It's A Wonderful Life

Help is coming

Sometimes, it is not clear what things people are going through: demands, pressures, trauma, psychological issues, unmet goals, unfulfilled dreams, or just the humdrum of daily life. In all this, one must continue to live and seek to thrive, because that is what living is all about.

I just finished watching an abridged version of the 1946 film, It's A Wonderful Life, on Amazon Prime Video, which would form the themes of our discussions in church during the Advent season that started last Sunday, but was deferred for the silver jubilee of our bishop's enthronement as a bishop in the Church of England.

There were times when I shed a tear while watching the film, which, on its release, barely broke even at the box office, but over the years, has become a Christmas staple of generosity and redemption against the odds. The need for a life partner, for prayer, and knowing you have a guardian angel can make all the difference to an existence bordering on despondency.

“Senior Angel: A man down on Earth needs our help.
Clarence: Splendid. Is he sick?
Senior Angel: No, worse. He's discouraged.” A conversation in heaven from the film.

Under the darkest clouds

The concept of being discouraged stems from various factors, including losing confidence or hope, feeling that one's efforts don't make a difference, or believing goals are out of reach. These issues meet us in different places and affect us to varying degrees.

There may be the kind of resilience that helps one see beyond the present, or sometimes one can get overwhelmed to the point of seeking an outlet. Either way, this represents the fragility of our humanity, which is difficult to explain to people who see us as stalwarts and leaders, in thought and deed.

In the last few months, even as I seem to have powered through a lot of things in health, at work, and in general relationships, I am drawn to the realisation that I might be exhausted. Feeling a lot better after cancer treatment, whilst grateful for the developments and progress, does not make it less impactful. It was a daunting situation, with support coming from just a handful of people.

The safety of withdrawing

Apart from the two weeks' break I had in August and September, I have worked since the first working day of the year, returning from sick leave and hardly structuring the return to work. In terms of family, most just thought it was another headache; only two of my siblings kept engaged from when I was diagnosed through my treatment.

I began to cut down on my social interactions and withdrew into my shell, my engagements mainly limited to my partner, my best friend, my church community, the work environment, and a few friends. I need the time to myself without shouldering responsibilities or fielding issues. I have done enough for the purposes of legacy, if that matters at all.

Even at the emotional low points, I must encourage myself. I see possibility within the flux and the fog, knowing the dark clouds have to shift for the sunshine to give light, warmth, and life.

Most of all, I am truly fortunate, exceedingly grateful, and amazingly blessed. “No man is a failure who has friends.” I am thankful for the friends I have; they pray for me, support me, encourage me, give me hope, and restore my faith, showing me such undeserved, unconditional love. It is indeed a wonderful life, after all.

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Writing Well: Craft and Wellspring

Well, it’s tough

“Of all those arts in which the wise excel, Nature's chief masterpiece is writing well.” This quote is attributed to both John Sheffield, 1st Duke of Buckingham and Normanby (1647–1721) and André Breton (1896–1966); however, I do not intend to make any issue of the results of my internet search.

Writing well can be viewed as both a wellspring and a craft. At least, this became my reading of the quote, not as a sign of wisdom, but as a recognition that the willingness to express oneself and the choice of expression have won changes in areas that seem intractable.

Over the last few weeks, the teams in which I work have found themselves subject to management's pressing inclination to seek statistical successes with little consideration of the effort involved that does not show up in the figures. It has been nigh on impossible to communicate the difficulties in our battles to tackle the problems we have encountered.

Well, Bad Faith

At one point, in what was clearly a breach of trust and confidence, we were both threatened and bullied. It was a particularly low exercise of managerial control, oblivious of everything but meeting some arbitrary target. It rankled so much that I even found my voice fading in agitation, anger, and angst whilst challenging the various ungallant uses of office.

Much as I appreciate that people in authority might be caught up in the illusions of power and demands, they cannot defy the reality of the practical elements necessary for achieving what they want. It is against this backdrop that I entered the fray of another push for targets without a sense of effort.

My goal, expressed a few days before, was for management to reward those putting in the most to achieve the target, even if the seemingly impossible target could not be met and the goalposts shifted in the meagre rewards they were offering. A difficult exchange ensued that first challenged the premise, then conditioned the situation, before adjusting the focus.

Well, Write Well

Fetching from the writing well of wisdom, gauging the time to interject and pressing the case, I first exposed the numbers malady before setting the perspective. This was presented in an inadvertent comment from a manager; my response was a case of writing well for effect.

It put the purpose on the defensive and led to a reassessment of the goal, but I held back from responding further. The ordered use of words is a skill demanding the scalpel blade of teasing rather than the machete of chopping. What ensued included receiving a slight rebuke, but the bruises of battle are part of being in a fight, though it rarely feels like one when the other party needs to exert authority.

The initiative eventually came without my suggesting it directly. Whether the target is met or not, the best-performing member of the team will be adequately rewarded. This should have been done the week before, beyond empty platitudes. Is it any wonder morale is so low?

Well, Just Write

The writing well is a resource from which I have dug deep to fetch the fresh water of writing well in the art of persuasion. The wounds matter less given the many victories won through time. I don't even bother to celebrate the wins, except in appreciation of the gift of writing well.

I suppose this is why this blog exists. Of all the mediums of expression available to engage us, writing has the potential to exist long after interest has been lost in hearing and watching people perform.

Caught in the act of keyboard bashing again

The incurable itch

There are times when I delude myself into thinking I am a writer, but the reality might suggest that all these years of blogging are pretensions to an ability I barely possess. "An inveterate and incurable itch for writing besets many, and grows old in their sick hearts." The Roman poet Juvenal's Satires X.

However, the translation from Latin suffers from so many kinds of paraphrasing and interpretation that it has become the more popular variation: "Writing is an incurable itch that affects many." Whilst I might have that occasional itch, it has become quite benign. I cannot be bothered to scratch it, nor is it so serious that I need a salve for it.

It is like learning to live with an infirmity; the inadequacy rings loud in your head, urging you to stop and pursue something else that belies a modicum of talent. On the other side, perhaps persistence counts for something. You do it long enough, it becomes practised, and you grow better at it. You gain the confidence that the little you manage to express can pass muster.

When I woke up just 25 minutes ago to think of something to write before the day's end, I felt it might be a jumble of incoherent words landing in an order that might suggest lucidity, but is clearly a malady bordering on insanity. Who really cares? Just bash the keyboard with your thoughts and see how itchy you really can get.

A whoosh moment

Coffee Gets Milky

The wind lifts the leaves and sends them dancing. What a thing it is to feel that sea breeze against your face, salt-sharp and bracing. This is Cape Town in all its contradictions: the water we adore from a distance, too dreadfully cold to ever step into, lapping at shores of the beach we walk but never wade.

Morning breaks, and somewhere in a sanctuary, someone reaches for their second cup before the first is fully drowned. Here, beneath vaulted ceilings that will echo with songs, the beans speak their own benediction, at hands one mirroring another.

The milk froths to an airy resurrection, poured into waiting darkness until the black turns cloudy with grace. It's communion of a different sort, but no less sacred for its secularity.

Notes Get Windy

In the dreaming hours, when consciousness drifts between waking and sleep, a figure moves through half-lit streets. From her handbag tumbles a scatter of notes, and in that suspended moment before she reaches down, the wind stirs with intention. You call out, to warn of the loss she's about to suffer, as dream-logic speaks in your voice.

Then the child appears, whimsical and wild as wind itself. From his lips comes a sound, a playful whoosh that blurs the line between breath and breeze. The notes lift, caught between gravity and air, between currency and sound, everything suddenly, impossibly airborne.

It's the kind of moment that clings to you after waking, vivid and strange, the sort of thing that makes you wonder if wind has always been this mischievous, this alive.

The shibboleth of fluency

Strangeness in the familiar

The languages we use in communication can determine how our use of words, structure, grammar, and style makes us winners or losers.

Conversation is a kind of interaction where we innately know the rules that confer belonging, distinguishing us from those who fall foul of them. However, it is placenames that defeat the foreigner in ways almost insurmountable.

When I lived in Holland, it was the beach town of Scheveningen that set the allochtoon apart from the autochtoon, until we eventually mastered the pronunciation. Any American visiting London would easily stand out whilst looking for Leicester Square or Southwark. When I do not hear 'southern' as 'surthen', I know who has travelled from afar.

Twinning the dissimilar

In South Africa, my Dutch exposes my foreign background; the placenames I pronounce in Dutch are barely recognisable to the locals.

This is where the identical needs closer observation to notice the difference. The twin test works like a linguistic shibboleth. Present someone with two nearly identical siblings and ask them to distinguish between them. The local spots the difference immediately; that distinctive mole, that particular smile, whilst the outsider sees only sameness. A casual glance reveals similarities, yet that tiny detail remains the tell.

So, it is with language. Just as twins operate in near-perfect synchrony, bewitching you with their sameness, you might navigate an entire conversation in flawless grammar. But stumble over 'Scheveningen', and the shibboleth has caught you. South Africans hear my Dutch-inflected Afrikaans and immediately spot what doesn't belong, differences imperceptible to my ear yet glaringly obvious to theirs.

Speaking so good

Tongue-tied to the point of speechlessness, you imagine running your hand through their curly hair. They smile and suddenly, as if possessed, or rather inspired, the utterance from your lips is a fluency in Afrikaans for which a shibboleth would fail to ensnare. Sometimes attraction trumps the test; inspiration defeats the very mechanism designed to expose you.

Language draws the pictures in the mind, and even if we say the words wrong because an accent defeats us, there's probably enough in it not to be misunderstood.

Men's things XXVIII: Shame, no national prostate cancer screening

An Unexpected Conclusion

I catch up on the news through the refined medium of chat shows, so I was unaware of the day's developments when my friend called to get an opinion. It was the news that national prostate cancer screening has not been recommended for men in the UK.

Whilst I am disappointed by the development, the science and research might suggest it could cause more harm; men could be diagnosed and overtreated for something benign. Because the usual growth rates for prostate cancer are quite long-term, stretching into more than a decade, immediate intervention is not always needed.

I appreciate all those arguments, but I can only share my own experience.

Pushing for Action

Firstly, the decision to get a PSA test was primarily at my own instigation and insistence. My GP had blood test results suggesting I had an anaemic deficiency for over two months, and did nothing about it until I asked why a reading was off the scale. During that investigation, I tacked on the PSA test.

As a black man aged 58, I fell into the cohort of those who could be affected by prostate cancer. Then my father indicated that he had it too, though I could not conclusively ascertain the facts.

The urinary symptoms of incomplete emptying or urgency I had attributed to the expected rather than the unusual. I was not expecting anything untoward.

Towards a Cancer Diagnosis

In early February 2024, the PSA reading was borderline on the high side of the normal range at 3.5 ng/ml. The other issue was that I had folic acid deficiency anaemia. I got a prescription for folic acid supplements and returned for another blood test at the end of March 2024.

By then, my folic acid levels had fallen outside the normal range, but the more concerning issue was the PSA at 4.0 ng/ml over the course of seven weeks.

The doctor then took the initiative to invite me to discuss this reading and conducted a digital rectal examination (DRE). His conclusion was an enlarged prostate gland with no nodules, but we needed to determine why.

This led to a referral to a hospital urology department, which, within weeks, scheduled a multiparametric MRI (mpMRI) scan at the end of April.

Challenging the Orthodoxy

At which point, I was reading up about tests, results, and indicators in the diagnostic path for prostate cancer. I then got an appointment with the urology department to discuss the MRI scan results.

We had barely exchanged greetings when the specialist literally blurted out, "We need to do a biopsy." No assessment, review, or discussion before telling me that. I pushed back and asked what the reasons were behind the decision, as the whole thing was both shocking and a surprise. The specialist would win no prizes for bedside manner.

Along with the many questions I asked, the answer that made me acquiesce was when he told me the PIRADS score was 4.

That result meant there was something concerning that had to be checked. There was no comfort with the ultrasound-guided transperineal biopsy of the prostate; even the lidocaine injections were painful, but I braced myself.

Cancer of the Prostate Gland

I had an appointment to review the results in mid-June. But my medical data in another hospital was merged into another assessment in early June, and there I learnt of the diagnosis of adenocarcinoma of the prostate gland.

When I met the urologist at the urology department, I told him I already knew, and we should cut to the chase. It was Stage 2 cancer, a Gleason score of 7 (represented as 3+4), contained in the prostate gland, and immediate treatment was recommended. I opted for radiotherapy.

In the process, I consulted with Prostate Cancer UK. I realised I could only be put on the longer hypofractionated radiotherapy over 20 working days, as my prostate was too enlarged for surgery to consider what could be saved of any sexual function, and brachytherapy could lead to serious complications.

You Always Excise the Cancer

Prostate Cancer UK felt I should have opted for active surveillance, but I had come so far in the medical analysis to back out. Apart from the fact that, besides the recommendation to treat it, I was not going to endure the presence of cancer in my body, waiting to see what it might do in years or decades.

Whilst the side effects were close to debilitating, they were manageable with good advice from the cancer health nurse consultant that my company recommended as I began treatment.

As prostate cancer leads the cause of deaths from cancer in men in the UK, and it impacts black men twice as much, the decision not to recommend national screening is quite unfortunate.

Get Screened and Scream Too

Even those with the BRCA gene mutation that suggests greater susceptibility to cancer will not find that out unless they are screened for it, probably in a separate medical checkup.

Reviewing all my medical notes, I cannot find any indication of any BRCA1 or BRCA2 gene mutation, and yet I have had two episodes of cancer malignancy in the space of 15 years.

Obviously, it means men must have a voice in their individual medical situations and advocate for the necessary interventions towards the best outcomes.

From my perspective, every time I have a platform to speak about men's health, I will say: if you're a black man over 45, you need to get the PSA test and go the full course until you are satisfied everything is fine.

Then, if anyone in your family (and that is mother, father, sister, or brother) has had cancer, get checked too. Demand to be seen as a person before you become a statistic.

Putting your health first, above any cultural, societal, or personal embarrassment, is paramount. Prostate cancer is treatable, especially when caught early. The lack of a national screening programme does not make it less incumbent on every man to step up and be part of ensuring that prostate cancer is no longer the biggest cause of cancer deaths in men.

Thank you.

BBC News: Men's things XXVII: The inconvenience of incontinence

References

Blog - Photons on the Prostate - A year from starting radiotherapy

Blog - A prostate cancer diagnosis, one year on

Blog - Photons on the Prostate - XVIV - I Just Can't Wait

Blog - Men's things XXVII: The inconvenience of incontinence

Blog - Men's things - Prostate Cancer blogs

Key

The PSA unit ng/ml is nanograms per millilitre.

In a year of remembering Dr Willy Legg

In a year of remembering

I never met Willy, but we had many conversations on WhatsApp and when he moved into a nursing home, there were bits of interaction when Brian went to visit him.

Last year, as Brian was about to leave for Cape Town to help me recuperate, he visited Willy and part of what transpired was Willy had a premonition and said he'll be gone before Brian returns to Bulawayo.

We were only about three weeks in Muizenberg, near Cape Town, when the news came that he had passed on. There have been snatches of memory and recollections since, many quite interesting and fond too.

I share one such memory below, which was a comment to the blog I wrote in tribute to Willy, a year ago. Unfortunately, the contributor did not leave a name.

The tortoise she birthed

To add to your fund of Willie stories: In amongst all the normal activities of being a clinical student in Harare Hospital, Zimbabwe, occasional remarkable incidents stood out.

One day, someone mentioned in the tea-room that there was an especially unusual case in the maternity unit. It was definitely worth going to see, and it involved a tortoise. Along with Willie Legg, with whom I was then sharing a house, I went to have a look at this 'most unusual case'.

In one of the small side wards holding the recently delivered mothers and their babies, we found a perfectly ordinary young mother in her bed; the adjoining bassinet contained a somewhat dusty but otherwise perfectly ordinary adult tortoise, complete with a few lettuce leaves.

Luckily, Willie spoke perfect Shona, so he asked the mother what her exact story was. She told him she had gone through her pregnancy without any real problems and had an apparently normal delivery in a district clinic. She had been greatly distressed when she was then presented, not with a swaddled baby, but a swaddled tortoise.

According to the established protocol for such things, she was transferred with her new and very obviously 'abnormal' baby to our teaching hospital, as this was a most unusual complication.

It appeared impossible to either of us that anyone could ever accept this story, so we asked the young midwife working on that ward what she thought of the story. She said, and I quote: “No, it could not possibly be true. I have examined the tortoise and noted that its umbilicus is fully healed.” I took this as a valid point, but not a completely satisfactory answer.

Naturally, we were nowhere near the end of the story, as the police were already on the case. It was soon confirmed that the clinic midwife had accepted a significant sum of money to give the newborn baby to a well-off local woman who was infertile.

The tortoise had been substituted for the baby, with the hope that this unsophisticated young mother would just accept this reptile as her unhappy lot. Luckily, this never had to happen, and justice was eventually served.

Blog - Dr William George Wykeham Legg (Willy)