The art of oncology

The main side effect of the six-month course of chemotherapy was ‘fatigue’. The main side effect of the three-monthly hormone injection is ‘fatigue’. The one and only side effect of the expensive, new-generation, last-chance-saloon anti-prostate cancer drug that I’ve been started on is ‘fatigue’. I’m clapped out.

At night I sleep for 11 hours and wake up tired. Then I have about three hours to spend doing things in an upright position before lunch. After lunch I sleep for another two or three hours. After a long afternoon nap I wake up tired again. But I can read lying down on the bed or the terrace recliner. Then it’s a gin and the crossword, supper, and I’m looking forward to going back to bed for another 11 hours. That’s it.

Experimentally, I went out the other evening. Local garden restaurant. Outside tables, widely spaced. Lights under the trees. Posh yet unpretentious. A real treat. The line-up was Catriona and my dear old pal Damien McCrystal, former gonzo restaurant critic, now in PR, who had driven down from Yorkshire in 16 hours for a few splashy lunches and dinners and to buy wine. I did my best to remain upright in my chair, to drink something, to stop thinking about how tired I was and share the abandon. But after the starter I had to excuse myself to walk around to the back of the house, where I knew there were some comfy sofas under the Aleppo pine, and lie down for 20 minutes, my heart pounding, and ask myself the question.

I’ve been trialling these pills for eight weeks. Even if they succeeded in keeping the cancer at bay for a few months or a year – at what price? And was it worth it? Then there is dear Catriona to consider, flogging her wee guts out. (She says I should think first about my grandsons.) I never was much practical use around the house, but at least I could trot about and empty the dishwasher, do the watering, take the rubbish and recycling out, shop, garden, make fires, drinks, salads and things on toast, accompany Catriona on her long walks, and in the evening go out for dinner and be convivial. Now I don’t even go for walks and Catriona does everything. Naturally one hopes that things will change, that the tiredness will lessen over time, or that the cancer will miraculously disappear, or that I will wake up and find that it’s all been a bad dream. But increasingly these fond hopes appear to be just that. And are the pills even working?

Well, yes – as it turns out – they are. On Monday I went down to Marseille and the oncologist said he was pleased by the significant reduction of the prostate cancer marker in my blood test. ‘But are you pleased?’ he said, giving me a peculiar look over his mask with his new, possibly long-haul sun tan. Which, I think, was a very clever way of introducing into our intermittent years-long conversation in bad English and rotten French the possibility that there was no longer any particular reason either of us should be pleased about the numbers unless my life was worth living. And that we had now reached the stage of treatment, very familiar to him as an oncologist, but not to me as a patient, where he would hand over the reins of my treatment quite happily if I wished it.

And later in our brief and deadpan conversation across his desk, he opened his palms and weighed the air, introducing me to my essential dilemma in more explicit and graphic terms. ‘Let’s face it,’ he seemed to be saying, first with that odd comment and significant look, then with the familiar, international gesture: ‘You’ve had a good run, my old son. We’ve done all we decently could, spent a shed-load of euros, and we will spend more and can keep you going for a while yet if that’s what you want. But do you? Starting from now our relationship is going to change and I am going to leave the major decisions up to you. Something for you to start thinking about, chief – if you haven’t already.’

All along, I now realised, this French oncologist’s trembling humility had concealed a kind of genius for what he does for a living. My first reaction was to admire it tremendously, like a child delighted by a sleight-of-hand conjuring trick performed by an adult. Here’s to oncologists everywhere, to their art as well as their science. And here’s to Dr Jean-Laurent Deville at La Timone hospital, Marseille, in particular.