Cutting to the chase

Bob Gervais
Posted 02.22.07

Perestroika really took hold in Russia under Mikhail Gorbachev in January, 1988. At about the same time, I had the tenth attack of tonsillitis I'd had since the previous September. Something else was taking hold in my body.

The next attack was in early February.

"You know, Bob," my doctor said in his soft, south-Asian accent, "I could give you another prescription for a penicillin product but it will only provide temporary relief. It appears that the germs are so well anchored in there that, when they see the penicillin coming, they just duck until it has gone by and then come back out of their foxholes and attack again."

The imagery was not lost on me. My training experience as a member of Canada's armed forces resurrected sounds of running feet, loud explosions, and diving for cover in shallow scrapes in the ground. I smiled at him.

No," he continued, "I believe that the time has come for surgical intervention. You need a tonsillectomy."

Images from my early childhood flashed through my mind. Children in beds, being pampered, their bedclothes and pillows being fluffed up; dishes of ice cream; solicitous and loving smiles from family members; a few days off from the drudgery of school. I had missed out on all that.

Now, here I was, approaching my fiftieth birthday, having been robbed of those childhood pleasures. What was the best I could expect? A few days off work and missed meetings that I would simply have to make up for when I got back.

"So, Doc," I said, "when do we want to do this? I'll have to let the office know that I will be off work for a couple of days."

The doctor suddenly sat bolt upright.

"No, I'm afraid not," he stated, slowly shaking his head from side to side.

He paused, screwing his face up as an internal search for words took place, then, smoothing out the air in front of him with both hands, as if to make place for the idea that was germinating in his mind, he began anew.

"When one is of a 'tender' age," he intoned, "one is taken to The Sick Children's Hospital where a tonsillectomy is performed."

I could almost see the quotation marks in the air as he spoke, his eyebrows having lifted at the mention of the word tender. He hesitated, not so much for effect, but obviously searching for vocabulary to continue.

"When one is more . . . ", he paused and I turned my head so as not to miss any nuance in his words, "more advanced in years," he suggested, "one is taken to the Royal Ontario Museum, where an archaeological dig is performed." He sat back smiling.

He sure did have a way with words. It was probably the look of puzzlement on my face that gave him the idea that I was completely lost. He then proceeded to present me with a basic course in anatomy outlining the function of the tonsils as part of the immune system in youth, and the total ineffectiveness of tonsils past the age of about twenty.

"The difficulty is that, in our youth, the tonsils literally hang in the back of the throat to maximize their ability to contribute to our immune system. As they are no longer required, they begin to recede into the soft flesh at the back of the throat."

This was all quite fascinating. War games, museums, hospitals. I was intrigued by where this might be going. He then delivered his punch line.

"So, for a very young person, a tonsillectomy is simply a matter of snipping them off, a couple of days recovery and then back into an active life." He leaned forward, almost conspiratorially. "For someone older, the tonsils have to be separated from the soft flesh in the back of the throat, taking car not to injure the spinal cord which is immediately behind."

He now had my full attention.

"Consequently, the surgery leaves a rather larger wound which takes some time to heal. You'll be off work for about a month," he concluded as re rose from the stool where he had been sitting in front of me.

"A month?" I exclaimed, incredulously. "Thirty calendar days?"

"Count them," he replied, heading toward the door. "I'll be right back with a surgery date." And he was. A date in early April at the Mississauga General Hospital.

On the appointed date, I arrived at the institution and was quickly processed, stripped, and gowned. You know, those pesky blue gowns that allegedly tie somewhere at the back where it is impossible to see what you are doing. While I was doing that a nurse came and sat on a chair beside the bed.

"Hello," he said. "My name is John. I need to get a bit of information," he said somewhat apologetically, motioning to the clipboard on his knee."

"Shoot," I replied. "I've not much else to do.

"He began the litany, checking items off as he went.

"Permanent marks or scars?" was the question that started it all.

"Tattoo, left fore-arm and birthmark on the right chest wall about the size of a silver dollar," I replied.

How many times in the past had I offered that bit of trivia to a medical professional. He glanced at the tattoo and asked me to show him where the birth-mark was. I opened the gown. He glanced up at the spot, stopped, and then stared. He stopped writing.

"How long have you had that?" he asked slowly and softly, extending his hand toward my chest.

"It's a birthmark!" I said.

"Has it always been that colour?" he inquired.

"What colour?'

"That sort of dark purple brown."

"I think it used to be a lighter brown," I said flippantly. "I suppose as my hair gets lighter some of the colour is draining down to the birth-mark."

"I don't like the colour of that," he said.

"I'll have it dyed for my next visit," I offered with a smile. He didn't smile back.

"No," he said, "I really, really don't like the colour of that.

He paused and moved his eyes from the offending mark to my face.

"Look," he said, in a placating tone, "would you agree to do us both a favour? When you are released in a couple of days, would you go and see a plastic surgeon and have that looked at? Would you?"

The anxiety in his tone suggested to me that it would be a good idea to say yes. It would also bring the questioning ordeal to an end.

"Sure, no problem," I said, smiling. "One doctor more or less doesn't matter to me, " I said. How well I remember that comment.

"I'll set the appointment up for you. The nurse will have the information for you when you are released," he said, extending his open right hand toward me. "Good luck with the tonsillectomy. I'm sure it will go well."

"Thanks," I replied shaking his hand. "Thanks for dropping by."

He smiled over his shoulder as he left with a wave of his hand.

Several days after the tonsillectomy, I found myself in the office of the selected plastic surgeon as he peered at the birth-mark on my chest wall.

"Yes," he said to himself, I think we'll just excise that and send it off for a biopsy. Just lie back on the gurney and I'll give you a little local freezing. We'll have you out of here in a jiffy."

As I stood buttoning up my shirt, he looked up from the form he was completing on his desk.

"Ok, Bob," he said, standing up. "Come by a week from today and we'll discuss the results from the lab. See you then."

Exactly one week later, I entered his office.

You know how it is in most medical offices, They stuff you into a small office or cubicle with the statement "The doctor will be with you shortly." Unusually, he was already seated behind his desk.

"Please have a seat," he said, somewhat preoccupied.

I was still lowering myself into the chair when he spoke his next words.

"Well, let's cut to the chase. It's malignant," he announced.

I stared across the desk at him, unsure of what to think, do, or say.

"There's no point in sugar-coating it. Now we both know the results of the biopsy so let's talk about where we go from here," he offered very professionally.

Do I remember the rest of that conversation? Not really. There was discussion of follow-up with an oncologist and success rates of similar surgeries.

Cancer? Me? How could I have gotten that? Words from past conversations with others flitted through my mind - radiation therapy, chemotherapy, new experimental drugs.

"I'm pretty sure I got it all," he said in a very assured tone, dragging me back into the conversation

I wondered if he said that for me or for himself. The rest of that short meeting is a bit hazy.

As I walked out of the office onto the Mississauga Street, a waft of fresh spring air tickled my nose and insisted its way into my brain.

"Don't I just smell so fresh?" it said to me shyly.

I inhaled deeply and looked slowly up at the cloudless canopy of sky.

"What a beautiful shade of blue," I remember thinking.

Ever since that day in 1988, I am ever so grateful for every sky I have the chance to see, sunny or shady, clear or overcast, brisk or warm.

Copyright © 2007 Robert Gervais/Log Cabin Chronicles/02.07