And Finally summary

When it was built in 1851, the Royal Marsden was the world’s first dedicated cancer hospital. Marsh knows the place well. Two years previously he wasn’t a patient at the Marsden, he’d given the hospital’s annual memorial lecture. He’s also operated on many Marsden patients who needed his specialized skill set.

So, when he walks in for that first visit with the oncologist, Marsh feels like he’s on familiar ground – until he’s weighed, undressed, and shuttled around to various waiting and examining rooms. That’s when his transition from doctor to patient takes hold and shakes him with fear.

Prostate cancer feeds on testosterone. Suppressing the hormone through castration can shrink the cancerous tumors. Marsh understands the methodology and the risks, but that doesn’t stop him from Googling side effects, potential complications, and life expectancy estimates. His haphazard online medical research causes the same kind of emotional swings it would for most of us. Marsh deflates with dread as he reads the worst-case scenarios and then rises with hope as he reads about optimistic outcomes.

But eventually, he turns off the computer. He knows any advice or hope he might find online can’t compare to the advice or hope he’d get from a real doctor – someone who actually cares about him, listens to his story, understands his fears, and looks him in the eye. Sadly, Marsh realizes that he wasn’t always that kind of doctor. He didn’t fully understand, or want to understand, the anxiety and unhappiness his patients were feeling.

Not only does the cancer diagnosis have Marsh critiquing his past actions as a doctor, it also has him critiquing himself as a patient. He beats himself up for waiting on the prostate exam. He lies in bed wanting to die. He imagines grisly endings, what his corpse will look like, and his wife, Kate, sobbing beside his cold, dead body.

Fantasizing about these worst-case scenarios is actually therapy for Marsh. He works the negativity out of his system and realizes he needs to make the most out of whatever time he has left. He begins to accept the natural cycle of aging. He’s been fortunate and has lived a full life. Now, it’s time to step aside and make room for the next generations. He stops obsessing over his illness and practices daily gratitude. Fear and worry still creep into his mind, but he learns to ignore them.

Marsh’s Oleysa stories often have a typical fairy tale ending: “And they all lived happily ever after.” But that’s not how cancer stories usually end. Even so, six months after he finishes radiation therapy, Marsh gets some very happy news: his PSA has dropped to 0.1. That’s as low as it can get. It doesn’t mean he’s cured, but the cancer is gone for now.

Marsh is thrilled, but he doesn’t enjoy it for long. Ten days after Marsh is cleared, Russia invades Ukraine. Marsh has been traveling to Ukraine and working there, pro bono, for years. He’d been operating and teaching new techniques to Ukrainian neurosurgeons, and still has many close friends in the country. He makes nightly phone calls to Lviv and Kyiv to check on his friends. Some of the calls are interrupted by the wail of air raid sirens.