When people ask me what I’ve learned from having cancer, it’s this:

My nasal hair is virtually indestructible.

That’s right. Despite eight rounds of chemotherapy it is back with a vengeance and like a teenager with his first car it does not know where the brake is. No longer content to lurk in the dark, intercepting germs, it has ambitious plans. So now I’m in a daily fight with the Rapunzel of nasal hair as it reaches eagerly for the light, yearning in its little hairy heart to feel the warmth of the sun and wave at passers by.

I’ve also learned that having cancer does not make you a nicer person. This is not what the script says is it? The way the script works our hero is noble under suffering and emerges having grown in humility and wisdom. If this was a book or a film then by now you’d find me dispensing sage meditations on the meaning of life.

Unfortunately I appear to have gained neither humility nor wisdom. In fact it’s just made me grumpy. Having walked in the company of death for a while I find myself increasingly irritable as if the whole thing is some sort of personal affront.

It was in this spirit, and £42 lighter, that I arrived at Barts for my 9am consultation. The consultant cheerfully explaining that she sees all her new referrals at 9am, presumably so they can experience the delights of peak time travel to London.

The fifth law of cancer treatment is a doctor, meeting you for the first time, loses the ability to read. It then becomes your job to explain your medical history and your fault if you leave something out. A corollary to the fifth law is information stubbornly refuses all attempts to share.

In obedience to the fifth law, she opened the conversation with ‘So you had a lump…’ I recorded this meeting and listening back I’m wincing at how grumpy I was. In my defence it is annoying to have to recite a years worth of treatment when doctors could just pass information to each other or maybe, I dunno, send each other the patient’s data.

None of this was helped when she explained that she couldn’t read my history because she didn’t have it, just a referral letter, and even though it had been a few weeks the scan data had still not arrived from Chelmsford.

I know what you are thinking. Chelmsford to London. How long to transmit some scan data? It appears that had they carved it in granite and pushed it on wooden rollers it would have got there faster.

So, not a good start but she was thorough, competent and professional enough not to spit in my soup despite my less than reverential attitude. I’d expected a meeting about a meeting but it turned out better than that. With the data that had reached them, she told me they did not think the remaining activity was cancer and probably no further treatment was needed.

Seventh Law: Two doctors looking at the same data will reach startlingly differing conclusions. At Chelmsford they referred me for a bone marrow transplant, at Barts, with the same data, they tell me it is probably nothing.

So what is it then? This party of active cells in my hip, active enough draw attention to themselves on a scan? Well, it might be a form of necrosis or ‘rot’ to you and me. Somewhere in the distant future I can hear the whistle of an approaching hip replacement. Goody.

So there we left it. They were expecting the scan data any moment and having a meeting about me on following Tuesday. We had a bit of discussion about the results of that meeting. Me insisting that she could phone me, she insisting that I visit again for a conversation. In the end we agreed that if it was not serious she would phone and if it was serious I would come in for a chat. Graciously, it was OK if I travelled off-peak next time(!)

So I walked out clutching my next appointment, fingers crossed that a phone call would render it unnecessary.

And then, true to form, I ate and ate and ate. Something about hospitals and something about needing comfort saw me giving a breakfast burrito and black coffee my undivided attention.

One week later.

It was a phone call in the end. That data which seemed so worrying, that potential bone marrow transplant? Nah. Now we want to repeat the PET-CT scan in three months and book you in for an MRI to take a closer look at what’s happening in that hip of yours.

So how am I? Eating. I catch myself visiting clothes shops, fingering big coats and jumpers. Why? It’s been a roller-coaster year and as the weather grows colder and the adrenaline seeps from my body I want to wrap myself up as tight and warm as possible and take a great big nap.

Soon I’ll have to add an MRI scan to my list of new experiences but until then, I’m back.

Brought to you as a public service:

First Law:

No matter where you go you will discover you have broken an unwritten rule.

Second Law:

You should try to wring some hope and humour from whatever is happening in the moment. It might be your last.

Third Law:

At some point, everyone you meet will want to make a hole in you.

Fourth Law:

Your body has a mind of its own.

Fifth Law:

A doctor, meeting you for the first time, loses the ability to read. It’s your job to explain your medical history and your fault if you leave something out.

Sixth Law:

‘You’re looking so well’ is a euphemism for ‘Andrew, I can see you STILL haven’t lost any weight’

Seventh Law:

Two doctors looking at the same set of data will draw startlingly different conclusions.

Oh dear, it’s time to break out the Warren Zevon again.

Imagine for a moment it was your job to dish out bad news to, say, a less than grateful 47yr old man who keeps asking questions. You might develop some defence mechanisms. You could send him letters instead of picking up the phone. You might couch what you say in impenetrable jargon to avoid having speak distressing truths out loud. And you might hand off the harder cases, like him, to another colleague as soon as you could.

All this and more was on display at Broomfield today.

However your best defence is probably “The Look”. Delivered by your opening glance, The Look says “I’ve got some bad things to tell you and this look is me telling you to prepare yourself so I don’t have to spell it out.”

When I saw The Look I knew it wasn’t over.

We got off to a bad start. Remember the first law of cancer treatment, no matter where you go you will discover that you have broken an unwritten rule? In this case I’d failed to receive a letter that would have saved her having to deliver the news out loud.

When I gently protested that I had not actually received said letter, she gestured to the date “Well you can see it was written on the 14th”. Clearly my new (and delightful) oncologist from Eastern Europe has still not grasped the full horror of the postal system at the hospital. By past performance I should get it next month.

This was not a good start. So, grabbing her copy, I started to wade through and here’s the skinny:

The thing about cancer is it doesn’t exist, in the same way that the Chinese language doesn’t exist. Chinese is a group of languages, some bigger than others. Cancer is a generic term for rapidly developing cells that go freelance and set up shop wherever the fuck they want instead of obeying their genetic programming.

Remember that scan from my last note? The radioactive glucose is drawn to these rapidly developing cells because they are greedy little fuckers with a sweet tooth.

(Editorial note: Sorry Auntie but I’m right past caring whether you mind the bad language or not…)

The scan report starts at my head and works down. All is fine until it describes the inside of my left pelvis as having a moth eaten appearance (thanks) from where the tumour took a nibble. And a little gang of rapidly developing cells are still right there, having a party inside my bones.

Who knows what they are up to? Might be residual disease (love that, “dis-ease”, bloody right) or might be healing activity (she said in a hopeful voice) and they are sending me to Barts for another expert to take a closer look.

The letter mentioned “autologous transplantation” as a possible treatment option. You might know it as a bone marrow transplant. Turns out this is more like an oil change and involves, wait for it, nasty chemicals and a long stay in hospital. Not nice.

Let’s weigh up the evidence:

• Item 1 - a jargon filled letter that allows medical professionals to talk to each other without patient understanding what is being said. Letter currently “lost in post”.

• Item 2 - swift buck passing to another doctor at Barts.

• Item 3 - The Look.

Hmm. What could it all mean?

I tell you what it means. The universal law of irony has lined up a typical British fudge. Am I cured? Nope. Am I dying? Nope. Am I left waiting somewhere in the middle with no clarity, direction or firm decisions? You got it.

At least nobody wanted to make a hole in me today.

More later.

(PS - Obviously it’s in my interests to over dramatize the whole thing (second law). Actually it’s now just a wait for a phone call, then another visit, then some tests, then some more shit. Not so bad. Stay tuned if you’d like to follow along.)

"Ooh, you're wearing jeans. We'll have to take those down past your knees"

An oddly sensual conversation don't you think? Especially as I'd only just met her...

Locked in a small cubicle on a low seat while she sat on a tall stool uncomfortably inside my personal space, it was a bizarre morning. The first iron law of cancer treatment is that no matter where you go you will discover that you have broken an unwritten rule. In this case, wearing jeans. Despite receiving joining instructions and a confirmation phone call I'd somehow missed the fatwa on wearing jeans for a PET-CT scan. Hence her eagerness that I should wear them past my knees. Normally when a young lady in a uniform starts talking about removing my jeans it costs me a lot of money, not to mention some subterfuge. On the NHS though, such things are free - the second iron law of cancer treatment being that you should try to wring some hope and humour from whatever is happening in the moment. It might be your last.

My next task was to sign the obligatory get out clauses - do you agree that even though we are going to stab you with a needle, inject you with radioactive isotope and whiz you through a scanner, anything that goes wrong is your fault? Yes. I do (see first law - it's always your fault).

Apparently a pantechnicon is a large van for carrying furniture. I never really understood the word before but it's on the only suitable word to describe this 'portable' PET-CT scanner parked up in the grounds of Colchester Hospital. More like the kind of tour bus favoured by pop legends it has a scanner, some seats, intimate cubicle (above) and a kind of hitech control room with screens and dials. Three operators run tag team - getting the all important signature, injecting, running away, escorts to the special toilet etc.

Which brings us to the third iron law of cancer treatment - at some point, everyone you meet will want to make a hole in you. Sure enough we soon got to the cannula part. I did my best to ruin his day by setting him up to fail "My veins are really hard to find, lots of people have probems." Kinda stupid when you think about it but it gives me a sick pleasure (see second law). He passed with flying colours only telling me afterwards that he'd been on holiday for two weeks and I was the first since getting back. The sweat and shaking should have been a clue.

Coordinating three patients and three staff in the CT Caravan is an art. Strapped to a syringe of saline I returned to the unshielded part were all the radioactive people get to sit. He returned carrying a lead lined case which opened to reveal a lead coated syringe (I'm not joking) full of radioactive glucose. He shoved this in, followed by the saline, and then retreated, all with rather too much haste for my liking. It got more surreal. I sat for an hour while my insides brewed nicely. Next, Iady nurse taking tag back, she escorted me to the special toilet where only the irradiated can pee. Festooned with warning notices I imagine this is cleaned by people in hazchem suits, although not recently.

Bladder empty as per instructions, I took my place on the scanning table. Aforementioned jeans to half-mast. Disappointingly I had to do this myself. Arms above the head and stay still for 20 mins. Of course, my face began to itch. (Fourth law of cancer treatment: body has a mind of it's own). The table raised itself and poked me in and out of a big polo mint while I did my best to sink into a trance.

Some music played but I couldn't make it out over the whine of the scanner. At least it didn't try and talk to me like the other CT scanners do. There is nothing more annoying than a machine trying to be chirpy especially one programmed by a Japanese engineer with only a hazy grasp of English.

Still radioactive I was released into the wild with instructions to stay clear of pregnant women and small children for six hours. No imagination these people - a fading green glow would be far more exciting (think Ready Brek) but it was very dull. No nausea, no coloured wee, not even any superpowers. 

Results in a week or so.

So, is the Chemo working or not? Good question. I’ve done four of a possible eight with the fifth one due on Friday. The only way to find out for sure is to take a look inside me, hence the CT Scan.

The problem with X-Rays is they past straight through soft tissues so what do you do if you want a picture of the floppy stuff inside? Well, one option is to slice me open and have a poke around but since this tends to be slow and expensive, not to mention uncomfortable, it is probably worth a hospital investing half a £mil or so in a CT Scanner. A CT or Computed Tomography scanner uses X-rays to produce an image of a slice of the body including all the soft bits. The end result is a kind of MTV/fly through video of your insides enabling Doctors to take a look without any messy business.

The scanner needs a bit of help though and the first bit of help is in the picture below. Here’s the routine.

First, turn up an hour before your appointment and accept a bottle of white paint to drink. You have to drink this over about 30 min then fill the bottle with water and drink the water over another 30 min. The white paint makes your intestines more opaque so they show up on the scanner. It also has a radioactive indicator (barium) which again shows up more clearly when scanned.

[You’ll understand that this is a layman’s very poor description of what goes on.]

Next you have to undress and don a fetching hospital gown. Why are these impossible to do up yourself? All hospital gowns seemed to have been designed for Houdini. Anyway you can keep your socks and shoes on. Picture me in a gown with socks and shoes clutching the rest of my clobber in a plastic bag. Elegant, I hope you’ll agree.

No hospital visit is complete without someone wanting to make a hole in you so, true to form, a nurse turns up next to insert a cannula. This went smoothly – the first of three times I’m going to be punctured this week.

Next a personal invite to the scanning room. And yes, it is just like something Willy Wonka put together.

The CT scanner is like a very large polo – not like the MRI scanner you might have seen, you go through it rather than inside it. A big polo made by Toshiba or as I like to think of it, fellow food lovers, a doughnut. You lie on a bed which rises and then moves you in and out of the doughnut. Toshiba made the doughnut talk and she speaks in a very forceful westernised voice issuing stern commands to hold your breath etc.

Anyway, I missed a bit. The point of the cannula is to put yet another sort of die inside you. This ‘contrast medium’ immediately creates a feeling of warmth in both buttocks. Yes. Side benefits.

You lie there, obeying the precise instructions of the doughnut, and then it’s all over. Takes seconds.

Next thing is to reverse your way out of the hospital.

Nice nurse removes the cannula and applies plaster.

Dress again. Strict instructions to drink a lot to shift those dyes out of my body.

Leave (or in my case, move swiftly to rapid application of coffee and bacon sandwich).

We’re on NHS time here so who knows when the results will be out but hope to have them before next Chemo on Friday.

I’ll keep you posted.

Click here to download:

diagnosis_to_post.pdf (503 KB)

The redacted bits are just personal info that would enable you to steal my identity - DOB, NHS no. Address etc.

Some things have changed since this letter was written: Weight now down to 89 kilos. Left leg oedema and scrotal swelling all gone and I'm taking this as a very positive sign that my lymph system is working much better again.

They aim to repeat CT scan in six weeks so I'll get an update on the nasties. Will try to get a print this time.

But just what is chemotherapy and what happens when someone "has chemo".

Glad you asked. Here's how it rolled for me today.

The Chemotherapy Unit at Broomfield Hospital is in a lovely new building, light and airy, free of noise and disturbance. The nurses (who are very kind) wear their own clothes and do everything they can to make it a pleasant and comfortable place to be poisoned.

Imagine 20 or so of the best adjustable chairs in the world each paired with a comfortable visitors chair. You find a chair, adjust it to your taste and your companion can sit beside you. Newspapers and free flowing caffeine plus a couple of trolley visits add to the colour.

Here's how a typical session goes for me:

* Arrive and hand in my Chemotherapy diary (see picture). In this they record my vitals and details of the exact treatments I'm having and the drugs I have to take afterwards.

* Next, see the Doctor. The Doc reviews recent blood test results and basically checks that you are fit to go ahead.

This time she showed me the pictures from my CT scan showing a large (15 x 10 cm) mass lurking in my left pelvis and various other nasties. No wonder my leg has been hurting. I wished I'd asked for a print. Not quite as tasteful as showing people your new baby scans but would have made a good talking point.

* Only at this point, and if everything is OK do they order your poisons. I've lost quite a bit of weight (13kg) so the doses all needed adjusting.

* While this is going on I've picked a chair and put a warming pad on my arm. The warming pad is supposed to make it easier for my veins to come to the surface so they can put the canula in. My veins, however, have got wise to this trick and seem to bury themselves as deep as possible if they get the slightest whiff of a needle.

* You can see the canula in my left hand (picture) and it's through this that all the chemo happens; roughly in this order:

First I have to swallow some pills - paracetamol and first doses of the steroid Prednisolone (the P of RCHOP). Then they inject an anti-sickness drug into the line to stop me vomiting. And then a dose of Piriton - which parents will recognise as an all purpose anti-histamine to damp down any reaction to the drugs.

Piriton leaves me nicely drowsy and ready to begin with the main event:

* Saline flush
* Rituximab - antibody that locks onto bad cells to kill them. As you can see from the picture it is light sensitive so has to be delivered from a sinister black plastic bag. * Saline flush
* Doxorubicin - that's the red one you can see being injected into my cannula. Turns my pee red.
* Saline flush

* Vincristine - tiny little bag, another poison. Also from a sinister plastic bag - zoom into the photo and you see these reassuring words "FOR INTRAVENOUS USE ONLY Fatal if given another way" Nice.

* Saline flush
* Cyclosphosphamide - slightly bigger bad, another chemo drug.
* Last 5 min saline flush

During all of this I'm reading, snoozing, listening to podcasts and generally not doing very much. Some of these things make you very drowsy and they are keen that someone else drives you home (thanks Mum!)

No internet access or phone service in the Unit. It's like a Faraday cage. Probably a good thing.

All of this, including the waiting around at the beginning, took about 6 hours.

* I also come home with a bag full of pills including a steroid called Prednisalone which is the last part of the Chemotheraphy. - 4 tablets a day for the next four days. As well as assorted antibiotics, anti-sickness meds and mouthwash.

So what's the point of Chemo?

My cancer, Lymphoma, arises from rogue white blood cells that have thrown off their genetic destiny and decided to go into business for themselves - growing, dividing and generally fucking things up. The Chemo does everything possible to kill them off, also killing off all the good parts of immune system in the meantime.

After 10 days or so the body starts manufacturing good guys again. Ideally the bad ones will never come back but it is rarely that simple, hence the need to repeat this cycle 6 - 8 times.

(Apologies to any medical folks reading for my laymen's explanations, any mistakes are entirely mine. And chemo treatments vary - this may not be typical)