Over The Abyss

“ . . . But so much was our love,
We would not understand what was most fit;
But, like the owner of a foul disease,
To keep it from divulging, let it feed
Even on the pith of Life.”

Tonight we are celebrating quietly. There is a puppy trying to nibble surreptitiously at my feet, the lights are low, there is jazz music playing from the kitchen and we are talking softly. Not a unique scenario perhaps, but precious for what C.S. Lewis called “the delights of domesticity.” But it is special to me for a different reason. By rights, I shouldn’t be here at all – certainly not in good health. Less than a year ago, I was diagnosed with advanced prostate cancer.

I’d been called in to discuss the results of some blood tests – never a good sign, but I was optimistic. I felt well and I’d overcome plenty of obstacles since I left the classroom to focus on addressing the silent epidemic that is reading failure at secondary school. Surely now, after all this struggle, it was time for a break in the clouds?

Apparently not.

For some reason, instead of the GP who had ordered my tests, I was seeing the senior partner in the practice. He peered at me over his spectacles. “Your results are very good on all tests,” he began, and then: “All except one.”

I waited for the bad news. “Your PSA score is very high. PSA is short for Prostate Specific Antigen. It spikes when there is a problem with the prostate. There is almost certainly something very sinister going on and I’m referring you for urgent diagnosis and treatment for cancer.”

Well, he’d certainly not beaten about the bush. There was probably room to work on his empathy skills, but at least I knew what the issue was. But I like to know the data, so I asked: “When you say very high, what’s the number?”

“252.”

“And . . . what should it be?”

“Less than 4.”

“Oh.”

I left the surgery feeling angry. Angry with myself for not having been checked sooner, angry with the health system (for no good reason) and angry with cancer that thought it could just invade my life and put our future, our family, and everything we’d worked for at risk. Explaining to your family that you have a high probability of advanced prostate cancer is not easy. You feel that you have let them down. You feel that you are making them sad, and worried, and that you can’t do much about it. You feel, in some indefinable way, that you have failed.

Cue tests and more tests, some of them unspeakable. But you grit your teeth and go through it, knowing if you’d been willing to submit to something milder a lot sooner, you probably wouldn’t be here. And then came the really low point.

We were shown in to the consultant’s room. Unfortunately he wasn’t the breezy, casual chap we’d met the first time prior to having tests and a biopsy. This man was stiff, cold and impersonal. It is not an exaggeration that there was a glitter in his eyes as he spoke.  “The cancer has advanced. There are two sites in the ribs, and two lymph nodes are enlarged. This means that the disease is not amenable to curative treatment. I have recommended that you are given a course of chemotherapy and have referred you to the Oncology Department.”

We were left with a nurse who urged us not to delay treatment. She said that I should put on some weight, get as fit as possible, prepare for four months or more of chemotherapy, and accept that cancer was going to change our lives forever. My time was now limited to a few years at best.

Fortunately, she was wrong.

When we met the oncologist, we had assembled a list of questions. In the course of the previous several weeks of investigations, we had been given different and at times contradictory information, and we could not contemplate major decisions about treatment without clarity. The remarkable thing about our oncologist was that in addition to being very well-informed about the latest research in her field, she listened to us. She let us put all our questions, and then responded carefully. She despatched some of our slender hopes gently but firmly, but then offered an unexpected ray of hope.

“The fact is,” she said, “The scan that you had has recently been shown in a study to be only 50% accurate. I can refer you to a hospital in London, where they can conduct a scan with a much higher reliability. Then you’ll know exactly where you stand and what your options are.” Naturally we accepted, but came away sombre in the knowledge that I might have been left to have palliative treatment, with curative treatment withheld, on the basis of an assessment with only 50% reliability. How many other people are driven down that road because they trust their doctors instead of questioning everything?

I have particular reason to question everything. Ten years previously I had had a brain tumour removed. I’d spent eighteen months asking for help and being told by GPs that my headaches were caused by stress, that I needed a good holiday, that I should drink a cleansing tea to help manage the nausea I felt, and finally that there was nothing wrong with me neurologically, but that I would benefit from a course of psychotherapy. When I finally did get an MRI scan, they wouldn’t let me leave hospital. There was a cyst the size of squash ball pressing on my brain stem and they feared I might collapse at any moment. (In fact, I almost did collapse on a street in Paris, when I was out on my own, but somehow got back to the apartment, literally one step at a time, where I was safer. So much for taking a holiday.)

That experience ended successfully, if somewhat traumatically, with surgery – except that I went back to work too soon. Note for any readers having neurosurgery: if someone cuts open your skull, lifts out part of your brain, and then puts it back and staples your head together again, don’t rush back to work. It will slow down, and possibly permanently limit, your recovery.

So now we question everything and everyone, and the end result of this is that we are sitting again in the oncologist’s office and she is giving us the results. “There is no cancer outside the organ,” she explains. “The enlarged lymph nodes have shrunk. There is only one possible site on the ribs, but it is so tiny that chemotherapy would not be of any benefit. I am therefore recommending you for a curative course of radiotherapy.”

I recalled how, a few months before, I had been horrified at the thought of having to take time off to have radiotherapy. Having recently faced the chemotherapy alternative, however, radiotherapy seemed like a very pleasant option indeed.

And so now, a few months later, I sit at home quietly celebrating the end of my course of treatment. It has not been easy – in particular, I had not anticipated the levels of fatigue and their effect on my mental functions. I’ve been a bit of a zombie for the last few weeks. But here I am, irradiated and at peace, and knowing that there but for the grace of God . . .

You may be wondering why I would share all this. I’m sharing it because I know that many of the people who read this blog are teachers, and teachers are particularly prone to put themselves last. It’s something to do with personality and motivation, and something to do with the culture we foster in schools. But, teachers – especially male teachers: do not delay in getting yourself checked for whatever need arises. I know that men can often feel that it is somehow shameful to admit that we might have a problem. We sometimes get laughed at when we do. “Man flu!” someone will scoff, while your head throbs and your stomach churns, but you have to hold it together because – why? So they won’t think you’re weak? Because that’s what men do?

The truth is, managing your health is vital to fulfilling your other responsibilities. Ignore the tactless colleague, and face down the unsympathetic, possibly sociopathic manager who grumbles about you having time off to deal with health issues promptly. They aren’t the people who care about you, nor are they those who depend on you. Teaching, with its amazing highs and lows, its adrenalin surges and desperate moments that can so quickly resolve into relief or even joy, has a way of distorting our priorities. To manage our health, and to flourish, we need to keep a little distance. Look after yourself. There are people who need you. Beyond your career, there is a life to be lived. Don’t let the love of your work trick you into becoming the victim of some ‘foul disease’.

Note for male readers:

It turns out that the only sign of prostate cancer you are going to get is a reduction in urinary flow. That’s the only external sign that something is wrong. If this happens, don’t assume, as I did, that it is simply a function of getting older. I was wrong! Prostate cancer also tends to be more aggressive in younger men, so forget all that stuff about it only affecting men over 55. It can affect you at a younger age and it is more dangerous when it does, so get checked at the first sign that something is wrong.

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