Tricia Marwick told how she selected questions for the Scottish Parliament's weekly showdown the day before a life-saving operation.
Speaking publicly about her illness for the first time, she said she was determined to carry on working as she fought the disease and is recovering well.
In a wide-ranging interview she also unveiled proposals to reform the parliament and issued a warning to First Minister Alex Salmond and the main opposition party leaders that they could be timed out in future if they continued to ramble during question time.
Already seen as a reforming presiding officer - a role equivalent to the House of Commons speaker - she insisted she remained "driven" to modernise Holyrood's working practices to ensure they held government ministers to account.
Ms Marwick, 60, the MSP for Mid-Fife and Glenrothes, underwent surgery to remove her gall bladder in January and had a further operation in the summer to treat what, at the time, was officially described as an obstruction of the bowel.
Over a cup of tea in her offices in Holyrood's Queensberry House building she said: "As most folk now know it was not quite that simple. I did have a bowel tumour which was removed at the end of June, beginning of July. So I think it's safe to say my health has been problematic over the past year.
"But you get on with it. I'm recuperating well. I'm exhausted but, like everyone else, I think it's been a long, hard year."
Ms Marwick surprised, even alarmed, close colleagues by refusing to take much time off. She was away from her desk for just three weeks after her first operation and a month after the second, immediately prior to the parliament's long summer break.
She said: "I had a fantastic summer recess when I sat out in the garden practically every day and had lunch with my grandkids, which was just great.
"I think in reality the aftermath of the operations was a doddle compared with how ill I'd been before. On the morning I was going in for my bowel operation, on the Monday, I was still choosing the First Minister's questions on the way down in the car. I recovered from the operation and the following Monday I was selecting First Minister's Questions and topical questions again. While I was physically not here, I still had my hand on the tiller."
Asked whether that was "silly" she admitted: "That's probably right. I'm quite driven. This job of Presiding Officer is a job I never expected to do. But I see the huge opportunities it brings to be able to shape the parliament and to rebalance the parliament.
"It's wonderful opportunity and I'm absolutely committed to make all the reforms necessary to the parliament."
She added: "What I'm really delighted about is that, despite the fact I've not been well the reforms, the changes I've wanted to make, have gone forward."
She was referring to a package of procedural changes that amount to the biggest reform of Holyrood since the parliament was created in 1999. Since she succeeded Alex Fergusson as presiding officer in 2011, ministers have been summoned to parliament on Tuesdays, the start of the parliamentary week, to face topical questions.
A "super-committee" of committee conveners has been created to grill the First Minister on his annual programme for government. And she hopes to enhance the status of committee conveners by making them elected by fellow MSPs rather than being appointed by their party.
The changes reflect a determination to remind MSPs that, as parliamentarians, they have a responsibility to scrutinise legislation and hold ministers to account that goes far beyond political point-scoring.
Her procedural reforms have been only half the story, however.
Two unexpected blockbuster exhibitions drew tens of thousands of people to Holyrood this year. Crowds queued around the block to see the freshly-stitched Great Tapestry of Scotland and its success was followed by a prestigious show of works by Andy Warhol.
Between them they attracted more than 50,000 visitors; great news for the parliament's recently expanded souvenir shop but, more importantly for Ms Marwick, they reinforced attempts to make the parliament more visible, open and accessible.
Ms Marwick is quietly proud the huge number of visitors was ushered in without logistical problems thanks to Holyrood's new high-security £6 million entrance hall, opened on time and on budget earlier this year.
She said: "What was significant about both the Tapestry and the Warhol exhibitions, both of which were absolutely wonderful, was not the fact that so many people came to see them but that half the people who came to see the tapestry had never been in parliament before and, in the case of Warhol, 56% had never been before. You want the parliament to be at the centre of what's happening in Scotland.
"If there is a fantastic exhibition, why shouldn't it be in the Scottish Parliament?
"We do things because they are good to do but at the back of our mind is the question how do we get more folk in here and engage with all the work we do?"
The surprise sight of people queuing to get into the Scottish parliament perhaps symbolises a year which could have gone down as one to forget for the Presiding Officer. That and the old saying: the show must go on.