that a doctor who knew about blood clots would visit me later in the day. Only he could decide whether I went home or not. He had the same name as a character in Wallace Stevens’s Notes towards a Supreme Fiction, who was also referred to as ‘major man’. By this time I was confronting the fact that I was slowly going mad, and that this wasn’t helped by the steroids and the lack of sleep and the general excitement about going home and seeing my boyfriend. In bed, I began to whisper ‘major man’ as Catholics in a similar state might call out the name of Jesus or his mother. I also prepared a joke to tell this doctor so that he might accept my urge to go home. Preparation was important, as I can’t really tell jokes. I just don’t know how. I can try to tell them, but they come out skewed and flat and somewhat sad.

When the doctor arrived, I worried, at first, that I had begun the joke too quickly. It was about Randolph Churchill having a tumour removed and the tumour turning out to be benign and Evelyn Waugh saying that they had removed the only part of Randolph that wasn’t malignant. The doctor laughed. He seemed like a good-humoured guy. He checked that I would be able to inject myself in the stomach every night with some blood-thinning agent. He told me not to take any long-haul flights for the moment. He suggested I see him before Christmas. And then he told me I could go home.

This time I marched proudly if rather slowly past the nurses’ station, thanking them for all their kindness and care. I got a taxi home. Soon, I would watch my boyfriend having his dinner and then we would light a fire and lie on the sofa. In the morning, there would be physiotherapy. In the meantime, I went to the bathroom and looked at the scarecrow in the mirror. I hardly knew what to say to him. ‘Was there a big crowd at the hospital?’ I began.

‘One less now they’ve let you out,’ he replied sourly. It would take a while before his hair and his eyebrows began to grow again. It would take him even longer to get used to having only one sad, lonely ball. They used to complete one another’s sentences, those balls, they were so close, but now the surviving testicle has to get used to the change. It has to realise that the time of two balls has passed. The age of one ball has begun.

Send Letters To:

The Editor
London Review of Books,
28 Little Russell Street
London, WC1A 2HN


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Vol. 41 No. 9 · 9 May 2019

Why do men with two balls dice with death for fear of losing one? They neglect the warning symptoms for a long time, risking that the cancer will spread, all for the shame attached to ‘one ball’ syndrome – ‘Hitler, he only had one ball’ etc. Aged 15 in 1960, I lost a testicle, and the embarrassment or fear of ridicule has been so great that I have never once told a male friend. Colm Tóibín has led the way (LRB, 18 April). It is time for men with one ball to come out, and for other men not to endanger themselves, or die, for the sake of losing a ball.

John Taylor
Bridport, Dorset

Vol. 41 No. 10 · 23 May 2019

As a urologist, I am appalled by your persistent use of the word ‘ball’ to refer to the testicle. Perhaps the gutter term used by Colm Tóibín in his essay is deemed quaint coming from a well-spoken literary writer, but now it has infiltrated your letters as well (Letters, 9 May and LRB, 18 April). Testicle, gentlemen and ladies. Testicle.

José Sotolongo
Accord, New York

Vol. 41 No. 11 · 6 June 2019

The published correspondence on Colm Tóibín’s essay about his experience of testicular cancer (LRB, 18 April) has consisted of a letter from a man warning other men against allowing the shame of ‘one-ball syndrome’ to lead them to neglect cancerous symptoms (Letters, 9 May); and a follow-up letter from a urologist chiding the previous correspondent and Tóibín for using the ‘gutter term’ of ‘ball’ instead of ‘testicle’ (Letters, 23 May).

I can only assume that the LRB is sitting on a stack of letters from readers expressing deep appreciation of Tóibín’s intensely moving essay. May we see them please?

Barbara Taylor
London N15

Dr Sotolongo wants us to talk about testicles, not balls (Letters, 23 May). He says ‘balls’ is a gutter term. I’m pleased to say there is now official guidance from NHS England advising clinicians to choose the words that work best (e.g. ‘pee’ and ‘poo’ instead of ‘wee’ and ‘stool’) so that patients, who may not be as posh as they are, actually understand. Sadly balls are not yet included on the list.

Martin Rathfelder

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