On Borrowed Time

Acknowledgements

ON BORROWED TIME

In the early spring of 2016 I woke in the middle of the night, at a time when my defences were down, aware of a lump in my throat. When I was a child there had been an advertisement on television called The Seven Warning Signs of Cancer. One of the signs was described as a lump or thickening in the breast or elsewhere. The reference to elsewhere was rather alarming. Although I did not yet know it, the elsewhere had finally caught up with me. Whatever it was that was not right persisted. Eventually I consulted the GP I have been seeing regularly for the past twenty-five years or so. I mentioned my lingering sore throat. Should I perhaps return to the ear, nose and throat specialist who had diagnosed a cancer on a vocal cord eight years earlier? He thought that to be on the safe side I should.

Even though the reason for my regular rendezvous with the ENT specialist over the past years was far from ideal – checking that the cancer had not made a return – strange to say I had grown to be very fond of him, with his warmth, humour and no bullshit directness. Because of the combination of his kindness and his old-fashioned Anglo-Australian grammar school manner – he always referred to my wife as Mrs Manne – I thought of him as a Weary Dunlop type. (This turned out to be more accurate than I imagined. Every year, he travelled to the Kimberleys and the Northern Territory to examine scores of Indigenous patients and conduct simple operations. As I soon learned when we were discussing future appointments, like Weary he has a keen and practical interest in social justice despite his conservative demeanour.) The specialist now looked down my throat with the aid of an instrument that passes through the nose, and in a matter of seconds announced, Cancer, I’m afraid.

Because of the previous cancer, I knew the ropes, or at least thought I did. A simple operation would remove some of the lump, in part so that an almost certainly unnecessary biopsy could be carried out. Then, so I imagined, I’d be travelling down to the Epworth Hospital in Richmond five days a week for radiation treatment or, in the worst of cases, maybe also chemotherapy. I phoned my wife, Anne, to tell her the news. On the car trip home, my mood was one of defiance and (inexplicably) slight elation. On our verandah, looking onto the garden of the cottage where we have spent the past thirty-five years together, Anne and I calmly discussed the many implications.

On 26 October the small operation took place at the Austin Hospital in Heidelberg. The biopsy confirmed the bad news. Shortly after, I spoke on the phone to the radiation oncologist at the Austin who had advised us at the time of the previous cancer. It was then that I learned I didn’t know the ropes. The oncologist thought that the larynx – popularly known as the voice box, although it is considerably more than that – would most likely have to be removed. Without even thinking I responded: I’d rather die. From time to time I’d seen a cheerful old codger in the local shopping centre speaking through the use of an electronic device placed against his throat. He sounded like a robot. This was what I thought might await me.

By now everything had become more intense. Before the biopsy, in Brisbane, where we were both speakers at a conference, I dined in a quiet restaurant with my friend of fifty years, Rai Gaita. A young woman approached us. She spoke almost with solemnity: What a beautiful friendship. How could she possibly know that? She told us she had been watching us for two hours. Around the time of the diagnosis, a book I had written on the ideology of the Islamic State was published. This meant that the news of the cancer’s return coincided with a number of public engagements, most of which had to be abandoned. I will never, however, forget one interview after the biopsy – for a religious program on ABC Radio National – which was not cancelled. I arrived at Southbank in torrential rain. To my complete surprise, the ABC building that I had visited scores of times looked like it had been bombed. It was, in fact, being entirely renovated. I ran in panic trying to find the new entrance. As the interview began, I was still panting. Andrew West, who had obviously read the book carefully, asked all the right questions. When we were finished I expressed my gratitude for his uncommon conscientiousness. I explained that this mattered to me more than usual as I was about to undergo a laryngectomy, and it would probably be the last interview I ever recorded. I was standing in a temporary tardis in Melbourne. He was in Sydney. Perhaps the combination of high praise and bad news overwhelmed Andrew. As we spoke, his voice broke.

Shortly after, Anne and I saw the Austin oncologist, a kind and sensitive man. We discussed alternatives to a laryngectomy, an unfamiliar word for me at that time. Radiation would most likely be useless, as my skin had previously been irradiated. Anne had read about so-called partial laryngectomies. The oncologist doubted this would be a possible treatment. My wife, who has dealt with horses for much of her life, has a far better understanding of physiology than me. She took in what I hardly heard. Without a laryngectomy, there was a strong possibility that within a matter of months I would be facing a very painful death. With delay now, the chance of performing a laryngectomy later might have passed. Nonetheless, despite all this, we left the appointment hanging onto the slender hope of some less radical treatment. The oncologist told us his colleagues would think that even considering anything other than a laryngectomy in my case was a serious mistake. He had, however, taken to heart my first words – I’d rather die.

The oncologist arranged two appointments: one with a surgeon and a speech therapist at the Austin, the other with a surgeon at the Epworth. At the Austin the surgeon who might operate had been called away. We spoke briefly to one of his colleagues. I recall, with a certain grim amusement, only one remark: A laryngectomy is a straightforward operation. More important was the meeting with the speech therapist. With an intact larynx, the throat facilitates four vital human activities: breathing, speaking, eating and drinking. Without a larynx, the principal functions of the reconstructed throat are eating and drinking. A new passage to the lungs, to enable breathing, has to be created surgically. The surgery leaves a roughly ten-cent-size hole below the chin, where the Adam’s apple used to be, which is called a stoma, another new word for me which would become all too familiar. Speaking is possible, we now learned, not only as in the past with an electronic device but also with a rather magical silicon prosthesis which connects the reconstructed throat to the newly created passage to the lungs. The Austin speech therapist introduced us to a laryngectomite of five years’ standing. He spoke remarkably well, in his old tone of voice, he told us, but with slightly reduced volume. He was presently trying to teach himself to sing. To speak he had to place his thumb over the stoma, which was concealed behind a piece of spongy cloth. He did not use the alternative way of speaking open to a laryngectomite – a flexible base plate holding an air filter that allows one to talk when it’s pressed down by the thumb. Before showing us his stoma hole, the laryngectomite asked us, rather delicately, not to be alarmed. We weren’t. To illustrate the point about the retention of the old voice even after the removal of the larynx, the speech therapist told us a rather charming story. A Scottish woman, about to undergo a laryngectomy, had inquired nervously: would she keep her Scottish accent? She was assured that she would.

Some days later Anne and I went to our appointment at the Epworth. There were, in fact, two surgeons. The cancerous growth on my throat was displayed on a television screen. The surgeons discussed the problem and the treatment options as we listened and asked the occasional question. The ideas of more radiotherapy or a partial laryngectomy were both summarily dismissed. Within less than half an hour of eavesdropping on their discussion, we had both been convinced. A laryngectomy was unavoidable. Indeed, because the cancerous growth was so large, the operation would also require a plastic surgeon. The younger of the two surgeons we met with would perform the operation. The slightly more senior surgeon assured us that he would trust him with the lives of his own family. The date for the operation at the Epworth was set: 24 November. My initial thought – that I would rather die than have the larynx removed – by now seemed a decade away. During this time there were a flurry of tests. The one I remember best was the so-called PET scan, to see whether the cancer had spread. It took place on the day of the American presidential election. When my body entered the chamber, horizontally, Donald Trump was faring surprisingly well. When it emerged, he was president-elect of the United States.

As the major operation approached, Anne asked me to say something on her phone so she would be able to remember my voice. I quickly wrote and then recorded a letter to the love of my life. The supposedly straightforward operation took ten hours or more. When I regained consciousness, there was a hole in my neck, my slit throat had been sown together, the area around the neck was grotesquely swollen, and of course I could not speak a word. Apart from the doctors and nurses, the only person I wished to see or to see me was Anne. To observe the condition to which I had voluntarily submitted must have been a terrible shock. Anne is incapable of self-deception and feels things intensely. And yet on that day and on every day after that I spent in hospital, she remained calm, cheerful and optimistic. Partners in life who have been truly close for a long time often begin to think and feel as one. Our new friend, Gerry Gill, calls this the third mind. One of the central concepts of Anne’s and my third mind is moral effort. This is what Anne was able to summon. Without her calmness, cheerfulness and optimism, her moral effort at this time, my body would, I suppose, have survived but my spirit would most probably have been, perhaps permanently, damaged.

On the first day after the operation, I was bright. On the following days that brightness faded. In this state I was encouraged by the energetic Epworth speech therapist to learn how to clean the prosthetic device by twirling a brush inside it while gazing into a mirror, an intricate manoeuvre involving not inconsiderable hand–eye coordination. I resisted. This was not, as she imagined, because I could not bear to look at the stoma. It was rather because I could not bear to look at my swollen neck. In one of my nightmares at this time, where I dived headfirst into an empty concrete swimming pool to my death, I was bloated and my skin a jaundiced pale yellow. I was also encouraged very early on by one of the ward’s physiotherapists to get out of bed. I tried to stand. As I was about to throw up, she faced a split-second choice as to whether the vomit should be captured by cloths or in a metal half-full wastepaper bin. Unfortunately, the conventional cloth option was chosen. Some of the vomit fell on the wounds.

Since the operation I communicated with pen and paper. I told Anne that there were two recurring phrases in my head. One was a paragon of manual ineptitude, a description given me by the filmmaker Ben Lewin when we were university students. This explained my pessimism about cleaning the prosthesis. The other was my weariness amazes me, a line from a Bob Dylan song. This was how I felt.

Even before I developed a temperature, Anne was the first to notice that something was seriously wrong. On a routine early morning ward visit, less than a week after the first operation, the plastic surgeon recognised that my condition was perilous and rushed me back to the operating theatre. A very kind and gentle man, he rang Anne to explain the situation and put his phone to my ear so she could talk to me. Anne realised that this might be our last conversation. While I was being operated upon, she listened to the letter I had recorded a week before and wept. For my part, foolishly I felt no fear. The second operation, to clear the infection and once again to reconstruct the throat, in part by drawing on muscle from my chest, also lasted ten hours or more. I have since asked my surgeons whether at this time my life was threatened. According to both, it was.

The anaesthetic was wearing off as I was wheeled from the operating theatre to the intensive care unit. I had entered a weird and profoundly disturbing state of consciousness – between dream and reality – that I have not experienced before or since, and to which I hope never to return. Names of wards, the true names, flashed past. When I reached the intensive care unit I was still in this netherworld. A voice kept asking: Professor of what? Professor of what? Later I recognised that the voice belonged to the ICU nurse assigned to watch over me. When I returned to the world, I asked for some sheets of paper so I could speak to Anne. I wrote: We made a MISTAKE – should have decided otherwise. NO TREATMENT no chemo no radiation I had a terrible nightmare coming out of the coma I feel clear in my mind I know there is now a logic I/we must see to its end I have never feared death I am resolute But. Shortly after, with the title of George Orwell’s short essay on Malcolm Muggeridge, The Limits of Pessimism, in mind, I wrote: The Limits of Optimism. This was the only time I was overtaken by despair. Anne talked me round. The head of the ICU asked me whether I’d like to speak to a counsellor. Why not? I wrote: Like Karl Marx I’m interested in everything. I doubt if he knew what I was talking about. But my spirit had returned.

After leaving the ICU, I settled again into the private room I had been allocated, very grateful that it was not shared, and quickly established a routine, as is my wont. First thing, an email to Anne and one or two emails, depending on my strength, to my daughters, Kate and Lucy, or, later, to my nephew David, son-in-law Daniel and closest friends. Then a morning newspaper. For the first time in my life, some morning television. Reading for an hour or two. Cricket or golf interspersed throughout the day, if being played. The test match was a blessing. An afternoon nap. And finally an evening film, almost always with Anne. We celebrated our thirty-fourth wedding anniversary sitting alongside each other by the side of the bed, with a Claude Chabrol moral-psychological thriller playing on my screen.

My physical condition was pitiful – voiceless; a feeding tube in my nose; another tube, affectionately called by doctors and nurses a trachy tube (short for tracheostomy), inserted permanently in the stoma to help it keep its shape; a catheter for pissing into; matted hair, which could not be washed lest water enter the stoma; stubble gradually turning into a beard, as my skin was too sensitive for shaving; a coated tongue, which felt like a swamp; my left arm in a cast to protect the area from which skin had been removed for grafting; grotesque, unsightly swelling around my stitched together neck, which I remained unable to look at in a mirror for several days; so many fresh scars in so many often unexpected parts of my body that I joked that I now resembled a veteran of the American Civil War; bowels occasionally blocked and then wildly out of control; and a mild case of pneumonia which the dry-witted respiratory physician who visited me regularly thought ranked no higher than fifteen in the list of my bodily ailments.

And yet, my spirits remained high. Opiates were undoubtedly one reason; among my notes I have found that shortly after my second operation I wrote: Morphine is my friend. But readers who have persisted so far will know the infinitely more important explanation. Anne was with me for several hours almost every day and in spirit always. So, too, although less intensely, were close family and friends. I was never less alone in my life than now. Had I been alone, God only knows what would have become of me.

To regain even a semblance of fitness, not my strongest suit even when well, the only possible exercise was to walk laps of the ward, which comprised a perfect square. I began with one lap but graduated to six a day and then, rather proudly, twelve. At first I was accompanied by a nurse or Anne, who, as we shuffled along, pushed an upright trolley to which my various tubes were attached. The number of tubes I needed reduced over time. Eventually I walked by myself unencumbered, a free man. On one occasion, a bloody patch suddenly appeared on my pure white hospital frock. The chest wound had oozed. It was easily repaired. In my hospital room the trachy tube had once mysteriously popped out. For this reason, as I walked by myself around the ward, I held onto it tightly, in fear that if it popped out again unnoticed while I was doing my laps a wardwide search party would have to be mounted. Trachy tubes are custom built; one size definitely does not fit all. On another occasion a physician accidentally knocked out my nose tube. The new one was stitched in. In my record of conversations, the plaintive cry: Please be careful with the nose tube, occurs at least a dozen times. The more senior surgeon paid a visit early one morning with his two-year-old son. One look at me – a bearded, bed-ridden man with a tube in his nose – and the boy burst into tears and ran to the arms of his father.

One day, on a walk through the ward, a new thought struck me with some force. Since childhood I had hated the look and the smell of hospitals, where my mother spent periods of time because of her multiple sclerosis. Since then I had scurried along their corridors, noticing as little as possible. Because of the operation, I now smelt nothing. And, as I did my laps, I found that I no longer averted my gaze from the people sitting disconsolately in their rooms staring at television screens, or hobbling around the ward in dressing gowns and slippers, or being wheeled on beds, their faces often blank with fear or pain. Simply as a matter of common courtesy, I nodded and smiled as I passed fellow patients, and also the growing number of hospital staff I had come to know. These people were no doubt part of a modern bureaucratic organisation based upon a careful division of tasks and a hierarchy – surgeons, physicians, administrators, nurses, nursing aides, cleaners, food deliverers and so on. Many worked with the most sophisticated contemporary medical equipment, which seemed to be strewn almost carelessly along the corridors of the ward. Yet these people’s working lives were dedicated to an ancient impulse which gave meaning to the idea of a common humanity, providing aid and comfort to the afflicted. And they were required in their carefully regulated work to fulfil, on the community’s behalf, what compassion, the finest of all the moral virtues, demanded. Hospitals were for me quite suddenly no longer places of dread to be avoided but secular cathedrals of the humanist spirit, worthy of celebration.

I did not speak a word for six weeks. But I was never silent, because of pens and a succession of A4 pads, most of which I still possess. Anne was of course my most important conversationalist. In my scrawls, she told me, she could still hear my voice. I also conversed eagerly with new acquaintances – the surgeons, physicians and nurses. As she sat on my bed, a nurse from central Queensland told me about her idyllic country childhood, and I told her about Cottlesbridge, where our two daughters had grown up and where we now lived with a menagerie of four cats, two horses and two dogs. Another was torn between a career in nursing or public relations. I told her that I believed nursing was 1000 per cent more important. Yet another, an inner-city Carlton-Balmain type, came up with three practical suggestions during conversation – a spoon to scrape away some of the swamp that had settled on my tongue; dry shampoo for my greasy, knotted hair; a ribbon attaching pen to pad to avoid unnecessary frustration. She smiled wryly when I called these ideas revolutions. One day a big bunch of flowers from Greenpeace and David Ritter arrived. The nurse who brought them had once worked for a conservation group. We discussed mutual acquaintances, one of the staples of pleasurable conversation. When the plastic surgeon returned from the week he spent in Burma shortly after my second operation, I told him about a friend, Martin Krygier, who was involved in a rule-of-law project there. We agreed that bringing the rule of law to Burma posed a far greater challenge than streamlining the delivery of surgery. I spoke to others about his altruism while he was away. The respiratory physician, in the characteristically Australian way, joked that he was probably holidaying in Queensland. These conversations would once have seemed inconsequential. They remain fixed in memory because of the circumstance in which they occurred.

Before eating or drinking after a laryngectomy, the patient is required to pass what is known as the swallow test. The test involves drinking, while standing, a mildly unpleasant liquorice-tasting liquid, which makes its way down the reconstructed throat as an X-ray is taken. If there are any leaks they can be seen. In the fortnight following the second operation I was twice transported to the Epworth’s imaging room. I failed the first test. The second test took place after I’d been reading the Australian. I was so angry about the campaign the paper was conducting against Gillian Triggs, the president of the Human Rights Commission, that I composed an opinion piece in my head, later published on the Monthly website, while waiting in a wheelchair by the imaging room. My anger was unconnected to the small leak the second swallow test detected.

We were now in mid-December. Christmas was approaching. Recognising there was no point staying in hospital, my plastic surgeon – who told me his mentor believed four weeks were needed for the post-laryngectomy throat to heal – suggested that I go home before returning for a third test scheduled for early January. This caused a little unease at the hospital. It was unusual for anyone to return home with a tube still in the nose.

I believe that the animals – especially the male Burmese cat – were pleased to see me. I was certainly pleased to see them. And I was happy beyond measure to be home. Accompanied by boxes of liquid feed (I refuse to call it food) and with a feeding pump and the dozen or so drugs I needed, Anne and I celebrated Christmas with Lucy, our younger daughter, and brought in the new year by ourselves. On New Year’s Eve we watched James Stewart in Frank Capra’s It’s a Wonderful Life (the film was carefully chosen) and then, to the distant crackle of fireworks, listened to Kathleen Ferrier singing Gluck’s What Is Life To Me Without Thee? with tears – of relief, of trepidation, of sadness, of joy, of love – welling in our eyes.

We were very tense before the third swallow test. But I passed. A short stay in the hospital was needed to check how well I could eat and drink. This time I was in a ward for four, with beds separated only by curtains. On one side was an old gentleman whose political opinions seemed to be shaped by Andrew Bolt and the Herald Sun. Across the way was an elderly Filipino, who had been taken ill while visiting his son and daughter-in-law. He moaned throughout the day and into the night in what appeared to be mild pain – as soon as he spoke to his son or the doctors he was cheerful. I have never more valued the politically incorrect British virtue known as the stiff upper lip. After the nose tube was removed – hallelujah! – drinking was easy, eating less so. Foolishly I chose broth. The hospital broth was intrinsically distasteful but it had, I surmised, only become truly disgusting when it interacted with the residue of the feeds that had been pumped into me over the past six weeks. Two spoonfuls and I was finished. I thought I would never be able to take broth again. I now assessed the system and the possibility of escape with a prisoner’s cunning. I was required to fill out forms specifying the volume of what I had eaten and drunk. I doubted that anyone was checking. I submitted falsified forms, exaggerating considerably but still within what I calculated were the bounds of plausibility, how much food and drink I could digest. The professor of what? was behaving like an errant child. For first time since my larynx was removed, I was desperate to get out of the hospital. After two days, Anne and I drove home, preparing for our new life.

I still did not speak. A few days later we drove back to the Epworth. We were greeted in a consulting suite by three surgeons – the two we had seen two months earlier and a female colleague who was involved in the second operation – one of the physicians, the one who had accidentally knocked out the nose tube, and the speech therapist, whom we had grown to admire greatly, whose concern for my wellbeing was obviously genuine. The assembled group peered closely at my neck. Anne and I had to suppress laughter. The consensus was that the stoma was beautiful. Thoughts about the eye of the beholder came to mind. I was asked to place a thumb over the site of beauty and say aargh. The aargh emerged. I was asked to count to ten. Once more, I succeeded.

To understand what follows, my state of mind at that moment must be understood. I firmly believed that it would take weeks or months of effort, under the guidance of a speech therapist, before I would be able to speak. There was even a slim possibility that I would never speak again. There was, however, a story that I was determined to tell the surgeons. The story concerned an episode of Australian Story I had seen on television in the ward, about an attractive young woman with a throat cancer like mine. She had refused to undergo a laryngectomy. Her father had searched the internet for an alternative cure and wanted the government to pay for a drug that had been successful with a different cancer. Now she was dying. This story revealed that by convincing us to proceed with the laryngectomy, by excising hope of an alternative, with what Anne had jokingly described as surgical precision, the surgeons had saved my life. I urgently wanted to speak so I could express the emotion I felt most powerfully at this time: gratitude. As I began, the words, the sentences, the paragraphs kept coming. The paragon of manual ineptitude had mastered breath control effortlessly. Although I was speaking in a whisper, the voice was in tone and register unmistakably mine. Anne wept quietly. When I had finished the story, there was a silence. And then the more senior surgeon said, with great sadness, She is our patient.

My new life as a laryngectomite now began to take shape. A section of the table in my study was turned over to bottles and packets of medicines. One bottle contained oxycodone. For the only time in my life, I grasped through the personal experience of mild euphoria why the world faces a drug-taking epidemic. When the bottle emptied I knew I shouldn’t try to replace it. There were three important new tasks: testing the prosthesis for leaks, by drinking and then examining the stoma; from time to time replacing the air filter when it was blocked by dry phlegm, or the adhesive base plate when the seal broke and speaking turned to hissing; cleaning the stoma and the prosthesis at least twice daily with a torch, tweezers and two twirling brushes. At first Anne did most of the cleaning. She believed her acceptance of my new body would help. We joked that we had found a new definition of true love – cleaning a partner’s stoma. Showering was made possible by a nifty plastic device inserted in the base plate. Eating advanced from milkshakes, pureed foods and scrambled eggs to pasta and other soft foods, and then to the old diet of meat, bread, potatoes and vegetables. I discovered that when I ate I could barely talk. The food wended its way slowly down the reconstructed throat to the stomach by force of gravity. Drinking lots of water during meals helped. But if I talked while drinking I gurgled. My new condition had, however, certain undeniable benefits. Because of the drugs, I slept better than for decades. Anne reported that I no longer snored.

After the final appointment at the Epworth where I spoke, we thought that, apart from regular check-ups, we were at least temporarily finished with hospitals. Not so. One morning a few weeks after going home, I discovered that the silicon prosthesis had disappeared. This was no minor matter. There were only three places it might have gone or might still go – the floor, the stomach or the lungs. The floor and even the stomach were unproblematic. If, however, it reached the lungs I might not be able to breathe. Anne tried valiantly but in vain to insert the far too flexible rubber catheter we had been provided with for such an emergency. Overnight, however, the hole which held the prosthesis had closed over. She called an ambulance. The paramedics arrived – to the delight of our two corgis, who adore all visitors – but they knew less than we what was to be done. Anne called one of the speech therapists in the rehabilitation rooms at the Epworth, who advised us to get to emergency as quickly as possible. It took four days and three hospital visits for a prosthesis to be inserted. My new rehab speech therapist battled nobly until he eventually succeeded. On the second visit, I needed to go from the rehab rooms to the surgeons’ consulting suite so that some so-called proud flesh around the prosthesis hole could be burned off. I was accompanied by the other rehab speech therapist, to whom Anne had spoken on the phone. She was heavily pregnant. As we were walking I coughed or sneezed – it is hard to say which – and a glob of phlegm landed on the linoleum floor. With delicacy, grace and good cheer, my companion bent and wiped it up. It was at that moment that I decided to write this essay. I thought then that it would be called either Gratitude or The Kindness of Strangers.

It would please no one more than me if this essay could have a modestly happy ending. That would be untruthful. During my times in hospital, and even for some weeks after, I experienced no pain. Re-reading my notes recently I found that in the last conversations with Anne before I could speak, I told her first that the skin around my neck felt numb and a little later that it felt tight. Eventually the tightness turned into pain. Humour can make almost anything more bearable. I christened the force that gripped me by the throat the Cottlesbridge Strangler. I asked my plastic surgeon and the original ear, nose and throat specialist for advice. Both thought an anti-depressant might help. It didn’t. For some time we believed that the pain was caused by lymphoedemia – the accumulation of fluids after the removal of lymph glands. I travelled across Melbourne on several occasions – two hours each way – to the only physiotherapist in the entire city who dealt with lymphoedemia of the neck. Her treatment – thrice daily exercises, gentle massages and a comical Joel Selwood-style head bandage* – successfully cleared the liquid. The pain, however, persisted. A pain specialist joined the ever-expanding circle of surgeons, specialist physicians, general practitioners and physiotherapists I had visited over the past months. Thus began a search for the right cocktail of drugs that would render intolerable pain tolerable without turning me into an addict, or make me, as the kind specialist would prefer me to say, dependent.

In one of the routine appointments, the fine young surgeon who had conducted the original operation told me in his quiet way that I should not expect the pain to go away, ever. With previously irradiated skin, what I was experiencing was not uncommon. During my most recent appointment, almost as an afterthought, he added that if the cancer returned there was nothing that surgery could do to help me. I now had the title for this essay.

*

My favourite radio program is the ABC’s The Coodabeen Champions, two hours on Saturday mornings of wonderful improvised humour about Australian football. Towards the end of each program the regulars are asked, What have you learned today? and are required to answer succinctly. It’s a good question. I will try to answer, in similar fashion, what I have learned in the ten months since discovering that throat cancer had returned.

I have learned that I am quite a stoical person, who can abide even very unpleasant bodily conditions short of intolerable pain. I have learned that dignity is a quality of the spirit that can be maintained even in the most compromising or comical situations, as the body gives way. I have learned that with moral effort – that idea again – even a person as naturally proud as I am can overcome embarrassment over conspicuous physical disability with friends, acquaintances and strangers. Having lived a professional life part of which relied on speech – lecturing, tutoring, speaking at writers’ festivals, launching books, appearing on radio and occasionally television – I have learned that with a poor quality or unpleasing voice one is expected as a matter of course to vacate the public stage. I intend to challenge that expectation. Perhaps I was lucky, and I realise I benefited from private health insurance, but I have learned that in Australia hospitals are remarkable institutions and the