Diagnosis: cancer

Here begins what I believe will be my most difficult post to write. Not because it is likely to trigger any flashbacks or repressed memories. Because I'm worried how those I love will take it. You see, this will not only remind them, quite abruptly, of news they received on that day and what it meant for us, but they're going to see the things I didn't tell them. And not just the things I withheld for a day or two, so I could do them the mercy of leaving some of their questions unanswered when I not only knew the answers but knew they were bad. So I could allow them some time to process before the next blow. The things I hadn't ever intended to tell them, about how I felt and reacted that day, simply because they weren't able to be there with me right when it happened, and I know that to think of my suffering and their inability to help will only hurt them. So please know that whilst I am writing this for what I believe are the right reasons - to provide some context to my story, in the hopes that it gives a possible basis for consideration should you or someone you know one day have to tell yours - I am doing so at some personal and associated emotional cost. All I can say to soften the blow is that recently I've witnessed and better understood my family's ability to endure hardship, and whether or not they believe it, what they have done in the weeks and months that followed the events below entirely overshadow any small solace they could've given me on that one shitty day.

Who to tell (what)

One of the hardest concepts I've had to grapple throughout this ordeal is what to tell and to whom. And it's not as binary as "what". Once I've decided someone needs to know something, we're into the truly ambiguous, the grey; "how much?". How much of the "what" do I tell them? There's more yet to decide, whether consciously or not; "when?". I mention the conscious (or unconscious) nature of this decision because it probably comes down to another split-second calculation I've made based on "how" I want to tell that person - is urgency the key, or do I sacrifice urgency to tell them in person rather than over the phone? Is a text too impersonal? Or actually, does it save them the embarrassment of crying on the phone? And anyway, should I give a toss about them crying? Come to think of it, do they? - And finally, notice I say "that person". Not "those people", and an odd choice you might think, because surely there are dozens of people at least? And true, turns out there are. I say "that person", because for at least a handful of those people, I'm weighing all of these questions, running through the hypothetical scenarios, calculating the cost-benefit, etc. in the hopes that I can reach an optimal solution for that person. I then get to do it all over again for that (other) person. And again. And then, eventually, I can figure out the groups: this branch of family; that branch; this group of mates; that WhatsApp group.

 
It's an inelegant way to describe a process that took me less time to conduct than it did to retrospectively dissect, decipher and document the manner in which I conducted it. Then again, I don't expect it to be easy for me to understand a complex amalgam of competing and interdependent, rational and emotional decision-making processes within my own exhausted brain. I'm slightly impressed I can remember what decisions I came to.

My diagnosis

So this was it. This was the unexpected phone call that delivered my diagnosis. 7 minutes and my fucking world changed. 7 minutes and I heard the words “cancer”, “testicular”, “lungs” and “Stage 4”. I expected "cancer", I was ready for that one. I hadn’t been ready for the others. Not at all. And for some reason, they all felt worse to hear than the word I know should be doing the damage.

I was at work. Well not at work, per se, but with work. My team and I were taking some of our staff through routine shooting practice on a pistol range. Two of my team were giving the safety brief. I'd just sat in through our team brief, and as the safety brief started up I had a call from a withheld number. I can't say I was expecting to hear from my consultant, it was Wednesday and I'd been told not to hear from him until the following Tuesday. I expected it was work. Best to step "outside" (we were already technically outside) and take it.

So over those 7 minutes I heard from my consultant, and heard each of those phrases. I wasn't in a great place to think of meaningful, relevant questions. I was borderline in shock. In any case, the few specifics I did ask about he seemed reluctant to give as it was best they came from the new specialist. A bit of context here; for over a month everyone had been convinced this was a sarcoma. The clue was the bloody great tumour sat in my pelvis causing all this mischief, so logically, I came under the sarcoma unit. The biopsy I'd had was to help to narrow down which of the many subtypes of sarcoma this was (right after we confirmed it was cancer, which of course we knew it all was, because one doesn't really get 6x11x17cm benign tumours in one's pelvis). So safe to say when it came back as testicular cancer it was a shock to all, but especially to me. I was ready for cancer. I knew the news was going to hit me, but I was bracing for that hit. What I wasn't braced for was a hit in the balls. And let's be honest, can you really brace yourself for a hit in the balls? Actually, cancel that analogy, it doesn't really work; I'm pretty sure through the slog of signs, symptoms and tests, a lot of people are mentally braced to be hit with cancer in the balls. I just wasn't. Not a bit. This, frankly, was bollocks. Aimed at my balls.

Anyway, that was at 0841 on Wednesday. I'd have to wait until Friday morning to speak to my new consultant. So what to do now? Well, first things, there was no way in hell I was in a position to monitor a shooting range for safety. Set aside for a moment my mental faculties laying on the grass somewhere nearby where I'd taken that call, either I'd just started to suffer from hayfever or my eyeballs were now leaking too. I went to the others and pulled Scotty aside - Scotty and Kamal were the two in my team I work closest with, and Kamal was busy briefing - I needed to pull out of this duty. He could tell instantly the call had been about my diagnosis and pushed until I told him the gist of what I'd been told. Scotty's a pretty battle-hardened (quite literally) soldier of 20+ years, and he's seen some stuff, but I don't think he was expecting to hear this. He took a knee on the grass with me and just absorbed it for a moment. Now I was worried about him. He started telling me I needed to get home, I needed to pack, I needed to be with family. Yes, I did, and I certainly wasn't avoiding it, but a few hours wouldn't hurt. In fact, I wanted those few hours. I told Scotty to go and get Kamal, we needed to tell him and figure out a plan that didn't require me. Kamal, like Scotty, has done his time in conflict. He's also pretty rigid when it comes to things like bearing, professionalism and rank. Even when we go out for beers, as a small team, all very close friends, he's the one who can't bring himself to call me Alex. Eventually he'll drop the "Sir" by forgoing any salutation whatsoever, but he still allows a micropause to say the "Sir" mentally and prevent himself from developing a stomach ulcer every time he needs to get my attention. Anyway, with all that context laid down, imagine my shock, at a time when I already think I'm at peak shock, he not only puts a hand on my shoulder but I swear he wobbled as he caught himself in a mental duel about whether or not to hug me. He'll deny it, but he hasn't got a blog.

We delay the shoot by 20 minutes or so. The guys see I'm ok and just need them to let me have the time. I've already figured out a plan to get me back to base in a few hours without derailing the day, and they agree.

At 0915 on the dot I get a call from best mate Alex. I'd messaged a few minutes earlier asking if we could have a call. Going by the context and it being during the working day, he'd have known something was up. We only chat for 23 minutes, and the first few I'm certain I struggle to get more than a few words out at a time. But eventually I do. We talk about the diagnosis and my plan for the day, particularly about what and how I'm going to tell my parents. The issue is, they're not expecting to see me till Friday, so my dilemma instantly boils down to "do I tell them now" or "do I doorstep them". There's no clear winner, but I'm leaning towards doorstepping them. Either way, we wargame a plan for both so I can refer back when I've made a decision. Next on the call log is another friend, Jess. We'd been texting about upcoming plans and as I take a moment of respite sat against a tree I know I should just ignore it for now, it's not particularly urgent, but I tell her I have to bail. I let loose that I've had results and for ease we call. It's about 20 mins, there are tears, but it's good. Each time I tell someone it gets a tiny bit easier, and I come away better prepared. Case in point: I bring Jess into the Tell them vs Doorstep them debate - with a doorstep they'll know something's up, but I'll be there, and I can tell them in person. Actually, just verbalising this is convincing me. Done, I'm going to doorstep them. Enter Jess: there are tube strikes today. OF COURSE THERE FUCKING ARE. I mean, it's been at least two days since the last lot, so we are about due some. I can't drive either, my right leg swells at the thought of moving. Well, I guess I need to ask them for a lift, which certainly means letting them in on things. Decision made, not by logic or rationale, but by lack of options. Still, I hate the thought of telling them this sort of thing over the phone. It's not fair for them to have to worry like this without being able to see me. It also serves no purpose. I reach a compromise: I'll tell them it's cancer (we all know as much, and I wouldn't be getting dragged in like this for good news); I'll tell them it's testicular (not ideal, but they'll ask and it's probably not something I can say wasn't given when I was receiving my biopsy results); the lungs and the stage 4 comment aren't making the cut, not this time at least. I figure, if it's all genuine, they can have it when I've seen it on a scan and heard it from my new consultant, who this time can at least give me some context: what does it mean for testicular cancer? How does it affect prognosis/treatment? That stuff. If I'm going to deal them a sledgehammer blow, I'll do them the courtesy of letting them inspect the hammer afterwards give them a couple days' warning it could be coming.

Insert quick Tarantino-esque smash-cut with fractured timeline forward-jump:

I watched those decisions play out - for me, my family, my cancer and my journey - and I stick by every one of them.

Smash back to 15th March:

It's now about 1020. I've had two phone calls, the odd face-to-face, tears have been shed. I've arranged my follow-up appointments, and graciously, I've spoken to a couple of oncology nurses, who unlike the ruthlessly matter-of-fact consultants, have a bit of time to give me some context and inject a little humanity. That helps. 

For a while I knew what got me through that first barricade. I wasn't sure how to articulate it, but I think I've got it now: firstly, verbalising the problem. And not just verbalising, but vocalising it, so that I could feel it. If I could feel it I could accept it, and normalise it, and eventually deal with it. Being scared of saying it aloud wasn't going to help me face it, and it sure as hell wasn't going to help me start speaking without crying again. 

Secondly, I needed friends to help me . And I don't mean friends who could logically deconstruct and process it. I've got Google in my pocket for that. I needed friends who would share in the emotional acceptance of what was happening. Someone to help me start turning words back into sentences. Someone who would cry first, reassuring me that it was ok for me to cry because this wasn't a "wobble", this was a normal way to react to an abnormal scenario. Someone who knew that at the most raw point, no words were ever going to make me feel better, but in that brief moment a hand on the shoulder just might.

What I felt then, I know now: by 1020, I've shed my last emotional tear and I'm feeling ready to face and fight this.

I didn't want to call my parents just yet. I wanted to let them know with enough time to get on the road and for us to beat the traffic back, but I wanted to minimise how long they dwelled on things at home. A dicey game to play with my mum's pessimistic disposition and rush hour M25, but I figured I at least had until after lunchtime. Best use the time to get back to base, pack my things and plan a script in my head, anticipating any urgent questions where possible. And also to tell work there's a good chance I'm not coming back in for a while.

I was lucky enough to get a lift back to base with Mo, a friend who's not only a mental health nurse, but a pretty solid listener and advisor. In that 90 minute car ride I motor-mouthed away like a livestock auctioneer. I posed questions, convinced myself of decisions, and asked more questions about cancer. It was 90 minutes I needed, and Mo struck the perfect balance of clinical insight and humanity. He's a son and a parent, and helped me to look at it from both angles free of judgement. I wish I'd recorded that journey if only to show others what to do in that incredibly unique scenario.

I get to work around 1300. I head straight to the office and immediately tell a close mate followed by some of the hierarchy. Both my immediate line manager and our organisational boss are brilliant. I couldn't have come away from those short chats feeling like I would be better supported throughout this process. I wasn't sure what the support would look like or how they'd achieve it with all the real world drama they have to respond to, but I didn't doubt them. I was free to grab a sandwich, head to my room and call my parents.

Like the other phone calls to take place that day (apart from the only one whose picture made it into this article...), the call to my parents was again just over 20 minutes. I was shocked at how well they took it. Maybe I underestimate the value in spending some time planning and refining my story, perhaps I just underestimated them. I'm constantly doing it, and constantly feeling silly for doing so. They hear all my points, they ask some reasonable questions, but they also understand that they'll be with me in a few hours and we have a whole car ride for that game. Instead they adopt a cerebral sidestep and help me to remember everything I'm going to need to pack. I'm no longer sure whether I'm trying to distract them from the emotion with deadline-riddle pragmatism, or the other way around. Possibly a bit of both, let's share the win and laugh at our common ignorance. Silly us, how quaint. Games and trickery aside, I pack, they drive, and a few hours later we're headed home. We hit the traffic, and we hit it hard. It's an uncomfortable drive, and pit stops are needed to accommodate my pain and the new stent adjoining my kidney and bladder. Still, it's been a uniquely trying day and late finish  to top things. so it warrants a Maccy's. I can't bring myself to put a "Happy Meal" to the test as I don't think it's up to the challenge, but my Big Mac is enough to help me end the day on an almost-positive.

I'm going to end this post here, because 99% of what I'd wanted to describe was my thought process as I first discovered and processed my diagnosis, and how I attempted to bring my parents into that shared understanding (and to what extent). For clarity, on the Friday I received confirmation of my diagnosis (with some very important clarification and context) which subsequently allowed me to tell my parents the full story as I now knew it, and fortunately one I was much happier to tell. But as I laid out in the beginning, there are probably some things to be taken away by someone else who received bad news, whether it's how to deal with it or how to share it. I'm not saying those lessons are to do what I did, not by a long shot, but they worked for me. They worked because of the variables involved - me, my parents, my friends. From what I've written, which I maintain is a pretty accurate version of events, maybe you can spot what will or won't work for you and yours.