Nun Better

 I have often shared how I think the best thing that happened to us since we came to the USA was the opportunity to discover the Queen of Peace nursing home in Queens Village. A nun from the home visited our parish back in 2015 and gave what may have been the least coherent but at the same time the most powerful speech I ever heard. My wife was entranced and we started volunteering at the home soon afterwards.

 

The home is run by resident nuns and is co-located with a novitiate. There are about a hundred elderly lay residents, with the expectation that this will be their final home on earth. Some survive only a few months after arrival while others soldier on for ten years or more. The intensity of care increases as residents move from the fourth to the second and ultimately the third floor.

 

Before the pandemic there was a whole army of volunteers visiting the home, helping the nuns and employed staff in a variety of ways. Our initial task was to help to serve the evening meal on a Saturday evening. My wife and I were assigned to the second floor, while the kids served on the third. We quickly realised that the staff could quite easily serve the meal without us, and our real function was to befriend the residents, giving them somebody else to pass time with. Over the years we have struck up lasting friendships with many residents, and many of them look forward to our visits and truly value our company. It can help them to stay healthy for longer and to find additional peace in what remains of their lives. In turn that love rebounds on us, filling us with joy and companionship. We always return from the home in a great mood.

 

After a year or two I expanded my service to include visiting to cantor a mass for them one weekday, and then to be a driver for residents with medical appointments around Long Island. Visits stopped abruptly when the pandemic struck and residents needed to be isolated from each other and inessential outsiders. A nun confided in me that she thought the pandemic aged residents on average by about five years, though mercifully there were few Covid deaths there. Cautiously, life has been returning to normal during 2023, and we are proud to be welcomed as part of a much smaller (so far) cadre of volunteers. Now we serve Sunday dinner, and I have just restarted going back there to sing occasionally too. Sadly, driving is off limits now as my condition means that I can no longer drive.

 

Over the years the home has offered us some of the funniest moments we can recall. My wife still tells the story of our very first visit, when one resident had the cheek to ask me what floor I resided on. The sad afternoon when I shared the news of my tumour with the residents was punctuated by a very deaf lady at one table replying to “I have a brain tumour” with a cheerful “Is it raining?” One centurion introduced the state of her bowels into virtually every sentence. Another insisted repeatedly that in earlier years he had been saved from a shark attack by a passing dolphin taking a ride on the back of a whale.

 

A large part of the mission of the order of nuns at the home is service. At Queen of Peace, that translates into helping the residents (including several retired nuns) to be as contented as possible during their final years and to prepare for a peaceful death. They perform this job magnificently. We have seen many miracles there. A common pattern is for a resident to be quite disturbed when they first come to the home but to become noticeably more at ease the longer they live there.

 

With my diagnosis, several of my thoughts are about being ready for death as well. I have listened carefully to the gospels of the last few weeks, seeking inspiration, not necessarily divine. I have never before thought of the advent message so clearly in this way, an d I have found that It makes more sense to me using the message as being ready to die in peace rather than anything concerning second comings or final judgements.

 

So my mind is on this morbid readiness, and the nuns I am privileged to meet every week are paragons of carers of people at the end of life, so surely there are some useful points to learn here. They might help me or my carers as the illness progresses. In fact they might help anybody, as we never know when illness may strike or when an elderly relative may require such care.

 

The primary way the nuns do their work is by example. You don’t hear long sermons from any of them. Their faith is clear to see, but they don’t ram it down anyone’s throat. Instead, they demonstrate lives of simplicity, humility, prayer, companionship, acceptance, generosity, kindness, compassion, and self-discipline. They each have their foibles, and no doubt there are disputes behind the scenes. They might not all like each other and certainly some of the residents are hard to like, but loving is more powerful than liking.

 

The toughest time for many residents is when they first arrive at the home. That stage of life can seem like a series of defeats, and moving into assisted living may be one of the biggest defeats of all. When we first meet a resident, they are often angry and rather disorientated. But the nuns make sure they have companionship and care, and soon friendships are struck and most come to embrace their new lives. This is achieved via example, sprinkled with a bit of smart cunning.

 

Then comes the time when life ebbs away. The important work has already been done, and most residents have some peace before the final days. But the nuns organise a 24 hour vigil to ensure a resident is never alone in their last days, and you can almost touch the love in the room. Occasionally we have had the privilege to be a part of that magic: one of my proudest achievements was to sing the favourite spiritual hymn to a dying priest in his last hours and to sense his appreciation.

 

The nuns don’t go around talking about death, but they don’t run away from it either. Their demeanour is designed to help the residents understand that this can be a peaceful final transition, whatever they believe. When a resident dies, there is respect and solemnity, but usually little wailing.

 

It is harder for the nuns to be able to provide much help for the families and carers of the residents because they usually have less chance to get to know these people deeply enough. But, for those family members and carers who can find time to visit, the same example is offered to them. It is surely a great comfort to know that one you have cared for and loved can find a peaceful end in the company of abundant love.

 

I am so fortunate to have Queen of Peace and its nuns and residents as role models. That list of seems like a pretty good set of attributes to aspire to. An interesting one is acceptance, because at first glance it seems in conflict with something else that people often urge me to do; that is fight. I don’t see any conflict. Of course we should fight our illnesses, not in a military or angry way, but with some steel and persistence and attempts to follow healthy practices and trust in medicine. Acceptance is the other side of the same coin. We are all unique but none of us are so unique as to be immune. Our best bet is to humbly accept what the fates have in store for us, and to find peace with that fate.

 

Thank you sisters, you are my greatest inspiration. I hope I can live, and die, showing something approaching the wonderful values you espouse. If I can, the primary beneficiary will be myself.    

Tears for Fears

 I have never been a great one for crying. I suppose I would wail as a small child as much as any other kid. But then I went to a UK boys only private school, where part of the implicit training is to learn not to show emotion or to blub. This was enforced by one’s peers, for blubbers were soon destined to be victims of bullying. I became as proficient as everyone else when it came to hiding feelings, and to literally hiding when the urge for tears was strong. That trait has not helped my quest to be a good husband or father.

 

As an adult, this training meant that I did not cry often, even in private, and I suspect it also acted as an inhibitor for being open with emotions, even to myself. I remember well the earlier crises in my life, notably the time when I abruptly departed from my first marriage and found myself alone in disgusting B&B’s. I would cry a little in those moments, and I even selected one or two mournful CD’s to play when I wanted to bring tears on, but the trickle of tears never really grew into a flood, despite all the shame and guilt.

 

If you want to induce tears in me, the best way is to take me to a darkened theatre or cinema and have me watch something sentimental. Often I will lose control of emotions, and when the lights go up and everybody is streaming out, I’ll keep my head down to avoid making my tears too public. I guess this is quite common, even among men, indeed even among repressed men. My wife is probably more typical in being driven to tears very easily by a sentimental show. She will even quietly head to the kitchen if she senses a violent or poignant scene is about to show.

 

The last twelve months of living with cancer have been different. I have found myself vulnerable to gushing tears, something that is new for me. It is hard to discern any pattern, but there are situations and places and times when I am more prone to an outburst. It also swings in cycles – some months seem to go by with nary a tear, and then the next month I find I am crying nearly every day. I am no longer so concerned with suppressing or even with hiding my emotions. But I am interested in what might be the causes of these variable patterns.

 

MSK were kind enough to refer me to a therapist, and my insurance has been kind enough to pay. I feel a bit of a fraud, because most of the time I feel quite emotionally stable. Most of our sessions seem to end with the therapist laughing and suggesting that I don’t need her very much. By now we have reduced our sessions to once a quarter, continuing in case I enter a phase when my need is greater.

 

One useful thing the therapist did for me was to encourage me to start an emotions tracker. I followed this quite religiously for the first three months or so. It is interesting re-reading the entries today. It is encouraging to note how much more stable and accepting I am now compared with the earlier phases of the illness. And there are a few clues in the tracker about what might cause me to burst into tears. If I am going to try to answer the “why” question, I suppose it would help to first analyse the “when”.

 

When do these tearful outbursts come? Overall, the trend is that they come less often. Nowadays a full month can go by with few or even no tears, but at first there were tears every week. Within that trend, there are peaks and troughs. I cry more often when not feeling well physically, or during the lead up to a procedure involving anaesthetic. There were also more tears before and during our trip to Europe in the summer, and when I was separated from my wife for a week while singing in Massachusetts. The tears most often arrive early in the morning, and when I am alone and quiet and prone to pondering. Most tears come alone, an exception being when I am parting from precious others – those goodbyes are the toughest things to cope with.

 

If that describes when I become tearful, it must help understand why. The reducing overall trend must signify a growing acceptance of my situation, together with a tentative growth of hope that the cancer might stay suppressed for an extended period. It is no surprise that the worst week for tears was the very first week I spent in hospital, receiving a torrent of bad news in a hectic environment, while also observing the anguish of my wife and family. What were these tears about? Well, initially it was grief for a loss of a long, anticipated, joyful future. Over time that grief has reduced, as I have been able to shift my focus towards celebrating a joyful present and nostalgia for a joyful past. 

 

Tears in the lead up to a procedure are also easy to explain. It is the same with every procedure, but I have been less tearful with each successive operation. One reason is that I am no longer on steroids. Steroids magnify every emotion; I was living an amped-up life at this time last year.

 

Procedures are risky moments. No matter what the surgeon says, every operation carries catastrophic risk, and the patient is sure to feel this intensely. I suspect the main cause for tearfulness prior to an operation must be fear.

 

I am fortunate in not being fearful of death itself. But I am fearful of a future so diminished as to be tough to bear for myself or for carers. The possibility of a prolonged life of constant pain, bodily malfunction or shifts in mind causing constant anguish, fill me with fear. I suppose there is not much I can do about it, beyond reminding my loved ones not to keep life-support machines operational on my account.

 

Then there is another fear, that of not being ready. The gospels of the last few weeks have been helpful here, even for somebody with little confidence in a second coming or pearly gates or final judgement. Our experience at the old folks home has also been invaluable, observing others prepare to die and their carers helping them with love.

 

Being ready offers peace in any situation, and being ready for death is peaceful too, even in a more extreme situation. In the days before my first biopsy, fuelled by steroids, I spent every hour trying to make myself ready for death. My mum or grandma might have articulated that by making sure she always wore clean knickers in case an ambulance driver or passer-by would spot dirty ones, but I was thinking about legacy. From writing hurried last wishes to sharing bank passwords and expressing love, I was trying to do what I could to ensure that those that I love have the best possible chance of thriving after I am gone. The pace was frenzied so long as I was on steroids, and has slowed since, but I still have one eye on being ready. I am thrilled to observe my wife preparing herself too. There will be tears, but she will be fine; they all will.

 

We should always think that way, even if not in immediate jeopardy, because a sense of readiness is a wonderful gift. We should strive to end every engagement on a loving note, and to mend any broken relationships as a priority. This is a gift to those we love who survive us. It is also a gift to ourselves, because peace only becomes more valuable as we approach the end. Nowadays I have little remaining fear of not being ready, and that is an enormous comfort.

 

I wonder if there is another cause for my tearful outbursts, unrelated to grief or fear. There is something I might describe as awe, when I wake up and quietly ponder how my life has been transformed. That can be sad, especially while every waking thought came with a strong context of cancer, but it can also be awesome. I have had a privileged time on earth, and perhaps have more time to look forward to. I have moments of awe when I get a chance to sing a favourite anthem with friends, perhaps more so if my mind is wondering if it will be the last time. I have joyful memories, I have a little pride, and I have love.

 

I suspect that sort of thought is often what presages tearful outbursts. Is that thankfulness, or humility, or care for loved ones? It may be a mixture of all those feelings and some others. In any case, when the tears flow, they are profoundly welcome.           

The Benefits of a Great Hobby

 I receive a lot of compliments about how I managing to stay positive and active during my cancer treatment. I am variously described as a trouper or an inspiration, and I suppose it makes me feel good. I am not sure how much of the praise is truly warranted. Is this a chicken and egg situation? Am I able to stay positive and active because I feel good physically? Or is the feeling good a consequence of staying positive and active?

 

No doubt the reality is a bit of both, but on balance I am on the side of the chicken on this one. I have been amazingly fortunate that my cancer symptoms have not been too debilitating, that my medical support has been excellent and that my treatments have generally been effective. That is the primary reason that most of the time I have been feeling fine, and that leaves an opportunity to live life close to its prior normal manner. Most cancer patients do not have that luxury, at least not for very long, and I certainly have no intention of crowing that the difference is my positive attitude. That certainly helps but is simply unattainable for many sufferers.

 

As so often, the biggest difference from attitude may come on the emotional side of the equation. Given some level of physical comfort, there is still a challenge to the emotions, that at times can be vast. In this sphere the egg might have an answer to the chicken. But even here, I am one of the lucky few to have had the possibility of keeping most of my emotions largely positive or at least not too dispiriting.

 

How is it that I have been so blessed so far? Again, I start with purely physical aspects that are largely beyond my control. I have been no health paragon through my life, though I suppose I did OK to avoid the blights of smoking and other addictions. Looking back, my smartest, or luckiest, move was to notice the minor symptom last summer and to do something about it. That led to the misery of diagnosis and treatment, but if I had not noticed or stayed quiet, the tumour would have been free to grow for longer and may well have become untreatable.

 

So, if this blog is to take the arrogant stance of offering advice to people without cancer, point number one is to look out for possible symptoms and, as they say in New York, if you see (or feel) something, say (or do) something. Hypochondria is not a great route to follow, but being aware that our bodies are fragile and looking out for early warnings is. Great plan.

 

Then I suppose point number two would be about avoiding a lifestyle that makes us prone to ill health. I am a poor role model for this one as a stranger to the gym and a sucker for sweet foods, but perhaps we don’t need to be exemplary, it is enough to avoid asking for trouble from drugs, tobacco, alcohol, obesity and the like.

 

Those obvious points are all I can think of about physical preparedness, but emotional preparedness is something else, and something that we generally have more influence over.

 

When we are young we all think we are immortal. That is probably a good thing; everything is a balance between risk and caution and if all of us favoured caution then there would be a lot less innovation in the world.

 

But negative health surprises can happy at any time, and become more likely as we get older, no matter how strong our physical preparedness. If indeed our attitude is important in determining how well we respond to such a challenge, then some emotional preparedness becomes a sound investment.

 

The most important way to be emotionally prepared for a health setback is to maintain our key relationships in as strong a state as possible. This starts with who we choose to live with. A life partnership always involves challenges, and that makes many of us cautious about commitment and sometimes to finding solutions when difficulties arise.

 

Such behaviour is not all that risky while we are young and healthy, and it can even be beneficial to build some experiences and derive key lessons from ditching or being ditched. But wow, does it help to have a. strong partnership once major health problems arise? A lot of trust and other relationship capital can make all the difference when it is really needed. Consider that next time you are tempted to strike out at your partner or moan about a widening waistline or some other triviality.

 

The same applies, albeit to a slightly lesser extent, with our children, siblings and other close family members. It is not necessary to live in each other’s pockets; we are all different and must find our own paths. But a bond of emotional support from an extended family can really help when the going gets tough.

 

Another opportunity for emotional preparedness comes from how we spend our free time developing hobbies. For about half of my life, my primary hobby was playing bridge, the card game. It helped me build a social network, challenge my competitive spirit and travel around the UK and Europe. It also became one half of the glue that bound my marriage together (our daughter formed the other half). In the end there was still not enough glue, but our shared hobby gave us more happy times than we would probably have been able to enjoy otherwise. My first concession when we separated was to give up bridge completely, so that she could retain her hobby without bumping into me all the time, which I judged would be emotionally important to her.

 

What followed after bridge? I rediscovered singing, something I had done in my youth and largely neglected since. Singing has turned out to have all of the same benefits that bridge had before, including providing some glue to my second marriage when we sing together and travel together for singing holidays.

 

Before diagnosis, I did not consider for a moment how fortunate a hobby singing would be once I became sick. I am so lucky that my cancer so far has allowed me to keep singing as fervently as before. If my greatest handicap is that sometimes the word or note on the left side of a new line of music seems to be absent, I can put up with that. Over the last nine days, I have enjoyed fourteen sessions of singing in ten different places, including three concerts, three other church services and even four pay checks. Few cancer patients can be as fortunate as that. And, going right back to the beginning and the claim that I may deserve compliments and even derive stronger health for my positive attitude, singing is no doubt the primary cause after my life partnership.

 

My luck is that I stumbled into a hobby which was not seriously inhibited by my cancer. And therein lies the last lesson I would like to share, one I followed myself purely by good fortune. As we reach middle age and the possibility of serious illness looms larger, we would be smart to think about our hobbies and perhaps to take up one or two that are more robust, and ideally which contain a social element. 

 

If I were a passionate skydiver, or explorer of exotic places, or even a builder of model aircraft, I would have had to largely give those things up, and the emotional acceptance of my disease would have been much more challenging. Graham the skydiver would have been consumed by his vertigo, the explorer by his nausea and the model builder by his loss of competence at close work. But Graham the singer can still perform, just about, and furthermore to retain an active social life and a close life partnership. He is grateful to have chosen that hobby. What will tyours be?         

A World of Blessings

 I have been feeling rather short of inspiration for blog postings over recent weeks. Perhaps my new life, always with cancer as part of its context but no longer dominated by it, has become so familiar in its experiences and its emotions to have become humdrum. If so, I guess that is a good thing. A few people have been wondering about my silence, and perhaps some are worried that silence portends change for the worse, but are frightened to ask in case it upsets me or somebody else. They can be reassured, with my thanks for their concern. Motivated to write but lacking fresh ideas, I had an inspiration this morning to return to one of the safest topics of all. I can count my blessings.

 

Perhaps the most immediate blessing to count is that it seems we can now put the October infection episode behind us. Looking back at it, perhaps I was less concerned by the infection than I should have been. Hospital was no fun and every procedure leads to thoughts of demise, but overall I managed to tolerate the experience rather easily. Maybe having my head opened up for the fourth time in twelve months felt less scary because of its frequency. But now that I can take some distance from the episode, I realise that my doctors took the infection very seriously indeed, and their prior experience would have given them great cause for concern. They threw all their weapons into the battle, and it appears that this was wise and successful. Four weeks after discharge, I am still pumping a heavy dose of antibiotic through my PICC line three times per day. But the message from three consultations last week was consistent. The experts were worried, but now feel reassured and very relieved.

 

I often speculate about how the illness is likely to develop, but nowadays I try not to ask too often and to take an attitude of worrying less but coping more. Every case really is its own story and will evolve at its own pace. The infection is quite a good case in point. It had little to do with the cancer, beyond the fact that chemotherapy might have made me more susceptible. It feels likely that when things eventually do head south, it might be because of a treatment side effect or even something completely unrelated to the cancer. I just have to stay positive and balance optimism with preparedness.

 

So my first blessing is that this particular complication did not turn into the beginning of the end, and maybe, just maybe, not the end of the beginning either (thank you Mr Churchill for the chance to use one of my favourite quotes). This outcome was not a miracle, but more a result of good fortune and good medicine, but it is still worth celebrating. The setback even came with a great bonus of a month’s pause in the chemotherapy (it will probably restart next weekend). I have had no trace of nausea for three weeks now, and my appetite is as strong and as joyful as it has been in a year. Last night we had a lovely dinner with good friends, including a bottle of wine. The chemotherapy seems to be doing its job and I will return to it without complaint, but the interlude has been a lovely reminder of past blessings. Perhaps there is a future for some of those blessings too.

 

Then I can constantly remind myself how blessed I am to be able to live a more or less unconstrained life. I cannot drive any distance, but I live in a city with great connections and have a willing driver as a life partner. I can pursue my singing hobby with abandon. I sang on seven of the first eight days of this month, and have at least seven concerts to look forward to singing in during the month starting on November 18, not including our lovely church masses.

 

If I want to whine about how awful the subway is during the evenings, I can remind myself that many people live where there is no subway at all. If I want to become miserable about the temporary block on my swimming, I can think of all the people for whom there is no available pool for miles. If I get annoyed by one surgeon making me wait nearly three hours in his clinic, I can recall that this has not happened before to me, consider the person who needed an urgent operation, and even spare a thought for the lost family evening of the poor surgeon himself, no doubt something he has to put up with far too often. If I feel like moaning about the cesspool of US politics and much of its policy, I can remember how lucky I am to have to chance to live here and to spare a thought for those in Gaza, or Zaporizhzhia, Sudan, Somalia or anywhere else beset by conflict.

 

I am blessed by having so many places I can find peace, notably our churches and the old folks’ home where we volunteer. These places enable me to pray and to remain thankful and positive. We can even still dream about a more permanent peace in Portugal before too long, if we can stay on track and clear away the remaining obstacles.

 

Much of this would not be possible without a supportive and caring life partner by my side, which might be the biggest blessing of all. Add in all the other wonderful family members and friends and it becomes simple to cast away any gloom.

 

Thankfulness is truly life’s magic sauce. And I have more reasons to be thankful than most.           

Prayer

 I have always been rather lazy with prayer, and sometimes confused about its purpose. Now I find myself on a large number of institutional prayer lists and included in the daily prayers of many people. Such care fills me with gratitude, and also makes me reconsider my own attitude to prayer.

 

I expect that my early history of prayer was similar to many of my generation. We might label our first prayers as level one prayers. These are not unlike the prayer lists on churches and so on. My mother taught me to kneel beside my bed each night and recite a litany of family members to be blessed. It would start “god bless mummy, God bless Daddy” and continue with my sister, aunts and uncles, grandparents alive and “in heaven”. I don’t think the discipline lasted very long after the parallel ritual of bedtime stories ceased.

 

As a kid, I think I was more interested in what I would now label as level two prayers. These are akin to requests from Santa Claus and are really personal begging. Most commonly, I would invoke this sort of prayer when faced with a threat, large or small. I could pray for something as mundane as a critical victory for the soccer team I support, or that I would not be caught out in some misbehaviour at school. Though the frequency of this sort of prayer decreased as I grew older, I confess that I still invoke it from time to time. When the epidural of my ex-wife failed to take effect at the time my daughter was to be born, and a decision was made to carry out a caesarean birth, I will have prayed level two prayers long and hard, hoping for a good outcome. Now, each time I face a brain procedure with a general anaesthetic, I find myself praying for a good outcome, and include some wishes for the blessing of my wife and family in the event that I don’t recover. Perhaps having all these other people praying for me might make me more inclined to pray for my own recovery, or perhaps I am just scared.

 

I first became more conscious of what I label level three prayer once attending Church became a more regular part of my life. I equate this sort of prayer to the simple idea of unhurried contemplation. This is the main opportunity I derive from attending Church services, but also just sitting quietly in a church or another place of peace. Around services, the quiet times at the beginning or end are excellent for contemplation. Services do tend to include a segment devoted to prayer, but this is usually a disappointment to me, especially in Catholic churches, where they just read out something bland written by a Vatican functionary, or, even worse, pursue a line akin to political propaganda.

 

Usually the most useful segments of a Christian service for contemplation are the readings followed by the homily. There is invariably plentiful material to contemplate in the readings, especially the gospel, and most weekends I will hear two homilies offering an interpretation, at least one of which is generally excellent.

 

This past weekend was a good example. The gospel told a parable where a rich fella invited the great and good to his banquet, but they failed to turn up, offering weak excuses. The host extended the welcome to all and sundry, who showed up and had a good time, but one dude showed up in unsuitable attire. I was expecting the host to show kindness and mercy to this chap – after all he might have been poor and certainly received the invitation late – but instead the fellow is cast out cruelly. “Many are called, but few are chosen” is the punchline.

 

Two good homilies set me thinking about this story. The essence is that it is not enough just to expect redemption, we have to do our bit to prepare ourselves. If we believe in life hereafter, we can consider the whole of life to be such a preparation. Only if we do this well, with serious intent, can we be hopeful of a kind judgment.

 

I spent much of last week in hospital, inevitably contemplating my own demise. On Saturday I found myself tearing up while leading the congregation in “Abide with Me”, as morbid a hymn as exists in the mind of most English folk. The whole experience, parable, homily, reflection and expression, acted as prayer for me. I welcomed it heartily. I find this happens most weeks and it helps me to accept the predicament I find myself in with greater equanimity, thought for others and peace.

The lovely thing about the gospels is how helpful they can be for prayer even if we do not accept a literal interpretation. So this week, with the procedure involving general anesthetic, as usual I spent time trying to be as ready as possible for the end, or even the beginning of the end. What does attending the party in suitable attire mean for me? My best answer is to ensure that my important relationships are all in good health, that there is no estrangement or unfinished business that might cause lasting damage to others should I not survive. This sort of prayer is also not entirely unselfish. Often, I find that trying to follow the messages in the gospels are a key too my own contentment.   

 

I was enraptured by a slightly different take on prayer some years ago while I was following a twelve step programme. The only mention of prayer comes in step eleven, which states “Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.”

 

I still find this formulation to be helpful. Twelve step programmes ask to accept the possibility of a higher power, but allow us to interpret the concept in our own manner rather than being beholden to any particular doctrine. Then, in the prayer, I like the way we are guided away from level one and especially level two prayer, instead accepting our fate, humble but not passive. We are powerful, and can achieve wonderful things, but at the same time we are powerless in the face of the majesty around us.

 

I am not sure if I am abusing the welcome of the Church and its adherents, but I permit this attitude to enable me to partake of the blessings of religion without necessarily believing very much of its literal doctrine. My concept of God is highly abstract. But who am I to deny such doctrine? I am profoundly grateful for the consideration and love of many religious people. Just last Sunday my wife and I received valuable comfort from a visiting priest at my hospital bedside. It did no harm to our humour to also learn that this lovely man carried the ordained name of Hyacinth, seemingly an important Polish (male) saint, but a name forever associated by Europeans with the eponymous Mrs Bucket of situation comedy.

 

This gratitude also brings me back to all those prayer groups and individuals praying for me. I hope I don’t offend by disclosing that I struggle to accept much of the literal language in some of our prayers. I consider myself blessed in being able to derive enormous comfort from my own prayers and from those of others, and respect every one of their beliefs and their faith. And, even if we do not have any confidence in the existence of an afterlife, prayer is surely helpful and a chance for us to do good for others even if our own time may be short. “Abide with me, fast flows the eventide”. After a tough couple of weeks, I can only wonder at the power of unhurried contemplation and the prayerful support of so many.           

Deja Vu all over again

 For most of us, anniversaries are more often memorials of tough times than celebrations. My mother became a widow on March 16 1976 and worshipped that date for the thirty six years she lived for afterwards. I tried to remember to call her on that date every year, and she had a ritual of visiting the room in the Eastbourne crematorium where they keep a book of remembrance. It was nearest thing she ever came to spirituality.

 

Now my cancer journey is at its first anniversary, and I wonder if, depending on how long it will continue, certain dates will assume importance for my wife and me. This week certainly bears remarkable similarities to the start of the journey, since I am back in hospital.

 

It was today, 12^th October, last year that I had the appointment with the neuro-opthamologist, in which he identified the brain as the root cause of my peripheral vision issues and advised me to check into urgent care the following day to find out exactly what was going on. That trip to urgent care led quickly to a CT scan showing a mass, then a more conclusive MRI that night, and the first biopsy five days later, involving six nights in hospital in all.

 

That set off twelve months of trials, starting with steroid land, the second even less optimistic biopsy, the long period of inconclusive diagnosis, the third hospital visit just before Christmas for the major operation, then the intense radiation therapy followed by the seven rounds (so far) of oral chemo. I have been lucky, because the basic cancer has not developed at all and has even been supressed for now by all the treatments. I have had a few little setbacks, but have generally felt quite well and able to continue a pretty normal life, with only the minor inconvenience of not driving and the various bouts of nausea and fatigue to put up with.

 

Then this month has been a bit tougher. The last chemo round was a bit harder to tolerate, and one of the occasional side effects, itchiness and rashes, came up. I had pills and creams on hand to deal with that, but it did lead to unusual levels of fatigue, before a new problem emerged via a swelling near the site of the original incision. Initial antibiotics did not clear it up, so last Thursday I was requested by my oncology team to report once again at urgent care. That has led to another minor operation and seven nights so far back in hospital, making seventeen altogether in the calendar year.

 

Even though I am in a different hospital and being treated for different symptoms and issues, the similarities to that first six-night hospital stay have been uncanny. It is not an experience I would recommend.

 

The parallels start in the urgent care department. The first time I drove to Long Island and parked the car there and left my stuff in it, all rookie mistakes. This time I went by subway and remembered to bring lots to read and very little else. Both times, the urgent care environment resembled a crowded bus terminus, teeming with people but achieving very little at any pace. This time I sat in a waiting room for a full six hours, during which little was achieved beyond the insertion of an IV line and drawing of blood, and rudimentary interviews with many people who did not seem motivated to communicate with each other. At least this time after the six hours I was actually placed in a real bed in a real ward, contrasting with earlier experiences languishing in other waiting areas and corridors.

 

So we come to the ward experience, also full of parallels. The rooms were probably designed for single occupancy, but long ago subdivided as twins. The patient rooms are overloaded with equipment and the neighbour is always too close and usually seems to prefer permanent junk TV on full volume. But what else are they supposed to do, especially if they are doomed to remain in the same dismal place for weeks on end? On this visit I am now in my fourth room, an improvement on the eight (including corridors and waiting areas) of my first hospital stay. Even so, being moved around is always unpleasant.

 

The equipment is plentiful and sophisticated, but still somehow flawed. Despite all the buttons and options, I have yet to feel comfortable in bed for a single moment. The machine dispensing fluids into my IV often beeps, perhaps because I moved my elbow microscopically or perhaps because of a tiny bubble in the bag. I have learned the trick to stop the beeping, but sometimes that only offers relief for a minute or less. And my neighbour often has no such trick available.

 

There are long spells of boredom, but also many visitors, often during the night. Some visitors have a routine task to perform, some have the job of checking up on me, and some are the real decision makers, whose communication skills are decidedly mixed. Most staff are friendly enough and many are lovely, they have their own priorities and inevitably deprive their patients of peace.

 

Just like during my first stay in hospital, an initial burst of tests and an MRI led to the conclusion that I needed to stay for an operation, for which I had to wait for a space in the schedule to open up, aware that other cases would have higher priority. Then, in both cases, the operation experience showed up other features of the hospitals. There is some preparation on the ward, then a spell in the pre-op area, where not a lot happens. Then I am wheeled into an operating room, put to sleep, and the next thing I know I wake up in the post operation recovery unit, an oasis of calm. This time, as has happened at least once before, my post-op residence lasted through the night, until a new home was found for me back on a ward.

 

The day or two after an operation are the most physically discomforting, at least in my case where the operations have been to my head area. It takes many hours for the post-anaesthesia pain to even start to subside, but there are still machines and buttons and wires everywhere, plenty of visitors, and not much real news. Then today, two days later, comes the welcome turning point, with a lot less pain and the start of talk about recovery, getting home, and next steps.

 

There are other uncanny similarities. The food is remarkably good. The fellow patients cover the gamut of resignation, anger, pain, boredom and a sense of life ebbing away. The staff embody humanity in all its richness too. And the extreme hierarchy among the staff is plain to see, including power exuding from some uniforms and even the physical features of groups at different hierarchical levels.

 

As usual, the emotional journey is as taxing as the physical one, but here perhaps my enhanced experience has helped me. For sure during the first visit to hospital a year ago we were excessively fearful, frantically preparing for a possible sudden death and attempting goodbyes and its contingencies. Such thoughts were present again this time, and inexplicable floods of tears still emanate, especially early in the mornings, whether out of fear, dread, love, thankfulness or some combination. But together we have kept our emotions in check better this time. Thankfully, things seem to be trending in a positive direction, and that last phase unleashes the same flood of thankfulness.

 

Are there any lessons from all of this? Staying out of hospital must be one, but hardly a very practical one, because if we are sick then we need treatment to get better. Getting angry should be avoided if at all possible, but can be difficult when in pain and filled with fear. Enduring hospital without a loving partner must be horrible, and must also inhibit recovery. It is always right to maintain the balance of hope for the best and preparedness for the worst. And, most of all, it helps to feel thankful.

Re-entry

 The French have a word for this time of year; they call it la rentrée. For the long summer break, including the whole of August, everything revolves around les vacances. Schools are empty of course, but so are offices, and forget about trying to find anyone resembling a plumber to fix your drain. Then comes September, and normal life returns, and everybody has to find a way to respond to the sudden change of pace once again.

 

It is less extreme, but even New York has une rentrée. For many of us, the summer is a time to dread rather than embrace, because the humidity is unrelenting and the noise of air conditioners a constant nuisance, yet we are still expected to function. Now, in September, all my choirs have restarted and the routine of the week has resumed. Yet for us, this year, our rentrée has assumed an exaggerated significance. I did not expect to be embarking on this season in such good health; indeed it always felt that this might be the season when things started going downhill fast. Yet a chance remark by our oncologist last week has helped to create a very different atmosphere, one of unexpected optimism. Of course that is very welcome, but it has created its own challenges. Bring them on.

 

I can’t fully explain how it came into my head that this period might turn out to be a milestone of decline. When I first received a preliminary diagnosis last October, I still recall the words of the surgeon after he had breathed dreaded words including “aggressive” and “high grade”. “Sometimes we are looking at years, and sometimes months” certainly came across to me as a warning to prepare for an early demise. The hope offered by the discovery of “unusual features” never amounted to much, since they were obviously not so unusual as to warrant any sort of unusual treatment. I avoided Google, but still could not avoid discovering the statistics of an eighteen-month median life expectancy after diagnosis and a five year survival rate under 10%.

 

Then came the operation and a period my family still describe as a temporary insanity, backed up by a series of quickly arranged visits which told their own story about what family members expected. Even when the intense treatment seemed to have suppressed the cancer and the MRI reports started to lead to medical smiles, our hopes were still cautious ones, and it spoke volumes when the oncologist encouraged us to visit Europe but warned us to “have our affairs in good order”. All of this led to what I characterised as “bonus time”, a period to enjoy as something of a last hurrah.

 

I am not sure that very much has changed now, except in our heads. Finding myself still healthy at rentréetime, with its resumed choirs and other routines, and seamlessly passing the halfway mark in the chemotherapy, were perhaps surprising enough to reset some expectations. But my wife and I surely sat up and took notice when the oncologist reacted to the latest clean MRI scan by starting to wax lyrical about patients of his who had thrived for ten years or more after a diagnosis like mine. Now, talk like that would be irresponsible if he did not feel such an outcome was a realistic possibility, and this general is certainly not irresponsible. 

 

We both decided very quickly not to go overboard with our reaction, and after a long cuddle and some tears we have not had much further discussion so far. But it was clear immediately that the remark, together with the other hopeful indicators, has had some influence on us. We will remain hopeful but also remain ready. After this treatment phase will end, all being well, in February, there will be a period without treatment, standard practice to allow to body to recover from months of well-intentioned poison. The most likely scenario is probably that the remaining cancer cells will remain docile for a while after that, but will then use the treatment lull to begin to reform into clusters and eventually regain their potency.

 

Still, the change in tone feels like a clarion call to convert hope and vague intentions into action, and not to waste too much time in going about it. Our intention remains to return to Europe next spring, but now the many complications involved have to be worked through rather than used as a reason for procrastination. Further, those plans have to somehow remain valid for a longer time period. As an example, until now my heart has not really been engaged in the plan to upgrade the villa. Perhaps a part of me doubted it would ever happen or felt that the project would surely no sooner be executed than become outdated by adverse medical changes. That is still quite likely, but we are now much more likely to find the energy to advance the plans. The mood will still be one of holding our breath and hoping and handling as many contingencies as we can, but that is no longer a reason to put things off.

 

So this September rentrée somehow feels especially poignant now, and in a different way to how I contemplated a few short weeks ago. True, it is a return to the old routine, albeit punctuated by some nausea and plenty of medical appointments, and that return would have been a source of immense gratitude anyhow, signifying a milestone I did not expect to arrive in good health. But now the return somehow feels rather more than one more extension of bonus time or one more section of an elongated coda. Now, even though very little has really changed, it almost feels like a temporary reprieve from the coda altogether, perhaps more of a da capo section to the piece. And da capo sections can have a propensity to be longer than the orchestra anticipated, to demand a renewal of orchestral energy, and offer an opportunity to discover something completely new in the music.

 

Our oncologist is indeed an accomplished orchestral player, a talent held in abeyance while his work is so demanding but something he frequently muses about restarting when he hears my wife and I banging on about our choirs. Perhaps he is ready for a more poignant and more fully encompassing rentrée as well? After all, I imagine he could almost see France across the Rhine from his college campus. No doubt this journey has many surprises to reveal yet, some of which will surely be devastating, and we will remain as ready as we can. But we are grateful to have been alerted to the possibility of an altogether more welcome surprise. Danke schön, Herr Doktor.

Storyworth

My daughter has been especially active in trying to create memories of me before it is too late. Part of her motivation is having a two-year-old daughter of her own. Her grandparents all died before she was born or early in her life, and she no doubt keenly feels some absence of memory and knowledge. She has made a lot of effort to see me physically since I received the diagnosis as well, despite living fifteen hours away by plane. 

One of her initiatives has been to sign me up to a website called www.storyworth.com. That is a service that offers the chance for members to write a series of short stories, not unlike blogs in some ways, to selected close family. It is all online and very simple, and Storyworth provides prompts for subjects to write about once the inspiration dries up.

 

In common with some other initiatives, this one has a rather morbid element. The context of impending death is ever present, and perhaps that would inhibit some people from signing on or from writing frankly. With our policy of openness and history of blogging, I have not encountered such issues, though of course some topics do make me weep on occasion. Overall, I welcome it despite the deathly overtone. It is a gift to be able to leave something meaningful to my granddaughter, even if her physical memories of me will surely be minimal.

 

I recommend Storyworth for anyone in a similar position, and perhaps more widely too. My sister did a great job in encouraging my mum in her later years to write some things about her life, but the structure offered by Storyworth might have helped her shape some of her writing more helpfully. The risk of the morbid aspect should be a prompt not to leave it too late to start something like Storyworth too. Many people of my generation are quite comfortable with writing: later generations, bought up with a lot less written language and a lot more visual and immediate content, will probably not take to it as readily.

 

I have a second and lazier motivation to create this particular blog post, beyond the recommendation of Storyworth. I can save myself some time today by simply copying and pasting a recent story. My sister recently invited me to create a Storyworth posting as though I were a guest on the long-running UK radio show Desert Island Discs. There have been over 3,200 episodes of the show, starting around the time I was born, though I have never listened to a single one in its entirety. The guest of the week, who these days I suppose we must relabel a celebrity, is invited to an interview to talk about what they would bring to a hypothetical desert island that they were hypothetically marooned on. The standard choice is eight music tracks, a book, and a single luxury item. It is a nice format for a show, and I enjoyed creating my own list after the prompt from my sister. Here it is.

 

Thanks for this Jacqui. I would surely be hopeless on a desert island, unable to start a fire or do anything practical. Ben Gunn was miscasting, unless he was supposed to be played in parody, which I am sure is how I executed the role, deliberately or not.

 

I shall start with tracks that remind me of my parents. For mum, Let’s Twist Again by Chubby Checker comes to mind. She would always be the first on the dance floor and was quite talented at the dances from that generation. For Dad, let us go with Downtown by Petula Clark, a quality Tony Hatch song of the 1960’s. Hatch was a British Burt Bacharach and wrote many great numbers for Clark and others. Mum always claimed that Dad had a crush on Petula. His choice of her songs showed some good taste at least. We saw her perform live once in Eastbourne, mum being typically quick to point out Clark’s colostomy bag.

Then a couple of songs from my own youth. I always rated Paul Simon (and loved seeing him live in his late seventies at Forest Hills) and my favourite track of his is Late in the Evening, an energetic dance number I would always turn up the volume for in the car or wherever else I was listening. My dating and dancing era was short, mercifully for any of the female gender, but in my last year at college I did some clubbing. The music was post disco and punk and pre synth and rap, and was often angry (thanks again, Maggie Thatcher). Let us take Tainted Love by Soft Cell as a typical example that comes to mind.

A bit earlier, in my teens, I came to appreciate small ensemble singing, epitomized by The King’s Singers. They made an album of songs by Flanders and Swann and by Noel Coward, which I played again and again. I could probably list every track in order even now. I’ll come back to that choice (which I guess would be my desert album if I were allowed one) later.

Now we move forward to when I rediscovered choral singing and classical music during my forties. I’ll take Fantasia on a theme by Thomas Tallis because it is peerless, and because it especially recalls my transition year of 1989, because the piece was on an album I played relentlessly while depressed and full of guilt from my separation. It was also during this period that I discovered early music through a choir set up by my first singing teacher. Our first concert included Jesu Dulcis Memoria by Tomas Luis de Victoria, as brilliant a short anthem as ever was written. Later it turned out to be the last piece of music I sung in church before the pandemic in March 2020.

Back to Noel Coward. The third wedding reception for Carmela and me doubled as a farewell to our community in The Hague, so I chose to sing Coward’s I’ll See You Again. A couple of years later I wanted to sing it again at a cabaret, and somehow a friend discovered the guy who had written the arrangement for The King’s Singers all those years ago, and sheet music duly arrived from him - he was flattered to be remembered for his work. I still have the sheet music and it would be great to perform it one more time, but other tracks from the album have become staples in my cabaret repertoire too.

For my last piece I have tried recall the many concerts I have had the privilege of performing in America, and I landed on one from a holiday/workshop at Princeton. A wonderful young choir came together with a few token oldies to perform the six motets of JS Bach. It was the most memorable concert, because by its end the whole choir, orchestra and audience were on their feet dancing with joy. Who said classical music was dull? From the motets, I love Komm, Jesu, Komm, with its middle section that just demands a dance.

So there are eight tracks. What about a book? I am going to cheat a bit. The film Philomena from 2013 had a profound effect on me; I was gushing tears for weeks. Judy Dench and Steve Coogan were magnificent, and the plot was brilliant and rang so true. My ex-wife suffered trauma with similarities to that portrayed by Dench’s character, and the film helped me to understand her anguish more closely. The film was based on a book by Martin Sixsmith titled The Lost Child of Philomena Lee. I guess I should read it.

For my luxury item I will go large and take our villa in Portugal. Nowhere has so many happy memories for me. If I could bring along some restaurants, chefs, boardwalks and nearby cities, all the better.

Thanks again Jacqui. Would you care to have a go at the same challenge yourself?

 

There it is. I have reached my target word count without the normal level of effort. That is especially welcome this week, as it gives me more time to process another change of attitude regarding my cancer, something that may signal another new phase. I continue to produce MRI scans that delight my oncologist, and this week I got the impression that he was inviting us to prepare for the possibility of a longer period of remission than we have been imagining so far. We know there are no guarantees, or even likelihoods, of rare good outcomes, but even thoughts of possibilities are encouraging and need thinking through. More on that next time.

Bonus Time Blues

 My treatment continues to go well and the side effects continue to be manageable, and somehow I am finding it a little bit easier now to be more optimistic about my prospects to survive healthily for perhaps another year or even more. But I am learning that that mindset comes with emotional side effects too, and they are not always quite so positive.

 

For most of the time I find myself feeling more and more blessed by this bonus time. I have even found ways to enjoy the dreaded New York summer rather more than usual, primarily by escaping it for as many as 55 days. We had 31 days in Portugal, then seven in Italy. Then this month I enrolled on a ten-day singing course in Massachusetts, followed by a week in Canada with my wife visiting her brother and his lovely family. Even the time stuck in New York has been more bearable than usual, with our weather on the benign side while it seems everybody else has had extremes to deal with.

 

One thing I have noticed as I move further and further into bonus time is that I feel less need to talk about my cancer. Partly that may be due to my own expectations of healthy survival time. The odds on lasting five years or more have not budged much, but the chances of getting half that far certainly have. When I recall the expressions in the eyes of medical professionals and loved ones and people with relevant experience, around the time of my major operation, I saw an expectation that I was not long for this world, and inevitably that affected my own expectation too. Now I am more optimistic, and the urgency of explaining the situation to others has diminished as a result. Partly it may also be physical, specifically how my head looks. After the operation and the start of radiation therapy, the scar on my head was clearly visible to all, and perhaps that led to some need to explain it. Now a lot of hair has grown back, weirdly in its original dark brown colour. Weird hair colours are commonplace these days so don’t beg an explanation, but it has covered over the wound, so fewer people look at me quizzically.

 

Perhaps I am also more cognizant of the preferences of others too. Most people going on a singing holiday want to cheer themselves up by singing, not depress themselves by hearing tales of the failing health of their fellow singers. I think I judge better now who to share with. Anybody under thirty, even close relatives, have no idea how to respond, so now I save them the bother by avoiding the topic altogether. On the singing course, I was selective and, I hope, smart, in choosing who might be interested in my story. 

 

Then I have noticed a new darker side of optimism. While every waking thought was about cancer, I found it easier to move quickly past any other possible sources of anger. I would follow the news less closely and less critically, perhaps because a part of me was always thinking that the consequences of that news were increasingly irrelevant to me. People I would previously have been annoyed by no longer had such a detrimental effect on my mood. And I even became somewhat less critical of the USA, after a period earlier in 2022 when its flaws became close to an obsession for me, one that only made me feel more and more judgemental and miserable. After the diagnosis I found that I could be more serene in many situations, especially once the steroids had been removed from my list of medications.

 

On my travels I found my more critical traits to have returned. On the singing course, why could I not simply celebrate day after day of singing in lovely surroundings and the chance to meet many truly wonderful people? I could do all that, but I also found myself comparing the charms of Northampton and its Smith campus unfavourably to its European peers, and noting how much even a small fraction of the alumni generosity showered at Smith could improve the decrepit public school system. I also started griping about some singers who talked too much and caused us to learn pieces more slowly than we could have, and the many flaws I perceived in the workshop design and teaching. This was the old curmudgeonly Graham re-emerging, to the detriment of everyone, including me. By the penultimate evening I was really quite angry, and it took me some days to realise how this anger only rebounded on myself and those unfortunate souls who happened to be in its path.

 

The same sort of thing happened again in Canada. Why could I not simply celebrate a joyful, relaxed week with my wife and her impressive, generous and kind family? I could indeed do that, but less benign thoughts came to the fore as well. We visited the splendour of Niagara Falls, but I could not help but feel angry about how the pristine natural wonder had been compromised by the horrors of US and Canadian urban planning, pandering to ugly corporate interests and the worst aspects of human nature. Then we returned to Mississauga, as ugly a sprawling suburb of an ugly city as could be imagined. My wife’s relatives have found happiness there and made wise choices, but I could not stop myself becoming angry at the endless rows of boxy houses, all with multiple large cars parked outside, interspersed only with shopping malls and parking lots.

 

This sort of negative thought came frequently to my mind during the long anti-US phase immediately prior to diagnosis, and now I see how I managed to move past them over the months when cancer expunged almost everything else. But in bonus time, cancer sometimes takes a welcome back seat, and the negative stuff occasionally takes its place alongside the positive emotions centred on gratitude. For a long time I managed to avoid becoming too angry with the US news, but now the prospect of another Trump-infested election cycle starts to fill me with horror, as does the other relentless garbage that passes for news, while real public policy issues are completely ignored. How can somewhere so wealthy tolerate so many of its people living in abject poverty? What on earth is the rationale behind China policy, beyond a childish macho desire to remain top dog? Six months ago I felt ready to delegate such challenges to the next generation, but now I find myself being sucked back into the ugly mess.

 

Fortunately, most of the time I still find myself able to move past these negative thoughts, relying on the good practices I acquired during the period before the start of bonus time. Anger and bitterness help nobody, grief and sadness are fine but can be overcome by love and kindness and gratitude, leading to companionship, acceptance and peace. I can be thankful to have been granted this bonus time to strengthen these positive emotions, for my sake and that of those that I love. It is not so difficult.     

attitudes and Decisions

 US Sports have some strange contrived rituals. Today is baseball trade deadline day, the last chance for teams to juggle their rosters before the playoffs. Teams in with a chance of success might pay more than usual for a player that could make a difference. It makes sense, but is a bit depressing for teams and their fans on the selling end of the equation. On Saturday my team traded one of their best players and it surprised me not at all when I tuned in to watch their game that evening to discover they were already losing 9-1 to a poor opponent. Talent matters, but a winning attitude and team mentality matter more.

 

It reminds me of when my career was on the rise and I could expect to be moved to new locations and positions quite frequently. I learned quickly that one imperative when arriving at a fresh outpost of the empire was to give the impression to the locals that I hoped and planned to be there a long time. I had to say it often, and I even had to believe it and act like it, or I would have no chance of building any respect and to create a winning team. As an itinerant expatriate, one of my family rules was to operate as if we would be staying forever, right up until the day we knew we were not. That also helped the family to invest in their situation and to stay happy.

 

Now I am on a very different journey and the advice I receive most often is that a positive attitude is the most important driver of sustained good health. Some people attribute the effect to prayer or superstition of some other external influence. In any case I find it to be true, and I have discovered some related facts too, such as the benefits of staying active when tired or eating when nauseous and not fancying much food. The problem with the advice about attitude is that it is not easy to act on it. You can’t create positivity out of thin air; instead you have to things to help stay positive. As well as saying it, you have to believe it and act on it, and that can be tough when your body is sending wholly different messages.

 

So far I have managed to follow my own advice most of the time, mainly because I have the advantages of feeling physically well and a strong medical and support team. I don’t judge those who can’t stay positive, because many of those people cannot share my very practical reasons for optimism and thankfulness.

 

Even within a general spirit of positivity and an attitude of getting on with life, there are limitations arising from my situation. As well as maintaining hope, I insist that it is important to try to be ready for what lies ahead and what may confront us at any time. If bad news comes as a complete shock, we are less likely to find a smart response to it when it arrives.

 

This dichotomy arises on an almost daily basis via practical decisions. Yesterday I received a renewal notice in the post for my favourite magazine, The Economist.  There are options to renew for one, two or three years, with discounts on a per issue basis for the longer options. The subscription does not break the bank, but certainly adds up over time.

 

For how many years should I renew? Previously I would have taken the three-year option without much thought, once I had confirmed that it was cost free to change the delivery address in mid-subscription. Now I will probably opt for a single year. Even though it also cost-free to cancel at any time, I cannot imagine my wife getting around to it in the event of my death or incapacity, and the odds of those eventualities have changed, whatever attitude I choose to take. This would be like all those streaming subscriptions we pay for month after month after having accepted an offer of a short free trial for a particular program and then not got around to cancelling. Another of my principles is not to create unnecessary complications for her.

 

It is amazing how many such smallish decisions face me week after week. The hard part is not the decision per se, it is the small reminder of an unwelcome reality. In a way it is just like my New York Mets struggling to compete after being separated from some of their best players.

 

I face this reality daily, and I have come to embrace it and to let it affect my mood only marginally. Others around me have to face it too. Imagine the people running some of my choral groups, in the process of signing people up for the coming season and hoping for enough certainty to enable them to plan repertoire and dates and budgets. I am not much use to them, only able to commit with a series of caveats, yet still creating guilt in their minds so they want to try to indulge me. None of this is made simpler by the complex decisions we face relating to my wife’s work and our possible relocation at some point.

 

My old expatriation rules surely apply. For most items and decisions, I must expect to be around here for a long while and have to actually want that eventuality. I have to say it, sound as though I believe it and act on it. For most decisions that is the determining principle. Six months expensive car insurance became payable this week too, and I simply paid it and moved on swiftly.

 

There is some sort of threshold in play here, and The Economist renewal lies somewhere near the boundary. For the biggest decisions we have to take the new reality into account. We now renew our apartment lease for one year instead of two and insist on a clause whereby we can exit cost-free and with limited notice. That ten-year debenture for membership of the new golf club in Portugal does not make much sense to consider now.

 

As with so much on this journey, the emotional and practical aspects interact, which I suppose is this the basis of the advice to try to stay positive. Every choice, every waking thought really, comes with the very clear context, the context of cancer. Still, that is how things are, and it is not hard to stay positive most of the time, given all the blessings I can count. Remembering lessons from former experiences does no harm either.