As Peter Knox from Exeter had the World Transplant Games squash gold medal hung around his neck last month in Perth, Australia, he could be forgiven for getting emotional. His path to that moment of glory featured more pain, stress and adversity than most of us face in a lifetime.
Peter, 32, was diagnosed with cystic fibrosis at birth. The condition clogs up the lungs with mucus and typically leads to repeated debilitating infections.
He was largely fine through childhood thanks in part to keeping fit by playing squash where he grew up in the Lake District, firstly at Cockermouth then Workington Squash Club. But the gradual deterioration of his health began in his teenage years.
By the end of his first year at university, his lung capacity was around 55%. “I joined the uni team and found I couldn’t handle the pace at all,” he tells Squash Mad. “I was forced to play ‘old man squash’, or trying to hit a quick winner to finish every rally – one way or the other – before exhaustion set in.”
By the time he was 24, even that was beyond him. There was so much damage in his lungs that he began coughing up blood whenever his heart rate got too high. “I kept playing for longer than I should have done. I just wanted to keep going,” he reflects. Finally, in early 2015, he played squash for what he thought might be the last time.
By this time, he was working as a sports statistician in Exeter, Devon. His lung capacity had dropped to around 45%. Treatments over time had also affected his hearing, leaving him totally deaf in one ear and with 50% hearing in the other.
Doctors gave him physio and exercises to slow the decline in his lung function, but he found them “so depressing” and shunned friends’ attempts at getting him to play golf.
Two years of dreadful, dispiriting decline followed. He was on oxygen full time and had to wear a mask at night to push air into his lungs. He couldn’t walk further than 100 metres without needing a rest. His parents interrupted their retirement to move 350 miles from the Lake District into the spare room of his flat to take care of him.
He decided to go on the list for a transplant in February 2017, by which time his lung capacity was down to 17%. He knew a transplant would be risky. “I was terrified,” he admits. “I was sort of in denial that my life was in danger, despite all the evidence to the contrary. But I realised there wasn’t any other option – if I wanted any kind of normal life, I had to go through with it.”
He got the call only four months later and although the operation was a success, an infection got into his surgical scar. Two more agonising years followed of trying to get rid of it with antibiotics. He spent long periods in hospital attached to tubes in an attempt to drain it off.
In March 2020, he was finally passed fit to resume playing squash – but we all know what happened to squash courts in March 2020! “I actually dealt with the pandemic really well,” he says. “It was the best time I’d had for half a decade! I’d spent the last five years not being able to do the things I wanted and relying on the internet for entertainment. Now everyone else was living my life.
“I got an exercise bike and a treadmill in the flat and got myself moving again. My legs were very deconditioned from doing nothing for so long, so I built my body back up again.”
He was immuno-suppressed after the transplant, but when he caught Covid and was only slightly ill for three days, that gave him the confidence to return to Devon & Exeter Squash & Racketball Club for some coaching, then build up to a return to competitive squash after a break of five years.
“Getting back on court was amazing,” he smiles. “It was so great to be out there hitting a ball and feeling like I could move, without thinking, ‘If I run for that ball I’m going to lose the next four points because I’m shattered.’ I just felt so free.”
His coach, Paul Smith, tries to teach him how to slow the pace down, conserve energy and win rallies without going for risky winners. “He has me practising all the shots I should be playing, but then in a match those old instincts to attack everything are so hard-wired that I go back to playing stupid shots again!” laughs Peter.
With his lung capacity back up to 90%, he entered the squash and tennis competitions at the British Transplant Games in Leeds last July. He won both – and earned an invite to the World Transplant Games in Perth this April.
He flew out a week early. He hadn’t been on a plane for 10 years due to the lack of oxygen on flights, but once that mental hurdle was negotiated, he practised with locals at Perth’s Squashworld Mirrabooka club and adapted his brand of ‘old man squash’ to Australia’s bouncy courts.
In the Games, he negotiated the first two rounds against France’s Alexis Cosnefroy and top-seeded Iranian Rezaei Hossein, then faced Gregory Serradinho of South Africa in the final and won in straight games. Oh, and by the way, he won gold in the men’s singles tennis and a silver in the doubles too!
“I called my parents afterwards and got a bit emotional because my mum had taught me to play squash when I was 10,” he says. “They had obviously then been through everything with me. It was very special.”
Peter still faces the threat of infection, his body may still reject the new organ (although the chance of that reduces over time) and he is at higher risk of certain types of cancers – but he is most likely to live to a normal age.
He has signed up for the Great North Run in September and hopes to defend his titles at the next World Transplant Games in Dresden, Germany, in 2025. Shorter term, he is looking forward to the start of the summer team event at Devon & Exeter and then resuming action for the club’s third team in the Devon League next season.
Understandably, he can’t help sometimes thinking back to the traumatic period before his operation. “I remember being in the waiting room before the transplant and they had this soothing moving pattern on the wall,” he recalls. “Mum and dad urged me to look at it and try to relax, but all I could think about was playing squash again. It took longer than I thought, but I got there in the end.”
Peter is urging people to let their loved ones know if they want to donate organs after they die, so others like him get a second chance at life. For more information about organ donation, click here.