Graham Clark
One Saturday morning in Amsterdam in the summer of 2002 I went to the bathroom and passed rich blood, the colour of claret, in my urine. I was surprised as I had slept very soundly and had not had any inkling that something was wrong. I’d had a wonderful week rehearsing a new production of The Makropulos Case and was to return to Bayreuth in Germany that afternoon where I was scheduled to sing the second and third cycles of Wagner’s Der Ring des Nibelungen the following week.
I laughed a little nervously when I saw the blood as it was clear, after a large cup of tea, it was one flush and I was not haemorrhaging. I couldn’t face going to hospital in Amsterdam as there was a huge parade that weekend and the hospitals would be full of casualties of all kinds. I didn’t want to dash back to London and visit a hospital there for much the same reasons and as I had my return ticket to Germany ready and was prepared to fly, I decided to return to Bayreuth, a smallish, but very well provided town and try my luck there. They also knew me well in Bayreuth and I was confident I would be treated sympathetically and quickly.
I arrived back late afternoon and went straight to the Festspielhaus where a performance was in full swing. The house doctor was there as usual and I told him that I had passed blood that morning in Amsterdam. He told me to go to the bar, drink a beer and come back and see him when he would take a sample. I could think of far worse things to do. I promptly did as suggested and the sample showed blood in my urine. He told me to go to Klinik Hohe Warte, the spectacularly equipped hospital behind the Festspielhaus, and register with A&E immediately. I went up the hill to the emergency entrance where two male nurses were sitting quietly watching a football match and jumped to attention. They called a doctor who appeared a minute later and another sample was given which again showed blood. He did an ultrasound scan of my kidneys and stomach and could find nothing startling. He said I was to return to the hospital first thing on Monday morning for an appointment with the urologist.
At 8am Monday I met Dr Arnold, a delightful and cheerful man, and the same procedure was repeated with samples. Blood was still showing, in very small flaky amounts, and X-rays were immediately taken of my whole body from top to bottom. These were inconclusive, so an internal inspection was detailed immediately. I was taken across the corridor where a team was waiting to perform a cystoscopy. With my legs in the air, a rather hefty female nurse leaned over me and whispered, ‘Zis vill hurt, oops’ and in went the cystoscope. When my eyes stopped watering, we were all joking about operas and roles and suddenly it went very quiet. Dr Arnold slid alongside me in his chair and said I had a tumour. I replied, ‘That’s why I was bleeding, wasn’t it?’ ‘No,’ he said, ‘I don’t know from where you were bleeding, but thank goodness we have found the tumour early. It must be removed as soon as possible.’ I asked, ‘How soon is soon, as I have performances this week starting tomorrow?’ He replied, ‘As soon as possible and if you take my advice, I am here, you are here, let’s do it.’
‘Whoa, wait a second, please,’ I said. ‘I need to speak to Herr Wolfgang Wagner about this, as I can still do the Ring this coming week, can’t I? I feel fine. Next week might be a possibility.’ It was agreed and I left the hospital and walked down to the Festspielhaus in a daze. This is all so surreal, I thought. I’m in the middle of a Ring at Bayreuth for God’s sake. I can’t jump ship. And what about the new production at Amsterdam? Suddenly Frau Wagner appeared and I blurted, ‘I’m afraid I have bad news. I have a tumour in my bladder.’ She burst into tears, gave me huge hug, took me upstairs to her office and called Wolfgang. He came rushing over and immediately said that health was the most important thing and I must have the operation as soon as possible. ‘Well,’ I said, ‘I can do the second cycle of Das Rheingold tomorrow and Siegfried on Friday as scheduled and perhaps have the operation next week?’ The telephone was immediately offered to me to call Dr Arnold and the appointment for the following Monday morning at 8am was promptly arranged.
I sang the second cycle, I felt really good and they were hugely satisfying performances, particularly emotionally. The following Monday I arrived at the hospital where I was prepped and had the operation. I was told it would be microsurgery and, hopefully, should be straightforward. I was put to sleep and I woke up briefly to hear Dr Arnold say all was well and went back to sleep. I finally woke up the following morning, Tuesday, and felt fantastic. Really fantastic. Dr Arnold came in and said I was very lucky; the tumour was lying on the internal surface of the bladder and was easily removed like cream off a cake. Another tumour was in the very early stages on the other side of the bladder and that had also been removed. However, as it was major surgery I was to remain in the town for a week. The third cycle of the Ring beginning the following week was out of the question as it was too physical and energetic. Wolfgang Wagner had been informed. But I could return to Amsterdam at the end of the week and rehearse gently for a month. In the meantime he would rush the results of the biopsy and hope to have them in a few days.
I left the hospital that afternoon and went back to the lovely small country pub and guesthouse I always stayed at outside Bayreuth in the depths of the glorious Bavarian countryside. The following evening at supper the news came that the tumour was indeed cancer, but it was at the mild end of the spectrum.
I returned to Amsterdam and sang The Makropulos Case without any problems and picked up my schedule again. I was very careful at the beginning and had strict instructions from Dr Arnold about how physical I could be in performance, but my singing was unimpaired as no tubes had been inserted down my throat and everything went to plan. I had all the scheduled cystoscopy check ups every three or four months, which became every six months and then annually and the bladder appeared absolutely clear and clean each time. This routine lasted ten years.
In 2012 I went for my annual check at RBH Reading and the surgeon said, ‘I think it’s goodbye today as you have been clear for ten years. Let’s have a look… Oh!’
The cancer was back. It was cauterized there and then and at each subsequent cystoscopy, but it would not go away. Finally, a lady surgeon said she was not happy and arranged a full CT scan and biopsy. This revealed ‘an extensive area of carcinoma in situ.’
A meeting was quickly arranged to see an urologist. The amiable Lt Col Shah met me and we had an open and frank discussion about options. He was clear that, in consultation with colleagues in Oxford and Slough, urgent action was needed. My cancer was evident on ‘all four points of the compass.’ I could do nothing, of course, or have BCG, but he felt the percentage of success might be limited. The third choice was a cystectomy with associated prostatectomy and lymphadenectomy. After consultation with my wife Joan, we agreed wholeheartedly to the cystectomy and I also opted for a neo-bladder, as the prospect of handling stomas and costumes and wigs and props on stage was rather daunting and would constantly remind me of my condition which I would much rather try to forget during performance.
During the course of the preoperative consultations, I met a lady anaesthetist. I asked her if I could avoid having tubes down my throat. She said unfortunately not as it would be open surgery this time and there was no alternative to a tube down my throat. However, she noted that I was a singer and as she lived next door to an opera singer she understood the anxiety. She promised that great care would be taken.
The day of the operation I was taken to the theatre for preparation and when the anaesthetist asked me to sit on the side of the bed and lean forward, a hand came over my shoulder and gripped my hand. It was the lady I had met previously. She said she had come to wish me luck and courage. How extraordinarily kind of her. Sadly, I never saw her again.
I passed out and woke up in the recovery room feeling groggy, but OK. At that point a team of young doctors came to my bed with a consultant surgeon. He rather curtly said I looked OK and they all moved on. The nurse gave me a glass of water, which I drank quickly and was immediately sick in a violent convulsive explosion. From that moment on I felt really lousy and remained so for the whole time I was in hospital, in spite of the operation being hailed a big success. I stayed for almost 3 weeks and was finally discharged Christmas week December 2012. The greatest discomfort I suffered during this time was wind around my waist. I managed the bathroom and the self-administered injections OK (but I bruised my arm black and blue), the huge swelling of my groin, testicles, legs and ankles, fecal impaction and constipation, the catheter washes and the night bags generally were all OK, although the night nurses were less proficient and less friendly than the superb and tirelessly cheerful day nurses and often needed help themselves. I managed the stairs OK and the varied meals and the water, which, oddly, tasted like the finest wine, but the wind in my gut was a griping torture. The day I was discharged I couldn’t breathe and walk properly for a while and had to cling to my wife and the railings for long periods until the pain subsided.
My wife and I taxied home surrounded by a mountain of postoperative medication and I went to bed. A couple of days later I had enormous pain in my kidney and had an infection that our house doctor treated promptly. Thereafter, I gradually recovered my strength although I had one more heavy infection. My voice was broken, however, and I thought my singing career was over. But, suddenly, one weekend in March I woke up feeling I had turned a corner. My voice recovered, I was up and about and walking freely on a daily basis by the river Thames and I felt that I would be able to pick up my schedule once more. I had cancelled performances in Copenhagen throughout the hospital and recovery period and Glyndebourne now beckoned with rehearsals beginning in April. I was determined to do it. It gave me an extremely strong focus to regenerate my strength and recover my voice and, happily, I managed to turn up for the first rehearsal as contracted. The daily management of pads, night bags and pills proved relatively easy to organize and I suffered no ill fortune.
When I hear the troubles some of my fellow patients have suffered, I realise I have been extremely lucky and have received wonderful surgical treatment for which I am so very grateful.
With the enormous help and care of my wife, I have continued to work and have performances scheduled for Berlin, Paris, Frankfurt, Cardiff and London in the coming year.
Hope springs eternal, it really does 28 May 2015
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