Farewell to New York

Our one-way tickets to Portugal are booked for October 19^th , just ten days away. There have been periods, especially since my cancer diagnosis, when we had many doubts about fulfilling our dream to live at our Algarve home, and even a few times when one or both of us became unsure that we really wanted that outcome. But, barring unlikely disasters in the coming days, we really are going to make it. How healthy I will be for how long remains far from certain, but we are generally determined to enjoy whatever time we have, always feeling grateful for the opportunities we have been given.

 

So, God willing, my next and subsequent posts will be created in Portugal. That means it is timely to reflect on the twelve years we have lived in New York. Overall, they have been good times for us.

 

I confess to having become quite jaundiced about th e state of US society in recent years. If I am asked about what I will miss, I happily list friends and family and my special Sunday mornings at St Josephs but the list ends there. A refrain of mine is to bewail how broken is US society in so many ways. Looking at all the most important indicators, from healthy life expectancy to happiness or road traffic deaths, the US has fallen from a world leader to a rich world laggard over the course of my lifetime. Yet none of these indictors even warrants a mention in what passes for political discourse.

 

Most Americans concur with my narrative about a broken country. But mot of those same Americans would still defend the narrative about the USA being the greatest country in the world. I can only think of one metric where that is clearly true, that being military might. But any analysis of how that mjght has been deployed since 1945 would reveal a litany of failure and devastation. And still countries are declared enemy combatants with little justification and huge consequences for everyone’s prosperity. \

 

Lexington is a reliably strong page in The Economist. Every so often columnists are rotated and I recall one farwell article. The first paragraph extolled America and following paragrapghs sought examples of America’s attraction. Every example brought out aspects where humanity had yet to do damage. The nature, abundance and fertility of land, and potential of America is unique in the world. Yet whenever humans muscle in this potential is sacrificed.

 

During our first summer here, we visited some lovely places including Lake George and Fire Island. I both cases, we tried to go for a stroll once we had settled in. But our walks were curtailed almost immediately by notices telling us that the land was private and out of bounds to casual visitors. What a waste!

 

Like departing Lexington, I started this piece with the aim of praising America, but found myself diverted into darker territory. I will try to restore some balance in the rest of this piece.

 

New York has been good for my family. My wife has thrived at work. We arrived with two timid pre-teens, yet each has developed into an impressive young adult. I invested heavily into my singing hobby and my effort was repaid many times over. Culture is often excellent in NYC.

 

America also does sports very well, once you get past the annoyance of domestic eventsbeing mis-cast as a world championships. We have had great days and nights enjoying live sports events. In our last weeks here we have enjoyed yet one more lovely night at the open tennis, I have added two more Broadway plays to my resumé, and I even got to sing the national anthem with a choir at Yankee stadium. I even think I got most of the words right, not a simple feat.

 

Inevitably, the final two years of our New York memories will be clouded by my cancer diagnosis. Right on cue, things took a turn for the worse in recent days. Yesterday we were offered a tough choice of whether to have one more operation. The left side tumours are well-suppressed at the moment, but the right side is growing. With heavy hearts, we agreed that an operation now would be too risky and burdensome, so in some respect we are accepting that the cancer will take its path. Until now, steroids and other treatments have kep episodes and the most unpleasant symptoms under control, but that is likely to become progressively more difficult in the coming months.

 

The USA may be broken, but it has as many good people as anywhere else, and it has been our privilege to meet, work with, admire and build friendships with many New Yorkers. Especially in the last two years, we have experienced deep wells of love and support, of friendship and hope. It all makes a difference, and we are so grateful for all of it. People are good. Americans are good. New Yorkers are good. My wife and I, and both our younger kids and our US based family, have been beneficiaries.

 

For us it feels the right time to leave this continent and to seek a more peaceful and comfortable life in Portugal, filling our last days together, whether few or many, with love, prayer and hope. We wish this country and indeed this continent, the strength to utilise more of its abundant potential. I will try hard to see more of the strengths and less of the brokenness from our new vantage point. I do feel that we are going home, after a prolonged and enjoyable adventure. Home is where the heart is. But we are grateful for the adventure and for everything it has offered our family. Fare thee well, great city and great country. Just go easy please on the ludicrous bragging about being the greatest.        

Happy

 One of my favourite jokes is about happiness. True to my love of dark British humour, the joke itself is not a happy one. It comes from the peerless TV show Fawlty Towers, and involves a conversation between Basil and Sybil.

 

Locked into a desolate marriage, the pair live their lives as separately as possible, Basil especially filled with bitterness, shame and resentment. On the occasion for this joke, things at the hotel have been going unusually well, and Sybil takes a risk by talking to Basil, a rare occurrence and one she will usually regret. She asks how he is feeling, and he replies neutrally. Sybil persists: ‘but are you happy, Basil?” “Happy?” “Ah, happy”, comes his reply. “I remember happy”. The depth of despair in this interchange is truly brilliant.

 

The joke came to my mind this week for a lovely reason. I discovered this week that, once again, I am happy myself. That is the first time I have been able to say that since our Europe trip in June. I was happy for that whole month, but then not since, until now.

 

It is hard to be happy, in more than a fleeting sense, if we do not feel fully well. I have experienced this issue many times, but especially during the last three months. Ever since picking up Covid on the flight home from Europe, I have not been fully well. The last months have involved an operation, many scans and treatments, and lots of side effects. Sometimes these have been severe and disabling, and always there has been a lingering sense of fear that things could be about to get worse or become permanently disabling. The fear is the toughest thing to get past. It is only now, with all symptoms back to where they were before the summer, that the fear has lifted. For the last two weeks my only issue has been the side effects from steroids, but that inhibited sleep and affected my mood. Only now, with steroids tapered towards zero has the door opened for happiness.

 

With the opportunity for happiness returning, I have been fortunate to have encountered several positive happiness triggers over the last couple of weeks. Perhaps the turning point when I fortuitously got my laptop back after the incident with hot tea. It is strange how helpless I felt without my laptop, and how its restoration pepped me up.

 

Next, I can swim again, now that eight weeks has passed since the most recent operation. Even better, the steam room at my local pool has been functioning properly for a change, so I can reward myself with a lovely steam after the exertion of swimming. But the main benefit of swimming has been the realisation that I can do it without negative consequences. On the subject of exercise, I am also delighted to discover that I can enjoy walking again. On Saturday I estimate that I walked for over ten kilometres, and only felt good afterwards. This week I also went to a Broadway play. Even though the play turned out to be a disappointment, that was one more experience to help me feel happy.

 

Positive self-assessment lies behind other triggers for happiness. While experiencing side effects from radiation, I was worried about my short-term memory. Memory issues were flagged as a common side effect, and I was warned that some of these could be permanent. So I have not been able to resist testing myself, especially when I wake up (which has been several times each night while I have been on steroids). Initially my results were inconclusive. I sometimes struggled remembering names, though I was not sure if that was a new or worsening phenomenon or simply something that had been true for months or years. But, once the other happiness triggers were in place, I realised that my memory was absolutely fine, as far as I could tell.

 

Another trigger was realising that my eyesight was improving again. I believe that eyesight issues had a lot to do with my episodes of disorientation during August. Into September there were certainly residual problems with lack of focus and blurriness. But these have gone now. Perhaps my hearing is restored too. It is certainly more comfortable wearing my hearing aids than it was a month ago. I find also that I can do some tough puzzles again on my laptop, another boost for confidence. Beforehand, either brain or eyesight issues made that infeasible. The burst of energy that came from completing one puzzle successfully was lovely.

 

I do miss singing in choirs, but that has led me to appreciate more the opportunities to sing that remain. Cantoring at mass at our local church or at the home where we volunteer has never given me more pleasure.

 

All these triggers for happiness seem to have been piling up over the last couple of weeks. But the biggest trigger of all is abundantly clear. We have booked our tickets to move to Portugal! In just four short weeks, all being well, we will be waking in Portugal each morning and savouring the peace, comfort and love that our home there has to offer. After a few false starts and delays, and after recent fears, it is such a relief to be so close to finally moving, and perhaps we can be lucky enough to still have an extended period of good health to look forward to there.

 

It feels wonderful to know that, once again, I am happy. I understand more fully now how tough it is to feel happy while suffering even mild discomfort, and, especially, when feeling fear about how symptoms might develop. But the fear has now passed for the time being, and that has created space for good people and good fortune, and even some smart moves by me.

 

Are there lessons to be learned here? I am not sure. I suppose a good goal might be find happiness even when not feeling 100%. That is tough. But perhaps we can achieve it. A key might be moving past fear. As the illness develops, I have to expect periods of discomfort, and ultimately permanent discomfort. Does that make happiness impossible? Perhaps it does, but maybe not if we can move beyond fear. That feels like a desirable goal. It feels like it will be easier to achieve in Portugal than here in the US, but I suppose we will have to discover that ourselves when the time comes. For now, I am happy once again, and feel very thankful for that.  

Good People

 I don’t believe I have suffered a day of extreme anxiety or depression in my whole life. That makes me feel blessed. Since my diagnosis I have met many medical professionals, and a lot of them have an interview sheet they must go through. Do I ever feel depressed or hopeless? Do I ever contemplate self- harm or have suicidal thoughts? I have never felt the need to pause before answering all these questions in the negative.

 

I suppose the situation may change as my illness develops and it is never smart to rule things out. And last week, with all its symptoms and misfortunes, turned into a test of my resolve. I was certainly low for a few days, brought down by physical and emotional woes. But I have emerged from that low point now and feel almost fully restored. For that, I have many people to thank, starting with my wife and family but including many folk I know much less well and who have fewer reasons to have supported me. People are good.

 

I am not beating myself up for getting a bit more miserable than was healthy for me, for plenty of things went wrong, all at once. It is not at all easy to discover almost overnight that the whole left side of my body had become largely useless, and the frustration from not being able to carry out simple tasks was horrible. I was dropping things everywhere and needed help with everything. I, rightly, had to sacrifice my singing, and that felt like a decisive moment.

 

And, as always happens when we are vulnerable, misfortunes piled upon misfortunes. The car decided that it was the ideal time to present us with an unwelcome large bill. And then I succeeded in pouring hot water all over my laptop, rendering the keyboard and touch pad useless. A bit of depression is understandable, surely?

 

Still, I came through it and out of the other side, and it feels worthwhile to analyse what made the difference, in case the issue might resurface at some point. Surely the main factor was a positive development in my physical health. Dear steroids, I hate you but I love you too, and you gave me my left side back, together with all manner of everyday necessary competences. So the medical professionals are owed thanks, though not as much as my wife, who stayed calm and supportive even when the steroids were making me tough company. Thank you, my darling.

 

But stories often revolve around more than grand heroes. I have always marvelled at how good nearly everybody is, and this period contains some lovely examples. Trust in people and they will repay you. Most of us are just trying to make this strange world a slightly better place for everyone living in it.

 

Friends and family played a vital role. My sister has always been a positive influence through my illness and it feels good to have her in the team. The same is true of all our children and many in our wider families. I am fortunate that I have healthy relationships with everyone I know well.

 

But then there are other friends. People queued up to come and visit me when I needed company. A musician friend continued to give me his valuable time when I needed distraction. Others dropped in just to chat, even if I was a steroid-crazed man at the time. It feels good to have this support, and it will be important to build up such a network once we reach Portugal next month, a network that we can help as well as to rely on when we need help ourselves.

 

But my idea for this posting is to focus on other heroes. The lady who runs the car shop that we use is a true saint. Working in a rough, male-dominated field full of unscrupulous greedy operators, she is a wonder. She has always given us honest advice with our own interests at heart. Her life has had its own tragedies, yet she maintained her integrity and I am thrilled to see how she has built up a successful business. Somehow I came through the ordeal of paying up lots of money for a necessary repair feeling better rather than worse. That would not happen at many car shops.

 

Then there was the computer. First I took it to some kids on the high street, who were condescending and plainly only interested in fleecing me for as much as they could get. Luckily I saw through that, but I was resigned to another big bill and living without vital files for a while.

 

Then I started meeting good people. The next morning I just about had the energy to make it to Costco, and walked right up to an Indian guy giving computer advice, again with my interests at heart. I learned that burying the keyboard in rice might bring it back to life, and perhaps the pad too if I gave it a bit longer. And I heard honesty and possible alternative plans, including a particular Apple store that specialises in repairs. I felt better already.

 

The following morning I had my keyboard back, and ventured to the local Apple store. Apple are pretty mercenary so I was not optimistic. But once again I struck gold.

 

This time my saviour was an agent in her sixties who continued to work part-time for Apple after her retirement. She was probably the only person in the whole store who could speak my language and actually wanted too. We talked through the chances of the pad resurrecting itself (low) and moved onto other fixes. I could buy a pad, and it would bne affordable and give me my computer life back straight away.

 

The lady had another trick up her sleeve, which was to find her pet technician, probably the only technician there who could speak her language, leave alone mine. Quickly they teamed up and sorted me out, and, better, I felt valued rather than bitter or humiliated, which I am sure would have been the case had I stumbled upon other staff members. Of all the happy turning points restoring my spirit, having my computer back might have been most influential. And normal good people lay behind this minor miracle. Well done Apple for an enlightened employment policy.

 

I could mention other heroes. This week has seen a series of heartening events. Bad things pile up in clusters, but good ones do too, and I have been a major beneficiary this week. People are good, and good people are doing good things all the time. The bonus is that, usually, those people feel good themselves. There is nothing more restorative than helping somebody. I needed help, and found it in abundance, from both familiar and unlikely places.

Sanity and Hope Restored

 Sanity and Hope Restored

 

This has been a tough week, perhaps the toughest since the initial weeks following the discovery of the tumour. We have struggled emotionally. Thankfully our wonderful oncologist and his splendid nurse practitioner were able to restore our morale earlier this week. We cannot be sure, but there is a good chance that the immediate slope from here can be an upward one.

 

Three weeks of radiation therapy finished this week, while the chemotherapy should also be doing important things inside my body, even if I don’t notice anything. The side effects from both treatments have been milder than before, with mimimal nausea and only some loss of appetite to handle. After a couple of weeks my hair started coming out, neither unexpected nor unwelcome. It was all going quite smoothly.

Then last Thursday a new symptom appeared and quickly become quite serious. It started with numbness in my left hand but soon spread to all of my left side. It felt like I had transitioned from a fully functional human being into a dependent invalid within a few short days. There was no quality feeling on my left side, so my movement was unsteady and prone to falls, though I managed to avoid any, somehow. The worst part was that the simplest of tasks involving some input from my left side became very hard. I could not dress myself, could not trust myself with an object such as a sharp knife, was tottering around the apartment and needed help at the toilet.

 

I expect it is hard to imagine just how humiliating, shaming and especially frustrating this become. I was not comfortable but could not safely move. My wife was wonderful helping, but her specific skills did not really cover the situation and I took some of my own frustrations out on her.

 

On Saturday evening I managed to cantor mass, somehow, despite needing help on stairs and having to secure myself whenever standing. Then Sunday mass with my professional group was even tough, a possible fall lurking behind every maneuver. Later that day I received the kindest firing letter ever, and it was a relief; I had no wish to embarrass myself and others through that experience again.

 

Through the weekend the condition continued to worsen. We adapted well together and avoided disasters, but then our minds took over. Was this permanent? Would it get even worse? If so, could I be left safely alone? Will be forced to rethink all of our plans? Was this the beginning of the end?

My Monday radiation was in the morning for a welcome change, and afterwards they wisely held me back to see a nurse. That started a process which led to taking steroids, and noticed a slight improvement.

 

Nonetheless we attended our regular oncology consultation on Tuesday morning in a state of high anxiety, both consumed by negative scenarios flooding our heads.

 

We were making the oldest mistake in the book, though of course it is very hard to avoid under such emotional pressure. We had been told clearly to expect a wide range of temporary, and a few permanent, side-effects from radiation, yet by Tuesday we had almost ruled that out as an explanation for my left sided weakness.

 

Fortunately, the nurse practitioner started to put us right, and the neuro-oncologist finished the job. It seems that a side effect of one sided weakness is quite  common during radiation, and, even better, a short regime of moderate steroids would probably sort out the problem. That was the moment we started to be able to escape the doom loop and to restore sanity and hope. And, sure enough, while there have been more bumps in the road, we can smile again and hug again and feel optimistic again.

 

I suppose the big question is why we have to make the mistake of entering the irrational doom loop? Can we aoid that next time? Perhaps marginally, but I doubt much more than that? Why not, since it so obvious? Because we are human beings.

 

Another universal, sods law, had more to say as the week progressed. First we had to pay a large bill for the car. Aaaaaaaat least our car mechanic is a saint. The, on Wednesday, I did my thing, as I do most days, of knocking over a cup of hot tea. This time I succeeded in a direct hit on my lap top keyboard and pad area. It is currently sitting in rice and we hope it might resurrect. If not we know exactly where to go next. It is lucky that our mood was lifting, otherwise that incident could have thrown us back onto the floor.

 

Last night we had a lovely meal out with close friends and that restored our sprits further. My appetite is now being bombarded by two opposing forces, and the steroids are starting to win, so I could enjoy my French meal extravagantly. Hope is never far away, after all. And kindness and thankfulness unlock it.

 

Are there any lessons from this week of challenge and its aftermath. Trying to avoid doom loops must be one. Being ready to ask for help when you need it is another. Accept the steroids with grace when you need them is a third (though I am sure we will be advocating a taper very soon).Another lesson: if you are warned of multifarious temporary and permanent side effects, then don’t leap to the conclusion that a symptom is certainly a side-effect, nor a conclusion that it certainly is not

Simpler, clearer, better - but also new needs of acceptance

 Simpler, Clearer, Better – but also requiring Acceptance

 

Seven short weeks ago we were in Portugal, enjoying a relaxing and peaceful time with blissful walks and lovely meals. We still had the lovely weekend in Brighton ahead of us, a time for singing and family. After that we returned to New York. Since then, much has happened.

 

We suspected we were returning to face a period of uncertainty, after my scans had taken a worrying turn during the spring. As it turned out, July would include an operation, four more scans, many other tests, long phone discussions with experts, and even a day trip to Boston to consult a different brain cancer guru. The whole month felt like a change of pace, including more urgency and packed with uncertainty, but behind it all lay the need to accept a change in my situation. Barring an unlikely miracle, our dreams of a long respite would have to be shelved. Now, the cancer was winning, its effects were creeping closer, and perhaps the best we could hope for was to hold it at bay for a while longer.

 

Inevitably, we found several aspects of our July experience quite tough. Each scan result or consultation required some time to process and forced us to come to terms with a new reality. We were incredibly lucky to have so much dedicated effort on our behalf from such impressive experts, and their candour was also welcome: still, each time we had to come to terms with the implications. There was an operation to recover from, and that involved further intake of steroids, which as usual adversely affected how I behaved with my wife, inflicting additional strain on both of us.

 

Also, while information was always welcome, the path forward remained uncertain. The experts made it clear that in this phase of response to cancer, patient input became more important. This was a clear message to us, and something else that required processing together. Choices would mean trade-offs. Eventually those trade-offs would becoming difficult, such as deciding how much we valued a prolonged life when that life might be painful and put strain on carers. We would need to face those choices together, while their impact on each of us could be very different.

 

Some relief became available at the end of the month. Firstly, my daughter arrived for a visit of a week, 32 weeks pregnant. The three of us had precious times together. Around the same time, all of the medical inputs somehow converged into a clear plan of action, and much of the uncertainty lifted, at least for a time. The window for surgery was probably closing, unless for a very specific purpose such as draining a new infection. Medical trials remain possible, but unlikely and with very uncertain value, and that window would close quickly too.

 

However, new treatments were available and potentially valuable. A specific fifteen-day course of radiation therapy, combined with cycles of a different oral chemotherapy, seemed to make sense. We could keep an immunotherapy, and maybe even a trial, up our sleeve.

 

This burst of simple clarity was very welcome, even though it required yet more acceptance of a reality without much major upside. I duly started the two new courses during last week. So far neither have resulted in the side effects I have become familiar with: I have experienced no itchy rash and almost no nausea either.

 

Even so, fate dealt us a new dose of reality at the end of last week. On Friday afternoon I suffered an extended bout of disorientation. I was at times confused, found it hard to locate and read signs, and lost some dexterity. Fortunately, my wife was with me for the entire episode, which may well have saved me from falls or other serious mishaps.

 

This new development is clearly of concern. At least it passed and has shown no sign yet of returning. It might have been a reaction to a specific circumstance, such as the new treatments. The symptoms had similarities to seizure activity, which is something I can protect against through medication.

 

As always, there is much to celebrate and be thankful for. Memories of June and family visits are fresh and comforting. The resolution of the phase of uncertainty into a clear treatment plan is a relief, and that treatment has been easy to tolerate so far. I can still read, and write, and sing, and pray, and much else besides. We have reconnected with our old-folks home. The episode, scary though it is, did not cause catastrophic damage.

 

Perhaps most comforting to me, the new clarity has made another choice more clear-cut. It has reinforced my desire to relocate to Europe, and soon. This choice perhaps carries a few medical risks, and is certainly tougher for my wife than it is for me, since for her the consequences will take more time to emerge and then will linger for a long time. Our shared parallel journeys to different destinations come into ever sharper focus. Thankfully, the last month, with uncertainty resolved, has helped us to reach new levels of acceptance and readiness.   

Recovering from Recovery

 Last Monday I had brain surgery number five. It was a relatively small procedure as brain surgeries go, and I must have recovered quite well because I was singing by Thursday. Now I have another scar on the other side of my head to match the ones from previous procedures.

 

While the surgery and recovery went well, one purpose was diagnostic, and those outcomes are not so good. After a full year where treatment seemed to keep the cancer in check, it is now clearly proliferating within my brain (though thankfully not anywhere else so far). Because I have so few symptoms and feel so well, the oncologists can now try different treatments, which will include more radiation therapy, different chemotherapy and perhaps some immunotherapy, whatever those things all are. If I am lucky these can give me a further period of good health, but from here we have to also accept that health is more vulnerable, and symptoms could appear, progressively or suddenly.

 

We are so grateful for all the support we continue to receive, from medical professionals, friends and family. In tough weeks like the one we have just been through, that makes all the difference.

 

The procedures all seem to follow the same emotional pattern, and I make the same wrong assumptions every single time. The tendency is to focus on the procedure itself whereas the tough part is actually what follows afterwards.

 

I remember well the frenzy of activity I went into in the days before my first surgery. Once I went under general anaesthetic, would I ever come out again? What do I need to tell my wife and family, just in case? What if I do survive, but as a vegetable or with severe disability?

 

I have been around the same loops with each subsequent procedure, but with a little more realism and a little less frenzy. I don’t sleep the night before surgery, but I find it helpful to distract myself and to travel to the hospital by public transport, fooling myself that this is just an ordinary day.

 

Of course all of these worries are logically rather silly. Yes, procedures carry material risks, but I am probably far more likely to die crossing the road each day than I am on the operating table. It is rather like the feeling we all have waiting for a plane to take off. We are probably doomed to suffer the anxiety, but at least we can remind ourselves of some relevant statistics.

 

The same mood prevails into the operating theatre itself, though of course the odds of real physical suffering during an operation under general anaesthetic are even more miniscule. It can go catastrophically wrong, but I would know nothing about it, at least until I might revive from coma or whatever other consequence arose. Once again, there is little logical point in all this focus and worry, but probably no escape from it either.

 

So anxious do I become about the operation itself, I always forget that the tough time is usually afterwards. There are many recurring features, and I am never well-prepared.

 

First of all, I wake up, heavily dosed with anaesthesia and disorientated. The medical staff are discussing their findings, openly, not knowing I am awake. I hear things I would rather not, and then spend hours wondering whether I heard them correctly or even dreamt them.

 

Then I find myself in another room with the welcome presence of my wife. She and the nurses scramble to find some juice or tea, realising that I have consumed nothing for over 24 hours. The anaesthesia starts to wear off and the pain might build. With an open wound in my head, there is no way to lie and be even remotely comfortable. I start to understand that this will be my fate for the whole night.

 

This time I was lucky to have a quiet, spacious room on my own and with an attentive nurse almost to myself. I can start to give thanks that I am still alive and functioning and that nothing major seems to have gone wrong. But the night is long, with no sleep to speak of, and low levels of pain building up through the night. Smartly, I persuade the nurse to allow me to sit in a seat rather than try to lie in the bed. That helps but makes sleep even less likely. Even if I can doze a little, the nurse has to wake me hourly to check my functions. It is all a bit like an eight hour night flight in an undersized middle seat.

 

Then there is the inevitable visit at 6am from the interns in the surgery team. They try to pass on news, generally bad news, but their skills at this are not great and in any case I am struggling to focus, and only later remember all the questions I forgot to ask.

 

Luckily this time went very smoothly, and I was allowed to go home barely 24 hours after arriving at the hospital, pain wearing off and a little sleep possible at home.

 

But the worst part is still to come. The pain dissipates, but the job starts of processing what has happened and what lies ahead, and of communicating this news to family. These are always the toughest weeks emotionally. This time we had two hours or more of dedicated tele-meetings with wonderful experts, very illuminating but utterly overwhelming too, and a little foreboding as well.

 

The last difficulty with recovery is perhaps the toughest of all. Just like after my initial surgeries, I now know I am much more vulnerable to changes in my condition. That will be a constant worry for a while. I already notice the return of phantom symptoms. If someone asks if my hands are tingling, they immediately tingle. If I am prescribed more seizure medication, I conclude that a seizure must be imminent.

 

I know I have many things to be thankful for, and that also helps, in the end decisively. By the time we must face the next meetings and the treatments that will follow, we will be ready.

 

I apologise for being a bit morbid today. As usual, my main purpose is to crystallise my own thoughts. If my thoughts trigger anything useful in anyone who has a similar experience, that is a bonus. If it just depresses you, then I am sorry.

 

Perhaps now there will be no more surgeries, which is a sobering message in itself but at least spares me the cycle of anxiety and recovery. If there is another surgery, maybe I might even be smart enough next time to know that the part to prepare carefully lies not before or during the procedure, but after it.    

Moving forward or going round in circles

Only nine days have passed since we returned to New York after our idyllic month in Europe, but it seems much longer. The relentless humidity poses its constant dilemma of putting up with either the fetid atmosphere or the noise of air conditioners, and it is sobering to reflect that there are many more weeks to endure before we can expect any relief. Every year I promise myself that never again will I suffer a New York summer. Perhaps this time my hope will finally come to pass.

 

It did not help that I managed to pick up a covid infection on my travels home, which led to some mild cold symptoms but also, more annoyingly, the need to stay indoors most of the time and to mask whenever I was near others. Thankfully that seems to have passed, but it is my third cold-like experience since April so my resistance must be low.

 

The return to the US also seems to have heralded another new phase in my cancer journey. A scan on Friday was followed by a series of consultations yesterday. There does seem to be new tumour material developing, and now the added complication of a tiny new spot on the opposite side of my brain.

 

The situation does resemble the months after my initial diagnosis. Lots of tests did not help a lot to clarify the diagnosis, but after a while the oncologists decided to act based on their best available guesses. This time their first action will be a biopsy next Monday of the other side of my brain. The hope is that this will either show up the new spot to be harmless so they can concentrate back on the right side, or something less benign in which case new treatment will have to address the issues on both sides.

 

Whatever the findings, we are expecting this procedure to signal only the beginning of this new phase. It will probably take a few interventions before a decision is made for a prolonged course of treatment. Part of me is quite relieved that this is happening during the summer, when there is precious little else to do in New York, and with some apparent urgency, so that we can hope that our move to Portugal is not delayed.

 

Nonetheless, all the news yesterday was a bit confusing and disturbing and will probably take a few more tearful days to digest fully. We have been in this situation before, and that experience has given us some tools to help us cope.

 

Important among those tools is to find ways to stay positive and to be thankful. As usual, relief comes as soon as we focus our minds into those directions. It is a simple and wonderful balm.

 

One reason for cheerfulness is our confidence in our clinical team, notably our lead oncologist and his neurosurgeon. They are obviously both established leaders in their fields, and their communication and behaviour is exemplary. Yesterday, bouncing between consultations, I heard evidence of them changing their minds about the best approach at least three times. Some people might be annoyed by that, but I only derived positive emotions and insights from their indecision. They acted as a true team, consulting each other frequently, as well as allowing us into their deliberations, showing respect as well as humility. We are truly lucky to have these two gentlemen at our service.

 

Then I can always derive comfort from how I am usually feeling. How could I be about to keel over when I generally feel so well and am able to carry out such a regular life? There may be damage in my brain, but it still seems to be able to function quite well. When I look around me in the street on in a subway car, most of the people of my age seem to be much worse off health-wise than I am.

 

There were a few quotable quotes from my consultations yesterday. Each oncologist visit involves a series of cognitive and physical tests, and I continue to ace all of them, except for the glaring gap in my left-side peripheral vision, which is no great inconvenience. The oncologist delegates all this to his nurse practitioner, but I noticed yesterday that he watched quite carefully. His verdict at the end was quite telling. He described me as neurologically intact, a new term to me. It was clear that he was quite impressed with this, and I could only reflect how lucky I am compared with most of his patients at this stage of their treatment. Later in the day the neurosurgeon appeared to show a similar emotion.

 

Then I feel truly blessed with the support I have received from friends and family, especially from my wife. We trust our medical team, but it is even more valuable that we trust each other. During difficult weeks like this one, we have established a routine of stoic acceptance followed by quiet reflection and then shared determination to move forward together. It is so obvious to each other that our primary motivation is the welfare of our partner, as we continue our parallel journeys to different destinations.

 

 

Our team is also supported by our shared dream of moving back to Europe and being able to spend even a short period of healthy time there together. We can almost touch the moment when that dream can become a reality now. The shared goal binds us together. We occasionally debate tactics, but always from an attitude derived from that shared goal. This is another powerful blessing.

 

No doubt I will once again be consumed by dread in the hours before the procedure on Monday, and no doubt there will be even tougher challenges ahead, perhaps very soon. But, almost all the time, I do not find it difficult to remain hopeful and thankful. By now we also have a lot of experience to draw on. Whether the current set of challenges feel new or somehow a repeat of what we have already been through, we feel we are as ready as we can be to face them, and to face whatever consequences may follow. I will remind myself of that as I ride the subway on Monday morning to the next episode in this drama. Our mantra has not changed. Reject anger, accept fear and fate, find solace in thankfulness. We hope that this mantra can still guide us, no matter how many times we seem to go around in medical circles or how much uncertainty we face.