COPING WITH CANCER
This is not a recipe, a prescription or a set of instructions: it’s a record of one person’s experience of coping with a pancreatic cancer diagnosis: mine. It may or may not be useful to other people, or for other cancers or other terminal illnesses. Neither is it an opening argument in a debate with people who might disagree: it’s a strategy which has worked well for me, thus far, and so it follows that it could help some other people.
Acceptance of the diagnosis and the likely outcome is the first, essential stance. Going into denial may offer some temporary relief but the reality is ultimately inescapable, and so it might as well be accepted from the beginning, because everything else depends upon that. Escapism may have a role to play in coping, but it’s a bit-part, not a ‘lead’: it’s a useful distraction to pass the time, have pleasure and enjoyment, inhabit another reality in books, music, film, tv, conversation, exercise, whatever, and I have done all of those things; but to the extent that we fully immerse ourselves in those alternative realities, so there is a jolt when they finish and the real world reasserts itself. When we have really accepted our condition, we have insulated ourselves, to a degree, from ambush: we are shockproof or at least cushioned.
Obviously, accepting the likelihood of death is too drastic for many cancers which are treatable; but where the survival statistics predict a fatal outcome as the most likely eventuality, death needs to be taken on board and looked in the face. This is where I disagree with many people who argue that you must ‘fight’ it to the bitter end, and there are many references in literature to ‘struggle’, ‘combat’ and people ‘winning their battle’ with cancer. Dylan Thomas told us to "rage, rage against the dying of the light". The metaphor of a personal war against the enemy may be heroic, and helpful to some people in encouraging the hope of survival, but ultimately fruitless: catapults vs nuclear weapons. In the early stages of my diagnosis I discovered that the long-term survival rate was 5% for pancreatic cancer, mostly because it was already too advanced before any symptoms appeared, to be curable. The determination of King Canute (Cnut) to turn back the waves seemed like a better metaphor. Of course there is a slight possibility that you will fall in that 5% who survive, but the odds are poor: people’s belief in luck against those odds is what makes bookmakers prosper. To those people who tell us to fight cancer, I would ask ‘How’? How exactly do you fight cancer? This is not a debating point: please tell me what you are supposed to actually do?
The maxim ‘prepare for the worst, hope for the best’ is something of a cliché, but like many clichés, it has some truth-value. It is simply the best strategy. Early on, some friends thought I was too pessimistic when I talked about my eventual death and how I was preparing for that outcome. The survival statistics make pessimism simply realism, I believe. There are also arguments that you have to adopt a positive attitude to ‘beat cancer’. I totally accept that a positive attitude is a great approach to life, bringing huge benefits in motivation, achievement and wellbeing; but that is a very different thing from believing that positivity can knock out cancer cells....take another bow, King Cnut. What I have adopted, is a positive attitude towards the remainder of my life, for example, refusing chemotherapy, so that I don’t ‘feel like death’ ahead of time. It was a decision, taken after long deliberation, to go for quality of life over quantity: the outcome will be the same, but the intervening period incomparably better. Chemotherapy can be brutal and have devastating side effects, including cardiac damage, which could be critical, given my heart history (see FESS). I had to endure some exceptionally painful procedures before radiotherapy, so it is not fear of the experience of chemotherapy, rather its damage to the body, and its efficacy: even after several chemotherapy treatments, pancreatic cancer tends to recur.
Most people have been very supportive of my position; however, one person said “You can’t just let it run and do nothing - it’s like signing your own death warrant”. If I had been quicker-thinking, I would have replied, “I’m not the one who has issued the death warrant, I’m just ticking the box to say that I accept the Terms & Conditions”. Time will tell whether it is possible to maintain a positive attitude to the very end: probably not, but I’m reminded of the sequence in The Magnificent Seven where the (Steve McQueen?) character tells the story of the man who falls off the top of a six-storey building, and as he drops past each open window, the people inside the building hear him say “so far so good, so far so good”....
As a young man I had some bouts of anxiety-with-depression: a long time ago but still vivid. Why has this not recurred during the last 6 months since I’ve known my diagnosis, and I have had every reason to feel precisely those emotions? It’s a hypothetical question and I don’t have a definitive answer, but I believe it is because I have accepted the reality of my condition, made the necessary practical preparations (Will, Lasting Power of Attorney etc), not succumbed to feeling sorry for myself, remained active and constructive, maintained a generally good mood and sense of humour, and, most of all, had the most perfect robust support from my family and friends - and seeing so clearly how this situation has brought out the very best in all of them.
My good friend Sharondipity has also provided two wonderful rationalisations for accepting my demise with grace: on the positive side, I have had a good life, achieved more than was probably expected of me, and played my part in launching my children into adulthood: my jobs are done. Also I was privileged to be born into a golden generation who has benefited from all the fruits of social democratic government: free education from playgroup to PhD level, the NHS, Legal Aid, State Pension, Unemployment Benefit and countless pieces of progressive legislation (all resisted by the Conservatives) on capital punishment, divorce law, abortion, race relations, equal opportunities, sexual orientation, sex discrimination, trade union rights etc etc, which have made this country a decent place to live in, until now.
On the other hand, my early exit means that I will completely avoid all the worst depredations of Brexit, Johnson, Trump, national decline, World Recession, more pandemics, disastrous climate change or nuclear war; and I won’t end up in a care home with incontinence and dementia. Excellent timing.
For a detailed account of the development of pancreatic cancer, read Chapter 69 in FESS: 'If Carlsberg did Cancers'
Soon after the onset of the disease I realised that it would be too exhausting and time-consuming to keep up individual correspondence with family and friends, updating my progress in detail along the way. Instead I posted a series of bulletins on Facebook and by email: these began with the offical diagnosis in March 2020, and omitted the long period between October 2019 and February 2020 when cancer was suspected but not confirmed. I did not want to raise alarms unnecessarily, or cause anxiety to my family and friends that might turn out to be unfounded. Although 'going public' on Facebook felt slightly inappropriate within the usual content of that platform, I have never regretted doing so, and the sense of being instantly in touch with so many people and having their messages of support from time to time, has been an important part of coping with the illness. Here are some of the bulletins: