PC (as in Prostate Cancer)

Sailing away from It

 My wife nagged me.  It was wonderful.  This may require some explanation.

Just before Christmas 2009, convinced I was in remarkably fine health for a 62-year-old, I was diagnosed with advanced prostate cancer, an aggressive kind that had torn through the walnut-sized prostate itself and gone on to colonize my pelvis and surrounding lymph nodes. All without causing symptoms or even raising my telltale PSA level: one of the small percentage of “false negatives” produced by that otherwise useful test.

Two eminent specialists looked at the scan and biopsy results, shook their heads gravely and gave the same prognosis: get your affairs in order, if you make two years you will be lucky.  Sorry about that.  Made for a rather sombre Christmas.  The transition was brutal: from daily-jogging, borderline hyperactive fount of energy and cheerfulness that sometimes dismayed my family, just retired from an unloved career negotiating oil concessions, looking at the world as though it was newly created just for me—to terminally ill, all in less than a week.  It happens to many people, of course.  Like most of them, I imagine, I went through a phase of “this can’t be happening to ME”, as though one belonged to a somehow exempt class, as though my “me” was somehow special, not to say immortal.  Lots of food for thought, probably much of it predictable.

But something did not let me accept it.  Or It as I came to think about it.  I did not reason, just threw myself into new, long-term things.  Learning modern Greek,  starting research for a biography on a historical figure I had always been interested in (see “Renaissance Emir“).  And mainly, sailing.

I had sailed only occasionally, beginning briefly at the age of 9 in the Gulf of Yokohama, where a friend of my parents let me loose in a small sailboat, then on dinghies in the Gulf of Oman when we lived in Muscat 30 years ago, and loved it, not just as one likes a sport, but I felt that the intersection of wind, sea, and sky was where I belonged.  And then 30 years flashed by with us, our chattels, assorted babies who became children and then grownups, all moving every few years (sometimes very few) from one country to another, with two evacuations from a war zone thrown in for variety.  Not much time for sailing, until this Christmas, when I woke up one day with the conviction that not only would I not go gently into anybody’s good night, but I would fight back, reject It with a rude denial.

Within a day I had combed the internet for sailing courses, registered myself and my slightly surprised younger son for a series of crew-level courses on the English coast, and signed up for a Day Skipper course out of Lefkada in the Ionian Sea just south of Corfu.  And with even more temerity, assumed that all that would have transformed me into a competent sailor by June.  I booked a 35-foot yacht to sail around the Ionian with my wife (a self-described “terra firma person” whose feet on the ground have provided a counterbalance to my aqueous nature over the years), our son, and our younger daughter who had just moved to New York and has a meagre two weeks of vacation a year.  They all went along with this latest folly, with good humour if varying degrees of enthusiasm and my daughter even said she would take some basic sailing lessons to prepare.

The spring was, for me, all about sailing and the sea.  Courses in sailing down on the Solent and Isle of Wight, but also VHF radio operation, marine diesel maintenance, safety at sea, and of course navigation, using the charts and compass and log to calculate where you are in case the GPS breaks down.  A special course in boat-handling to cope with parking a large-ish boat in the crowded harbours of the Mediterranean.  Reading books about sail trim, the collision avoidance rules, signals by flag and fog-horn and patterns of lights that help you tell a trawler from a minesweeper at night (well, if it mattered at all it might matter a lot). How to signal a Mayday on the radio or using flares and rockets and bombs of orange smoke.  A whole new world, with intensive spoken Greek to top it off.

Just before leaving for Greece in mid-June, my oncologist reminded me of It, putting me through a battery of scans to see if the treatment was working.  This is mainly a cocktail of different hormones the side-effects of which would have been serious in a younger man, resulting in what they call “chemical castration”.  A horrid word but in my case, the end of an already diminished sex life (by age or disease, who knows?), redistribution of fat (to the tummy) and, for a time, hot flashes and teary episodes, not tragic if, in the words of George Burns, you consider the alternative. If you have lived as a man, enthusiastically so, for 62 years, why not try a few years as a menopausal woman?

The initial scan results looked good, so we set off for Greece via France in especially good spirits.  But then my usually uncommunicative doctor actually called me, catching me as the old station wagon left the Paris Boulevard Périphérique and nearly causing me to drive off an overpass, which would have been ironic.  For the news was that the cancer had regressed, completely, from the bones and lymph nodes and now only resided where it began, in the centre of the prostate gland.  This was probably manageable and they would design a course of radiotherapy later in the summer. A “prognosis-changer”, as he put it, with the former two-year deadline rising at least to five and possibly beyond, and the new treatment would be with “curative intent” rather than just palliative.  I am sure that sailing around the Greek islands, after all that preparation, the pristine natural beauty, the charm of tiny, unspoiled fishing villages, the weather, the food and wine, the fun of boats, the friendly island people, all that, would have been wonderful, literally the fulfilment of a dream, in any case.  As it was, it was as close to Paradise as I can imagine.

Back home in London, life resumed its course.  I knew that there are no miracles and that the fight is far from over, but was able to get back to something close to life pre-diagnosis, only a little fatter and more interested in talking frogs than willing princesses, as the story goes (hopefully anyone who has not heard that joke can figure it out from the punch-line, or leave a message on this webpage).

Now I must confess to having had the best possible ally.  I will not gush about how supportive my wife was, and is: it was as though she had been born for this role and until that moment had suppressed a huge talent for making one feel that things are brighter than they say, that anyway one is not alone, that one is living with a wellspring of love and unconditional solidarity.  Making every day a joyful one, with no laments or tears to waste a minute of the time remaining, presumably diminished from what it “ought” to have been.  Humouring my whims and moods and wishes, she who had put up with a lot over the years and was not one to mince words when pushed too hard. A moratorium on nagging; not that she was a great nagger, but, well, occasionally it would seem a bit like it when I was sluggish or obstinate or neglectful of things important to her.

And then that fateful Sunday.  Suddenly, the dust and cobwebs and junk in our garage, a former animal stable with feeding troughs and general mess dating from before the French Revolution, all of which I have happily ignored for years despite her pleas for me to give it a clean-up, got the better of her.  And then I knew that for her, I am not sick anymore.  And that it is better to be healthy (even with an occasional nag) than sick (this really is more profound than it sounds).

Now, three and a half years later, the prognosis is looking even better.  I went through seven weeks of radiotherapy to the prostate, previously colonized lymph nodes and pelvis, without any of the horrendous side-effects I had been warned of.  For the doctors were of two schools of thought: the traditionalists who thought that “T4 (metastatic) prostate cancer cannot be treated locally”, that is through surgery or radiation, the game (doubtful improvement) not being worth the candle (possibly wearing a bag for the rest of one’s life); and those who thought that given the cancer’s spectacular regression, it might be worth a try, however statistically hopeless the possibility of cure might seem.  I wish everyone could have as painless an experience of intensive radiotherapy as I did.

I have now been taken off hormones, a period called “watchful waiting”.  I have regained some of my old self-centered male prerogatives and reactions, lost belly fat and re-grown hair here and there.  My oncologist is a firm believer in diet and supplements to combat cancer, so I take Vitamin D and green tea extract daily.

Along with the sailing, of course.  For I am convinced that psychology is every bit as important as treatment.  And the part of prostate cancer that resides in the head, whatever stress or worry that might have contributed to the appearance or aggressive nature of It, continues to be battered into remission (at least) on the pristine blue waters of the Ionian islands.  Incredibly, my terrestrial wife herself came up with the idea of actually buying a boat, to be left with a charter company in Greece but available to us for two annual spells of three weeks each.  Six weeks sailing a year, meaning that I am constantly either on our lovely Moira or dreaming about the next time.  “Moira”, by the way, is an ancient Greek word meaning “allotted portion or fate”, and she is just big enough for us to be able to invite a friend or two to share her with us.

When my wife—who is becoming more of a sailor every time—is aboard, we putter from island to island, legendary places like Ithaka and Kephalonia.  One major focus is trying to find the places behind the events in the Odyssey according to now one, now another of the competing theories.  By day we sail if there is wind, dropping anchor in an empty cove (or, just for fun, at Skorpios, just off Jackie’s beach hut, a tiny, wistful box in white trimmed with blue, ever forlorn and empty). Night finds us in tiny harbours like Kioni, where we nestle in among the colourful fishing boats.  I am constantly amazed at how little things have changed since Lawrence Durrell wrote his travelogue The Greek Islands, there is so little concrete or other signs of the aggressive development that has turned so much of the gorgeous Spanish coast into a garish travesty of what it once was.

When it is just me and a male friend or two, we are slightly more adventurous.  My son came again, and his passion for history had us seek out the Nekromanteion (“Oracle of the Dead”), a weird and still not-fully-understood complex of buildings up the coast on the River Acheron (still called that, pronounced “Acherondas”).  This is just where Homer said Odysseus went to find the entrance to Hades, in his quest to find out when and whether he would ever make it home to Ithaka and the (he hoped) faithful, patient Penelope.  There he poured out libations of blood to attract the shades of, among others, his mother (“Sorry I was not home when you died, Mom!”), Achilles (“I had rather be a slave on earth than a shade in this gloomy place”), and the blind seer Teireisias (“you’re not out of the woods yet”).   You go past ancient walls and strange gateways and pilasters, finally climbing down a steep iron staircase to a subterranean chamber with niches in the walls. There are actually channels in the floor of this deepest part of the site (which includes “Cyclopean” stonework dating to the time of Homer if not of the Trojan War). The imagination runs riot.

***

One lasting side-effect is of course that I understand a lot more about being on the receiving end of an advanced cancer diagnosis.  I used to shy away from friends who suddenly found they have It in one form or another, thinking surely they don’t want to talk about it, what can a healthy person say to make “them” feel better, and generally not knowing what attitude to take.  I thus avoided an awkward subject in good Anglo-Saxon fashion.  Now, I seek out friends or acquaintances who have had such news, to let them know that they are not alone, modern lepers whose disease is not thought contagious, but whose anguish or despair might be.  For me they are brothers and sisters as all people ought to be at all times, “in an ideal world” as they say.  Without waiting for that, I welcome them to this exclusive club—exclusive, because it rejects all those smugs still living with the illusion that they are and always will be healthy.  We members have been served with tangible reminders of our mortality, and this gives us something very precious: the realization that every day, every minute must be made to count, to provide the maximum texture of having been lived well.  Must one be sick to attain this realization?

Hormones, moral support or attitude, dumb luck or a freak of nature, I will never know what exactly caused this sea-change in the nature of It.  Having just celebrated my 66^th birthday (I was supposed to have bowed out well before now), I have the feeling that even if It were to reappear tomorrow, as it of course could, I have had a good measure of revenge.

Update January 2019

Almost 10 years–who would have thought?  Not me, not my doctors, but there you are.  Now the old PSA has started to rise inexorably, and the latest scan did find several new diseased lymph nodes.  Nobody ever thought the remission would go on forever, but, undeterred, I am planning this spring’s cruise on dear Moira, with old and newer friends and of course my chief therapist and lover.  Plan is to sail to Puglia in Italy: how exciting, to cross the busy Adriatic from Corfu!  grabbing this wonderful thing called Life by the horns, or whatever, but not letting a moment of it pass untasted.

Update November 2019

now it really is 10 years since the Dread Diagnosis.  latest numbers are good, new treatment (Abiraterone plus corticosteroids) keeping the numbers low.  Only issue is the steroids have made me put on several kilos, mostly in the gut and face (the “Brezhnev effect”), but as someone said when asked how it felt to be 90, “When you consider the alternative..”  Had a great spring cruise on Moira, then a summer full of granddaughters and their mothers, then an autumn cruise which provided some of the best sailing wind ever.  So the message is, “Don’t let them get you down, keep morale up, stay busy doing something that requires effort and concentration, ban dark thoughts and (nearly) everything is possible…”

Update May 2021

well, two spring cruises on Moira forgone because of the dread Covid.  Trivial compared to what so many people have endured, but a sadness all the same.  The PC has regained a little terrain, with two small colonies suddenly appearing in the liver (did you know that when PC pops up far from the prostate, it is still PC and acts like it, and is treated like it?)  So instead of sailing this spring (impossible because of the virus) I am having chemotherapy, six sessions of a poison called Docetaxel; as of this writing, three down and three to go.  By all accounts I am having an easy time of it: on my bike when not too fatigued, still have the hair I am stupidly vain about, eating and sleeping and all that.  Wine and some foods taste weird, and alcohol does not agree with me (like getting a bad hangover from a glass of wine that tastes metallic anyway).  But all that will pass and Moira’s autumn 2021 cruise is now in the planning stages…  as Kavafy says in his magnificent poem “Ithaka”,

may there be many Summer mornings awaiting you

when with delight and joy you anchor in a harbour never seen before

Update July 2021

a scan in March found a couple of small lesions on the liver, so the doctor threw me immediately into chemotherapy.  The drug is called docetaxel, and it is a rigorous operation: side effects include fatigue, lack of stamina (not quite the same), numbness in the feet and fingers, and a radical alteration to the sense of taste.  Wine tastes yeasty like it has vinegar in it: so I gave it up until tonight.  tonight, the Dr said I have had enough chemo and cancelled the session set for day after tomorrow.  this is a great relief!  hopefully the old toes will recover their feeling. but tonight’s champagne tasted fantastic.  I suppose there are worse things than to be condemned to drink only champagne!