The specialist that Doctor Duangtip sent me to see was a kindly-looking man in his late fifties with greying hair and metal-framed spectacles with round lenses. I waied him as I walked into his office. He seemed momentarily confused at being waied by a farang but he waied me back half-heartedly, then stood up and shook hands. His hand was as dry and cool as a lizard. Mine was bathed in sweat and I wiped it on my trouser leg as I sat down. His name was Doctor Wanlop and he was, according to Doctor Duangtip, one of the most experienced intestinal cancer specialists in Asia.
There was that word again.
Cancer.
Doctor Wanlop had more certificates than Doctor Duangtip, but his were all from Thai institutions. Like Doctor Duangtip he had a computer on his desk and he tapped on the keyboard and studied the screen for several minutes before turning to smile at me.
‘My colleague explained about CEA?’ he said, peering over the top of his spectacles. He spoke in English, which was fine with me.
‘He said it was a marker for…’ I hesitated. I didn’t want to say the word. I wanted to use something less final. Something I could tell my wife.
‘For colorectal carcinoma,’ he said.
Whoa there, hoss. That sounded a hell of a lot worse than cancer. Colorectal carcinoma? Where had that come from?
I took a deep breath. I didn’t want my voice to tremble when I spoke. ‘For cancer, he said.’
There. I’d said that. The world didn’t end. The sky didn’t fall in. But I didn’t feel any better.
Dr Wanlop smiled. It was a reassuring smile, a smile that told me not to worry, that he knew what he was doing, that he would cure me of whatever ailed me. My heart was pounding like a jackhammer. The heart of a twenty-five year old.
‘Carcinoembryonic antigen, to give it its full name, was used as a test for cancer of the colon for a few years, but I’m not convinced that CEA levels are a valid marker for tumours,’ he said.
That sounded hopeful. It sounded a hell of a lot more hopeful than colorectal carcinoma. And he was smiling reassuringly. That had to be a good sign.
Right?
‘In fact, I can say with confidence that of the last twenty people who passed through that door with elevated CEA levels, not one had a tumour.’
I frowned. ‘But Doctor Duangtip said that CEA was an indication that there was a problem.’
‘It can be. And it’s only right and proper that he had you come and see me. But I don’t think you should worry too much. These days we tend to use CEA more as a treatment marker. If after we’ve carried out a procedure we get a sudden elevation in CEA, then we know that our procedure has not been effective.’
Thais aren’t great at breaking bad news. In the old days, when they’re going to execute a criminal, they hid the machine gun behind a sheet. The condemned man didn’t even know that he was going to be shot until the bullets ripped through him.
Doctor Wanlop was certainly making me feel a lot better, but I wasn’t a hundred per cent sure that he was just sugar coating his diagnosis to stop me worrying. Maybe he just wanted me to feel better, right up until the moment that the cancer ripped through my guts.
‘So what happens next?’ I asked.
‘We should have a look inside,’ he said. ‘Reassure ourselves that there isn’t a problem. Assuming that we don’t find anything, we will know that you have a naturally high level of CEA.’
‘An operation, you mean?’
‘Not exactly. We can put a very small camera inside your intestines. We give you a small injection, just to relax you.’
Right.
Fine.
That doesn’t sound so bad.
Not really.
‘And you’ll do that for me?’ I asked.
Doctor Wanlop smiled and shook his head. ‘I used to, but I’m too old these days,’ he said apologetically. ‘You need nimble fingers, and a lot of practice. I do so few these days that it takes me forever. But I can recommend a colleague who is an expert in the technique. She can do the entire procedure in less than thirty minutes.’
She?
A woman was going to run a camera through my intestines?
Interesting.