We are continuing our good start here in Portugal. We have now spent three months residing here, and my health has remained consistently strong through that time, with no new symptoms or recurrence of previous symptoms to report. My medication and treatment list has been consistent since we arrived here and seems to be working for now.
This good health is a blessing in so many ways. Looking back on the period just before our move, I can’t imagine how we coped and how we have somehow emerged on our feet.
I started this piece with something of a plan to document the progress of my cancer during 2024 and how we responded. 2024 did feel like a year of decisions. But how many of these decisions really were milestones involving genuine choices?
Throughout my illness, and probably for most others facing similar situations, there have been apparent choices, but I now suspect that mostly these are not real choices. Partly we may instead be using our thoughts and the opportunities for consultations to help us face up to new realities. Partly the illusion of choice may be to support a feeling of agency, convincing ourselves that we are active partners.
Upon reflection, it feels more accurate to characterise these milestones as events or developments rather than choices. Mostly, we listen to our medical advisors and accept what is usually an obvious path, even if this advice is often presented to us as a choice.
There have been many developments but arguably few true choices. The initial diagnosis took time to come into focus and remains incomplete. The major operation and initial radiation and chemotherapy all involved choice but felt more like mere acceptance of a clear reality. There seemed only one logical way to respond to the infection of October 2023.
There was more apparent choice during the summer of 2024 once the first chemotherapy lost some of its effectiveness and MRI’s started to show more tumour growth. But again, as things developed, were we making choices, or simply allowing medicine to take its logical course?
Looking at the medical history in this way, I can really identify only two major points of decision. The first true choice was in November 2022, when my wife campaigned aggressively for Memorial Sloan Kettering in New York to replace our initial providers. It feels like we ended up in the best possible place with the best possible care.
I believe the second true choice occured much more recently, in fact during our last week in New York during our final consultation at MSK. I had endured a difficult few weeks of symptoms and side effects, and at this meeting we learned that the most recent MRI revealed substantial swelling and probably an acceleration of tumour growth. We were warned not to be surprised if episodes and symptoms cropped up more regularly from now on.
A little to my surprise, we were then offered a genuine choice. We had previously accepted that the windows for operations, clinical trials and experimental treatments had probably closed for us by then. Useful treatments remained available but effectiveness would reduce, perhaps quickly. Now we were informed that Dr Brennan would be willing and available to operate one more time later in the week.
The implications and possible outcomes of accepting the operation were made clear to us. Risks would be high, recovery slow and beneficial outcomes far from certain. Steroids, chemo, and immunotherapy still had some useful road for us to travel. But the operation had considerable upside as well.
We made our decision within a few minutes, and a lot of the decision was driven by non-medical factors. That coming Saturday we were booked on our one-way flights to Faro. Taking on the operation would have delayed that for months, and probably forever. We declined the intervention. Dr Mellinghoff steered us through the moment with aplomb and wonderful sensitivity. The die was cast, and here we are in the Algarve.
Reflecting more, the decision to come here looms larger and larger, in some ways overshadowing everything else in what was already an eventful year. And the main outcome from these reflections is how ill-prepared we both were.
We have had chats for many years about my wife taking retirement and us coming to live here, but until cancer came along there were valid reasons to defer any decision. Then came cancer, and a year ago we came up with the ABC concept, where A was healthy time together, B was a period of caring and C was widowhood. We still find this to be a helpful model.
In January of 2023 my wife declared that she was ready to stop work and come here at some point in 2024. June solidified the intent, and we went ahead with it in October.
But how prepared were we? On our parallel journeys to different destinations, what were the pros and cons for each of us? Did we need contingency plans? If we chose to stay in New York, what would that mean for each of us? How could we make our ultimate choice work best for each of us? Did we really understand the issues from the perspective of our life partner? Our recent beachside walks suggest to me that the answer to many of these questions was a resounding no. This was one of most consequential decisions of each of our lives, yet we stumbled into it.
I could quote many examples of how we were misleading ourselves and each other. One powerful one from my side was finally accepting that Portugal is not nirvana. Previously, I suspect a part of me felt that nobody in their right mind and given the option would ever choose to live anywhere but Portugal. Well, it does have its advantages, but it has challenges too, in A, B and C. I undersold my wife with my sloppy thinking. She was similarly influenced by her own blind spots.
We can deepen these discussions further as things develop. It does feel now that the decision was final, for my lifetime at least. We will hold each other close, celebrate each day and be thankful for the time we have. There is always ample opportunity for gratitude. Walking by the beach and working to understand each other better invites gratitude in abundance.
We have already enjoyed family visits here and are getting to know good, rewarding people. We hope we can look forward to more of the same. Perhaps stumbling into such a huge decision will continue to play out well for us. But I have to accept that the process involved was highly flawed. So be it.
