contact with the realities of working class life and those with extreme social circumstances and to his credit, he continued to work on the health needs of London homeless to the end of his professional career.
For Paul there was : "Nothing more fascinating than taking scientific advice, converting it into practical action and encouraging the public to understand and support the action". Nevertheless, he admitted : "I could no longer do justice to the intensity of work needed during major national incidents such as coronavirus. Nevertheless I feel privileged to be involved still through an emeritus role and able to help wherever I can as the nation responds to the present crisis".
He was both philosophical and courageous as he faced death in his country home with his wife and fellow doctor, Gillian. He said : "Perhaps it is the same for us all, whatever our age—if we know that we are approaching the end of our life, it is helpful to have a place of contemplation. I walk from the back door, along an old track and across the field that is the home of two familiar chestnut coloured horses. They raise their heads as I pass, and a poorly constructed wooden bench sits in the field beyond. It is perfectly situated for the view, which appears just as the path starts to descend a sandy ridge. Two rough planks, one to sit on, one for leaning, are fixed to the two decaying tree stumps that form its legs. It wobbles slightly but is strong enough for me to rest and ponder"."I am not an old man, but like the bench I won’t last long, but I don’t rail against the world as I sit on the bench. I’ve seen enough people die younger and in worse circumstances for that. I do watch the world go through its familiar cycles, knowing that I won’t see many more. The inquisitive lambs of spring, full of life then suddenly disappearing as their short lives end in the abattoir. The crops, subtly changing colour through hues of verdant green, then replaced by the bare soil of the ploughed fields after harvest".https://www.bbc.co.uk/sounds/play/p092dllz She asked him about the bench and he revealed that it was a place to "think about some of the things that seem particularly important". He said that one of the things he had "spent time contemplating, is how you actually die and it seems to be the worry more than the fact that I'm going to die. We know, all of us, that we are going to die at some point, but the actual way that you die is quite scary and quite difficult to think through".
Paul said that he liked "the idea that I could have an extra phial of morphine in the fridge so that if everything just becomes too much and the symptoms can't be controlled, I'd have an option to use that in the last few days of life and accelerate things if that was the only way of getting things under control and maintaining any sense of life that I do have, as a reasonable quality. But that's not available within the law at the moment".
In lending his support to an 'Assisted Dying Inquiry' he said : "What I think we do need to do is to have a really clear view of what the problems are that people face as they come to the end of life and what people, who are dying, facing the end of life, actually want to happen. So I think it is important to have an 'information gathering'. What are the views of the palliative care geriatricians and other specialists ? What are the views of doctors as a whole ? Certainly, from my understanding, 80% of the public think this needs to be looked at and quite possibly a law change".
He went on "The dangers that people are worried about, it seems to me, come in 3 different ways. One is that because its legal it becomes an expectation that people have an assisted death. The second is that staff involved, the palliative care physicians involved might feel compelled to participate in assist dying when have a deeply personal view that this is the wrong thing to do. And the third is that peoples lives are sometimes different from the norm, whether its because of a disability or some other issue, that their life becomes devalued in some way".
He concluded "My view is that we need to do that information gathering, then we need a group of people who are expert in medicine, in the legal profession, in public opinion and so on to look at what the potential solutions are, to look at the experience in other countries Oregon, the Netherland and elsewhere and come up with a carefully thought through set of changes. I think its complicated, but I think its not beyond us to sort this out".
Writing in the blog, 'The Hippocratic Post', Paul said : "I was in a bookshop last month and my eye was caught by a book of poems. I am not an avid reader of poetry and haven’t written any since being at school. However, there was something about the style of writing that made me wonder if I could express a little of how it feels in a poem. With apologies to those of you who are experts in poetry, here is what I came up with. As with all poems it is best read slowly, and aloud to yourself if you can do so without looking too foolish".
'So how to approach the coming three months Till time brings along the next scan? Honesty tells me I don’t have a clue I guess I’ll just: keep calm, carry on.'
The poem perfectly expressed the philosophy he had now adopted and he said : "The longer I live with a “treatable but not curable” cancer the more I realise how much good there is in life that I can focus on today, this week, this month. The uncertainty that treatments might work for much longer than expected helps me to keep that focus. It allows me to keep calm and carry on".
"I have found it is empowering when you face death head on. It means you focus your attention on the really important things and it makes me appreciate this life more than ever. When people complain about growing old, as I used to as well, I reply that growing old is a privilege and one that I wish now I could have".
In the event, we must assume that at the end of his life Paul did not have that extra phial of morphine in his fridge to be used by him to alleviate his pain. Much of what he has said about his condition and treatment with its CT scans struck a chord with me. Having been diagnosed with bladder cancer, I underwent a course of chemotherapy and than had a cystectomy to remove my bladder along with a dozen lymph nodes, my prostate and appendix. At the same time the surgeon removed a short length of my colon to create my new ileal conduit. That was 5 years ago. I was lucky. Unlike Paul, my cancer hadn't metastasized and travelled to other parts of my body, like my liver.
Paul, enacted, in his professional life and as a force for good, his advice to others :
"If you want to make a difference in life, influence those who are around you"