Cross Everything: A personal journey into the evolution of cancer

By Henry Scowcroft

'A moving, compelling and vital book, that sheds much needed light on the very latest understanding of cancer.' - Siddhartha Mukherjee, author of The Emperor of All Maladies

'A gripping, heartbreaking, accessible personal journey through love and cancer' - Charles Graeber, New York Times bestselling author of The Breakthrough

'Sensitive and informed. Essential reading for anyone supporting a loved one through cancer. Heartbreaking, emotional – and totally and utterly uplifting and hopeful.' - Deborah James (@bowelbabe), writer and broadcaster

'May be the most heartbreaking medical memoir you'll read.' - Daily Mail

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An extraordinary memoir that explores the further reaches of today's cancer science – alongside a deeply tender story of loss, grief and love.

When Henry Scowcroft's partner Zarah was diagnosed with stage IV bladder cancer in her mid-thirties, their world fell apart. In order to cope with the upheaval as they endured scans, aggressive chemotherapy and hospital stays, Henry began writing down and sharing their experiences with friends and family.

His day job as a writer for the charity Cancer Research UK helped him to explain everything he was learning from the coalface of cancer treatment – including Zarah's diagnosis, and their rollercoaster journey through the health system.

After Zarah's untimely death Henry found some closure and comfort by trying to learn more about her cancer from scientific analysis of the test results and biopsies taken during her treatment, and enlisted a team of doctors and researchers to help him. Could he have done more? How did Zarah's tumour develop? Could there be a legacy from her death that would help others diagnosed with cancer?

This heart-wrenching memoir of love and loss is interspersed with Henry's mission to understand the cancer that took his partner too soon.

• Language: English
• Publisher: Bloomsbury Publishing
• Release date: Feb 18, 2021
• ISBN: 9781472975133

Henry Scowcroft

Born into a family of scientists and medics, Henry Scowcroft is an experienced science writer, with a Bachelor's degree in biochemistry (Oxford, 2000) and a Master's degree in Science Communication (Imperial, 2003). Since graduating he's worked in a variety of roles at Cancer Research UK, all of which have centred around one thing: communicating the complex, emotive issues around cancer to a variety of audiences, including patients, the public, journalists, policy-makers and the charity's supporters.

Book preview

For everyone who has ever lost anyone to cancer;

and to everyone who is living with cancer right now.

Contents

Introduction

1   Team Twat

2   Here comes cancer

3   Chemotherapy

4   Annabell’s story

5   What next?

6   Waves a hundred feet tall

7   Who was Tina anyway?

8   Some musings on cancer

Epilogue

Acknowledgements

References

Bibliography

Index

Introduction

Although this is a book I never wanted to have to write, I’ve always loved writing. One of my earliest memories is of posing for a photo for our local newspaper, after winning the £10 prize in a writing competition run by the local library. A decade later, as a biochemistry student, I remember sitting in an intense, cramped tutorial, my tutor’s face a picture of bemusement at my latest attempt to crowbar alliteration and assonance into dry academic essays on mitochondrial respiration or bacterial cell division.

But it never occurred to me, back then, that I’d end up as a writer. Instead, I’d chosen to study science thanks to a natural, deep-seated (and occasionally annoying) curiosity about the world around me, inspired by my grandfather, a professor of botany. I’d had aspirations to follow his footsteps into a career in research. But over the course of my degree, as I left behind a string of failed experiments, partially contaminated laboratories and broken glassware, it turned out that writing was by far my strongest suit, and where my future lay. It probably helped that my mother has been, for more years than I can remember, a gardening columnist for a national newspaper, with a quite wonderful turn of phrase. And while she never directly encouraged me into a career in writing, the joy and pride she so obviously takes in wrangling words into her weekly column must have provided some sort of inspiration, even if indirect.

Eventually, it was the urge to marry my two passions – to explain science through the written word – that led me to study for a post-graduate degree in science communication, and which subsequently propelled me into a job as a science writer at a charity: Cancer Research UK, a large, well-loved medical research organisation, headquartered in London. But back then, despite the organisation’s long and impressive history – a 100-year-old cancer research charity, the largest in the world – I had no special affinity for or connection with cancer. It was, simply, my first proper job, and one in which I was determined to make a reputation for myself, as someone who could help people engage with and understand the scientific research that had so fascinated me at university.

And so, from the early 2000s until the mid-2010s, I earnestly bashed out a constant stream of articles for the charity’s website, on a blogging platform that I and a couple of colleagues set up and managed. As the years went on, they both left the charity to pursue careers as science writers. Both are now published authors in their own right; I always doubted I ‘had a book in me’, and was content to keep on churning out articles about pretty much every aspect of cancer for the charity’s supporters and the wider public, safe in the knowledge that I was probably doing some good in the process.

But that all changed in 2016, when my girlfriend, Zarah, was diagnosed with incurable bladder cancer. Suddenly, out of the blue, my relationship with the disease became personal as well as professional.

One particular memory sticks out, shortly after Zarah’s diagnosis. A corridor, and an earnest conversation with a colleague who had survived breast cancer years previously – a gruelling experience, which had had a profound effect on her. ‘It’s going to be a really rough ride. Find something you love doing, and make time to do it. It’ll keep you sane. You obviously love writing – maybe write your way through it?’

I took her advice to heart. I’d already assumed the mantle of keeping our wider network abreast of Zarah’s travails via a series of regular emails. As her disease progressed, writing these became a sort of therapy – a way to order the chaos of cancer into something we could cope with, and to use the skills I’d honed over the years writing for Cancer Research UK to reassure, explain, and contextualise Zarah’s plight for the many who were deeply concerned about her. Quite frequently – to her occasional frustration – I’d stay up till the small hours, getting the text just right, trying to convey our hopefulness and stoicism, explain what might happen next, what the options were. And in the course of those emails, one phrase kept coming up again and again – a plaintive imperative, addressed to the emails’ recipients and their inevitable offers of help and support:

‘Cross everything.’

As I was to realise, it’s a phrase that conveys much about the reality of a cancer diagnosis – something that no amount of blogging about dry academic research papers can teach you. Will the treatment work? What will the scans show? Can we go on holiday? What can I do?

Zarah and I often talked about writing a book about her experience, and ‘that’s one for The Book’ became a bit of an in-joke between us, to be wheeled out in the face of some of the more ludicrous episodes we faced.

We never discussed who’d actually write it. It turned out that it was a job that would fall to me alone.

In the aftermath of her death, several people remarked to me that I ‘really should do something’ with those emails. The missives had, it transpired, very much hit the mark, revealing to their recipients much about cancer that they’d not known before: the daily grind of the disease’s tragic ebb and flow, but also – thanks to the medical and scientific insight I felt necessary to include – something of cancer’s underlying nature that many had found helpful. The juxtaposition of the science with the personal seemed vital in conveying both topics.

My decision about whether to adapt these emails, somehow, into a book was further influenced by a small legacy she’d left, in the form of DNA analyses and tissue samples, saved on NHS servers or frozen in anonymous stasis in a freezer in the local hospital. Could these, I wondered, be drawn together to answer questions about her disease: how it originated, what fuelled its growth, and why it was so aggressive. Questions, I suspect, everyone affected by cancer has, but which I was, it seemed, in a position to at least try to answer. And so I set about trying to do so.

Working with researchers to answer these questions has, of course, been a journey of personal closure as much as the substrate for this book; but I hope the answers – and what I learned about cancer along the way – can crystallise, in the book’s readers, an understanding of cancer, and that this is, in some way, as helpful for people who read it as writing it has helped me.

So what you’re about to read is, in essence, two interwoven stories.

On one hand, it’s the story of a tumour, told, as best I can, through careful analysis of Zarah’s biological data and that of her cancer. One thing above all else that has fascinated me in all my years writing about cancer is the growing understanding of its evolutionary, Darwinian nature – how, all too often, despite the best efforts of the doctors that treat it, it evolves, adapts, resists and survives. Far from being an inert, uniform ball of cells, researchers are discovering that tumours are dynamic, constantly adapting, ever-changing, battling with the body’s defences for supremacy – and are starting to unpick the rules that allow them to do so. I hope the story of Zarah’s tumour, and what I’ve been able to learn about how it evolved, serves as a useful vessel through which to convey this modern view of cancer.

The other story is essentially human: a tale of the life and troubles of a remarkable, compassionate, hilarious, open-hearted woman; one that I hope I’ve done justice to, and that bears proper testament to the joy she brought so many of us – both before and after her diagnosis – and the impact she’s had on the lives of those who knew her.

And although I am in no way religious, I hope that, in some small way, this book passes on something of her remarkable spirit, to live on in – and perhaps inspire – all of you who read her story.

1

Team Twat

I: The mother cell

Scene: The interior lining of a human bladder. A thin, spherical layer of tissue that forms an impenetrable, intricate, elastic barrier – a vital line of the body’s defences.

Zoom in: The tissue’s surface reveals itself as an endless patchwork of millions of specialised translucent cells, each clamped tightly to its surrounding neighbours, each having graduated from the layers below, and each destined to spend the remainder of its short life locked in a defensive posture, until eventually it withers and dies, to be replaced anew from below.

Pull focus: Stacked beneath the topmost layer lies stratum upon stratum of immature cells, each making a slow journey upwards, to take its place at the surface to mature and fulfil its destiny.

Focus deeper: Sandwiched between the surface layers and a thick external layer of muscle: the vital basal layer. Just a single cell thick, but responsible for everything stacked above it, a continuous font of new life.

Zoom in: Nestled alongside millions of identical neighbours in this delicate layer: a cell. A tiny, unremarkable, disc-shaped bubble of gelatinous life just micrometres in diameter – one among millions. From the outside, all is quiet, the silence belying a hum of invisible activity, the cell’s energy devoted, for the last few weeks, to replicating the nearly 2 metres of filament-thin DNA packed into its nucleus with near-perfect fidelity, checking, double-checking, preparing, recharging.

Hold focus. Wait. Watch.

It’s here that our story begins.

Suddenly, inside the cell, things spring into life as it starts once more to divide. Each step tightly coordinated and refined by evolution over billions of years, the delicate membrane surrounding its nucleus dissolves while, simultaneously, the nanometre-thin DNA filaments contained within begin slowly to condense into 46 short, stubby chromosomes, each containing two duplicates of a vital chunk of genetic information – thousands of genes held in a few nanometres of chemical architecture. The book of life, in duplex form.

From nowhere, a rigid scaffold precipitates, stretching out across the cell’s interior, forming a series of ghostly skeletal tracks that run from one end of the cell to the other.

The disc-shaped cell begins to swell, balloon-like, into a sphere.

Then, like a regiment of soldiers lining up in formation, all 46 condensed DNA chromosome doublets start to assemble across the cell’s diameter, perpendicular to the skeleton, each somehow knowing its precise place in proceedings.

Everything in place, the real action begins. Ratchet-like, burning up extraordinary quantities of fuel, the skeleton pushes against itself, forcing the cell apart, tugging one half of each chromosome pair in an opposite direction. The balloon inflates further, and yet more newly formed scaffolding – this time radiating out from the centre to the cell’s outer membrane – pulls inward, constricting the membrane around the balloon’s centre as if caught in an invisible drawstring.

Slowly at first, then increasingly rapidly, the membrane draws in as the chromosomes segregate – until finally, with all 46 chromosomes safely separated and sequestered into each compartment, the drawstring tightens to pinch the cell clean in two.

The mother cell has a new daughter.

And this newborn offspring now begins the slow migration upwards, away from its mother, towards the surface – programmed to mature into one more building block in the bladder’s protective lining.

The mother cell, its job done for now, begins to rest and recharge, readying itself for the next cycle.

But something is amiss. Somehow, at some point during the replication of the cell’s metres of delicate DNA, and the wrenching violence of the cellular division, a defect has become embedded in the fabric of its DNA: a submicroscopic lesion that will sow the seeds of a future, unimaginable tragedy.

The exact date of my first encounter with the force of nature that was Zarah Harrison is a matter of some debate, and depends on the exact definition of ‘meet’. Both of us belonged to a large, sprawling group of dictionary-definition ‘metropolitan elite’ types with a healthy appetite for music, festivals, pubs and general late-night hedonism. It was a collision that, given our similarities on so many fronts – not least our love of a cheesy and laboured pun – was bound to happen at some point. It was a surprise to many of our close friends that it took as long as it did.

According to eyewitnesses, the first time we occupied the same room was in the small hours of the Somme-like, rain-ruined Glastonbury 2007, in a mud-infested tea tent. Neither of us can remember this, but apparently it happened.

Then there’s the photograph of Zarah on Facebook, at Bestival in 2009 on the Isle of Wight, surrounded, as she so often was, by a multitude of gay men. In a corner of the photo: my cagoule-clad elbow. Zarah had no memory of meeting me there; I vaguely recall bumping into them all while meandering around the festival.

By the time we first recall actually speaking to each other, a year later, in the queue for a boutique music festival, we were certainly aware of one another’s existence, if only via the strange and entirely modern phenomenon of being tagged in our friends’ social media posts, or otherwise intruding into each other’s online lives (I confess, I occasionally clicked through to her profile to find out more about this bleach-blonde so many of my friends knew. Is that online stalking? I suspect it’s relatively normal behaviour. But after I confessed this to her, she’d delight in taking the piss out of me as ‘a creepy Facebook stalker’).

At the time we first spoke, I was with my best friend and housemate, James, who was accompanying me to the festival in part to act as my emotional crutch – I had, just two weeks previously, emerged from a full-on and emotionally draining relationship, and was in a pretty fragile state. I’d almost not gone. As we stood in the queue, James was approached by a striking-looking blonde woman dressed in full pirate regalia, who started chatting to him (he and Zarah had known each other for several years, having travelled together in India and Southeast Asia). Recognising her off Facebook, I elbowed my way into the conversation. Later that day, the festival slowly getting into full swing, a group of us entered a mutual orbit, booze in hand, in the middle of a lawn near the main festival area, and the two of us ended up chatting some more.

Zarah remembered it vividly. ‘Every time I looked at you, the background went out of focus. And every time you said anything, I’d laugh. I totally knew then.’

Our orbits collided more fully later that night. Our large group of late-night revellers was infiltrated by a couple of randoms, one of whom had a ghastly Nickelback mullet/ponytail type affair, and who proceeded to make a series of clunky, offensive, mildly homophobic comments. Our group dispersed to get rid of them, agreeing to reconvene at a more secluded area, free of inadvertent bigoted dickheads. Zarah and I, who had by now already progressed from ‘highly engaged conversation’ to ‘occasionally but not so secretly holding hands while no one was looking’, headed off into the darkness… only to find Nickelback following us expectantly. We figured the best way to throw him off the scent was to engage each other in a long, passionate snog. It worked.

And so we tumbled joyously into the early stages of what would become the defining relationship of our lives so far. We blagged a lift home from a mutual friend, and made plans to go on a cinema ‘date’ together the following Sunday. This was unexpectedly brought forward to Saturday night as Zarah, drunk and leaving a friend’s wedding, texted me to see if I was still up. I was. She arrived, hammered, at 1 a.m., calling up to me on the balcony, clutching a magnum of champagne, in a bright purple dress with a gregariously frilly red underskirt – a dress that came to define her.

We spent the next day together. I cooked a fry-up for breakfast, and we ate it in bed while reading the Observer. A good sign: no competition over the different sections (she went for the Lifestyle and Travel, I for the Comment and Sport – yin and yang already). We eventually made it to the cinema for the late showing. The whole date was us to a tee – late, but we got there in the end.

Over the following months we took things as slowly as we were able, Zarah being unbelievably patient with me as I mended my head after my recently finished relationship. As I healed, our own partnership gradually grew into something profound. In early October we went away together for a weekend in the Cotswolds (‘Off cottaging’, she’d cackle). On the drive home, I introduced her to an album with which I’d recently become obsessed: Sufjan Stevens’ Come On Feel the Illinoise. As the chorus to the track ‘Chicago’ came on, my hand was resting on the gearstick. She put her hand gently on top. That’s when I knew.

‘Chicago’, of course, became ‘our’ song.

Just seven months later, in May 2011, she moved into my flat in Bethnal Green. It wasn’t something we’d planned: her landlord had decided to sell the house she and three of her friends were renting. Although we pretended otherwise, the decision was a no-brainer. James was still living in my spare room; the three of us instantly clicked as a household.

She’d been born in Ireland, in August 1978, in the rainy port city of Cork. The late 70s were not a prosperous time – Ireland’s entry into the European Union around six years earlier had opened up the country’s traditional manufacturing industry to international competition. Long-established processing factories were struggling, and unemployment was rising. The Celtic Tiger was yet to be born, its roar – which would eventually summon multinational tech and pharma companies to rejuvenate the Cork economy – still a long way off.

Nevertheless, Zarah’s parents – Sean, a dashing, charismatic jack-of-all-trades, and Florence, a glamorous former model turned fashion designer – had found a way to provide their daughters – Zarah, and Amber, four years her senior – with an above average upbringing. Around the time Zarah was born, the family moved into a large house in a small residential neighbourhood in the city’s north side called St Luke’s, where they were to stay for more than two decades.

It was, to begin with, a happy childhood, and Sean and Florence provided a protective environment for the two girls to grow up in. ‘We played out in the road,’ recalls Amber, ‘and always had a nanny, or a housekeeper, to look after us. We were well off by the standards of Cork at the time.’ Zarah looked up to her older sister, following her everywhere. ‘I sort of hated it at the time, but that’s standard big sister stuff, I guess. She always had a kind heart, and quirky habits, paired with a strong sense of independence, and for some weird reason she’d always had this bright red little nose.’

As the girls entered their teens, things between Florence and Sean began to deteriorate. Zarah, something of a daddy’s girl, was kept out of the firing line of their blazing rows, unlike Amber, who was 15 at the time. By her account, it was not an easy separation. After a few years of turbulence, Sean eventually moved out, and Florence brought up the girls on her own, taking in students as lodgers to help make ends meet. The family home was sold, and the proceeds invested in a series of properties – Florence switched careers to focus on managing them. When the Tiger finally roared in the early 90s, Florence was in the perfect position to benefit.

Despite religious upbringings themselves, neither Sean nor Florence was especially religious – something of an anomaly in a deeply Catholic country – and this was reflected in Zarah’s education, which both her parents took seriously, recognising the value of a good schooling. A spell at a Protestant state school was followed by another at a prestigious Irish-speaking Catholic one. She thrived at neither. But then came one of those moments that becomes the stuff of family legend. Zarah must have told me the story at least 20 times.

Ahead of starting their Leaving Certificates (the Irish equivalent of A-levels), Zarah’s best friend at the time, Hannah, was to move to a new school, Newtown – a couple of hours away in County Waterford. Zarah was desperate to join her there, but there was a catch. Newtown was a school founded in the Quaker faith, and only Quaker children could qualify for a free boarding place. But Zarah wasn’t deterred – she had a cunning plan. ‘My mum was away for the weekend with a friend of hers in Dublin, and Hannah and I hatched a plan to tell Mum that I’d decided to become a Quaker.’ On Florence’s return, Zarah was desperate to tell her mum the ‘news’, only for Florence to have some of her own. Reluctantly, Zarah let her mother go first: ‘Zarah, at the weekend, my friend took me to one of her Quaker meetings – and it was just so wonderful! So I’ve got some news. I’ve decided that I’m going to become a Quaker!’

Zarah and Florence had always had – despite their lack of formal religion – a tendency towards the spiritual and mystical. So when Zarah revealed to her mother her own plans, both excitedly decided that it was no mere coincidence, but something that was somehow Meant To Be. Thus, Zarah’s adoption of the Quaker faith was, from the get-go, deep, full and sincere. She started at Newtown a few months later.

By now a charismatic extrovert like her dad, Zarah quickly became popular at her new school, often leading late-night illicit forays into the local town for boys and booze, and generally making mischief. A school friend once told me of her attempted insurrection in the face of an impending vaccination. ‘We were all lined up against the wall waiting for our turn, and there comes Zarah, walking up and down the line, fierce as you like, telling all the girls they were our bodies and we didn’t have to accept it if we didn’t want to. None of the teachers knew what to do.’

This rebellious streak and fierce sense of social justice was beginning to manifest itself in other ways. She’d often proudly recall heading up to Dublin, on her own, to join a pro-choice rally – her first such experience. And it was probably in part behind her decision, upon finishing school at the age of 17, to leave Cork to study for a qualification in Fashion Journalism at the London College of Communications.

She arrived in London in 1997 – accompanied by Florence, who’d helped her move over – on the same day that Princess Diana died. Florence recalls pandemonium on public transport, as the UK engaged in a surreal outpouring of grief. Zarah used to joke that the country only had room for one ‘queen of people’s hearts’.

She took to London instantly. On her first afternoon in halls of residence, Florence fondly recalls her daughter walking up and down the corridor, knocking on doors, assembling a posse for the pub.

Despite always being proudly, patriotically Irish, the city became her home, and she’d often declare that she had no plans to go back to live in Ireland. After getting an NVQ, she started work at a London-based publisher, moved into a flat-share with a bunch of good friends, and set about having as much fun as she possibly could.

II: The mutation

Years have passed. Deep in the lining of the bladder, the damaged mother cell has been robotically, rhythmically, carrying out its duty, division after division, daughter after daughter, its lifetime progeny now numbering millions. Most have since perished, their short lives spent at the front line, clamped tightly together as part of the bladder’s protective internal lining, eventually to be replaced from below.

It has not been an easy time. In fact, the mother cell is exhausted. For the last few years, the lining of the bladder – normally home to a symbiotic, peaceful lawn of bacteria – has been regularly invaded by hordes of foreign microbes, outbreeding the natives to establish rampant, unruly colonies. The invaders’ presence has called in the cells of the body’s immune system – fleets of large, wobbly, bacterium-eating neutrophils, along with specialised secretory cells, whose chemical signals carefully coordinate and control the response to the invaders.

As a result of this ongoing, low-level cellular skirmish, the mother cell has been working overtime to send new daughters to perish on the front line, a routine accelerated by the wash of signals from the immune system. These days, it barely has time to pause and recharge before the next round begins.

And all this time, despite appearing outwardly normal, this particular mother cell, along with all its progeny, have carried a tiny defect in their DNA, introduced during that fateful cell division many years ago. Back then, almost unnoticed, a snippet of information carried on a short stretch of a very long DNA chromosome – the ninth-largest of the 23 pairs in the mother cell’s nucleus – was accidentally deleted. Lost along with it were instructions to assemble a particular protein molecule, a small part of a complex machine honed by millions of years of evolution to govern whether the cell that contains it should divide – a go/no-go system designed to keep everything in regular order.

Each time the mother cell produces a new offspring, this tiny defect – in a tiny part of its multilayered control system – is passed on. Consequently, though imperceptibly, a small patch of the bladder’s defensive lining is now made up of ever so slightly abnormal cells, all descended from their ever so slightly mutant mother.

Yet, so far, this solitary genetic deletion has had minimal consequence: those same evolutionary millennia have conspired to ensure that, in the nucleus of every cell in the bladder – including the mother cell’s – resides a second copy of this lost information: each of the cells’ chromosomes has a life partner, a subtly different sibling with which it has cohabited in the nucleus ever since the mother cell’s distant ancestor was first formed in a womb long ago, after egg and sperm first fused.

And so, despite the loss of this tiny info-snippet – a genetic recipe for a small but vital cog in a larger control system – the back-up copy allows the mother cell, and its daughters, to function safely and normally.

Until today.

Once more, just as it has countless hundreds of thousands of times before, the mother cell gears up for another exhausting round of division, activating microscopic molecular machines to crawl along all 2 metres of its 23 chromosome pairs, sucking in simple molecular building blocks and fusing them together, to painstakingly create an exact copy of each in its wake.

Normally, as with every one of the mother cells in the bladder, a multitude of error-correction mechanisms ensure that this division is a near-flawless process, introducing at most a handful of minor, inconsequential errors across the billion letters of molecular code contained in the cell’s DNA genome.

But today, just as the cell’s replication micromachinery arrives at the remaining, working copy of the control gene… once again, by awful, tragic coincidence, something inexplicably jams, twisting and breaking the DNA strands, shearing the precious molecule in two.

Immediately the machine seizes up. Molecular alarms ring out. The entire process of DNA replication in the mother cell grinds to a halt, and more cellular control systems kick in to try to rectify the situation.

Sensing the error, the cell activates yet another molecular machine to rescue the situation – a DNA editing machine. This tiny DNA editor locates the chromosome’s twin, spools to the region bearing the long-since deleted control switch – and uses it as a template to try to patch up the fractured DNA.

The cell, of course, has no consciousness, no motive, no awareness of what it is doing, of the irreversible error it’s making.

Mechanically, faithfully, it transcribes the region bearing the missing information over to the second chromosome. In doing so, it hard-codes the control gene’s loss forever into the cell’s genome. A vital cog in the cell’s control system has just been irretrievably deleted – overwritten in error. The mother cell now is a second step along its catastrophic journey. A cellular car with its brakes gently, imperceptibly damaged – if not, yet, snipped entirely.

But for now, the immediate crisis is over. The replication of the mother cell’s imperfect DNA is complete. And just as before, all 23 duplicated chromosome pairs – two of which are now imperceptibly shorter – condense and line up. The cell’s internal skeleton assembles, the cell balloons, the invisible drawstring tugs its membrane inwards – and everything is wrenched apart once more.

By mid-2011, Zarah and I were fully coupled-up, comfortably cohabiting and getting to know each other’s extended networks. For Zarah, this included a tight-knit group of female friends accrued during her years in publishing – and a constellation of gay men who, since everyone else was busy breeding, very quickly became a big part of our social lives (I’d go weeks without seeing a straight man outside of work). For me, this included a wide network of friends I’d collected while playing music in bands throughout my 20s, some very close friends from work (Zarah became a regular at our post-work pub sessions) and a tight-knit group of friends from my university days. Previous girlfriends had occasionally struggled with this latter group – Zarah, however, fitted in as if she’d been there from Freshers’ week.

We were in our mid-30s, happy and settled – even if we did quickly acquire a reputation for being both horrifically late for everything and also the last to leave. These were characteristics we’d both had individually; combined, we enhanced each other’s disorganised superpowers tenfold. We summed up our shared bacchanalian fecklessness with a self-deprecating nickname – ‘Team Twat’ – that later on we’d whisper to each other, with an accompanying hand-squeeze, when things got tricky.

Team Twat decided very early on not to have kids – a decision that always raised an eyebrow among our be-kiddled friends (‘Oh, is there something, you know… wrong?’, one cheerfully asked, upon learning of our barren intentions). It was an easy choice to make – both of us had our own reasons but we shared the main ones: namely an anxiety over passing on the baggage from our difficult childhoods, and a love of a good hungover lie-in. As well as sidestepping these crucial issues, it was a relief not to have to worry about the practicalities of incomes, house sizes, school catchment areas, etc. Life was simple, fun, and happy.

As well as getting to know each other’s broader groups of friends, we also met each other’s families, always a milestone in any new, serious relationship. My first trip to Cork was particularly memorable. We’d intended to fly late on a Friday after work; however, events conspired to have us miss our flight (‘events’ as in we were engrossed in a crossword in a bar in Stansted airport – so ‘Team Twat’), so we had to check into a hotel near the airport and get up at 4 a.m. to ensure seats on the first Cork-bound Ryanair flight. So when we arrived, we were shattered. Zarah’s mum, Florence – a wonderful, chaotic whirlwind of a woman, who adored and doted on her daughter –