Cancer & Entrepreneurship

Disillusioned with the corporate world and mesmerised by a whole season living in my campervan in the French Alps, I decided it was time for another change. In September 2013 I resigned from Deloitte Consulting and set up my own business as an entrepreneur coach. After five months spent climbing and skiing consequential lines, my rationale was simple: entrepreneurship was going to push me hard and I might end up penniless, but I’d learn a lot and it couldn’t kill me. On that basis, and with some ideas about how I’d grow my business in mind, the decision was made. Just 18 months into my entrepreneurial journey I was told I had Stage 3 colorectal cancer. That most definitely could kill me and I was petrified.

I don’t want to use my illness to define me but it hit at a very specific time in my life. Given the craziness of the experience, it feels like a missed opportunity not to share it and raise awareness. I didn’t keep a diary, so this is an opportunity for memories and personal reflection. I have also recorded a Podcast with Jerry Colonna and the gang at Reboot, a coaching company that helps people to deal with the internal ups and downs of entrepreneurship.

This is my story of being an entrepreneur with cancer.

Cancer World

Friday 13th really is unlucky for some. That was the day, in February 2015, that I was diagnosed. My life changed in an instant and it won’t ever be the same again.

Two weeks beforehand blood tests carried out by the GP were all clear and a Consultant had told me that I had Irritable Bowel Syndrome. He recommended a Colonoscopy just to be on the safe side. Just a month before I’d been back in the French Alps, freeride skiing for three weeks and living in my van again.  Stress levels were on the high side, though that seemed understandable so early into my business. My dodgy bowels didn’t seem too out of the ordinary (yes I had blood, if you do too then there’s no need to panic but go and see your Doctor).  Most people my age seem to have some sort of stress-related illness these days, and at my age I figured I couldn’t have anything serious. As far as I was concerned, I was a fit and healthy thirty-something with slightly dodgy guts.

But my Colonoscopy revealed something altogether different. “That shouldn’t be there and we’ll need to chop it out” the Surgeon performing the procedure said, as we both stared at the big screen in front of us. The tumour was staring me in the eyes and, despite my brain and body being suppressed with drugs, it was very clear that all was not right. “Are you telling me that I have cancer?” I asked. “I’m afraid I am” he replied.

The first few weeks are tortuous as you wait for the scan results and for the Doctors to work out what’s actually happening and how to treat you. The absence of any information at all is impossible to deal with. About the size of a golf ball, the scans revealed that the tumour was ‘locally advanced’ but there was no evidence that it had spread (metastasised) to other parts of the body. The Doctor told me that they were “optimistic” that they could get me through this.

Nothing can prepare you for the journey that you are embarking on: a journey that you don’t ask to go on. I decided to give up my job and become an entrepreneur, but I wasn’t given a choice about whether to deal with cancer or not. Entrepreneurship required one hundred percent focus and now it felt like I needed to find one thousand percent to hopefully survive cancer. And right at the start of the journey, it is just hope, because at that stage no one can tell you what’s going on. I had no idea how I was going to get through this one, and if at all.

Chronic uncertainty and fear rules your brain. Never before had I realised just how much I loved those closest to me until I found myself staring so closely into their eyes, the fear on both sides apparent. Never have I explored the concept of my own mortality in such a vivid and terrifying way. I cried and I cried. I had panic attack after panic attack. Valium helps but you can only take so much. Our brain has an incredible capacity to dampen the memory and pain of such dark times. They occupy a space deep in the dark recesses of my mind, but I don’t want to ever forget them as they’re an exceptional leveller.

Let the bad times roll

Between March and April 2015 I received 28 daily treatments of radiotherapy, combined with Capecitabine oral chemotherapy. I was operated on for 6 hours then embarked on four and a half months of chemotherapy; 8 rounds of 48 hour FOLFOX infusions.

20151105_191115As a patient, you live in a state of existence not happiness, as someone on a continual cycle of medical appointments, scans, examinations, blood tests, operations and drugs. Lots and lots of drugs. So many drugs you lose track of what you’re even taking and what they’re for. Drugs to offset the side effects of other drugs, and drugs that on occasions brought on severe anxiety and suicidal thoughts such that I wound up in front of a Psychiatrist. The brain’s desire for the whole thing to just stop can take it to some incredibly dark places. It’s obvious to me what my hero David Bowie was referring to when he sang “I’m so high it makes my brain whirl” in his parting song Lazarus. It’s all too screwed up to really translate into words.

At one point, half way through my chemotherapy treatment, my Oncologist wanted to give me a treatment break for a week. I was beat up and I looked a mess. My white blood cell count was getting dangerously low. I contested, saying that I just wanted to crack on and get it over with. “I have killed people with chemotherapy” he said. “Not many, but I can remember their faces”. I took the break. On another occasion, the chemotherapy nurse was preparing my PICC line for administration of the drugs into my arm. The line was 50 cm long and went all the way up a vein in my arm to my heart, to ensure the drugs are being distributed from the core. It stayed in for the duration of my four and a half month chemotherapy treatment. “If this line leaks”, the nurse said, “and the drugs get onto your skin, then you need to go to A&E immediately as it will burn you”. The only words I could find were “okay, and you’re pumping this shit into my heart?” She didn’t have a response to that.

Chemotherapy stories aside, the good news is that I’m doing really good, relatively. I’m now well on the road to recovery. But it’s a long one and I’ve still some way to travel, physically and mentally. The side-effects of chemotherapy are brutal and it takes many months for the body to recover. I also have to have another operation in a few months time to tie up a few loose ends, so to speak. To the extent that the doctors can be sure (there is no magic test) the cancer is gone and I have a good prognosis.

Seeking Wisdom

When this journey began, I made a commitment to myself to emerge from it stronger than when I went into it. Not in an overly-Stoic “what does not kill me makes me stronger way”, but from the perspective of understanding my place and purpose in the world.

I have a better understanding of how my brain works

I earn a living from helping people identify and navigate their biggest business challenges. I enjoy evaluating and making difficult decisions and helping others do the same. I get paid to be calm and collected when others around me feel like they are losing their heads. I deal in information and logic and I am supposed to be rational. However, dealing with my own irrationality on this journey has been incredibly hard.

I found myself losing my mind through a combination of acute mental fragility and the concoction of crazy drugs I was pumped with (steroids to offset the side effects of the chemotherapy drugs, and the affectionately known ‘chemo brain’). I also found myself faced with some incredibly tough and potentially life-saving and life-changing decisions during my treatment.

I’ve long struggled with an anxious mind. Over the years, I’ve developed the self-awareness to know when my anxiety is an issue and to do something about it. Most of the time my brain functions very well but it has been known to drop off a cliff of rationality. My diagnosis equipped me with what felt like a very rational ‘excuse’ to be highly anxious. Its acuteness and duration gave me an opportunity to really explore it and learn further.

It was Daniel Kahneman’s book Thinking Fast and Slow that had the most profound impact upon me. In particular, his evidence-based exploration of the System One (automatic, frequent, emotional, stereotypic, subconscious) and System Two (slow, effortful, infrequent, logical, calculating, conscious) thinking by which our brains form thoughts. It turns out our thought processes are replete with all manner of biases of judgement and choice that can negatively impact our evaluations of people or events. None of us are particularly rational a lot of the time. Just knowing this and the self-awareness that came with new knowledge of what my brain was doing, and why, undoubtedly helped me to bring it back around and calm down.

I try much harder to embrace uncertainty

I now understand with considerably more clarity that humans crave certainty. A sense of uncertainty about the future generates a strong threat or alert response in our brain’s limbic system. We hate uncertainty and, in an effort to counter it, we try to predict the future. We do this in life, and we do it in business. The problem is that we are notoriously bad at it.

Try this for a thought experiment. Think back ten years and recall your life plan at that time for the ten years to present? Have you achieved it in its entirety, and in a way that makes you genuinely happy? I’ve asked dozens of people this question over the last 6 months and not one of them has been able to answer with definitive confirmation. Yet still we will plan the next ten years of our lives (and beyond) and we’ll be sure to get that wrong too. The fact that we will add in a large dose of optimism bias will compound the problem.

I’m not excluding myself from this affliction. As a management consultant, I was always a man with a plan. But I hadn’t ever factored in to my life plan the conversation that I had with the Surgeon on Friday 13th February 2015 and what would follow. When something so profoundly and abruptly interrupts you, it is difficult not to question whether your approach is valid. I am not now anti-planning. But I do see that fixed definitions of success and rigidity of approach dangerously set us up for disappointment. As Ali Schultz from Reboot says“plan the work, work the plan, and be ready for a revisionist strategy when necessary”.

Though irreverent at times, Nassim Taleb further deconstructs our yearning for certainty by countering it with a non-predictive view of the world. In his book Antifragile: Things that Gain from Disorder, he describes how “some things benefit from shocks; they thrive and grow when exposed to volatility, randomness, disorder, and stressors and love adventure, risk. and uncertainty”. I’m not on board with all his thinking, but the notion that we can use such factors to our advantage is compelling as both an individual and an entrepreneur.

I am a positive sceptic

Immediately after my diagnosis, I was told by the Surgeon that had performed the colonoscopy that the tumour was situated so low in my bowel that the only way to remove it was to perform a procedure called an Abdominoperineal Resection (APR) [1]. This would leave me with a permanent colostomy bag. I asked if there were any alternative treatments but I was told there were not. As someone who has always embraced optionality (now more so than ever for reasons self-evident in these paragraphs) I struggled with this enormously and still do.

Alternative treatments did exist, just not within the General Hospital in which I had presented. Self-referral to another NHS Oncologist in a specialist centre revealed a number of progressive treatment options which I chose to pursue [2]. With a new Oncologist, Surgeon and medical team I took an alternative approach to radiotherapy and surgery. The tumour shrank from the radiotherapy such that the Surgeon was able to perform an Ultra-Low Anterior Resection and I have so far avoided the fate of a permanent colostomy.

This highlights the intensely complicated nature of medicine and the illusion of validity that surrounds expert opinions. When we are presented with information from experts and other reputable sources, do we take that information at face value or do we seek to unpick it? For me, questioning conventional wisdom and seeking a second medical opinion has profoundly impacted my future quality of life and outlook upon it. For future reference, if you are an expert then I will treat you with the upmost respect, but you’ll excuse me if I still question what it is that you are telling me, and the context in which you deliver it, to draw my own final conclusion.

This being so, so what?

Yvon Chouinard, the Founder of Patagonia and another hero of mine, once said that something is “not an adventure until it goes wrong”. By his definition, having cancer has most definitely been a very big adventure. But why do I draw similarities with entrepreneurship?

Entrepreneurs crave adventure.

Like my Doctors did with my treatment, entrepreneurs challenge the status quo and conventional wisdom, motivated by a deep desire to improve the way the way that things get done for everyone. In doing so, they adopt a broader capacity for taking (managed) risks and accepting the consequences.

Perfect data is wonderful but it rarely exists. Entrepreneurs work with available, but incomplete, information and synthesise it into something that is more informative than its constituent parts. They then make tough, calculated decisions with the appreciation that they cannot know they are right but that they hold an informed belief that they are doing the right thing.

As I was fortunate to have an incredible medical team around me, entrepreneurs also surround themselves with an amazing team of people.

Entrepreneurs embrace the inherent uncertainty that comes from operating in a world in which the future is not knowable and use that to their advantage.

Despite the incredibly dark times, I hope that I have embraced the spirit of adventure throughout my cancer journey cancer. I hope that I’ll be a better entrepreneur for it. Whilst it would be ridiculous to sit here now and tell you that I am glad I have had this experience, I can’t tell you that I regret it either. That’s easy to say now, but it has happened and there was nothing I could feasibly have done to prevent it. I have learnt an extraordinary amount from it and I must keep moving on. I’m doing my best to steer clear of any big adventures for the time being though.

You can listen to my Podcast with Jerry Colonna below.

For more information about bowel cancer, particularly in younger people, here is the link to Bowel Cancer UK’s Never Too Young campaign.

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[1] I have included the full names of the surgical procedures for SEO purposes, in order to raise awareness around potential treatment options for anyone who may be searching around to find theirs (as I was). Nothing in this post though should be construed as medical advice in any way whatsoever.

[2] The limitational realities of our public healthcare system, and the medical approach initially adopted, combined to provide me with only one treatment option (albeit a life-saving one). That accorded with standard NICE guidelines for treatment of my illness, but it was arguably not the most progressive of approaches. It should be noted though that whilst choosing the more progressive treatment pathway brought significant upside in avoiding a permanent colostomy, the downside is that with progression comes uncertainty and therefore risk, as information and knowledge is less plentiful.

I couldn’t have got through this without the incredibly close support of my Mom and Dad, for whom this journey has been every bit as hard. Thank you to my friends who have been amazing and to my work colleagues, particularly those in the startup community, who have been so supportive. Thank you to my GP Dr. Eleanor Barry for her proactivity to get me to a diagnosis and the medical team that diagnosed me. For my full treatment, thank you to everyone in the Radiotherapy and Chemotherapy Units at Mount Vernon Hospital. I will never be able to say thank you enough to my core medical team at Barnett Hospital (Royal Free London NHS Foundation Trust) who fully embraced the spirit of adventure with me, in the most progressive and professional way. To my Oncologist Dr. Rob Glynne-Jones, my Surgeon Mr. Colin Elton and my Nurse Specialist Angela Wheeler, thank you.