Thursday 6th October, 2011

Chemo 3 and Reflections on Steve Jobs

I woke up this morning to the news that Steve Jobs had died. I had several meetings with Steve in the course of my career and they left a lasting impression.

The first occasion was when Steve was with Apple for the first time. I remember going to an open evening at my daughter's school and telling the RE teacher that I has just got back from a trip to the US, where one of my meetings was with Steve Jobs. He was a Macintosh fanatic and it was hard to get him back to talking about my daughter at all.

The other occasions were when Steve was heading up a new company, Next, before he returned to Apple. I learned a lot of lessons about communicating with senior management, some of which I still refer to in the training I deliver today. I remember Steve as being impatient and arrogant, qualities that must have contributed to his success. However, he was also willing to spend time to explain things. Every appointment I had lasted longer than planned.

The most important lesson that I got from Steve, and one that I use as an illustration when talking about effective communication, related to the need to be able to create a true executive summary.

Before one of the meetings, I was asked to prepare an executive summary. Steve's PA sent me instructions.
- No more than 2 US Letter pages (For people more familiar with international paper sizes, US Letter is not very different to A4)
- 14 point type, double spaced
- A single column, no more than 4" wide.

This does not allow for any fluff. The purpose of the executive summary is to attract attention, not to close the sale. Given that I got more time than I was originally allocated, I deemed my executive summaries to have achieved their objectives.

Steve Jobs will be sorely missed in the IT industry. Only time will tell whether his succession planning was effective.

Today is a day at hospital for the administration of the third dose of chemo. Traffic congestion meant that I was a little bit late, but given that I had to be here all day 10 minutes doid not really matter.

One of the nurses treating me today is the one who looked after me on 25th August when I had so much pain in my hip overnight. She asked me how the treatment was going and her immediate reaction was "That is because God is with you".

As a Christian, she remembered the discussions we had while waiting for the on-call doctor to prescribe the morphine injection.

I am going to try not to repeat all the details that I captured last time I was in for chemo, but I do want to keep a record of the timeline.

09:44 Canula fitted.
10:04 Anti-histamine "pre-med" administered.
10:42 Started administration of Rituximab. Lots of problems with air in the IV line.
12:51 Rituximab drip complete.
13:30 Saline flush complete.

This mornings drip went relatively quickly. As a result, the pharmacy were not ready with the syringes of the really nasty drugs that make up most of the chemo dose.

So far today, I have processed 6 AtE workbooks, so time is not being wasted.

14:40 Start of chemo infusions
15:10 End of chemo infusions

I was now waiting for the drug for the lumbar puncture to come from the pharmacy.

16:25 Lumbar puncture to inject chemo into spinal chord. So far, I have had three lumbar punctures and all three have been virtually painless.
16:40 Start of an hour on my back.

An observation. For the first two administrations of chemo, the nurses were very careful to administer the drugs one at a time, so that if there was any adverse reaction, it was possible to tell which drug was responsible. I noticed that the treatment record card had an expanded section to record reactions to the first chemo treatment.

Now that I have been through the process twice, everything was done much more quickly. What took almost 90 minutes first time round, took 30 minutes today.

After the first lumbar puncture, I had to rest on my back for two hours. Today, I only had to rest for 1 hour.

We got away from the hospital at around 5:45, more than an hour earlier than we expected.

On the way home, I heard a speech that Steve Jobs gave at Stanford University in 2005 on the subject of death, which so paralleled my initial experience that I was moved to tears.

"About a year ago, I was diagnosed with cancer. I had a scan at 7:30 in the morning and it clearly showed a tumour on my pancreas. The doctors told me that this was almost certainly a type of cancer that is incurable and that I should expect to live no longer than 3 to 6 months. My doctor advised me to go home and get my affairs in order which is doctors' code for prepare to die.

It means to try to tell your kids everything you thought you had the next 10 years to tell them in just a few months. It means to make sure that everything is buttoned up, so that it will be as easy as possible for your family. It means to say your goodbyes.

I lived with that diagnosis all day. Later that evening, I had a biopsy. They took a few cells from my pancreas. I was sedated, but my wife who was there told me that when they viewed the cells under a microscope, the doctors started crying, because it turned out to be a very rare form of pancreatic cancer that is curable with surgery. I had the surgery and thankfully, I am fine now.

No-one wants to die. Even people who want to go to Heaven don't want to die to get there. And yet, death is the destination we all share; no-one has ever escaped it, and that is as it should be, because death is very likely the single best invention of life. Its life change agent. It clears out the old to make way for the new.

Remembering that I'll be dead soon is the most important tool I've ever encountered to help me make the big choices in life. Because almost everything - all external expectations, all pride, all fear of embarrassment or failure - these things just fall away in the face of death, leaving only what is truly important. Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart.

Your time is limited, so don't waste it living someone else's life. Don't be trapped by dogma - which is living with the results of other people's thinking. Don't let the noise of others' opinions drown out your own inner voice.

Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven't found it yet, keep looking. Don't settle. As with all matters of the heart, you'll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don't settle."

See the whole speech on YouTube.

Another plaudit for the NHS. I am finding it quite cumbersome getting round the house with crutches and asked one of the receptionists in the haematology department if she knew where we might be able to buy a sturdy walking stick. Today while I was having my chemo, someone from the physiotherapy department came up and measured me and a few minutes later produced a stick which is perfect for taking the weight off my hip as I move around the house.