Cancer, paralysis and facing death: Paralympian David Smith on learning how to live

David Smith won a gold medal as part of the Team GB rowing squad at the London 2012 Paralympics, but he does not want to be remembered as an Olympic medallist.

At 44, the Scotsman has learned more about how to thrive in life through experiencing aggressive recurring cancerous tumours and living with a spinal cord injury, than he has with an Olympic medal.

He was first diagnosed with cancerous tumours on his spinal cord in 2010. After his first surgery, he had to restart his life and learn how to move and walk again. The journey to London 2012 ended in triumph, until the cancer returned not once, but four more times. Again and again Smith would have to go through the same rehabilitation process.

Smith, who was awarded an MBE (Member of the Order of the British Empire) in 2013 for services to rowing, has had multiple surgeries, one of which -- in 2016 -- left him paralysed down his left side. However, despite the downward spiral of relentless, cruel diagnoses, Smith is extraordinarily resilient, warm and humble, and fiercely optimistic about maintaining his physical and mental health. His new goal is not related to medals -- it is to live.

"Coming close to dying taught me how to live," he says. "Can someone who has not been there learn that? I think they can, but it takes work and it takes being aware and knowing you're alive. I think when you're aware that you're alive then you can start to learn how to live."

Smith has always been fit and active. After rowing he moved to cycling and joined British Cycling's para-squad. He now does a range of sports including swimming and weight training to keep his body active.

In his 20s, he lived unaware of the tumours growing slowly and crushing his spinal cord, but he knew something was unusual. "I would stand up out of bed and fall on the floor and I was always in excruciating pain so I never knew what it was like to not be in pain," he recalls.

When he got his first diagnosis, it was like an awakening. "I think up until that point I had almost gone through life unaware, almost taking things for granted, being on that roller coaster of chasing goals, what's the next thing, and never really pausing to savour the moment.

"And then on that one day, you could say that's where things changed, went wrong. You could focus on the negatives, but I tried to reframe it and say 'what were the learnings' of that day, and it was definitely the first time I've ever really been aware of being alive."

Following the first surgery in 2010, Smith had a stroke and was temporarily paralysed from the neck down. London 2012 was "a crazy idea," he admits, but he needed a long-term goal to visualise. "The first one was to try and sit up in bed. I remember the doctor saying 'Can you touch your nose with your right hand' and I couldn't even do that. It took me a month, and then another month to be able to sit up and then stand, and that whole time I knew that I would make the start line in London. It wasn't in an arrogant way... you have to have that belief in yourself, if you don't nobody else will."

Smith believes he is fortunate throughout his life he always knew his "why" for doing sport, rather than chasing prestige. "I realised at that point [in hospital] all you have is memories and how do you get memories? Through experiences, but you've got to savour those experiences," he says.

"I just loved sport so when I was lying in that hospital bed, it doesn't matter who you are, what you've got ... you are very stripped back and you do realise that sport is so much more than medals and chasing performances ... why I got into it was because I loved the energy, what it stood for, the characteristics and values it gave me and ultimately it gave me a sense of freedom which I couldn't find anywhere else."

Smith said he believes he got through multiple diagnoses and surgeries by applying the strength and resilience he learned through sport to the situations he found himself in.

"What I learned through all those years of sport, and the tumour and all the adversity that was flung my way, it taught me how to deal with things and how to have resilience and ultimately how to listen to the voice in my head and come at that with compassion rather than judgement.

"The road from there [the first surgery] to London -- to say it sounds easy -- it was horrendous and I remember telling myself at the time there's no way I could ever go through this again ... I've had to do it repeatedly, and even as I sit here with you now, there's no way I could go through surgery again. But, you do. And that's the beauty of the human body and the human mind, it finds a way."

The first surgery was only the beginning. Like many people who have had cancer, Smith would return to hospital for two scans a year, and over the next 11 years he would continue to be diagnosed, have the tumour removed and repeat the gruelling treatment and rehab process.

But that punishing process can lead down sombre paths. Smith says when faced with death, it forces humans to ask uncomfortable questions. His awareness for being alive stems from the cancer and his disability plunging him to dark depths, mentally. There were times that he felt he no longer wanted to live and slowly an acceptance that he'd had a good life and it was his time to die began to seep into his mind.

"On those bad days, I struggled to get out of bed," he recalls. "And then I'd think 'you know what, maybe I'll just die soon, probably get diagnosed again, I've had a great life and I'm ready to die.'

"At my lowest point I remember lying in my shorts on my shower floor thinking I just don't want to live anymore. And I thought this is crazy, why wouldn't I want to live?

"I went away and I did a lot of work and I studied neuroscience, psychology. I looked into how the mind works in flow states and the benefits of what sport does. I knew I felt good doing sport but I wanted to know why so I could really understand it and how important it is to me."

In doing so, he grew continually more self-aware. Recognising the times he needed to catch himself from falling into a mental black hole, what tool or coping mechanism could bring him back to the light, and work backwards through the psychology to determine what led him there originally.

"I never ever once said 'Why me,'" he says. "It was more a question of why not me. I never looked for sympathy, I would say I definitely went through bouts of depression, but I would never say I sat there and said 'Poor David, this is a shame.'

"My answer was like 'Well, I can still move, I can still be, let's go out and smash life today.'

"It all comes back to awareness and being aware of what's going on inside your mind. And when it's a dark place in there it's quite easy to say 'I don't want to deal with that' and for me personally, that's not a great thing because it's just building up."

Smith has a metaphor to describe his four coping mechanisms or "pillars" as a chair. If you're sitting on the chair and you take a leg away you might still be supported by three. If you take two legs away it's unlikely you're going to still be sitting, and if all four go then you fall to the floor.

"My four pillars are [doing] sport, connecting with nature -- being out in the mountains, the trees, the sea, ocean, with the fish, animals, that's a big one. Creativity -- writing, that sparks my curiosity. I love to write because it gets everything that's in your mind onto paper and you can make sense of it -- journaling. And people.

"On a good day I'm hitting all four, I'm not thinking of tumours, spinal cord injuries or anything like that. I'm living where my feet are."

Smith admits he had his time of working towards big goals, national team selection, and medal goals but sport is now a lifestyle for him and he savours every moment.

"What it [sport] gives me now is something completely different. Actually I would say mentally, I'm much happier."

The danger, he says, is that with Olympic and Paralympic sport you live four years ahead of your time and athletes can forget to live in the moment. But at the same time he wrestles with the feeling of unfinished business from his "athlete side" in believing he could have been a world champion and hasn't quite reached it, versus his "human side" in remembering "what our values are and what our purpose is," and why he started.

"Really all we have is right now, we don't know tomorrow and four years is such a long time. I've realised that between every diagnosis of every tumour it goes so quickly. One minute you blink and [you've had] six surgeries and you're in your 40s.

"Unfortunately the minute I went to cycling in 2013, I've pretty much had a diagnosis every single year. I've had to learn to walk four times, I've faced death six times, in surgeries and sat in those rooms and looked around and thought 'is this the last thing I'm going to see' six times now."

What's remarkable about Smith is that despite it all, he says paralysis is "potentially the greatest thing that's ever happened to me, and at the same time it's the worst thing that's ever happened to me.

"The gold medal and the sport is up there, and I'm grateful for those memories ... but I think if I hadn't been ill and hadn't faced that discussion about dying and paralysis I wouldn't be who I am today.

"I'm proud of the person I've evolved into. I feel the ground under my feet every day. I hear every single bird noise, I notice every tree, I see everything. I love that because I am fully engaged with life, and if I hadn't gone through what I have in the last 11 years, I might not be that person.

"I only have life for every six months. When it's green, I get another six months of living, which takes me up to the next scan. I say that I'm content with my life if I was to die tomorrow, but I don't want to die -- I want to live. I love life, and I think that's what keeps me going. If I can keep moving my body and keep doing sport, then I'm happy."

Smith is reflective as he looks out onto the River Thames behind us; it's a warm, spring, blue-sky day in the capital. At the time of our interview, Smith had returned to London for another scan and was awaiting the results. Looking out to the river, he seemed as though he was absorbing some of the nature that keeps him grounded, pondering my final question about his legacy.

"I'd much rather be known as someone who can influence people's lives," he says. "For them to make better choices and for them to see how lucky we are to be alive and not to get caught up in all the noise that's out there and the stuff that doesn't really matter.

"I don't want people to say 'Oh yeah, that's the dude that won a medal [in London 2012].'"