I was 65 years old, had always been healthy and hadn’t been seen a doctor for over 30 years. I was single, self-employed and lived alone. I had been an only child and had no close living relatives. I had registered with a medical practice in early 2021 in order to qualify for a covid jab. I had none of the classic symptoms of prostate cancer but I had stopped ejaculating fully. I decided that I ought to have it checked out and in September made an appointment to see a GP at the surgery. He was not the doctor that I was registered with but he did the usual tests and asked the usual questions for a new patient. He rang me the next morning to tell me that my PSA level was over 70, which is extremely high. I knew then that it was very probable that I had prostate cancer. A series of appointment letters then arrived and I had to drive to Lancaster on my own for scans. Then an appointment with the urology department. I knew what the result would be when there was a Macmillan nurse in the room. She gave me her card and I had a short meeting with the consultant. When I asked about an operation he said no - it would be drug treatment because the cancer had spread. That was it. I drove home and waited for the next appointment letters for a biopsy and then a bone scan that would reveal what the treatment was going to be. In the meantime I received a copy of a letter that had been sent to my GP by the hospital telling him that I had metastatic prostate cancer that had spread to my lymph nodes and bones. I had to drive to the Kendal hospital on my own to have multiple needles fired into my prostate via my rectum, then drive back again with no one to discuss this with, and drive to Lancaster on my own for another scan. No one asked me about my circumstances or offered any support or told me that although the diagnosis was terminal, life-prolonging treatments were available. I didn’t ring the number on the card that the Macmillan nurse had given me. The meeting with an oncologist to find out about my treatment was still weeks away, and in the meantime my mental health, which I had always believed to be robust, took a nosedive.
I have since read 'Patting the Shark' by the Australian surf writer Tim Baker. It is an account of his diagnosis and treatment for advanced prostate cancer at the age of 50 and how he has coped with the life-changing physical and mental effects, particularly of androgen deprivation therapy, which he described as soul-crushing. He too received the news that he had cancer at a meeting with a urologist in a matter-of-fact way with no offer of support. He was lucky that he had his wife with him and after the traumatic experience of having his life suddenly up-ended he was able to make lifestyle changes and find therapeutic practices that made living with cancer more bearable. He says that:
"...the way a cancer diagnosis is delivered would seem to be key to how the newly diagnosed patient manages their new reality. In many cases, the abrupt and insensitive nature of this process plunges the patient and their loved ones into a state of crisis they may never fully recover from. The sudden descent into traumatic and toxic treatments only exacerbates the distress."
He fantasises about an alternative reality where the urologist delivers the news in a more sensitive way and has arranged for support systems to be in place if wanted. These might include a meeting with a hospital social worker and specialist prostate cancer nurse immediately after the urology meeting, and a coordinated health care plan with the availability of referrals to up to five allied health professionals. This would include seeing a psychologist to walk through the trauma of the diagnosis and provide some coping tools and strategies.
I received no help whatsoever when I was told that I had cancer and the help that I eventually received after a psychiatrist diagnosed me as having 'nihilistic delusions' came in the form of involuntary incarceration, treatment with powerful drugs usually reserved for schizophrenia and manic depression, followed by forced electroconvulsive therapy.