At the coalface of cancer

Vol. 48, No. 1 | NZPA | Sat January 31st, 2015

More people are being diagnosed with cancer in New Zealand and people who work for police appear to be no exception to that trend.

Anecdotally at least, it seems that in the past decade or so there has been an increase in cancer among police, particularly brain-type cancers.

No one really knows why, but there are plenty of theories, from improved diagnostics to the effects of shift work, which in 2007 was classified by the World Health Organisation as a possible human carcinogen due to the disruption of circadian rhythms.

The Cancer Society says one of the reasons the disease appears to be increasing is that the population is growing and getting older.

The Police Association is trying to monitor the incidence of cancer among police. That data is still being collated.

Cancer is the leading cause of death of New Zealanders, but the Cancer Society says many cancers can be cured if they are found and treated in time. It estimates that in New Zealand about one person in every three who gets cancer is cured.

In this issue, Auckland police officer Craig Cartwright writes about his current cancer treatment and Police Association President Greg O’Connor recalls his experience with bowel cancer.

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Sergeant Craig Cartwright, 42, general duties section supervisor, Auckland, is on leave while he has treatment for cancer.

I lie back and try to relax as a ham-fisted sawbones thrusts what feels like a rusty harpoon in and out of my neck. I had been starting to think it wasn’t so bad after all, when he spears a nerve. I almost tear the arms off of the chair, letting out a girlish shriek that clears the waiting room. “All done,” he finally says. I turn to him, cold sweat pouring off me, tears of gratitude and relief pricking my eyes. “Thank goodness that’s over, doctor,” I reply. “Yes,” he says, “and only one more to go.”

The minute I felt the lump in my neck, I knew I had cancer. My neck had been sore for a week, but being a naturally tough bastard I had ignored it. Then I discovered a golf-ball-sized and very tender lump just above my collarbone.

I waited for a week or two to see if it would disappear. Despite copious applications of Deep Heat, the lump remained, so I took myself, and the lump, off to see the GP. He identified it as an enlarged lymph node and, to my relief, prescribed a course of antibiotics, as most enlarged lymph nodes are caused by an infection.

Had he examined me a little closer, he would have discovered that I also had lumps in both sides of my neck, and in both armpits.

I was happy enough with the diagnosis for the time being, although I would still find my fingers fluttering nervously around the lump in my neck.

It didn’t go away. In my cowardice, I put off going back to the doctor. I knew it would mean a biopsy, and I didn’t fancy having a needle shoved into a very tender lump in my neck. By that time, I had convinced myself it was something entirely innocuous anyway. I shouldn’t have dithered – I was dying.

Craig Cartwright

Eventually I did go back, this time to a specialist. The dreaded biopsy wasn’t as bad as I’d feared – it was worse. Afterwards, when I had picked myself up off the floor and wrung out my sweat – and tear-soaked T-shirt, I listened while the specialist spelled out what he thought I had. Lymphoma.

I remember looking out the window at the uncaring Auckland traffic as I tried to take in what he was telling me. “Isn’t there something else it could be? I got strangled out at judo the other day, maybe the pressure on my neck...?”

“Craig, it’s not from judo. It’s probably lymphoma, unless, I suppose, the tumours are benign...” He trailed off. Clearly he thought that idea was far-fetched.

Tumours?

What followed were a CT scan and a return visit a week later.

It wasn’t good news. The scan showed more tumours around my lungs, heart and all down my windpipe. If it was lymphoma, it was stage two of four. I found out later why there is no stage five. Stage five is otherwise known as death.

Within a week I was under general anaesthetic getting an excisional biopsy, and a few days later the specialist rang and told me what I had – Hodgkin’s lymphoma.

By that time, it was actually good news – Hodgkin’s is the best of a very bad bunch, and is immensely better than neck cancer (an entirely different and even scarier variety of cancer).

Lymphoma is cancer of the lymphatic system, which transports a fluid called lymph around our bodies, and plays a big part in our immunity. Throughout the lymphatic system are lymph nodes, which are what the doctor feels for when he checks to see if we have swollen “glands”, which might indicate an infection.

When someone suffers from lymphoma, tumours form in the lymphatic system. These will eventually kill the patient, if he or she doesn’t catch something first and die thanks to a weakened immune system. In my case, the tumours would have continued to grow inside my chest until I eventually wouldn’t be able to breathe.

Broadly speaking, there are two types of lymphoma. Hodgkin’s lymphoma, of which there are four types, and non-Hodgkin’s lymphoma, of which there are many varieties.

One difference is that non-Hodgkin’s can pop up anywhere in your lymphatic system – your brain, for example (non-Hodgkin’s is the lymphoma that cricketer Martin Crowe has).

Hodgkin’s lymphoma is the rarer of the two and, luckily for me, is usually more treatable.

My next stop was the haematology department, where the doctor told me I had a 90 per cent chance of being alive in five years.

Some people would later express delight at this, as if I had had nothing to worry about after all. Perhaps they were right. I, however, found it comparable to being told I was about to be thrown off of a building, but had a 90 per cent chance of surviving the landing. Ten per cent might not sound like much of a risk, but it’s damned uncomfortable odds when your neck depends on it.

The doctor wanted me to start chemotherapy the next day. It didn’t seem real. I recall going into the ward and seeing all the cancer patients hooked up to drips – the sallow skin, sunken eyes, bald heads – and thinking how I didn’t belong there. I was waiting for someone to yell “cut!”. No one did.

Chemotherapy made me immensely tired. I felt as if I had aged 30 years and been transported to Jupiter – suddenly gravity was 2.5 times stronger. I found myself crawling up the stairs at home and lying around all day.

Before chemo, I had decided I would keep fit; now, the idea of training seemed like a bad joke. Each treatment took more and more out of me. By the time the last one came around, I had had enough of it.

It’s not surprising it knocked me about. I noticed the nurses were always very careful with the bags of chemo drugs and one day I asked why that was. I was told that it’s very dangerous stuff. In fact, a drop of the fluid had recently accidentally landed on a nurse’s arm. A welt had instantly formed – almost a blister – and remained for a few days. This substance was being mainlined into my body.

During the treatment, I was hospitalised twice – chemo kills fast-multiplying cells in your body, such as cancer cells, but also the cells that form hairs and white blood cells, which left me with almost no natural immunity.

This meant that an infection might easily kill me. Some cancer patients get sick, try to tough their fevers out, and die in bed. When I got a fever, I called the hospital pronto.

I met an awful lot of people way worse off than me. One was a 24-year-old girl, diagnosed four years earlier with Hodgkin’s. Sadly, chemo had no effect on her tumours. In the end she had been offered palliative care. Her life depended on her raising $300,000 for a drug that might save her life, but which Pharmac wouldn’t fund for another year or two. She’d be dead by then. Last I heard, she was selling raffle tickets.

I met a lady who had lived on the ward for 18 months while the chemo took almost everything she had left. She was excited about the upcoming bone marrow transplant that would give her a 30 per cent chance of surviving five years. And she was a lucky one; some people die on the ward waiting for a tissue match that never happens.

I met a miser who had scrimped and saved for a retirement he would never reach – he was dying of leukaemia, filled with regret that he had been so mean with his money. Another man cheerfully told me he had three months to live, and yet another had had part of his skull removed to relieve the pressure from a tumour. Terrified of slipping over and injuring his exposed brain, he would always get a nurse to shower him.

Craig Cartwright

If I survive this experience, I am certain that it will be a life-changer for me. I’m no longer worried about retiring – even if the chemo drugs and radiation hadn’t given me a higher chance of getting other cancers and even heart disease, I still wouldn’t be counting on reaching old age. Cancer isn’t something that happens to other people any more.

I have learnt how valuable my health is, and I wouldn’t trade it for all the money in the world. There are people all over New Zealand right now who would love to feel healthy just one more time. Many of them never will.

I’m grateful, too. Grateful my cancer is treatable. Grateful that even if I die from it, I’ll have some time to do a few things, and to spend time with friends and family. Grateful to have such a great job, and be working for an organisation that has a culture of taking care of its workers when they’re sick.

Most of all, though, I think I’ve discovered what’s really important in life. Here’s a clue – it’s not money.

I’m pretty sure that it’s everyone we love, and everyone who loves us.

I’m about to receive my first bout of radiation, and I’m being moved into position in the machine. I’m dreaming of Aitutaki in the Cook Islands, with its azure lagoon and gravity that is less than half that of Jupiter’s, and where I know there is a giant trevally and an ice-cold drinking coconut with my name on them. As the radiation starts and I smell something burning, I promise myself that I will try to live each day like it’s my last. One day it will be.

Photos: Senior Sergeant Craig Cartwright, above, was diagnosed with Hodgkin's lymphoma last year.

Hodgkin's Lymphona Symptoms

  • Painless swelling of lymph nodes in your neck, armpits or groin
  • Persistent fatigue
  • Fever and chills
  • Night sweats
  • Loss of appetite
  • Itching
  • Unexplained weight loss — as much as 10 per cent or more of your body weight
  • Increased sensitivity to the effects of alcohol, or pain in your lymph nodes after drinking alcohol
  • Or, there may be no symptoms or only one.

 

Do's and Don'ts for friends of cancer patients

  • Never give medical advice. Your friend has a team of highly skilled and knowledgeable doctors using cutting-edge medicine they have studied their whole lives, focused on using every resource at hand to give your friend the best care possible. Just because you’ve heard about so-and-so who drank goat urine through a copper funnel and cured his cancer, it doesn’t make you an expert. Anecdotal evidence isn’t evidence of anything. Just let the doctors do their job, and don’t make your friend feel like a mug for trusting them.
  • If you have kids, please vaccinate them. People undergoing chemo have low immunity. Children undergoing chemo are unable to get vaccinated – even the vaccine could kill them – so they are particularly vulnerable. People with low immunity rely on the immunity of others to keep them well.
  • Never say, “If there’s anything I can do or that you need, just ask.” Almost everyone seems to say that to cancer patients. If you really want to help, do something. Drop around a movie, a packet of biscuits, some juice, or, if it’s not going to work out, build them a coffin. It’s the thought that counts.

 

Confronting a killer

When Association President Greg O’Connor was told the news that he had a well-advanced tumour in his bowel, he had just picked his disabled son up from Hawke’s Bay and was setting out on a long drive back to Wellington.

“I had four hours to mull it over, but I had to focus on the trip and my son and I didn’t have the option of feeling sorry for myself at that stage,” he says.

He didn’t know much about cancer then, and even less about bowel cancer. “I certainly didn’t know it was such a big killer of New Zealanders.”

There had been some symptoms – fatigue and bleeding – which he had ignored for a while, but eventually he went to the doctor and had a colonoscopy which led to the diagnosis in 2007.

There were various options for treatment, including the then new “Swedish model” of initial chemotherapy and radiotherapy followed by surgery. “I’d always wanted a ‘Swedish model’,” he jokes, “but a Volvo or a blonde!”

He took the Swedish option, which meant several weeks of early morning visits to the hospital. He coped well with the treatment and continued to work, even though, he says, it was like having a permanent hangover. “Few people knew I was unwell and that’s the way I wanted to keep it.”

Keeping working and not having too much time to dwell on his condition was helpful, he says. That same year, he was challenged for the presidency and that “focused my mind”. He had also been pretty fit before the diagnosis and he thinks that helped him cope with the treatment too.

In hindsight, though, he says he was probably running on adrenaline most of the time and “probably in major denial and a bit naive”.

Greg O'Connor

Eventually, that year, he had surgery to remove what remained of the tumour. It hadn’t metastasised and it was all removed during the surgery.

He had six weeks off work to recover. It was a bad time. “I began reading about cancer and started realising how serious it was. I hit rock bottom then and started to think I might not make it.”

He started looking for reasons why it had happened to him. “There was no history of cancer in my family. I started wondering about the long-term effects of my year doing undercover work in the 1980s. It was standard to have to drink copious amounts of alcohol, spending a lot of time in pubs, eating poor food, keeping irregular hours and feeling stressed. I was looking for explanations.”

Coming out of hospital had been tough and when he returned to work he had a colostomy bag for nine months – “I went to all the AGMs with that in tow.” Having the bag removed entailed more challenging and painful surgery.

Seven years later, Greg is clear of cancer, but acknowledges it has changed him. “Once you have had cancer, it’s always there with you. You go on a journey and life is never the same again.”

His advice to others now is, if you have symptoms, “don’t muck around, listen to your body, if something doesn’t seem right, it probably isn’t”.

Photo: BILLIE WIN.

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