Life, as we all know, can change in an instant. This month has been a rollercoaster of uncertainty and unexpected turns.

In cancer, one of the measures that oncologists use commonly is something called performance status. While it sounds like a readiness score for an Olympic performance, it is much more mundane. Performance status refers to how well a person with cancer can perform their usual daily activities and maintain their physical function.

ECOG (Eastern Cooperative Oncology Group) Performance status scale ranges from Grade 0, which is fully active, able to carry out all pre-disease performance without restriction, to Grade 5, which is dead.

How time fleets. I started this note shortly after my return from Lisbon, but it has since languished for a variety of reasons. They will become apparent as you read on.

Thursday night at choir practice, the choir director announced the next song we were going to sing—"Cup of Blessing, Bread of Mercy." But I heard "Threat of Mercy," and the phrase stuck with me. I'll try to explain as I go through.

I'm back from the AACR (American Association of Cancer Research) conference in Chicago and wanted to make some quick observations before I forget.

As I was writing this blog post, I kept thinking about the number of people who approached me after my interview with Andre Picard - health columnist from the Globe and Mail. Many affirmed the power of my vulnerability but also said that my words had moved them to tears. I didn't set out to do that intentionally. As I tweeted on social media, maybe my talks should come with trauma warnings.

Six weeks can make all the difference in one's outlook on life. A few weeks ago, I was seriously considering palliative care and what it would look like. Now, I have transitioned to planning trips throughout the spring and into the fall. There is hope.

Sometimes, life takes fairy tale turns. This is such a turn. It started with a phone call at noon on the Thursday before Christmas. There was a cancellation and they had a chemo chair available on Friday morning. At 8:30 am. "Take your dexamethasone ASAP and try and get your three doses in before you see us in 18 hours..."

For the last few months, many people have asked how long I will be on my chemo-pemetrexed maintenance. My flip answer would be "until the end of time." The end of time came quicker than I expected and in a way I didn't expect. It turns out it isn't quite the end of time, but the future treatment options are limited.

Cancer patients often talk about calendars. I have no big things on my calendar beyond the end of November. Until now. I ended up in an incredible conversation with a group from Barcelona. When they discovered that I spoke Spanish, I got a dinner invitation. Dying is not an option. I have turn up in Barcelona in September 2025 for an incredible paella. I can live for that.

World Conference on Lung Cancer