May 2020 – The most unusual trip to Italy, skilfully handling COVID challenges...

I am writing this post from the hospital where I do my chemo, having come back from my trip to Pisa to ablate the liver metastasis. So, how did I manage to get there, do the operation and travel back in just a week – or indeed how did I manage to do this at all given the COVID restrictions throughout Europe?

Well, let’s say that it was not very straightforward and, most of the time, I was not even sure whether I was blatantly violating or strictly adhering to the continuously changing lockdown provisions!

The first challenge I faced was to get to Pisa of course. Jane and I agreed that I would go on my own since, in case I got stuck in Italy, she would be able to take care of the kids.

I started looking for flights immediately after my dad told me about his proposed solution. All direct flights to Pisa were cancelled but, after a bit of research, I found out that Alitalia still run some flights from London to Rome – these were mostly aimed at repatriating people that got stranded abroad.

I managed to buy the last of the few available tickets for the following day and then decided to rent a car to get from Rome to Pisa. The distance between Rome and Pisa is around 350km – not exactly around the corner. Under normal circumstances, the journey would take several hours, but my hope was that the total lockdown would help me to do this in around 3 hours. Still a long time for somebody that is not in the best shape but I thought it would be doable and safer than taking a train.

I also had to make up my mind on what to tell the kids, who didn’t know about the newly discovered metastasis and the need to ablate it. After some hard thinking, I decided to tell them that I had to go to Pisa for a few days in order to explore the possibility of undergoing a new therapy, based on a vaccine, which if successful, would allow me to stop or reduce the frequency of chemotherapy. This was yet another lie, but it is true that I am pursuing such an option in Frankfurt – more on this on the next blogs.

So, in the morning of the following day, Jane drove me to the airport, we said good-bye to each other and my solitary trip to my country began. Solitary given that Jane, my rock, would not be there this time and solitary also because Heathrow airport was so empty that it looked like a post-apocalyptic movie setting.

Checking-in was easy as I only had to explain the medical reasons behind my trip which, unsurprisingly, were considered serious enough to allow me to go. And going through security was equally straightforward as there were only a handful of passengers in the whole terminal and no queue whatsoever.

The whole process was so easy that I got to the gate around 3 hours before the flight. I immediately found a seat in front of the gate, took my latex gloves off to open the packaging of an energy ball, and suddenly realised, in horror, that my wedding ring was missing! It must have got stuck inside one of the previous gloves I used and I must have thrown it accidentally in a bin. I frantically looked around for ages but with no success.

So after almost twenty years of wearing that ring every day (our anniversary is on the 2nd September this year), it was gone forever. I got quite upset about it and started thinking that this may be a bad sign for the journey I was about to undertake.

The flight to Rome was actually quite comfortable as there were no more than 10 passengers (which I was surprised about given that I had apparently bought the last available ticket) and everyone had at least three or four empty rows of seats around them, which made it look like we were all on a private jet.

As the plane was about to land, I was amazed by the total absence of cars on the roads and, wherever I was looking, it looked like the whole area had been evacuated. I was partly expecting this as I knew that the lockdown in Italy was much stricter than the one that was imposed in the UK. Nevertheless, to witness it with my own eyes was quite shocking.

More questions were asked at the customs about the reason for my trip, but the various forms I had completed were quickly approved and, once I got hold of my rented car, the journey to Pisa began.

Again, I was struck by the absence of cars on the roads – traffic was so inexistent that I kept encountering (and having to avoid) a large number of birds walking in the middle of the road, obviously thinking that this had become their own territory in this new crazy world we live in.

I arrived to Pisa three hours later as I had hoped and was able to see my beloved parents for the first time in months. We were all wearing masks and sitting far away from each other but it was fantastic to spend some time with them and being able to eat my mum’s amazing food again.

The following day (27th April) I went to the hospital, took a COVID swab, which turned out to be negative, and then discussed the imminent operation with the doctor in charge. We agreed that this would take place on the 30th April and that I would be able to leave the hospital one day later, in the absence of complications. The doctor strongly disagreed with my plan to fly back to London shortly after, but I am so used by now to take risks, that I barely registered those words of caution. I had booked a flight for the 2nd May and was determined to take it to go back to Jane and the kids.

On the 30th April, I was admitted to hospital after yet another negative COVID swab. I shared a room with a guy in his seventies, who had just had a liver transplant and was amazed by his resilience, optimism and love for his life. We chatted quite a bit during the two days I was there and I found our conversations very uplifting.

The operation took place in the afternoon. This time it would not be an RFA ablation like the one I did in London in January, but a microwave ablation (so-called MWA). As explained in an excellent article by Loukia S Poulou et al. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450182/):

“The therapeutic effect of both methods relies on thermal injury, but MWA uses an electromagnetic field as opposed to electrical current used in RFA. Unlike MWA, the effect of RFA is partially limited by the heat-sink effect and increased impedance of the ablated tissue. Compared with RFA, MWA attains a more predictable ablation zone, permits simultaneous treatment of multiple lesions, and achieves larger coagulation volumes in a shorter procedural time. Major complications of both methods are comparable and infrequent (approximately 2%-3%), and they include haemorrhage, infection/abscess, visceral organ injury, liver failure, and pneumothorax. RFA may incur the additional complication of skin burns. Nevertheless, there is no compelling evidence for differences in clinical outcomes, including local recurrence rates and survival.”

In short, the two techniques seem broadly comparable and different hospitals appear to have a preference for one or the other for reasons that I do not fully understand.

Anyway, the operation was performed by an excellent surgeon and, when I woke up, she explained that everything had gone according to plan despite the slightly awkward position of the metastasis, which was not very easy to reach. This is all I could take in, since exactly like the previous time, I was in quite a lot of pain after the procedure and, on top of it, a bit confused by the anaesthesia.

But by then it was already evening and, with the help of painkillers and sleeping tablets, I was able to sleep relatively well and the morning after I was fully ready to leave the hospital. Indeed, I was very eager to do so since it was my dad’s 79th birthday and I wanted to spend as much of the day as possible with him.

My dad came to pick me up at around 11am and we had some really nice chats with him and my mum throughout the day, which was great although I became quite emotional about my situation at various points in time. I practically never let myself go even when I’m on my own but, being in the house where I have spent so many lovely moments with my parents, my sister, Jane and the children (and with no bad memories linked to my illness as I had not gone back to Pisa since I was diagnosed in February 2019), made me happy and miserable at the same time.

The following day it was time for me to go. My parents were worried about me embarking on a journey less than two days after the operation but I knew it was the right thing to do (also because I had chemo planned in London two days after getting back from Pisa).

The journey from Pisa to Rome was very similar to the one I did just a few days earlier (i.e. lots of birds flying around and virtually no cars). After dropping the rented car, I quickly checked-in and then got on a flight which was even more surreal than the last one.

This time the plane was one of those that are used for intercontinental flights – massive. And the number of passengers, if anything, was even smaller than on the journey from London. The whole thing was so bizarre that I remember taking pictures and sending them to my friends for a laugh.

Jane came to pick me up at the airport. It was great to see her – we were both happy and relieved that I had not got in trouble in Italy and that everything had gone according to plan. Jane was also very nice about the wedding ring mess-up and she promised to get me a replica as a birthday present, which she did a few days later, on the 7th May, the day I turned 48, a milestone that seemed impossible to reach a year ago.