How to deal with cancer while running a startup

My 30th birthday was in a week. For many young adults, this would be a time of mixed feelings. The excitement of a celebration with friends and family, but perhaps also the concerns of getting ‘old’ and maybe even a quarter life crisis.

In my case, I didn’t have time to think about such luxuries thanks to an unexpected birthday present: thyroid cancer.

I haven’t shared this story publicly before, but I wanted to write down what happened and how I reacted. I can’t promise to write the definitive guide for dealing with all medical conditions while running a company. Everyone is different and I’m in no ways an expert. I did some things right and other things very very wrong. I wanted to share my experience in the hope that it might help someone who finds themselves in a similar situation in the future.

“This is none of my business…”

I was in the Bitwala offices late 2018 and we had just had a heated strategy meeting. I love these sessions as there is always a passionate discussion in our management team about where we should take Bitwala. They were also long and draining and so when I received a Telegram notification from our Head of Trading starting with “This is probably none of my business, but…” my first reaction was “so don’t write it then.”

I did end up opening the message and what I read was something very different to what I expected. “This is probably none of my business, but I noticed your neck looks big today.” My neck looked big? That was news to me.

I went to the bathroom and checked in the mirror. I was greeted by the realisation that a plump layer of flesh hugged the bottom of my throat, almost as if I had swallowed something or had suddenly gained some weight, but only in one place.

I confronted my Head of Trading to ask him to help me understand what it could be. “It was my hairdresser who told me,” he said. A couple of years prior while getting a haircut, his barber noticed a swelling on his neck. It turned out to be a growth on his thyroid.

A photo from roughly two weeks before I was diagnosed.

He told me that I should go to see my GP to get it checked out. My first reaction was “I don’t have time for this. There’s so much to do!” We were a few weeks away from our relaunch and it was a critical time for the company. I couldn’t just leave in the middle of the day when I had so much on my plate.

Fortunately, I only allowed myself to be so stupid for a moment before leaving to see my doctor. “It’s probably nothing” she reassured me, “but just in case, let’s give you an emergency note and send you to a hospital to get it checked out.” I remember finding this especially concerning as she had switched to English. Normally we only spoke German, but this time she wanted to make herself unmistakable.

What happened next was a very quick escalation. Blood tests, consultations, scans and, of course, a lot of German bureaucracy. Within a few days I got a call from the surgeon who told me that they wanted to do an emergency operation. “It’s just a precaution” she said, “but if it is something more than a growth, we need to act now.”

Again, my first reaction was that I couldn’t do anything to hurt the business and if it was just a precaution, it could probably wait. Luckily, my mother talked/shouted some sense into me.

I was a few days away from turning 30 and I remember jokingly thinking to myself that at least I wouldn’t have to organise a birthday party — something I’ve always found very stressful.

I packed my overnight bag, got my paperwork in order and gave my colleagues the message “keep calm and carry on”, reassuring them that I would be in and out in a couple of days, ready to keep fighting to make sure that our launch was a success.

Two operations. Three days.

I arrived at the hospital in the early hours of the morning and prepped for the operation. I was nervous, tired, but mostly importantly just looking to get the damn thing over with and get back to normal life which included my grueling work regime.

I woke up in the post-op station. “I’m feeling pretty good!” I remember thinking. I was taken back to the hospital room and enjoyed a very small birthday celebration with my mum and sister until they were kicked out by the nurses.

Lying in bed, I imagined going back to work even earlier than planned. How cool would it be if I was back in the office like nothing had even happened? Looking back now I’m ashamed, but on that same day, I even checked my work emails. Of course, it didn’t help with anything. It was just me trying to prove to myself that, in effect, nothing at all had happened to me.

The next day the doctor came in and stood over my bed. I instantly sat up straight, trying to show that I was fit enough to go home. I was hoping to argue for an early discharge. Her expression told a different story.

“I’m afraid we’ve found a tumour in the part of your thyroid,” she told me solemnly.


That was a shock. I had cancer? I couldn’t believe that. A week ago I was 100% healthy. Now this person was telling me that I had a life-threatening tumour grasping my throat.

She reassured me that they would be able to do another operation to remove the tumour and that there was a very high success rate. For me, this was perhaps the most shocking thing that anyone had ever said to me, but she delivered the news in a very ‘matter-of-fact’ way, even being a little over-direct. I guess they have to do this a lot and it’s best just to tell it straight and let the patient react in their own way.

My thoughts spiralled, jumping from the self-pity of a nascent 30 year old who should be celebrating his birthday to a stubborn defiance which saw this particular incident as ‘just another challenge to get through’ like so many others on my to-do list.

Talking of to-do lists, what about Bitwala? I’d already taken two days off and had imagined myself confidently strolling back into the office, making light of my surgery.

How could I burden my team with this news when we were all so busy around the singular goal of getting our product back on line.

The next day I woke up early to prep for my second operation in three days. There was none of the anticipation or adrenaline of the first time. Just the grim acceptance that this was something that needed to happen and I was going to be in the hospital for a while longer.

I woke up later that day and felt entirely drained. I was generally fit and healthy and had bounced back well after the first surgery, but the second was the straw that broke the camel’s back. I lay in bed feeling tired and miserable.

If anything, the second operation had increased my desire to go back to the office. It was my way of defying my cancer and proving that I was ‘normal again.’ Also, I wanted to be there for my team and felt guilty being absent at such a critical time.

As you’re reading this, you probably realise that it’s a mistake to rush back to a high-pressure startup environment as soon as possible after two major surgeries. I think I probably knew as well, but, as a result of my stubbornness, I made this mistake regardless and was back in the offie within a week.

I regret the way I handled things and am sure that it made the recovery longer and harder than it had to be. I hope that if anyone finds themselves in a similar situation, they do not fall into the same mistakes as I did.

Things I did badly

Trying to go back to work as soon as possible

“I’ll be back on emails in two days.” I defiantly told my team. I had assumed the ‘happy path’ for my surgery — no cancer, no complications and a speedy return to health.

This was a mistake as the reality is that I wasn’t in control of when I would be ready to go back. The fact that I had told people when I would be back in the office put extra pressure on me as I felt guilty about missing that date. It also meant that I had to continually update my team on my news to realign expectations.

Don’t set a date for when you are going to come back. Ask your doctor how long a typical convalescence is and have a rough time in mind, but do not commit to anything. You need as long as you need.

Refusing to acknowledge myself as ‘sick’ even for a second

Apparently one of the differences between people who live in the countryside versus the city is how they perceive it when something changes states. In the countryside, you’re used to the waxing and waning of seasons with cycles of crops that grow, flower and then die. In urban environments we see things as either broken or fixed.

In my case, I saw myself as a healthy person who was experiencing a minor inconvenience that I needed to get over as soon as possible. I was determined not to see myself as a sick person and not be seen as a sick person by my colleagues.

Do not see it as binary or something that should be ‘fixed’. Getting over a major operation is not complete when you leave the hospital. Instead, accept what has happened to you and the fact that you will not be fully fit again for quite some time. There will be physical and mental scars that need to heal gradually over time.

Not giving myself time to reflect and learn from the experience

You know those people who have had a death-defying experience or illness and afterwards talk about ‘how everything changed’ for them?

Not me. I was so determined to get back to normality and put this experience behind me that I didn’t give myself the chance to reflect and learn from the experience.

I didn’t give myself the space to think about how this had affected me and to consequently grow from it. This could have been a life-changing opportunity for me to gain a new perspective on the world. I am sad that I didn’t take it.

Things I did well

Create a limited support network

Initially I had told my mother not to bother coming over to Berlin from Bristol. “I’ll be really busy” I told her, expecting to spend two days in hospital then be back at full speed at Bitwala. I even worried that she would ‘get in the way’ of me working, encouraging me to do something silly like rest and heal.

Luckily, she was, again, able to talk some sense into me and it turned out to be absolutely crucial that she was there to support me during, what turned out to be,in one of the most difficult weeks of my life.

I had also shared the news with some friends who came to the hospital to visit and even brought me a birthday cake. Having these people to support me made what I was going through much easier to deal with.

What I will say, however, is be careful who you tell and when.

Imagine if your best friend called you right now and told you that they had a life-threatening disease. You would be shocked. You’d be upset. You’d probably go through a smaller version of what that person is going through.

The reality is that when you tell people what has happened to you, they react in a human way and are upset. When you’re barely keeping your own shit together, it can sometimes be a burden to tell other people what is going on as you then have to be strong for them too in a sense.

I remember a time that I had done a good job of processing (or so I thought) what had happened. I had a call with a friend who burst into tears on the phone and that undid all the work I had done for myself.

I’m not saying that you shouldn’t rely on your friends and family to support you. You absolutely should. My advice is to keep the circle small at first and as you feel emotionally stronger over time, share with more people.

The same goes for work. I told two people what was really going on and the rest of the company just knew that I was having an operation. It made things easier as there were only a few reactions to deal with.

Not allowing the illness to define me

Believe it or not, my thyroid cancer is a running joke in my friend group. This is perhaps a reflection of my very British sense of humour, but for me making fun of it was the best way to remind me that I was in control.

It’s really important not to reject what has happened to you or to create a wall around it, but at the same time, don’t let it have more control than it needs to. Don’t become someone who is defined by that condition.

For all the entrepreneurs out there

Running a startup can be one of the most rewarding and exciting, but also stressful things in your life. My favourite startup quote summarises it nicely:

“You only ever experience two emotions: euphoria and terror. And I find that lack of sleep enhances them both.” — Marc Andreesen

There will always be things that are urgent and seem like they are the most important thing in the world. When you put your heart and soul into a high-potential, fast growing business it’s hard to see it any other way.

But, you have to remember to #PutYourselfFirst, especially when a big personal challenge comes up.

When I got sick, I didn’t do this and I learned the hard way. I’m sharing my story to encourage entrepreneurs to deal with things in the right way.

If anyone is going through something similar and wants to chat, I offer free mentoring slots through The Mentoring Club.

Bitwala in our Prague company trip.

Startup advisor | Co-Founder & CEO/CTO @Nuri