Teratoma is a cancer of young men. When Alex was shown to his bay, he found five companions already comparing notes on how their last three weeks had gone, debating whether the local football team would ever get off the bottom of the league table, and whether bald can ever be sexy – of specific importance to young men whose chemotherapy had rendered their heads as shiny as polished eggs. They all had drips in one arm and, dressed in shorts and T-shirts, were lounging on their beds or walking around with their drip stands, sharing magazines and chewing gum. They were waiting for their first dose of anti-sickness medication, after which the saline bags on their drip lines would be replaced by bags of chemotherapy. They welcomed Alex like a brother.
‘Which side, mate?’
‘Spread far?’
‘Tough luck, mate, but they’ll see you right in here.’
‘You gonna shave your head or just wait for your hair to drop out?’
I was the most junior doctor in the cancer centre, and I was attached to this thirty-two-bedded ward. Drawing the curtains around Alex’s bed for privacy, I explained the way the chemotherapy would be given. The other five young men in the room gathered in the far corner and continued to discuss last night’s TV and the football World Cup in Mexico, in voices loud enough to demonstrate that they were not eavesdropping: each of them had, in his turn, once been here for the first time, scared and embarrassed and embarrassed to be scared; each had learned the dark humour of the cancer ward and of the Lonely Ballroom. It wasn’t just the remaining testis that was lonely.
All the Lonely Ballroomers were participating in clinical trials. Data were (and still are) gathered from centres all over Europe, and it is this constant, trans-European collaborative effort to find the highest possible cure rate that has made it possible to expect cure in more than 95 per cent of teratoma patients; even people with cancer as advanced as Alex’s have a cure rate of over 80 per cent. Their chemotherapy is highly toxic, not only to their cancer cells, but also to their bone marrow, kidneys and other organs.
During this arduous treatment, the hardest toxicity to bear is nausea. These boys are really, really sick: they vomit and retch and feel horribly nauseated for the full five days. Far better drugs are now available to manage treatment-induced sickness, but back then we had a cunning plan to reduce their experience of nausea: for the full five days they were given a mind-bending combination of drugs that included high doses of steroids, a sedative, and a drug related to cannabis. This made them sleepy, happy and very high. Random laughter and ribald jokes became the norm once the drugs began to disinhibit them. The Lonely Ballroom may have been a cancer ward, but it was always a cheerful one, and as the drugs wore off on day five, the guys could remember remarkably little about the experience apart from their mellow fellowship.
I explained all this to Alex, who had been told it all in clinic, but as is often the case with shocking news, he had retained only a little: cancer, everywhere, chemotherapy, blood tests, sperm count, bald, sick, off work. Helpful details like curable, optimistic, getting back to work, had simply gone over his head. He was terrified, and ashamed of being terrified; like all mountain climbers, he could face the fear of a fall and sudden death, but the idea of watching as death approached, helpless as the sacrificial virgin tied to the stake to await the dragon, was paralysing. He should be a hero like his namesake, not a helpless victim. He felt his fear and labelled himself a coward. His shame outweighed even his fear.
Laughter from beside the windows: ‘Butch’ Wilkins, the England midfielder, was being interviewed on TV and had just been asked whether coping with the harsh tackles sprung on him by other teams’ defenders took balls. Cue belly-shaking laughter from the men with surgically adjusted tackle and single balls. Vicious humour was their weapon of choice in public. Behind the curtain, Alex regarded me with sorrowful eyes, slid down the bed while raising the sheet towards his chin, and whispered, ‘I can never be as brave as them …’ as a tear rolled slowly down his cheek.
‘You only need to get through this a day at a time,’ I began, but he started to rock backwards and forwards, gulping and trying desperately to remain silent as he was overtaken by sobbing. The window boys diplomatically turned the TV up. They knew, so much better than I, how the fear of the fear is the worst aspect of all.
I feel so helpless and inept. Is crying in front of me even more undermining for him? If I leave now, will that look like abandonment?
I could feel my cheeks burning, and my own eyes brimming with an overwhelming sense of helplessness before the immensity of Alex’s struggle.
I mustn’t cry, mustn’t cry, mustn’t cry …
‘I just can’t imagine how hard this is for all of you in here,’ I said. ‘All I know is that everyone looks like you on their first day. They all did – and look at them now.’
‘I’m such a coward,’ he whispered as he continued to rock, his sobs abating.
Lost for words of comfort or of hope, I reach for my tray of kit to set up Alex’s drip, and he holds out both arms as if to be handcuffed.
‘Are you right- or left-handed?’ I ask, and like so many artists he tells me he is left-handed. While I prep the skin, tighten the tourniquet and look for a suitable vein, I ask about his art, and he tells me how much he loves the creative process: imagining the work, almost feeling it as a reality; building each canvas, layer by layer and colour by colour; how he dreams in textures and surfaces as well as pictures and colours, endlessly fascinated by the combinations of surface and space, colour and blankness that he sees in nature when he is walking and climbing. He is completely transported as he speaks, and in minutes his drip is attached and his face is calm. I ask permission to pull back the curtains, and we see his five room-mates playing cards beside the TV, a circle of shiny heads and drip stands like a peculiar toadstool ring sitting in a copse of metallic trees.
‘Want to join in, mate?’ one of them asks. Alex nods, and grabs his drip stand. I escape to ponder whether bravery is about being fearless or about tolerating fear. Why do the ideas for helpful responses arise only as I walk away from the bed?
By late afternoon, all the lads are high as clouds and vomiting for England. They lie on their beds and attempt to aim their laid-back heads towards the washing-up bowls that are provided for them: they are too sleepy and slow to catch sudden vomits in the small plastic kidney bowls used for the rest of the ward. They laugh at each other and cheer each other on, and by the time I head for home they are all singing along tunelessly to that year’s World Cup song – which may not, in fact, have had a tune anyway.
Three weeks pass, and it’s another Monday in the Lonely Ballroom. Six lots of blood tests to collect; six drips to set up; six sets of mind-altering drugs to prescribe; six reviews of the last three weeks. Alex is no longer a new boy; he knows the drill, and his shiny head now matches his room-mates’. There is shared outrage at Maradona’s ‘hand of God’ goal against England. Alex’s chest X-ray shows that his many cancer deposits are shrinking very quickly. I take the big, grey transparencies to show him, and he is intrigued by the images, by the contrast of dark and light, the puffball shadows looming large and white against the dark lung tissue, and the huge reduction in size after only the first round of chemotherapy. I explain that all the other secondary deposits in his liver, kidneys and abdomen will be doing the same thing: shrinking away as the chemotherapy has its effect. This increases his chances of cure even further. He nods, serious and thoughtful. I wonder about asking how he feels in himself, whether his fear is still so raw, but I am afraid I may undo his mask, and that he may not wish to go there. I move on to the same, yet always completely different, conversation with each of the other patients.
That week, I was on call on Wednesday evening. I always inspected the Lonely Ballroom drips before going home, because if any failed during the night I would have to drive back and resite them. The guys were quiet. England were on their way home from Mexico, there was a heatwave and the ward windows,