Went to Oncology in late July to hear the results from the CT scan I had many weeks before that. Short summary is there was no good news. It’s still progressive, which is bad, but then there’s nothing new or catastrophic to report either. Most of my tumours are increasing in size. For example, the largest area of soft tissue on my upper left lung went from 37mm to 46mm and continues to obstruct the left upper lobe. It’s pushing against my left pulmonary artery and I must hope that it doesn’t push through to trigger the La Traviata outcome. There is more soft tissue in the pelvic area, in something called the presacral space, which tends to cause pain in the lower back and hips.

Also on the agenda was my suitability for the drug trial. The genetic screening result came back negative – I’m not in the 20% minority and don’t have the right wrong gene. Therefore there’s no place for me on the amusingly-named “STARTRK” trial, and I won’t be boldly going anywhere.

One interesting revelation was I could still opt for more chemotherapy, if I so desired. I said that I didn’t think I wanted to do so. I now regard chemo like the “dead cat bounce” they talk about in stock markets. The poison kills enough cells and pauses growth to make a short term impact, but it isn’t lasting. It may even provoke my over-eager genetic triggers to produce even more cancerous cells as a response. I left enough wiggle room so the consultant could tell me what a fool I was, and that it was best for me, but generally he agreed that my decision was “right for me”.

At least the Thoracic Park adventure continues. I was there just after for a spot of injecting, cutting and general vacuuming of the lung tissues. They’d left it a while since my last visit, and I think they’d forgotten me until I reminded them. But they did a tidy, neat job, and I’m better for it. Unlike the Piss Factory, who seem to have finished with me now, without so much as a farewell night out.

So, where does this leave me, Doc? I’m a bit of a conundrum to them. When I first appeared on their horizon in 2009 I was something of a classic “type 4” – advanced cancer, diagnosed late, wonky stem cells, poor prognosis, etc. But (with their help and treatment) I’m turning into more of a “type 2” where the decline is of the slower variety. Just another reminder that any specific cancer is really many different forms of disease hitting the same organ, and any cure has very many targets to pursue, with all the excitement and frustration that entails. They can’t do very much, but at the same time not much is going badly. Remember I’m supposed to be on a “two years, probably not five” countdown and that timer started 20 months ago. I have to say I don’t feel like I’ve used up >80% of the allotted time. Maybe it feels more like the 33% option.

This is clearly a good thing. The longer, the better. But at the same time there is no certainty. I’ve just read Paul Kingsnorth’s novel “Beast” about a would-be hermit, alone on the moor and probably unhinged, who stalks and/or is stalked by a mysterious big cat (very Beast of Bodmin). There’s a sentence in it that makes me think of cancer: “I am in the presence of something that does not know time“. Michael Faber’s short book of poems “Undying” tries to make sense of it all while watching his wife Eva die from cancer over a six-year period. He calls it “a harmony of dark biology“. On the one hand, more time is good. On the other hand, who doesn’t want to wake from a nightmare where you are being stalked by the dark beast? To quote Umberto Eco: “is this not a death undying?“. Yet I know that I am definitely no Tithonus, doomed to get older without ever dying.

I am fairly sanguine about it all. I am equally concerned about putting some vivification back into my life. We went away twice in July, which can be a big deal for me and my personal medical supplies mobile apothecary. It all went pretty well. I connected with as much of the wildness in man and nature as I wanted. The pleasures required are small and simple – a type of bird or butterfly will do it. Maybe my role now is just to get on with it, smile a bit, and not be too much of a cancer bore. “To be a rock and not to roll”, as the song says. You’d think that under the circumstances one would want to gorge on life’s pleasures before time runs out, to take in all the sapori e saperi that is to be had. But the appetite is weak.

Meanwhile, the Exterminating Angel smiles, and moves along.

Well, that’s been an interesting couple of weeks. An end to the European dream as set out by Winston Churchill in 1948, among others. The cold shivers of the first blast of the Economic winter waiting just around the corner. The simian-like racists with their freshly-issued permits to abuse. The loss of life opportunity for a whole generation of young people. A new low in the perpetually downward spiral of the body politic. And I still have this bloody annoying cancer.

“I’m not afraid of death, I just don’t want to be there when it happens.” Woody Allen once said. You could replace “death” with “Brexit” as far as I’m concerned. I’m looking at both right now, and death isn’t as far behind in the popularity polls as you might have been led to believe ;-).

When I’m drunk or upset I can only think in Galway-ese. It was weeks of internal dialogue along the lines: Well they’re all just a bunch a’ messers and chancers actin’ the bollix and you’d want to go flaking them with a hurley, so you would. They madden me somethin’ powerful, so they do. Will ya get down out of that, Nigel, ya feckin’ little amadáin ya. Now! will ya only look and see what he’s after doin’, the ugly little shite. He’s after shaftin’ the lot of us. Well, I hope he feckin’ dies roaring, God forgive me.

On top of that, I had the bad luck to click on a book called “Into Extra Time” which “comprises the powerful reflections of a Jesuit priest which he wrote during the final months of his life following a diagnosis of cancer”. God bless the poor dead man, and all that, but the feckin’ Amazon engine has me plagued and close to distraction with a barrage of recommended books by God-botherers. All trying to tell me how much comfort I can find. “Is it after givin’ me relief and solace ye’re after?” thinks I, “well, ye can all feck off for a start and take that pile of wasted trees with ye.” If it’s extra time, it’s like extra time in a dreary dull 0-0 game that you just know will go to penalties, and you couldn’t give a fish’s tit for either team.

Sorry. No, it’s fine. I’m alright now. But it’s no wonder I’m skipping along the watchtower with Bob and Jimi looking for some kind of way out of here. There’s too much confusion and I can’t get no relief.

Metaphorically, it’s turning into the year without a summer. Literally, the Year Without A Summer was an actual thing. It happened to be exactly 200 years ago, in 1816. It was down to volcanic eruptions in SE Asia that created dust clouds over the world and caused a volcanic winter. These days, I suppose we make our own volcanoes. Anyway, it caused food shortages and general privation everywhere, including England. It led to such things as the Littleport Riots in May 1816.

It coincided with the end of the Napoleonic Wars (Waterloo was in 1815), and soldiers were coming home from the wars. The English Corn Laws had just been passed by a Tory government to impose huge tariffs on imported grain, in order to keep prices high in favour of well-off farmers (mostly Conservative landowners). The effect was to dramatically raise the cost of food, and it led to a protest movement against the “bread-taxing oligarchy.” To offset the damage, ‘Poor Laws’ were passed that would supplement wages and alleviate the lot of the poor. But these just kept wages low as farmers knew that their labourers’ wages would be topped-up by the system.

Plenty of John Bull flag-waving patriotism went on display, as once again the labouring poor were asked to pick up the bill for wars and greed. Lots of “tax credits” to hide the reality of a “zero hours”, low-pay culture where you worked for a pittance and got treated like dog shit. When it was repealed in 1845, it was partly because of the Irish Famine. Mostly, it was because the rich industrialists got fed up paying higher factory wages so that rich landowners could enjoy higher profits.

To go back to the riot for a moment, it happened close-by in Littleport, Cambridgeshire. A group of people had a “few scoops” in the Globe Inn (alas, it was demolished in 1962) and they then set off to relieve the local wealthy of some of their worldly possessions. Braved-on by this, they gathered up a few fowling guns and pitch-forks in a waggon and horses, and began a march to Ely. Needless to say, the Dragoons, Cavalry and gentlemen militia were soon dispatched against them. The culprits were rounded up, and trials were held in June. Some were transported to Australia, but five were condemned to death. There was then a delay for a week because they had to hire the black-draped Gallows cart and horses all the way from Cambridge – no one local was willing to supply. On Friday 28 June 1816, the five were hanged and buried in Ely. Their memorial plaque says “May their awful fate be a warning to others”. Indeed. Step carefully, you plebs and oiks.

If this happened in Ireland, we’d have a rousing ballad to commemorate them, and we’d still burn with the indignation of their killing. A few days now after the 200th anniversary of their deaths, a little traditional camaraderie goes out to them from me. Poor is poor, no matter what your national flag.

Ah, Memorials, Commemorations and all that. I went to a classical music event in Madingley last Sunday week that was surprisingly good. One song-cycle took the words from Orwell’s 1984: “In his waking thoughts he called it the Golden Country.” I went back to the book for a quick re-read. The Party slogan just seems to have special resonance for these times: “Who controls the past controls the future. Who controls the present controls the past.” The mutability of the past is bad enough, but I keep looking at Media mind-twists on the present and constantly asking: who falls for this shit?

Winston Smith escaped the grey drudgery of his IngSoc existence by dreaming of the Golden Country. In truth, it sounds like a rather ordinary place. An old, rabbit-bitten pasture, with a foot-track wandering across it and a molehill here and there. The UK was asked to vote last week for a return to the past, to some long-gone image of a Golden Country.

I wonder how George Orwell would have voted in the referendum? Who knows, but his Internationalism was well-proven and there is that famous essay from 1945 in which he distinguished between nationalism (=bad) and patriotism (=less bad). Nationalism makes people disregard common sense and ignore facts. Patriotism is “devotion to a particular place and a particular way of life, which one believes to be the best in the world but has no wish to force on other people.” Not a great demonstration of logical thinking either, but at least a bit less bad. Still, at least you can impress your chums by saying that Gove is a misguided Patriot (doesn’t that just sound like a missile out of control?) whereas you have no time for those nasty Nationalists abusing people in the street.

So, here we are two hundred years on from 1816. Climate forces still background our experiences, and we play out the charade of history before it. We still have the under-privileged getting shafted by the Elite, and ever more elaborate tapestries of lies are woven to distract our eyes from it.  Hegel just about nailed it when he said that “We learn from history that we do not learn from history.” We the Golden Country!

I want to write my book. The one that has the cover blurb “When he beat cancer in 2016, he decided to share…”. But it looks unlikely.

I’m willing to try. The ‘running repairs’ on the lungs (as both I and the doctors now call them) carry on at 5-6 week intervals. Last time, the gauzy bandage they put over my eyes slipped and/or I wasn’t so sedated so I watched the screen and saw the camera navigate around the tubes of my lungs. It was fascinating. The scope would touch the side and trigger a little irritation, and a millisecond later I would give a little cough. Then the viscous tube would shudder and a little blood and mucus would surround the camera. It would be sucked away. I would suppress the urge to cough and we could then settle down to more probing and cutting and injecting. A fantastic voyage, indeed. As the camera was coming out, it went past two creamy-white blobs on the surface of my windpipe. I heard the surgeon say to his colleagues “there’s two more. we’ll get them next time”. Now I don’t even need the CT scan booked at the end of June. I know what they’ll find. Unless of course the lung guys get to the tumours first.

But these are just tinkerings with the problem. The real cure for cancer requires the miracle drug. And so to early drug trial phase 1 meeting I go. Yes, we have a candidate drug, they say. Something for someone like you who tells us he won’t take any chemotherapy in combination, no matter how potentially appealing the drug we offer.

It’s one of the tyrosine kinase inhibitor drugs. Yes, I know, but let me try to help. Tyrosine kinases are the chemicals that act like an on/off switch on proteins to trigger growth. These proteins are triggered by your genes. Very specific genes trigger very specific proteins and when we look at cancer cells we see too many of these proteins. So, if we could only stop them growing…

The drug being considered for me acts on a very small range of proteins and only around 5% of cancer patient populations have the ‘right’ sort of mutations. So, only a 1 in 20 chance that I’ll be one. The way they find out is to send a bit of my biopsy tissue from the great freezer to the laboratory of the drug company in the USA. They take a look and report back in a few weeks. As the OncDoc said, if it’s a match the red lights will start flashing and the klaxons will go off. Another way of saying: don’t build up your hopes.

He also said it was pretty much the last roll of the dice where drug trials were concerned, for the foreseeable future. They have nothing else.

Drugs that act on such specific proteins, explicitly detected in a person, are the epitome of personalised  medicine. Quite the opposite of the salted earth approach of chemotherapy. Maybe there are other drugs, in other trials, at other hospitals?

And there are other drugs, certainly. Some do the opposite to the inhibitors. They “take the brakes off” your body’s immune system and flood the place with good antibodies. Others act like vaccines and trigger the body to target cancer cells for destruction. Others are “Trojan horses” that get inside the cancer cells and cause them to die. All of it traces back to the discovery of T cells – the immune cells that kill cancer, in 1998.

I’ve had some of them (e.g. Cetuximab) already, with no great results. You read about others in the papers (“wonder drug”, “cure for cancer”). An example is Nivolumab, which was recently licensed in the UK for Kidney Cancer. Another one is Ipilimumab. It’s used to treat melanoma and is ‘only’ 4,000 times more expensive than gold.

But it’s a tough one. There has to be a UK trial. It has to be for your sort of cancer. They have conditions that you must meet (e.g. no more than 2 types of chemotherapy in your history). And, most stringent of all, that you have the right sort of wrong genes.

If you are not mindful, looking for a trial can be a hope-shredder.

No wonder that you turn to the bookstore for the manual to beat cancer. Just drink it, eat it, live it, think it, and all will be changed utterly. It’s like the “Scarborough Fair” ballad, but maybe more along the lines Parsley, Sage, Rosemary, and Dying.

It’s all down to our blinkered Western philosophy of medicine and the evil machinations of Big Pharma to keep the truth from us. Just consider the list of herbal remedies (e.g. garlic, mistletoe, hypericum, lingzhi mushrooms, milkvetch) that we could turn to instead. Look, the people of China and Vietnam even call the mushrooms “soul/spirit”. They must be good for you? Or, at least OK to take in parallel with traditional medicine?

Maybe not. One study in 2010 showed that a daily dose of St John’s Wort (hypericum) decreased levels of the active metabolite of Irinotecan (chemotherapy) by 42%.

Just think positive thoughts. Thinking positive affects the immune system in a good way so it’s just like taking all those monoclonal antibodies, only free and with no side effects.

Maybe not. Psychologists who have looked at the effects of optimism on immunologically affected diseases such as HIV and cancer have not been able to find a positive link. In fact, there is the disappointment hypothesis: “When things go wrong in a big way, the optimist may be particularly vulnerable.” (Tennen and Affleck, 1987).

I read one account of a “cancer survivor” who pushes the positive thoughts thing as the reason he was cured. He just mentions in passing where his brain tumor was located. He ignores the fact that it is possible to cure some brain tumours with surgery if (like his) they are located on the outside of the brain. Surely, it is his surgeon that deserves the credit?

I never forget my personal outcomes. Like 95% of people with colorectal cancers I had  adenocarcinomas. Like 50% of those patients I was diagnosed with liver metastases. But, only a small proportion of patients with liver metastases are candidates for surgery. I was one of those. Without it, I would have died. Probably sometime in 2010 or 2011.

“What a mean old bastard” you may by now be saying. He’s against a bit of yoga even though it may reduce fear and fatigue for cancer patients. I’m not and I’m certainly not advocating pessimism. I know the sense of helplessness that makes the self-help stuff so beguiling. But I worry about distractions that take us away to a crazy wild optimism (“I heard they had a cure for cancer”), the slow arbitrariness of drug approvals in cash-strapped health systems, and the politics of price controls for insanely-expensive pharmaceutical drugs.

Lighten up.

The worst of all is when someone with a marketing or business consultancy background goes through the cancer thing. They are compelled to tell the story and put it all inside some nice marketing framework. So, let’s go from genes to memes, just like Richard Dawkins did.

There may be someone out there starting his or her book on How to be a Cancer Survivor, so here is a handy list of memes that they could use: Cancer Dojo, Cancer Hacks, Cancer Keeper, Cancer Maven, Cancer Mojo, Cancer Monkey, Cancer Paradox, Cancer Principle, Cancer Senshi, Cancer Warcraft, Cancer Wars, Cancer Whisperer, and Cancer Wrangler. [Warning: some of these may already be in use in actual books, like.]

Others I have considered but cannot really recommend include: Dances With Cancer, The Lean Cancer Handbook, The 7 Habits of Highly Effective Cancer Survivors, Blue Ocean Cancer, Game of Cancer, Keep Calm and Have Cancer, Real Housewives of Cancer County, The Only Way Is Cancer, and CancerShifter.

Definitely stay away from Y U NO Beat Cancer?

The last few lines from Samuel Beckett’s The Unnameable (L’Innommable) have been on my mind.

It will be I? It will be the silence, where I am? I don’t know, I’ll never know: in the silence you don’t know.
            You must go on.
            I can’t go on.
            I’ll go on.

Such a strong feeling that I am between places. Anohni, when she was Antony, said she was scared of the middle place, the one between light and nowhere. But this isn’t about “the passing”. This is about the weird drag of wanting something to happen but not wanting it because it isn’t a good thing. On the surface it’s all very humdrum – the time dust that settles on my life layers deep and I can’t be moved to brush it away.

I went back for some more cryotherapy on my lungs. I came and went with the familiar operation in-between. I didn’t speak after with any medical staff. I figured if there was something they wanted to tell me, they would seek me out. Even the radical is banal now.

I had a letter from the Hospice. It told me that I was being discharged from their active casebook because they hadn’t heard from me (the explicit arrangement was that there would not be any need for contact until I got really sick, but I wanted to be known to them). It was like being chucked out of the disco by the bouncers for something you hadn’t done. The Death Disco, in this case. Should I complain? Do I really want to be allowed back in that particular club? There was no-one there I fancied anyway. Maybe I should just trudge home alone through the streets of the living. I can always go back. They’ll save the last dance for me.

My bank took away my old gold credit card. They replaced it with a new one, a new type of deal that matters nothing to me. It’s a new colour. Now, even my credit card is black.

Jenny Diski died of her cancer last week. One less Death Lit auteur for us all. Nobody was better at having cancer than she was. Her memoir “In Gratitude” has only just been published. I ordered it in tribute.

“Under no circumstances is anyone to say that I lost a battle with cancer. Or that I bore it bravely. I am not fighting, losing, winning or bearing,”

We should respect that, but we can still note that she met Death the mugger in a dark alley, and she faced down her assailant with a sharp wit and dignity. I’d like to emulate that.

It’s Spring, so I went to my favourite Bluebell wood to see the hazy waves of shimmering blueness among the trees. It did not disappoint. But with all the Easter 1916 stuff swirling in my mind, I could only think about Padraic Pearse and his poem written on the eve of his execution:

“The beauty of the world hath made me sad, This beauty that will pass” 

The next doctor I see will tell me about a possible Phase 1 drug trial. Yet another possible cure for Cancer that needs a guinea pig. I’ll listen carefully to the list of side effects, and if that doesn’t sound too bad, then who knows, I may say yes?

Until then, I drift.

There must be something I can dream tonight” sings Patti Smith in “Elegie”, her tribute initially to the memory of Jimi Hendrix and then later on to the memories of everyone she has known who has died. All the friends who can’t be with her today.

The writers of sad and sombre elégies for those that have died from cancer have had a busy time of it in the past month or two. A roll call in the style of Patti would include: Lemmy, David Bowie, Alan Rickman, Terry Wogan, Umberto Eco. I lie in bed listening to the news of their deaths on Radio 4 and I wonder how others hear it when the word “cancer” gets mentioned. You wonder if other people try to decode the hidden messages: “following a short illness”, “long and brave struggle”, “short battle”, and so on. Whether they try to map those shorthand codes onto cancer types such as Liver or Pancreatic. Or is it all too much for them to cogitate? Just another reminder of the arbitrary cruelty. Another horror story of a fatal shark attack in what should have been a tropical paradise. I suspect as much.

“There must be something I can dream tonight”, Patti Smith may have thought when she sat down to write “M Train“, her book of memories that could be subtitled “Elegy in a New York Coffee Shop”. The dream she actually got was of a laconic cowboy who tells her that “It’s not so easy writing about nothing.” I think it is a sad but fascinating book. It’s haunted by death. I worry that she is depressed, but she writes ” I slip into a light but lingering malaise. Not depression, more like a fascination for melancholia.” I like the way her stories weave through things I recognise. I’ve only ever stayed in one hotel in Tokyo, and she writes about the Hotel Okura. She talks about the avenue of plane trees on Jesus Green, which is one of the prettiest views in Cambridge. And she reminds me that I really, really need to go visit Wittgenstein’s grave, given it is less than 1/2 a mile from where I now sit and write. One for the Spring.

Just like Elvis, I’ve found a new place to dwell. I’ve started to hang out at the Urology Clinic. Or, as I like to call it (in homage to Patti Smith), The Piss Factory. It may seem like an ungrateful name, but I do mean it kindly and everything we talk about and do there involves the pissing function.

Well, the boys in the Piss Factory they made a date for me at the end of January. They gave me a spinal anaesthetic so that I felt nothing from the waist down. Then they hollowed me out so that my piss could flow again. They call it TURP, I call it re:Boredom. They chipped away a few stones while they were in there. That infection wasn’t long putting down its crystalline roots. After, the surgeon said “those bits I took out from your prostate don’t look benign to me”. But only Pathology can tell.

It’s a bit bloody and messy this gouging of the prostate so they put the catheter back in after. Three days later I’m back at the Nurse-led clinic and they remove it. “Go drink”, I’m told, “piss twice to get rid of the blood, then report back”. I sit in the waiting room next to the water cooler and drink. Then drink some more. And some more. But I just sit there, no urge at all. I report back with my failure. Ultra-sound happens. “Not enough fluid”. “Go drink some more”. But even after more lunchtime drinks and a pint sized cup of coffee it’s not happening. I’m ready to give up and report back again. I’m on the couch. It’s so hot in here, hot like Sahara. I’m in the room and the nurse says “Try one more time” offering me the plastic beaker of forlorn effort. Then I feel this sensation, a little painful but not much, and suddenly my piss flows like the Tiber and carries with it this big wad of clotted blood. I fill the beaker of hope.

But I never know when to stop, do I? It trickles and drips constantly. I’m on the pads. I put in a mental order for a bulk shipment of the Big Boi Pee Pee Pants.

They send me home from the Piss Factory with the phone number of a medical devices company sales rep and a couple of spare pads. We stop at the supermarket chemist to buy some emergency supplies. Days pass, and I make contact with the sales rep. He has to come around, it’s a personalised measurement. He leaves me with a sample. I try it and it is good. I have to get a GP prescription. Best appointment offer is +3 weeks. I go in personally. Long story short, a kind receptionist takes my case on and later that day I have a prescription to collect. But the doctor has written me up for 4 pairs of underwear ranging from small through medium to large. What does she expect is going to happen to me? Can she even be trusted to buy her own knickers? The struggle begins again with the Pharmacy. If I am lucky, and roughly 4 weeks after the great De-catherisation, I may have ample supplies. It’s not dignified sharing this with you. Or over-sharing this with you, probably. But this is the grind that grinds you down when it should be all about Mindfulness and stuff, innit, and getting your head in the right place. As Virginia Woolf once said: “I meant to write about death, but life came breaking in as usual.

In between, there was a CT scan and the results were back this week. The lumps that are blocking my prostate are cancerous. While I was considering the curious case of the cancer in the meantime, I had been wondering if this would be a new primary cancer (Prostate) or just some new metastases from the original CRC. It’s the latter, which I suppose is some small consolation.

There is better news from Thoracic Park. The cryotherapy they did has significantly reduced the size of the lesion in the trachea, and the hoovering-out of the gunk from my bronchus has helped my lung upper left lobe to regain some of its function. It means I can breathe better and I’m coughing up a lot less blood. Excellent palliative stuff, will keep me going longer.

It’s like being in the Anglo-saxon world that Paul Kingsnorth writes about in “The Wake“. The Anglo-saxon word for the body is “Banhus“, which is translatable to “bone house” in modern English. What a truly fucked-up banhus I have. The Anglo-saxon word for piss is “Hland“. You’ve read this far, so I guess my hland is your hland. But best of all is “Dustsceawung“, which means to consider the melancholy that accompanies ruin and decay. The dust sadness.

If I told you “that meal was sublime” you’d think I was simply saying it was good, even great. A valid, if simple, interpretation. If I said “that meal was beautiful”, you’d infer the same thing. “Sublime” has undergone the opposite of being hyperbolised. It’s been played down to have an understated meaning. This is a pity, because Edmund Burke went to some trouble in 1757 to establish a difference between the beautiful and the sublime. The beautiful is just nice to look at, but the sublime invokes feelings of awe, fear, danger, terror, and wonder.

“WHATEVER is fitted in any sort to excite the ideas of pain and danger, that is to say, whatever is in any sort terrible, or is conversant about terrible objects, or operates in a manner analogous to terror, is a source of the sublime; that is, it is productive of the strongest emotion which the mind is capable of feeling.”

A Philosophical Inquiry into the Origin of Our Ideas of The Sublime and Beautiful

Let me help you imagine this. As an apex predator, the shark is a masterpiece of Nature that you can readily admire. But if you find yourself on a surfboard on the ocean and a large black silhouette swims under your slender platform, you will experience the sublime.

As you’d imagine about anything relating to aesthetics, art and beauty, this gets talked about a lot by art critics. When you are done here, wander over to The Tate for a longer read. You’ll discover the genre of the romantic sublime, in the poetry and paintings of the English Romantics. The painting of the wild landscape or the poem about the ruined abbey had to go beyond literal and rational depiction, and transcend into the realm of the awesome thoughts that it could evoke. For the earlier Romantics like Wordsworth, it was enough that it was “felt in the blood, and felt along the heart”. The later Romantics, like Shelley and Keats, would carry on to look for the terror within. They sought out the simultaneous sense of beauty, harmony, tragedy, and horror. They were in line with Schopenhauer, that greatest of über-miserabilists, in that to consider the sublime is to look at forces so vast and so powerful that they could crush the human thinker like the mere speck of dust you are. From the awesome to the awful.

This all means something to me because for a while now I’ve been trying to talk about Cancer not as some battle to be won or (usually) lost, but as a force of nature that is, in it’s way, beautiful. But this never seemed quite right, and talking about Cancer in the context of beauty and pleasure sounds like a sort of reality denial. I was trying to capture this in 2012, when talking about the essay in Kathleen Jamie’s “Sightlines”, and again last year in 2015 when I talked about the beauty that makes you shudder.

I just lacked the correct philosophical framework, and now I think I’ve found it. Cancer is not a thing of beauty, it is sublime. Cancer is Nature, and Nature is sublime.

Cancer is the shadow of a shark under your raft.

And so the story goes he wore the clothes. He said the things to make it seem… Probable.


When I was 12 and looking around for male role models, the standard issue on offer had long curly locks / facial hair, wore a cheesecloth shirt and faded blue denim flares, and had a gold medallion peeping through his unbuttoned shirt. He walked in a cloud of Brut after-shave, spoke of women as “chicks” and valued his masculinity more than anything else. Even more than The Eagles.

And then, there was this Starman on the radio. We picked him up on Channel 2. He told us it was alright to be different. We were pretty little rebels, driving our Mamas and Papas insane. As long as you knew who Jean Genet was (or were prepared to find out), you were in. If Life is a University, he was the hip Lecturer.

Back then in 1972, David Bowie made a palimpsest of mine and many a child’s life. Everything was scratched out, ready to be written again.

It’s been more than forty years since then. Not every song and new record seized on as avidly as in the beginning. But as I continued to think my life in song lyrics, it was frequently one of his that sprang to mind.

Time Takes A Cigarette, Puts It in Your Mouth

Five Years. That’s All We’ve Got

Looked A Lot Like Che Guevara

Always Crashing In The Same Car

Cancer, eh? Too soon to know what type. To know the back-story. It doesn’t really matter. I still owe you. I haven’t lost a father or a brother. I was a follower of the Prophet and now he has left us.

In the blessed and cold, in the crutch-hungry dark, was where he flayed his mark. Oh, and he is gone.

I am becoming a connoisseur of writings about the experience of having terminal cancer. About the experience of being told “you’ve got cancer”. About living with the disease. About the desire to cling on to life when death is imminent. About what you leave, and what you leave behind.

Let’s call the genre “Death Lit”. I like to tell my friends that I read about Mortality so that they don’t have to (yet).

There are some good ones to choose from. In Cambridge alone there are two notable writers living with terminal cancer and writing about it. I can read about people who take their treatments in the same hospital as I do; who meet maybe the same doctors in the same treatment rooms. Although, I do like to think my Oncologist has time for me only.

There’s Clive James and his Reports of my death series in The Guardian. The London Review of Books has Jenny Diski’s series, starting with A Diagnosis. Both are still going, but they share a concern that perhaps it’s been too long a gap between the public announcement and now. The series can only have so many episodes; the play only so many acts, before it just becomes tedious for the audience.  However, I hope to have the same ‘problem’ in my plot development, and already have a blog title ready for it: It’s Alright To Linger. They too must linger; there’s no danger of any of us being called malingerers.

Returning to the Death Lit, you have Christopher Hitchens, who died in December 2011 aged 62 from oesophageal cancer. After his diagnosis, he wrote a book Mortality. In it, he talks about how he is given a passport and a personal escort to a place called “Tumourville” for his “year of living dyingly“. With all the meds, he could say: “I don’t have a body, I am a body.” He lost his voice as a consequence of the illness, and that left him with one over-arching wish: to win back his “freedom of speech”. That sounds familiar.

Oliver Sacks (“The Man Who Mistook His Wife for a Hat”) died August 2015 aged 82 from eye cancer that spread to his liver. He wrote about it in the New York Times. He quotes the philosopher David Hume, who found himself in a similar predicament in 1776, but said “I possess the same ardour as ever in study, and the same gaiety in company.” Sacks writes that he is not without fear, but mostly feels gratitude: “I have loved and been loved.”

Henning Mankell (“Wallander”) died October 2015 aged 67 from lung cancer that led to metastasis in a cervical vertebra. He contributed several articles to The Guardian. He talks about “Brief, clear moments of despair.” On the advice of his wife, he wrote about waiting because cancer involves so much waiting. Eight months after diagnosis, looking out on a damp September evening, he wonders if he is “still the same person now as I was then?”

A very good question, indeed. It’s like that Lou Reed song: “Candy says I’ve come to hate my body. And all that it requires in this world.” And, “What do you think I’d see? If I could walk away from me.” Does cancer change you? There are no maps of this place, and we’re just snowflakes drifting down onto its damp earth. We are gone before we can speak.

These are all well-known authors. Then, there is the age thing. All of them have (or had) at least reached their 65th year. Many of them speak explicitly of their ‘good innings’ or some equivalent metaphor. Not so for Kate Gross (“Late Fragments”), who died December 2014 aged 36 from colon cancer that spread to her liver. She left two young children, and the “Afterwards” was as important to her as the “Now”. I can relate to that.

These erudite people share similar sentiments. There are so many common themes. We’re not “fighting cancer” (at best, it’s fighting us). We’re not braver than most, it’s just where we find ourselves. And bravery is choosing to do something scary, such as climbing a mountain or donating an organ. Plenty of bravado, however. We can stare this thing down.

One theme is whether to hope? How do you find hope when there are no grounds for hope? You don’t have to look hard to find examples where someone’s child or parent is terminally ill with stage 4 cancer and metastasis not responding to treatment, and they believe their only option is to try some treatment at a clinic that will cost $40,000 for the first session of ‘alternative chemotherapy’. Alternatively, go full-out for a miracle food diet or supplement:”Man Rids Body of Cancer Using Frankincense / Sandalwood / Turmeric / Kale / Cannabis Oil” (delete as applicable). Actually, I’m willing to try the Cannabis Oil. But, spare me the healing and transformation stuff please.

To use a phrase from Antonio Gramsci on modernity, the challenge is how to “live without illusions and without becoming disillusioned.

One more theme is the magic of small things. In the hyper-reality now illuminated by terminal illness. I don’t know if there is some chemical given off by the maddened, growth-crazy genes in my cells sending me on little psychedelic trips. All I know is that on a sunny December day I saw the orange and red berries on the bare winter branches, and they were dazzling jewels against the azure sky.

Mostly, the theme is about facing death. Which of course requires you meeting Death first. I’ve been thinking some about the personifications of Death. As usual, my mind is a jumble of poems and song lyrics.

There is Charon, the boatman who ferries you across to the underworld if you have a coin in your mouth or over your eyes to pay for passage. There is T.S. Eliot’s Eternal Footman, who holds your coat (you won’t need it ‘down there’, it’s already warm enough) and sniggers as he does so. “And in short, I was afraid.” Emily Dickinson has us meet Death the Coachman, who kindly stops his carriage for her. And I really like the Supernatural Anaesthetist from the Genesis song, which is an outfit that Death made himself. His method requires a mere puff of anaesthetic into the recipient, who is then no more. In the sleeve notes we learn that Death likes meeting people and wants to travel.

Of course, there is the Reaper, who is sometimes Grim. It reminds us we are all equal in the end. The scythe cuts through all the stalks without preference to any. Probably why the image became popular around the time of the Black Death. You can play chess with him, and maybe that will save some people at least for a while longer.

It’s interesting that Death is nearly always a male figure, at least in English and German cultures. Yes, there are the Moirai and the Parcae sisters in Greek and Roman mythology; where one of the sisters cuts the thread of life that her other sisters make and measure out. But in more modern culture, Death is rarely personified as female.

Not so in Mexican culture, which has Nuestra Señora de la Santa Muerte (Holy Death) to help with a safe delivery to the afterlife. Santa Muerte is usually depicted as a skeleton in a hooded robe and carrying a scythe. It’s Grim Reaper-ess meets Virgin Mary territory. Mexico also has La Calavera Catrina, the rich and dapper well-dressed skeleton that has become a standard icon for Day of the Dead imagery. Not that this was on any benefit to its creator, José Guadalupe Posada. He died penniless in 1913 and was buried in a mass grave.

The idea that Death could be a mother figure seems more appealing than all the disengaged male alternatives on offer. Mother Death is there for healing and to keep you safe, but when the time is right she will take you away from here. It’s another transition, just like birth.

A short animated film called “Coda” came out in 2015 and won a ton of awards. It tells the story of a drunken man who dies after an accident, and his soul is “collected” by Death from the park where he has taken refuge on a bench. She (Death) is ever so kind. She is patient and instructive, and grants him the wish to see “many things so I remember”.

Coda from and maps and plans on Vimeo.

It’s all romantic stuff. I still think it will be like Tony Benn said in 2012. He said he was “not frightened about death. I don’t know why but I just feel that at a certain moment your switch is switched off and that’s it. And you can’t do anything about it.

But if we must insist on imagery and personification for the ‘passing over’, we should at least pick someone nice to be our travelling companion.

In the more mundane meantime I start 2016 with a bang: on January 4th I return to Thoracic Park for more of their fine cryotherapy injections of ice into my windpipe. Hope my voice isn’t affected. I have a customer presentation on January 5th in London. Maybe I can ask Death to change the slides.

In November I went for the results of my CT scan. I’d had the scan early because the original date clashed with a short holiday in Norfolk. There, I watched the seals bask, listened to the curlew’s cries carry across the salt marsh, and basked in warm sunshine in the shelter of the sand dunes. After the basking we trudged 5 miles back along the pea shingle and I pissed blood for the rest of the evening, so I fear even Nirvana has its nuisances.

They told me there’s a new tumour. This new little pony lies on my Trachea, which is the windpipe that then divides into the bronchi before they enter the lungs. This one is nasty in so far as it’s a focal lesion that has started on the outside and wormed its way through the lining to form a little bulbous mass inside the duct of the pipe. This could be worse if it goes the other way. There are many arteries around there, and if it breaks though one of those… Well, then the levee breaks, my lungs fill with blood and it’s over. It’s similar to one of the ways that tuberculosis carries you off.

He likes to give me extra, does my Oncologist. He reminded me of the tragic end scene in Guiseppe Verdi’s opera “La Traviata” (The Fallen Woman), in which the heroine (Violetta Valéry) dies of a massive blood clot. Now, you just don’t get that type of quality in a lesser institution, and I’m dismayed the CQC does not take this into account as a factor. Feed the mind, I say. We’re going to die anyway, but absolve us first from the original sin of ignorance.

“How romantic”, I muttered. “I rather like the sound of that”. How we all laughed. I must have subconsciously channeled Byron, who famously said that he’d like to die from consumption. But, in the end, only Keats could achieve it, as he made his way to the icy silence of the tomb.

Verdi travelled to Paris in 1852 with his own “fallen woman”. There, they saw the theatrical hit of the day, which was an adaptation of Alexandre Dumas’s novel “La Dame aux camélias”. It’s the tale of a prostitute who falls in love with a young nobleman, much to the outrage of his family. She is the lady of the camellias because she wore a white flower when available, but a red flower when indisposed by illness.

Maybe I could adopt this convention, and place a flower (red or white) at the top of this blog to signal my health. The trouble is, I prefer to grow red camellias.

As soon as he could, Verdi hotfooted it back to Italy and wrote his opera around it. Violetta is his ultra glamourous Parisian good-time girl who knows how to party and still spit scarlet blood onto white cloth with the best of them.

You’d recognise the tunes from La Traviata if I hummed them. There’s the drinking song “Brindisi” and “Sempre Libera” (Always Free) with its many soaring trills and high notes. But it’s the finale of Act III that we must now have in mind – “Gran Dio!…morir sì giovane” (Great God!…to die so young).

Gran Dio! morir sì giovane,  (Good God! That I should die so young,)
io che penato ho tanto! (After so much suffering!)
Morir sì presso a tergere (To die so near the dawn)
il mio sì lungo pianto! (After the long night of tears!)

Unfortunately the opening night was not a success. It’s said that the audience could not empathise with a well-upholstered Soprano playing the part of a beautiful waif-like creature consumed by the ravages of consumption. So they booed.

Should I too follow the cadence of days in a foreshortened life and penser sur mon mort inactuelles? It’s true that I cough, spit and live in my viscous world where unfortunately nothing is vicarious. My words are earthy: phlegm, mucus, sputum. My colours are smeared: blood-streaked, frothy pink, pearly-white gelatinous. It’s all so achingly fragile.

But we never give up, my aria-admiring Oncologist and I. He referred me back to my old friends in the Thoracic Park to take a look at these lungs of mine. Today I had another CT and a Bronchoscopy. It was partly to take a look at the possibilities for stenting the collapsed lobe, but it was also interventionist. They used cryotherapy on the new tumour, which was a first for me. It is a technique where they freeze the cancerous tissue towards destruction. They did not go on to “pull it out” as they’d suggested they might during the pre-op. But there is time. My tumour must not feel a warm and capable living hand, but rather the cold and icy fingers of cryosurgery. Perhaps that will haunt its days and chill its dreaming for a while.

It all went well and I was able to go home a few hours later. But, you’ll excuse me now if I leave you to wallow in my pensive, poetic melancholy. I shall lay the back of my right hand against my forehead, throw back my head, and sigh. There are fresh, clean, white sheets on my bed and I do have rather a bad cough.

Why do we say we are “feeling blue”? Why blue? When tall ships sailed the oceans, it was the custom to fly blue flags and paint a blue line along the hull when a ship returned to port having lost the captain on the voyage.

I was thinking about blue when I heard the designer Zandra Rhodes on TV refer to a painted wall in her garden as “Frida Kahlo blue”. Maybe, I thought, but to me that’s peacock blue.

There’s no conflict, really. Frida Kahlo & Diego Riviera’s house is now the Frida Kahlo Museum in a suburb of Mexico City, and it is called La Casa Azul (The Blue House). The cobalt-blue walls are much the same colour as peacock-blue breast feathers. Although to speak of a peacock’s colour as paint pigments is not especially correct. It isn’t about the pigments, but rather the shape of their feathers which reflect light at different wavelengths (“reflectance”). I don’t know if Frida had any peacocks, but the Museo Dolores Olmedo (she was the patron of Frida & Diego) still has peafowl in the gardens.

Someone who definitely had peafowl was the writer Flannery O’Connor; she of the Southern Gothic genre. When she fell ill with Lupis, a nasty little illness in which the body’s immune system attacks healthy tissue, she returned to live with her mother at the family farm in Georgia. She ordered some Indian Peafowl – a male peacock, two peahens, and some pea-chicks. Her collection grew rapidly. She stopped counting after 40, and some accounts say she had as many as 100 birds. Her birds were not very popular. Her mother complained they ate the flowers; her uncle lamented the loss of all the figs,  and the farmhands said the birds ate the animal feed. Not that this much bothered Mary Flannery O’Connor, who carried on building the collection. She wanted to see one or two of them every time she left the house, but it turned out different: “Now every time I go out the door, four or five run into me—and give me only the faintest recognition.

There’s a sharp difference in the way folklore treats the peacock. In Asia, it’s all about the radiance of the tail – a galaxy of stars and planets on display. In the West, it’s more about pride and conceit. In the Arabic tradition, the story goes that it was a peacock that let Shaitan (Satan, aka Iblîs) enter into Paradise. Satan gave the gullible peacock a prayer to recite, which then corrupted the serpent, who corrupted Eve, etc. The whole lot of them got expelled for their trouble and as a little extra the peacock’s formerly golden feet were turned into ugly chicken-feet things. The Christians liked this theme immediately. As Saint Thomas (Aquinas) says: “When a peacock vaunts its tail and sees its feet, it immediately puts its tail. In a similar way, when some good people are carried away by pride, which I hope will not happen, may they take a look at their feet and be made humble.” It’s not true that a peacock hides his tail on seeing his feet, but there you have it so it must be true. In Jamaica, they have a saying: “Peacock hide him foot when him hear ’bout  him tail.”

The colour blue is a thing of beauty, and the peacock is a beautiful creature. I think that I should have some peacocks. It would be a fitting statement in my end-time. I’m not entirely sure however how they would cope with the icy winds sweeping over East Anglia when winter comes.

You get to wondering how many times you might see the leaves turn red and yellow, and whether there will be many more summers. Clive James has terminal leukaemia, and he wrote a poem Japanese Maple last year which said he wouldn’t be around to see the maple tree turning red this year.  Of course he’s still here (which is a very good thing) but a little embarrassed by it.

There was a blog in the British Medical Journal (BMJ) last Christmas which said that death from cancer is the best form of death. “You can say goodbye, reflect on your life, leave last messages, perhaps visit special places for a last time, listen to favourite pieces of music, read loved poems, and prepare, according to your beliefs, to meet your maker or enjoy eternal oblivion.

Or, keep peacocks in the garden. If that isn’t too gross an act of pride. Another weird sin.

My peacocks will have to be metaphorical for the time present. And so, I’m happy to tell you about an especially fine specimen that strutted around, let out a cry, and shook it’s tail in my life this week. On Tuesday I had my appointment in Addenbrooke’s for the vocal cord procedure. I had overcome nerves about the whole throat-cutting thing, and I just wanted to do it.

The plan was changed first thing (“we’re going to try it by injection first, and only cut if that doesn’t work”) and then amazingly changed again when I reached the operating theatre. The anaesthetist (may his name be blessed forever) said he had no objection to putting me under general anaesthetic. All the fuss and bother of August, gone in an instant.

That was only the beginning of joy. The first tremors of pleasure.

When I came around in the afternoon, I had my voice back. Well, 95% of it or so anyway. It was such a huge relief to be able to talk again.

I had not dared to hope for such a good result. Now, out of the blue, here was something to take me out of the blues.

I could talk about this pain or that operation that I need to do next, but right now I’m just watching the peacock do it’s thing. With a big grin on my face.