The story of Eva’s gradual decline now reaches its apogee: that should be the high point, but in this case the high point is Eva’s last operation, appropriately called a commando operation. It was the most extensive operation she underwent, and it was very hard emotionally for us both. But very hard for her physically too.
It’s appropriate too to recall it today, World Cancer Day, – and tomorrow sees the third anniversary of her death.
The PDT may have worked, but the cancer returned, more aggressively than before. Eva had had several months of respite, but then during a routine check-up in Amsterdam, we heard the bad news. Actually it wasn’t a surprise any more: it was after all the seventh time it had returned. Eva expected the news, and had warned me beforehand. This time we were told that the only option was the commando operation. We knew about the operation – oncologists had told us – we knew it was seen as the ‘operation of last resort’. Now, it was the only option: otherwise the future was certain death. ‘How long?’ we asked. ‘There’s no way of telling,’ came the answer, ‘six months, a year maybe, but it’s difficult to say.’
‘Explain the operation,’ we asked, almost wishing we hadn’t. The doctors explained the preparation and then the details of how they would cut Eva’s face from the middle of the lower lip, right down the chin, the neck, and part of the chest. A second cut would be made along the jaw line so that the skin could be completely peeled back to gain access to the tumour. Additional incisions would be needed across the chest, since they would remove some muscle and transplant it to the mouth. Various holes would be made to insert catheters and other tubes. The whole operation sounded extensive, but the description was, well, ‘clinical’. ‘How long is the operation?’ ‘Eight hours, maybe longer.’
We discussed the operation together and with the specialist cancer nurse. There was no other option. Eva was extremely anxious – not for the operation itself, but for the scars and the consequences. The doctors explained how, afterwards, the scars would become almost invisible, and that if necessary, cosmetic surgery would be done, either at the same time or subsequently. Finally, Eva decided. ‘I’ve nothing to lose, but it’s my last operation,’ she said in her strained voice.
The day of the operation came. For some unknown reason, I hung about outside the operating suite after Eva went in very early one morning, even though I knew I would have to wait most of the day. We had not said anything in case the worst happened. We both knew it was possible, but maybe the eyes said it all. I felt as though I’d be tempting fate if I said anything. So I kept my thoughts to myself, and wished Eva strength. I’m sure she knew what was going through my mind. I’m also sure that Eva, despite her anxiety, was almost at the stage of past caring. If she were to die, then so be it – that was her attitude. I’m sure she did not want to die, but the balance had definitely tilted out of favour.
I recall walking up and down along the side of the canal, of going to drink endless cups of tea or coffee, of reading bits of papers or books and then not knowing anything of what I had read on the page. I watched the clock. One hour. Two hours. I tried to visualize what was happening to Eva. I had looked up all the details of the operation – not for the squeamish. I never showed Eva any of the pictures (and none are posted here either), nor told her everything I had read. Three hours. Time passed every so slowly. I walked up and down the canal again. Now I remember it was sunny, and the sun shivered through the tree leaves. Four hours. Five hours. Now I remembered having a silent conversation with a large duck that shared the embankment with me. The doctor would phone if anything happened. Oh yes, one of our local oncologists was working at the Antoni van Leeuwenhoek Hospital at this time, and he was on the team performing the operation. Six hours. Yes, he would phone. I returned to the hospital canteen to wait. More coffee. Seven hours. I could feel the anxiety growing. The hands of the clock moved so slowly. Was it only five minutes ago that I looked at it? Eight hours. Would he phone? I went back up to the operating suite. ‘No, she still is surgery. No, we don’t have any news.’
Nine hours. I went outside, walked up to the canal. Communed with the fat duck again. Nine hours thirty-six minutes. The phone rang. ‘She’s just coming out of surgery now. You can see her in about half-an-hour.’ ‘She’s alive?’ I asked. ‘Yes, of course.’
I rushed back, forgetting about the duck, and sat in the waiting area outside the operating area. The minutes ticked away. ‘They’re just making her comfortable,’ said a nurse. Finally, after what seemed like another hour I was allowed into recovery for a few minutes. ‘Prepare yourself for a shock,’ said the nurse, as she described inadequately what Eva looked like after surgery.
No description can clearly prepare you for what you see. I expected bandages, plasters, dressings. There were none. Just masses of staples. Staples all round her chin, down her throat, across her neck, across to the shoulders, down across her chest and under the breast. Hundreds of staples, tightly binding the skin on either side of the incisions together. No staples in the face itself. There the surgeons had used stitches in some way so that they were scarcely visible. The incisions were dramatic.
Eva lay at a 45° angle – ‘to prevent fluid building up’ – looking barely alive. Tubes from all orifices, with breathing assistance. ‘Oh my God, what have I agreed to?’ I thought. I could not believe that such radical incisions would ever heal. Her face had become an incredibly swollen balloon. ‘That will go down in a few days,’ said the nurse.
I could stay only briefly, but the next day she looked more alive, although they kept her heavily sedated so that only her eyes fluttered blankly. She fixed me, and in that momentary stare I saw a decision. ‘Never again’.
Eva remained in the hospital for three more weeks, gradually recovering. They had reinserted the nasal feeding tube. But the serious problem was her lack of speech. For some reason she could not manage to activate her voicebox to make intelligible sounds. She never spoke again.