"Donald, this is Dr. Berlin. I'm looking at the ultrasound results. We identified what appear to be two large tumorous masses. They're consuming the entire right testicle."

I wasn't sure how to respond. "Has it spread?"

"It's unclear. We need to do a biopsy. The lymphatic system, lungs, and brain are the most common areas." He paused. "We need to see you right away."

There's no good time for cancer, but this timing was cosmically bad. After a year of preparation, I had just left my job to start a real-estate technology company called Hightower. My co-founders and I were in an all-out sprint building our MVP and kicking off conversations with investors. In addition to conventional startup questions like "Will we raise venture capital?" and "Will people actually use our product?" I now faced an entirely new set of questions about my health and its impact on my startup.

However hard things had seemed before, it was clear that they were about to get a lot harder.

I spent the following months recovering from surgery, propped up on strategically placed pillows, and limping around like an extra in The Walking Dead. I worked from a creaky futon, designing and coding what became Hightower v1. My co-founders visited for daily product-planning sessions. I pushed through the mental fog of painkillers or went without them in favor of a clear head.

Three weeks after the operation, my surgical incision opened and a grapefruit-size hematoma began spilling from my abdomen. Wound-care appointments and oncology visits filled the nooks and crannies between Hightower working sessions. I carried gauze and bandages in a ziplock bag to clean and repack my surgical wound throughout the day. I drove three hours for a CT scan on Christmas eve and four hours for a PET scan on New Year's eve. All of this as we built our MVP, bootstrapping our way toward an alpha-release and our first round of investment.

By January 2014, my health care team had recommended against chemotherapy in favor of regular CT scans and blood work. Hightower had shipped v1 of our product to a closed group of customers. They loved it. We also closed a $2.1 million seed round led by Bessemer Venture Partners and Thrive Capital. This gave us the money we needed to move the company to New York and begin building the team.

In the 12 months since our move, Hightower has grown from three people to over 30, raised another $6.5 million, and outgrown our office four times. Staying on top of my health while growing a company this quickly is not easy. Even in its "absence," cancer takes many forms--medical bills, CT scans, x-rays, blood work, and waiting rooms. Cancer feels like the world's worst employee, demanding time and mental bandwidth while providing nothing in return. But because cancer has been with me from Hightower's start, it's much more like a co-founder, one I never bargained for.

Launching a startup is challenging even under the best of circumstances. A "hot off the press" cancer diagnosis has a way of ratcheting up that challenge with intense personal pressure and uncertainty. Many things could have made this time worse. But there are three things that I would have been sunk without.

The first is health insurance. I had bad health insurance. I didn't know how bad it was until I got the bills. But bad health insurance is better than no health insurance. Thankfully I hadn't gone for check-ups during an uninsured period just prior to my diagnosis, as I would have later been denied all coverage based on a pre-existing condition (a battle I had to fight regardless). Get health insurance. Not doing so is an act of negligence that puts both you and your team at risk.

Next is team. Team can be defined broadly and certainly includes family and friends. Through the lens of a startup, it means only your co-founders. Books have been written on co-founder selection. It's an art. When the shit hit the fan, my co-founders never asked me to step back, never proposed a succession plan, never talked about how this might "harm" the company. My co-founders drove me to my surgery. These are the type of people you want on your side.

The third one is the ability to manage stress. When I was in the thick of it, there was incredible pressure to tap out, to gather my things and go home. But I believed that if I could make it, if I could keep it together and carry my weight as a founder without pausing, without blinking, and without complaining, that I could make it through just about anything. My reward would be my company and the knowledge that while I don't control circumstance, I do control how it affects me.

I was 30 years old when I started Hightower. I didn't realize that I had been taking the next 30 years for granted until they were clearly at risk. Fighting for Hightower wasn't a fight to start a company--it was a fight to preserve this union of ambitious vision and incredibly smart, fun people. Facing one's mortality has a way of clarifying what's important. Having done so, I assure you that rewarding work alongside world-class colleagues is special and worth fighting for. I hope you find this for yourself, if you haven't already.

Published on: Feb 4, 2015