A man I know, who was recently diagnosed for the first time with cancer, told me a story today. When he talked to his boss about the diagnosis and how it would affect his work, he said that he felt as if he had been hit by a train, but that he quite obviously had not been hit by a train. In the recently published book When Breath Becomes Air by Paul Kalanithi the author says that before he was diagnosed with cancer he knew that one day he was going to die but he did not know when, and after he was diagnosed with cancer he knew that one day he was going to die but he did not know when.
Some cancers have immediate and painful symptoms, others can have none at all until they have spread throughout a body. No matter how severe or debilitating is the actual disease, living with cancer is entirely mental. It is very hard work sometimes not to give into one of the many dark emotions a diagnosis of cancer brings with it. Some of us share the experience openly, many others keep their own counsel.
About two weeks ago I had my regular blood test. It is always the same: full blood count, liver and kidney function and PSA – the marker that indicates the presence of my disease. I am following the advice of my oncologist and managing the disease with an intermittent medication schedule – six months on, six months off. I am currently two months into a period without medication. The blood test results show that during this period the PSA value has risen from 0.5 to 4.8, indicating that when the medication is taken away, the cancer comes back. Although I knew this and although I already knew that this cancer of mine is very aggressive, I had not expected it to return so vigorously so quickly.
It was like being hit with that train. Again. Every time the PSA rises it hits me. But it doesn’t. Apart from the disappearance of the side effects of the medication, nothing has changed. I feel no different. There are no debilitating symptoms interfering with my life. The cancer continues to be contained within my prostate and it has not shown any signs of spreading any further. And even although I was told more than three years ago (by a different doctor in a different country) that even if I took the medication, I would be dead within three years, I still do not know when I am going to die.
I have to keep myself mentally active and I have to acknowledge every dark emotion that comes upon me. To use popular parlance, I must be mindful. So I plan trips into the mountains, I pour over maps and prepare. For if it is my destiny to live with cancer, then I am going to be alive for as long as I can, see the summits of as many Scottish mountains before the disease makes it impossible. When I think about it like this, life was never quite so alive before I was living with cancer.