The insidious thing about cancer is that it starts attacking you long before you even realise you are in a fight with it. So, by the time you had your boxing gloves on, cancer had already dealt you many punches, one of which could be the final knock-out blow!

In my case, I can exactly trace the un-expected attack by cancer to July 2017, when I was last given a full clean bill of health in my annual examination so, it had almost a full 12 months head start on me when I finally began to realise what was happening to me internally.

And yet, I consider myself lucky; very lucky to be alerted ‘early enough’ that I was in a deadly fight with the liver cancer, Cholangiocarcinoma.  There were absolutely no outwards signs like jaundice, fatigue, or unusual pain.  As a matter of fact, I never felt better.  I was on a health and fitness kick for months and lost about 8 kg in six months, so much so, I lost two trouser sizes. So, I was fighting fit but, not fighting cancer.

Every July / August for the last 15 years, I have been having full medical checkups to make sure everything is under control. Over the years, the tests showed minor deficiencies in vitamins or elevated blood pressure, which were dealt with and I moved on with confidence for another year.

This year however, on 6th August, I went for the medical check-up and to discuss the blood / urine tests with my examining doctor. The blood tests showed an abnormally high liver enzyme count, where the young examining doctor urged me to repeat the blood test and grudgingly, I did.  He called me and said the new tests are consistent with the previous results and suggested an ultra sound check of the liver and again, I grudgingly went along where my natural tendencies would have been to ignore the instructions and get back to work.

The ultra sound tests pointed a suspicious unusual images on the surface area of the liver and recommended a full MRI scan for a more comprehensive report.  With a great deal of cajoling by my doctor and for the third time inside a two-week period, I agreed to go for the unpleasant, claustrophobic, and very noisy scan on Friday 17thAugust.

It was at this point that my initial suspicions were aroused.  The radiologist said the scan would take about 30 to 40 minutes but it took almost 90 minutes.  I knew they were repeating the same kind of tests because when you are inside the scanner in a very awkward position where you must stay still for the duration, you focus on something or another to while away the time.  I studied the pattern of the instructions they were giving me and realised they must have repeated the same test twice, thinking they messed up the first time.  When I emerged from my ordeal, I was told that as it was Friday, the results would be out early the following week, which I was ok with.  However, that very afternoon, I was told to go collect my results at 5:00 pm!  This also raised another alarm in my mind.

I collected the results, walked back to my car and sat behind the steering wheel looking at the large envelope for about 15 minutes. Finally, I drove home without opening it.

I had something to eat, looked for other minor reasons not to check the results, persuading myself that I was not an expert to interpret the report.  But then a voice in me said ‘at least you can interpret “all clear” words in the report. I finally opened the envelope and took out the thick album of images together with a two-paragraph report. The first one did not help at all. The second and shorter of the two paragraphs delivered the following 5-word conclusion: “suggesting malignancy more likely cholangiocarcinoma”.

To be honest, I was given an internal jolt but not so dramatic or as big as I would have imagined.  For a start, the word ‘suggesting’ is not definitive and leaves room for doubt.  I also, thought since the radiologist repeated his test so many times, he must have been an incompetent fool! Finally, the speed with which he prepared the report in less than 6 hours also gave me the view he was in a week-end mood and not so focused on his job.

As I had a busy weekend ahead, I put the whole matter out of mind, or tried to.

At this stage, the only two people who had any idea of what was unfolding were my wife Claire in England and my brother Samir in Jordan. During that two-week period, I had been keeping my wife Claire aware of what was happening over Facetime in the most general of terms in order not to alarm her.  I gave Samir slightly less information but he is a specialist in Life & Medical insurance so, he had his own suspicions.  Independently, the three of us conducted our own researches, investigated and built a sketchy spectrum of possibilities, from the very optimistic to the most serious of outcomes.  All three of us put brave faces on matters when we spoke nevertheless, Claire in particular kept on urging me to pursue the matter to an eventual positive conclusion.

It took two full weeks, from the initial high liver enzyme alarm to reading the MRI scan report, for me to come to terms that I might be in serious, serious trouble!  By my own standards, this was a very slow thought process to absorb the enormity of the situation.

In the next instalment, my mind moves from slow realization to speed of thought and implementation.