25. Trains

1 Dec 2019 – Sunday

Some of the earliest evidence of what might be described as trains goes back to Corinth in Greek times. Grooved tracks cut into limestone were used to guide wagons carrying boats along a 6 to 8km long path known as Diolkos. Much like the Panama and Suez canals, the short cut not only avoided boats sailing dangerous capes, but also reduced journey times. But while the Suez and Panama canals are products of the 19th century, Diolkos was built in the 6th century BC, and operated for more than 600 years into the 1st century AD. Of course power was provided by men and animals but the core principle of a railway was there.

Suez and Panama construction began in the same century that railways took off. The Liverpool and Manchester Railway, opened in 1830, was the first modern railway, carrying both passengers and freight. By 1870 Britain had about 13,500 miles of railway, peaking in 1914, at about 20,000 miles run by 120 competing companies. For an excellent, humourous read on the development of railways (and not at all factual) you could do worse than read Raising Steam, by one of my favourite authors – Terry Pratchett.

My own rail journey seems to have changed. It seems I’ve missed my stop. My laparoscopy last Wednesday was to determine to extend of the peritoneal spread. Such spread is measured with a PCI score (peritoneal cancer index). The peritoneal is split into 13 sections and a score of 0 to 3 given for each section – total 39. The PCI is one measure used to access whether HIPEC surgery (hot chemo wash) is going to be possible, most hospitals have a cut off around 14-18 higher than, it won’t be effective. In May my surgeon estimated my PCI at 6, in September the CT scan showed “a bit more”, well now it is 29. HIPEC was my stop, I’ve missed it.

There’s one more stop before the end of the line, but the conductor says there are no direct return trains. Just a replacement bus service. The replacement service is called PIPAC – Pressurised Intra Peritoneal Aerosolised Chemotherapy. As you’d guess from the name, high pressure chemo gas is pumped into the stomach to come into contact with the cancer. It’s laparoscopic, repeated every 6-8 weeks and used in parallel to intravenous chemo. PIPAC is also experimental, the NHS is running trials. The hope is that the approach can lower the PCI to the extent that HIPEC becomes an option again – all change please. So it is not curative and there are restrictions on patient suitability, so it may not be possible for me. However, I’m now in contact with the two doctors running the trial and there may also be a private option.

The final irony. After returning home on Thursday with the depressing news, then preparing for bed, I joked with Clare that I didn’t need to worry about cleaning my teeth anymore. Not 12 hours later a rear molar broke apart – Mind the Gap.