[*FP}— CANCER, the reason for the long suspension of publications in Padronel

05-09-2019

Carlos M. Padrón

Prologue .- Contrary to my habit of not counting the chickens before they are born, I have begun to write this article on 03/20/2019, that is, several days before the events that, at least I hope, will occur in the end.

Because of the subject and the language used, the narration may not be pleasant, but the reader will always have the option to interrupt it.

I did not advertise this, and I only told my relatives here and my closest friends not given to social networks, because I did not want messages to start coming to pity me, asking about my condition, how the treatment was going, etc. That publicity would not have helped me, but I do believe that reading this article can help some people know what cases like mine have, and prepare to face them. That is why I publish it as completely as possible because, moreover, I believe that a trance like this one in which one plays a life deserves to be remembered in all its details.

~~~

The visible origins of what happened can be traced back to 2012 when I had a colonoscopy at the Centro Médico Docente La Trinidad (CMDLT) in Caracas. The fluid that Dr. Bandres asked me to take to cleanse my intestine was for me, that I have very “delicate” skin and tissues, like hydrochloric acid, and caused the so-called sentinel hemorrhoid to burst, which is practically in the anus. As a very “humanitarian” gesture, Dr. Bandres just laughed mockingly when I complained about that.

As a consequence, from there, every time my bowel movements were of soft stool, one part fell into the toilet and the other part went up the right buttock. If this happened at home I resorted to the bidet, but if it happened outside the house I needed a lot of toilet paper to clean myself, and for this reason I always carried with me, in a fanny pack a good supply of this type of paper or equivalent. One of the doctors I went to advised me not to have surgery because the postoperative period would be very long and, above all, very painful.

I followed his advice, and with the hardships of such a hemorrhoid I lived since 2012. In the final months of 2016 I began to sometimes notice slight blood stains on the toilet paper with which I was cleaning. To the touch I did not detect the hemorrhoid, as I had detected it before, and, in my ignorance, I deduced that the blood was a consequence of that hemorrhoid had burst, retreated and bled. In addition, and as if to confirm my suspicion, the phenomenon of diversion of excrement was not as pronounced as before.

When arriving in the Canary Islands in February of 2017, that blood in the toilet paper appeared only occasionally, but at the beginning of 2018 the appearance was constant and the quantity was increasing. As the general practitioner who then had me here shielded herself on pretexts for not examining me, in July I turned to a gastroenterologist (here called digestive) of private medicine.

He reviewed me, and as a very self-explanatory conclusion, he just said to me, “Go to the Health Center and tell them verbatim ‘I’m shitting blood!’ “

So I did, the health system moved, and on 08/27/2018 I had a colonoscopy at the Hospital General de La Palma (HGLP). By the time I got out of recovery and met with Chepina, my wife, who was already talking to Dra. Marlene Domínguez, the Venezuelan gastroenterologist who had already seen the result of the colonoscopy and showed me the photo, she told me that I had a rectal adenocarcinoma (a cancerous tumor) of 4 cm located 5 cm from the anus, and that, a little higher, I also had diverticula. By routine procedure, she added, a biopsy would be made of the small piece that was taken out of that tumor, but that of cancer was safe.

Intrigued I asked her what were the common causes of such tumors.  She told me to be a smoker, drink a lot of alcohol, have a bad diet, lead a disorderly life, family history, etc. To my response that none of that had anything to do with me, she added “And one more reason: stress”. And I think that in this one it was right, because during my last 12 years in Venezuela ­­—in which, by medical order, I had a monastic life, leaving home only in cases of real need, and with zero social activity— I had stress to rent, sell and give away . Apparently, the result was a cancer made in Venezuela by the Socialism of the XXI Century.

The friendly doctors who knew about my case —some of them I have a lot to be thankful for— said that no one died of that today …. as long as the patient submitted rigorously and completely to the prescribed treatment, which, because of the length and its side effects, was always an ordeal.

And yes, once it was underway, this treatment was a real ordeal that, from the beginning and in a selfless way, helped me to cope with Chepina, both physically and emotionally and, of course, in the control of food and medicine, and in the administration of effective home remedies (I call them menjunjes), because my depletion of faculties was increased as the treatment progressed.

What was seen by Dra. Domínguez was sent to Dra. Alejandra Rodríguez , oncologist in practice at the HGLP, who told us that she would make her report and that, as we understood it, she would send it to the Provincial Oncology Committee, a group of oncologists and digestive surgeons who they receive cancer data and, meeting online every Monday, decide how, when and where to apply the treatment to the patient, which oncologist will supervise it, which surgeon will operate it, etc.

The first thing asked by Dra. Alejandra Rodríguez was to do an analytical (I guess specific for the case), a TAC scan and an MRI, and with the results she concluded that my tumor was “localized” (I understood that it had no “branches”) and had affected only one ganglion. All those reports, placed in my file included in the Social Security database, came to the oncologist Dr. Pedro Valle , who works at the Hospital Universitario de Canarias (HUC), located halfway between the center of Santa Cruz de Tenerife (Santa Cruz) and La Laguna, and one day they called me so that, with a companion person (in these cases it is obligatory), we showed up at the HUC on 04/10/2018 for a first consultation with Dr. Valle and with Dr. Hermógenes Díaz, who would be the surgeon who would operate me, and prepared to reside there, in Tenerife, for almost a month and a half.

Patients who, like me, do not live in Tenerife, where the HUC is, but in another island, and must travel to Tenerife, the Social Security pays them the transportation, accommodation and maintenance costs of the patient and his/her companion, a very significant help because treatments like mine require long, frequent lodging, and several flights.

At the Hotel Las Torres, very close to the HUC (about 10 to 12 minutes walking), we got a room with a kitchenette, and for Tenerife we ​​went. It was then when I announced in this blog the first of the suspension of publications, ‘for reasons beyond my control’, lasting several days.

On the first appointment, Dr. Valle told us that he would treat me with radiotherapy and oral chemotherapy simultaneously. The radio would be only on business days (I received 38 sessions at the rate of four “shots” each), and the chemo —which would be oral, less aggressive than the one injected, but poison after all— would consist of a dose of 1,650 mg of Capecitabine (some pills that were given to me in a way that did not spare one) every 12 hours for 42 days, that is, 84 doses, as shown in the table below, which I prepared for visual control of the treatment.

clip_image001

For the chemo I chose as a schedule 09:00 in the morning and 21:00, or 09:00 at night. Dr. Valle also described some of the side effects that this treatment would cause to me, insisting that the list of these, not exhaustive, varies by patient, and that some of these effects can last for months and up to a year, being the most notorious those that occur during the two weeks following the end of treatment.

As can be seen in the table, my radiochemical treatment would end on November 14, when I would return to my house and would wait for the HUC to call me, first for an MRI with an advanced technology device that is in Tenerife very close to the HUC, and then for my operation, which would be, according to Dr. Valle, between 8 to 10 weeks after the treatment ended, that is, after 14/11.

For his part, the surgeon Dr. Hermógenes Díaz told us that if he had been present when the Provincial Oncology Committee analyzed my case, he would have recommended me to go immediately to the operating room, but since it had been decided otherwise, my operation, of high risk, would be to open my stomach, get me a piece of rectum (something like a meter) that included the tumor and diverticula, annul my anus, and make a colostomy, that is, put on my left side a bag that would collect the excrement . He added that sometimes, and depending on the result of the operation, that bag is removed after a few months and reactivates the anus, and other times it is left for life. He also said that there have been rare cases in which tumors like mine disappear with the radiochemo and the plan can be changed. According to him, my operation would be between 10 to 15 weeks after the end of the treatment, and he asked me not to disappoint him.

Intrigued, I answered that I did not understand that, and I was more surprised when he answered that there are patients who, although it seems a lie, abandon the plan and no longer appear, something that I verified that it did because, in conversations between patients and companions in the waiting room for radiotherapy, they told real cases. One of the patients present and who had previously opted for abandonment, had to return to radiotherapy, but already sentenced for metastasis.

During those 42 days, Chepina, the help without which I do not know what I would have done, bought food in one of the several neighboring supermarkets and, using the small kitchen that was in the apartment, prepared breakfast, dinner and the menjunjes already mentioned, one of them a shake with powders that were pure protein, and others were carrot and beet juices, and guava and red paprika.

Every Friday they made me an analytic that would be in the hands of Dr. Valle when on the morning of the following Monday we went to an appointment with him to review the plan. The first analyzes showed platelet descent, which was expected, but suddenly that descent stopped, which could be attributable to Chepina’s menjunje.

In one of those Monday appointments with Dr. Valle, he mentioned that he had told me that my operation would be between 8 to 10 weeks after the treatment ended on 14/11, while Dr. Díaz had told me that would be between 10 to 15 weeks after that date. Dr. Valle’s response, which I did not understand what relationship he had with the weeks, was “We (I suppose he was referring to the group of oncologists of the committee) sought not to put you in the bag. I will talk to the surgeon”. And my reaction was to join the palms of my hands with prayer and say “Please!”, because the idea of ​​such a bag stuck to my left side in order to collect excrement I never liked , although, using my vein of black humor, which has caused several troubles, one day I told Chepina that this bag had three advantages: 1) It does not force to leave running in search of a bath; 2) The gases do not give a bad smell;  3) It implies a great saving in toilet paper. But Chepina did not like my conclusion.

Among the side effects considered most frequent according to Dr. Valle’s list were lack of appetite, nausea, vomiting, skin lesions, reduction of the size of the bladder and consequent need to urinate more frequently, discomfort when starting to urinate, tingling or burning in the abdomen, and alteration of stomach and intestinal functions. This alteration turned out to be what made me live in squares, because besides the intestines suffered, like many other parts of my body, the effects of the chemo, were also the most affected by the bombing of the radio and, consequently , the evacuation pattern became chaotic and unpredictable.

Sometimes the desire to evacuate were many, and upon arrival in the bathroom the result was only gas and mucus; sometimes the desire was —or seemed to be— few, but the result was a heavy deposition. The common factor was always, in any case, the need, for foresight, to be near a bathroom, because in four times during the treatment I did not arrive in time to a bath, the evacuation took place anyway fouling underpants,(I will wear or not compress), pants, socks and even shoes. I just had to take refuge in a public bathroom (luckily, almost everyone is clean here) and start washing, cleaning and making use of clothes, spare pads and plastic bags that Chepina always wore. She was once forced to enter the men’s room to help me.

As for the skin lesions, I had burns, scratches, bladders, blisters, rashes, rare bluish pigmentation in hands and nails; tingling under the skin, like of bubbles that struggle to get out; symmetrical itch in the calves (in the same place in both), or in shoulders, chest and sides; patches of dry and corrugated skin on the back of the lower half of my body that sometimes felt like wet areas, but were dry; and even cuts as painful as those that can be done with a sheet of paper and that, moreover, appeared on any side of the body, even in the most unusual. In some I could cure them, but in almost all Chepina was responsible for facing them.

One afternoon we went to Santa Cruz to pay a visit. When leaving to return to the hotel, the soles of my feet hurt so much that I could barely reach. When he checked them out at the hotel, Chepina found them full of blisters, like water bladders, which were even under their fingers. At the nearest pharmacy the necessary was bought and Chepina was bursting and curing the blisters one by one, which was repeated for a couple of days as they continued to come out, although less and less. Something curious about these effects is that, at least in me, they appear suddenly and they also leave suddenly.

The other side effects announced —nausea, vomiting and nausea— could not be with me, which, I believe, was largely due to the fact that I never fell into pessimism since my father taught me how to eat everything since I was a child; at the table in my house the expression “I do not like it” was forbidden. Consequently, as of all, but, in my state of inappetence, among the short list of what allowed me to eat (the forbidden food was much longer) there were dishes whose memory caused me less repudiation than others, and we gave ourselves to the task of looking for where they prepared them in an acceptable way for me.

That’s how I discovered that a chamomile before lunch prepared my stomach well, and a chicken soup, too. A restaurant in La Laguna where, as in almost all, you could get chamomile, served a good chicken soup, a good pork chop, and pieces of chicken or rabbit, and I tolerated those dishes well, so that restaurant went in my list. And also one of Santa Cruz that stands out for homemade food, fast service and decent prices, where, in addition to chicken soup or chamomile, I could eat Arroz a la Cubana —white rice with beans and a banana fried—, something difficult to obtain because, for what remains mysterious reasons for us, it is very rare that the restaurants here serve white rice, something that in the Venezuela in which I lived would have been unheard of.

With those three dishes, and going by tram one day to Santa Cruz and another to La Laguna, I banded the first days, until, after a lunch in La Laguna, Chepina wanted an ice cream dessert. While she went to an ice cream parlor, I waited for her sitting on a bench in the street (I was not for unnecessary trips), and on her return she told me that this ice cream shop, which was made by Italians, was also a restaurant that offered four dishes in its menu of pasta.

The mere mention of the pasta stimulated me (in this blog I counted some time ago that I think I was Italian in another life), and the next day we went to lunch in that restaurant. The pasta seemed very al dente. I asked to be cooked a little more and it turned out that the pomodoro penne was for me as a lifesaver and settled down as another option for my lunches. From there, and with few exceptions, I followed the sequence of a day lunch at the Santa Cruz restaurant, the next day at the La Laguna restaurant, the next at the La Laguna ice cream shop, the next day back to Santa’s Cruz, and so on.

After “tasting” the rigors of this regime I sympathized, and I feel more and more, the patients who receive chemotherapy and are those people with a “fine peak” who do not like this, the other and the other. I knew of one who vomited everything he ate, they submitted him to intravenous feeding, and soon died.

During the radio session on Fridays they used to do x-rays for me, and from the second Friday, at the end of the radio session I was approached by a nurse from the several who had there for, tablet or papers in hand, to do a survey during which and in successive Fridays it took place, ask more, ask less, a dialogue like this:

– Don Carlos, do you feel a lot of pain?

– Pain? I do not hurt anything.

– Nowhere and at any time?

– Nowhere and at a any time.

– What about nausea?

– Until now I only had one for how badly it smelled me when I passed a seedy restaurant, but I covered my nose, walked away as fast as I could, and the nausea stopped.

– So you have not vomited?

– No, I have not vomited even once.

– And do you eat well?

– Although I do not feel like eating, breakfast, lunch and dinner because I was ordered to eat, but only as what my stomach accepts and as far as he allows.

– How is that how far is allowed?

– Well, there comes a time when my stomach “tells me” “Not one more bite, because if you keep going you’ll vomit!”. And that’s where my food arrives.

– How do you tolerate the dose intake of the chemo?

-When I wake up in the mornings I feel so weak that to get up I need to take hold of the little will I have and the one I do not have, but I manage to get up. Breakfast (a sandwich of sliced ​​bread with a slice of ham and another of cheese, or a fried egg or a French omelette) accompanied by the stuff that my wife prepares for me. And before half an hour of having eaten and drunk that I take the dose of Capecitabine and go back to bed. About 45 minutes later I feel strong enough to go to the bathroom, clean up, get dressed and walk out here in order to arrive here around 11:45, as my radiotherapy appointment is, theoretically, at 12:15.

Unable to contain his astonishment, upon hearing this story the nurse told me:

– Can you do all that with just resting 45 minutes after takig the chemo pills!? I do not get it!

The first time this dialogue took place, the nurse, with a frown and a look of skepticism, made me understand, with that exclamation, that it was difficult for her to accept my answers as true or normal. As most of the questions and my answers to them were repeated in the second survey, the third, a nurse who had come before was accompanied by another, older and perhaps higher, to serve as witness, and when the survey ended, the nurse who had already come gave the other a look of “Do you see what I told you is true?”. She shrugged and when she left I’m almost sure that I heard her say something like “This guy is Martian”.

And then there were no more polls. When I returned home I told one of the doctors who had helped me here, in a humorous tone he said “Sure, you broke their statistics”.

After the treatment on 14/11, in my farewell appointment with Dr. Valle he told me that he wanted to see me a month after they operated on me, and the results of a special analysis and a chest and abdomen TAC were already in the system, which could be done on La Palma (as indeed they did) and for those who gave me the corresponding orders.

According to what was anticipated by Dr. Valle, the side effects riddled me during the two weeks immediately following 14/11, reaching things as absurd as that I, who have never known what is even a discomfort in the denture, one morning I woke up with tremendous pain in all the teeth of the upper jaw, especially one in particular that had become sensitive. At 48 hours, that pain disappeared as suddenly as it had arrived, although the piece in question needed root treatment. Weeks later, the same in the lower jaw, and in particular in the union between the lip and the base of the gum. A couple of applications of a special cream, and goodbye pain.

In sight and hearing I noticed a deterioration that those senses did not have before the treatment.

Days later, they called me from HUC so that on 07/12 I would have an MRI, but not at La Palma, but at IMETISA (Instituto Médico Tinerfeño S. A.), where they say they have the most powerful MRI team in the province. And it seems that this is so because when I look with amazement at the size of the machine with which they were going to make me the study, the specialist in his handling asked me if I had done a resonance before. To my answer that yes, that I had done two, corresponded with a “Well, the machines with which they were made are toys compared to this one”.

He placed me properly on the stretcher of the machine and put on headphones (hearing aids) to prevent the loud noises that the machine would emit damage my ears … and began the scandal that at one time seemed a percussion concert of a Caribbean group, and in others the stretcher hit my back several times so that the intestines were in proper position to “photograph” them.

The result of the resonance, once prepared by the specialist, would be incorporated by him into my file in the Social Security database, and about him Valle and Díaz doctors would tell me in the next appointment.

That next appointment took place at the HUC on 20th and 21/12. When Dr. Valle read the report of the resonance, he looked at me with a reassuring expression and said “We have good news: the tumor has disappeared”.

For his part, the surgeon, Dr. Hermógenes Díaz, also celebrated that disappearance and told us “Before this, I will not do the operation I had said I would do, but a simpler one that is done with the TAMIS technique (Transanal surgery minimally invasive). He took out his cell phone and in the calendar he counted up to 9, from which I deduced that he would operate me after 9 weeks from 14/11. He gave me the order, marked urgent, so that in the HGLP he would make me the pre-anesthesia exams and examinations, and when he said goodbye he said: “Sir, you have taken out the lottery!”. My faith and optimism, based on the fact that “nobody dies of that nowadays”, increased several whole numbers with these words of Dr. Díaz.

A few days later they called me from the HGLP to go pre-anesthesia, and that made me guess that they would call me soon for the operation.

The supposed 9 weeks would be fulfilled on 01/06/19, but as that day arrived and I had not been called by the HUC, I began to call myself until I found the department that knew about the plans for my operation. To my question of when this would be, the elusive answer was that it would still take “a little more”. I asked then how much was that “little bit more” in terms of time, and the answer was that, due to lack of availability of operating rooms, it would take one or two months.

As the operating rooms argument did not convince me, I continued to investigate by another route, I found the waiting list and the answer was that the delay was due to lack of beds because the flu epidemic had overwhelmed them all to the point that some of the Intensive Care Unit (ICU) were occupied by flu patients who did not require intensive care.

On 02/23/2019 I received a call from the HUC, about noon, in which I was told that, for the purposes of my operation, I should be at the HUC on Thursday, March 7th at 08:00 in the morning. … but that they would confirm that, also by call, on day 6. I assumed that this confirmation call or suspension would also arrive at noon, which is when, once discharged some patients, and the HUC would know what beds would be free.

As the travel agency told me, because of the Carnival —parties that I detest since I had the use of reason — the flights between La Palma and Tenerife were all full, but they would see us get a seat in some. Days later they said that they had gotten it on a flight that would leave at 12:00 noon on 06/03.

Given the possibility of a late call on the 6th confirming or suspending my appointment on the 7th at the HUC, we decided to leave our bags on the 5th at night and leave for the airport on the 6th at midmorning. If in the trip, of about 45 minutes, the call arrived suspending the appointment of day 7, we would return to house, but if it confirmed it we would take the flight of the 12 to Tenerife.

But the travel agency continued to work on my case and days later they told me that they had got us a flight by 6 o’clock on the afternoon of the 6th, which allowed us to wait at home for the call that, as I suspected, arrived almost at 12 noon on that day 6, but, finally, confirmed that I should be in surgery of the HUC on Thursday 7th at 08:00 in the morning, and put on the blog the second notice of suspension of publications ‘for reasons beyond my control’.

We traveled on the afternoon of the 6th, we stayed at a good friend’s house, and on the 7th I was on time in the HUC surgery admission section.

The allocation of bed confirmed the shortage of these, because instead of giving me one in the plant reserved for digestive, I was given in the trauma (room 522, bed 1), and once I took possession of it I was said I could not eat food or water … and just in case, since nothing was told me about it, I did not have breakfast on the 7th, so my last meal had been dinner on the 6th.

About 9 o’clock in the morning of the 8th, and using the wheeled bed I was in, they took me down to the operating room. To avoid thrombi, they injected something into my abdomen and put on some elastic stockings that tightened me from the feet to the groin, and then anesthetized me with a mask.

The next thing I remember is that five women had me immobilized in my bed. One held my feet, two of them (one on each side of the bed), the legs, and the other two (also one on each side of the bed) hands, while saying “Quiet, Don Carlos, quiet!” but I could not be calm because I saw that the bottom of my bed was tucked inside a large monitor, like a 100-inch TV screen, and I wanted to get my bed completely to escape from that, but the ways (for medication and hydration I had put one in each hand) stumbled with the edges of the monitor and prevented the bed from leaving.

Suddenly, to my left appeared another woman who told me:

– Do you know who I am?

– Yes, you are Chepina —I answered her.

– Well, rest assured that this is only virtual reality.

– Virtual reality is not like that! —Chepina says that was my angry response.

And I think I calmed down afterwards. When I was taken back to my room, embarrassed I managed to apologize to the staff that was still close to me. They told me not to worry because my reaction to anesthesia was very common, and that they were used to reactions much worse than mine.

Dr. Diaz spoke with Chepina, told her that the operation with TAMIS had gone well, that the result of the biopsy that would be done on the slice or piece of rectum that was taken out of me would be ready between one to three weeks, and that I should keep rest, avoid efforts or lift weights, and consume only a soft diet. The same told me when a few hours later he visited me in my room where, “enjoying” from Saturday 9 of the famous hospital food, every time I needed to go to the bathroom —which was very frequent — I had to go slowly and rolling the stand where the bags of fluids connected to my body hung. Apart from these, in the abdomen I was injected with heparin, also to prevent thrombi.

On Wednesday, March 13, I was discharged. That night we stayed at our friend’s house, where Chepina had stayed while I was hospitalized, and when I woke up on the 14th, I had such a weakness that I could barely reach the bathroom, shower and go back to the room. The same friend took us to the airport and helped Chepina with suitcases and others because my weakness was such that I could hardly stand up.

We had breakfast at the airport (sandwiches and coffee), and being seated on the plane that would bring us back to La Palma, I felt as if a switch had passed inside me that injected me with energy and made the weakness disappear. And then I realized what the reason for it was that I had 3 days without food and 7 without coffee! So the first thing I did when I arrived at the airport in La Palma was to have two more coffees, and an arranged affair.

During the next few days the desire to go to the bathroom intensified, sometimes for a normal bowel movement, but most of the time for only gas and mucus. As the mucus became more and more reddish, I asked for a blood test in my stool on my own, and tested positive. On Tuesday 02/04 we went to consultation with our family doctor. He ordered me to do an analytical with urgency and that on Thursday or Friday I went back to consult to know the result.

On Thursday 05/04 we went to have lunch with some friends. Before leaving the restaurant I made a normal bowel movement, but only a little after, at about 5 pm, the friends left us at home, I had two bloody stools, in the second one, which sprouted without warning and when I was foot, it was very abundant and with a fairly large clot. After cleaning up the disaster, we went to the Emergency Department of the HGLP where they left me hospitalized, again with serums, and they did exams, tacts, tests, interrogations, etc.

By noon on Friday 06/04 the blood in the mucus was very little, before which the doctor who treated me said that, according to the oncologist, the expulsion of blood was something specific to the operation that had been done to me, and he signed up.

By pure serendipity that doctor asked me if they had given me the result of the biopsy. When I said no, she asked me to wait, and on her return she gave me not only the result of the biopsy but also the CT scan. And, oh, wonderful !: both said that there were no cancer cells in my body, that is, that the adenoid carcinoma of the rectum had been eradicated without leaving any trace.

I returned home giving thanks that on Thursday 05/04 the incident that made me go to the emergency department of the HGLP had occurred.

At noon on Tuesday 23/04 I had a consultation with the oncologist Dr. Valle at the HUC, who, as I said, has directed and monitored my treatment. This was the first consultation with him after I had surgery on 08/03.

The most important thing that occurred in this consultation was the official ratification of what was indicated in what 06/04 had given me in the HGLP, because, after Dr. Valle reviewed the documents, printed and on screen, about I had my case, he told me “The analyzes and studies that have been done after the operation indicate that, with regard to the tumor, you are cured”.

After I told him what and how I felt, he concluded by emphasizing that, in addition to periodic check-ups (the first will be next July), I must learn to live with the side effects (of radio and chemo) while they last, and the worst of them is what I have called chaos defecation (the buzzword is mine).

I think this is a reason to ratify the words of the surgeon Dr. Hermógenes Díaz (“Sir, you have taken out the lottery!”) and to start a new stage of life, not only because I must learn to live otherwise, but because, at least for now, the horrible ghost of cancer has disappeared.

The day before yesterday, 07/05, I had an appointment at the HUC with the surgeon who operated on me, Dr. Hermógenes Díaz, with which I finished the postoperative consultations. After reviewing my case, he said that I was about to have a colostomy —that is, to have the ominous bag put on me—, he ratified Dr. Valle’s verdict, including the periodic reviews for about three years, and set the first one with him also for July, as ruled by Dr. Valle. As for the side effects, including defecatory chaos, he insisted on the need for me to flee from stress.

I only have to thank the Spanish Health Service —in particular the person of all the professionals who took care of my treatment and operation— , my medical friends who helped me from the beginning, my non-medical friends, my relatives and the acquaintances who encouraged me to continue with optimism, and, above all, Chepina, without whose physical and emotional support, dedication and constant care I do not know what would have happened to me.

Reflections

About what is commonly attributed to luck,

· Was it good or bad for me to be disturbed by the sentinel hemorrhoid?

· Was it good or bad that Dr. Hermógenes Díaz had not been part of the committee that diagnosed my case?

· Was it good or bad for me to leave Venezuela when I left to come and settle in the Canary Islands?

· What would have happened to me if my case had been treated in Chavez Venezuela?

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