When the monster lurks deep in your nasal passage

Elijah* was only 17 when his world flipped over and he was swept under by the tide. One does not just get up, dust himself off and get back to being a teenager after being tossed a cancer diagnosis.

Elijah was busy being a typical teenager; hanging out with his friends at the local marketplace, shooting pool, cheering their favourite English Premier League soccer teams at Johnny’s pay-to-view cubbyhole late into the night, then sneaking back home in the dark.

There was no space in this whole equation for a lanky almost seven-foot tall teenager to accommodate the big C-word.

One minute Elijah was out in the field cutting Napier grass for his father’s enviable Freshian cows and the next he was in the hospital with his nose bleeding.

The nosebleed may have been curtailed but thereafter, things seemed to be spiralling out of order. First it was the recurrent headaches, then the ringing noise and pressure in his ears. His little brother complained of his loud snoring while his mother noted his appetite was withering.

Two months later, Elijah was back in the emergency department with another torrential nosebleed.

Nailed the diagnosis

He was admitted for observation with his nose tightly packed, forcing him to breathe through his mouth. While his family was anxiously seeking answers, Elijah lay on his bed staring out of the window, listening to his team play on a small transistor radio.

He was missing out on the excitement of watching the game with his buddies at home.

I met Elijah the next day, seated outside the ward on the stone terrace, soaking in the morning sun. He was listening to the BBC channel. The thought of having to recount his story to a medical student did not appeal to him but he had nothing better to do, so he indulged me.

By lunch time, we had become friends. He had tolerated me through the intense medical examination performed only by an amateur learning the ropes. I fished out every single enlarged lymph node on his neck and documented it in his file. I hated what I found and did not have the heart to hint to him that he may possibly have cancer.

The following day, we assembled in the side room in the ward to discuss Elijah’s diagnosis out of earshot. He was a minor and his parents were not present.

The otorhinolaryngologist (ear, nose and throat surgeon) acknowledged my attention to detail even though I had not nailed the diagnosis. I was excused. I had never seen a nasopharyngeal carcinorma before.

Elijah was glued to the little radio the next morning. I was not even sure whether he had been told of his diagnosis. However, when I said hello to him, he looked up and told me his first visit to Nairobi would be due to cancer.

We sat side by side on the stone slabs outside the surgical wards every afternoon with Elijah as he went through his tests. First was the biopsy. This was followed by tonnes of blood tests, a CT scan of his head and neck, chest X-rays and the abdominal ultrasound.

Blocking the airway

Three weeks later, I was bidding my new friend goodbye. He was headed to the city for a date with the radiotherapist as our hospital did not have the machine.

The monster at the back of his nose was not relenting. The tumour was growing as if on steroids, blocking most of his airway, causing him to breathe through his mouth permanently now. His headaches were almost constant and the nodes on his neck were the size of grapes.

The tumour grows in the space at the back of the nasal passage, the nasopharynx. It is common in adolescents and older men above 60 years. It is twice as common among males than females. The treatment is primarily by radiotherapy with fairly good success especially in the younger patients.

For the first time, Elijah spoke about his fears. The fear of death, missing out on life, the heartbreak it would cause his parents to lose their firstborn. His biggest regret was to die without ever having watched Manchester United play live at the Old Trafford. He did not even have an identity card and had no idea what university life meant.

It took a lot of campus luxury sacrifices to afford him his farewell gift, but it was well worth it. It was incredible the way his face lit up at the sight of his Manchester United shirt. When one is going to war, he needs all the artillery he can get. Let us just say that red devil fan may just get to visit the theatre of dreams before he dies.