He has had surgery, chemo, a recurrence, a bowel obstruction, more surgery, a second opinion, peritonitis, a major wound infection and has been told he has limited time left. He's having more chemo to improve his quality of life and limit the tumour but ultimately that will change nothing. In the last few days he has again been admitted to hospital with another obstruction.
The medical and physical parts of this process will become increasingly difficult. I've been a close observer to the process too often before. Fortunately or otherwise my friend and his partner have not had the same experience. They don't have an intimate knowledge of what's to come.
In cognitive terms this is very hard to rationalise however. My friend was so recently fit, strong, energetic and absolutely in command of his chosen craft. His energetic stride, nearly impossible to keep up with and his energy and appetite a thing of wonder.
On his good days he looks little different, except for the obvious impact of exertion and the pallor of his skin. A delightful meal, dispatched in short order; an enlivened conversation; an energetic bush walk all lead you to thinking that this is the same old person you've known over time. It's a sudden jolt when you re-remember that here is a man with a death sentence. That's the thing he finds so hard. We talked about his strong preference to simply have died unexpectedly one day, far in the future. The difficulty of waking each day knowing that things are not going to improve much if at all, that whatever effort he makes - and he's making lots of effort to extend his life - it's unlikely to change the outcome. The difficulty of waking each day, knowing that the end is close and he doesn't want it at all.
I live every day with cancer, I've been through the process of being told I have cancer, that I will never be cured. But I also have every expectation that I will die, in due course, with cancer, not from it. Nevertheless I've got some small insight into the mental pathways that arise from that knowledge. It is much, much harsher for my friend. Some days he feels so good he, almost, cannot believe what he's been told. On other days the knowledge is clear, present and almost overwhelming. He describes it as being like what being on death row must be.
The physical hardship will get worse for him but the mental anguish and the ongoing grief for him and all of us around him is what's hardest to take at the moment.
Note: Apologies to Elisabeth Kübler-Ross for stealing the title.