“You’re cured”. How can such simple words mean so much? And it is not the first time that I have been the recipient of such good news. Twenty years ago, after having undergone surgery to excise a high risk malignant melanoma, I received a similar verdict in the same hospital, the quite unique Christie. Then I stood, this time I was seated. Then my hair was blond, now it is grey. And I am being informed that recent blood tests indicate that The Alien, an aggressive Gleason 8, is no longer in attendance. The PSA level came in at less than 0.1, the testosterone level less than 0.2. Results that I had hoped for were now indisputable hard data. The would be assassin has fled the scene, defeated by the advances in medical science together with the combined efforts of the doctors, nurses, radiographers and many others, some working in distant pharmaceutical laboratories. People who I will never meet.
I exit the hospital into a late, cold, darkening wet Friday afternoon harbouring complicated emotions. I am euphoric yet chastened as I remember my mother and all the cherished life-long friends who I have lost, four alone in the last two years. Due to late diagnoses, their prognoses were quite poor. They lasted for only a few weeks. I deeply miss them more than I can put into words. Most of you reading this will share the same feelings of irreplaceable loss.
I have looked at some stats. There are approximately 1,000 new cancer cases in the UK per week. And although cancer survival rates are improving, more than 3,000 people die from cancer each week. One quarter of these will last no longer than six months, mainly due to late diagnosis. And, although the UK is the fifth largest economy in the world, Britain has the worst cancer survival rate in Western Europe. How can this equate? Is there something profoundly wrong here? I have always taken great care to maintain an apolitical blog but I am compelled at this point to say that so often I have strongly disagreed with Governments’ (pl) spending priorities. So often I am of the opinion that significant amounts of the public purse are carelessly spent, perhaps squandered on projects, causes that I deem are not nearly as vital as saving, extending, improving the quality of peoples’ lives by providing enhanced medical provision. But enough of this. It’s a worn tired debate. My hat, or yours, thrown into the ring will go unnoticed. Back to the thread.
For the second time in my life I have somehow, for no apparent reason, managed to evade the voracious, pitiless grasp of The Grim Reaper when so many countless others have not. Many years ago I reached the firm conclusion based on thinking, observation and evidence, that life is a random, illogical game of chance. We delude ourselves if for one moment, we think that we are in control of our lives, our destiny. Some will simply be luckier than others and no amount of philosophy or theology can make much sense of that because there is no sense or reason to be found. Disappointingly so, there is no Grand Plan. The Gods are cruel and indiscriminate, perhaps even more so than homo sapiens. They give life only to take it away on a whim, a throw of a dice, a spin of the wheel. I am remembering a hymn sung at my old school. One of the lines – “Live every day as if it were thy last”. We should have sung that one line. Every day. Fortissimo.
And now what lies ahead a propos further treatment? The thirteen weeks cycle of Prostap injections will continue for a further two years. During the third year the side effects should, hopefully, disappear. But I must be careful to say that side effects can be widely different for every man. For me they mean that I must fight the ever present fatigue each day beginning with every morning. It is ever-present. The temptation to sit and do nothing is to be resisted. It is always a challenge. A test of will power. Resolve has taken the place of testosterone as a driver. However, it is possible to wade through water however deep. And then there are the hot sweats, at the moment 70 – 90 per week. They are quite debilitating. I am presently attending weekly sessions of (western-based) acupuncture at the Christie with the hope that this treatment can, to some extent, alleviate the frequency, intensity and duration of these nuisances. Getting up six or seven times per night to wipe myself dry results in sleep deprivation adding to the levels of fatigue.
I will be monitored every six months for the remainder of my life. At present the one major indicator of renewed malignancy is a PSA test and I am, in addition, scheduled to visit the Urology department at the Wythenshawe hospital. I have not been there for some months. I hope there is some kind of trail for me to follow. The numerous signs pointing the way to this department have never worked for me.
And at times there are still some residual, quite inconvenient side effects from the month of Radio Therapy that I had in August/September. Scroll back to ” Medical Science v The Alien – A Month of Radiology”. September 16th 2018. And, as a reward for doing so, you will find a photograph of me after my last treatment ringing Emma’s bell.
And my music? Some years ago when I started this blog it was my sole intention to chronicle my progress as a composer but, as my diagnosis fifteen months ago so changed my life, I decided to write about my life as a composer living with cancer. The rate of my composing has slowed due to the fact that on so many occasions I can barely summon the energy to rise to the cognitive level required for composition. But I have persisted. I have never given up. I don’t give up on very much at all. And I have written many new pieces, all of them of quite short duration and, in doing so, I am nearing the completion of my next project, more of which I will disclose in future posts. And, after this incredible news regarding my health I can settle and write that tenth piano sonata. And the eleventh. And the twelfth.
During the last fifteenth months or so I, as a patient, visited three Manchester hospitals – The Christie, Wythenshawe and Trafford. There have been many visits sometimes two, maybe three a week, and on every single occasion I have been so greatly impressed by the professionalism, the singular dedication of the doctors, nurses and all the supporting staff. These are exceptional people working every day under considerable pressures and stress. Their efforts can only be described as truly heroic. And it is because of these people and others involved in the development, the rapid advance of medical science that I can now look forward to extension of my life. I will be forever in their debt.
For me now, there is light at the end of the tunnel but, as I look back on the last fifteen months, there was never any other outcome to be considered. Not for one second. One has to always believe and, if there is nothing else, there is always hope.
Thursday 28th January. The weather is in synchrony with the season. Snow has somehow managed to penetrate the ever- present mantle of Manchester’s polluted air. The mercury hovers around zero. Vehicles are stranded, abandoned and on the pavements (sidewalks) people tread according to their age. The elderly with caution. The young progress regardless of the fact that there is absolutely no friction ‘twixt foot and the compacted, trodden snow. I also see the occasional T- shirt and shorts. What unaccountable science is going on here?
I am bound for the Christie hospital for the first of nine treatments of acupuncture which might, hopefully, ameliorate the debilitating effects of the hormone therapy, which, in conjunction with radio therapy, is being employed to keep The Alien at bay. I find my way to the Re-Upholstery Department and after only a short wait am called, beckoned, welcomed and led into a small room.
Joy has entered into my life.
She sets about the chore of assembling some kind of patient profile. I can anticipate the questions, Joy cannot anticipate the responses. Allergies? Salads and children. My subsequent answers are equally informative. The profiling is quietly abandoned for the day, put to one side.
And now it is down to the business. Within a few minutes twelve needles are growing vertically from my feet and legs. An extraordinary sight. Joy dims the lights and leaves me lying on the bed for thirty minutes or so. It’s very quiet amongst the shadows. My thoughts play a game of bagatelle whilst I wait impatiently for her return upon which the lights are brightened and the room filled once again with her practiced dialogue. The needles are removed, carefully counted. Am I supposed to feel any different? I take a quick inventory of myself. No, I don’t think so. But, during the following week, I experience half my usual number of hot sweats and, for several nights, sleep for more than my usual 4 or 5 hours.
Seven days later I am in the same tiny room. Joy needs to know how I have reacted to the first session of acupuncture. The response, however, is not straight forward. The improvement on the frequency of hot sweats might be due to the fact that the week has been the last in the thirteen week cycle of Prostap (H.T.) injections which is my regime. I usually feel better at this stage. Or could it be that the acupuncture is already having beneficial effects? It is supposed to be an accumulative treatment. This line of enquiry is laid to rest.
This week 16 needles sprout from my feet, legs, hands, brow and head. Joy is upping the game. A routine is already becoming familiar. Dimmed lights, a disappearing Joy, a sudden silence. Again, I am alone, insulated, surrounded by mute shadows painted on the walls at such variance with the energy and vibrancy that is just feet away on the other side of the door.
This is all very strange and my unfocused thoughts resemble the uncontrolled, random trajectories of a pin ball machine. After a seemingly endless thirty minutes Joy materialises and brightness and normality are restored. She resumes her practiced dialogue whilst the needles disappear, one by one. This week we both count together.
I exit the Christie into the cold, dark chill of an early February evening and soon become part of the endless, slow- moving line of commuter traffic. Will those sixteen needles have any favourable effect upon the fresh injection of the Prostap? I usually feel quite below par for some days after an infusion of this powerful cocktail. Let’s see……………
This review is by Peter Byrom-Smith who is rather more than a critic. He is a composer, he lectures on musical composition and hosts a radio show on Fab Radio International. I always welcome being discussed, dissected by fellow musicians, especially when they are composers. They typically exhibit great dollops of empathy, perception and acuity when writing about my Non-Prescriptive compositional techniques.
His review is most positive and his comments generous although, not for the first time, Scott McLaughlin’s magnificent notes receive some flack.
I will again rise to the defense of Scott (that’s Dr. Scott) McLaughlin’s sleeve notes. Who, other than he is able to write with such clarity, erudition and authority about the insanity of quantum entanglement and the complexity of my compositional techniques? Yes, Scott also reads Difficult Science and has closely followed the evolution of my compositional techniques for many years. I know that many people, including reviewers, are dependent upon his notes to gain a greater understanding of my music.
I do, however, have one quibble with the review. Mr. Byrom-Smith labels Entangled States as “An interesting concept album”. This is the first time any reviewer has used this term in connection with my music. I think that Mr. Byrom-Smith might be applying that word “conceptional” in the sense of an album whose parts hold a greater purpose collectively than they do individually – where the process of creation is more important than what is actually created, the idea or the concept being the most important aspect of the work as opposed to the outcome. I am guessing, surmising here. I have not discussed this with the author. My presumption may be way off-track. I might be interpreting his label wrongly. But he does refer to ES as “an interesting conceptual idea”. That’s a clue, isn’t it?
If this is the case and my suspicion is indeed correct, then I must state that my Non-Prescriptive ideas, techniques and methodologies have been developed solely in order to achieve a quite specific end result. They have never been considered (until now ?) as an end in themselves.
Allow me to extend two examples which I think are relevant to this point.
Firstly, 12 Tone Rows or serialism. This once reactionary methodology is associated with Schoenberg and his contemporaries, the Second Viennese School, c.1920. This system was never an end in itself. It was developed essentially to challenge the traditional tonal, melodic and harmonic structures which had been the bedrock of western music for four centuries. The fundamental concept of the 12 Tone Row System was designed to give equal importance to each note of the diatonic scale. Doh was dead. Doh was no more! Atonality was the new big idea.
Secondly, counterpoint, sometimes although not always correctly, referred to as polyphony.
This complex and rather cerebral compositional technique was developed in the Renaissance and perfected in the Baroque period by J. S. Bach and his contemporaries. Typically the music is identified by having several lines or voices that utilise the same melodic idea. The result is a rich harmonic tapestry, each part contributing to and enriching the whole. One of the greatest examples- for me as a pianist- of counterpoint is Bach’s 48 Preludes and Fugues c 1730. It is no coincidence that Entangled States is also made up of 48 pieces. Bach’s 48 was inspirational for me. And also, like Bach, I wanted to fully demonstrate my own compositional ideas that are embodied in my Non-Prescriptive techniques. The 48 also known as the Well-Tempered Clavier (no, I’m not going there) has been performed many times by giants, Ashkenazy, Barenboim, Gould, Richter inter alia. But significantly, not one recording of the 48 has been described as a concept album. Ever. QED…
That’s my cavilling done with. That’s my two cents- worth. Think of it what you will. I do hope Mr. Byrom-Smith responds and that we can engage, exchange ideas, discuss this point. Is that label justified?
The review is written by editor Jeremy Condliffe whose family runs this independently- owned weekly newspaper. Since it was founded in 1893 this journal has had only four editors. I find that quite remarkable. It typically distributes 16,000 copies across south Cheshire and north Staffordshire.
Unfortunately, the link provided gives access to only the first paragraph of the review and I somehow do not think that you will subscribe to read the full article. In lieu, here are some extracts:
“Ms Dullea improvises where she needs to, and like a good writer can ape the style of different people, she presumably does a good job of inserting what Craven wants; perhaps he doesn’t want anything, just something. He is non-prescriptive after all.
“What does it sound like? It lacks most of what music normally possesses but is neither unstructured or formless … and it is never strident or intrusive.
“It also reminds us of Steve Hillage’s seminal ambient album, Rainbow Dome Musick which just emerges for a while then stops.
“Basically: nice piano, expect mood more than tunes.”
That’s quite some connect. Rainbow was written in 1979. It was a music ambient conception that was pioneering, ahead of its time. It was one of the very first of the genre of electronic psychedelic that became so popular in the 1980s. Just what is the connection that Mr. Conliffe is attempting to make here? Perhaps the answer lies in his last sentence:
Monday 6th August. A blue sky, bright sunlight, temperatures in the high twenties. The heatwave continues and shorts worn with socks are now the fashion.
I make my way to the Radiography Planning Department at Manchester’s Christie Hospital. The purpose of my visit is for a unique plan of treatment to be prepared. I have a CT scan which gives my cancer specialist, Dr. James Wylie, information from which he can devise the course which will last for four weeks. A calculated amount of high energy x-ray beams will be directed at the prostate. This will cause damage to the cells of The Alien which, in turn, will stop them from dividing and growing. The hormone therapy which I have had during the preceding six months has possibly decreased the size of the prostate by as much as 20 per cent and made The Alien more susceptible to RT.
During the scan three tiny tattoo marks are made in specific areas on my hips and lower abdomen. This will enable the radiographers to set myself and the linac in exactly the same alignment for each of the 20 sessions. The scan also shows the precise location, size and shape of the prostate which ensures that the radiotherapy is targeted at The Alien and that the surrounding tissue – mainly the bladder and the colon – receive as little as possible.
The First Week of Treatment.
Monday 20th August. It’s still very warm but I forgo the shorts. I present myself at The Christie Radiotherapy Department and am directed to Suite 3. There are 11 suites in total. I am welcomed by staff clad in maroon coloured scrubs and am comprehensively briefed on procedures and possible side-effects. I am trained, prepared for what will very quickly become a familiar routine.
I climb onto a table, there is a soft, yielding headrest and my knees are slightly elevated by a cushion. The tattoos are exposed and painstaking alignment commences. Small movements of myself, the table and the linac. Measurements are read and sharply defined green lines move over my lower abdomen. Millimetres are critical. The team become focused on the alignment. It has to be precise. They notify me that they are leaving to go to their shielded control area. The team can observe and talk to me via CC TV.
Suddenly, silence, stillness. I concentrate on remaining perfectly motionless. I am not quite cognisant of what is to happen but the arms of the machine, a linear accelerator, which surround me begin to make noises and begin a slow 360 degree sweep in one direction, pause, generate different noises, and then proceed in a slow 360 degree rotation in the opposite direction. The machine is quite vocal. It sings its song. Whilst I am zapped by high energy x-rays I lie and listen to the music of the machine. There is no sensation and I am somewhat disappointed that a Star Wars-like coloured beam does not emanate from one of the pieces of equipment circling me. I am informed that each machine costs in excess of £3,000,000. The greater part of the linac is installed in and beyond the wall of the room at the head-end of the table.
The Second Week.
I am now an old hand. Grizzled, experienced. The staff and I are on first name terms. I am informed that I have, for some unknown reason, become one of their “favourites”. What have I done to deserve that honour? Can it be my happy socks?
And halfway through the week the anticipated side-effects begin. I have read about them, been informed of them by the radiographers and now they are upon me. Urgency and frequency. I am given Tamsulosin by a doctor. It gives no apparent relief and my journey by metrolink tram to the hospital becomes increasingly fraught.
The Third Week.
The side effects become more acute and, by necessity, I am confined to quarters except for my daily commute to The Christie. I have now exchanged the mode of travel from the tram to a car. This journey typically takes 25 minutes. With some foresight and planning I can just tolerate this amount of time. My appointment times are helpfully changed so that I am able to travel when there is slightly less congestion on the roads. There is always traffic congestion in Manchester. It is the second most congested city in the UK after London.
I am now visiting the bathroom 10 – 15 times during the night. I am becoming incredibly fatigued. I no longer go to my music studio (The Struggle). The beam is affecting my bladder and colon.
So it’s time to turn up my resolve. I am determined to see this through. I am resolute. The equation consists of short term difficulties, inconveniences, disruption, against an extension of my life. It is a no brainer.
And several of the radiographers have gleaned during our conversations that I am a composer. A few have read my blog and show an interest in my music. Next week I will present them with some of my CDs as a grateful thank you. It will be different from the cakes, chocolates, wine and flowers that constitute the usual currency of patients’ gratitude. The staff, are beyond praise. They help to create and sustain the ethos which makes this hospital such a special place. They are all mostly young, some having just completed their three years of training. When they are asked what they do, I would like to imagine their response as being along the lines of “I save lives and give people hope”.
The Fourth Week.
I am finding that the weekends of rest are necessary. I am informed that the tissue surrounding the prostate, which is suffering collateral damage from the radiation, can recover to some degree. Again I turn up the resolve button. I am reduced to a state of almost total exhaustion, this post has taken several days for me to write. Interesting prose and wit elude me.
As ever the days slip by. Time is slowed. It is moving slower than the rate of tectonic drift. There has been no respite from the side effects of urgency and frequency. Doctors inform me that this is not uncommon and that the condition will typically continue for six to eight weeks after completion of the course.
The final date of treatment at last becomes the present. It is Friday 14th September. My course of treatment commenced in hot Summer weather, today it is distinctly Autumnal although the leaves have not yet begun to fall. Two radiographers, Thomas and Aneeka, guide and instruct a student who has difficulty in manoeuvering my body into the correct alignment. She will learn. There is an air of celebration. We joke (“Here I lie prostate before you”). The machine commences its circumnavigations and sings its song. We hug and say our goodbyes and I bid my farewell of these special people.
Previously, when the bell has been rung, I, together with all the others in the vicinity have applauded. That signifies many things including feelings of empathy and brotherhood (sisterhood?) And now it’s my turn. I have been waiting a long time for this. I grasp the plaited rope and ring the bell the required three times fortissimo. I leave the hospital with layers of complex emotions.
It is often an emotional moment when patients who have completed their course of chemo or radiotherapy get to ring the bell. And there is a fascinating, rather magnificent history attached to this celebration.
Emma Payton was eight years old when she was diagnosed with a rare form of soft tissue sarcoma on her face. After some treatment at The Christie it was decided that she would benefit from Proton Beam Therapy. At that time The Christie did not have this technology so Emma went to a hospital in Oklahoma, USA. There, on the final day of her treatment, she rang the bell. It was an already established tradition. Her family were so inspired by the moment that they have since donated almost 200 bells to hospitals across the UK.
As you can see from the photograph, the bell is a rather hansom specimen, highly polished. It has a nice length of plaited rope attached to the clapper. The verse on the wall behind the bell reads:
Ring this bell
three times well
its toll to clearly say
my treatment’s done
this course is run
and I am on my way.
Emma Payton/Maria Watt
When the bell is rung everyone in the vicinity, staff and patients, stop what they are doing and applaud loudly and enthusiastically and with recognition.
This year The Christie Proton Centre opens for business. Emma and her family have reserved the special one hundredth gold bell for the proton beam therapy department.
Moving on, looking forward.
I am informed that the side effects of the RT will take 6 – 8 weeks to resolve. During this period I will adopt a period of iron discipline. I will consider eating lettuce, having an alcohol free day and inducing sleep by listening to minimalist music. I have acquired a pedometer app on my phone. I will acquaint myself with this toy, mindful of the fact that my walks around the ‘hood will, by necessity, have to remain within a short distance of the bathroom and I will watch programmes on the TV which show people running very quickly. Exercise by proxy.
30 months of HT (Prostap) lie ahead. I will seek to find ways of mitigating the prominent side effects of this which are, for me, fatigue, breathlessness and frequent hot sweats. As soon as it is possible I will resume the commute to the Struggle and summon the required level of cognitive energy that I need to compose. My music is perhaps the principal victim of this rather unfortunate period in my life.
I am all too aware, despite the last line of the verse attached to Emma’s bell, that my journey, as Florence refers to it, is far from over. Dr. Wylie informs me that my type of cancer is slow to react to the treatments and that it will be six months before he will be able to assess the damage sustained to The Alien which is persistent and intelligent. It is able to adapt and react to HT. It is a wily beast. (Sorry Doc, I couldn’t resist).
The engagement between The Alien and medical science is far from the end. It is neither won nor lost. Perhaps it is simplistic to think in terms of winning and losing. Perhaps it is best that I don’t think in these terms at all and just get on with my life, my music.
Some four years ago I made a small pencil mark on a blank sheet of manuscript. The relocation of stuff in my head to stuff on paper had at last begun. This project had been swirling about in my thoughts for quite some time and now my ideas had clarified, become defined to the point at which I knew I could take on the challenge of what I considered to be quite a daunting undertaking.
That moment was the first step on a long creative process which has involved the combined skills of a small group of supremely talented people – Mary Dullea, Alex Van Ingen, Scott McLaughlin, Peter Vodden and Stephen Sutton. For regular habitues of this blog these are familiar figures and need no introduction. Without them my ideas, my music, would not go beyond the confines of my studio. I am deeply indebted to each of them.
Entangled States extends my Non-Prescriptive methodology. For further explanation I refer you to Scott McLaughlin’s well-researched and detailed sleeve notes. These can be downloaded. The structure of E.S. is comprised of 48 pieces of short duration. 24 are written in my low-order format and 12 in middle-order/high-order formats each of these having 2 realisations. This to demonstrate the raison d’etre of Non-Prescriptive compositional and performance techniques – namely that each piece can be played (realised) in an infinite number of ways.
Divine Art has described Entangled States as an “astonishing masterpiece of contemporary complexity”. I hope that this epithet does not deter people from listening. It might be that many people are not attracted to the idea of introducing further complexity into their already complex lives.
Entangled States seeks to push against certain established compositional boundaries. An increasing body of opinion reckons that I am “taking music in a different direction”. If this is the case I must hope that I can take my audience with me to wherever my journey leads.
Now that the CD has been released I must await the comments and evaluations of the reviewers. Perhaps it should not be so, but as a composer I exist embalmed in permanent layers of doubt and uncertainty and, from choice, work in a self-imposed near- vacuum. Their generous comment and approval lends me some degree of assurance, a motivation to continue, so necessary on the many days I hit the compositional buffers.
To conclude this post I include a very recent brief review from Naxos which is the largest independent label in the world and one of the biggest-selling classical labels. It is also one of the largest global distributors of independent classical record labels such as Divine Art.
“Eric Craven is like no other composer – both because for most of his life, he has been a recluse from the musical establishment while living out his role as family man and teacher, and also because his compositional technique is his alone. Aleatory in general principle but more complex, his works contain elements of both high-order and low-order ‘non-prescriptive’ writing – in other works varying degrees of flexibility allowed to the performer. Totally abstract in form and concept, though inspired by a principle (here, the particle entanglement in Quantum Mechanics), the pieces, especially ‘low-order’ where the score is more prescribed, can take on the appearance of other forms such as baroque fugue, romantic prelude or even soft jazz. Moreover the music is hardly ever ‘challenging’ for the listener, with quasi-tonal, melodic flow. In many ways Craven is laying down a new direction for piano composition. Mary Dullea in her third album of Craven’s music demonstrates her amazing pianistic prowess but also her perceptivity and understanding of the scores which she realises in full showing wonderful expertise in interpretation. Dullea, as both solo artist and member of the Fidelio Trio, is becoming one of the ‘must-hear’ pianists in the contemporary music world.”
I am in a state of suspension, both physically and psychologically.
Two weeks ago the results of tests indicated that my testosterone level remains stubbornly high. This, given my cancer, is not good.For those of you who are not oncologists, a brief explanation.
Prostate cancer cells usually require testosterone to grow and flourish. Fortunately hormone therapy can stop the body from making testosterone. The effectiveness of the HT can be measured via the level of testosterone.So Dr. Wylie, he of The Christie,is concerned, has ordered more tests in three weeks. I am waiting, counting down the days, hoping for a better result.
At the moment, and it will be for only a short time,until my body learns to tolerate the HT, there are side effects.Before the course of HT commenced I was able to do 60-80 star jumps, press-ups, take stairs at a gallop and sprint along streets, after making sure I was not being observed,for the sheer delight of being able to do so. Things are now different.I am breathless on standing. I can walk, I can talk but not at the same time.I am slowly, reluctantly learning to acknowledge and accept my new physical limitations.
And I am tired, exhausted at breakfast time. I spend hours each day falling into a deep. dark, dreamless pit of unconsciousness. I am generating my own anesthetic.
I am desperately trying to maintain my composing. It’s what I do. It’s what I am but , at the moment, progress is minimal.I am finding it most difficult to maintain the necessary focus, intellectual activity for more than a very brief time.I have something to say and I cannot say it.
The next post will have good news. I promise.You deserve it after this protracted stream of miserable reports.