'I want to live'

When Paul d'Auria was diagnosed with a rare cancer, doctors thought he had only months left. So why is he still alive, 12 years later? It's about attitude, he tells Joanna Moorhead

Paul d'Auria shouldn't be around. Twelve years ago he heard the worst possible news from his oncologist: a rare chest cancer he'd been treated for the previous year had returned. He had, said the doctor, between six and 12 months to live. For Paul and his family it was, of course, an appalling blow. He was 32 years old, a commercials director with a handful of accolades and the promise of a fruitful career. Three years before, he'd married Caroline, with whom he'd worked at the BBC, and they'd recently had their first child, Charlie. In short, he had everything to live for. To everyone who knew them, the news seemed too cruel for words.

Paul and Caroline lived on our road; the first thing I ever heard about him was that he had cancer, that it was bad, that he wouldn't survive for long. But he didn't look ill: in fact, he looked one of the healthiest people on the street. He didn't look, or sound, like a "cancer victim", either. Paul d'Auria was a man who was dying of a disease that didn't frighten him. In fact, his attitude has always been the same: he sticks up a metaphorical two fingers at the condition which has ravaged his body. And his attitude has paid off, though, for more than a decade, he's stared this illness in the face, lived with it every day, never been told he was "clear" or "cured". He's carried on - sometimes despite terrible pain - and, quite simply, refused to lie down and die.

Ironically enough, it was on the night Charlie was born in 1991 that Paul had the first inkling something was wrong. "I went home from the hospital and a few hours later I was having such awful chest pains I had to call out the doctor," he says. "I thought I'd pulled something helping support Caroline through her labour. I thought it would settle down."

It didn't: and he was eventually admitted to hospital for tests. "They found I had a ruptured diaphragm, so I was operated on," he says. "It was minor but after a few days nothing was happening. One day I said to the doctor: next you'll be telling me it's cancer. And he said 'actually, we think it is'."

Two days later, three tumours were removed from his chest wall. He had thymoma, a rare cancer arising from the thymus gland. The following week was touch-and-go; when he finally came round he was told his only hope was a course of chemotherapy at the Royal Marsden Hospital.

"I did everything the doctors said," he remembers. "I turned up when I should, I followed every bit of advice to the letter. I felt awful but the cancer seemed to be on the retreat. A year after my initial diagnosis, I was told the disease was gone."

A few days later, the d'Aurias marked Charlie's first birthday with the sort of celebration they thought they'd never have - and for a few brief months things started to return to normal. Then, 10 months later, a routine scan revealed that the disease was back. It was June, and Paul and Caroline were about to go on holiday to Italy - he's half-Italian, and they love travelling there. "We went ahead. It was like a terrible farewell journey. But while I was there something changed in me. I decided that I'd make my own judgements about my body."

What that meant then, and what it still means now, is - as he puts it - keeping one step ahead of both the disease and the doctors. Many people with cancer go to see their oncologist with their hearts in their mouths, waiting to see what the scans reveal or the tests show. Paul is different. "When he tells me about a new sort of chemotherapy and says I should have a specific dose over a specific period, I think about it but I don't always agree," he says. "Sometimes I say I'll have a smaller dose over a different period. I always, always listen to my body when I'm having chemotherapy. It does work, but you can't ever forget how poisonous it is. When it's getting too much, I stop - even if the course isn't complete."

Nor did he believe any more that conventional medicine alone would keep him alive. The long list of alternative treatments he's tried over the last decade includes massage, faith-healing, electronic pain-killers, vitamin supplements and various diets. Many of the anti-cancer regimes he's followed are the sort of things that have conventional medics laughing in the aisles. A couple of years ago, his case was written up in The Lancet.

Paul is a man who's proved the doctors wrong but the thing he's proudest of proving them wrong about happened in 1998. When he was first treated he was told the chemotherapy would rule out more children. For eight years the d'Aurias thought Charlie would be an only child, until Caroline found she was pregnant. "It seemed like a miracle," remembers Paul - and their son Rowan was born.

I was among the friends who rejoiced with the d'Aurias when Rowan was born - and I was a regular visitor in the first few days of his life. On day five, Paul phoned in a panic: Caroline had been having problems feeding Rowan, and the midwife had said he'd have to go back into hospital. As they pulled off in an ambulance, I remember thinking that after all the d'Aurias had been through, Rowan simply couldn't have anything seriously wrong.

He did. Transposition of the main arteries: he needed urgent open-heart surgery. Two days later, at the same hospital - London's Royal Brompton - where Paul had had his first surgery, his baby son had a five-hour operation. It was a searing time.

Today Rowan is a healthy four-year-old. Charlie is 12 and at secondary school. Paul is still directing commercials and, a few years ago, he and Caroline managed - against the odds, given the difficulties in getting a mortgage when you've got a terminal illness - to move house.

Paul still looks astonishingly healthy - all the more amazing considering that one of the unwanted consequences of being pumped full of endless blood products was that, several years ago, he discovered he'd contracted hepatitis C during one of his early hospital stays. He admits it's a bit ironic to think he might survive cancer and then succumb to hepatitis.

His most recent scrape came just after Christmas. He was feeling more and more short of breath, and if he'd been your regular cancer patient he'd have been straight to his oncologist and on to the ward. But he's not the kind of guy who lets cancer mess him around: he knew he was ill and getting iller, but he also knew he had a commercial to shoot. "I'm the director: I have to do my job or I don't get paid - and there's a lot of money riding on a big commission," he says. "I thought, if I'm dying I want Caroline and Charlie and Rowan to have the fee. So I just carried on, day after day, althoughI'd come home from work at 3pm and I wouldn't have the energy to get upstairs to bed until 6pm."

"I went down from 12 and a half stone to just over 10. I was in terrible pain. Usually on a shoot the director will bellow 'cut!': I couldn't even talk, so I had to beckon the assistant director over and whisper it to him so he could yell it out. The client was there to watch and I think they thought I was either mad or a genius."

On the day the film was completed, Paul had a taxi waiting outside to take him straight to the Royal Marsden. "I lay down in bed and I knew that I had a fight on my hands," he says. He did - it turned out he had a massive chest infection and, three days later, Caroline got the call she'd always dreaded, asking her to get to the hospital quickly. Later on, when the crisis was passed and we were all joking about another close shave, Paul disputed this version of events and claimed he was just taking a nap as his family huddled around his bedside. The doctors who'd done the ward round, though, clearly thought he wouldn't make it through the day.

Professor Ian Smith, Paul's oncologist at the Royal Marsden, an eminent specialist who's seen thousands of cancer patients in his time, agrees that Paul is something of a phenomenon. "He's got tremendous attitude and spirit - he's done extraordinarily well and he's lived for a lot longer than I thought he would when we first met.

"Cancer is never completely predictable and every now and again you get people who do extremely well against the odds. It helps that Paul was, and still is, extremely fit, and, over the years he's been ill, treatments have improved and he's benefited from that."

One of Paul's jokes is that Smith stifles a yawn when he goes in. "He's not used to having a terminal patient around for 12 years, and I'm getting a bit boring for him." Happily, Smith admits he's not prepared to make any predictions at all as far as Paul's future lifespan is concerned. He could be bored for a long time yet.