We are now in the centenary of the Battle of the Somme ^[1], one of the largest battles of the First World War fought by the armies of the British and French empires against the German Empire.

For that reason, I have been re-reading Somme: The Heroism and Horror of War by Martin Gilbert. It is striking how many men who became well known in later life served at the Somme, for instance J. R. R. Tolkien and the composer Ralph Vaughan Williams. Some of these veterans suffered long-lasting effects from their time there.

One such individual is my motivation for writing this column. Something that he said about his experiences when injured seemed to resonate with my experiences as a multiple myeloma survivor. Perhaps this is just be­cause I think about myeloma too much, and so see connections to it all over the place, I’m not sure.

The person in question is Harold Macmillan ^[2], who served as an officer in the elite British army unit the Grenadier Guards. Macmillan later became British Prime Minister, from 1957 to 1963. (It always surprises me that two of the quintessentially English figures of 20th Century politics, Macmillan and Winston Churchill, were actually half-American, since their mothers were from the United States.) Macmillan was severely injured in the hip at the Somme in September 1916. He was on crutches for four years, and was left with a shuffling walk for the rest of his life.

After retiring from active politics, Macmillan became Chancellor of Oxford University for many years. The Chancellor of a British university is some­thing of a ceremonial position, usually held by a celebrity of some sort. I saw him only once when I was an undergraduate at Oxford. He was escorting Queen Elizabeth while she was on a visit to the university. After their official dinner that evening, the two walked around the quad­rangle of my college, and we students stood and applauded them as they did so. It somehow seemed a bit strange to clap people just for walking a few hundred yards, but that’s what we all did.

I experience flashbacks to that evening every year when I attend a local cancer fundraising event. The sur­vivors make one circuit of the track before the teams start their all-night fundraising laps. The volunteers applaud us as we make our single lap, which reminds me vividly every time of how we applauded the Queen and Macmillan all those years ago.

The main reason, however, I think of Macmillan in connection with cancer and multiple myeloma is some­thing that he said about his experiences at the Somme. Of course, the context is very different, but the underlying idea resonated with me.

When he was injured, he lay in pain in a shell hole in no-man’s land through much of that day. He spent that time reading his pocket edition of a play by Aeschylus in the original Greek. Finally, when darkness had fallen, it was safe for stretcher-bearers to come out and take him and other injured soldiers away to a field hospital. On the way there, the confusion produced by darkness and artillery shelling led to him somehow becoming separated, fortunately in relative safety, from his companions.

Reflecting later on his experiences, Macmillan compared what it was like being with others and then being alone as follows:

“Bravery is not really vanity, but a kind of concealed pride, because everybody is watching you. Then I was safe, but alone, and absolutely terrified because there was no need to show off anymore, no need to pretend … suddenly there was nobody there … you could cry if you wanted to.”

I was very interested to find this quote, as it fits with some observations I have made over the years about coping with multiple myeloma.

I don’t think that I am an immensely proud person, but I definitely hope to behave in such a way that people don’t think that I’m making an undue fuss over things. I try not to use the old song title “Poor, Poor Pitiful Me” as my template! In very different circumstances, Macmillan obviously felt much the same. Maintaining a brave face in front of others can, I think, help you to stay a bit more positive about things. (Of course, it could be argued that writing a column where you complain about your experiences with dexamethasone and so on is perhaps not fully compatible with maintaining a stiff upper lip in public!)

Conversely, when alone, things can start to look blacker. Thus, when Macmillan became separated from the others, he for the first time felt truly terrified, even though he was in a much safer location than he had been earlier in the day. In our case, on a day when, for instance, bad test results come in, it can be much harder to stay brave about the situation if you are on your own. I am fortunate that I am not having to deal with myeloma alone. That must make an already difficult experience even harder to cope with.

Of course, everyone deals with things in their own way. As we used to say back when I taught spacecraft design, “There is no single right answer.” That is why the U. S. Mercury and Soviet Vostok spacecraft look completely different, even though they were both solutions to the same problem: “Design a spacecraft to take a person into orbit and return them safely to the Earth.” So, many survivors may not agree about the benefits of having people around to stay brave in front of. And, of course, it can definitely be therapeutic to have the occasional moan with your “inner circle.” No one can be brave all of the time.

Despite these caveats, though, I would guess that Macmillan’s words will resonate with many myeloma patients.