A few observations.

I think that I may need to review the 'tea-lady hypothesis' (see 14th November post) because yesterday I was not only called into my appointment 30 minutes early but into the office of the 'main man', my QEH consultant oncologist. Now, he is a genuinely approachable, personable and unassuming guy but in view of my earlier theorising I wasn't sure that my 'promotion' meant good news. However, after a discussion about my blood pressure readings (again presented by me as though from one health professional to another) in which he assured me that the numbers were within the acceptable range (our exchange was probably a little too technical for a lay audience, so I'll spare you the detail) I asked him 'How do you think I'm doing?

I'm aware that this it the same question I asked of the pharmacist and specialist nurse three weeks ago but it seemed to me that there's no harm in a little bit of clinical triangulation. Anyway, the answer was again encouraging . He stated that until recently all patients, in the country, receiving my drug, Sunitinib, came through him in Birmingham. From his research on the total of nearly 200 some 60% fail to reach the end of cycle 2 without experiencing side effects that either result in a reduction of dosage (with implications for efficacy) or transfer to another treatment programme.

So, we (i.e. Diana and myself) agreed that was good news. I asked whether the research  had been published but apparently it has yet to be written up (I'm just wondering whether I'll be cited as one of the team?) Suffice it to say, my 'tea-lady hypothesis' is now being amended to accommodate the 'Research Collaboration Variation' which explains exceptions such as that occurring yesterday.

Cycle 3 has begun; day 3/28

A change of tone.............

Yesterday I had further communication from my German friend, Gerd (you can read it under 'comments' for the last post, 23rd November). He writes about the 'narrow bridge' or wafer-thin divide that exists for all us between having and not-having, a life-threatening condition like cancer. He also writes that he admires or 'adores' my writing of this blog with its 'self-ironical' style. I therefore suspect or hope that the passage above would also find favour with him - and perhaps others.

But there is a wafer-thin divide for me too; between the chatty, light-hearted, 'self ironical' style that I have learned to adopt and something darker, much more bleak. It is as thin as a radiogist's film image, as brief as the time it takes to say 'More bad news I'm afraid', as evanescent as a phone call....... and I know that I'll be lost in a windswept denuded landscape, an arctic tundra, a lone figure for thousands of square miles..................

But I'm sure that you probably already knew that.

On the subject of tundra, I spent Tuesday of last week with Dave at Slimbridge WWT, watching wildfowl (ducks, geese and waders) and swans, recently arrived from the far north. Although I understand the popular, all-year, zoo-appeal of flamingoes and other captive exotics from around the world, I'm not too sure that they 'fit' with the birding ethic of studying wild birds within their natural habitats.

After a chilly afternoon spent observing birds from various hides positioned above and alongside the fields, creeks and lakes beside the Severn estuary we ended the day in paradise; in a heated hide with comfortable seating and huge picture windows giving stunning views of thousands of ducks, geese and Bewick swans at feeding time. ('So much for the 'birding ethic'!', I think I hear you say.)

The other highlight from the visit was avidly observing, in its natural habitat, the lesser-spotted TV celebrity, Kate Humble (from BBC Springwatch, Autumnwatch and other programmes). I studied her behaviour for some time within a small flock of  males.

I thought it inappropriate however, to make use of my binoculars given that we were separated by only a few empty tables in the restaurant.

Another surgical procedure...............

Now, if you were paying attention earlier (and I could hardly blame you for losing the will to live, let alone for failing to pay attention) you'll know that I have two major conditions; advanced kidney cancer and sciatica/back pain. It was the search for the cause of the latter that led to the discovery of the former. Having been found, treatment for the cancer understandably assumed priority and the back pain went onto the 'back burner' ('back burner' - geddit?) So, with the cancer treatment now established as relatively routine it was time for the back to come to the fore ( Ta ra! - 'Oh well - please yourself.')

In terms of my day-to-day quality of life it is the back/leg condition that has the greater impact so I was pleased (as well as apprehensive) at the prospect of being re-admitted to hospital.

So, yesterday then I was back at the Royal Orthopaedic Hospital for an epidural procedure. As a good number of you will know this entails injections (of, in my case, steroids) into the base of the spine. After kitting me out with some very see-through, paper underpants and the usual operating gown that served to provide public display of the aforementioned underpants (together with their contents), they gave me a light general anaesthetic. For this reason I'm unable to tell you a great deal about that which occurred after I lay face down on a bed/table configured in such a manner as to give even greater prominence to my posterior. An oxygen mask was strapped to my head and I was asked to tell the anaesthetist when I felt myself going lightheaded.

I was still waiting to give him the signal when I woke up in the recovery ward. I spent an interesting hour there watching beds with their prone patients come and go. Eventually I heard a young nurse calling for 'Frederick' and guessed that this might have been me. We got to know each other well in the next three hours of bedrest that I was required to take under her, and Diana's, supervision. She is Filipino and hates GPs, dentists and hospitals unless attending as a professional. After a pleasant meal of chicken soup, chicken pasta and ice-cream (following the 'complications' arising from my last stay in hospital, I've given up asking for the meat-free, dairy-free diet. Do you know, I even suspect that the chicken wasn't organic?!) I settled in to a prolonged spate of txtng while Diana went to find a restaurant.

My three hours on the ward passed very quickly. The Filipino nurse's concern for my welfare, as well as a desired glimpse of my surgical underpants, led her to insist that I sit on the bed for several minutes before standing and 'making a twirl'. After some demurring on my part she insisted too that I had the porter take me out to the car park in a wheelchair (this is after I had dressed). It was a good decision as the pain in my back was returning.........

And it is now the day after and so far things are as they were. The anaestheic has worn off, the neurological pain in my left leg is still there, as is the mechanical pain in my lower back. They did say it could take several days........... I live in hope.

As for the ulcer, about which I blogged in the last post, I'm pleased and a little embarrassed to admit that it has disappeared almost as quickly as it arrived. Eight more days, chemo-free and I'm back onto the third cycle.

I know, you can hardly wait for me to blog about it.

End of day 27/28, second cycle

The night before the last tablet and I am awake at some unearthly hour, running the very tip of my tongue against the inside of my incisors. The sensation is as unmistakable as it is disappointing - a small ulcer - and just 24 hours from the drug summit and the exhilaration of the downslope!

Now in the last few days of the second 'chemo cycle'. I went to the Cancer Centre at the QEH last Thursday for my regular three weekly check-up and was seen by the specialist nurse and the pharmacist. I was pleased - on the principle that you are more likely to be on the schedule of those with the most elevated status when there is some perceived problem. So, my record of an early appointment with the oncology consultant, then with his registrar and now with the pharmacist could be viewed as a promising trend. I'm hoping that on my next visit I get to be seen by the tea-lady.

There was some concern, however, about my raised blood pressure and a suggested doubling of the hypertension medication but when I asked for feedback on my progress they were very positive.

And speaking of the positive - we've now been on our first proper holiday since the traumatic days of late spring. We spent three nights in the Lake District in a National Trust cottage little changed since the 1920s. Together with Di's sister, Liz, her husband Chris, Chloe their daughter and Mike, Chloe's partner, we explored the unbelievably perfect landscape around Great Langdale. One morning, rising before the others, I walked out onto the hillside and began to climb. After only a few hundred feet I was totally exhausted. Interested as I am in amateur dramatics, I decided this was a personal, portentous, watershed; those peaks of yesteryear would not be revisited; no more would I look down on the valleys, birds and diminutive lakes from some high mountain. I returned to the cottage, a chastened man of Wordsworthian proportions (we'd visited Dove cottage the previous day). After a breakfast that tasted of sawdust we commenced our excursion over Lingmoor Fell (no relation). A couple of, at times, admittedly very tough, hours later we stood on the top of Brown How; looking down on the valleys, birds and diminutive..........

I spoke to Claire the other day. Our conversation turned to the way she had responded to concerns for my health. She said that the time spent visiting us over the summer and reflecting on the circumstances since her return to the US had revealed an appreciation of the important things in life and a new directness in expressing herself. This realisation took me back to those earlier posts about the 'silver lining' and the Steve Jobs quotation - this experience is not confined to the 'patient' but is shared with those who are most closely connected. It felt like a significant moment.

As will be, I hope, the steroid injections I am due to have administered to my lumbar spine at the Royal Orthopaedic Hospital next week during my drug-free 'holiday'.

My NHS career

It's been a busy time since I last blogged.

My NHS career has been going from strength to strength and for a period last week I was working at it pretty much full time. It can't be long now before I have my own parking space and possibly a desk with a laptop and phone. Thank goodness I decided to give up my earlier career in Education when I did.

On Wednesday, I saw the consultant ophthalmologist who examined my right eye for developments in the small haemorrhage and 'cotton wool spot' referred to in an earlier post. To my relief she announced, after a lengthy period spent following her instruction to look directly at her earlobe while she, at intimately close quarters, shone a light into my eye, that she could no longer find the offending areas. My eye had healed itself.

On leaving the hospital we drove to visit Judith and Gethin in the South Derbyshire village of Ticknall. After a late lunch we walked in the grounds of Calke Abbey. There are oak trees in the ancient woodland of this National Trust property that are as old as any in Europe. They are truly stupendous. The trunks of these trees are a frozen symphony of timber and deeply fissured bark. Massive burls swell like outsize, solid boils on the trunks or boles that are, in some places, hollow and rotted. Yet the trees still generate new growth of twig and leaf among the dried stag's horn branches. The wreathing embodiment of time, some have existed since before the Norman conquest. They were here long before any of us and will outlive us too.

The following day I had two appointments.

In the morning we spoke to a member of the consultant oncologist's team. After some discussion about my blood pressure - which centred on the data I proudly presented from readings on my domestic monitor - she was satisfied that I was ready to start my second 'chemo' cycle.

There was some concern about the level of my white blood cells but another sample taken from my, by now almost empty arm confirmed that the count was headed in the right direction. At the time of writing I am on day 3 of 28.

There was time then for an interval before my afternoon appointment at the Royal Orthopaedic Hospital. We went first to the Barber Institute on the campus of the University of Birmingham. There is, if you were not already aware, some wonderful art within this impressive 1930s building. We were fortunate enough to join a lunch-time talk given by the gallery's director of education on Anthony van Dyck's, Ecce Homo. You may not recognise the name but you probably do know the image; a powerful version of a nearly-naked and bound Jesus mocked by a Roman soldier who is placing a cape around the tormented 'King of the Jews'. The painting may be striking but it is also disturbing in that the soldier is black and his association with the malign darkness that contrasts with Jesus's luminous skin says something about contemporary attitudes to issues of race and ethnicity. For this reason it had been highlighted as the gallery's contribution to Black History Month.

We had lunch at Winterbourne before heading up the Bristol Road.

The new self-check in systems at both the QE and the ROH work very well and before long we were being warmly greeted by the consultant orthopaedic surgeon, Mr Ishaque. He showed us some images from the recent MRI and Xray. He said that these images indicated that the fatty sheath that surrounds the nerve in the spinal column was missing at one point in the lumbar region. The cause was the irregular shape of my lower spine. The images are disturbing but he also appeared to be confirming that there was no link between the kidney cancer and the back/leg pain - which was good news.

The other good news was that the diagnosis (very similar to that made by the ROH physio a year ago) led on very quickly to a treatment procedure; an injection of steroids into two sites close to the 'squeezed' nerve. These injections may help to reduce pain in the short term and through reducing inflammation in the affected area, in the longer term as well.

There are of course no guarantees and I will have to wait at least 4 - 6 weeks.

However, I now feel better for having a diagnosis, relief that the cause is not an unidentified secondary tumour and reassured that I am 'in treatment' rather than waiting, waiting, waiting.

So, it has been a significant week; in part, luminous, in part, disturbing, in part - a walk in the park.

Who is the Bonjela fairy?

Gerd is asking more questions. This time they concern the ways in which my illness has impacted on my thinking about the spiritual world.

But on second thoughts perhaps it isn't about that at all.

Perhaps it's more about the way in which when someone has cancer, a life-threatening illness, and has signalled a willingness to speak of it, this enables the asking of questions that concern each of us the most. Gerd has already said something like this when he comments on the way my blog has been of some use to him in exploring how he might face a similar circumstance (he has had a recent 'health scare'). All of you, of a certain age, have to live with the possibility that it might strike you as well. If we haven't had cancer or aren't currently living with cancer - I guess we are preparing for the possibility of getting it.

So, I accept that it is important to ask these questions and I'm happy to play a small part in enabling this kind of reflection but I suspect that the real answers lie within each of us.

For what it is worth, my thinking about matters spiritual hasn't changed since learning that I have advanced kidney cancer. I have written in an earlier blog that I have experienced a re-ordering of priorities but if this involves anything spiritual (such as a keener sense of being part of the natural world) I guess that the seeds of it were always there, B.C.

Meanwhile I am more than happy to be in receipt of people's prayers. It is important to be 'held in mind', however that is expressed.

Someone, for example, thought about me recently in a very practical manner. He or she posted a carton containing fluid for treating mouth ulcers through our front door. I have tried to discover who this 'Bonjela fairy' might be, but have failed. If you are that person I would like to register my thanks.

Thanks too, to Marian and Diana for walking with me last Friday on the final 8 or 9 mile section of the Worcestershire Way. We started in the village of Longley Green and finished in the Victorian spa town of Great Malvern. In stunning sunlight we crossed yet another ridge (see earlier posts), entered a long valley carpeted with apple and pear orchards before ascending (in my case, with great difficulty) the flanks of the Worcestershire Beacon on the, largely treeless, Malvern Hills. We looked down on the Severn plain, the distant Cotswolds and the town climbing the lower slopes beneath us.

We finally felt compelled to descend to find a cup of tea and to then catch the train to Kidderminster where our chauffeur, John, awaited our arrival.

If there is a God he was with us on that memorable day.

Another day, another side effect

Imagine for a moment that it is Sunday lunchtime and instead of placing a small, entire, new potato into your mouth, you mistakenly push your fork into a live coal instead. As soon as the coal touches your lips and tongue you realise your error and desperately reach for a glass of water. This is akin to the sensation experienced by the small crop of ulcers I am growing inside my mouth. I've been swilling a lot of cold water recently, not to mention enjoying a suck-cession of lollipops.

These are another of the recognised side effects of the 'chemo'. The irony is that the onset of this problem occurred during the two week break between successive 28 day drug cycles. These ulcers are showing little sign of healing and my concern is that they are still around when I start the next cycle. Meanwhile eating; whether it be new potatoes or porridge, is proving to be an unpleasant experience - and as most of you will know, eating has long been a favourite hobby of mine.

To speak of happier times - I have been busy as well. Bodenham arboretum (near Kidderminster) with Kate and Leon on Sunday, Westonbirt arboretum (near Tetbury) with Mary and Pete on Monday and Upton Warren Nature Reserve (near Bromsgrove) with Dave for a few hours birding on Monday - autumnal compensations courtesy of the natural world.

Meanwhile Gerd continues to ask important, probing questions. He says that Steve Jobs was quoted on German radio as saying, "Cancer for me is a useful instrument to decide on the important things for my life". You can see that this is a re-translation, English to German to English - but the meaning is clear and Gerd asks whether it is the same for me.


The answer is a definite 'yes'. A pattern has emerged in terms of the things that are now more important; friends and family relationships and experiencing the natural world. I increasingly want to spend time visiting, talking, walking, birding, botanising. I want to know more about buildings, heritage and art as well. These interests were there before but perhaps more obscured by other 'wants'. I have less 'to do' but have never been busier. 


But I don't exist in a constant state of minute-by-minute awareness of my mortality. Steve Jobs had perhaps a more aggressive and perilous cancer than mine. There is a struggle taking place between a heightened sense of living-in-the-moment and the resumption of a normal existence. 


However, there are always plenty of reminders of the new realities I face - like painful ulcers in one of the most sensitive parts of the body - but when you are helped to identify a shoveler duck for the first time or see the delicate, rust-coloured foliage of a narrow-leafed (Raywood) ash, there is then an appreciation of beauty, complexity and depth - and a growing sense that because I can 'see' it, I am a part of it. This, for me, is a source of comfort.

The following day, 28

Just back from the GPs. Within hours of yesterday's blog I had taken two late night readings of my blood pressure. I took two because the first was so horrendously above the diastolic alert figure that I was hoping a re-run would reveal the first to have been a gross anomaly. It didn't.

Last night I went to bed wondering whether I would wake with sight in only one eye.

As ever, I was being overly dramatic. A re-take of my bp in the morning was still high-ish and so, as advised by the oncologist, I contacted the GP surgery.........

The practice pharmacist looked at my listed readings over the last few weeks, took another reading and prescribed some anti hypertension medication.

'How long will I be on this?' I asked.

'For the rest of your life,' he replied.

Amlodipine reduces blood pressure by opening capillaries in the extremities. If I should get undue swelling in the hands and feet there are other drugs that can be prescribed; medication for the side effects of the side effects.

And only yesterday I thought I'd made it. Just goes to show..............

Day 27

Day 27 and tomorrow morning sees the last  'chemo-like' capsule (of this first cycle) slip down my throat. It seems to me a significant moment. As the days of this week have passed so the more consumed I have become with reaching this landmark moment. Perhaps this is all rather unnecessary. However, my blood pressure readings have climbed in recent days and have now reached the 'red zone' - anything above 160/100 according to the young oncologist I saw last week.

If day 28 passes without 'incident' I should hold a party.

From tomorrow I have a two week drug 'holiday'. Within this time I'm hoping that the side effects like the metallic taste, fatigue and raised bp will diminish. I'll let you know.

And coming up; the return to the Royal Orthopaedic Hospital and an appointment with the consultant I last saw just before my nephrectomy. A useful meeting which included first-time viewing of the alien invader sitting on my left kidney ended with him telling me that he was taking me off his list. The reasoning was that the impending operation would be likely to have an impact on the neurological problems with the back and leg. As regular readers of this blog will know, this did not come to pass. I'm fed up with the discomfort I experience even though the medication I take keeps it under some control - I hope for some further intervention.

I recall that when the ROH first diagnosed the cause of my back/leg problems as a 'protruding disc' I shied away from the suggestion of a series of epidurals and if that didn't work, surgery. I opted to treat the condition, conservatively and went on to try yoga, osteopathy, physiotherapy. They didn't work. Now, I'd be more than happy with just about any treatment offered.

I'm not always like this - there are other things in my life. There are. Really.

Now let me think.............

Day 18

Day 18 - except it isn't because you are unlikely to read this on Monday 26th September. But with that info you'll be able to work out the numbers. They said that the side effects would begin to kick in when I was through the first 14 or so days. They weren't wrong.

For a few days now I've been retiring to my bed like some frail consumptive from a Victorian novel. Ever since undertaking a ten mile walk along the Grand Union canal last Wednesday with some former work colleagues, I've been experiencing flu-like symptoms. Whether it was/is flu or not, I'm not sure but of the list of side effects I was warned to expect, fatigue, a strange chemical taste and a yellowing complexion are all now in evidence.

The odd thing is that although I know the drugs are responsible for these unpleasant changes there is absolutely no option but to continue to take the source - it seems very counter intuitive. Diana's take on this is to say that as I feel worse I can reassure myself that the drugs are working. I see her point but............

I'd like to add to my occasional list of ethereal experiences (see The Beauty in Brum, 13/7) the pleasure I derived from accessing Snow Hill Station at the end of our canal walk from Livery Street. Arriving on the elevated open platform (not the oppressive, gloomy area under the overhang) I was delighted by the opportunity it afforded to scan the city to the north and east and to watch the continual stream of traffic flowing up and down Great Charles Street/Queensway. In bright autumn sunlight I can recommend it - but it's always possible that you may need, first, to have your acuity sharpened by the onset of palliative care.

There have been other high-points. Stephen, soon to reach the age of 36 years (for those of you who remember the light-haired 3 year old in his John Lennon NHS specs) flew in from the States for a week' stay . He left yesterday. The idea had been that I would drive him to Heathrow but given my return to bed, it didn't seem like such a good idea by Saturday afternoon.

My friend Gerd, asks if my positive approach, from his reading of the blog, is a true reflection of my feelings. It's a good question. The answer is, 'not really'. I write for the person who's face I cannot see and who may not wish to read of sadness and despair.

There's one thing about which I will admit to feeling sad; the fact that my longstanding allotment buddy, Geoff, has also been diagnosed with cancer and it appears (though this awaits confirmation) that the primary tumour is in the kidney. I'm not saying I'm more upset by his experience than my own - but the one opens a tap to the other. Bear us both in your best wishes and prayers. There is still more to come before this blog is done.

Side effects

Well, we had the the meeting with the oncologist at the Queen Elizabeth Hospital (that's Queen Elizabeth II's mother not the current queen - only discovered this fascinating fact when I was prowling the corridors looking for a shop. It makes sense. The original buildings look to be 1930s so the naming no doubt goes back to that pre-coronation time).

As assumed, the thrust of the consultation was that I was advised to start the targeted drug therapy but I hadn't anticipated that they would suggest that I did so immediately. I had been hoping that they would tell us the findings of a detailed comparison of the pre and post op CT (soft tissue) scans as far as the lungs were concerned. That didn't happen. For the oncologists the baseline scan is the first post op and for that reason perhaps (?) they had not prioritised the comparison with the first. We were given some vague reassurances that the 'nodules' (new word) had not increased but this appeared to be contradicted by some other info they gave us which suggested they had increased in size (and quite considerably).

This is the world I get into. What are they saying? What does it mean? What are they not saying and what does that mean?

I think one thing is clear - as far as they are concerned the important comparison is between the baseline (first post-op) scan and the next which will be in a few months time when I am well into the treatment.

So far, so good, with the drugs. A 50 mg capsule of Sunitinib each morning slips down easily. Today is day 4 of 28 and then I take two weeks off before starting the cycle again and so on and so on until and unless the scans reveal that there is little or no clinical benefit from the treatment or I get a transfer to that well-stocked pharmacy in the sky..........

We were given an account of possible side effects. The list grows every time someone goes through them with us. I, of course, assume that I will have all of them; nosebleeds, diarrhoea, nausea, mouth ulcers, face rash, skin problems with palms and soles of feet, yellowing of skin, fatigue, high blood pressure etc etc etc. I may become unrecognisable!

At the moment, I'm fine but the cumulative effects are most likely to emerge in weeks 3 and 4.

Given that this therapy is very expensive (figures vary but I'll post definitive info when I get it) I was interested in what assurances I could be given that the Q E H Trust would continue to fund it indefinitely. It felt like I might have hurt their feelings from the reaction I got. There was no question - 'the drugs are NICE approved', 'as long as there were clinical benefits..................' - but I'm thinking about austerity and its side effects.

Tomorrow I join Marian in Bewdley for part 3 of our Worcestershire Way walk; from the village of Martley to Longley Green. Part 2, Shaver's End quarry to Martley, took us over a number of wooded ridges giving us some further majestic views over the English countryside. We plundered the wayside trees for damsons, apples and pears. Though we consumed our backpack victuals both of us had more weight to carry at the end that we did at the start. Neither of us felt hungry when we reached our rendezvous point.

I look forward to further adventures.................and their side effects, possibly.

Those blue-remembered hills

Is there anybody still out there? I could hardly blame you for losing interest and taking up daytime television watching instead............ but do let me know if you are still reading.

So what's been happening?

Well, it's more a case of what is about to happen. On Thursday (8th September) I have another appointment with the oncologist to discuss the next steps in the treatment programme. For some reason they want to distinguish between the drug therapy that I'm due to receive and the term, chemotherapy. Mine is called targeted therapy, the generic drug treatment is Sutent and the specific drug I'm due to receive, Sunitinib. (There's an article waiting to be written on the origin of drug names).

Well that's what I was told a few weeks ago. They may change their minds because last week I went for another CT scan so they could have an up to date picture on how the disease is 'progressing'. This new info could be critical. So this is scary stuff. Wish me luck. Some have said they are praying, some are crossing their phalanges - I'm more than happy to accept all and any offers.

Meanwhile my physical recovery from the operation continues. Claire has gone home now, with Amichai and the kids, to witness the ravages of hurricane Irene. Fortunately no damage had been caused to their house in Morristown, New Jersey, but the power was out for a few days.So, though I may no longer have my personal trainer to assist me I still have her exercise and stretches programmes to follow.

In order to feel better about being less than perfect with the exercise and stretches regime, I also go walking. It seems to be the one thing that I can do to build my fitness that doesn't cause problems with the left leg. Last week I walked the first eight miles of the Worcestershire Way with my old friend Marian. The start/finish of the 33 miles route between Bewdley and Great Malvern runs past her front door.

That walk in last Friday's stunning weather was memorable. This part of Worcestershire is very hilly and scarcely-populated. We couldn't see our ultimate destination, the whale-backed Malverns, because the Abberley Hills dominated the greeny-blue horizon. I can recommend the experience to anyone.

By the time we reached Shavers End Quarry, disused but taking a large visible bite out of the forested hills, I was pretty tired. This was my most sustained period of exercise since the op. Marian and I are due to recommence the walk this Wednesday (7th September), weather permitting. If anyone else within hailing distance wants to join us they would be more than welcome - just get in touch and I'll relay the details.

I intend to post details of the meeting with the oncologist as soon as I can. And if you can't be a Deist, try to be a Phalangist.

pT3aNxM1; Fuhrman Grade 4

It's been another lengthy interval since my last post. My old friend Gerhard from the beautiful city of Heidelberg asks whether my feelings about the blog have changed. It's not that I've lost interest or questioned its usefulness. The reason for the 'silence'  has everything to do with the ongoing discomfort/pain I continue to experience when I sit for any length of time.

So the update on my condition is a mixed one. I continue to make progress in terms of the wound and the surgery but the leg/back sciatica-type pain persists and sometimes causes despair.

I have had two recent consultations at the Queen Elizabeth Hospital; the first with the urology surgeon, Mr Patel, who expressed some justifiable pride on examining my scar. He gave us the mathematical expression in the title. Succinctly it means that I have renal cell carcinoma (RCC); p stands for pathology (the condition of the organ), T3a means 'the cancer extends into the renal vein or the fat around the kidneys but not the fibrous tissues (Gerota's fascia)', Nx means that the lymph nodes were not examined (unnecessary as they already  knew that cancer had spread which is what the M1 denotes, M meaning metastases.)

Fuhrman grade 4 means that the cancer is aggressive, 4 being the highest grading.

So, that didn't appear so good........ we didn't stay long. Some weeks ago we had taken out membership of the University of Birmingham's, Winterbourne Gardens, which lie close by. It has become our custom after every hospital visit to spend some 'recovery' time amid the trees and flowers. We drove there directly.

The follow-up meeting with the oncologist took place two days later. We had more time with Doctor Karina to talk through the treatment programme that would now follow from the histology results. She had some further bad news when she explained that the metastases had spread to both lungs and numbered 4 or 5, rather than 2, as we had been previously informed.

However she was upbeat about my longevity - though there are of course no guarantees. She explained that aggressive RCC responds well to the oral medication I would start in a few weeks time. She also added that this was a drug I would be on for the remainder of my life. The cancer would eventually find a way 'round' the medication; the treatment was palliative and not a cure.

I have another CT scan in a couple of weeks and the drug treatment commences a few weeks later - the delay is to give my body a chance to recover from the surgery.

Meanwhile these damn back/leg symptons continue - I have been re-referred to the Royal Orthopaedic Hospital and see the consultant in October. I'm still being 'twin tracked' though Dr Karina has raised a new linkage possibility - that the neurological condition stems from some, as yet undiscovered, tumour.

I've more than used up my tolerance-at-the-computer time and your capacity to absorb medical information.

I hope to blog more discursively in the near future................

The week of widening circles

This has been a week in which many of the footholds, along the rocky road to recovery, have proved to be pretty secure.

Following deliverance from the dreaded d and v I have spent much time during the last week in the company of Diana. At the start we ventured forth in my second post-operative car journey. Suffice it to say it proved to be a case of my wound having healed somewhat - or Di's driving technique having improved since the day of discharge nearly two weeks earlier. We visited two country parks and completed two modest walks all the while ensuring that we were never too far from my new favourite permitted food - ice lollies.

The second walk was interrupted by an elderly gent with a walking stick who made some jocular reference to the speed at which I was walking. I resisted the temptation to trump his witticism with a flash of my 40cm scar.

The following day we made a trip to the new sushi bar in Touchwood - expensive and exhausting - but then, to be fair, I have always found visits to any shopping mall exhausting (and expensive), so little can be deduced concerning my physical recovery.

On Thursday we went even further, an hour's drive into the Northamptonshire countryside. Di's sister, Liz, lives in the hamlet of Sulby, near Welford and while the two of them went for a coffee and window-shop in Market Harborough, I was deposited into the safe hands of Alison, guardian of the magical Sulby Gardens. Alison's nine acres are devoted to the provision of a refuge for local wildlife. The gardens thrum to the rhythm of nature's families - flower, insect, fish, bird, mammal. That day's highlights included the sighting of slow worms, a grass snake, numerous tench and rudd, a couple of the 15 or so species of dragonfly that inhabit the numerous ponds and the identification of various hoverflies in one of the wildflower meadows.

The week ended with a visit to the Eye Clinic, currently at Selly Oak but soon to transfer to the QEH site. An examination by the consultant concluded that the retinal haemorrhage in my right eye was still visible but 'calming down' and that I would continue to be monitored without treatment. Everything depends on ensuring that my blood pressure remained reasonably low. I asked for a signed letter stating that everyone has to be nice to me and ensure that I am subjected to no undue stresses.

Warning - if squeamish, turn away now

This blog is not for the faint-hearted. Those of a nervous disposition are advised to turn away now.......

There is nothing quite so joyous as the gestation and safe delivery of a solid, tawny, stool - still less a series, after a debilitating week of d and v. It/they appeared early this morning, while most of you were mercifully, sound asleep - the deserved and desired product, no doubt, of the cutting out of some drugs from the regimen I've been taking. Di had been researching side-effects and the spotlight had fallen on ferrous sulphate ( taken because I was anaemic after blood loss during the operation) and tramadol (a painkiller) so we'd excluded both over the previous couple of days.

Pharmaceutical replacements were already in the pipeline however because as if d and v were not enough, I'd also experienced an onset of obsessive itching that has left much of my skin looking like an aerial view of the surface of Mars. So you drop a couple of drugs here, you take on a few more there - anti-emetic tabs, anti-histamine tabs and skin lotion. The kitchen work-surface looks like an illicit pharmacy. Come round for a meal and who knows what ingredients will be on the menu?

But returning, as I must, to the subject of my stools, they now hold the promise of the onset of a new phase in my recovery. The wound is healing and the 'cling film' covering it is beginning to peel away. (If interested, for a small fee, there are pictures, taken by an indecently-enthusiastic Diana). The remaining bruising is much less psychedelic though it is also difficult to escape the sense that the left side of my chest has been encased in a steel clamp. I practise deep breathing in order to stretch the wound; the skin, muscle, tissue.

Unfortunately the neurological problem with my left leg continues to make it difficult to sit comfortably for any length of time.

Finally a mea culpa; over the last few days I have been guilty of some severe bouts of 'feeling sorry for myself'  and must apologise to anyone who feels they have been a victim. As ever the star award goes to Diana for disdainful dismissal of my morose comment when boxes of the prepared nutrient meal appeared; 'God, I know death must be near when Complan is in the house'.

I'm back - well, at least most of me is.............

Firstly, I'd like to apologise to everyone who has been reading the blog (and I know from emails, followers and cards that there have been a few) for the interval that has elapsed since my last post.

It hasn't been an easy time.

Thank you Claire, for keeping the blog going over the time I was in hospital (even if your spelling of metastases was inclined to wander off the beaten track!)

I hope to write more about the period in hospital at some later date but will settle today for finding the energy to briefly update you all since my return home just over a week ago.

I'll admit that I wasn't looking forward to the transfer. Given the difficulty I was having in getting from the bed to the bathroom, coping with the many moments of energy expenditure entailed in travelling from my automated bed on the 4th floor of the QE to a 'fixed bed' many thousands of steps up from the ground floor of our house seemed an impossible task. I was firmly assured that it wasn't.

Nevertheless, the car drive felt like we were on a grand prix circuit, slewing around corners with Di apparently searching for every pothole she could find. At times like these the suspension on a standard motor car appears less than adequate.

Approaching our destination I experienced some nausea ( another word already on the move in hospital - from nor-zee-a to nor-sha. We must resist this trend to Americanisation). I stood in front of our newly painted pink door (!), bent double, hoping against hope that my body wasn't going to be wracked by a vomiting attack. The strain on my recently lacerated side would have been excrutiating. Di and Claire looked on helplessly until the moment passed. I pretty much flew up those stairs and into that wonderful bed I had so recently maligned.

Since then it's been pretty much a story of gradual progress marred by two developments; firstly, the realisation that the neurological discomfort/pain in my leg (the search for explanation to which had led to the discovery of the tumour) had not gone away and secondly; the onset in the last five days or so of a phase of d and v. This is not good news because apart from the debilitating effects it also plays havoc with the pain control regimen.

I'm just about at the end of my energy store at the moment. I can't end without telling you about the amount I owe to Diana and Claire and Joe for their care of me. They have been so attentive, so responsive to my needs - and they are faced with some time yet to come.

Many thanks too, to everyone for your support, cards and kind words. It is difficult to ensure that everyone gets an individual response but your thoughtfulness, especially at a time when my reserves are low, is much appreciated.

Thursday Update from Claire

Dad came home yesterday afternoon from the hospital. They had him all packed up and ready to go when Di went to visit at 2:30pm.

He is doing well and able to get up and down the stairs. He still tires very quickly, sleeps a lot and is on all kind of pain medication. Its good to have him home though where we can keep a close eye on him.

I have a feeling he'll be back updating this blog himself before too much longer...

Tuesday News (from Claire)

Today was the first time I'd seen dad for 2 days as I didn't make it in yesterday when Di and Joe went to visit. Imagine my surprise then to find him up and about (walking back from the toilet) and in his pyjamas (no more natty hospital gown).

He continues to look better and brighter and his appetite seems to be fully back to normal. He does still tire easily but we hope to have him home tomorrow and away from his continually vomiting neighbour on the ward.

Mini Update (Claire)

We went back in to see dad again today and 24hours have shown a big improvement. He was talking a lot more clearly and was just much more 'with it'. He was eating more today and although he still gets tired a lot he managed to sit in a chair for an hour. The staff are good but seem to be under pressure from the consultant to get him back home asap!

Operation Update from Claire

Its a bit daunting stepping into dad's shoes to write this blog - I have to remind myself that people's main reason for reading it is to keep abreast of dad's progress and his creative writing skills are simply a bonus!

So in my own way (apologies in advance for spelling errors) I'll update you...

For those with limited time (I have a tendancy to ramble), in summary the surgery went very well with no surprises. Dad is doing well and looking good, despite being in some pain. Read on for the long version....

Dad, Di, Joe and myself arrived at the QE hospital at 6:45am, and went straight to the new Admissions Department. This consisted of a waiting area with a few chairs and glass-fronted booth containing an assortment of nurses. So we settled down to wait. After a while dad was ushered away for what I assume were some simple pre-surgery checks and to get into his lovely hospital gown (or as I liked to call it, dress) and his dressing gown. Then he returned to us and we settled back in to wait again.

Around 9:30am we were brought out of our lethargy by a sharp rapping of knuckles on the glass of the nurses booth and dad and Di were summoned to speak to the surgeon. When they returned I could tell immediately the mood had shifted and not for the good. The surgeon had apparantly informed them of all the things that could go wrong and additional scenarios that might happen - spleenectomy, chest drain, further evidence of metastesees in local organs etc. This really brought home to me how the positive everyone has been the last few weeks since their visit to Dr. Jane Plant in London and now we were struggling to find that again. They were told that the surgery would kick off around 10:30/11am so we resumed waiting.
A little while later another surgeon came out to talk to us and this one had a much warmer demeanour and positive manner (he was also rather good-looking which helped also - well helped me anyway, I'm not sure it had any effect on dad). The surgeon spent a little time talking about the operation and what would happen and told us it would all be happening very soon.

By 12pm it became clear that the original estimate of a 11am start time was a little off and we started to look a little enviously at the other admissions we had arrived with at 7am as they were all wheeled or walked away. Dad however seemed perfectly happy to be reading his paper and not in surgery! Back to waiting and around 1pm we were told they'd changed the 'order of play' and he might be moved up to the ward before the op but currently there wasn't a bed available. Finally by 2pm he went in to pre-surgery and a little while later he was wheeled away, with Di looking on, for anaesthesia.
Fast forward to 8:30pm and Di found out that he was back on the ward and doing ok. We found out today that he didn't have a spleenectomy, there is no chest tube, he didn't need intensive care and they didn't even have to remove the rib they thought they would have to. No one has talked about any new metastesees so we're taking that as good news also. I went in to visit him earlier today and all in all he's doing very well. He is in some discomfort but his colour is good and he is (mostly) lucid. I have just heard from Di that tomorrow they hope to have him up and about a little. They hope to have him home by Tuesday or Wednesday next week.

The beauty in Brum.

In the last few weeks Diana has done little work in the 'paid employment' sense. However today she has to attend a court hearing to be cross-examined on the content of a care proceedings report she wrote as the commissioned independent social worker. She usually travels to the centre of town by bus but I volunteered to take her and thereby reduce 'wear and tear' on her uncomfortable but professionally-tonal heels - they always come out for such occasions. After some demurring, she accepted my offer.

I think that there must be something wrong with me.

This isn't the first time I've experienced such a thing in recent weeks, but as I drove, the city streets, even in rush hour, appeared attractive, full of colour and interest. I could take pleasure, and find fascination, in the commonplace, the mundane. I found myself absorbed by the variety of texts on white vans, advertising slogans, buses and street furniture. City workers, intent on reaching their destinations, were part of a constantly shifting and unknowable complexity of lives filled with unimaginable connections. Buildings, some of them seen as though for the first time, appeared impressive, indicative of the city's confidence and dynamism. I even found myself strangely detached from and observant of, the time-saving, gap-finding strategies of other motorists.

Thinking about it now, two days out from my op., I guess that although I have reached a condition of some emotional stability, something of the vulnerability and fear remains. I was, I am, sensitised to the existence of life; life in a city, condensed, intensified and on constant, shape-shifting display.

I would like to continue to be a part of it.

An unexpected gift.

While we were away in Wales, Parcelforce and the Post Office tried to deliver two objects too large for the letterbox. We got around to collecting them today. The first, at the Kings Heath postal depot, contained a couple of books Di had ordered from Amazon; Jane Plant's recent publication, 'Eating for Better Health' and another by Colin Campbell, a nutritionist she admires, entitled 'The China Study'.

Diana had thought the books might have been posted separately but, since they were packaged together, what, we wondered, was in the other? We had to drive to another Post Office in Moseley Village. As we travelled I read an endorsement from the Sunday People for the Plant publication; 'This book could - quite literally - save your life'. This sounded promising.

I stayed in the car while Diana gathered her proof of identity and the card that had been pushed through the door and made her way across the busy Alcester Road. I had time to glimpse at 'The China Study', subtitled 'Startling Implications for Diet, Weight Loss and Long-Term Health' and described on the cover as 'The most comprehensive study of nutrition ever conducted'. To be honest, although I am interested in this stuff a part of me is glad that Diana is the one who is undertaking the research.

The next time I saw her she was staggering towards me carrying a large box. It was addressed to 'Rod Ling and family' and two sides were covered with an array of stamps that would have made quickened the heart of any philatelist. The stamps were arrayed in slabs like exotic wrapping They were obviously foreign. They were Israeli and so enticing they must have been approved by the State Tourist Board. The box had come from my son-in-law's family, the Lichtensteins, in Tel Aviv.

Struggling to control the excited child in me I peeled away the tape to reveal an amazing collection of nuts, dates, prunes, halva, dietary supplements.. At least I think they are dietary - Amichai will have to translate some of the labels.

As for the nuts and dried fruit no translation was necessary. Perhaps these juicy, treacly dates are medjool. I didn't stop to ask Di whether Jane Plant and Colin Campbell would approve.

Many blogged thanks to the generous Lichtensteins.

Pre-assessment day, Tuesday 5th July

Looks like this surgery thing is for real then. A part of me had been hoping that it was some kind of dreamtime or that I was in a remake of The Truman Show and somebody soon was going to shout 'Cut!' and 'It's a wrap!' - but there's still no sign of it happening and the inevitable conclusion follows....

So, I had the assessment; height and weight (I pointed out to a pleasant but 'heard-it-before sister' that I was wearing a particularly heavy trousers belt with a solid metal buckle), bloods, ECG, MRSA swabs, urine sample, bp and undertook a thorough questionnaire. Most of this was about reassuring the QE that I was fit enough to undergo general anaesthetic - an outcome confirmed by a young female doctor who seemed perplexed by the revelation that I had been 'put to sleep' before but not as a result of any hospital visit. I was referring to the now outmoded but once common practice of anaesthetising by gas for dental extraction.

All this heavy-duty reality checking was a long way from an idyllic three-day weekend spent in mid-Wales. We had spotted a 'window' in our schedule last Friday. Claire had given us time off from grandparent duty and Di had contacted a recommended B&B located above Lake Bala. 'Bryniau Golau' was a favoured holiday location for Grahame and Tricia (fellow allotment-holders) and so we headed north-west early on Saturday afternoon.

The weather was wonderful - as you know - but the hedgerows, the trees, the wayside flowers, the stillness of the lake, the chapels, the churches, the orchids in the dunes at Aberdyfi, the vistas, the Mawddach estuary, the mazey-medieval, black-stone, streets of Dolgellau, the road up the valley and over the moor and down to Lake Vyrnwy - images burned into the retinae - but hopefully missing that small haemorrhage I was on about several 'posts' ago.

And back to Brum on Monday evening; humdrum Brum, home-come Brum. The best holidays are those you are glad to get away for - and glad to return from. I needed to be home because I needed to get my head into  a place where I could think about what was to come.

Today is Friday July Ist

Today is Friday July 1st but this post is largely concerned with Wednesday, 29th June. Diana had set up a meeting with someone we'd first heard about following her diagnosis with breast cancer nearly 5 years ago. Professor Jane Plant is a professor of geochemistry at Imperial College, London. She contracted breast cancer herself nearly 20 years ago and was given just a few months to live. My understanding is that as an academic scientist she felt herself well-placed to conduct a literature review of the published research relating to the factors causing cancer and possible ways of treating it. She became very knowledgeable about the importance of diet and its relationship to the epidemiology of cancer. She went on to write a number of books and to establish a consultancy. I emailed her and outlined my condition. She suggested that we waste no time in visiting her in London.

Jeff and Marian, long-standing friends from my university days were ready to offer us a bed for the night but we knew that, however pleasant and relaxed the evening spent with them, we'd have to make a quick return on the Thursday to keep our appointment with the Royal Orthopaedic Hospital in Birmingham.

The journey to London was uneventful, apart from my forgetting to collect my shoulder bag from the luggage rack on arrival at Euston. It was successfully retrieved at the cost of an hour of our buffer time and an unwelcome increase in my bp.

Our meeting with Jane Plant at Imperial College lasted an hour. She asked questions and took notes. We asked questions and Diana took notes. It's difficult to sum up this intense period spent absorbing a great deal of information but I was buoyed by her optimism about my prognosis. She felt that conventional medicine (surgery and chemo) would in combination both excise and 'hit' the cancer already in my body; her contribution would be to offer advice on the way diet and environmental awareness could help prevent further metastases from gaining a hold.

So there was much talk about growth factors, the various no-no's, dietary supplements and other anti-cancer foodstuffs. Some of this matched the info we'd already garnered from another book, some did not. She was not a fan of the book in question and as they disagreed about the efficacy of a daily glass of red wine I was saddened to lose one of the few benefits of returning to the 'fold'; comprised of those who imbibe alcohol (after my long ten years in the wilderness).

I won't go into the dietary details - they are available in her various books. Just one comment though - if dairy products are as much of a public health issue as she, and, I believe, others think, why are we not picketing supermarkets, cheese-manufacturers and yogurt-bottlers? Her advice is not just for people like me - seeking to  lengthen their lives having contracted cancer but for everyone - including those who are, as yet, cancer-free.

One more thing - Jane also had little positive to say about the private clinic with whom Diana had set up an appointment in the coming week - so that looks like saving us a lot of money and time; money and time we can spend on a mini-break beside Lake Bala this weekend. Adios (as was said to Andy Murray a few minutes ago!)

Alien, the image.

Things have been quite eventful over the last two days. I'll work backwards. This afternoon (Thursday) we had an appointment with the consultant surgeon at the Royal Orthopaedic Hospital in Birmingham. I was keen to hear what he had to say about the second MRI the ROH had requested; the one that identified the 'renal mass' and led to the subsequent dramatic changes in my world. I was particularly interested to know whether he thought the nephrectomy (removal of the affected kidney) would help me with the continuing discomfort experienced in the back and leg.

He said he thought it would and showed us some of the MRI images on his computer.

I now think I understand the core psychology - the zeitgeist - that lies at the heart of the Alien movies. (If only John Hurt's character had been given an early MRI things may have turned out differently.) The consultant showed us a large interior mass which almost obliterated my left kidney - the chances were that it was no longer functioning and had not been doing so for a long time. A distinct bright circular area towards the base of the mass was also evident. This he said was a fluid-filled cyst and would also be removed.

Seeing these awful and striking images was somehow, strangely, reassuring. Removing this invading 'organism' now made urgent sense and brought with it the prospect of some easing of the discomfiture in my leg which has been worsening.

He also pointed out (and showed us further images to illustrate) that easing the neurological symptoms in my leg was unlikely to affect a chronic degeneration in my spine, involving scoliosis and the erosion of several discs in the lumbar region. He estimated that I was probably a good 2 - 3 inches shorter than would have been the case if my back was in a state of good repair. The arthritic condition in my lower back meant that I was 'fully entitled' to experienced some pain!

I have to go to bed - I'll write about the 24 hours that preceded these events tomorrow! This involves an encounter that was more 'ally' than 'alien'.

The eye has it.

Monday morning and I'm into the first of a series of hospital and clinic appointments. Be warned, the next few days could be seriously tedious.

So, I'm at the Eye Hospital in Selly Oak because our friend Rustom, the optometrist, had taken us, several weeks earlier, through a series of tests, as per usual, because we had one of our regular, if infrequent, sessions with him. I was in a sorry state that day and he left me feeling even 'sorrier'. He discovered a 'cotton wool spot' and a small haemorrhage in my right eye, a probable indication of hypertension. He wrote a report for the GP surgery and forwarded a copy to the consultant at the Eye Hospital. An appointment duly arrived for a Monday morning, first by SMS and then by post.

After a brief wait a nurse took a couple of blood pressure readings which were higher than either us would have liked and then a  registrar confirmed the 'cotton wool spot' and haemorrhage. He also found a small clot in the eye. The consultant was called in, examined the eye and agreed that the course of action would be to monitor the condition in view of everything else that was taking place (i.e. upcoming surgery), the fact that my sight was currently unaffected and that the condition may have arisen naturally from the ageing process.

I was impressed with the staff and the service in a hospital that was obviously hard-pressed and busy; less than impressed with the outcome.

You may wish to overlook the following, plaintive, declaration; leg, back, kidney, lung, now eye - what other parts of me are going into decline?

Then today, Tuesday, some good news - a visit to the GPs to have my bp monitored produced three readings in the high normal range and feedback on my bloods (from three weeks previously) that were good for general health, liver and kidney function. Maybe............ just maybe............

Hope for the best.......

I do hope for the best. I see myself somewhere far out on that rat-tail of a graph surviving beyond the median, beyond 3 years, 5 years, perhaps 10 years. I am so keen to see the members of my family grow in all senses of the word and have more children, my grandchildren, my great nieces, great nephews. I am not ready to leave because there is still much to say, to taste, to see, to hear, to feel.
But I also have to give some time to prepare for the worst. There are things that have to be 'put in order' even if I don't feel like doing them. And there are 'I love yous' to be said and written.

I started the above some days ago - then got stuck. The only way to unstick is post and be damned. Then I can move on....

Having considered the matter

I have spoken to a few people about this blog idea and sent some of them the url and now reached what I think is a considered opinion - I will continue - at least for the time being and if I should change my mind - then I guess I'll just stop.

Today, or at least the first part of the day,  has been one of 'hovering on the edge of the abyss'. I still ask the same crazy question, 'How can this be happening to me?' Just a short time ago I was in the club that assumed I could go on indefinitely. Sure, I knew that the No. 50 bus could upset my plans but I thought like that only to ensure that it didn't happen; operating on the principle that the future is unpredictable, so anything I could imagine happening, wouldn't happen.

Now I'm in a different group, one that I didn't ask, didn't want, to join. I imagine that people must already be looking and thinking about me in the same way that I had thought about cancer sufferers - 'otherly', deserving of sympathy but different to me.

I am still the same person - only more so, is what I want to say to people who think like me, or thought like me. 

The kind words, the care and concern, the hugs - they do help - but the abyss is still there. I think I'm adjusting - I know I'm adjusting - but is the adjustment simply a filmy covering? I have yet to face surgery - that is real. There are no uncertainties, no alternatives about that.

Today we drove to Heathrow to collect Joe following his premature departure from a voluntary teaching placement in China. I am so proud of him for taking on such a huge challenge. We have yet to discuss the one that we face together and separately. He will need time to adjust. I will tell him; I am still me - only more so.

A new day

Perhaps it's time to return to the first of my reasons for writing a blog - updating people on what is happening.

Well, not a great deal, at the moment. I, we, are in this phase of knowing that an event (operation) is coming (15th July) but still living the 'old life' with many of its normal routines and patterns. I know that some people think that I have a tendency to favour a melodramatic turn of phrase (!) but I do think of this time as being similar to one of those sci-fi airlocks that space travellers enter when moving from one atmosphere into another. I will soon live in a new body - one that has been opened up and relieved of some of its content, shortly then to be subjected to a noxious cocktail of chemicals that will wreak yet further change.

My GP advised me to shave my beard off; that way it will be less of a shock for others when my hair falls out.

There are of course other appointments before the op. I have appointments with the Eye Hospital (Selly Oak) (following Rustom's discovery that there is a small haemorrhage in my right eye - perhaps related to hypertension), the Royal Orthopaedic Hospital (still working on the backpain/sciatica problem) and of course a pre-admission assessment at the QE.

And so the days fill. If we are to get away for a few days there are, even now, very few 'windows'.

Yesterday was good. I abandoned members of my family to visit school to help with the relocation of 'stuff' used at last week's incredible Reunion attended by 6 - 700 people (another Moseleians Association success).

Within minutes of arriving I found myself hugging and talking to a succession of women! I finally made it to the rendezvous point - only to discover the 'stuff' had been moved to the vehicles and would need to be unloaded at the other block.

Then more tactile women appeared and I was further delayed. By the time I got back to the old building they had emptied the cars. They left me, with my bicycle, to watch a staff cricket match (I declined a shouted invitation to 'get your pads on, you're needed') because another woman was approaching, arms extended.

Sometimes I see silvery linings within this airlock....................

Second thoughts about a blog

Di is not so sure that the idea of a blog is a good one. I'm not sure either. I think we both doubt the wisdom of putting information into cyberspace, an impersonal void into which anyone may stumble. I think that Di feels this is also somehow presumptuous and I understand that.... but there is a new urgency in my life and I feel entitled to make mistakes.

This sense of urgency can be frightening.

I went to Moseley village with Claire yesterday. She wanted to take a yoga class at the Buddhist Centre and I wanted to talk to Prabakara about the reasons for my failure to appear in his class in recent weeks. While Claire was busy I shopped for 'anti-cancer' foodstuffs in Nima's and the Co-operative supermarket.

Then I went for a coffee at the Java Lounge and talked with Akram, the owner and a former pupil of mine. I was unsure about telling him the details of my illness but he asked me, 'How are you?' and I decided to give him a full answer to that simple question.

I'm glad I did. He told me how he and others always considered me to be a positive person, a teacher who took an interest in them and gave them encouragement. Given his faith perspective, he wanted me to be positive now, to see my circumstance as a condition that was in some way a source of learning. I'm paraphrasing our exchange of course but I was impressed - he is only 28  and I'm not sure that I could have such a sense of equanimity at his age. I took his ideas and re-cast them in a 'humanistic', more secular, mould,

I felt better for that conversation. I have felt better on a number of occasions after talking to others. I need time alone and especially time with Diana but others are able to bring me comfort, care, love and calm.

I hope this doesn't sound too presumptuous, too self-indulgent. If I 'keep it real' it can't be, can it?

Let's get the hang of this............

So why am I writing a blog?

Reason no.1; to keep people informed about my condition without their having to resort to ringing/texting/emailing. I understand that it's not always easy to do so, perhaps because of concerns about being intrusive and of course there are times when we are both overwhelmed or in 'another place' - though I wouldn't want to deter efforts at staying in touch because these personal messsages of support and concern are important to us.

Reason no.2; this is more to do with me. It's to do with the idea that by writing about my situation I might just be able to understand it and myself a little better - that it might be, in some way, therapeutic.

So - let's start with the facts. This way everyone gets to a baseline. I have been told that I have cancer in or on my left kidney, a tumour 12 cms in diameter. I have known this for about three weeks following an appointment at the haematuria clinic at the Queen Elizabeth Hospital. I had been referred after a second MRI scan had located something on my left kidney, a 'cyst' said the GP trying to let me down slowly, but I'll admit to being concerned when he repeated the words, 'I'm sorry'.

Why had I gone for an MRI? Because the Royal Orthopaedic Hospital was trying to establish the reasons for my lower back pain and sciatica-like discomfort/pain in my left leg. The first MRI, in their own 'tunnel model' had given me an unpleasant claustrophobic experience but I'd stuck with it just long enough for the images to confirm a diagnosis of a protruding disc.

So, I told the ROH that I'd like to try and manage the condition 'conservatively' - yoga, chiropractic, osteopathy, physio - in order to ensure that if I had to go for surgery it would only be as a last resort. Four months later I went back and asked for further help. This time I was referred to a private clinic for an MRI in a newer 'open model'. This time there was no claustrophobia but some days later the GP rang.

After the shocking news from the specialist nurse in the urology department (haematuria clinic) I collected just about every scan there is, ultrasound, bone, CT, before returning for the meeting with the consultant to learn the outcome and the treatment programme.

We were last in and perhaps that should have been a clue. When he said 'it's not good news' I felt a strange sense of no longer being within my own body. Not only did I have kidney cancer but it has spread - two small lesions in my right lung. The prognosis - with a kidney removal followed by chemotherapy the mean survival stats gave me just over two years.

That's the baseline. I need to pause because my leg is still playing up when I sit for any length of time. I'll be back.