The wonderful things I learnt during my treatment for prostate cancer
By George Monbiot, published in the Guardian 9th May 2018
If I could turn back the clock, magically deleting my prostate cancer, the surgery I needed and its complications, would I do so? It seems an odd question. But I find it surprisingly hard to answer.
It wasn’t a lot of fun. I stopped breathing in the recovery room, which felt as if I were drowning. I hated being catheterised. The painkillers I took locked up my bowels, forcing me to excavate them by hand, as straining could have torn the delicate stitching above them. I succumbed to a post-operative infection, that kept me awake for seven nights. Just as the infection passed, the muscles around the operation site went into spasm, causing such pain that I found myself curled up on the floor, nails hooked into the carpet. After three days of this I was rushed to hospital, unable to pee, as everything had clamped shut. Having another catheter inserted, three weeks after the first one had been removed, felt like a miserable regression.
But I feel I have learnt more about myself and the world around me over the past two months than over the preceding twenty years. The first revelation was the astonishing power of human kindness. The team that treated me, at the Churchill Hospital in Oxford, made me feel I was part, however briefly, of a vast but close family. The consideration of the doctors and nurses, who managed to create the impression that they had all the time in the world, even as they were rushed off their feet; the instant responses of the ward and the triage team whenever I ran into trouble after I was discharged; the regular phone calls the surgeon made to see how I was coping were more than just professionalism. It felt like care in every sense. I am convinced, in the light of my research for our album about loneliness, that this attention was crucial to my recovery.
At home, I came to think of my bed as an oxytocin tent. The hugs my family gave me relieved both pain and the symptoms of fever faster than any of the drugs I took: the analgesic effect of physical contact, now widely documented, has not been exaggerated. And I drew courage from the thousands of wonderful messages I received. Thank you.
With this help, I discovered unimagined strengths. You can make resolutions that seem plausible – until they are fully tested. In the last article I mentioned the three principles that, I felt, were essential to happiness: imagine how much worse it could be, rather than how much better; change what you can change, accept what you can’t; and do not let fear rule your life.
So did they work, or did I abandon them and freak out? They held up remarkably well. By reciting them to myself every day – before the operation, in its aftermath, during the complications and as the test results loomed – I never wavered, never fell prey to fear or anxiety. Knowing that I was in the best possible hands, I accepted what every day brought without worrying about what might happen on the next.
I felt not only that those three principles had been vindicated, but that they could be assimilated into a broader rule, namely: the state of being for which we should strive is to be attached to life without being possessive of it. We should seek to love our lives and live fully, but not to extend them indefinitely. We should love our children exuberantly, but not cling to them or curtail their freedoms. We should treasure the material world, without seeking to own and control it.
The doctrines informing us that virtue, purity, jnana or sunyata can be achieved, in some interpretations, by detachment from the physical senses and the material world – whether Classical, Christian, Hindu or Buddhist – hold little appeal for me. A large body of literature suggests that well-being is intimately linked to attachment; not only to other people, but also to the natural world. As Jeremy Lent argues in his life-changing book The Patterning Instinct, the association of the tangible world with corruption, pollution and obstacles to enlightenment has informed our disdain for nature and accelerated its destruction, with devastating effects on our happiness.
But while attachment seems vital, in both senses of this word, liberating myself from the urge to possess has proved an astonishing antidote to fear and tension. I resolved to enjoy whatever life I had, and not to regret its loss if it seemed to be drawing to an end. The strength this lent me will enhance as many years as remain.
As it happens, I have been astonishingly lucky. That spasming appears to have been the short-term pain that presaged long-term gain. My wonderful surgeon, Alastair Lamb, applying recent research, used a technique that involves preserving more of the urethra. It feels like a breakthrough. One possible side-effect of this procedure is the hypercontinence I suffered. As soon as the second catheter was removed, this relaxed into normal continence, a result I had not expected for a long time, if ever. Until recently, such an outcome would have been unthinkable.
Similarly, albeit with the help of the blue pill, I have regained full erections. While I can no longer ejaculate, as seminal fluid is produced by the prostate, orgasms feel just as they did before. (Forgive me if I’m oversharing. Our health – men’s health in particular – has been plagued by undersharing). Again, this recovery seems remarkably fast. After my last article, several well-wishers told me “I’ll be rooting for you.” Thank you, but it is no longer necessary.
Most importantly, my test results suggest the operation has been successful. I’ve been given a 90% chance that the cancer will not return in the next five years. I feel I’ve been granted another life.
The quest now is to ensure that other men are as lucky as I have been. Above all, this means developing better diagnostic tests, to ensure that prostate cancer, as mine was, is caught early. An analysis published in March concluded that the standard (PSA) test produces so many false positives and – more dangerously – false negatives that it has “no significant effect on prostate cancer mortality” over the following 10 years. Several promising improvements are being developed, including a cluster of tests called Stockholm3 and the mpMRI scan.
But much more funding is needed to assess and universalise them. The £75 million the government promised last month will help, but it’s not enough. The March for Men and other campaigns by groups such as Prostate Cancer UK seek to fill the gap – please support them.
I will not abandon this issue, but I look forward to returning next week to the topics that still frighten me. The argumentative old git is back.