My Tryst with Destiny - for the second time

 By Dr Nihal D Amerasekera

My first brush with death was as a child when I had a tonsillectomy. I have written about it to this blog some years ago.

My professional life ended in April 2007 with my retirement. I wanted some peace and quiet and time to travel the world before old age caught up with me. I achieved my objectives to reach where I am today. Society encourages us to extend our youth until at some stage our body and mind tells us otherwise.

On the 15^th of February 2016 when I was spending time with our elder son in Birmingham I noticed a bit of ‘red confetti’ on the toilet pan which I assumed was the work of my grandkids playing with coloured paper. This happened again in my own home.  I went to see my GP who confirmed it was haematuria. Now the clock started to tick and my journey into the unknown began.  Urologists got involved with a gamut of investigations. The cystoscopy showed a red patch in the bladder and they wanted to arrange a biopsy. By now I had signed the legal papers to move house to a flat in London 50 miles south. I was to stay with my son until our own flat was ready. The Urologist said it was urgent but I told him I am not ready and will get it done after the house move is completed. He wasn’t best pleased.  if it is cancer this has to be dealt with swiftly. I have passed the biblical age of 3 score years and ten, my obligations were done and felt I am ready to unfurl my sails to see the world beyond.

Cystoscopy is a procedure that requires great care by the urologist. There is a tendency nowadays to be blasé about sterility because of the plethora of antibiotics available. Still there are many who die of septicaemia and infections caused by resistant strains of bacteria. After the cystoscopy I developed the most severe attack of cystitis with a fever, rigors and a painful dysuria of the worst kind. I was in a wilderness of confusion. At no time have I felt closer to death. Passing urine was like cutting the urethral lining with a knife. Luckily  the doctor had given me some antibiotics which took 48 hours to take effect.

First we moved in with our son.  It was more than  a month later we were able to move to our own flat. If I was harbouring a tumour, the time bomb was ticking. I managed to see a GP and get a referral to a Urologist at the Royal Free Hospital in London. I was seen on the 26^th of May when they repeated the Cystoscopy. There was no change. Further investigations took a great deal of time and effort. Finally a biopsy was done on the 24^th of June. I cannot fault their professionalism, care and expertise. Discussions with doctors about one’s health is never easy. The advice is coloured by the rules and regulations in healthcare, its limitations, political correctness and disclaimers. This makes it all difficult for the patient to comprehend.  I wish I was aware of this in my own professional years. After the procedure they told me it would take 2-3 weeks for the report.  I awaited the results of the biopsy with some trepidation and also surprising calm.

On looking back it is strange to be a patient sitting on the wrong side of the table after being a doctor for 40 years. Diseases only happened to others!! An interest in what lies beneath the skin and behind the symptom has been our concern and now we are the symptom.  I have often wondered when one is a patient if that medical knowledge is a help or a hindrance. On the one hand one worries about the rare complications and unlikely side effects and on the other one is aware of the endless possibilities and how to make best use of the situation and the advice.

The continuous news of death and disease of family and friends are a reminder of one’s own mortality. Awaiting the biopsy results was at times a nightmare. A lot of the time I felt strong and was able to put those negative thoughts behind me. Occasionally I was overcome by darkness and why me and why now? What if it is malignant and required further surgery radiotherapy/chemotherapy. This requires regular visits to clinics with countless blood tests and investigations. Such a restrictive life would never be pleasant and may not be worthwhile. What if it all has spread beyond the bladder and was terminal. Such thoughts did cross my mind. Fear took me to a terrifying place located at the outer edges of human tolerance.  During those times of despair life turns round 180 degrees. Habits of a lifetime of acquiring wealth, gloating on achievements, avarice, greed, hatred and pride – all these things just fall away in the face of death. What remains is what is truly simple and basic. Even current affairs and news items somehow seem irrelevant. The future, the next year and even the next month seem distant, elusive and unreachable. The deep and gnawing pain and sadness of separation from my immediate family was always foremost in my mind.

Why can’t there be a better way to exit this world without all this torment and anguish? I also discovered that eventually one learns how to incorporate death into one’s life. It becomes an unwanted traveling companion that stalks you day and night. At times I couldn’t hide my feelings of utter grief, distress and wretchedness. This must have been hard for my wife to bear. I think finally human beings are programmed to accept the end of life. Then things fall into place and serenity and calmness prevails.

There are many of my batch who have now departed this world. I have often wondered how they coped with the inevitable and what thoughts crossed their troubled minds. I remember the final call I made to “Claude” Bernard in his death bed. He said “ND, I am not frightened to die but wish to live to be at my daughter’s wedding in a few weeks”. Sadly his wish wasn’t granted. His voice still echoes in my ears.

On a fine summers day in July I received a call from the hospital to attend their Urology Clinic the following week. This heightened my awareness of the possibilities but I was able to remain calm.  Being in the waiting room to be called by the Urologist was the longest half hour of my life. I resorted to meditation and mindfulness to bring some peace and serenity to my soul. We shook hands when he gave me the all clear. Immediately I was transported to a blissful paradise and felt young, elated and energetic once more.

This ordeal has changed my life forever. It has concentrated my mind on what is important. Religion has never played a dominant role in my existence except when I was growing up in Nugegoda,  living a Christian life. The ten commandments and the teachings of Jesus Christ gave me a good grounding on how to live my life. As a teenager and later a medical student I drifted away from all this and became an agnostic.  This remained with me almost the whole of my adult life. This last episode has brought me closer to the merits of meditation, the benefit of mindfulness and the virtue of the five moral precepts. The 5^th precept however is harder to keep as I love a glass of wine!! I will try to follow the 4 noble truths.  “Nirvana” the elusive state of final liberation from the cycle of birth and death still seems so far away.

The “Mozart Effect” with classical music is tremendously helpful in bringing about peace to one’s soul in stressful situations. Listening to the classics is something that can be done in the confines of your own home. Music of Chopin, Beethoven and Mozart was of great help to me all through my ordeal.

I am the beneficiary of hard work in my youth and have had a life well and fully lived. Despite some disappointments along the way, much to my surprise, I am happy, and often sublimely so. The fine lyrics of that famous song “My Way” does echo my feelings overall. I prefer that 1959 Edith Piaf favourite   "Non, je ne regrette rien",  NO REGRETS.  Shirley Bassey belts it in English with much gusto and feeling. Well actually, I do have just the one despairing regret – not being with my parents in their hour of need at the end of their lives.  I am confident they will forgive me that huge dereliction of duty.