The Boy, the Mole, the Docs and the Hospital

28th October 2021

It was a beautiful Autumn morning in Hampstead last Friday. I stopped in the car park on the Heath, and as I walked a little way along the path towards Hampstead Village, I couldn’t help but smile as I enjoyed a brief respite from work, the bright sun shining down on me and my feelgood moment.

When I reached the Royal Free, I climbed the stairs to the main entrance, donned my mask, and entered the hospital, navigating through the corridors until I found the usual clinic. A few minutes later, I was back in a hospital gown, ready for my annual skin cancer check.

I was diagnosed with malignant melanoma thirteen years ago. For a long time I thought about it every single day. But life moved on, I gradually came up with other things to worry about, and the fear subsided. These days it rarely enters my head, until my annual check up comes around and suddenly, for just a couple of hours, I am a patient once more.

It all began with a mole. A small dark mole at the top of my chest, over my left shoulder blade. I have a few of them, so had no reason to give this particular one any special attention. But I noticed it occasionally in the mirror, and something gradually registered, without me consciously focusing on it. What was that thought? Over a period that may have been weeks, may have been months, an idea formed that maybe this particular mole looked a bit darker…actually, quite a lot darker… than it should.

I would have left that vague thought unexpressed, were it not for my dad. He’s had a couple of instances of malignant melanoma over the years, both times through moles that turned out to be cancerous. Those incidents scared the shit out of us at the time, but now his crappy genes served a useful purpose in frightening me into vocalising something which I would otherwise have ignored for far too long, being an idiot man who avoids dealing with difficult stuff like that. I held off for a while though, recognising an inevitable chain of events to follow that I wasn’t ready to face. Until I was.

“Lois, does this mole look a bit dark to you?”

While I am, on such matters, a man of procrastination, Lois is a woman of action. She took one look, said all the things I didn’t want to say, and got me an appointment the very next day. The doctor who examined it took two looks, and while he didn’t give me a definitive diagnosis, his tone was not a reassuring one, as he urged me to get a hospital appointment as soon as possible.

Within a few weeks, they’d removed the mole (along with a nice chunk of extra flesh to be on the safe side) and I was back at Barnet Hospital for my results. We were met by a registrar who clearly hadn’t been briefed. He looked at my case notes, failed to hide the worried expression which emerged as he read, and quickly excused himself, leaving my notes up on his computer. I would have sat there, scared but obedient, until he returned, but Lois is South African. She grabbed the keyboard and scrolled through the document, and that’s how we learned that I had skin cancer. Although I’d been expecting it, being told that my excised mole was indeed malignant was still a difficult day. But not, as it turned out, my most difficult.

Here’s the good news about malignant melanoma — if you catch it early enough, it ends right there, with that rudely aggressive mole put in its place in the hospital dustbin. And that’s what we hoped and expected would happen in my case. A brief fright, and move on.

Here’s the bad news about malignant melanoma — if you don’t catch it quickly enough, it’s a bit of a fucker.

I’m going to try to keep the icky medically stuff to a minimum here, and focus on the lighter side of getting cancer, but there are some technical points that are key to our narrative. If melanoma spreads, it does so through the lymph system (confession — 13 years on, I’m still not really sure what the lymph system does except act as a convenient transport system for malignant cells — their very own Northern Line). The medics offered a further procedure, known as a sentinel lymph node biopsy, in which they remove the closest lymph nodes to check for signs of spread. They had identified my nearest lymph node — lets torture our analogy a little further and call it my Woodside Park Station — in the left hand side of my chest. While the doctors didn’t seem too worried, they offered me this procedure as a belts and braces safeguard. I almost turned it down, as it didn’t sound like a lot of fun, but wiser voices prevailed.

I went to meet my surgeon just before this operation, and he explained that they would be going in below the left side of my jaw. He said they would be careful, but there are some very sensitive nerves in there, and some of them could get cut. He warned me that if that happened, I might lose the ability to smile on the left side of my face.

I was all over the place, I simply was not listening. I’d have said ok to anything. If he’d told me he was going to swap my arse with my elbow, I wouldn’t have known the difference. Fortunately somebody by my side was paying a lot more attention. Lois told our guy, an uber-confident plastic surgeon, that he was planning on cutting me in the wrong place, that we’d previously been told that the surgery would take place further down in my chest. Our surgeon, now a little less confident, went back to my records, and realised he was about to make a terrible mistake and cut away at a bit of me that did not need cutting.

And that is how Lois saved my smile.

Another meeting at a hospital, this time the Royal Free, to share the next results. I never really considered the possibility that this one would be anything other than a formality, so when they told me that there had been (minor) signs of spread, I was completely unprepared. I’d gone to this appointment on my own, so had to phone Lois and my parents to tell them that this was far from over. These were not easy conversations, and I heard myself delivering the news as if listening to somebody else doing the talking. Because it couldn’t be me.

The following year was a surreal period. I hadn’t spent a lot of time worrying about my mortality before, I’d always assumed that awful things happened to other people and that I was contractually entitled to a long and full life. Suddenly, every day was full of obsessing about what would become of me, and the corollary — what would become of my family? We had three children under the age of 4, with Avi just 6 months old when the fun began.

The particular prognosis meant that there was no benefit in undergoing chemo or other treatments with nasty side effects, but there was a further operation to remove a potentially problematic lymph gland. I vividly recall lying on a trolley, waiting to go under general anaesthetic before this op, and coming up with a game to entertain myself while I waited for the dark void — my own version of Deal or No Deal. If the Banker came to me with an offer of a guaranteed number of years in return for surrendering the randomness of life expectancy, what was the minimum that I would now accept? I was 39 years old at the time, and decided that the answer was 20. I’d take 20 good years — enough to see all the kids into adulthood. Deal.

After this op, Lois and my mum came to visit me with chicken soup and pasta. Coming off the anaesthetic, I was on a high, motor-mouthing nonsense with the equally delirious patient on the next trolley. I was still on an operating trolley — when Lois enquired why I wasn’t in a bed, she was told that they had run out of beds, and that I would be trolleyed for the night. Between random jabberings, I expressed some distress at this situation, so Lois and Maxine smuggled me, still in my hospital-issue gown and paper slippers, out of the hospital and back to home comforts. Our very own great escape.

One year on…

There had been no further sign of pesky cancer cells. My oncologist had organised a regime of regular PET scans and skin checks, and I was back in to see him for my latest scan results. Swings and roundabouts, he explained. The good news was that everything continued to be clear on the melanoma front. The slightly less good news? Something had shown up on my prostate. Just excellent. He thought it unlikely to be prostate cancer, but a few more tests, just in case. Always a few more tests…

I returned to my office after receiving this latest news. I thought I was calm in the circumstances, but I must have been flustered, because I got a little confused and googled pancreatic cancer. For 20 minutes I read the likely prognosis, quietly begging the Banker for a few more years. I called the nurse, who reassured me that that I had got my Ps mixed up — pancreatic would have been a rather different conversation.

The prostate tests were all clear (though only after the urologist turned me into his very own ventriloquist dummy, following up with a TV broadcast live from where the sun don’t shine). Gentlemen of a certain age, get yourselves checked for that one too — it’s another one best caught early. But prepare to squirm.

Every year since then, the risk, and with it the fear, has lessened. When the oncologist signed me off several years ago, that was a big moment. I talk to my family more than they would care for about sunscreen and sun tops and keeping out of the goddamn sun. I came out of the initial experience in classic “I’ve looked into the abyss, and now I’m going to make every day count,” style. Until the daily grind intervened, and with it an acceptance that trying to live every single day as if it’s your last gets a bit exhausting.

But I still have my annual trip to the Royal Free Hospital for those skin checks. It’s a helpful reminder of how fortunate I’ve been, and how precious and limited our time here really is. If you’ve made it this far, you’re 10 minutes down on when you started, so thank you for sharing them with me. I now embrace my finitude (and for more on that, read the wonderful Four Thousand Weeks by Oliver Burkeman). So I try my best to rejoice in every day that the five of us still live together in one very noisy household, and to make the most of having a fully functioning smile, while I renegotiate that deal with the Banker.