I reached a milestone this week. The most intense phase of cancer treatment concluded after six long weeks of radiation and oral chemotherapy. I came through it largely unscathed, and it is a wonderful relief to not have to commute for treatment every morning and to feel the nausea sliding away and my appreciation of food return.
I find it hard to define distinct phases for this cancer journey, but one characterisation might set the first phase from August to December and all about discovery and diagnosis, and a second phase ending this week all about intense treatment. The third phase, starting now, envisages more of a maintenance level of treatment, with a higher dose of oral chemotherapy but only for five days per month. We can almost describe this as waiting and monitoring and hoping. Still, this is something to celebrate. One person very close to me confided that they feared we would not reach this point, and for sure others had the same thought in their head.
In some ways this is a strange form of success. For most projects we define clear, observable, measurable goals and can produce a dashboard to summarise performance. What would that look like for the phase just completed? I believe it would have just two items. Firstly, survive, endure, and maintain functional activity. And secondly, run up a series of zeroes onto the scorecard. The list of zeroes is long and thankfully unblemished. No new or worsening neurological symptoms. No infections, no fevers, and no seizures (apart from those under general anaesthetic). No severe or persistent headaches. No issues with blood where it shouldn’t be or insufficient blood where it should be. No slips or falls or serious loss of balance. No cognitive or motion issues, or scar or scalp damage.
I almost feel like Max Scherzer, playing a baseball game where my team has no offence but plays defence every inning. I must pitch a shutout, through the whole game and into extra innings, realising that any scrambled run for the opposition signifies defeat. At least I have the best available defenders and pitching coaches and they have plenty of weapons to stymie the offence of the opposition. At this point the opponents are batting with a bunch of clueless rookies, but we all know that any kid can walk into a perfect swing and that rookies learn and improve.
It feels great to see all those zeroes on my imagined Citi Field scoreboard (and perhaps soon I can celebrate seeing some for real once the season starts next month). But, without being in the least bit ungrateful, there is something missing in this game. Where is the offence? We love to see great pitchers, but the real glamour in the game comes from home runs. Everyone can remember that last year Aaron Judge scored a record number of homers, but only the diehards can quote the stats of the Cy Young (pitching) award winners. I am playing in a game where only the opposition can score homers. I can accept that.
Another issue crops up now as the intense treatment phase concludes, that that is about our planning horizon. When playing to survive, endure and function, that is the only meaningful horizon. Every plan pointed to reaching the (negative) goals achieved this week. But successful projects have simultaneous goals for multiple time horizons. In business I have generally advocated for three horizons. The shortest looks forward only a couple of weeks and is all about immediate execution. The second horizon plans towards the next project milestone. And the third horizon looks, with less specificity, for progress towards the ultimate successful completion of the project.
In my project the intense treatment phase only really included the shortest horizon, and goals of zeroes (and no actions) in the second horizon. That was necessary. But what now? Can we dare to reintroduce a third horizon?
Things can go very wrong at any time, but I understand that at this point I have a reasonable shot at a period of several months or even longer of relatively good health. The zeroes are being posted, the great tools to stymie the opposition batters have been applied with apparent success, and even the maintenance tools are pretty good. My tumour chose to be rather docile while it was free to run riot during the diagnostic phase.
Yet there is something scary and difficult about reintroducing a longer horizon. Would such thoughts jinx it? Might it result in loss of focus and offer a hanging slider for some opposition rookie to knock out of the ballpark? Or is it a smart thing to do? Projects often fail because they forget the third horizon. What is the point of goals that only survive and endure anyway, leading only to yet more survival and endurance? I don’t have a long bucket list, but at the same time I have no wish to suffer progressive disability and to impose that burden on my loved ones.
I am discovering that it is easier to narrow a time focus than to widen it. Smart as ever, my wife has started asking me third horizon questions, usually at six o’clock in the morning. Should we think about moving back to Europe after all? Can she rethink her career goals once again? I cannot yet offer any answers. I am out of practice. There are many new considerations to factor in. I must stay realistic. My team has no offence, and my primary task remains to help prepare my loved ones for the time when the opposition score that home run. All timeframes remain highly uncertain. And I am frightened.
So, all being well medically, the coming weeks will involve some new thoughts and new discussions. We would be remiss not to consider the opportunities that those zeroes might be providing us. Perhaps there is a worthy or fascinating project out there that I have never considered. I have not really got into deep thoughts about the meaning of life, but this is the sort of situation where they might emerge.
In the meantime, we must remember what has helped us to reach this milestone in a healthy emotional state. However we eventually address the third horizon, we should do it as a unified team, recognising that the fundamental reality is unchanged and that we are on parallel journeys to different destinations. And we have more reason than ever to be thankful.
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