On Bor­rowed Time

When I re­gained con­scious­ness, I could not speak a word

The Monthly (Australia) - - CONTENTS - by Robert Manne

In the early spring of 2016 I woke in the mid­dle of the night, at a time when my de­fences were down, aware of a lump in my throat. When I was a child there had been an ad­ver­tise­ment on tele­vi­sion called “The Seven Warn­ing Signs of Can­cer”. One of the signs was de­scribed as “a lump or thick­en­ing in the breast or else­where”. The ref­er­ence to “else­where” was rather alarm­ing. Although I did not yet know it, the “else­where” had fi­nally caught up with me. What­ever it was that was not right per­sisted. Even­tu­ally I con­sulted the GP I have been see­ing reg­u­larly for the past 25 years or so. I men­tioned my lin­ger­ing sore throat. Should I per­haps re­turn to the ear, nose and throat spe­cial­ist who had di­ag­nosed a can­cer on a vo­cal cord eight years ear­lier? He thought that to be on the safe side I should. Even though the rea­son for my reg­u­lar ren­dezvous with the ENT spe­cial­ist over the past years was far from ideal – check­ing that the can­cer had not made a re­turn – strange to say I had grown to be very fond of him, with his warmth, hu­mour and no-bull­shit di­rect­ness. Be­cause of the com­bi­na­tion of his kind­ness and his old-fash­ioned An­glo-Aus­tralian gram­mar-school man­ner – he al­ways re­ferred to my wife as “Mrs Manne” – I thought of him as a Weary Dun­lop type. (This turned out to be more ac­cu­rate than I imag­ined. Every year, he trav­elled to the Kim­ber­leys and the North­ern Ter­ri­tory to ex­am­ine scores of Indige­nous pa­tients and con­duct sim­ple op­er­a­tions. As I soon learnt when we were dis­cussing fu­ture ap­point­ments, like Weary he has a keen and prac­ti­cal in­ter­est in so­cial jus­tice de­spite his con­ser­va­tive de­meanour.) The spe­cial­ist now looked down my throat with the aid of an in­stru­ment that passes through the nose, and in a mat­ter of sec­onds an­nounced, “Can­cer, I’m afraid.” Be­cause of the pre­vi­ous can­cer, I knew the ropes, or at least thought I did. A sim­ple op­er­a­tion would re­move some of the lump, in part so that an al­most cer­tainly un­nec­es­sary biopsy could be car­ried out. Then, so I imag­ined, I’d be trav­el­ling down to the Ep­worth Hos­pi­tal in Rich­mond five days a week for ra­di­a­tion treat­ment or, in the worst of cases, maybe also che­mother­apy. I phoned my wife, Anne, to tell her the news. On the car trip home, my mood was one of de­fi­ance and (in­ex­pli­ca­bly) slight ela­tion. On our ve­ran­dah, look­ing onto the gar­den of the cot­tage where we have spent the past 35 years to­gether, Anne and I calmly dis­cussed the many im­pli­ca­tions. On Oc­to­ber 26 the small op­er­a­tion took place at the Austin Hos­pi­tal in Hei­del­berg. The biopsy con­firmed the bad news. Shortly af­ter, I spoke on the phone to the ra­di­a­tion on­col­o­gist at the Austin who had ad­vised us at the time of the pre­vi­ous can­cer. It was then that I learnt I didn’t know the ropes. The on­col­o­gist thought that the lar­ynx – pop­u­larly known as the voice box, although it is con­sid­er­ably more than that – would most likely have to be re­moved. With­out even think­ing I re­sponded: “I’d rather die.” From time to time I’d seen a cheer­ful old codger in the lo­cal shop­ping cen­tre speak­ing through the use of an elec­tronic de­vice placed against his throat. He sounded like a ro­bot. This was what I thought might await me. By now ev­ery­thing had be­come more in­tense. Be­fore the biopsy, in Bris­bane, where we were both speak­ers at a con­fer­ence, I dined in a quiet restau­rant with my friend of 50 years, Rai Gaita. A young woman ap­proached us. She spoke al­most with solem­nity: “What a beau­ti­ful friend­ship.” How could she pos­si­bly know that? She told us she had been watch­ing us for two hours. Around the time of the Bris­bane con­fer­ence, a book I had writ­ten on the ide­ol­ogy of the Is­lamic State was pub­lished. This meant that the news of the can­cer’s re­turn co­in­cided with a num­ber of pub­lic en­gage­ments, most of which had to be aban­doned. I will never, how­ever, for­get one in­ter­view af­ter the biopsy – for a re­li­gious pro­gram on ABC Ra­dio Na­tional – which was not can­celled. I ar­rived at the Mel­bourne stu­dio in tor­ren­tial rain. To my com­plete sur­prise, the ABC build­ing that I had vis­ited scores of times looked like it had been bombed. It was, in fact, be­ing en­tirely ren­o­vated. I ran in panic try­ing to find the new en­trance. As the in­ter­view be­gan, I was still pant­ing. An­drew West, who had ob­vi­ously read the book care­fully, asked all the right ques­tions. When we were fin­ished I ex­pressed my grat­i­tude for his un­com­mon con­sci­en­tious­ness. I ex­plained that this mat­tered to me more than usual as I was about to un­dergo a la­ryn­gec­tomy, and it would prob­a­bly be the last in­ter­view I ever recorded. I was stand­ing in a tem­po­rary tardis in Mel­bourne. He was in Syd­ney. Per­haps the com­bi­na­tion of high praise and bad news over­whelmed An­drew. As we spoke, his voice broke. Shortly af­ter, Anne and I saw the Austin on­col­o­gist, a kind and sen­si­tive man. We dis­cussed al­ter­na­tives to a la­ryn­gec­tomy, an un­fa­mil­iar word for me at that time. Ra­di­a­tion would most likely be use­less, as my skin had pre­vi­ously been ir­ra­di­ated. Anne had read about so-called par­tial la­ryn­gec­tomies. The on­col­o­gist doubted this would be a pos­si­ble treat­ment. My wife, who has dealt with horses for much of her life, has a far bet­ter un­der­stand­ing of phys­i­ol­ogy than me. She took in what I hardly heard. With­out a la­ryn­gec­tomy, there was a strong pos­si­bil­ity that within a mat­ter of months I would be fac­ing a very painful death. With de­lay now, the chance of per­form­ing a la­ryn­gec­tomy later might have passed. None­the­less, de­spite all this, we left this ap­point­ment hang­ing onto the slen­der hope of some less rad­i­cal treat­ment. The on­col­o­gist told us his col­leagues would think that even con­sid­er­ing any­thing other than a la­ryn­gec­tomy in my case was a se­ri­ous mis­take. He had, how­ever, taken to heart my first words – “I’d rather die.” The on­col­o­gist ar­ranged two ap­point­ments: one with a sur­geon and a speech ther­a­pist at the Austin, the other with a sur­geon at the Ep­worth. At the Austin the sur­geon who might op­er­ate had been called away. We spoke briefly to one of his col­leagues. I re­call, with a cer­tain grim amuse­ment, only one re­mark: “A la­ryn­gec­tomy is a straight­for­ward op­er­a­tion.” More im­por­tant was the meet­ing with the speech ther­a­pist. With an in­tact

lar­ynx, the throat fa­cil­i­tates four vi­tal hu­man ac­tiv­i­ties: breath­ing, speak­ing, eat­ing and drink­ing. With­out a lar­ynx, the prin­ci­pal func­tions of the re­con­structed throat are eat­ing and drink­ing. A new pas­sage to the lungs, to en­able breath­ing, has to be cre­ated sur­gi­cally. The surgery leaves a roughly 10-cent-size hole be­low the chin, where the Adam’s ap­ple used to be, which is called a stoma, an­other new word for me which would be­come all too fa­mil­iar. Speak­ing is pos­si­ble, we now learnt, not only as in the past with an elec­tronic de­vice but also with a rather mag­i­cal sil­i­con pros­the­sis that con­nects the re­con­structed throat to the newly cre­ated pas­sage to the lungs. The Austin speech ther­a­pist in­tro­duced us to a la­ryn­gec­tomite of five years’ stand­ing. He spoke re­mark­ably well, in his old tone of voice, he told us, but with slightly re­duced vol­ume. He was presently try­ing to teach him­self to sing. To speak he had to place his thumb over the stoma, which was con­cealed be­hind a piece of spongy cloth. He did not use the al­ter­na­tive way of speak­ing avail­able to a la­ryn­gec­tomite: a flex­i­ble base plate hold­ing an air fil­ter that al­lows one to talk when it’s pressed down by the thumb. Be­fore show­ing us his stoma hole, the la­ryn­gec­tomite asked us, rather del­i­cately, not to be alarmed. We weren’t. To il­lus­trate the point about the re­ten­tion of the old voice even af­ter the re­moval of the lar­ynx, the speech ther­a­pist told us a rather charm­ing story. A Scot­tish woman, about to un­dergo a la­ryn­gec­tomy, had en­quired ner­vously: would she keep her Scot­tish ac­cent? She was as­sured that she would. Some days later Anne and I went to our ap­point­ment at the Ep­worth. There were, in fact, two sur­geons. The can­cer­ous growth on my throat was dis­played on a tele­vi­sion screen. The sur­geons dis­cussed the prob­lem and the treat­ment op­tions as we lis­tened and asked the oc­ca­sional ques­tion. The ideas of more ra­dio­ther­apy or a par­tial la­ryn­gec­tomy were both sum­mar­ily dis­missed. Within less than half an hour of eavesdropping on their dis­cus­sion, we had both been con­vinced. A la­ryn­gec­tomy was un­avoid­able. In­deed, be­cause the can­cer­ous growth was so large, the op­er­a­tion would also re­quire a plas­tic sur­geon. The younger of the two sur­geons we met with would per­form the op­er­a­tion. The slightly more se­nior sur­geon as­sured us that he would trust him with the lives of his own fam­ily. The date for the op­er­a­tion at the Ep­worth was set: Novem­ber 24. My ini­tial thought – that I would rather die than have the lar­ynx re­moved – by now seemed a decade away. In the weeks fol­low­ing the di­ag­no­sis, there were a flurry of tests. The one I re­mem­ber best was the so-called “PET scan”, to see whether the can­cer had spread. It took place on the day of the Amer­i­can pres­i­den­tial elec­tion. When my body en­tered the cham­ber, hor­i­zon­tally, Don­ald Trump was far­ing sur­pris­ingly well. When it emerged, he was pres­i­dent-elect of the United States. As the ma­jor op­er­a­tion ap­proached, Anne asked me to say some­thing on her phone so she would be able to re­mem­ber my voice. I quickly wrote and then recorded a let­ter to the love of my life. The sup­pos­edly straight­for­ward op­er­a­tion took 10 hours or more. When I re­gained con­scious­ness, there was a hole in my neck, my slit throat had been sewn to­gether, the area around the neck was grotesquely swollen, and of course I could not speak a word. Apart from the doc­tors and nurses, the only per­son I wished to see or to see me was Anne. To ob­serve the con­di­tion to which I had vol­un­tar­ily sub­mit­ted must have been a ter­ri­ble shock. Anne is in­ca­pable of self-de­cep­tion and feels things in­tensely. And yet on that day and on every day af­ter that I spent in hos­pi­tal, she re­mained calm, cheer­ful and op­ti­mistic. Part­ners in life who have been truly close for a long time of­ten be­gin to think and feel as one. Our new friend, Gerry Gill, calls this the “third mind”. One of the cen­tral con­cepts of Anne’s and my third mind is “moral ef­fort”. This is what Anne was able to sum­mon. With­out her calm­ness, cheer­ful­ness and op­ti­mism, her moral ef­fort at this time, my body would, I sup­pose, have sur­vived but my spirit would most prob­a­bly have been, per­haps per­ma­nently, dam­aged. On the day af­ter the op­er­a­tion, I was bright. On the fol­low­ing days that bright­ness faded. In this state I was en­cour­aged by the en­er­getic Ep­worth speech ther­a­pist to learn how to clean the pros­thetic de­vice by twirling a brush in­side it while gazing into a mir­ror, an intricate ma­noeu­vre in­volv­ing not-in­con­sid­er­able hand-eye co­or­di­na­tion. I re­sisted. This was not, as she imag­ined, be­cause I could not bear to look at the stoma. It was rather be­cause I could not bear to look at my swollen neck. In one of my night­mares at this time, where I dived head­first into an empty con­crete swim­ming pool to my death, I was bloated and my skin a jaun­diced pale yel­low. I was also en­cour­aged very early on by one of the ward’s phys­io­ther­a­pists to get out of bed. I tried to stand. As I was about to throw up, she faced a split-sec­ond choice as to whether the vomit should be cap­tured by cloths or in a half-full metal wastepa­per bin. Un­for­tu­nately, the con­ven­tional cloth op­tion was cho­sen. Some of the vomit fell on the wounds. Since the op­er­a­tion I com­mu­ni­cated with pen and pa­per. I “told” Anne that there were two re­cur­ring phrases in my head. One was “a paragon of man­ual in­ep­ti­tude”, a de­scrip­tion given me by the film­maker Ben Lewin when we were univer­sity stu­dents. This ex­plained my pes­simism about clean­ing the pros­the­sis. The other was “my weari­ness amazes me”, a line from a Bob Dy­lan song. This was how I felt. Even be­fore I de­vel­oped a tem­per­a­ture, Anne was the first to no­tice that some­thing was se­ri­ously wrong. On a rou­tine early morn­ing ward visit, less than a week af­ter the first op­er­a­tion, the plas­tic sur­geon recog­nised that my con­di­tion was per­ilous and rushed me back to the op­er­at­ing theatre. A very kind and gen­tle man, he rang Anne to ex­plain the sit­u­a­tion and put his phone to my ear so she could talk to me. Anne re­alised that this might be our last conversation. While I was be­ing op­er­ated upon, she lis­tened to the let­ter I had recorded a week be­fore and wept. For my part, fool­ishly I felt no fear. The sec­ond op­er­a­tion, to clear the in­fec­tion and

And yet, my spir­its re­mained high. Opi­ates were un­doubt­edly one rea­son … shortly af­ter my sec­ond op­er­a­tion I wrote: “Mor­phine is my friend.”

once again to re­con­struct the throat, in part by draw­ing on mus­cle from my chest, also lasted 10 hours or more. I have since asked my sur­geons whether at this time my life was threat­ened. Ac­cord­ing to both, it was. The anaes­thetic was wear­ing off as I was wheeled from the op­er­at­ing theatre to the in­ten­sive care unit. I had en­tered a weird and pro­foundly dis­turb­ing state of con­scious­ness – be­tween dream and re­al­ity – that I have not ex­pe­ri­enced be­fore or since, and to which I hope never to re­turn. Names of wards, the true names, flashed past. When I reached the in­ten­sive care unit I was still in this nether­world. A voice kept ask­ing: “Pro­fes­sor of what? Pro­fes­sor of what?” Later I recog­nised that the voice be­longed to the ICU nurse as­signed to watch over me. When I re­turned to the world, I asked for some sheets of pa­per so I could “speak” to Anne. I wrote: “We made a MIS­TAKE – should have de­cided oth­er­wise. NO TREAT­MENT no chemo no ra­di­a­tion I had a ter­ri­ble night­mare com­ing out of the coma I feel clear in my mind I know there is now a logic I/we must see to its end I have never feared death I am res­o­lute But.” Mo­ments af­ter, with the ti­tle of Ge­orge Or­well’s short es­say on Mal­colm Mug­geridge, “The Lim­its of Pes­simism”, in mind, I wrote: “The Lim­its of Op­ti­mism”. This was the only time I was over­taken by de­spair. Anne talked me round. The head of the ICU asked me whether I’d like to speak to a coun­sel­lor. Why not? I wrote: “Like Karl Marx I’m in­ter­ested in ev­ery­thing.” I doubt if he knew what I was “talk­ing” about. But my spirit had re­turned. Af­ter leav­ing the ICU, I set­tled again into the pri­vate room I had been al­lo­cated, very grate­ful that it was not shared, and quickly es­tab­lished a rou­tine, as is my wont. First thing, an email to Anne and one or two emails, de­pend­ing on my strength, to my daugh­ters, Kate and Lucy, or, later, to my nephew David, son-in-law Daniel and clos­est friends. Then a morn­ing news­pa­per. For the first time in my life, some morn­ing tele­vi­sion. Read­ing for an hour or two. Cricket or golf in­ter­spersed through­out the day, if be­ing played. The test match was a bless­ing. An af­ter­noon nap. And fi­nally an evening film, al­most al­ways with Anne. We cel­e­brated our 34th wed­ding an­niver­sary sit­ting along­side each other by the side of the bed, with a Claude Chabrol moral-psy­cho­log­i­cal thriller play­ing on my screen.

My phys­i­cal con­di­tion was piti­ful – voice­less; a feed­ing tube in my nose; an­other tube, af­fec­tion­ately called by doc­tors and nurses a “tra­chy tube” (short for tra­cheostomy), in­serted per­ma­nently in the stoma to help it keep its shape; a catheter for piss­ing into; mat­ted hair, which could not be washed lest wa­ter en­ter the stoma; stub­ble grad­u­ally turn­ing into a beard, as my skin was too sen­si­tive for shav­ing; a coated tongue, which felt like a swamp; my left arm in a cast to pro­tect the area from which skin had been re­moved for graft­ing; grotesque, un­sightly swelling around my stitched-to­gether neck, which I re­mained un­able to look at in a mir­ror for sev­eral days; so many fresh scars in so many of­ten un­ex­pected parts of my body that I joked that I now re­sem­bled a vet­eran of the Amer­i­can Civil War; bow­els oc­ca­sion­ally blocked and then wildly out of con­trol; and a mild case of pneu­mo­nia that the dry-wit­ted res­pi­ra­tory physi­cian who vis­ited me reg­u­larly thought ranked no higher than 15 in the list of my bod­ily ail­ments. And yet, my spir­its re­mained high. Opi­ates were un­doubt­edly one rea­son; among my notes I have found that shortly af­ter my sec­ond op­er­a­tion I wrote: “Mor­phine is my friend.” But read­ers who have per­sisted so far will know the in­fin­itely more im­por­tant ex­pla­na­tion. Anne was with me for sev­eral hours al­most every day and in spirit al­ways. So, too, although less in­tensely, were close fam­ily and friends. I was never less alone in my life than now. Had I been alone, God only knows what would have be­come of me. To re­gain even a sem­blance of fit­ness, not my strong­est suit even when well, the only pos­si­ble ex­er­cise was to walk “laps” of the ward, which com­prised a per­fect square. I be­gan with one lap but grad­u­ated to six a day and then, rather proudly, 12. At first I was ac­com­pa­nied by a nurse or Anne, who, as we shuf­fled along, pushed an up­right trol­ley to which my var­i­ous tubes were at­tached. The num­ber of tubes I needed re­duced over time. Even­tu­ally I walked by my­self un­en­cum­bered, a free man. On one oc­ca­sion, a bloody patch sud­denly ap­peared on my pure white hos­pi­tal frock. The chest wound had oozed. It was eas­ily re­paired. In my hos­pi­tal room the tra­chy tube had once mys­te­ri­ously popped out. For this rea­son, as I walked by my­self around the ward, I held on to it tightly, in fear that if it popped out again un­no­ticed while I was do­ing my laps

Hos­pi­tals were for me quite sud­denly no longer places of dread to be avoided but sec­u­lar cathe­drals of the hu­man­ist spirit, wor­thy of cel­e­bra­tion.

a ward-wide search party would have to be mounted. Tra­chy tubes are cus­tom built; one size def­i­nitely does not fit all. On an­other oc­ca­sion a physi­cian ac­ci­den­tally knocked out my nose tube. The new one was stitched in. In my record of con­ver­sa­tions, the plain­tive cry, “Please be care­ful with the nose tube,” oc­curs at least a dozen times. The more se­nior sur­geon paid a visit early one morn­ing with his two-year-old son. One look at me – a bearded, bedrid­den man with a tube in his nose – and he burst into tears and ran to the arms of his fa­ther. One day, on a walk through the ward, a new thought struck me with some force. Since child­hood I had hated the look and the smell of hos­pi­tals, where my mother spent pe­ri­ods of time be­cause of her mul­ti­ple sclero­sis. Since then I had scur­ried along their cor­ri­dors, notic­ing as lit­tle as pos­si­ble. Be­cause of the op­er­a­tion, I now smelt noth­ing. And, as I did my laps, I found that I no longer averted my gaze from the peo­ple sit­ting dis­con­so­lately in their rooms star­ing at tele­vi­sion screens, or hob­bling around the ward in dress­ing gowns and slip­pers, or be­ing wheeled on beds, their faces of­ten blank with fear or pain. Sim­ply as a mat­ter of com­mon cour­tesy, I nod­ded and smiled as I passed fel­low pa­tients, and also the grow­ing num­ber of hos­pi­tal staff I had come to know. These peo­ple were no doubt part of a modern bu­reau­cratic or­gan­i­sa­tion based upon a care­ful divi­sion of tasks and a hi­er­ar­chy – sur­geons, physi­cians, ad­min­is­tra­tors, nurses, nurs­ing aides, clean­ers, food de­liv­er­ers and so on. Many worked with the most so­phis­ti­cated con­tem­po­rary med­i­cal equip­ment, which seemed to be strewn al­most care­lessly along the cor­ri­dors of the ward. Yet these peo­ple’s work­ing lives were ded­i­cated to an an­cient im­pulse that gave mean­ing to the idea of a com­mon hu­man­ity, pro­vid­ing aid and com­fort to the af­flicted. And they were re­quired in their care­fully reg­u­lated work to ful­fil, on the com­mu­nity’s be­half, what com­pas­sion, the finest of all the moral virtues, de­manded. Hos­pi­tals were for me quite sud­denly no longer places of dread to be avoided but sec­u­lar cathe­drals of the hu­man­ist spirit, wor­thy of cel­e­bra­tion. I did not speak a word for six weeks. But I was never silent, be­cause of pens and a suc­ces­sion of A4 pads, most of which I still pos­sess. Anne was of course my most im­por­tant con­ver­sa­tion­al­ist. In my scrawls, she told me, she could still hear my voice. I also “con­versed” ea­gerly with new ac­quain­tances – the sur­geons, physi­cians and nurses. As she sat on my bed, a nurse from cen­tral Queens­land told me about her idyl­lic coun­try child­hood, and I told her about Cot­tles­bridge, where our two daugh­ters had grown up and where we now lived with a menagerie of four cats, two horses and two dogs. An­other was torn be­tween a ca­reer in nurs­ing or pub­lic re­la­tions. I told her that I be­lieved nurs­ing was “1000 per cent” more im­por­tant. Yet an­other, an in­ner-city Carl­ton– Bal­main type, came up with three prac­ti­cal sug­ges­tions dur­ing conversation – a spoon to scrape away some of the swamp that had set­tled on my tongue; dry sham­poo for my greasy, knot­ted hair; a rib­bon at­tach­ing pen to pad to avoid un­nec­es­sary frus­tra­tion. She smiled wryly when I called these ideas “rev­o­lu­tions”. One day a big bunch of flow­ers from Green­peace and David Rit­ter ar­rived. The nurse who brought them had once worked for a con­ser­va­tion group. We dis­cussed mu­tual ac­quain­tances, one of the sta­ples of plea­sur­able conversation. When the plas­tic sur­geon re­turned from the week he spent in Myan­mar shortly af­ter my sec­ond op­er­a­tion, I told him about a friend, Martin Kry­gier, who was in­volved in a rule-oflaw project there. We agreed that bring­ing the rule of law to Myan­mar posed a far greater chal­lenge than stream­lin­ing the de­liv­ery of surgery. I spoke to oth­ers about his al­tru­ism while he was away. The res­pi­ra­tory physi­cian, in the char­ac­ter­is­ti­cally Aus­tralian way, joked that he was prob­a­bly hol­i­day­ing in Queens­land. These con­ver­sa­tions would once have seemed in­con­se­quen­tial. They re­main fixed in mem­ory be­cause of the cir­cum­stance in which they oc­curred. Be­fore eat­ing or drink­ing af­ter a la­ryn­gec­tomy, the pa­tient is re­quired to pass what is known as the swal­low test. The test in­volves drink­ing, while stand­ing, a mildly un­pleas­ant liquorice-tast­ing liq­uid, which makes its way down the re­con­structed throat as an X-ray is taken. If there are any leaks they can be seen. In the fort­night fol­low­ing the sec­ond op­er­a­tion I was twice trans­ported to the Ep­worth’s imag­ing room. I failed the first test. The sec­ond test took place af­ter I’d been read­ing The Aus­tralian. I was so an­gry about the cam­paign the pa­per was con­duct­ing against Gil­lian Triggs, the for­mer pres­i­dent of the Aus­tralian Hu­man Rights Com­mis­sion, that I com­posed an opin­ion piece in my head, later pub­lished on The Monthly web­site, while wait­ing in a wheel­chair by the imag­ing room. My anger was un­con­nected to the small leak the sec­ond swal­low test de­tected.

We were now in mid De­cem­ber. Christ­mas was ap­proach­ing. Recog­nis­ing there was no point stay­ing in hos­pi­tal, my plas­tic sur­geon – who told me his men­tor be­lieved four weeks were needed for the post­la­ryn­gec­tomy throat to heal – sug­gested that I go home be­fore re­turn­ing for a third test sched­uled for early Jan­uary. This caused a lit­tle un­ease at the hos­pi­tal. It was un­usual for any­one to re­turn home with a tube still in the nose. I be­lieve that the an­i­mals – es­pe­cially the male Burmese cat – were pleased to see me. I was cer­tainly pleased to see them. And I was happy be­yond mea­sure to be home. Ac­com­pa­nied by boxes of liq­uid feed (I refuse to call it food) and with a feed­ing pump and the dozen or so drugs I needed, Anne and I cel­e­brated Christ­mas with Lucy, our younger daugh­ter, and brought in the new year by our­selves. On New Year’s Eve we watched James Ste­wart in Frank Capra’s It’s a Won­der­ful Life (the film was care­fully cho­sen) and then, to the dis­tant crackle of fire­works, lis­tened to Kath­leen Fer­rier singing Gluck’s “What Is Life to Me with­out Thee?” with tears – of re­lief, of trep­i­da­tion, of sad­ness, of joy, of love – welling in our eyes. We were very tense be­fore the third swal­low test. But I passed. A short stay in the hos­pi­tal was needed to check how well I could eat and drink. This time I was in a ward for four, with beds sep­a­rated only by cur­tains. On one side was an old gen­tle­man whose po­lit­i­cal opin­ions seemed to be shaped by An­drew Bolt and the Her­ald Sun. Across the way was an el­derly Filipino, who had been taken ill while vis­it­ing his son and daugh­ter-in­law. He moaned through­out the day and into the night in what ap­peared to be mild pain – as soon as he spoke to his son or the doc­tors he was cheer­ful. I have never more val­ued the po­lit­i­cally in­cor­rect Bri­tish virtue known as the stiff up­per lip. Af­ter the nose tube was re­moved – hal­lelu­jah! – drink­ing was easy, eat­ing less so. Fool­ishly I chose broth. The hos­pi­tal broth was in­trin­si­cally dis­taste­ful but

Here was even a slim pos­si­bil­ity that I would never speak again. There was, how­ever, a story that I was de­ter­mined to tell the sur­geons.

it had, I sur­mised, only be­come truly dis­gust­ing when it in­ter­acted with the residue of the feeds that had been pumped into me over the past six weeks. Two spoon­fuls and I was fin­ished. I thought I would never be able to take broth again. I now as­sessed the sys­tem and the pos­si­bil­ity of es­cape with a pris­oner’s cun­ning. I was re­quired to fill out forms spec­i­fy­ing the vol­ume of what I had eaten and drunk. I doubted that any­one was check­ing. I sub­mit­ted fal­si­fied forms, ex­ag­ger­at­ing con­sid­er­ably but still within what I cal­cu­lated were the bounds of plau­si­bil­ity, how much food and drink I could digest. The pro­fes­sor of what? was be­hav­ing like an er­rant child. For the first time since my lar­ynx was re­moved, I was des­per­ate to get out of the hos­pi­tal. Af­ter two days, Anne and I drove home, pre­par­ing for our new life. I still did not speak. A few days later we drove back to the Ep­worth. We were greeted in a con­sult­ing suite by three sur­geons – the two we had seen two months ear­lier and a fe­male col­league who was in­volved in the sec­ond op­er­a­tion – one of the physi­cians, the one who had ac­ci­den­tally knocked out the nose tube, and the speech ther­a­pist, whom we had grown to ad­mire greatly, whose con­cern for my well­be­ing was ob­vi­ously gen­uine. The as­sem­bled group peered closely at my neck. Anne and I had to sup­press laugh­ter. The con­sen­sus was that the stoma was “beau­ti­ful”. Thoughts about “the eye of the be­holder” came to mind. I was asked to place a thumb over the site of beauty and say “aargh”. The aargh emerged. I was asked to count to 10. Once more, I suc­ceeded. To un­der­stand what fol­lows, my state of mind at that mo­ment must be un­der­stood. I firmly be­lieved that it would take weeks or months of ef­fort, un­der the guid­ance of a speech ther­a­pist, be­fore I would be able to speak. There was even a slim pos­si­bil­ity that I would never speak again. There was, how­ever, a story that I was de­ter­mined to tell the sur­geons. The story con­cerned an episode of Aus­tralian Story I had seen on tele­vi­sion in the ward, about an at­trac­tive young woman with a throat can­cer like mine. She had re­fused to un­dergo a la­ryn­gec­tomy. Her fa­ther had searched the in­ter­net for an al­ter­na­tive cure and wanted the gov­ern­ment to pay for a drug that had been suc­cess­ful with a dif­fer­ent can­cer. Now she was dy­ing. This story re­vealed that by con­vinc­ing us to pro­ceed with the la­ryn­gec­tomy, by ex­cis­ing hope of an al­ter­na­tive, with what Anne had jok­ingly de­scribed as “sur­gi­cal pre­ci­sion”, the sur­geons had saved my life. I ur­gently wanted to speak so I could ex­press the emo­tion I felt most pow­er­fully at this time: grat­i­tude. As I be­gan, the words, the sen­tences, the para­graphs kept com­ing. The paragon of man­ual in­ep­ti­tude had mas­tered breath con­trol ef­fort­lessly. Although I was speak­ing in a whis­per, the voice was in tone and reg­is­ter un­mis­tak­ably mine. Anne wept qui­etly. When I had fin­ished the story, there was a si­lence. And then the more se­nior sur­geon said, with great sad­ness, “She is our pa­tient.” My new life as a la­ryn­gec­tomite now be­gan to take shape. A sec­tion of the table in my study was turned over to bot­tles and pack­ets of medicines. One bot­tle con­tained oxy­codone. For the only time in my life, I grasped through the per­sonal ex­pe­ri­ence of mild eu­pho­ria why the world faces a drug-tak­ing epi­demic. When the bot­tle emp­tied I knew I shouldn’t try to re­place it. There were three im­por­tant new tasks: test­ing the pros­the­sis for leaks, by drink­ing and then ex­am­in­ing the stoma; from time to time re­plac­ing the air fil­ter when it was blocked by dry phlegm, or the ad­he­sive base plate when the seal broke and speak­ing turned to hiss­ing; clean­ing the stoma and the pros­the­sis at least twice daily with a torch, tweez­ers and two twirling brushes. At first Anne did most of the clean­ing. She be­lieved her ac­cep­tance of my new body would help. We joked that we had found a new def­i­ni­tion of true love: clean­ing a part­ner’s stoma. Show­er­ing was made pos­si­ble by a nifty plas­tic de­vice in­serted in the base plate. Eat­ing ad­vanced from milk­shakes, pureed foods and scram­bled eggs to pasta and other soft foods, and then to the old diet of meat, bread, pota­toes and veg­eta­bles. I dis­cov­ered that when I ate I could barely talk. The food wended its way slowly down the re­con­structed throat to the stom­ach by force of grav­ity. Drink­ing lots of wa­ter dur­ing meals helped. But if I talked while drink­ing I gur­gled. My new con­di­tion had, how­ever, cer­tain un­de­ni­able ben­e­fits. Be­cause of the drugs, I slept bet­ter than for decades. Anne re­ported that I no longer snored. Af­ter the fi­nal ap­point­ment at the Ep­worth where I spoke, we thought that, apart from reg­u­lar check-ups, we were at least tem­po­rar­ily fin­ished with hos­pi­tals. Not so. One morn­ing a few weeks af­ter go­ing home, I dis­cov­ered that the sil­i­con pros­the­sis had dis­ap­peared. This was

no mi­nor mat­ter. There were only three places it might have gone or might still go – the floor, the stom­ach or the lungs. The floor and even the stom­ach were un­prob­lem­atic. If, how­ever, it reached the lungs I might not be able to breathe. Anne tried valiantly but in vain to in­sert the far too flex­i­ble rub­ber catheter we had been pro­vided with for such an emer­gency. Overnight, how­ever, the hole that held the pros­the­sis had closed over. She called an am­bu­lance. The paramedics ar­rived – to the de­light of our two cor­gis, who adore all vis­i­tors – but they knew less than we what was to be done. Anne called one of the speech ther­a­pists in the re­ha­bil­i­ta­tion rooms at the Ep­worth, who ad­vised us to get to emer­gency as quickly as pos­si­ble. It took four days and three hos­pi­tal vis­its for a pros­the­sis to be in­serted. My new re­hab speech ther­a­pist bat­tled nobly un­til he even­tu­ally suc­ceeded. On the sec­ond visit, I needed to go from the re­hab rooms to the sur­geons’ con­sult­ing suite so that some so-called proud flesh around the pros­the­sis hole could be burned off. I was ac­com­pa­nied by the other re­hab speech ther­a­pist, to whom Anne had spo­ken on the phone. She was heav­ily preg­nant. As we were walk­ing I coughed or sneezed – it is hard to say which – and a glob of phlegm landed on the linoleum floor. With del­i­cacy, grace and good cheer, my com­pan­ion bent and wiped it up. It was at that mo­ment that I de­cided to write this es­say. I thought then that it would be called ei­ther “Grat­i­tude” or “The Kind­ness of Strangers”. It would please no one more than me if this es­say could have a mod­estly happy end­ing. That would be un­truth­ful. Dur­ing my times in hos­pi­tal, and even for some weeks af­ter, I ex­pe­ri­enced no pain. Re-read­ing my notes re­cently I found that in the last con­ver­sa­tions with Anne be­fore I could speak, I told her first that the skin around my neck felt “numb” and a lit­tle later that it felt “tight”. Even­tu­ally the tight­ness turned into pain. Hu­mour can make al­most any­thing more bear­able. I chris­tened the force that gripped me by the throat the Cot­tles­bridge Stran­gler. I asked my plas­tic sur­geon and the orig­i­nal ear, nose and throat spe­cial­ist for ad­vice. Both thought an anti-de­pres­sant might help. It didn’t. For some time we be­lieved that the pain was caused by lym­phoedemia – the ac­cu­mu­la­tion of flu­ids af­ter the re­moval of lymph glands. I trav­elled across Mel­bourne on sev­eral oc­ca­sions – two hours each way – to the only phys­io­ther­a­pist in the en­tire city who dealt with lym­phoedemia of the neck. Her treat­ment – thrice daily ex­er­cises, gen­tle mas­sages and a com­i­cal Joel Sel­wood– style head ban­dage – suc­cess­fully cleared the liq­uid. (For those who do not fol­low Aus­tralian Foot­ball, Joel Sel­wood is the Gee­long cap­tain, fa­mous for his courage, who rarely emerges from a game un­blood­ied.) The pain, how­ever, per­sisted. A pain spe­cial­ist joined the ev­er­ex­pand­ing cir­cle of sur­geons, spe­cial­ist physi­cians, gen­eral prac­ti­tion­ers and phys­io­ther­a­pists I had vis­ited over the past months. Thus be­gan a search for the right cock­tail of drugs that would ren­der in­tol­er­a­ble pain tol­er­a­ble with­out turn­ing me into an ad­dict, or make me, as the kind spe­cial­ist would pre­fer me to say, de­pen­dent.

In one of the rou­tine ap­point­ments, the fine young sur­geon who had con­ducted the orig­i­nal op­er­a­tion told me in his quiet way that I should not ex­pect the pain to go away, ever. With pre­vi­ously ir­ra­di­ated skin, what I was ex­pe­ri­enc­ing was not un­com­mon. Dur­ing my most re­cent ap­point­ment, al­most as an af­ter­thought, he added that if the can­cer re­turned there was noth­ing that surgery could do to help me. I now had the ti­tle for this es­say.

My favourite ra­dio pro­gram is the ABC’s Cood­abeen Cham­pi­ons, two hours on Satur­day morn­ings of won­der­ful im­pro­vised hu­mour about Aus­tralian foot­ball. To­wards the end of each pro­gram the reg­u­lars are asked, “What have you learnt to­day?” and are re­quired to an­swer suc­cinctly. It’s a good ques­tion. I will try to an­swer, in sim­i­lar fash­ion, what I have learnt in the 10 months since dis­cov­er­ing that throat can­cer had re­turned. I have learnt that I am quite a sto­ical per­son, who can abide even very un­pleas­ant bod­ily con­di­tions short of in­tol­er­a­ble pain. I have learnt that dig­nity is a qual­ity of the spirit that can be main­tained even in the most com­pro­mis­ing or com­i­cal sit­u­a­tions, as the body gives way. I have learnt that with moral ef­fort – that idea again – even a per­son as nat­u­rally proud as I am can over­come em­bar­rass­ment over con­spic­u­ous phys­i­cal dis­abil­ity with friends, ac­quain­tances and strangers. Hav­ing lived a pro­fes­sional life part of which re­lied on speech – lec­tur­ing, tu­tor­ing, speak­ing at writ­ers’ fes­ti­vals, launch­ing books, ap­pear­ing on ra­dio and oc­ca­sion­ally tele­vi­sion – I have learnt that with a poor qual­ity or un­pleas­ing voice one is ex­pected as a mat­ter of course to va­cate the pub­lic stage. I in­tend to chal­lenge that ex­pec­ta­tion. Per­haps I was lucky, and I re­alise I ben­e­fited from pri­vate health in­sur­ance, but I have learnt that in Aus­tralia hos­pi­tals are re­mark­able in­sti­tu­tions and the peo­ple work­ing in them al­most in­vari­ably ca­pa­ble and kind. Shortly be­fore my di­ag­no­sis, a friend took his own life for fear, ac­cord­ing to his sui­cide note, that in old age he might ex­pe­ri­ence some­thing akin to what I was about to go through. I have learnt that I very much want to live, for a hun­dred rea­sons, and that I will one day share with Ge­orge Or­well “a vi­o­lent re­sent­ment at hav­ing to leave this world which, when all is said and done, suits me so well”. I have learnt that there is al­most noth­ing more pre­cious in this world than the love of fam­ily and friends. I will never for­get the heart­felt emails from Kate and Lucy or the ex­quis­ite apri­cot roses sent by Morry and Anna Schwartz. And above all other things I have learnt what the mar­riage of two minds and bod­ies can mean, and that the truest and deep­est words in the English lan­guage come from the an­cient mar­riage vow: “to have and to hold … for bet­ter, for worse, for richer, for poorer, in sick­ness and in health, un­til death do us part”.

Pho­to­graphs by Tom Ross

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