Around the corner: a cancer patient’s journey

by Superintendent Simon Nelson
Head of Criminal Justice and Custody, Sussex Police
Vice-President of the Disabled Police Association

I share this story in several parts in the hope that others will be able to take something away for themselves. I apologise in advance if it at times hints at self-indulgence or evangelism, but wrote this when things had moved on enough to share this journey in life – a term sometimes overused but anything that makes you stronger without killing you surely offers something along the way! The messages you take away are for yourself but my hope is that you will appreciate the need to relish life, take nothing for granted, and especially to the chaps: be proactive with your health concerns. There are some dark corridors for us to travel down, but there is a happy ending, obviously!

Discovery
Twelve years ago, I had been recently promoted to Chief Inspector and given responsibility for a District. It is a big jump to the command rank but I was eager to at last have the responsibility for a large team and all that they were able to do for those communities. Leadership has always been something I am passionate about: the ability to care for and encourage others, the opportunity to motivate a team to all work together in the same direction, and to be there for those who needed us in the police environment – all create a niche for me. Yes I still enjoy my life outside of work but it is never a struggle to go in and have never felt the need to watch the clock, working when I needed to but by no means over-excessive hours. I have enjoyed every role I have worked in and promotion has been a natural consequence of enjoyment, passion and innovation, as well as combining the talents of others with the same commitment.

After six months in the role and all the hard work that entails, my life took an unexpected turn. I had recently separated from my wife and had a place of my own where I lived the mixed blessings of my own space without my children aged 4, 6, and 8 being with me all of the time (bedtimes left a gaping chasm). Although I am not the biggest football fan, I had been watching the World Cup and, after going to the bathroom during halftime, there was something different that troubled me, prompting me to call NHS Direct. They told me to go straight to hospital and to phone for an ambulance if I felt unwell on the way – scary, bizarre and completely unexpected. I drove to A&E and instead of the usual four-hour wait I was fast-tracked to an examination room where they confirmed that I had the symptoms of internal bleeding. I was moved to a ward where I stayed until the following morning, when I was told that I probably had a stomach ulcer and would need to have an endoscopy (camera down). This suspicion was confirmed, leaving me with some medication to deal with my anaemia and reduce my stomach acids so that I could be discharged. This took a couple of days after which I was released back into society and back to the job I enjoyed so much.

I was invited back for an MRI scan, which I assumed was to confirm that the ulcer had healed properly. The nurse operating the scan asked me if I was allergic to seafood and I asked in my usual style “Why, is there a buffet?” to which she patiently explained that iodine is used and they needed to consider the risks. I laid back and did as I was told. A few weeks later I was invited back to an outpatients appointment; it was the first thing in the morning, I went in half-blues having advised my team that I would be in to work afterwards. I felt as fit and well as I ever had, and when I was called, I bounded in to see the Senior Registrar who was waiting for me. His face was a direct contrast to my beaming smile and as I sat down he asked, “Hasn’t your GP contacted you?” My ignorance prompted him to continue: “We have had rather a nasty shock from the biopsy we took from your ulcer, and it confirms that you have stomach cancer” – at this point a Macmillan nurse came in and sat next to me. I reverted to work mode as tunnel vision and fog descended, asking what the bottom line was and how likely it would be that I would be here in five years’ time? He reassured me that my age, my otherwise good health, and the likelihood that this 1.5cm tumour had been caught early, were all to the good. I went next door with the nurse and crumbled. I had young children and needed to be there for them as well as having so much to share – this was being stolen from me. I thought I was bomb-proof – I took pretty good care of myself, I didn’t drink much, never smoked, and was by no means obese. I left the hospital in a haze, went to see my ex to explain that I would not be in a fit state to have the children that coming weekend, and then went to my mum to highlight the positives – fortunately she had a friend staying at the time but I understood a parent’s nightmare is to outlive their children. I then went and met up with the person I had been seeing and, as we had been talking about living together, and my treatment was likely to be in Brighton where she lived, we decided to move in together.

After a few days I now realise that my mind shut itself to a little psychological cupboard labelled Survival, and would stay there for many months. My intuition was also telling me that this was not my time to check-out and I that I was needed for others things – I have never subscribed to organised religion but tend to pick-and-mix from each and maintain an open mind. I went into work, met with my management team, and told them the news, explaining that I would share the answers with them when I knew them – they were understandably shocked and, like many in our service, stood shoulder-to-shoulder with me while I stared at the horizon for those weeks of uncertainty.

A series of tests followed, including scans and a laparoscopy which involved a keyhole examination under general anaesthetic to see if there was any evidence of secondary cancers in other organs. I met two wonderful people: my Brighton Macmillan nurse, and my consultant. He was able to connect with me as a younger patient and had the ability to give me straight messages whilst still inspiring courage. Before the last examination it became clear to me that it was D-Day – the truth was on the horizon and I went to theatre with a bad case of the shakes. After it was confirmed that there was no evidence of further tumours the consultant announced that he intended to treat me aggressively, as I was young and healthy enough and this would increase my chance of survival: I would have four cycles of chemotherapy and as it was a junction tumour at the bottom of the oesophagus I would probably then lose the bottom third of that and two-thirds of my stomach. The Macmillan nurse explained that there are many diseases which relate to ‘uncontrolled cell division’ but are collectively labelled as cancer, and that the typical five year survival rate for stomach cancer was around 50% – statistics rule when it comes to cancer performance. She also explained that my chemotherapy regime (which vary greatly between patients) would include three ‘medicines’ which had nausea as a side effect – oh joy! I was hoping that I would able to continue to work but I was only able to manage this until the first chemo session, which was the point I officially went on sick leave (this was August and I would return the following July).

Perhaps one of the hardest things to do was to attend that first chemo session feeling fit and well, volunteering myself to be poisoned. As most would, I dreaded chemotherapy: it was not pleasant but you plug on with it and I had professional people who gave me every cause to believe…

Treatment
My chemotherapy regime had the sole intention of attacking rapidly dividing cells, combined with the alternative agenda of making me feel as rough as a junior hand on Deadliest Catch. Although there is a lot of medical investment and drive to improve treatments and make them more selective, they still result in collateral damage i.e. helpful rapidly dividing cells, particularly blood cells, are also destroyed. Sperm are also affected but I was fortunately blessed with three wonderful children. A fellow police officer had been in a similar position in the past and provided a donation before his treatment, later to result in a successful pregnancy and a chance encounter with his cancer consultant at the entrance to the same hospital, presenting his legacy – priceless.

The Macmillan nurse gave me some critical advice about cancer which I must also mention here: DO NOT do your own research on the internet – there are diverse, unqualified and contradictory accounts out there which confuse, scare and broadly offer little reassurance. Your medical support will advise on which ones to trust and keep you informed, but bear in mind the nature of cancer treatment is ever-changing and survival rates have so many variables. Each year offers new opportunities which, combined with keeping yourself well, offers reasons to be optimistic.

So, chemo is harsh on the body, hence a three week cycle includes a final week of recovery to allow your good cell count to recover, and if you pass that blood test you have the privilege of proceeding to the next cycle – which was always, as you just want to plug on and tick the days off. My regime was made up of a half day having two chemicals intravenously including one which went in red and came out red, followed by two weeks of taking the other one in tablet form three times a day. The benefit was that I was able to spend most of my time at home and in my own space. Each day I would pack my bag with an iPod, books and plenty of water which I would need to drink due to the corrosive nature of the chemicals, and drove to the cancer centre at the hospital. I learned that this was a great opportunity to download and listen to some of those classic albums I had previously heard on vinyl or tape and appreciate them in digital format. Certain contemporary tracks also became my personal anthems, including Suffer Well by Depeche Mode which was also good for a sing-along in the car and away from other patients! I also started this period of treatment with other naive aspirations such as learn some yoga, learn a language etc. – ultimately impossible in practice.

Unfortunately I do not have the most visible blood vessels, and my first session would always start standing at a sink with my hands in warm water. The staff and the centre did everything they could to make you feel comfortable but ultimately you just wanted out, to get home and tick off another day. There is a perverse irony in wishing your life away in these circumstances.

Over the coming weeks reactions from friends and acquaintances were mixed, and your circle of friends adjusts as a consequence. Some avoided, some came out with frankly some really weird questions, some were warm and supportive; and others accepted that something had changed, but I should be treated the same. I was disappointed at times but tried not to judge. If you find yourself dealing with someone in these circumstances they usually experience a well-meaning tidal wave of support which quickly dwindles away to a trickling brook as the weeks go by and an awkwardness of ignorance consumes itself. Don’t rely on the ‘if there is anything at all I can do’ card – very often they won’t know but will just appreciate occasional chats or random acts of kindness. If these are unexpected they hold a lot of weight and I really appreciated some I had, including a heartfelt call from former Chief Constable and an offer from a former senior colleague to go trout fishing with him whenever I felt the urge. Others know the things I appreciated.

The mother of my children took the time to explain to them in simple terms what Dad was going through, including that Daddy would lose his hair. The first time I picked them up after that happened, my middle son came bounding down the stairs with a beaming smile, shouting “Hey Dad, where’s your hair?!” Children keep things simple – they can teach us things – it is grown-ups who make things complicated.

The side effects of chemotherapy are unpleasant but manageable, including relief through other forms of medication. It would usually take a few days for me to start feeling nauseous and I would then sleep in my own bed. I felt fragile and drifted around, but I got up and showered every day. I also developed a love for the American series Frasier which has stayed with me and I never tire of it. Days 3-15 were like an alternative reality, existing in a haze and very often feeling like you were walking on the moon: after the first week I could slowly have a stroll to the shop but hated experiencing the lack of strength and capability – as a six foot four 16 stone man who holds a warrant card, it was complete helplessness. I experienced a range of emotions during my treatment, many of which I did not understand until afterwards, but I did resent the smokers and some of my usual customers when I walked past them.

A friend advised me to shave my hair off before it fell out so that it was my decision rather than it being imposed on me. This made it slightly easier when it quickly came out in tufts one day, and although unpleasant, not nearly as traumatic as it is for women, whose hair is usually so fundamental to their physical identity. It was an excuse to wear some crazy bandanas which I would not have usually got away with! I was astounded by how cold things now were, and even a pillow felt uncomfortably chilly. My partner was incredibly supportive and could not have done more for me: I still believe that it is harder for the loved ones who have to look on. Many have said to me “You were so brave, I don’t know if I could have gone through that” – I appreciate the kindness but at the risk of being blunt, you try to survive or you give up and die: true courage is deciding to do something when you have a realistic choice not to.

Each chemo cycle came and went, and I was able to maintain a reasonable diet to make sure that I was able to recover quickly for each. The effects of the treatments were cumulative so each set became harder, but only two days were missed due to extreme side effects, the details of which I will spare you. Every weekend I was due to have the children I had them, even two particularly rough weekends when they were picked up and dropped off for me. I had to do everything slowly and even making their beds and cooking for them (which I insisted on doing and does not reflect on others) took ten times longer. They were so incredibly thoughtful, sensitive and understanding – I am incredibly proud of them and they are growing up to be fine people.

It was now the November and my four cycles were completed. I had until January when my operation was due to get back up to strength. I met with my consultant and it was time for me to hear the details of the next stage: he explained that it would involve a five hour operation and I needed to be aware that there was a 5% risk of me not coming out of it, which he compared to the 3% for a heart bypass op. In daily life I would have dismissed those odds but this was significant enough to be a possibility. He also advised that it would probably result in two weeks in hospital.

Over the following weeks I spent time in the gym, working on my fitness to shift the odds further in my favour, and allowing some time to feel tired but relatively normal. Being a practical sort I also took time to make sure that the details of my finances were all clearly set out and took some time to write my funeral plan. There was not a need for anything like ‘farewells just in case’, but I did want to have a say in what any potential send-off might look like, particularly as I had such a profound love of music. Choosing the right songs for your own funeral is obviously surreal but there are lyrics and songs I know which would have suited and leapt out at me while I was listening to albums. Only this past year have I been able to listen to music without occasionally thinking “that would have been good for the funeral”.

When January came I went into hospital and had medication to prepare me for the operation, and the following lunchtime I was wheeled away. My parting farewells were loving but casual and we all maintained a credible stiff upper lip. As ever, most of the staff were incredibly caring and encouraging, working in another very demanding area of the public sector. I was taken to a side room and had an epidural line fitted for pain relief after the operation – then cue darkness…

I came round in pain and then started to be sick. This was a serious risk to my stomach wound and I was quickly given an injection to stop this. I also subsequently found out that the epidural had not gone where it should be and was ineffective (an unusual but possible outcome). When I was calm again it was explained to me that the tumour had been slightly lower than expected and the consultant had elected to remove the stomach completely – shocking and confusing at the time but I am in no doubt a qualified decision. I spent some time in recovery and then was transferred to a ward with an assortment of lines and drains, but had been spared the broken ribs and extra drain that removing part of the oesophagus would have required. Over the following days and nights the focus was on survival sleep (gastro wards have many older people who have high demands and can become confused, which was very sad); losing a line/drain a day; and trying to reduce the need for pain relief. After a few days I came off the morphine and started ‘clucking’: I had the itches, twitches and overly-active brain that only hints at what addicts have to go through in rehab.

I was fed through a tube into my gut – I had been re-plumbed, leaving an otherwise effective digestive system minus a stomach. Each day resulted in steady progress and earned gold stars from the consultant and his team, even if did receive the occasional advice for being overly ambitious. I was also aware of the realistic risk of picking up a further infection the longer I stayed there. After just over a week I was healing well and had a barium x-ray to check the integrity of my insides before I could be allowed food or drink. I got the all clear before having the best cup of squash and corned beef hash I could imagine (I never thought I might say that!)

A couple of days before my operation, a young guy of 26 had been admitted with chronic anaemia. He was a well-educated confident type who had sat on the bed next to me polishing off some hummus and M&S snacks with his girlfriend while I lay there nil-by-mouth. Skip seven days forward and he was next to me again, distraught with his family after being told that he had bowel polyps and concerning shadows on his kidneys – this quickly threw me back to the previous July. My instinct was to run but my intuition was to stay, and I asked the fantastic nurse who was responsible for me to just mention to him that it could be worth us having a chat if and when he felt like it. This happened just before I was discharged, we chewed over our re-evaluated attitudes to life and I explained something that had become clear to me: if you’re on a list, it’s going to happen – my treatment had gone well but I could walk out and a lorry drive into me. Live your life – hope and fight every time you have reason to.

It was good to be home and over the following six weeks I healed well, had the final tube and staples removed, and I went back to see his consultant who informed him that he had become aware of some interesting new research. You dare to ask and then are told that there has been overwhelming success for those who have had six cycles of chemotherapy – “Seriously, are you moving those goal posts or what?!” He respectfully pointed out that a further two cycles was an option for me to consider, but there really was no choice – I would have grown my toenails longer for this chap if he considered that it might help, such was my confidence in him. I had little idea of how tough those weeks would be and how close I would come to throwing in the towel. The previous cycles had caused the veins in my hands to harden and collapse but, as luck would have it, I had two left suitable for the last matches of the season. The cumulative effects of the chemo and nausea sans stomach would prove to me my ultimate test, but a sense of achievement at the end was overwhelming and I could now focus on getting better, adjusting to a ‘new normal’, and the mysterious process of grieving for a part of you that you were born with and has now gone…

Recovery
It was now well into April and my consultant advised me that I should be able to return to some form of work in the July, something at long last to aim for aside from treatment and survival. Over the weeks since the last chemotherapy cycle my head had started to clear and only very occasionally did I get that distinctive metallic taste in my mouth, or feel woozy and need to rest. I developed a liking for crosswords and found that they were an excellent way to improve concentration, as well as crank-starting the grey matter into some sort of decent condition. You may recall from earlier how I later a perceived a sense of disappearing into a small room within my mind: this was apparent when I came out of it, which was soon after my last treatment, and it was as if I had been released back into society again. Although I had my old job to go back to, I was aware that it had been covered by a succession of others and the team there needed capable and consistent leadership, so I relinquished the right to return to that role.

Let us talk about the new deal struck for my body and the life I now share with ornithorhynchus anatinus, our friend the duck-billed platypus, which is the only other animal to live without a stomach.

My stomach had been removed in its entirety and some complex re-plumbing had taken place to ensure that the rest of the sizeable digestive system worked well and there was the minimum possibility of bile making its way upwards. Two one-way valves had gone with the stomach, so I no longer had the option to do anything other than sit up whilst eating or drinking, and needed to leave it a while before doing otherwise. I know what you are wondering – where does dinner go, you ask? Answer: same place, smaller portions. After my operation the biggest meal I could eat was the size of a Findus lasagne, but the body is an incredibly adaptable and resilient thing, and whether it is due to changes in gut behaviour or mental processes, the gut becomes more accommodating over time, meaning that I am currently able to eat a normal size dinner in a restaurant – I can even have a pint! Many times over the years I have been asked, “But what do you have instead of a stomach?”, and usually I am happy to explain that I can do without, but one individual was so insistent that they sparked the sardonic side in me and I exclaimed, “They replaced it with a pig’s stomach, and do you know, my appetite has gone through the ceiling!”

New bodily challenges included reflux – when the digestive conveyor belt goes into subtle reverse – and ‘dumping’. This is not as you would imagine, and actually relates to sugar concentration gradients causing water to leave your cells, resulting in cold sweats and feeling light-headed – similar to feeling drunk but usually occurring when you would least wish to feel like that. This usually resolved by drinking more and having a sit down. As with other parts of this blog, I apologise to the medical professionals for my layman’s explanations and possible inaccuracies. Another notable change in routine was not to drink before (fills you up), during or half an hour after meals – to make sure that the body’s ability to absorb the nutrients was not affected. Due to the stomach usually ensuring the effectiveness of vitamin B12, I needed to have a quarterly injection of that for the rest of my life. I also experience occasional periods of extreme fatigue due to an inefficient digestive system, routine anaemia and dehydration but, in keeping with typical police humour, a colleague reminded me that could well be down to age.

The challenge was, and continues to be, consuming a minimum of 2,500 calories in any 24 hours, through grazing on food. This sometimes means eating in meetings: a lessening taboo now but in the early days I would sometimes get comments such as “Can’t wait ’til lunch then?” and “Brought anything for anyone else?” I liken my body to a steam engine (it has never been a temple!) in that coal has to be steadily shovelled in, otherwise it will gradually come to a stop. The stomach purpose harks back to the days when we had to hunt in all seasons and the next meal was not guaranteed – this allowed us to feast and lay down reserves, now manifesting itself as a challenge for modern society and our health service. But without, your body is not as efficient at breaking down food and intake needs to be in moderation. On the plus side, I could eat high calorie foods: butter on toast and anything else I wished, although I did find that I was now less tolerant of dairy products and had to moderate oily foods. Otherwise, curries, mild chillies and everything else did not seem to be a problem, and I enjoy a daily injection of good strong coffee. After a year of not wanting any wine or coffee, the effects of trying these again were extreme, especially as stimulants pass quickly into the bloodstream.

Over the course of several months I lost three stone, comforted by the reassurance that my weight would plateau. Being a stocky build had given me confidence and proved useful – especially when it came to forcing doors open before we had tools to do that, and restraining those who were trying to hurt others. I was by no means skinny now, but as a man, it required some mental adjustment especially when it came to eating: a lot of the marketing in fast food restaurants etc. was centred on big man meals; and when visiting other restaurants I would intentionally look at the smaller meals I could finish. I now order what I want, sometimes children’s size portions, and if I leave some I emphasise to the staff how much I enjoyed it – I now appreciate quality a lot more over quantity.

Trips to the gym were now interesting for both myself and the staff there. In the past it had always been lower weights and higher reps to burn fat and tone muscle; now I had low percentage body fat and needed to build muscle bulk with bigger weights and less reps. This had the unexpected consequence of increasing my power-to-weight ratio and I discovered proper chin-ups! I had to take things easy with the abdomen as the muscles started to heal together again and realised how much strength was usually derived from that part of the body.

I was incredibly lucky to work for Sussex Police, who through the Chief Constable at the time, Joe Edwards, used their discretion to keep me on full pay after being off for six months. If I had worked for a small business and did not have an income protection policy in force, the financial pressures would have mounted – a key element of support that Macmillan often have to assist with. Before being admitted to hospital for a few days to treat the ulcer and anaemia, I had not had a day off sick during the preceding twelve months, and it made such a difference to have all of those previous years of loyalty taken into account. On the flipside, after six months of statutory sick pay you are required to go to Jobcentre Plus and fill out many pages of incapacity benefit application, which then makes up part of your salary, with the Pay Office continuing to ensure that your total income remains the same. Letters from HR and the Pay Office were templates, completely impersonal, and made any person on a low ebb patently aware that were part of a process. There have been improvements since then, and although processes are still needed in our business, these experiences increased my resolve to make sure that people remain at the forefront of what we do.

Over the few months of treatment recovery I was able to spend some time building my strength up in the garden. The weather was good during the late spring and I was able to savour the peace, open air and the scents of nature, and as chemotherapy sometimes affects your sense of taste and smell it was great to have a normal appreciation of things. When I was first diagnosed with the cancer a friend told me that it would change my outlook on life; there is an element of truth to this, but I had always been someone who had been able to stand on a hill in the countryside and say “Wow”, or walk out the house and appreciate the smell of fresh-cut grass. I decided it was time to have a psychological wash-up, and work supported me in arranging several counselling sessions in order that I could be as confident as I could be that there was nothing in there that was likely to haunt me in the future. Most police officers accept counselling as a routine element of our business – officers are exposed to trauma every day and it is all too easy to forget that it is not what the mind should accept as normal. Only once had I been caught out with a rescue at work which did not seem at the time to be obviously traumatic, but resulted in nightmares for a few weeks. Within those sessions I was able to reflect on how I had felt and attempted to rationalise the broad raft of emotions I had experienced at different times and at different stages. It was now time to return to work.

A return to work plan, which allowed a gradual build-up of hours in a support role at Force HQ, had been put together for me. During the first week I was astounded at how difficult it was to even concentrate on IS systems I had been so familiar with, and I tired quickly, but things improved steadily and I did as I was told, sticking to the programme – not running before I could walk. One of the hardest parts of the first year was bumping into people I had not seen for a while. I had always been adamant that the cancer would not define me but I had naturally and understandably acquired a label – ‘Cancer Survivor’ – and this had temporarily eclipsed any professional reputation I may have established. Many were incredibly pleased to see me and it was good to see them; some threw themselves awkwardly into doorways; others went on as if I had never been away. Challenging for all of us, but the incessant well-meant questions were repeatedly answered.

Battling with a serious illness, as a patient or loved one, takes its toll and the consequences are not always immediately apparent. I was aware that my partner had suffered from depression in the past but not to the extent, or the details of some of the childhood trauma she had endured. As someone who had not had any previous experience of mental illness in my personal life, I was slow to spot the mounting symptoms of bipolar disorder which culminated in my partner suffering extreme paranoia and becoming increasingly unpredictable during these episodes. This must have been so incredibly scary and confusing for her as the mist closed in and everything became questionable. It was especially difficult for both of us due to both working for the same organisation at that time, and I was aware that some of the things she said and did had become a source of some sympathy, but often entertainment, gossip, and subjected to the occasional disrespectful terms. Mental illness continues to be the source of intolerance and misunderstanding in this country – if you are diagnosed with cancer you get support and sympathy by the bucketload; suffer a severe episode of a mental condition and there is often little tolerance or understanding.

As this came to a head, and immediately prior to her being admitted to hospital, my partner demanded that I leave our home, and I moved into temporary police accommodation – I also had the children to consider – there was no going back in any way and the damage was irreparable. The hardest part was being prevented from providing her the support she had offered me while I will ill. We did talk a few weeks afterwards, when I moved to a rented house, and she asked if I could forgive her for the things she had said and done – there was no need for this, we made peace and moved on.

After six months I wanted to be back out on Division and working somewhere where I could tap into the energy of others, and was offered a place as part of the Command Team in Brighton and Hove. I spent a year in this fantastic place as the Chief Inspector responsible for Performance, before being offered the daunting challenge of Chief Inspector of Operations. The city has around 450 licensed premises, hosts the second largest number of protests in the country and is home to Brighton and Hove Albion FC, who were in the process of building a 21,500 seater stadium on the edge of the city – I would have strategic responsibility for all of that. It was a steep learning curve and I was able to test my physical and mental resilience, attending a public order (PSU) initial course, before eventually attending other courses to qualify as a public order Operational Commander (Bronze) and Tactical Commander (Silver). This was all on the eve of the recession, or the Credit Crunch, at that time, and we entered into a significant period of protests and minor unrest. As a Bronze I was sometimes out on the ground for hours and, in addition to the equipment that public order officers carried, I made sure that I had snacks in all of my pockets to fuel up along the way, and gradually grew confident that I was up to it.

Over the years I came to realise that my illness caused me to question the future and drawn me into short-termism. Much of my life was surrounded by contingencies: not wishing to be surprised, always prepared, and ready to deal with any threat, even from others when it was never likely – we learn as we live, and need to look forwards with wisdom rather than regrets. Horace’s quote carpe dium is usually truncated – in full it is: Dum loquimor, fugerit invida aetus: carpe dium, quam minimum credula postero (which translates to: ‘While we’re talking, envious time is fleeing: seize the day, put no trust in the future’). In other words: accepting that it is not wrong to look to the future, and that living for today does not have to mean extreme sports – we need to treasure opportunities and moments in time. Over the past few years I have enjoyed many of these, including telling stories next to bonfires with the children – no doubt you treasure your own and I hope that you will have many more. Those of you who follow me on Twitter also have a window into some of these special times and achievements. Sometimes I see others living the world behind a lens or updating social media on the phone when there is a moment to capture in your heart: occasionally, put it down and look to the side. Your mind is the finest memory card you will ever have, and it is connected directly to your eyes.

So – here we are, with the addition of few visits to hospital, a new eating routine and quarterly injections – not a bad deal really. The body healed well and it is now difficult to see the scar that runs down the centre of me – in fact I have the closest to a six-pack that I have ever had (all that hard work in the past and the reality was that if the fat goes, the muscles show!) I was also fortunate that my consultant chose not to remove the belly button, which had been a distinct possibility.

I have been fortunate to have a loving family who supported me. On reflection it took a year to recover physically and a further four to recover mentally. After six years I felt able to share these experiences without fear that I am tempting fate, affecting my reputation at work, or resurrecting the traumas of the past. We all carry scars and they give us tougher skins, but never allow them to make you hard or let them define you – kindness is a strength, not a weakness, and absence of fear offers the confidence to bare your thoughts as I have tried to in this blog.

Eleven years have now passed and led to a promotion – my body does not offer the freedom to do some of the things I previously could and I meet the Equality Act definition of ‘disabled’, but I still regard myself as very able.

Thank you for bearing with me during this occasionally wandering tale – I hope that it has informed, reassured and influenced some for the better. Please be tolerant and empathise with others who have their own loads to carry, be proactive with your health checks and enjoy life – you never know what is around the corner…

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