When I Die

by Philip Gould

  I was a new person, but in this respect I felt a bit like an old person in disguise. What I tried to do during that holiday was seize the moment and smell the roses. Whenever Gail and I were together, which was most of the time, we were extraordinarily close. She kept trying to get me to eat. Unable to keep a lot of food down, I had become a very fussy eater, but I liked one speciality of the hotel, strawberries dipped in chocolate. So Gail ordered plates of them, leaving them around our room hoping I would absent-mindedly start eating.

  But the conflict between the deadline for the book and my commitment to Gail produced one of the most guilty and unhappy feelings I have had in years. I was caught between breaking a contract and breaking a vow.

  After a week we moved north, travelling by train from Naples via Rome to the beautiful coastal town of Orbetello. The journey was a long one, more than four hours, and to Gail’s distress, I could never get comfortable. She knew something was not right. We arrived late at night and I had to leave Gail to struggle with our suitcases across the long, deserted station to the exit on the other side of the track.

  Our new base, the Hotel Il Pellicano, was as welcoming as the first, but by now it was becoming clear that although I was eating more than I had done recently, my weight was falling. Gail noticed that I had begun to look thinner again.

  I started to experience violent pains towards the end of a meal, and found I was vomiting up more food than I was able to eat. Meals became an endurance test yet again.

  When we came home a week later I still felt that, for all its flaws, the holiday had been an extraordinary success. But as soon as I got back to London Gail insisted that I phone the Marsden and tell them of my difficulties. Come in as soon as possible, they told me. And so the process began again.

  This time, somehow or other, we were able to transcend the difficulties that would have seemed almost insuperable many years ago. I had a series of tests at the Marsden immediately but the first results seemed all right. I was relieved, if not relaxed.

  A few days later I visited my publisher, Tim Whiting, at Little, Brown’s offices on Victoria Embankment. I was there to discuss with Tim and my editor Zoe Gullen the final draft of the updated Unfinished Revolution. This task, which had caused me so much heartache, was over at last.

  The phone rang. It was the Marsden for me. Tim steered me into a small quiet room and left me to take it.

  My blood tumour marker had increased from 5 per cent to 58 per cent.

  I knew then the game was up.

  I called Gail and she agreed. She more than agreed. She knew too.

  She told me she had been under the impression that my desperation in finishing the politics book and writing the early chapters of this one was born of a desire to get everything down before I died. I had to admit that I too had a lingering feeling that the moment I finished the second book, my purpose in life would be completed and the end would begin.

  The Marsden sent me for an immediate scan and the tone of their instruction clearly indicated that something menacing had emerged. At that moment, I made a decision: I would rather face this with acceptance. What was happening was that the cancer had come back.

  I went in at about five in the evening and was told that whatever happened I would have to stay in that night so they could sort this out. I knew then that we had reached a critical moment.

  Gail arrived looking flustered but strong. We sat ourselves in the day unit at about half-past eight. The neon light was glaring. The industrial cleaners were starting their nightly work. This was a kind place, but we felt beleaguered and isolated.

  Through the glass doors we could see David Cunningham and his team, looking scared and clearly acutely worried about me. Eventually, Kaz Mochlinski emerged to tell me that the cancer had indeed returned, this time in the lymph nodes above and below the radiotherapy area.

  David came in and was very clear, serious and stark. I asked him what my worst-case prognosis was.

  ‘Three months,’ he said.

  Gail asked what the best case was.

  ‘Three months.’

  I described earlier what it is like to be told for the first time that you have cancer. You instinctively believe you can defeat it. Being informed of a first recurrence was confusing. It should not have happened and made no sense to me. Only through that long conversation with Tony Blair did I feel able to make sense of it by understanding that cancer wanted more from me, and that I had to change more and to develop a stronger sense of purpose.

  But the third diagnosis of cancer was entirely different.

  This was like being hit by a ten-ton truck on a wet, cold night in Indiana.

  The reality, the possibility, the certainty of death suddenly became absolutely real. Completely inevitable and frankly frightening. In a moment we had moved from a sense of having some control to feeling complete loss of influence. We were at the mercy of events now.

  I had just a very few months to live.

  David was magnificent. He told us that the cancer could be treated and listed our options, but there was no doubting how contingent it all was.

  I would not last more than three months. We were no longer acting in a normal patient–doctor relationship, in which cure or recovery is the aim, but as a team planning how to manage my death.

  Gail and I left that meeting feeling more mauled by events than at any of the other cancer meetings. Emotionally this seemed almost unrecoverable.

  We arranged the next few days’ logistics. I would move into the Marsden almost immediately and have a new feeding tube put in, and the next day would start the chemotherapy that in theory would continue for six months.

  Everything was now happening very fast. The speed of this plan of action was impressive, but it also gave me a rather alarming sense of the vulnerability and impotency of my position.

  Other people tried to buoy up my spirits. Mike Griffin called from Newcastle to say that the cancer was still treatable, even if only in the context of a disease that was now out of our control.

  I phoned Tony Blair and for the first time in our long professional and personal relationship he did not quite know what to say. But he recovered soon enough.

  We got through the weekend and planned what was supposed to be a one-night stop in the Marsden. And once again we encountered the familiar contours of the cancer sufferer’s life.

  Once again, we turned up early and nervous. Once again, there was the same old business of finding a room. Once again we had to begin establishing relationships with staff at the hospital, building a micro-community.

  I had been told quite explicitly that with an operation like this there was a degree of risk of leakage and other side effects. But the operation was conducted with great professionalism by Satvinder Mudan, the surgeon who had entered my life at the very beginning of my cancer journey and who now had a part to play as it neared its end.

  He was as confident and opinionated and charming as I remembered him. The operation was scheduled for the Monday and he delayed a flight to China in order to perform it himself.

  Because of the nature of the two previous oesophageal operations I had undergone, it was a difficult procedure, but we were hopeful. As it turned out, the operation went well, but there was cancer evident in the lymph nodes, on the bowels and elsewhere.

  That night the pain began.

  It came excruciatingly and intensely through my digestive system. Not only did it hurt a great deal, it also indicated that there might be a leak. If there was, that would delay chemotherapy. If chemotherapy was delayed, my death might not be.

  It was imperative to start chemotherapy as quickly as possible. David Cunningham, whom I had found generally to be a cautious man, was determined to begin it the following day. That was both efficient and chilling. The cancer had to be killed fast, otherwise it would kill me.

  That was his position at the beginning of the morning. By the next day all had changed yet again.

  The pain seemed to arise from a leakag
e or a build-up of fluids that might quickly go away. But this still meant the chemo was going to be delayed, and delayed chemo would inevitably hasten my death.

  The next night was worse. I was suffused with discomfort and generally in pain. And I was taking my first feeds via the new tube. This produced a bitterness in my mouth and a feeling of sickness that was nearly intolerable. I was vomiting often. And I began to suffer delusions because of all the drugs I was taking.

  This continued day after day until it was decided that the only thing to do was to stop all forms of treatment and all food and see what happened. It worked. My gut calmed down and by Friday I felt that the worst was over.

  But I believed, and so did Gail, that there was now a good chance I would not leave the hospital again.

  By mid-afternoon on the Tuesday after the operation, David came for a meeting. He told us he was changing his strategy and pushing back the chemotherapy for at least a week, possibly two. It was clear that things were veering off course.

  He told us that we were all in this together, but I could sense from his grave tone his foreboding about the risks. He was having to navigate a slow ship across a rough sea, in visibility too poor for us to see where we were headed.

  Saturday morning. Gail came to visit me in hospital and thus began three of the most extraordinary days of my life. I have never been a particularly emotional person but now I could see no alternative but to show her how I felt about everything that had happened and everything to come. I looked at Gail and wept.

  I wept for the lost opportunities. I wept for the lost moments of happiness. And in the end, I wept for the lost companionship. I had never before been able to talk to her, or anyone else, with such intensity.

  The power of cancer was proving much greater than the power of death. Until now I had always seen life as a succession of doors with names on them. Names like Birth, First Job, Marriage, Children, Retirement. And at almost every threshold I had crossed there was some genuine conceptual connection between what I expected to happen and what actually did. I felt this was dramatically not true of the door marked Death. When it comes to death there is a great gap between the name on the door and the reality.

  I know that everyone has a different view of death, a different perspective on it, but I think they also share a consensus that death is wrong and belongs to another time and place.

  Death is usually depicted as a time of decline, of growing irrelevance, as the ending of growth, the cessation of contribution. To some extent those things may be true. But for the dying themselves, like me, there is another dynamic at work: the sheer intensity of death leads us to assess our world in ways we have never done before, each contributing to a kind of pre-death moment of judgment.

  For some it is God who judges us. That may be so, but I suspect that in fact it is we who judge ourselves. The unvarnished certainty that you are going to die within a certain period of time is an immensely powerful thing. It provides the opportunity for fulfilment and the experience of extraordinary depths of feeling and the chance of reconciliation that would never otherwise occur.

  I spoke to David Sturgeon, a respected consultant psychiatrist, about these views. He said two things to me that affected me deeply.

  The first was that the only way to have a good death is to accept it. The second was to understand that for many people, if not most, death is the most important time of life.

  I remember very clearly seeing my daughters born and my father die. Both experiences had equal power. The babies arrived largely shorn of consciousness; my father, aged seventy-eight, departed with years of experience of life. What you are at the beginning of the journey is as important as what you are at the end.

  Death is not frightening if you accept it. It is a time for immense change and transformation, a time to fulfil yourself and others, and a chance in a small way to change the world.

  And these three days with Gail were life-changing for me. I was prepared to smash down my emotional barricades and be fully open and honest with her. I was ready to show her my acceptance of death and my vulnerability.

  She responded in the same way, and by the afternoon our relationship had reached an intensity that we had never touched before.

  The following day, Sunday, was different. Gail came to my room in a more angry frame of mind. At first she was cross with me over some small incident with Grace, but then she transferred most of her anger to an episode from many years earlier in our marriage. I had wanted us to move home to be nearer to good state schools for our daughters. She had wanted to stay in a house she loved. I had prevailed.

  This was what she was angry about. She was saying: why did you do this? Why did you move me and my family from a lovely house to one we didn’t like so much, in another part of London?

  Times like this, when I had taken such an abrupt and brutal approach, or when I had spent night after night conducting focus groups, neglecting the kids, who were asking for my help and not always getting it, troubled her. And she said so.

  She also felt that I had indulged in a long-term strategy of destruction in which, after she had built up wonderful houses or institutions, I would almost always destroy them. I half-expected her to ask: what have you been on all these years? But she did not.

  I could see for the first time that some of my actions had been driven less by a need for power in our relationship than by my own insecurity about it. Now I could see how wrong I was, both about Gail and myself.

  On the other hand, I could see that I had hugely underestimated her fantastic, almost unlimited skills. It had taken living on Planet Cancer, and in particular realising I was close to death, for me to see these for what they were.

  My response to Gail’s anger was to accept it, to apologise and to show that I understood that what I had done was wrong. I replied: ‘Well, you are right to be angry, quite honestly.’ And then, after that, we moved on to a different place, one we have never left.

  I realised that there was a huge process of reckoning to be done.

  Reckoning is not some concept that just happens by itself. It is not going to happen after you die. You have to look into your life. And you think, oh my God, these are the things I have done. I have a little bit of time here; I can resolve them.

  I have done a lot of that with Gail, and I have done the same with others, including the children. But of course I have known Gail for forty years – we have had a lot of time together, and we still have a little time. It is different for my children. They are young, twenty-five and twenty-two, and are trying to come to terms with all of this. Sorting things out, individually or between us, is more rushed and difficult in some ways. But the honest truth is that I have found that if one has the will and the intention, it is possible to effect enormous transformation.

  I have always got on moderately well with my sister, Jill, but never super well. Now, because of this situation and because of the conversations that we have had as a result of it, we are getting on much better than ever. There has been time to make these changes.

  These reckonings with people whom I love would not have happened were it not for our knowledge and acceptance that I will die of cancer soon. Because they know I am going to die and I know that I am going to die, we are willing to do it. But because I have been given this little bit of time, we are also able to do it. In this way death gives meaning to life.

  On Monday, the final day of my stint at the Marsden, the tenor of our conversation changed again. Now we looked to the future. We began talking about buying a new flat for Gail and the best way forward for her without me. We discussed the best ways for her to develop her life.

  We had moved in three days from nostalgia, via anger about the past, to a sweet and meaningful discussion of the future. I believe this was a transcendent moment in our marriage, after which we moved to a new level of understanding of each other.

  Gail has changed, I think permanently. This has not been just a surface change either. It is a change that is deeper and
better rooted than that. She has become slowly and surely a different person. Warmer, less private, more open. She has begun to trust me more. Her response to my cancer in its terminal stages has been unbelievably tender and loving. This love is of a degree and intensity I have almost never felt before.

  There have been good times and bad times. But these are new times.

  The Death Zone

  I am going to die. My death is inevitable and is likely to come within the next few weeks, perhaps even within the next few days. It is real. It is a fact of my life. There is no opportunity to cop out or dissemble. There is no way to avoid it. It is there. I am going to die soon. As long as I keep telling myself that and do not seek to evade it, I am in the right place.

  The awareness of death that I had throughout my life was, I see now, an illusion. Even when the doctors said there was a 25 per cent chance I would die, then a 60 per cent chance, there was always an escape. It is only when they said: Philip Gould, you are going to die. Get used to it. This is going to happen in months or weeks but it is going to happen. Only then do you become aware of death, and suddenly life screams at you with its intensity.

  The doctors who matter, the doctors you trust, always confront this reality. They tell you: sooner rather than later, you are going to die. For example, at the beginning of this process I went on television and said, ‘Well, they told me I’ve probably got three months to live.’ I went along, saw my doctor and said, ‘Yeah, three months to live,’ and he said, ‘No, that was six weeks ago. You have just six weeks left now.’ And that absolute harshness and clarity and real connection to the time you possibly have to live is the key to this.

  I believe that only when you accept death can you free yourself from it, deal with it, move forward from it. Acceptance is the key.