Finally, after you accept what you must, control whatever else you can. A friend of Steven’s felt he was being a burden to his parents and moved into a private home for people with AIDS; he liked the home particularly because he felt needed by other people there. Another friend of Steven’s had wanted to be sick at home, but after he had diarrhea and his sister had to change his sheets and wash him, he decided to go to the hospital instead.     If you cannot control your life in big ways, control it in small: you never lose control over everything. Lisa would ask her husband, “Do you want the water glass here or there? Do you want to wear your blue shirt or your white one? Do you want cocoa or coffee?” When Dean needs to go to the hospital, he routinely takes along his own lamp and radio. You can always affect the course or quality of your life somehow.     This strategy of controlling what you can extends to the social service and medical systems.
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Franklin grew up in a neighborhood where violence is a fact of daily life. He had dropped out of high school after tenth grade, and at age twenty-one he was working in a factory and living with his mother and siblings. Franklin had formed an early attachment to a girlfriend he’d met in junior high school, and by the time of his injury they had a young son. Though his girlfriend and son lived with her family, Franklin saw them daily and was very close to his little boy.Franklin was shot while walking in his neighborhood. It was a random street shooting, and Franklin thinks the teenagers who shot him were trying to “prove themselves” for gang membership or were just showing off. Franklin was shot first in the leg, then in the back. He remembers lying in the street, waiting for help. “1 had a lot of wounds and bleeding. I turned myself over and realized I couldn’t move my legs. 1 didn’t feel much pain.” But Franklin remembers feeling scared and alone. He could see some people sitting on a front porch. “I asked someone to come over and talk to me while I was lying on the ground. Someone called for help and someone came over and talked to me.” Everything seemed unreal. When the ambulance came, Franklin remembers the paramedics cutting off his pants and putting him on a board. “Police were asking my name and address, who to contact,” he recalls. “Then they put me into an ambulance.”Franklin’s memories of the immediate aftermath of the shooting are somewhat vague and jumbled. This is typical in cases of trauma. At the hospital, he recalls, “I was awake while they were pulling the bullets out of me. When they got me back to Intensive Care, that’s when I finally slept. They had to close up a lot of flesh wounds. I think I got hit in my lung – I had some tubes.” Franklin later found out that he had been shot twelve times. He had a collapsed lung, which was repaired. Fortunately the bullets had missed other vital organs, so he was able to survive the assault.The doctors told Franklin that he had a spinal cord injury at T9 (the ninth thoracic or upper back, vertebra) and that his prognosis was unclear because he had a lot of swelling around his spinal cord. Until the swelling went down, they wouldn’t know whether he would be able to walk. Franklin recalls feeling overwhelmed. He couldn’t focus on the meaning of the doctors’ words, so he told them to talk to his mother.When the doctors determined that Franklin had a complete spinal cord injury and explained the consequences, he cried a lot. He realized he would have to use a wheelchair for the rest of his life. He imagined life as a paraplegic as much worse than it turned out to be. “I was lying down the whole week I was in acute care,” he remembers, “and didn’t think I’d be able to do all the things 1 can do now. I got dizzy when I got up, didn’t want to bother with it. I thought I wouldn’t be able to deal with it.”That first week, Franklin was scared and sad. He and his family cried a lot, though he recalls that his mother, girlfriend, and siblings were always there for him and told him “everything was all right, whatever happened” to him.Franklin’s medical condition stabilized quickly and he was transferred to a rehabilitation hospital about a week or so after his injury. His mood improved immediately, as he started getting out of bed every day, became more active, started lifting weights, and “started feeling like 7 can do this’; stopped saying 7 can’t do it.’” In rehabilitation, the staff showed him how to get in and out of a chair, get dressed, and check his skin. “Once I started doing things on my own, I felt like everything was going to be all right,” he recalls. “Even if I can’t walk, I’ll still be going about life, doing the same things that I always did, just a little bit different.”Injuring your spinal cord transports you into a whole new territory. What can you expect during the “wilderness” phase? This depends on the individual. Each person’s experience, and each person’s base of knowledge, is different. And spinal cord injury affects people differently, depending on the location and type of the damage. The level of injury (where on the spinal cord the injury occurs) defines the point below which paralysis can occur. Whether the spinal cord is completely or partially damaged determines the extent of the weakness or paralysis. How quickly emergency intervention begins and the quality of medical care received also affect outcome. Franklin was young, strong, and lucky. Someone else – someone older, younger, weaker, or with a different injury or outlook – would have a very different experience.Nearly everyone with spinal cord injury requires emergency room care, acute hospitalization, and inpatient rehabilitation. In many cases, surgery is required to stabilize the spine; other people do not require surgery. Some have long hospital stays; others, short.
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The most common cancer affecting the uterine lining is the ‘endometrioid adenocarcinoma’. This means that the tissue looks like the endometrium (‘endometrioid’) and is a glandular cancer (‘adenocarcinoma’) that is, it arises in the glands of the uterine lining. There are three types of endometrioid adenocarcinoma. The first is most commonly seen in oestrogen-driven tumours, i.e. the ‘well-differentiated’ endometrioid adenocarcinoma, which looks similar to the normal uterine lining and has a high cure rate. In contrast, the ‘poorly-differentiated’ endometrioid adenocarcinoma looks highly malignant under the microscope and the cure rate is lower. The third type is in between this well- and poorly differentiated situation, i.e. a ‘moderately well-differentiated endometrioid adenocarcinoma’.'Adenosquamous’ cancers contain both the glandular tissue seen in the lining of the uterus and the squamous tissue seen covering the surface of the cervix.The ‘papillary serous’ and ‘clear cell’ cancers look very similar to those cancers seen in the ovary and often act like ovarian cancers in the way they spread. They tend to invade deeply into the muscle and to have spread beyond the uterus at the time of diagnosis. The endometrioid adenocarcinoma is more likely to be localized within the uterus itself. They are the most malignant and challenging of all cancers affecting the uterus.Endometrial cancers first of all invade into the muscular wall of the uterus (the myometrium) and are most likely to be confined there. They can spread down to the cervix, either along the surface of the lining of the cervix or into the substance of the cervix itself, so that occasionally it is difficult to work out where the tumour started.The spread of the cancer along the fallopian tubes to the ovaries and lymph glands within the pelvic and abdominal cavities occurs in about 15% of cases at the time of diagnosis.It is clear that once the cancer has spread, successful treatment is less likely. There are currently no screening tests available for endometrial cancer but a number are currently under development and provide us with some hope that in the future, more of these cancers will be diagnosed when they are confined to the uterus itself.As the cancer grows and spreads, the most common problem is bleeding which, although rare, can become very heavy indeed and possibly life threatening. Radiation therapy can stop the bleeding, or rarely, the blood vessels to the uterus can be blocked (‘uterine artery embolisation).It is rare for the cancer to invade through the front wall, but if it does then the bladder can develop a hole and urine will leak through the vagina (‘urinary fistula’). Surgery is required to repair the bladder because the leakage of urine is constant, sometimes occurring at night, and is associated with chafing of the vulva area and the inner thighs. This can be uncomfortable and painful.If the cancer invades through the back wall, then the rectum can be involved and a hole (fistula) from the rectum to the vagina occurs. This also requires surgery because faeces and gas (flatus) can then leak through the vagina with obvious discomfort, foul smelling odour and great mental stress for the woman.If the cancer is untreated and spreads outside the uterus, then the common sites for it to go to are the lungs, bones and liver. If the disease spreads to the lungs, then breathlessness, pain on breathing and cough can develop, whereas if it goes to the liver then usually this is painless. If the liver surface is stretched then pain underneath the side of the diaphragm can occur. Secondary cancers in bones are always painful and can cause fractures. However they respond well to radiation treatment in most cases.*2/144/5*