Liam's Story

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Liam's Story

Initial thoughts and story

They say that life begins at 40 but Liam Ryan could not have anticipated the changes that he would experience in his life on reaching that milestone. Perfectly healthy on his fortieth birthday he was to undertake a journey that would take him through 3 life threatening illnesses in hospitals in three different countries before he reached 41 and a return to a city he thought he had left for good, Liverpool.

I am originally from Horseleap in Co. Westmeath and my own connections with Liverpool go back a long way. In 1982 I was accepted to study architecture in Liverpool John Moores University. After qualifying I remained on in Liverpool to work with a local practice and did not return to Ireland until 1996, bringing home a little more than I arrived with, a wife and two children. My wife Pam is also an architect and two years later we set up our own practice in the twin towns of Ballina-Killaloe on the Tipperary Clare border. Everything was absolutely fine in our lives until my world was turned upside-down last May when out of the blue I was diagnosed with a massive cancer tumour behind my right cheek.

I was not an obvious candidate for cancer. At 40 I was still running regularly having completed 6 marathons and had never smoked. The last time I was inside the walls of a hospital was when I broke my arm at 17 in school and I was taken to Nenagh. My health ever since then had been very good. However I was now to learn that this disease does not conform to any preconceptions or patterns when it comes to seeking out victims.

The first symptoms I experienced where intermittent but severe headaches in late April, 2002 and after attending both my GP and dentist I was admitted to the Regional hospital in Limerick with what we all thought was a sinus problem. I was taken to theatre for a routine sinus wash but when my consultant, John Fenton and the ward sister, Carmel O'Sullivan arrived at my bed the following morning I knew something was wrong. The curtain was drawn around the bed and Mr. Fenton didn't have to say much more than his opening words 'I'm afraid this is serious'. In his investigation he had extracted what he described as a 'cheese like' substance and his worst fears were confirmed the following day when a scan revealed that I had an enormous tumour.

It was the news that everybody dreads and most cancer sufferers will tell you that the worst day of all is the first time you get the news. It is cancer with the biggest possible 'C' and it is very hard to see beyond the worst case scenario. My condition was diagnosed as Squame cell Carcenoma but this is a broad description for a group of head and neck cancers that would also include skin cancers. In reality my condition was very rare, only about two in Ireland per year, and comprised a tumour in the maxio-facial area of the head. In my case it had grown to a stage four cancer, the most advanced possible ( one consultant said we could call it stage 44 ) and because of the size of the tumour, running from my cheek around my eye and right back to my brain, it looked as if that I was now beyond surgery and there was therefore little that could be done. John Fenton admitted to me that I was the second worst case he had ever seen and the worst case was dead in a month. Things were not looking good.

My association and by now friendship with John Fenton had become crucial to my direction from this point. John, as it turns out had spent 3 years in Liverpool in what he regarded as the best head and neck cancer facility in Europe and because of my age and family circumstances his recommendation was that if possible I attend the treatment center that would give me the best possible chance. At this stage, from our conversations he was also aware of my links to Liverpool and and knew that this would be a big advantage if I was referred to Merseyside. Pams family are still in Liverpool and I still have many friends there from my college and early working years so in many ways it was even a more appropriate referral for us than Dublin would be. We were delighted to be going somewhere we knew well and in a strange way it was almost as if Liverpool was calling me back again now that I was in trouble after always sorting me out before.

On practically all of the days I had before going to England I ran at least four miles around the narrow roads of Ballina and Killaloe. I'm not sure why. Partly to just get away and to start getting mentally prepared for what I was about to go through and partly to get fitter thinking that that was the best possible preparation I could make in order to help my case. As I hit the road the great community that I live amongst here fell on their knees and I was showered with hundreds of cards, Mass bouquets, relics and prayers. Now that I knew my disease however I realised that the bulk of the work was going to have to be done by myself. As I assessed my situation I knew that there would be only one escape door and the common denominator for all who beat cancer is a positive attitude and a will to live, no matter what. I knew that this was my end of the bargain. The medics would do their job but it was up to me to have my head sorted for the challenge and be the best possible patient I could. The rest would be in Gods hands.

My first visit to Liverpool was at the end of May to meet my two consultants, Simon Rodgers and Dave Husband. By now I could feel the tumour growing under my cheek and their assessment was that the surgery would be very high risk but without it I would only have months to live. There was also a possibility that I would not recover from the surgery and the other option was to do nothing and just live out whatever I had left. Having explained the procedure they moved to leave the room to give us time to decide but I told them there was no need to go. At 40 with 3 small children months were of little use to me so the decision was already made. I pressed the consultants to give me some idea of my chances of cure. They explained that the normal procedure for this operation would be to remove the tumour and a further centimeter clear all around. In my case this was not going to be possible as the tumour was so extensive it was backed up to my brain stem. They both agreed my chances of cure were only about 5%.

We left the hospital that evening with the very daunting figure of 5% ringing in our ears. I was later to speak to a friend of mine, Paddy Hynes from Athlone, who had beaten bowel cancer and he completely reversed my attitude towards this figure. 5% is fine he said, 1% is all you need Liam and it is now your job to make sure you get yourself inside that percentage. There is absolutely no reason why you can't. You are the man! It was the best piece of advice I received during the entire ordeal and said with such single minded conviction that from then on I was almost bragging about my 5% chance. Paddy also said to me that I will simply be on a different road for the next 12 months or so and after that I'll be busy getting on with the rest of my life. This was great stuff and I just focused single-mindedly on the chance that I had been given rather than the odds that were against me. Deep down I also knew that there would be time to prepare for the worst case scenario if every single escape route closed in on me but in order to give my fight the best possible chance I would not even contemplate that likelyhood until all possible hope was completely exhausted.

After leaving the hospital we took advantage of our child minder and decided to go for a drink to reflect on what we had been told. As we passed through Williamson Square in Liverpool city center I just happened to glance into a dark corner and there I witnessed something that I had only ever seen before on films. I saw a man about my own age with his trousers down around his knees and he was injecting heroin into his thigh. I stopped to show Pam what I had seen and she was equally shocked. At that point in time I thought that like for like his chances were better than mine but if he goes to hospital nobody will care. He won't have any visitors, no cards no support group from Ballina Killaloe or old friends from Liverpool. Very few will really care whether he lives or dies. At that point I felt lucky I was me rather than him.

The date for the operation was fixed for July 8th . The surgery would involve the removal of the tumour as best they could, the removal of almost all of my cheekbone and my right eye and the removal of half of both the roof of my mouth and my top set of teeth. Replacement bone would then be taken from my hip to rebuild the cheek and lining would be removed from my stomach to hopefully reseal the roof of my mouth.

The entire procedure took 12 hours and was undertaken by Simon Rodgers and his senior assistant David Vaughan who hails from Co. Cork. I came around in intensive care with Pam at my side. I knew that if things went badly wrong regaining consciousness after the surgery would have been at risk so I was very grateful to open my eyes. I was in good spirits and aware of my location if not fully of my condition which is apparently a normal state in intensive care. The morphine banishes the pain but thankfully not the awareness.

The great news was that although damaged, the surgical team had managed to save my right eye and the flap to the roof of my mouth appeared to be a success. My fitness had also been a factor in my favour as the intensive care staff could not believe the strength of all my readings on the monitors.

For the next week I was unable to eat, drink or talk as I was breathing through a trachyostomy and fed by a peg tube directly into my stomach. Two days after the operation Simon Rodgers came and sat on the end of my bed. He said that he felt it had gone well. They had removed all of the tumour that they could see and admitted that by the end they were very tired and were close to things they just didn't want to be near, like brain and spine. He told me that my operation was just about as big as they come and was on a par with surgery for a major car accident. I almost felt embarrassed by what I do myself as he spoke and I started to appreciate the incredible work that surgeons do. A 12 hour day is a long day for anybody but these incredible people had spent 12 hours in the middle of my head. It doesn't get any bigger than saving or improving peoples lives and I felt guilty that I had so little awareness of their work until now.

My first week after the surgery was probably the worst I've had in a long time. Although not in severe pain I was in what I would describe as 24 hour discomfort. In fact it has given me an insight into the condition of a patient to such an extent that I will now no longer trust a hospital if you phone up and are told that some is comfortable. You can take it from me that they may be stable but they are very much 'uncomfortable'! I was awake for every second of the first two days with nothing to interrupt the timeless agony. I was unable to sleep because of the trackyostomy and unfortunately I was within view of the clock on the ward and this only helped to increase my frustration. Every five minutes passed as slowly as an hour and I literally spent these days just wishing a week away.

My running experience was a great source of strength to me at this time. When I was brought back to the ward I had about ten tubes coming out of me and on the following day when the first of these was removed, an anesthetic feed in my foot, I remember clenching my fist thinking one gone nine more to go. I could relate how I was feeling to the 20 mile stage in a marathon when with 6 miles still to go you had nothing left but you dug and found something. In running when it is not going well I would often introduce a strategy of run what you see, literally get to the next bend or top of the next hill and then concentrate on the next stretch and so on. I applied the same tactic to these days of recovery and all I wanted was some progress for each day that came. This could be the removal of a tube or to sit up or get out of bed and eventually to talk, eat, drink and walk for the first time again.

I hated the trachyostomy. It was the worst part of all. Apart from the physical discomfort it had a psychological impact of tying you to the bed like a noose around your neck. I appreciate that with my mouth out of action it was keeping me alive but it was not pleasant. The worst thing it did was make me cough when I didn't really want to cough. As it discharged air down my throat this air was moistened and the moisture would then collect on my chest. This would result in me coughing to clear my chest but each cough was extremely painful to my newly re-shaped hip and because the trackyostomy was lodged in the middle of my throat the coughing was ineffective anyway so I was caught in this vicious and very painful circle.

I felt as if I was stripped right down to basics that first week by not being able to eat, drink or talk. I would communicate to visitors with handwritten notes but would tire easily at this. However it was only now when I was denied these fundamental activities that I appreciated all of the simple things that we take foregranted on a daily basis let alone something complicated like going for a run or driving a car. I found a positive channel for my thoughts to cherish all the wonderful things my body could do and I vowed that I would not let myself forget these feelings and become complacent ever again about the wonderful gifts we have all been given as human beings.

After a week the trachyostomy was taken out and by then I detested it so much that its removal gave me a huge lift in terms of progress. Within a few minutes I uttered my first words and was brought a glass of iced water. It is hard to find words that are strong enough to say how good it tasted but I suppose if you could imagine your favourite drink on the hottest day you've ever experienced, it would come close. I didn't feel hungry when I was fed through the peg tube but I did feel quite thirsty. I kept getting flashes of a drink in my mind and after a day or two this grew to a billboard sized image of a long, tall, cold glass of Coca Cola. The more I tried to stop thinking about it the bigger it got. It was torture but again I promised I would appreciate every single drink I would ever have again rather than insisting on ice or lemon or that it isn't cold enough or whatever.

My progress in the second week was almost miraculous. I was eating now and my physiotherapist ( they nicknamed him the phsyioterrorist !) was amazed at how quickly and how well I was walking. I put this down to the strength in my legs from the running and again I adopted the same spirit for walking again as I would for the pain of getting through a marathon. I was definitely through the wall now and starting to cruise into the last mile or two knowing I was nearly home. Towards the end of that second week I looked as if I was going to break all kinds of records for recovery from major surgery and then disaster struck. I got meningitis.

I don't remember very much about the first few days of meningitis. I was apparently drowsy for a day or so and whilst the nursing staff initially thought I was sleeping off the tiredness from the surgery, Pam, who was constantly at my side knew something was wrong. When I came round two days later I was in the neuro wing of the hospital. I had been rushed there with suspected hydrochefalis but thankfully the water on the brain was only temporary and a lumbar puncture confirmed that I had meningitis. I had a very tricky 12 hours apparently but as I was asleep, the main commotion went on without me taking any part. When I awakened I was mainly concerned with how much I had regressed from the last time I was awake. There was those tubes again and I was confined to bed again after my walking had gone so well but the main drawback was that I felt absolutely exhausted. I was also slightly despondent to be confined to bed again and I spent the next week retracing steps that I had previously achieved, like eating, sitting out of bed, standing and eventually walking again.

The meningitis however was now under control and I made steady progress over the next two weeks. I was having regular visitors at this stage, many of whom were generously making the trip from Ireland. There was nothing like a new face to give me a lift on any given day. Then, once I had completed the antibiotics, I was stable on my feet and in great form so I was deemed fit enough to be discharged.

The consultants did not want my radiotherapy treatment to begin much later than 6 weeks after the surgery and thanks to the meningitis one month of this period had now been used up. It was now a case of getting as strong as I could and hopefully starting radiotherapy within 2 weeks. We moved in with my first cousin, Mary Naughton, originally from Clara, Co. Offaly and normal life began to creep back slowly into place for me. As my strength increased I was able to venture out to the odd pub or restaurant but then on August 20th another setback was waiting for me.

I woke up that morning and noticed my right calf was very swollen. I didn't pass much remarks at first but by the following morning it was huge and I was rushed to the main hospital in Liverpool and diagnosed with deep vein thrombosis. Yet again I had been caught in time and I was released from hospital by the end of the day. The swelling started to go down the next day and although I was joking that most people with DVT's have to take round the world flights to far-flung exotic locations to earn them, whereas all I had done was caught the Seacat from Dublin, I was a little despondent that here I was with yet another setback to overcome. The main impact of the thrombosis was that I was now dragging my right leg and my mobility was substantially curtailed. However it passed quickly as within a couple of days the swelling was gone and I was properly back on my feet again. It was critical that nothing else went wrong at this stage because my time limit for starting radiotherapy was now almost up.

It was confirmed that I would begin my radiotherapy on August 28th as Dave Husband claimed he could not postpone it any longer. I had still one more unexpected twist to face when I started to experience severe headaches the weekend before I was to start. We were very worried at that time because all we could think was that this was the tumour trying to re-establish itself after the longer than expected delay since the operation. I was taken for a scan and although the results weren't fully clear Dave Husband felt that it showed enough to suggest that the tumour may well have been trying to re-form. He couldn't afford to postpone the radiotherapy any further and now decided to introduce three chemotherapy treatments to directly attack the area where the tumour appeared to be visible. The first chemo session took place straight away and involved being hooked up to an interveinous drip for a full day and overnight stay in the hospital. I'm glad to say I did not experience any side effects from the chemotherapy sessions and thankfully didn't have a headache after that.

My radiotherapy had now begun and in many ways this was my best period of the entire treatment. I was to attend on a daily basis for seven weeks with each treatment lasting no longer than about 15 minutes. A clear plastic full face mask was made from a plaster cast of my face and this was secured over my head for every treatment to ensure that the radioactive rays hit exactly the right spot every day. I was the man in the 'plastic' mask. The facilities were like a scene out of Star Trek as whilst I lay on a moveable table, with my mask over my face, the radiotherapy device would hover over my head like a miniature spaceship and travel to three different positions to send out its invisible rays.

I was gaining in strength all the time at this stage and apart from my daily lunchtime treatment session the rest of my day was free. I started to live again. I had a lot of visitors coming from Ireland now and I had the energy to show them some of the sights in Liverpool that I knew well so we took in the two cathedrals, the Albert Dock, Speke Hall and tours of the Wirral on a regular basis. I was also able to attend matches at Merseysides 3 football league clubs, Liverpool, Everton and Tranmere Rovers and return to a lot of drinking haunts that I had not been in since I was a student.

The first couple of weeks of radiotherapy passed off without incident. One of the three angles of treatment was through my right eye, which had already been damaged by the surgery and the skin around this area began to show signs of stress on the 3rd and 4th weeks. The staff told me that this was normal and that it would probably escalate to a point where my mouth would swell and I would have to be re-admitted and fed through the tube again. Now that my life was back to some kind of normality again I would have regarded being re-admitted to hospital as the worst possible setback but there was little I could do as there was still 4 weeks of radiotherapy to go. Remarkably however my skin didn't deteriorate over the next few weeks, there was no swelling of my mouth and I knew when I got to the second last week that I would make it. The radiotherapy staff told me that I must have had amazing skin to have held out over 7 weeks which was a lot longer than most of the other patients courses.

When you get cancer there is very much a feeling of joining a club. First of all you discover that there is an awful lot of people in the same boat that you never knew about before and then you realize you have a very strong bond with all your fellow sufferers. At lunchtime every day in Clatterbridge Hospital this club would transform into our own little group of patients brought together by our disease. The people in my group were mainly older women with breast cancer and every day we would support and entertain each other and get to know each others families. We had never met before and probably never will again but for these weeks we were all the sincerest of friends because we were united by the strongest bond of all, the will to live.

As the end of my radiotherapy approached and taking into account that I was in such good form I was getting desperate to return to Ireland. It had after all been 4 months since I was last home at this stage. I was to see Dave Husband on the Friday of my last radiotherapy session and I was braced for him to say he needed me for another week or two but ready to challenge him if he suggested that he needed me for longer. To my complete surprise he said that I had done so well through radiotherapy that he no longer needed me. I was free to go. I spent the rest of the weekend celebrating and thanking friends and family for their brilliant support and we loaded up and sailed on the Monday, October 14th . We were going home.

My situation now was that I had all the treatment that was possible. The surgery was so extensive and so complicated that it would not be repeated and because the tumour was so large I had been given all the radiotherapy I could possibly take. The hope therefore now was that this treatment would have effectively eradicated the tumour and there was nothing else that could be done if it came back. With head and neck cancers tumour invariably return quite quickly so it was considered that if I got 18 months clear I would be OK.

I had no problem accepting this as I appreciate that there is a certain amount of risk in everybody's daily life and I hadn't lost sight of the fact that, considering the odds, I was very lucky to still be alive anyway. There can be danger when you play sport or cross the road or drive a car and I was happy to include the possible return of the tumour with these as a normal part of my life from now on. Now that it was all over I was very grateful to the surgeons for their great work and to the great faith my family and friends had put into my recovery and of course, to God.

I returned home to an incredible welcome and learned something new again. After our hero's in the world of sport, music, politics, arts and industry people who beat cancer are also up there in terms of achievement. The people of Ballina and Killaloe gave me the most amazing reception on return which was the culmination of all the support they had provided for me throughout my entire ordeal.

The next few weeks were spent taking things very easy and we then decided to book a sun holiday to give ourselves a break and re-group as a family after the summer we had.

We flew to Lanzarote on the 14th of November. At last my life was heading in the right direction again and we were going to see out the year on a high note with two weeks of warm weather and return home for the run-in to Christmas. The three boys were all excited and it was just what they and Pam needed after all they'd been through since May.
However the holiday spirit was not to last long as two days into the holiday, I began to feel unwell. Initially I was just in bad form but Pam had to call for a doctor when I became violently sick. We were very fearful at this stage that this was the return of the tumour and the doctor did little to ease our fears when she almost tearfully said to Pam 'Well at least you have the children. They are beautiful'. I was taken to the tourist hospital on Lanzarote but my case was too serious for them to handle so I was taken by helicopter to the main hospital for the Canaries on Gran Canaria. I was never on a helicopter before and now when I got my big break I was unfortunately in such a condition that I wouldn't be able to remember it.

In Gran Canaria another lumbar puncture confirmed meningitis again and this time it was two days before I was out of danger and yet again I had just been caught and treated with the antibiotics in time. My three sisters were summoned and flew out while I was in intensive care. I came around on the third day and realised that once again I had not been conscious while most of the action was going on. I was back again to where I had been before, hooked up to a drip to treat meningitis with the main danger having passed. However I was to discover a new series of challenges.

From my performance in Liverpool after the surgery I was almost blase about adopting a positive attitude towards recovery. Knowing that it gives you the best chance of beating any disease I couldn't understand why everyone could not be positive about getting better. I was to learn in Gran Canaria that this approach is not as simple as I might have thought. I was not a happy patient for my first week in hospital over there. I was finding it difficult to come to terms with the landslide of emotion I was experiencing of having arrived on the islands for a holiday right down to now being on the flat of my back in a hospital. A lot of smaller details also combined to further fan the flames of my discontent. The food was awful, I was unable to converse with the other patients and had little communication with the doctors and nurses and I suddenly felt very vulnerable being so far from home in a strange land. I suddenly realised that sometimes it isn't all that easy to be positive.

After a week I settled better. I realised that I had meningitis again and that the only way forward was to complete the medication and beat it once again. I had also given up on any hope of rescuing the holiday at this stage. I was on my feet now and able to eat in the cafeteria and had Pam and the kids and the girls in to see me daily. I was also starting to get literally hundreds of text messages through from Ireland. Hurray for modern technology.

On December 4th, after three weeks in hospital, I had completed the antibiotics and was passed fit to fly and return home. By now all I wanted to do was to just get out of 2002 but the following week the very final twist was to come when our youngest boy, Abe, was rushed to the Regional Hospital in Limerick with, unbelievably, meningitis. With the law of averages we just thought it couldn't be possible. This was 3 cases of meningitis in the one house in 8 months. He was in for 5 days with Pam at his side and once again thankfully, it was a case of being caught in time. They came home on the Friday before Christmas and for the last few days of the year I was ready for the bubonic plague, scarlet fever and hailstones the size of footballs. Thankfully they didn't come.

Midnight, December 31st 2002, happy new year ? - it sure was !

Now that I can look back on it all it was an incredible experience to go through and although very daunting and frightening at times it also had so much that was positive. I met so many incredible people that I just wouldn't have come across any other way. I realised that I've got a fantastic wife and family and I live in an unbelievable community here in Ballina. I have a much greater appreciation for the great work all health workers do and I'm again enjoying so many things I can do as a human being that for years I took for granted. I?ve basically been re-invented as a person and I am just full of the joys of simply being alive.

You will often here from cancer sufferers that in a way it was the best thing that ever happened to them. Although extreme I can understand this sentiment as it can be the turning point that forces you to look at how you are actually living your life. It makes you see the real issues again and encourages you to make the necessary changes to ensure that these real issues are once again your priority. It forces you to think of life and death and where you stand in spiritual terms. It makes you look into yourself.

And finally when you beat it, it makes you proud that you took something on with the odds against you and won through. You live to fight another day.

4 years on....

It is now more than four years since I survived cancer against great odds. Having had a stage 4 tumour surgically removed from the middle of my head, after being given a 5% chance of survival, my radiotherapy treatment was completed in mid-October 2002. I therefore have a year to go in that 5 year zone that is just about exclusive to cancer survivors - remission.

Remission is one of those in-between states, like limbo or twilight, that is neither one thing nor the other. For cancer sufferers you are deemed to be neither ill nor officially cured and filed away in the 'let's wait and see' drawer. I suppose in many ways it's like somebody who gets a suspended sentence for a crime. You don't have to go to jail but you?re not off the hook either and will be under review until the sentence is up. However whereas some offenders might be disappointed to get a suspended sentence, for all cancer survivors remission is just fine. The going to jail part of the equation is just not an option for us.

For me, given that my chances of survival were so low, remission has been a very pleasant phase of my disease. It has been the calm after the storm. A chance to review and reflect on all that has gone before, a second opportunity to simply appreciate just how good it is to be alive. Survival, of course, was the only focus initially but the bulk of my appreciation now has moved on to how well I have recovered. In the thick of the fight, against the odds I had been given, I was only concerned with staying alive but the price of that survival could so easily have been the loss of my sight, or the strength of my limbs but especially the ability to talk and eat because of all the bone that had to be removed from my cheek.

Four years on not only can I still talk and eat for Ireland but I can also work, drive, walk, sleep, travel, swim and for me the best of all, run. I have completed two races this summer at 5K and 10K. Having been given a very slim survival chance, I have come through a 12 hour surgical procedure, followed by 7 weeks of radical radiotherapy treatment and all I have to show for it is a mild, but occasional, discomfort to my right eye and a restricted opening of my mouth, about half an inch, which incredibly hasn't prevented me saying or eating anything I did before. For three years after the treatment the main drawback was extreme tiredness but now, as an architect, I am busier than ever and have at last been able to seriously resume my role in our practice with my wife Pam. From a position where I can now see the wood from the trees in I am quietly amazed to have come through all of this and be basically 95% of what I was before. My recovery is now an even bigger story than my survival ever was. Miracle no. 2 has outdone miracle no. 1.

Remission therefore builds this platform of perspective for you to review and appreciate the life you have had and are still having. It is from this platform that you will hear cancer survivors say that the disease has changed their life for the better. If I am 95% physically of what I was before I must therefore be 195% mentally. Nothing fazes me now, not traffic jambs or bad weather or missing a flight. They are simply not important compared to what was important to me 4 years ago when my life was on the line and I won't ever let myself lose that sense of perspective. I make a point of visiting a church every day, even if just for a minute, just to give myself the space on a daily basis to acknowledge how privileged I am to still be here. My priorities in life have been completely shuffled around and I now make more time for family and friends and all the things that are important to me where before I would just have been too busy. Last year when I couldn't get a ticket for my eldest boy, Christy, for U2 in Croke Park we simply jumped in the car and drove to see them in Cardiff. Such a 'Plan B' wouldn't have ever been allowed to enter my head in my first life, pre-cancer.

One of the other great aspects of the remission period it that it gives you an opportunity to discover, appreciate and acknowledge all the great work that was done on your behalf to help you get to this stage. In my case this began with the incredible support of my wonderful wife Pam and my 3 great sisters, then extended to the entire community of Ballina/Killaloe and finally the unbelievable medical skills of Carmel O'Sullivan and John Fenton in Limerick and Simon Rodgers and Dave Husband in Liverpool. It allows you the time and strength to visit all of these people and hear their side of your story and thank them all personally for their wonderful work.

Remission is also a time when you look at your own mortality because you have just stood it down and sent it packing but you know one day it will be back. Even here there is perspective to be gained. As I assessed my situation I realised that although still relatively young I have lived a life and a good life at that. I suddenly realised how fortunate I had been compared to stories you can read everyday on the newspaper, the seventeen year old that comes off a motorbike or the 3 year old diagnosed with a terminal illness, not to mention all the unfortunate people whose lives are cut short by the cruel hand of others. Those people have not had anything like all of the opportunities that I have had in my life just to this stage.

This perspective helps me to not just appreciate everything I have experienced in my life to date but also to cherish the remainder of it like an unexpected gift. It's all a bonus for me from here and the realisation that I am getting a second chance at life will never be lost to me. Every day is now a little treasure and every event or occasion that those days bring, like a Heineken Cup to Munster, is quietly noted and appreciated. Those days are starting to turn into months and years but even if I were to go tomorrow the four years since I have been treated have made it all worthwhile in themselves. When I was diagnosed my youngest son, Abe, was still only one and it looked as if I was to be denied seeing his personality develop. Now he is nearly six and we have become the best of friends, having shared holidays, football matches, birthday parties and many colourful stories about what his dad got up to when he was a boy.

Remission has granted me all that and looks as if it will grant me a lot more, but for that alone, it has been a 4 year journey that has been travelled with a very grateful appreciation for every step that has been taken.