Unpaid Care and Cognitive Load: 7 layers beyond the hours of care

Unpaid Care and Cognitive Load: 7 layers beyond the hours of care

  September 27, 2026    Stephen Cobb

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Care Load: decisions, monitoring, anticipation, information, coordination, interruption, emotion, plus physical care tasks.

 Unpaid care is one of the largest forms of work in modern economies, an economic fact that is too often overlooked or intentionally ignored by government policy makers, companies, and institutions; leading to untold misery and hardship for billions of people. The scale and depth of this issue is my focus in this article, which explores not just the "hours of care" but also the load.

Roughly 60 million Americans provide unpaid care for an adult family member, neighbour or friend (as estimated by the AARP in its 2026 Valuing the Invaluable report). Those caregivers provided roughly 50 billion hours of care in 2024, with an estimated economic value of $1 trillion, equivalent to the work of nearly 24 million full-time workers. (See Notes and References below for stats and sources.)

In England and Wales, the 2021 Census identified about five million people providing unpaid care. Around 1.5 million were providing 50 hours or more a week. Across the UK, research published by the Centre for Care and Carers UK estimates the economic value of unpaid care at £184 billion a year. For comparison, the combined National Health Service (NHS) budget across the four UK nations in 2021/22 was £189 billion. In economic terms, unpaid carers are providing something approaching the value of a second NHS.

To me, those are staggering numbers and they demonstrate that unpaid carers are not a marginal part of the health and social-care system. they are one of its foundations. But as a caregiver myself, I want to point out that those statistics, eye-watering as they are, don't paint the full picture.

There's more to caring than physical tasks

Attempts to quantify caring naturally gravitate towards things that can be counted: hours spent helping someone wash and dress, preparing meals, administering medication, driving to appointments, shopping, cleaning, making phone calls, or dealing with paperwork.

These are real demands, and they can be considerable. But measuring caring by hours of activity misses something important: how much of your mind the carer role occupies.

Psychologists use the term cognitive load to describe the demands placed on our limited capacity to process information, make decisions and keep things in working memory. Caring can create a particularly persistent form of cognitive load because the responsibility does not necessarily stop when a specific caring task has been completed.

A carer may spend ten minutes arranging a prescription, maybe half an hour going to collect it. But the mental work surrounding prescriptions can last much longer. Has it been ordered? When will it arrive? Are there enough tablets to last until then? Has the doctor changed anything? Does another appointment need to be made? Is the dosage correct? 

Seven care loads?

Looked at this way, caring contains several different kinds of load besides task load or "physical things that have to be done." I have made a list of seven loads that contribute to overall cognitive load and the total care burden. These are based on my lived experience as a carer and described using my partner rather than caree or person cared-for:

1. Monitoring load: keeping track of my partner's symptoms, medication, mobility, cognitive ability, mood, food, appointments, finances, changes in behaviour (acute or over time).

2. Decision load: repeatedly deciding questions around daily life, events, and circumstances, such as: is this important? does this matter? is action needed? who should I call? how urgent is this problem relative to all the others?

3. Anticipatory load: thinking ahead. Will my partner be safe tonight? What if they fall? What happens if I am ill? What needs to be arranged next week?

4. Information load: absorbing medical terminology, understanding my partner's illness, navigating health and social-care systems, understanding benefits, filling in forms and trying to distinguish reliable advice from misinformation.

5. Coordination load: dealing with clinics, doctors/GPs, hospitals, pharmacies, social services, relatives, transport, and other organisations (that rarely operate as one seamless system).

6. Interruption load: the difficulty of concentrating on my own endeavours like volunteer work, reading, hobbies or rest, when I know I might need to respond my partner's needs at any moment, sometimes urgently.

7. Emotional load: not simply worrying about my partner, but continually adjusting my own behaviour to their illness, disability, distress, cognitive state, coping level, mood, etc.

There may be other loads not covered here. Every carer-caree situation is different, for example, my 97-year-old mum has care needs that differ from my partner's. Some types of care load may overlap. However, across the board these loads are born by a cater even while nothing observable is happening.

That is why the familiar question, “How many hours a week do you spend caring?” can be surprisingly difficult to answer. If a person needs 20 minutes of assistance at 9 AM and another 20 minutes at 1PM, has the carer provided 40 minutes of care? Or have they spent more than four hours organising their day around the possibility that they may be needed? 

All of this matters because statistics influence policy. If unpaid caring is conceived primarily as a collection of tasks, then support for unpaid carers will tend to focus on quantifying, allocating, and/or reducing those tasks. That can be useful, but it is not a comprehensive strategy for addressing social care needs.

For many unpaid carers, what is needed is not simply help doing things. It is relief from having to remember, monitor, anticipate, coordinate, decide, and maintain capacity (physical, cogntive, and emotional).

While the economic statistics reveal the enormous scale of unpaid care, the concept of cognitive load helps reveal something that the statistics struggle to capture: how much of a person’s life caring can occupy even when no clock is running.

What unpaid carers/caregivers need

When we understand unpaid caregiving through the lens of these seven loads—and the macroeconomic pillars they support—the inadequacy of our current assistance for carers becomes glaringly obvious. From a UK perspective, if a local authority offers a carer three hours of "respite" by sending someone to sit with their loved one, it temporarily relieves the task and monitoring loads. But it does little for the other loads. The carer is still managing the schedule, anticipating the emergencies, and making the medical choices.

I see the unpaid carer as a load-bearing pillar of our healthcare system. If that pillar gives way, the entire structure collapses. Recognizing these seven loads is the first step toward effective support. We need community infrastructures that don't just offer to take over the physical tasks for an afternoon, but actually help shoulder the administrative, decision-making, and emotional burdens. 

We need government policies that recognize carers not as a free resource to be exploited, but as an essential workforce that requires comprehensive, multi-dimensional support. Until we stop asking "how many hours" and start asking "how many loads," we will never truly understand what it costs to care, or what carers need to survive caring.

Notes and References

Care on a global scale:

Hours: People around the world perform roughly 16 billion hours of unpaid care and domestic work every single day. [1]
Economic value: The International Labour Organization (ILO) estimates "invisible" care labor equals an astonishing US$11 trillion globally, or about 9% of total global GDP. [1, 2]
Workforce equivalent: Unpaid labor equals the output of roughly 2 billion full-time workers receiving zero pay. [1]

Gender Disparity:

Unequal share: Women and girls perform more than three-quarters of all unpaid care work worldwide. [1, 2]
Daily time commitment: Women spend an average of four hours and 25 minutes a day on unpaid tasks, compared to just one hour and 23 minutes for men. [1, 2]
Labor market barrier: Unpaid responsibilities keep hundreds of millions of working-age women outside the paid labor force entirely. [1]

UK perspective

Over one million people have left employment to care in the past two years, equivalent to around 1,500 people every day. This is a 150% since comparable polling in 2019 when it was 600 a day. —Carers UK polling in 2026 

High financial worth: Research from Carers UK and the Centre for Care values unpaid care in the UK at £184.3 billion every year. [1]
Millions of carers: Millions of people across the UK balance unpaid caring duties with formal employment or leave the paid workforce altogether to care for loved ones. [1]

One in five workers: are providing unpaid care, an estimated 6.7 million people. — (Carers UK polling in 2026)

Meanwhile in England: There is a massive amount of relatively fresh statistical data about carers in England, with year-to-year changes, in the Survey of adult carers in England 2025 to 2026. For example, 82% of carers who care for someone aged 75 or older are themselves 75 or older. (An example would be my 79-year-old cousin looking after her 102-year-old mum, or me in less than two years.)

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Caring for loved ones while you work? Employer not helpful? You're not alone, help is available

Caring for loved ones while you work? Employer not helpful? You're not alone, help is available

  September 15, 2026    Stephen Cobb

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Photo by Caroline Klepper @unsplash

This article is about the practical application of one particular aspect of unpaid carer policy in the UK,  something called Carer's Assessment. This can play an important part in exercising your rights as a carer in the workplace, particularly if your employer is not supportive.

More broadly, I hope this will help all unpaid carers in the UK, while also illustrating what governments in other countries, America for example, could do to support the many millions of people who make a vital, but too often undervalued, contribution to society.

Are you an unpaid carer/caregiver?

Are you looking after someone, taking care of some or all of their needs for weeks or months at a time? If you are doing this in the UK without being paid for it, for example caring for a friend or relative, you are referred to as an unpaid carer. In the US, the equivalent term is caregivers. Both terms embody the distinction between doing care work without pay. 

In America, it is estimated that between 59 and 63 million people currently provide unpaid care to an adult loved one. In the UK, there are between 5.7 million and 8.9 million unpaid carers, depending on exact criteria. I am one of them. However, although there are millions of us actively involved in the often hard work of caregiving, it is easy to feel alone. 

Every day of the week a non-trivial amount of my time and energy goes into looking after my disabled partner and elderly mother (97). And for the most part I do this work by myself. Thankfully, I don't have to hold down a job at the same time, but that's because I am in my 70s and living on a pension (there is work I would like to still be doing, but I have some health problems of my own and don't have much energy left after my care work.

There are a lot of people who work a full-time job as well as provide unpaid care, and I know from talking to some of them that not all employers are as sympathetic to carers as they should be, and easily could be, if they made an effort.

Sadly, the implications of unpaid care work are not, in my opinion, sufficiently well understood or adequately accounted for in the economic, health, and social policies of most countries. Too often that is reflected in workplaces where accommodations to support unpaid carers are not made; a short-sighted approach to effective business management. 

That said, the situation for unpaid carers appears to be considerably better in the UK than the US (and I say this as someone who is a citizen of both countries and spent roughly 35 years in each of then). What follows is a brief account of mandated support for unpaid carers in the UK workplace. 

Government Support for Unpaid Carers

In the UK, unpaid carers have several significant legal protections.

1. Carer’s Leave Act 2023 (in force since 6 April 2024)

The Carer’s Leave Act grants every UK employee the statutory right to one week of unpaid leave annually to care for dependants, that is, individuals dependent on them due long-term illness, injury, disability, or age-related care needs. Employers must accommodate a carers request to use this leave. Employers have limited ability to postpone carer’s leave requests. Harper James

This entitlement applies to employees from their first day of work, and employment rights—such as holidays and returning to their job—are protected while on leave. The person you are caring for does not have to be a relative; it can be anyone who requires care for a period of over three months due to a physical or mental illness or injury. NHS Highland

Crucially, an employer cannot require evidence proving entitlement to carer’s leave. The leave can be taken as individual days, half-days, or a full week block, but a minimum of half a working day must be used at a time. Warners Solicitors

2. Time Off for Dependants (Emergency Leave)

This is a separate, older right that covers unexpected emergencies. The right to time off for dependants came into force in December 1999 and is incorporated into the Employment Rights Act 1996 — giving employees the right to take a reasonable amount of unpaid time off for urgent family reasons. Dismissing an employee for taking this time off is automatically unfair. HR-inform

This is in addition to the new carer’s leave — the two rights sit alongside each other. Brent Council

3. Right to Request Flexible Working

Employees in England now have the right to request flexible working from day one of employment. While the employer does not have to grant the request, they do have to provide a “genuine business reason” for refusing it. This could allow you to adjust your hours or working pattern to better accommodate youe caring responsibilities. Carers Trust

4. Protection from Discrimination (Equality Act 2010)

This is a really important one. The Equality Act 2010 protects carers from direct discrimination or harassment because of their caring responsibilities; this is known as “discrimination by association.” Kingston Council

It is illegal for an employer to discriminate against someone because they are an unpaid carer. An example of discrimination would be if an employer punished an employee for taking time off to care for a dependant, but did not punish other employees for taking a similar amount of time off. Sense

Practical tips for exercising carer rights:

• Document everything: keep a record of any criticism you receive from. your employer arising from your role as an unpaid carer.

• Consider getting a carer's assessment: this will formalise your carer role and make it "official" (see below).

• Formally notify your employer: let them know that you are exercising your rights under the Carer’s Leave Act, referencing your specific care obligations.

• Check her employment contract: many employers offer more generous provisions than the statutory minimum.

• If you receive criticism arising from your carer situation, and it persists after you have explained your situation, contact ACAS (free, confidential advice) or seek guidance from Citizens Advice or Carers UK.

The key takeaway is that criticism or adverse treatment for exercising these legal rights could potentially constitute a breach of your statutory rights or even unlawful discrimination. Your employer is on very shaky ground if they are penalising you for this.

What is a Carer’s Assessment?

A carer’s assessment is one of the best things that happened to me and the people I care for (my carees as I like to call them), and it's free. Technically speaking, carer’s assessment is a formal intervention under the Care Act 2014 through which a local authority determines whether a carer has a need for support to help them live their day-to-day life and to continue providing care. You do not need to be living with the person you are caring for. (For example, I am registered carer for my mother who lives in her own flat.)

Any carer can request an assessment and the local authority has a legal duty to carry it out (Social Care Institute for Excellence). The assessment looks at the person’s regular care duties and how the volume and nature of those duties affect their wellbeing and ability to manage the rest of their life. 

After the assessment, the local authority should offer practical, financial, or emotional support that both they and the carer feel would be beneficial (Carehome). In my case, I was immediately provided with a big slice of peace of mind and so were my carees. This took the form of a carer registration number, emergency phone number, and ID card. 

If anything happens to me — e.g. the proverbial hit by a bus scenario — someone can call the number and find out what my carees need. Arrangements for continuity of care can then be made. When I explained this to my partner she was delighted. The work of documenting her needs had been done and was available if needed.

Why carer's assessment helps with employers who are not helpful

In terms of your rights as a carers, there are several practical ways carer's assessment benefits you and the person(s) for whom you are caring:

1. It creates an official record. The assessment formally documents your role as a carer and the needs of the person(s) beng cared for. If your employer ever challenges your absences due to caring or takes action against you due to your caregiving roleher, you have an authoritative, independent record of your caring responsibilities — not just your word.

2. It strengthens your employment position. Under the Carer’s Leave Act 2023, you don’t technically need to prove anything to your employer, but having an assessment on record makes it significantly harder for an employer to dispute the legitimacy of your situation or claim your are misusing your rights.

3. It may unlock practical support. The local authority must assist the carer in preparing a support plan to outline how their needs will be addressed, and must consider the support needed across a variety of areas, including practical help. This could include things like respite care, which might actually reduce the frequency of emergency absences from work. Disability Rights UK

4. It may open financial entitlements. Depending on your circumstances, you may also be eligible for Carer’s Allowance, and the assessment process can help clarify what your are entitled to. This could include paying for help that reduces your need to take time off work.

It’s worth noting that the employment rights, including the Carer’s Leave Act and protection from discrimination, do not depend on having had a formal assessment. You have those rights regardless. The assessment is not a prerequisite, but it is very valuable supporting evidence, particularly if carer-related  issues with an employer escalate.

Added Benefits of Carer's Assessment

Once you go through the carer's assessment process your role as a carer is registered with the local authority. That is what I refer to myself as “her registered carer” when speaking to doctors and other health/social care professionals about my mum or partner. For example: “Hello, I am Stephen Cobb, Mrs. Cobb’s husband and registered carer.” 

While the term registered career does not have formal legal standing, it can be a very effective term to use. In addition, when you have completed a carer’s assessment you can refer to yourself as “her assessed carer” which does have some legal standing.

Further benefits can arise over time because some local authorities have a process for checking to see if registered carers are receiving all the assistance to which they are entitled. (For any readers who are thinking "you mean they actively try to give away taxpayer money?" the answer is yes, because unpaid carers save taxpayers billions, and helping unpaid workers to cope helps those savings to keep flowing.)

Bear in mind that not all care-related benefits are means tested. My partner was encouraged to apply for something called Attendance Allowance, a weekly sum paid to ease the financial burden of having people attend to the needs created by the medical conditions she has. She did apply and was approved without questions about her income or assets. If you are caring for someone who receives Attendance Allowance, you may be entitled to receive Carers Allowance, to help with costs associated with your care role. (I will expand on this in another post when I get time.)

How to request a Carer’s Assessment

Contact your local council’s adult social care team and ask for a Carer’s Assessment. It can be requested directly by individuals and doesn’t need a GP referral or any employer involvement. The NHS website and Carers Trust UK both have straightforward guidance on the process if she needs a starting point.

Once again, let me say that I found completing the Carer's Assessment, knowing that the information about myh partner's needs was well-documented with the local authority, along with the extent of my role in her care, was an excellent stress-relieving exercise. As a result of the process, we both carry cards that identify who to call in case of an emergency. For example, if I get knocked over by a bus, someone looking through my wallet can see that someone depends on me for support, and there is a number to call that will start the process of providing support in my absence. If my partner gets knocked over, her card means that same support process is initiated and I can be notified. She found that this greatly reduced her anxiety levels.

Unpaid carer support beyond the UK

Sadly, I have not had the time to research the availability of similar levels of support for unpaid carers and other countries. While living in America, I was not aware of anything like Carer's Assessment; however, that doesn't mean it doesn't exist. What has impressed me since moving back to the UK seven years ago is how much support there is for unpaid carers, and how many government measures have been put in place to ensure employers do the right thing when it comes to employees who have had to take on unpaid care work.

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Prostate cancer data update: numbers and sources

Prostate cancer data update: numbers and sources

  August 31, 2026    Stephen Cobb

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The rise of prostate cancer (Urological) in the UK from April 2020 to October 2024 

As I have said elsewhere, I am reading and writing a lot about prostate cancer these days, not just because it is something that numerous friends and I are dealing with in our own lives, but also because it is a large, growing, ageing-population-driven cancer burden. In my opinion, not enough people are aware of this, so I want to leverage my own experience to raise awareness. This post focuses on the numbers, the scale. Separate posts will address the scope, what having prostate cancer means to them what has it.

The scale of prostate cancer is now comparable to that of breast cancer as a public health issue, and in some key numerical measures it has overtaken it: UK deaths, recent UK diagnoses, and projected US new cases. I'm not pointing this out to diminish breast cancer, but to show that prostate cancer has become a similarly major national cancer problem and deserves the same seriousness in public awareness, early detection policy, treatment capacity, and survivorship support.

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Thank you for your patience, new look and feel is now live

Thank you for your patience, new look and feel is now live

  July 27, 2026    Stephen Cobb

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💥 Founded in 2005, Cobb's Blog has been through many changes over the years. The old look and feel was not fit for phone viewing and needed an update. The new layout is easier to navigate on all screens 😃 

On laptops the design accommodates more items in the side menu, while presenting them in a handy burger menu on phones. A new addition is the Prostate Cancer page. Warning: graphic content 😳

If you think the colour palette is a bit weird that might be because I am colourblind 😬 I like the way it looks but let me know if it hurts your eyes, or you find any problems — Stephen

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Prostate Cancer Diary: Day 115 — Therac 25 and a thankfully minor glitch in my radiotherapy

Prostate Cancer Diary: Day 115 — Therac 25 and a thankfully minor glitch in my radiotherapy

  July 24, 2026    Stephen Cobb

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[Note to readers: I am not posting prostate cancer (PCa) diary entries every day. To be honest, I can't keep up. The hormone therapy (ADT) that I started three and a half months ago has slowed me down, as has the radiotherapy (RT) which I started on the first of July. I've been warned that the effects of RT build toward the end of the sessions and even beyond, before tapering off. Thankfully my last session is July 28. Hoping to pick up the pace mid-August. In the meantime, I will post what I can, when I can.]

July 24. 2026

This morning, I was off to a flying start at the Arden Cancer Centre. Arrived early for my 9:15 appointment thanks to light traffic. Was called in at 9:13. Bladder scan was positive and I was ushered into theatre right away. The team was in good mood, joking with M, one of the TRs I haven't met before. Apparently, she had "saved the day" the day before when a late start due to routine system checks backed up appointments pretty badly. (News that made me even more grateful that they had squeezed me in early yesterday.)

I hopped up on the scanning table, pulled my pants down, and they quickly placed the modesty wrapper in place. Then it was just a few minutes before the targeting scan was happening. Whir, whir, as the massive VersaHD head unit rotated, imaging my innards in great detail, then:

Click! The machine froze and started going beep, beep, beep...

Naturally, my first thought was: Therac-25! Quickly followed by: "Don't worry, the photon beam is not on, there's no radiation happening, this is just the targeting run." Also: "Surely they can hear this beeping."

Turns out, they could hear the beeping, and they spent several minutes trying various measures to clear the error that was causing it before coming into the room. They assured me it was nothing to worry and an engineer was on his way. They also started checking the equipment to find a way to silence the beeps. Eventually, the beeps stopped and the engineer arrived. 

The decision was made to proceed with my session on a different, identical VersaHD machine, and the bed was lowered. I pulled up my pants and was helped down. As I was putting on my shoes to walk to the other machine, I said something like:

1980s radiotherapy machine, the Therac-25
(Original source: untraceable)

"At least it's not a Therac-25." 

To which several of the team responded, "What's that?"

But to my delight, the engineer launched into a very good summary of the Therac-25 incident.

This was a series of six massive radiation overexposure accidents involving a computer-controlled radiation therapy machine called the Therac-25, between 1985 and 1987, driven by race conditions, poor software design, and removed hardware safety interlocks. These software faults caused patients to receive up to 250 times the intended radiation dose, resulting in severe burns and multiple deaths. (Wikipedia).

Fortunately, when the details of these horrific incidents came to light, the entire medical technology world took notice, and the Therac-25 was subjected to intense scrutiny. A range of problems was identified:

• a race condition in the software that allowed the high-power beam to fire without the beam-spreader plate in place, 
• an overconfidence in software safety that led engineers to remove hardware interlocks present in earlier models, 
• poor error reporting that displayed cryptic codes like "Malfunction 54" instead of clear warnings, 
• and a culture at the manufacturer, AECL, that was slow to investigate and acknowledge the reports of injury.

The fallout reshaped how the industry thinks about safety-critical software. Nancy Leveson and Clarence Turner's 1993 investigation became a foundational case study, still taught in software engineering and systems safety courses today. It clarified the dangers of relying too heavily on software alone to enforce safety without independent hardware checks.

More concretely, the incidents contributed to tighter US FDA oversight of software in medical devices, spurring the development of formal standards such as IEC 62304 for medical device software lifecycle processes and IEC 60601 for electrical safety. 

The Therac-25 failures also pushed the field toward practices like formal hazard analysis, independent redundant safety mechanisms, and rigorous change-control procedures for software updates, recognizing that a single software fix, applied without full re-verification, can introduce new failure modes just as dangerous as the ones it was meant to fix.

And that is why I was not too alarmed by today's glitch in the VersaHD that has been photon-beaming me. Although the hardware and software employed in prostate cancer radiotherapy today are orders of magnitude more complex than those of 40 years ago, I am confident they are far safer as well.

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Prostate Cancer Diary Day Two (of too many?)

Prostate Cancer Diary Day Two (of too many?)

  March 29, 2026    Stephen Cobb

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Yesterday's trip to Sainsbury's did not yield a suitable physical diary in which to record my "prostate cancer journey." But I did enjoy a couple of eggs on toast and a decaf flat white. I did not make a decision about which prostate cancer treatment path to pursue.

Sunday 29 March, 2026

Prostate identified in digital rectal exam (DRE)

I always take a little time on Sunday mornings to reflect. It's a lingering echo from growing up in a churchgoing family. A regular topic of that reflection is gratitude. I am truly grateful for how fortunate I have been in life, and how to have had a life full of many wonderul experiences and people, a life that has lasted over seven decades so far. 

All of which helps when you have to face the fact that there are cancer cells growing deep inside your body. Cells that could reach your spine and other organs and eventually kill you. Cells that are not going to go away without some fairly serious trauma. In the case of prostate cancer like mine that trauma is either:

A. Surgical removal or all or part of the prostate - an organ about which many of us humans remain relatively ignorant for most of our lives. (See diagram for location, relative size, etc.)

OR

B. A two-pronged attack through hormone manipulation and radiotherapy. The latter uses high-energy electromagnetic radiation to "zap" (target and damage) body tissue, specifically and hopefully, the cancer cells in the prostate.

The odds that either A or B will put the cancer into remission (no longer active) are about the same. Unfortunately, both A and B can have some serious side effects like incontinence, loss of erection and/or ejaculation, and more. I will delve into these in a future post.

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Prostate Cancer Diary Day One (of how many?)

Prostate Cancer Diary Day One (of how many?)

  March 28, 2026    Stephen Cobb

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UK Prostate Cancer statistics from NHS via Prostate Cancer UK

Prostate cancer, often referred to by doctors as PCa, appears to be on the rise in the UK and the US. Ten years ago my brother found out he had it. That prompted me to get tested and in 2021 doctors detected "a tiny amount of cancer" in my prostate. Unfortunately, by 2025 that amount had increased to the point where treatment was needed. By March of 2026, the medical system was ready to offer me that  treatment. 

[Note: This blog post was supposed to be the start of a diary documenting the process of deciding which treatment to have, and then my experience of that treatment. Unfortunately, I have not be able to find the time and/or energy to write many diary entries beyond this one. But I have left it here in the hopes of filling in the gaps later.]

Saturday 28 March, 2026

When I woke up today I found I was thinking about prostate cancer treatment; not just my prostate cancer treatment, about which I must make a decision in the next few days, but prostate cancer in general. More specifically, my mind was going over the timing of that treatment and, as I put on my dressing gown and headed for the stairs, the term lackadaisical came to mind.

According to Vocabulary.com: "Even though lackadaisical sounds like it has something to do with a shortage of daisies, it means lacking in spirit or liveliness, showing little enthusiasm, effort, or determination. And that's the vibe I've been getting throughout my "prostate cancer journey." That journey started slow and low key in 2021, which was fine, but in the past 12 months it has heated up. The medical response has not been as urgent as I would have liked.

However, when I got downstairs, thoughts of cancer treatment were suddenly replaced by remembrance of something I didn't do yesterday: reconfigure the WiFi so that printer works properly. I remembered this because I need to print out the latest correspondence from the urologist if I am going to make the case for greater urgency. 

The reason why I didn't fix the printer yesterday, when I realized there was a problem, will help illuminate my current situation. The problem occured while my partner, CC, was using the Internet, and I didn't want to bother her. This would not have been a big deal six or seven years ago, but these days CC suffers from chronic fatigue and is cognitively impaired due to two brain haemorrhages and an insidious genetic condition. All of which makes tackling domestic IT issues a lot more complicated than it used to be.

On the plus side, CC sleeps until nine in the morning most days, so stuff like reconfiguring the WiFi is best done at the start of the day. However, by the time I made my cereal and coffee and sat down to catch up on email and news this morning, I could already hear CC getting up to go to the bathroom. 

When that happens I listen for her to walk back to her room because, if she is not planning to go back to sleep, she will typically call downstairs to ask for a beverage. Today she requested a ginger ale, not the usual tea or hot chocolate. So I took her a glass of GA and decided to do the WiFi tomorrow.

Which was fine because today I need to write down the big idea I had when I woke up this morning: Write a diary! My thoughts about the many days that have passed between the various stages of my prostate cancer diagnosis and treatment. The idea? 

Prostate cancer (PCa)
under a microscope

Yes, I know writing a diary is not an original idea. Indeed, it would be natural to expect that a human in their eighth decade, one who has been writing stuff for seven of those decades, an educated chap who for many years earned a living from his writing, would be no stranger to keeping a diary. Yet somehow I've managed to get this far without keeping track of my thoughts any actions on a daily basis. 

Of course, like many writers, the thought "must write a diary" was not immediately followed by the act of putting pen to paper. No, my first impulse was to tell myself I needed to buy a diary to write in. Pretty sure I've seen A5-size diaries at Sainsbury's. So maybe the next step on this journey is drive there, grab a diary and an early lunch, and ponder my prostate cancer treatment options.

Given the stage I am at, technically known as Grade Group 3, Gleason 7 (4+3), organ-confined, the basic choice is between surgery to remove the prostate, or a combination of radiotherapy and hormone therapy to kill off the cancerous cells and the testosterone on which they feed.

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