These memoirs and reflections have been on file on my computer for some 10 years or more and have been worked on intermittently over this period. Time out was taken to complete the life stoy of my great grandfather subsequently published in Sentenced to Cross the Raging Sea (2004)and again later when the story of my eight great grandparents was documented in Eight Pioneering Australians (2008).
I have become a compulsive writer and find it is a sj’djf’ajdf’aj discipline above all others that focuses the mind and encourages embryonic ideas to come to fruition. It is relaxing and engaging and with the miracle of computers and scanners the end result is pleasing even if the content does not always come up to expectations.
Now aged 76 and currently undergoing hormonal and radiotherapy treatment for moderately advanced prostatic cancer one has become acutely aware that the future is of limited duration. Not that there are any undue concerns regarding this fact as life has been inordinately generous in its dealings with me. My current predicament though underlines the urgency for me to get on and get these memoirs documented and in some sort of order whilst there is still time.
One would hope that future generations may find these musings of interest, as I most certainly would have, had my forbears troubled to put pen to paper to record their own particular musings. Life has been lived to the full. It has been exciting, rewarding and I have been extraordinarily lucky in my immediate family; their caring and loving attitude towards me and each other, is very humbling but at the same time immensely inspiring.
The chapter on my father, written at least ten years ago, is of interest in that it records his death as being from prostatic cancer, and this, almost certainly, will be my destiny also. The reader may well ask why a surgeon with inside knowledge had not troubled to have regular PSA (prostatic specific antigen) checks over the years after his father died of the condition. The answer lies in this particular fact. Eighty per cent of eighty year old males have a focus of prostatic cancer somewhere in their prostate but most die without that focus being the cause of their death. Radical prostatectomy is a harsh treatment for what is mostly a benign behaving cancer. It has attendant risks of incontinence and impotence and so, like marriage, is not to be entered into lightly, but only with due circumspection. Until the behaviour of a particular cancer could be predicted by the urologists or pathologists I had not been prepared to submit to such a procedure. So, why have the test? It has always been a dictum of mine – ‘only do a test if you are prepared to act on the result’. Why then have an annual test and plant seeds of worry?
Nevertheless, it was a surprise when all sixteen prostatic biopsies revealed undifferentiated prostatic cancer with a Gleason score of 4+5 = 9, clinically T2a and a PSA of 35! How long had these wide spread changes been evolving? Six months, five years? Probably closer to the former.
Despite my analogy to my treating surgeon that breast cancers in the elderly are rarely aggressive and do not demand aggressive treatment, he propounded the view that such is not always the case with prostatic cancer and that he, furthermore, was proposing to ‘throw the book at me’ with antiandrogen hormone treatment, external beam radiotherapy, high dose local brachytherapy and whatever other unpleasantaries came to mind! Such is life.
The stage reached in this discourse prior to this prostate distraction was my (delayed) graduation and appointment in Wanganui, New Zealand. It is strange how chance plays such an enormous part in our lives. The surgical viva that led to my delayed graduation in 1957 was a brief three minute encounter with the examiner. I was tiring, as was the examiner, whom I thought showed considerable disinterest. The patient in question had varicose veins and required the performance of the Trendelenburg test. Now one would have imagined that having been asked that question on a ward round by Syd Krantz,[1] an Honorary Surgeon at the RAH, and found wanting some six months earlier that I would have pursued and thoroughly grasped the concept. But not so. Had I been able to reproduce that test, I would have passed, would have remained in Adelaide, and my life would have followed an entirely different course. How do I know this? Those of us who failed to satisfy the examiners in surgery on that occasion were granted an interview with Allan Lendon, the Director of Surgery. He told me that I had passed the other viva in surgery for which, coincidently, he had been the examiner.
And so the question of chance remains endless. Had my great grandfather been hanged at Lancaster Castle at the age of 17 … had that particular sperm not outswum the other million to reach the egg first …
Incidently, and coming closer to home, that particular little sperm that swam faster and stronger than the rest still had an Achilles heel of which perhaps even Darwin failed to take account. Thus even the giants among us have their feet of clay!
All of those little sperms carry an autosomal dominant X-linked gene on one of the 23 X chromosomes. This gene (HPC-1) encodes the enzyme ribonuclease, a tumour suppressor.[2] In my case somewhere, somehow (ancestrally) this gene had undergone a germline mutation with consequent loss of prostatic tumour suppression. This suppression normally keeps the replication of cells orderly and controlled. Without suppression a cell may replicate randomly, rapidly and uncontrollably, in a bizarre fashion, and with unrecognisable shape. It thus becomes a cancer, which has the capacity to spread to lymph nodes and even enter the blood stream and disseminate widely in the body. Different tumours have a predilection for particular organs. Thus the prostate is particularly fond of making its home in bones. In my father’s case it made its home widely throughout both his lungs, appearing on X-ray like the miliary spread of tuberculosis.
Does every sperm carry the germline mutation? Is there and will there be a place for genetic engineering? And so the questions go on, even entering the philosophical and finally theological! One thing is certain; the onset of cancer has the effect of activating the brain and generating a more acute focus of the mind.
How true are these recollections? It is said that the passage of time distorts the mind, and recollections become larger than life, and not entirely accurate, lest they should spoil a good story! To the best of my ability I have tried to avoid these temptations, although in one or two situations the expressed views may, just may, have succumbed to this temptation!
And what if nobody reads what has been written? That matters not in the least as the very act of recording experiences and thoughts of a lifetime has been therapeutic and stimulating, particularly in reviewing the conclusions reached at the time, in the light of three quarters of a century of accumulated experience. Finally, the format, the essay. It reminds one of the exercises imposed at school to test knowledge of the reading list; the rewriting of other writers’ arguments. The essay ( essayer, French totry) was first used by a Frenchman, Michel De Montaigne around 1572, when, over a twenty year period, he wrote discourses on any subject that happened to present itself to him, some short, others longer, all fairly unconnected. It is a convenient form for my present intent and may include widely differing subjects of interest, perhaps from sailing to the philosophy of golf, to surgery, to religion, who knows. The subjects will all reflect some personal experiences accumulated over a lifetime, and yes, some opinions are sure to be aired.
- Syd Krantz returned from WWII with a huge reputation for his work as a POW surgeon on the infamous Burma Siam Railway. Weary Dunlop received all the notoriety but others including Albert Coates and Allan Hobbs were equal contributors.
- http://www.medterms.com/script/main/art.asp?articlekey=19507 Sourced March, 2010. This explanation is here made deliberately simplistic as many genes on various chromosomes are known to be involved.
RG Johnson 