I walk down to the waiting room and call out his name. After introducing myself we walk down to the consulting room together. Bob is in his fifties, owns his own successful company and knows his own mind. I open his notes, there’s a brief letter from his GP about piles causing rectal bleeding which have been treated with piles creams for the last 6 months, these haven’t helped his symptoms. He would like some more definitive treatment for his symptoms. I imagine him putting the morning aside to get his piles sorted, I can almost see the entry in his diary.
Bob tells me about his symptoms. “It’s been going on for ages now. I get bleeding pretty much everytime I go to the toilet. It’s fresh blood mainly when I wipe. The GP gave me some piles cream to use – but it hasn’t really done anything.” “So what about your bowels, have they changed?” I ask. “Yeah maybe a bit l go to the toilet maybe 3 times a day no. Sometimes I go a sit on the toilet and nothing happens. I have had couple of times when I have thought I needed to pass wind and just blood came out”. My cancer antennae start twitching, Bob is describing tenesmus – a feeling of wanting to defaecate when nothing happens and also “wet wind”, both these are symptoms associated with rectal cancer. I ask a few more questions about his past medical history, Bob is pretty fit and his only health problems have been knee injuries from football. I ask Bob to undress and get onto the couch so I can examine him. The abdominal examination is normal and I ask Bob to turn over on his left side so I can do a rectal examination. “Don’t fancy your job much!” he quips. I put on a pair of blue rubber gloves and apply some lubricating jelly to my finger. “Just a little finger inside the bottom now” I warn. I feel it immediately, a hard, craggy malicious mass in the rectum – its a rectal cancer. I take some biopsies with a pair of forceps and ask Bob to get dressed.
I leave Bob behind the screens and go and sit back at the desk. I imagine the next few weeks for Bob; scans, a colonoscopy, maybe some radiotherapy and a big operation. Bob reappears, “So what’s the verdict then, Doc?” he smiles. I want to pause time, I know he has cancer and he doesn’t. I want to preserve and stretch this exquisite moment. Of course I cannot do that. “Well Bob, I have found the problem. When I examined you I can feel a lump in the rectum. I am afraid that it’s not piles. The lump I can see is almost certainly a cancer of the rectum.” Bob’s face dissolves, smile gone now, confusion and anguish in its place. He swears, several times. “So err its not piles then?” he says, clutching at straws. “No” I say quietly. We sit there together in silence for what seems like ages, but was probably a minute or less. I feel a huge urge to break the silence and speak, but I know Bob needs time to process the bombshell I have just dropped. I manage to control the urge and sit in silence opposite Bob meeting his gaze. Eventually it is Bob who breaks the silence, “So what happens know?” he asks quietly. We make arrangements for some scans and a colonoscopy. Bob is distracted and I know any more information in, the unexpected bad news has overloaded his mind and shut down his capacity for rational thought. I arrange to see Bob after his scans and ask him to bring his wife with him next time.
April is Bowel Cancer Awareness Month.