The Route Less Travelled

Odysseus' journey home was notoriously long and notoriously complicated. Here is a map of his route. It is rather speculative, but gives you the idea. He could have got to Ithaca quite soon after leaving Troy by just hanging a right as he passed the western coast of Greece. But no.

It was partly his fault. That's what you get for hiring a ship without GPS. But the main reasons for the circuitous route are the interventions of the now all too familiar hirsute gentleman with the trident on the left of the map. His sour expression suggests he is working out how he can create a bit more trouble. The chap on the right with the pet eagle sitting about where Mount Olympus is, is his brother Zeus, ready to intervene with a thunderbolt if things get too out of hand. But no god, not even Zeus, can undo the work of another. So of all the Greek heroes returning from Troy, Odysseus collected the most sea-miles. As a result, when he finally did get home, he was pretty knackered.

My own journey is beginning to resemble his more and more.

After my last dose of chemo, which was in mid-September, it looked as if I was ready for a stem cell transplant, as explained in my last blog. I had series of tests to check that my body could deal with it and I then took a nostalgic trip down to the Marsden at Sutton, near where we used to live, where they have a special unit with some spanking new machines which separate out the stem cells. They are blood-spinning machines, but just to make things more impressive they call it the 'Apheresis Unit'. After all, why use an English word if there's a Greek one to hand? (Apheresis means 'taking away', though it does not say what is taken away, so you enter the unit on trust, hoping that when you leave they let you take most of your useful bits with you.)

The first thing they took away was of course some blood - just to check that everything was OK. Just as you can't be a proper doctor without a stethospcope round your neck, every proper hospital sucks some blood out of you as soon as you arrive, just so as you know you're in the right place. They also need to check you are the right person by repeatedly asking for your name and date of birth. They know all that already of course, so it also serves as a check that you have not yet gone gaga.

This time, when the nurses saw me there was some genuine scepticism about my identity because from the forms they had been sent they had assumed I was Filipino - as they themselves all were. The reason was that they had never come across an Englishman called Bungay (which is not surprising) and 'ng' is a letter of the alphabet in their language, so my name sounded Filipino with three elements to it: 'Bu-ng-ay'. When I told them I pronounce it 'Bun-gay' with two syllables it caused giggles all round, so we were all looking forward to a fun day.

Alas, after a while one of my new friends came back full of smiles and announced that I didn't have enough stem cells in my blood to enable them to carry out what they call the 'harvest', and I would have to come back in a few weeks' time to try again. So after all too brief a stay, we parted our ways. I was back to the beginning and stuck in port.

To while away the time before the next attempt at apheresis, the team decided to get me back into hospital for a long course of antibiotics to clear up any remaining infections (including pseudomonas of course). One bright afternoon an imposing delegation of nurses, doctors, registrars and even a consultant entered my room and took up positions around my bed, so I knew something was up. There was no priest, so I supposed it was good news. It was, and heralded another change of course.

They had just finished one of their Thursday morning pow-wows and had come up with a new plan. Instead of the stem cell apheresis, they wanted to give me a 'bi-specific antibody' called glofitamab. I tried to look enlightened by this news, but was not very convincing, so I tried looking enthusiastic instead to give the impression that I had always secretly wanted one of those.

In essence, this rather new and clever drug binds both to my T-cells and the cancer cells, which enables my own T-cells to kill the cancer. As it binds to two specific kinds of cell at once, it is called bi-specific. As it gets my own T-cells to attack the cancer it is also called a T-cell engager. So no more chemo, and it can be done on an outpatient visit once every three weeks, so no more long hospital stays. But of course there's a catch.

It can provoke CRS. I thought the CRS are French riot police, and given their record I wasn't keen on provoking them. However, if you are not behind some barricades on the streets of Paris but lying in an English hospital, CRS stands for 'Cytokine Release Syndrome'. It is when your immune system goes on a riot and starts attacking your own body, which is less violent than the French version, but still unpleasant. It is quite a common side-effect, but the boys and girls in white coats know all about it and will be ready with counter-measures, which is why they keep you in hospital overnight for the first few sessions.

So here we go. I have had the first round of preparation, and am due in again on the 23rd for the first round of the real thing. They expect to discharge me on Christmas Day when there will be no public transport, so I will have to hail a sleigh to get me home. But now a new course is set. I wonder what awaits this time - sirens, witches, nymphs, giants, storms? Or perhaps - just perhaps - a calm sea and prosperous voyage.

Merry Christmas!