“I’VE got to the point that I’m not scared of dying anymore, I’m more scared of not living.”

David Smith has, over the past eight years, been forced to endure an almost constant cycle of tumours, surgery and rehabilitation. But the past two years have been the toughest, with Smith finding himself paralysed from the neck down and wondering if he would ever be able to describe himself as an elite athlete again. It has given the Paralympic gold medallist a different perspective on life.

“Going into the most recent surgery, I was really scared and I’d never felt like that before,” he said. “I remember waking up in the ICU and I couldn’t move. The first eight weeks, I’d go to sleep every night believing that in the morning, my arm or leg would be able to move. But nothing was happening.

“The really hard part was that because I was in a neurological ward, everyone has brain tumours, you see people dying and I saw several people take pretty much their last breath. In the moment, you don’t realise that everything you’re being hit with is being embedded in your subconscious mind.”

Smith knows what it takes to be at the top of his sport. He was born with a club foot, with his bones needing to be repeatedly broken to correct it. But this never held him back, earning a black belt in karate, becoming East of Scotland 400m champion in able-bodied athletics and only missing out on a spot in the GB bobsleigh team for the 2006 Winter Olympics by a fraction of a second.

But the start of his tumours derailed his sporting ambitions, and caused him to turn to para-sport.

In 2012, he won Paralympic gold in rowing but with medical issues forcing him out of the boat, he then took up cycling. He was a part of the GB team and had his sights set on the 2016 Rio Paralympic Games but at the start of that year, was given the dreaded news that a tumour had been found next to his spine and he needed urgent surgery.

So serious was his condition, Smith was told that had the tumour been just two millimetres to the right, he would never have walked again.

But it was not the immediate aftermath of the surgery that really affected Smith, it was the mental toll of realising that sport, which had been his entire life, could be only a distant memory for him.

“I went to Stoke Mandeville Hospital and that’s when it really hits you,” he said. “You go through these stages of denial, frustration and then the stage after that is depression. Everything that I’d been through really hit me and I realised I’d lost my identity. I could just about walk but there was no way I could get on my bike and at that point, I hit rock bottom.

“In the past, I’d had my sport to go back to but this time I felt like I didn’t. I had no purpose.”

But an invitation by the former Scotland rugby captain, David Sole, to speak at an event about resilience, was a turning point. Smith realised that he was in the midst of the five stages of grief and from that point, he vowed to make things happen for himself.

He finally managed to get back on a bike – or was lifted on to the bike – and pedalled for the first time in over a year. It was, he says, an incredible feeling.

But this was still not enough for Smith, with the pull of elite-level sport a constant presence. And finally, his hard work paid off. On Thursday, Smith will pull on the GB jersey and line up at the UCI Para-Cycling Road World Cup in Ostend, Belgium. It is, he admits, surreal.

“I wasn’t entirely convinced that I’d ever be in this position again,” he said. “So when I’m on the start line, ready to roll off the ramp to ride, I think I’ll just pause and take it all in.

“If I compare myself now to the old David Smith, I’m nowhere near where I was. But I’m only functioning with one arm and one leg so considering what I’ve been though, I’m in really good shape. And so whatever I do in Belgium, I have to see it as a great performance.”

The nature of elite sport encourages athletes to continually look forward and not to live on past achievements. But, fthis year Smith has allowed himself a moment for reflection.

“I was in Mallorca for a training camp and, for the first time in my life, I stopped and said well done to myself,” he said. “I thought yeah, I’m proud of myself and I’ve never been able to do that before. Everything I’ve been through to get to this race means so much more than anything in the past. It’s because I know what I’ve been through and it’s been hell.”

His experience of the past two years has changed Smith and given him a new outlook on sport and life.

“I’m never free of this, there’s always the chance that this will come back so I’ll still be having regular scans,” he said. “So I really have the mindset now of going out there and making the most of every day and living life to the max. I struggle doing everything through the day – washing, eating, cooking because I’m in constant pain. The only time I feel completely free is when I’m on the bike or in the pool –that’s the only moments in my day when I don’t feel disabled.

“When I was lying in a hospital bed, I realised that life is about experiences. I love what I do and I need to always remember how lucky I am to be able to get on my bike because if things had worked out just a little bit differently, I could be sitting in a wheelchair and that’s why I make the most of every day.”