The Appointment I Nearly Missed

I almost didn’t go to the dentist appointment that found my cancer.

It had been booked months earlier, one of those routine check-ups you agree to because the next available slot is apparently in another geological era. By the time it came around, I had almost forgotten about it.

A tooth on the right-hand side of my mouth had started niggling. Nothing dramatic. The sort of thing that probably needed a filling, a quick lecture about flossing and an amount of money that would make me briefly reconsider the value of having teeth.

Without that tooth, I might have cancelled.

I took an hour off work and drove into Barnsley.

The dental surgery on Huddersfield Road had been there for most of my life. I had been going since I was a child. My dad went there. I had once stood in the hallway after having several teeth removed under laughing gas, crying while blood dripped onto the lino.

The walls had been painted since then. The chairs had changed.

The wall was still there.

I was looking at it when the nurse called my name.

“Joseph Butler.”

I hate Joseph.

Joseph is the name I get when I am in trouble. I have always been Joe. Even being diagnosed with cancer did not improve my relationship with unnecessary formality.

I followed the nurse upstairs to the room I had sat in countless times before. Same chair. Same equipment. Same small window. Different dentist.

My usual dentist was away after an operation. His wife, also a dentist, had returned to cover for him. It was her first day back in practice.

I was her first patient.

There are several points in this story where a tiny change could have sent everything in another direction. This was one of them.

She asked whether I had any problems.

“Just a tooth on the top right,” I said. “A bit tender.”

She lowered the chair, pulled the light across and began the usual inspection. Numbers and surfaces were called out. The nurse wrote them down. I had no idea what any of it meant, but it sounded reassuringly ordinary.

Then she reached the left side of my tongue.

Her face did not change dramatically. There was no sharp intake of breath. No music started playing. The smile stayed where it was.

The rest of her became still.

“Have you had ulcers there before?”

“Yeah. Fairly regularly.”

I had recently had one in roughly the same area. It had healed, or I thought it had. I was twenty-seven. I did not smoke. I was not a heavy drinker. I had no reason to look at a white mark on my tongue and imagine anything more threatening than a mouth ulcer.

She asked whether I would mind being referred to the oral and maxillofacial clinic at Barnsley Hospital.

She did not think it looked sinister.

Those were the words.

She had recently been briefed about referring anything that met certain criteria. Persistent ulcers. Unexplained patches. Marks in the mouths of people with recognised risk factors.

I met none of them.

She could refer me anyway, just to be safe.

I nearly said no.

That is the part I return to.

Not because I refused. I didn’t.

Because I nearly did.

I had already taken time away from work. The mark did not hurt. The ulcer had apparently healed. The dentist herself had said it did not look sinister. A hospital referral felt excessive, the medical equivalent of calling the fire brigade because the toaster smelled warm.

Still, I was already there.

Another hour away from work would not kill me.

So I said yes.

Refer me.

A letter arrived about a week later. It described itself as an appointment reminder, despite being the first I had heard about the appointment. The NHS still does this. It remains both irritating and strangely comforting.

The appointment was the following morning.

I told work I would go to the hospital first and come in afterwards.

That was the plan.

Hospital. Quick check. Work.

One less loose end.

I walked to Barnsley Hospital because the parking there was, and probably remains, an act of organised hostility. The route took me up Rowland Road, a steep hill I had walked years earlier in the middle of the night to visit my grandad during his own cancer treatment.

We sat together for hours that night. He talked about bread, pies and his childhood. Stories I had heard before.

He died the following day.

I did not connect that walk to my own cancer. There was nothing to connect. I was twenty-seven and healthy, apart from a tender tooth and a white mark that nobody seemed particularly worried about.

The MaxFax waiting area looked like every hospital waiting area.

Plastic chairs. A water cooler without cups. A television showing a house being built somewhere far more attractive than Barnsley. People who looked as though they had a proper reason to be there.

I considered leaving.

The mark had faded. I could not feel anything. I was using an appointment slot that someone genuinely ill might have needed.

Then the television caught me.

A couple were building a house in a forest with a living roof, plants laid over the top so the building would disappear into the trees. I wanted to see whether it worked.

A nurse called my name before I found out.

“Mr Joseph Butler.”

There it was again.

The registrar looked through my notes and seemed mildly confused.

“I’m not really sure why you’re here,” she said.

Good start.

I explained the dentist, the white mark and the referral. She examined my mouth. By then, another week had passed. There was very little left to see.

She went through the recognised risks.

Smoking?

No.

Heavy drinking?

No.

An ulcer that had remained for more than three weeks?

Not that I knew of.

Family history?

No.

She had no particular concern. Neither did I.

She said she would speak to a colleague.

A second person looked.

Then another decision was made. Small enough to sound routine.

They would take a biopsy.

Just to be certain.

The mark became a biopsy.

The biopsy became another appointment.

That appointment became a room with too many people in it.

A consultant told me that nine hundred and ninety-nine times out of a thousand, he was able to give people good news after results like mine.

I was the one he couldn’t.

The white mark was mouth cancer.

Stage IVa.

The tender tooth on the opposite side of my mouth had nothing to do with it.

Within weeks, surgeons removed and reconstructed part of my tongue using tissue from my forearm. They opened my neck, removed lymph nodes and rebuilt what they could during an operation that lasted sixteen hours.

Then came chemotherapy, radiotherapy, speech problems, eating problems, pain, scars and the long work of learning how to live in a body that no longer behaved automatically.

Years later came the book.

All of it sits on top of a series of ordinary decisions.

A dentist returned to work.

I happened to be her first patient.

She had recently been reminded to refer suspicious changes.

She noticed something on the wrong side of my mouth from the tooth I had gone in to complain about.

She offered a referral despite telling me I did not fit the expected picture.

I said yes.

A registrar who could barely see the mark asked a colleague to check.

Someone decided to take a biopsy anyway.

You can call that early detection.

You can call it good clinical practice.

You can call it luck.

All three are true.

What I cannot call it is a strategy.

I did not attend that dental appointment because I was responsible, health-conscious or particularly good at looking after myself. I went because a tooth hurt and cancelling required slightly more effort than turning up.

That is not inspirational.

It is honest.

We like survival stories to contain clear choices. Someone notices a warning sign, acts immediately, fights bravely and emerges with a new appreciation for life.

Mine began with procrastination, inconvenience and a television programme about a roof.

The danger in telling the story too neatly is that people begin to believe they would behave better. They imagine they would recognise something serious. They would book the appointment promptly. They would never dismiss a symptom because they were young, busy or convinced that cancer belonged to a different kind of person.

I thought that too.

Mouth cancer did not look like the picture in my head.

I was twenty-seven. I was a non-smoker. I had no known risk factors. The mark did not seem dramatic. It was not the reason I had booked the appointment.

Cancer does not care whether you fit the picture.

Most persistent ulcers, patches, lumps and unexplained changes will not be cancer. That matters. Panic is not useful.

Neither is ignoring them.

There is a point between terror and dismissal where you allow someone qualified to look.

That is all I am asking.

Not fear.

Not obsession.

An appointment.

The boring one. The inconvenient one. The one you have already rearranged twice. The one you are considering cancelling because work is busy, parking is awful, the symptom is probably nothing and you do not want to waste anyone’s time.

Probably nothing is still worth checking.

Later is a dangerous country.

I almost didn’t go to the appointment that found my cancer.

I went.

I am still here.

This essay describes my own experience and is not medical advice. Most mouth ulcers, patches, lumps and other changes are not cancer, but persistent or unexplained symptoms should be checked by a dentist or GP.