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For many people with cancer, the Covid-19 pandemic has meant cancelled treatment and great uncertainty about when procedures can begin again.
Ann Morgan, a former pharmaceutical worker from Tunbridge Wells, had seen progress in her personal battle with the disease following care first at Tunbridge Wells Hospital in Pembury and now at Nuffield Health Hospital in Tunbridge Wells - but she says she is left wondering if the coronavirus crisis amounts to a "death sentence" for her.
In her own words, the 66-year-old shares her unique perspective of life during the pandemic and tells of how she has now managed to reach a place of peace.
"Is Covid-19 my death sentence? I’m ready. In July 2019 I was diagnosed with advanced bowel cancer with metastases to the liver and lungs.
"The surgeon tasked with delivering my diagnosis told me that he would not operate unless my bowel blocked and then he would clear it and pop a bag on it. He explained there was no way to dress up my hopeless outlook. He arranged for a Macmillan nurse to contact me and asked the oncologist to make an appointment to discuss chemotherapy. But, he was very clear, I had no future. I felt nothing as I left the appointment. No bitterness, no sadness, no anger.
"My oncologist was, and remains, a paragon of humanity. I told him I didn’t want to know my prognosis. But a nurse indirectly gave it away when she said I would be eligible for Attendance Allowance. It’s only offered to cancer patients with a life expectancy of six months. If that had been true, I would have died just after New Year.
"Instead, I had an unexpectedly good response to chemotherapy, the tumours shrinking more than would have been anticipated. I tolerated it well and was enjoying a good quality of life. I joined a running club to jog/walk weekly, visited my family in Scotland, met with friends; managed to travel to Mallorca to visit friends there. I knitted to keep relaxed in the evenings – beanies for cancer patients and a coat for our new puppy. My life returned to a semblance of normal.
"As a cancer patient I was likely to be at higher risk of being seriously ill..."
"After 14 chemotherapy treatments the tumour markers – which indicate if the chemotherapy is effective – reached a plateau. There was no point in continuing treatment. However, all my tumours had shrunk considerably on the latest CT scan. My husband and I wondered if surgery might now be possible. On March 11 my oncologist arranged for an MRI scan of my liver to be sent, with past CT scans, to a specialist liver surgeon.
"My chemotherapy stopped. I would now have monthly reviews of my tumour markers whilst awaiting the opinion of the surgeon. But for the first time I had hope. If the bowel and liver tumours could be removed it was likely that my life might be extended considerably beyond what could be achieved with further non-surgical treatments.
"Then Covid-19 hit. The government published guidelines to avoid contracting the virus. My husband and I read them avidly. As a cancer patient I was likely to be at higher risk of being seriously ill, and dying, if I caught the virus. We had been practising most of them for months.
"Handwashing was something we had been doing as a matter of routine for the last seven months. Where we might have touched something carrying bacteria or a virus we washed our hands or applied hand sanitiser. When we went for coffee we checked out the customers ahead of us for coughs and sneezes and sat at the furthest point away from them. If we had to sit less than two metres from them we would leave for another coffee shop.
"We made it sacrosanct to walk in the fresh air every day whatever the weather.
"And I watched the horrific scenes in overwhelmed hospitals in the countries worst hit by the pandemic.
"Then it was announced the United Kingdom would need to use operating theatres as additional ICUs to treat the huge influx of seriously ill Covid-19 patients.
"Time for my moment of truth. I could see there was no way that our already overstretched healthcare system would be able to offer the full range of services to patients like me. Without hospital treatment, very sick Covid-19 patients would be dead within a matter of hours, or days. Most cancer patients did not fall into that category. Our needs were not a priority. Not now.
"In my life I have been very fortunate in so many ways but my luck is running out. No one knows when the pandemic will end. My oncologist doesn’t know when any treatment can recommence.
"I had spent seven months coming to terms with the likelihood that my ninety-seven year old mother would outlive me. Now I have to learn to cope with the thought that I could end my days in social isolation. My husband and dog could be the only beings that I would be able to say my last goodbyes to in person.
"I hope and pray that people will be able find what is important in life..."
"I have still not heard whether my liver tumour might be operable. My hope of having life-extending surgery is very tenuous at this point. Today I was told that the blood test to measure my tumour markers has been postponed. I continue to live one day at a time and take pleasure in the tiniest of things – a robin landing on our bird feeder, our puppy taking a roll on our lawn, my husband wearing his own crazy version of personal protective equipment to greet the person delivering our online shopping.
"I would never wish cancer, let alone terminal cancer, upon anyone, but the truth is that it teaches you what is important in life. Friends and family are more precious than I ever realised. Being kind to people feels good – much better than being cleverly mean. There are no certainties in life and death is inevitable. I have embraced all of these and find myself in a place of peace – more peaceful than I have ever felt in my life. I wish I had found this place many years ago.
"I hope and pray that people will be able find what is important in life during their enforced isolation. That they focus on cherishing their loved ones, and find joy in every day during these exceptionally difficult times. That they are kind to others. That they come to realise that there is never any guarantee that life will continue for anyone tomorrow. That they find their peaceful place before they are forced to by circumstances."
A spokesman for Nuffield Health, which operates the hospital where Ann Morgan is being treated, says it has made all of its hospitals available to the NHS during the covid-19 pandemic.
They said: "Treatment decisions for all of our patients at this time are individualised and taken by the consultant in partnership with the patient and family. Decisions are being made using NHS England guidelines based on risk versus benefit to treat and will be different for each patient's circumstances. The situation is regularly reviewed and treatments will resume when it is right to do so."
Dr Navin Kumta, GP and chair of NHS Kent and Medway Clinical Commissioning Group (CCG), said: "The NHS across Kent and Medway is also committed to continuing to treat urgent cancer patients in line with national requirements.
"We are making changes to local services to allow that to happen and to provide urgent cancer treatment away from where Covid-19 patients are being cared for. Radiotherapy and chemotherapy services will continue for patients across Kent and Medway where it is deemed to be urgent by the cancer clinical teams."
Information and support, including advice on the impact of coronavirus on cancer care, is available on the Macmillan website.
The charity’s online community continues to provide emotional and peer support and the Macmillan Support Line is open seven days a week between 9am-5pm on 0808 808 00 00.
