Monday, 29 December 2025

Have Yourself a Neutropenic Christmas

Neutropenia is the fancy name for when your neutrophils, which are the bacteria-fighting cells in your blood, get obliterated by illness or treatment. 

Many types of chemotherapy cause neutropenia, which is why cancer patients are often immunosuppressed. We remember those immunosuppressed folk from Covid - the ones that gave us a sigh of relief when the death numbers were published because they had Underlying Conditions, and were therefore Sitting Ducks, and didn't count. 

Having little or no ability to fight infections is a pretty serious situation to be in. We all know what it is like to feel a cough or a cold coming on, and to feel sorry for ourselves for the impending few days of snottiness and general urgh. But if you get an infection and you have no internal ways of killing it off, you will need some other kind souls to intervene. Usually, this will end up being the kindest souls of your local intensive care unit, who have skills of life-saving that David Hasselhoff could only ever dream about. 

The advice for people who are taking chemotherapy is to check their temperature every day (with a thermometer that works) and if it goes above 38º, then they must go straight to the hospital. The recommendation is to be seen and treated with one hour, as this is the magic window before sepsis overwhelms your entire system and you basically shrivel up into a dying purple heap on the floor. I am aware of many fellow cancerheads who have had a number of what they call "blue light" experiences, where they have hollered for an ambulance at the first sign of a fever and hightailed with all the bells and whistles (literally) into the nearest emergency department. I don't actually know anyone from Cork who has done this, as I think we have an additional protective factor when it comes to invoking the emergency services. The weight of Morto can often far exceed the weight of I Am About to Die in our critical thinking strategies. Better to have your cold purple heap scooped into the back of a hearse than to disgrace yourself by calling a false alarm.

But that one-hour golden window is an interesting one to contemplate around Christmas time. Will I check my temperature before I put the turkey on the oven and if it's high, risk an even more cremated bird than usual as I nip off for a quick resuscitation? Will I bother with the thermometer at all on Christmas Eve, in case I miss out on Santa? Will I ignore every possible symptom of ill-health and decide that only a coma is a good enough excuse to ruin Christmas for everyone? 

Also, people with low neutrophil levels are supposed to: 

  • avoid crowds
  • avoid close contact, such as hugging or kissing
  • avoid soft cheeses, undercooked meat and poultry and the skin of raw veg
  • avoid fast food or takeaway food
Have you ever seen a list that more encompasses the spirit of the festive season? Kissing people in a huge crowd while eating deliciously manky burgers? That's the Christmas party out the window so. Hugging snotty children while munching on a brie and cranberry sandwich? Nope. Rooting around in the 5-day-old turkey trimmings for a final tasty little morsel? Out of the question. 

I tried to navigate the chicanes of immunosuppression this Christmas, but it was very hard. Yes I would love to see you, but no I can't hug you or sit near you if you sniffle. Yes I will go to see the Frank and Walters, as always, but I will stand with my coat on at the side of the room, trying to pretend that the scarf wrapped around my face is a stylish fashion choice. Of course I will go and enjoy the festive spirit in the Marina Market, but only by standing in a freezing draught and keeping my Ninja-ears peeled for the vaguest hint of a cougher. 

It didn't help that influenza was rampant, and as usual people were very blasé about it - until they got it, of course. Then they wail and gnash their teeth and say "never again!" - but forget about the vaccine again next year. 

I survived a trip to London, on planes and trains and buses (not the Tube though, I am not insane) and it all went well until I suddenly panicked about the flight taking more than an hour, which meant that if I started going septic as we were taxiing, well then I would surely be dead by the time we landed in Cork. But as long as no one noticed until we were in Irish airspace, at least I wouldn't end up in an NHS hospital...no E111 card will save you there. 

If I have a choice, I will choose not to to be neutropenic at Christmas again. It's a real humbugger.                 


Friday, 21 November 2025

IV League


I came up with that last night in bed. IV League, like Ivy League, but it stands for 4 in Roman numerals. Stage IV, metastatic cancer. We are in the IV League.

I dunno, it worked better in my head than it does written down. 

*Needs work*.


I have been procrastinating, again. 

It has become almost pathological, but I find it funny because I am procrastinating more now than I ever did, and technically I have less time to be messing about. The nettles should be being grasped. The bull should have his horns well and truly grabbed. The iron is bloody scalding and I am just sitting watching it hisssss.

And yet, what's the rush?

A few months ago (almost 4, if we are being pedantic. Or IV, if we are being Caesar), I found out that my belly probably has new cancer in it which was causing fluid to build up in my peritoneal cavity. I mentioned that this particular problem, ascites, makes doctors very certain that things are Not Good. It is always a worry when doctors are certain about things, because they are never certain about such minutiae as what time they will be at their clinic, or which week they are going to fill in your form. So all the doctors (me included) were thinking, "ooh. ascites. bad" (we are very good at Poetry for Neanderthals). 

Lo and behold, perhaps ascites isn't the worst thing to have. 

I had to cancel a trip to Egypt, where I was due to attend the MWIA Congress and be present for the outcome of the election of the next Executive Committee. I was delighted to become the Vice President for the Northern Europe Region of MWIA, and I was able to attend the ExCo meeting via Zoom. It wasn't quite the same as being there, but I felt I was able to participate and contribute, and I am looking forward to being involved in the next Triennium of this hundred-year-old network of medical women. 

I did think a little bit about the ethical quandary of taking on a role which should last three years, when I may find that my health makes it impossible for me to complete that term. And then I thought about all the things I would not have said "yes" to since 2014, if I had taken my prognosis as a fact rather than a whim.

Median survival 15 months. 

That would have meant that anything after February 2016 was out. No trip to Madrid with my fabulous girlies to celebrate our 40ths. No Vienna. No Bilbao. No Doctors' Discos 1, 2 and 3. No Brighton Marathon (I mean he could have done it without me but it wouldn't have been the same).

5 year survival around 13%. So nothing much after Nov 2019. 

No WiMIN Conference Numbers 2 to 7. No trip to New York for my first encounter with MWIA. No Postgraduate Diploma or Certificate. No new job(s). No first and last days at primary and secondary school. No snuggles from babies that became cuddles from children and then hugs from full-grown humans. 

So pah to your sage nodding and thoughtful grim-set mouths. 

I have literally no idea what comes next.

Christmas, I guess.  

Friday, 19 September 2025

Autumn Leaves

I wonder why so many people like autumn. Long before we had heard of hygge and pumpkin spiced lattes, many of my friends would say things like “thank god for tights” and celebrate when the heating spontaneously sparked up on a random September morning. 


I think it’s because summer is just too much pressure. MUST enjoy ourselves. MUST get out in the sunshine. MUST be all golden and glowy and active and lithe. MUST HAVE FUN!!


We had quite a topsy turvy summer. 


It began with our youngest daughter being sicker than any child of mine has ever been before. She had a perforated appendix and we spent five nights in hospital. It was horrific. 


She’s better now, thank goodness. 


Her main concern was that her scars would be healed in time for our massive family holiday in Mallorca in July. A gathering of nearly two dozen Fitzgibbons+ in one place. Yikes. 


It was lovely – hectic, but lovely. We celebrated my mother’s 80th birthday, in the same place we celebrated other family birthdays before, and it is humbling to think how lucky we are to still be able to come together in this way, without illness (or homicide) coming between us. 


I was feeling a bit off while we were there, because my belly had mysteriously swelled up in the few days before our departure. I had had my routine surveillance scan just a couple of weeks earlier, and that was stable, so I figured my guts were just reacting to the anticipatory anxiety of the big get-together. It didn’t stop me from swimming every day or clambering over the hot rocks, so I wasn’t too concerned. 


When we got home I assumed things would settle down. Instead my belly button kept bulging more and more – I have a hernia there since one of my operations, and it is like a little sentinel of bloating, a reminder to lay off the white bread. But this time it was staying stuck, and I started to worry that it might be incarcerated (which is not a good thing for a hernia). I have an inguinal hernia too, and that was beginning to bulge alarmingly. 


I decided I better do something, before my entire guts burst out of my abdominal wall. I went to the Emergency Department, which actually isn’t as bad as people make out. I met some lovely nurses and doctors, who very gradually and carefully let me know that my pregnant-looking abdomen was not due to an overdose of baguette, or a strangulated loop of bowel, but was in fact a result of litres and litres of fluid filling my peritoneal cavity. This is called ascites, and if you say that word to a medical person they are physically incapable of stopping their face from saying “oh shit”, even if they try to shrug it off and smile a fake smile. 


Ascites is generally a result of liver failure, or else a few other things that are even worse news. 

My liver was fine. 

The word “curtains” went through my head a number of times.

This was unlikely to work out well. 


I had a drain inserted to relieve the pressure, which was by now pretty excruciating. 

Many many litres of apple-juice-looking fluid came out of me. I felt, and looked, a lot better. 

None of the apple juice had any cancer cells in it. Weird. 


Still though, it was very likely to be from the cancer. 


I left hospital and entered full-scale denial. Off camping for the week. Lovely. 

I felt so good I declined the offer of returning early from our week away to have a permanent abdominal drain inserted. Sure wasn’t I grand? Not a thing wrong with me. 


A couple of days later I was bursting again. Unable to move in the bed without severe pain. Feeling about 50 weeks pregnant. I had to go back to the ED. 


This time my hospital stay was quite a bit grimmer, for a number of reasons. Mostly because I felt like an idiot for not pre-empting it by having the drain put in when it was offered. 


Anyway, the very kind people didn’t hold my stupidness against me, and gave me lovely drugs while they tunnelled a tube into my belly flesh. This device allows me to attach a bag to myself whenever my tummy swells, so that I can harvest another litre or two of apple juice and prevent the pain and waistband-bursting expansion. 


I’ve been doing this now every couple of days for 5 weeks or so. It’s a strange sensation, like a tiny vacuum cleaner swooshing around in my innards. The fluid even flutters and rumbles, very similar to the feeling of a baby moving around in there. But this time I have no idea of my due date. 


I had a PET scan which was expected to confirm that my cancer had spread to my peritoneum (the lining of my abdomen). This was the most likely cause for the ascites, and even though there were no cancer cells in any of the many samples of fluid that were sent to the lab, we still assumed that the PET scan would show little shiny white spots of metastases in my belly sac. It didn’t. 


It showed some bits of something that could be metastases, but they didn’t light up like my liver had last year. My liver is all calm and quiet now, subdued by my last round of chemo. And these peritoneal nodules are not “avid” (that’s PET-scan speak), they are more like Ferris Bueller in a chemistry class. Languid. 


Right now, I don’t really know where I stand. 


I will have a laparoscopy, where a learned chap will look into my abdomen with a camera and see if he can spot some nasties. And if he does, he is a dab hand at eviscerating them. Only thing is, that often involves excavating quite a few innocent viscera too. Peritoneal surgery is no walk in the park, and has to happen in Dublin which is an additional urgh for me. But of course I will be grateful and happy that learned chaps are willing to do what they can to continue to prolong my life. 


So autumn has begun with me regularly harvesting apple juice from my own tummy, and pondering the march of time. 


Winter is ahead. Let’s get those cosy pyjamas out.