Fifteen months on from there, and after a variety of what we might call ‘learning experiences’ along the way, I have just had an operation to remove the cancer. The outlook is good, and I go for a hopefully final check up with the consultant next Wednesday.
Having cancer, even a slow growing one like prostate, is no fun at all and I would not wish it on anybody.
But are there benefits? Insights I have gained along the way that I can share?
Are there lessons that the often intense experience of having cancer has pushed me to address, and which others can learn from without having to go through the experience?
I hope so.
After some reflection I think there have been four key sets of learnings along the way.
Change 1: Diet and Environment
Around the time of my diagnosis I intuitively made two changes in my life. The first was that when I had to move house I felt a very strong pull to get out of the city and into the countryside.
I also began to eat better. I already had a fairly healthy diet, but once I had cancer I cut down on the processed meats (and meat in general) that I had known for years could be a cause of cancer. And I also found that healthy foods I would have said before were “too expensive” suddenly became incredibly good value. After all, if you haven’t got your health, you haven’t got anything.
So I ate better, and I ate less. And I moved to a location that restored me every time I looked out of the window.
I already knew that diet and environment could affect my health. So why did I wait until I had cancer to change them?
Change 2: Exercise
The second major change I made after being diagnosed with cancer was to take more exercise.
I was already reasonably fit, though not particularly sporty, but meeting one of the top prostate cancer surgeons in the country convinced me that I needed to get fitter.
At the end of our blunt and sometimes challenging first meeting I asked him whether my specific case details (my age, PSA level, size of prostate, location of the cancer, family history, and so on) meant that my operation was likely to be particularly easy, difficult, or just average.
His reply was that none of that really mattered. What mattered was that I was tall and slim.
Once I had got over my initial surprise at being called either of those things, I decided that if my weight to height ratio was what was going make the difference then that was what I was going change.
I stretched myself with yoga and walking, and by the time of the operation I had lost a couple of kilogrammes and was feeling much better in myself. I am also sure that my recovery from the operation is now proceeding much more quickly than it would otherwise have done.
But again, why didn’t I do this before I got ill?
Change 3: Taking responsibility for my own… ‘healthcare’
The third thing that having prostate cancer did for me was force me to take responsibility for my own healthcare. It did this in three situations of increasing criticality.
In the first situation, at the time of my first blood test, my doctor/GP did nothing to explain to me the well-known inaccuracies of the PSA test. I thought I understood these well enough and didn’t think that it would affect the course of treatment, so I didn’t force a discussion with him and just went along with what he recommended. With hindsight I wish I had had that conversation.
The second situation arose with the consultant I saw next. He wanted to do a biopsy immediately. When I tried to discuss with him the risks of this procedure and the possibility of alternative approaches he refused to engage with me, dismissing all alternatives as “experimental” (which I knew was not the case). Rather than pressing harder, I calculated that if I couldn’t trust him to have an open and honest conversation with me then I couldn’t trust him to do the best for me when I was on the operating table. I walked away.
This was an improvement on my first reaction, but still I had not learned the lesson. My opportunity to do so came about a year later, after a number of further tests and a great deal of research on my part.
Now I was meeting the surgeon who would potentially operate on me to remove my prostate gland, and whose skill in doing so would determine not only my success in removing the cancer but also the quality of my remaining lifespan (depending on the damage he inflicted on nearby parts of my body).
Again, he refused to engage in adult to adult conversation, preferring instead a parent/child approach. He was unhelpful to the point of being rude. “If my children had spoken to me like that…”, a friend who came with me to the second meeting said. And, like the first consultant, he confidently told me things that I knew simply were not true (for example, that the outcomes for surgery and radiotherapy were broadly the same).
I found myself caught between on the one hand a rising sense of urgency of the need for surgery and the knowledge that two good sources had said this was a very good surgeon, and on the other hand a sense of disquiet that he was not engaging with me in the kind of dialogue that I wanted.
I followed my heart and my head. I researched the facts, and tried to get him to engage with me around those facts. When he refused a second time I disengaged. And this time I also took the missing step: I created a better alternative for myself. I booked an appointment with one of the best prostate surgeons in the country, who operated on me about a month later.
The outcome of that operation has vindicated my decision. The previous surgeon had planned to completely remove two important but non-essential sets of nerves that run either side of the prostate, “to be on the safe side”. This would seriously have impacted the quality of my life, for the rest of my life. The surgeon I went with saved 70%-80% of the nerves on one side and 100% on the other. A huge difference in outcome, and a huge difference for me.
The learnings, though difficult for me at the time, are clear in hindsight:
- Trust your gut/intuition
- Notice whether the person is engaging with you in an adult to adult conversation
- Listen to the ‘experts’ but do your own research as well
- Find the questions that will make the difference you want to your outcomes, and be sure to ask those questions
- Know your timeframe
- Find someone who can engage both technically and emotionally in the way you want.
Hold on to what really matters to you, and don’t give up responsibility for making it happen to anybody else.
Change 4: Deciding what matters to you / what’s important
Facing death (which is always a possibility with cancer, no matter how slow growing) does tend to focus the mind.
In my particular case I was also reminded of some words I’d spoken at my father’s funeral. I said I’d known since I was six or seven years old that this day would come, so I couldn’t really say I was surprised. And later, “They say that when you die your life flashes before your eyes. I bet his life was worth watching.”
Of course the same applies to me. I’ve known since I was six or seven years old that one day I will die. We all will. It might be cancer now, or something else later. In either case, all we can do is make sure that when it happens our lives will be worth watching.
Having had cancer has been a great opportunity for me to get clarity, real clarity, on what I want to do, and how I want to do it. Because when my life flashes before my eyes only I will be watching.
In the time leading up to my treatment I allowed myself to focus only on myself and my health as my number one priority. I let all the things I ‘should’ be doing fall away, which was a new and liberating experience.
I gained a new appreciation of the everyday little things I’d taken for granted. I noticed Nature and the coming of Spring in new ways, realising that in 100 years time I won’t be around to appreciate them. There’s so much beauty in the world and it has become important for me to stop and pay attention to what is actually happening around me during the time that I am alive to see it. And I have similarly taken a step forward in my ability to accept and appreciate myself and other people for who we are.
Looking forward at the rest of my life, I had the opportunity to ask myself, very starkly: if I only had two years to live, what would matter to me during that time? And what would not?
Having gained that clarity, let go of things that didn’t matter, and gained a new appreciation for what is around me, I find myself not only feeling lighter but with new energy.
The result is that I have developed a new capacity for what I want to do with the rest of my life, and how I want to live it.
Does it take facing cancer to achieve that? Or can it be achieved by anyone once the lesson is shown?
In summary — four questions that seek your answers:
In reverse order, here are four sets of questions that I hope can help you gain clarity and action in your own life:
- What work are you here to do? What truly matters to you?
What don’t you care about? What can you let go?
In a wider sense, what would make your life worth watching (for you) on the day you die? What will it take for you to have lived a worthwhile life?
- Are the people in your life helping you get to where you want to be?
Are they engaging with you in adult-adult conversations? Or are they (like some of my consultants) being rude, uncooperative, or downright misleading?
What researches do you need to do?
Can you change the conversation, by changing the way that you engage with them?
If you chose to walk away, what does good/better look like?
And is it achievable in the time available? Or (better), do you choose the challenges you will face if you stay or the challenges you will face if you walk away?
- The key measure affecting the outcome of my operation was my ratio of weight to height.
What key factor (attitude, capability, skill?) will have the most impact on whatever goal you are focused on?
What would it take to shift that measure in your favour?
Are you willing/able to make that happen?
- What in your diet and environment is potentially toxic — to your body, mind, and psyche? And what is beneficial?
What can you change: start or stop, add or remove? What will you keep the same?
They say that every challenge is an opportunity to grow, and I certainly found that attitude helped me enormously in facing cancer. My hope is that these words will enable you to learn from the experience without you having to go through it.