Everybody hurts...

Day 38  

General status update 

Hair: There. Still.  

Nausea demon: He didn’t get much of a look in today. There was a new arrival from the infernal regions, all revved up and raring to go. 

Chemo Muse: whipping me on in the face of extreme inertia, not to mention existential despair. I have no idea how I managed to write any kind of  blog post at all today. If it‘s total rubbish, you can blame the 

Despair Demon: Woke up this morning, like someone in a blues song, feeling that at some point during the night the demon of Despair had drifted in through the bedroom window, and settled herself around me in a clinging, crippling fog.  Yeah, I’ve got through 37 days of chemo – but there’s still another 70 or so to go and – I’m so damn TIRED of it already. Tired of feeling sick all the time, tired of feeling toxic inside, tired of feeling weak and tired… all for something that only has a 7-8% chance of stopping the cancer from coming back. I wish she’d stop whispering all this stuff in my ear – it’s really not helping.

Chemo Brian: He came down to the hospital with me this afternoon, and I fell asleep on his shoulder during the 1 hour and 15 minutes I waited after the appointed time to have my PICC line flushed. It was an excellent nap. 

Fatigue/weakness: My constant companions.  

Sleep, lack of: totally n/a. - fell asleep in the haematology clinic waiting room at the hospital today, surrounded by strangers.

Anxiety level (1-10): Whatever

 

State of mind: Not waving, but drowning.

The thing I remember most clearly from the moments immediately after being told I had breast cancer is trying desperately hard not to cry. Looking back, I’m not quite sure why, but it seemed tremendously important at the time; perhaps it was because of my extreme aversion, rooted in our disastrous initial encounter the previous week, to the person breaking the news to me.

To be fair, the abominable Mr G, Consultant Breast Surgeon, does the deed gently, in a manner which cannot be faulted - but you know what they say, it’s very hard to recover from making a fatally bad first impression. Having told me that I have invasive ductal breast cancer in my right breast, and that they think the tumour is about 1.4cm in size , Mr G begins to explain the finer detail, as I gaze at him blankly though a mist of tears.

This is the most common form of breast cancer: my tumour has been found relatively early, and is only stage 2; although it is an invasive cancer, they don’t think it has yet spread to my lymph nodes, or anywhere else. The recommended course of treatment is surgery to remove the tumour – a ’wide local excision’ or lumpectomy, just taking out the tumour and a margin of tissue around it, which means that I won’t lose my breast – followed by a course of radiotherapy, and then several years of hormonal drugs, depending on the exact hormonal status of the tumour, which has yet to be established. At this stage, chemotherapy does not seem to be indicated. This is a very treatable cancer, and my prognosis is good.

As he is explaining all this I suddenly recall that you’re meant to take notes in these situations, as afterwards you may not remember much of what the doctor tells you. I start fumbling around in my bag for my notebook and pen, muttering ‘I must take notes’.

Vanessa the Breast Care Nurse intervenes then, speaking for the first time. ‘Don’t worry about that now, Caroline’ she says, very gently. ‘I’ll go over it all with you again afterwards.’

There isn’t a great deal more to be said, anyway. I am to be put on the waiting list for surgery, and the operation will probably take place within 3 to 4 weeks. In the intervening period, Vanessa will be my point of contact with the hospital, and deal with any queries I might have. And right now, we are to adjourn to another room with Vanessa, so that we can go through everything again rather more slowly, and she can give us some information leaflets.

I thank Mr G politely – since his initial rudeness to me I have taken to treating him with exaggerated courtesy – and Vanessa leads us to another room, with comfortable chairs around a table on which stands a large box of tissues.

I start to cry properly now, less inhibited with Mr G no longer present, and bury my face in a handful of tissues. R has his arm around my shoulder, stroking my arm, and Vanessa brings me a glass of water.

I smile my thanks at her through my tears ‘You have a very difficult job, having to cope with people’s reactions at times like this.’

‘It’s not easy’ she replies ‘But the best thing about it is seeing women get through all this, and come out the other side. As you will, although it may not seem like that now.’

And with that remark, instantly bringing a positive note into a very dark moment, when R and I are transfixed with shock and horror at the news we have just received, Vanessa sets the tone for our relationship; she is not only a kind, compassionate person, whom I instantly like and trust, she is also extraordinarily good at her job.

Slowly, we recap the information about my illness, and Vanessa marks the relevant pages in a Macmillan booklet about breast cancer, ticking everything that applies to my particular cancer, type of tumour, and proposed course of treatment, so that I can go back and read it later, and know exactly which bits apply to me. It’s still all quite confusing –

What’s the difference between stages and grades of cancer? Why do some people have radiotherapy and some have chemotherapy, and some both? What is all this business about the hormonal status of tumours?

- but I know the information is all there for me to read and digest later on.

There is one outstanding issue, though, which I feel impelled to raise. I tell Vanessa the story of what happened with Mr G. the previous week at my biopsy appointment, how he hadn’t bothered to introduce himself to me, how angry this had made me, and how this discourtesy had made me extremely reluctant to have anything more to do with him.

‘I hate to be difficult’ I say ‘but I am very, very unhappy at the thought of that man coming anywhere near me with a scalpel. Is there any chance that I might be able to have a different surgeon for the operation?’

‘Oh, don’t worry’ says Vanessa ‘He doesn’t operate here. You’ll definitely be getting a different surgeon’.

The sense of relief is enormous.

She goes on to explain how I will have to come back to the hospital for various appointments before the operation: to meet the surgeon, and discuss how he will perform the operation; to be assessed for my fitness to undergo a general anaesthetic; and finally, the day before the operation, to have radioactive dye injected into my breast, so that they can identify the ‘sentinel’ lymph node. During the operation they will remove the first lymph node under my arm into which the dye has drained from the breast, as this will be the first port of call for cancer cells, if the cancer has begun to spread. If the sentinel lymph node is clear of cancer, as they think, no further action will need be taken; conversely, should there be any cancer cells in the sentinel node, further action, as yet unspecified, might be called for. But that’s not a bridge we need to cross until and unless we come to it.

As we gather up the various leaflets and information sheets prior to leaving, Vanessa hands me one further item, a card from somewhere called ‘The Haven’, in Fulham. ‘It’s a support centre for people with breast cancer’ she says ‘they offer complementary therapies, counselling, nutritional advice – a wide range of services. It’s all free. Many of our patients find it a great help.’

I look down at the card, beautifully printed, engraved with the pink ribbon logo, and think:

 But this place is for people with cancer…

 Oh.

Yes.

Right.

 

That would be me.

 

There is an Angel of Death, and her name is Vanessa

Day 33:  

General status update 

Hair: its continued adherence to my head, after 2 doses of chemo and 30 odd days, is a matter of wonder and amazement all round. Amusingly, on Twitter I have just been followed by the company that makes the cold cap, and another organisation which promotes its use. I may yet get to star in their promotional literature.

Nausea demon: he didn’t come home last night, but waltzed in trying to look nonchalant this morning, as the Chemo Muse and I were eating our breakfast. No-one said anything about anything, and the Chemo Muse and I decided to have another round of toast. 

Chemo Muse: keeping me busy; in a previous existence she may well have been an overseer of galley slaves, using a sharp flick of her whip to encourage the poor groaning wretches chained to their oars. Not that I resent her, or anything.

Chemo Brian: keeps beckoning me towards the sofa – it is so, so tempting, yet I must resist. 

Fatigue/weakness: back with a vengeance. I went out for some fresh air, and was barely able to put one foot in front of the other. Felt so weak and vulnerable, especially when a big burly bloke came up and asked me for money. Scurried – sorry, tottered – back to the womb-like safety of Gurkha Towers fairly shortly afterwards. 

Eyes: The 70s disco light effects have now abated, but there’s someone else on my chemo thread having strange eye occurrences, so it may have been chemo-related. 

Sleep, lack of: n/a 

Anxiety level (1-10): I simply don’t have the energy to be anxious at the moment 

State of mind: Trying very hard not to think about the fact that there are going to be another 70 days and nights of this.

 

 

In the days before the abolition of capital punishment in the UK, when a prisoner in the dock saw the judge donning the black cap, he or she knew that the game was up: they were about to given the death sentence. Condemned prisoners thus knew their fate immediately, before the sentence was pronounced by the judge; the modern equivalent of the black cap and its symbolism is the presence of a Breast Care Nurse at a meeting to discuss the results of your biopsy.

A week after my bruising encounter with the biopsy needle and the abominably discourteous Mr G, R & I sit in the waiting room at the Charing Cross Hospital Breast Care Clinic at just after 9am; we have an appointment at 9.10 am to hear the biopsy results that will determine my future. It has been a difficult week, with far too much time spent googling breast cancer, and finding far too much information about its confusingly many different varieties.

My tip to anyone in the same situation would be NOT to do this, although I doubt it would have deterred me, had I been given such advice. Iin retrospect, however, it was just a very scary waste of time: the only particular sub-variety of breast cancer you need to know about is the one you are actually diagnosed with, if it comes to it. I would have been much better off spending the time watching my as yet unviewed boxed set of series 2 of The Killing.

There are only a few of us in the waiting room, as it is so early, and our faces are all painted various shades of pale and stressed. I look round at the other women, two of whom are wearing the tell–tale chemo headscarves, and think ‘No-one is here for a good reason’. After a few minutes Mr G enters the clinic and, as he walks past, smiles at me.

Much like a Roman augur scanning the entrails of a bird for portents of divine intent, I am desperate for any sign that the future might be going to pan out the way I want it to; I thus interpret this smile as a favourable omen.

 ‘He wouldn’t have done that if I’d got cancer, would he?’ I say to myself, by way of reassurance.  ‘He wouldn’t have smiled at someone if he was about to tell them they had cancer’.

We don’t have to wait long. Mr G comes to the office door and calls us in, and as we sit down he says ‘We’ll start in just a moment – as soon as the Breast Care Nurse comes to join us.’

And this is the moment I know for certain that I have breast cancer, because it doesn’t seem feasible, even to one as open to denial as I then was, that a Breast Care Nurse is going to be joining our meeting in order to advise me on how to look after my breasts better, so that they don’t grow any more of these silly lumps in future.

There is an Angel of Death and, as it turns out, her name is Vanessa.

When Vanessa the Breast Care Nurse has joined us, and been introduced, Mr G has to don his metaphorical black cap and pronounce the sentence.

He leans forward very slightly and looks at me.

‘As you know,’ he begins ‘we were very worried about you last week…’

I’m sorry, WHAT? I don’t know any such thing. You didn’t SAY you were very worried about me, you said I had a lump with a pronounced ridge. No one at any point mentioned being very worried about me. Since when does ‘lump with a pronounced ridge’ mean WE ARE VERY WORRIED ABOUT YOU?’ Am I expected to make inferences from your oblique pronouncements? Would there have been anything wrong with saying ‘We are very worried about you BECAUSE you have a lump with a pronounced ridge, and that is a Very Bad Sign which  means you almost certainly have breast cancer’?

Wouldn’t it have been more sporting to have given me a bit more of a f***ing CLUE? How was I expected to know that ‘lump with a pronounced ridge’ = ‘breast cancer’? I’m not the lump expert, Mr G – you are. 

‘..and I’m afraid to say that the biopsy results have confirmed that you have Invasive Ductal Breast Cancer.’

Then R is holding my hand tightly as the world goes all blurred; my old life has vanished in an instant, and a new and very frightening one has come to replace it.

 

 

 

Addendum, 12th January 2012: it has been pointed out to me  - by my old tutor at Oxford, who takes his job so seriously that he is still critiquing my work some years after his professional responsibilities towards me  ceased – thank you, Philip! - that it is rather alarmist to compare a diagnosis of cancer to a death sentence and, of course, it is true that a diagnosis of cancer is not necessarily a death sentence.

 

I have already written on the blog elsewhere about my own prognosis:  given the nature of my tumour, and the various treatments I have had, am now having and will have later - surgery, chemotherapy, radiotherapy, and the hormonal drug Tamoxifen - I have a roughly 91% of disease-free survival for the next five years. I have NOT received a death sentence. Probably.

But in the blog post I made the analogy between the donning of the black cap and the appearance of the Breast Care Nurse to recreate my state of mind at the time; that was what went through my mind at that moment. When I heard that the Breast Care Nurse  was coming, I knew immediately that at the very least I was about to be told that I had a life-threatening illness,  and at worst - if it turned out to be a very aggressive cancer, or one that had already spread to my bones, brain or liver - it might mean, effectively, a death sentence.

Vanessa has been a huge support to me, and is incredibly good at what must be one of the

world’s most emotionally harrowing jobs, something I will be writing about later – but at the moment she first came into my life, her very appearance in the room symbolised the fact that I was about to hear some very bad news indeed.

‘Please allow me to introduce myself...’

Day 30:  

General status update

Hair: no change.

Nausea demon: exhausted after giving his all in the titanic struggle of the last few days, he is mostly staying in his room at the moment, allegedly working on an overdue essay for his OU Counselling Diploma, although it’s the first essay crisis I’ve ever witnessed accompanied by an Angry Birds soundtrack. 

Chemo Muse: demanding that we sit down and have a strategy meeting to plan the remaining 13 days of this chemo cycle, so we can maximise my productivity before it all goes haywire again at the beginning of FEC3. 

Chemo Brian: We’ve had a few interesting conversations over the last few days about his rock’n’roll past, and it turns out he was actually at Woodstock – amazing! He can’t remember anything about it, obvs. 

Sense of smell: spectacularly ramped up again - every whiff of cooking food is the olfactory equivalent of Very Loud Rock Music of the Most Unpleasant and Cacophonous Kind; in essence, I have Megadeth performing a stadium concert in my nose.

Superpowers: It has been suggested to me by a friend with a close acquaintance with the Marvel Comic films that my chemo ordeal should qualify me for at least one superpower- if I have any choice in the matter, it’s certainly NOT going to be sense of smell. 

Fatigue/weakness: was unpleasantly surprised today, when I went out, by feelings of physical exhaustion and extreme weakness. Found it v. challenging to climb 2 small flights of stairs, and had to get a taxi home, because I felt as if my legs were on the point of giving way, and I was likely  to end up in an undignified crumpled heap on the pavement at any moment. This is entirely normal for chemo patients, as far as I can gather; after all, I am walking around in a cloud of mustard gas, albeit on the inside. 

Sleep, lack of: sleep deficit starting to build up again after 3am bedtime yesterday, but not yet critical.

Anxiety level (1-10): just humming away there steadily, in the background. Tunelessly.

State of mind: Dogged

 

When Dr. Frank Burns, in the Korean war medical comedy M.A.S.H, complained that he couldn’t understand why people took an instant dislike to him, Captain John McIntyre simply replied: ‘It saves time, Frank.’

Imagine the soul of Dr. Frank Burns incarnated inside the etiolated body of Lord Peter Wimsey, with Savile row suit, de haut en bas manner and languid patrician tones to match, and you will have some idea of what faced me when I went to the Breast Clinic at the Charing Cross Hospital at the end of August for further investigation of the lump I had found 2 weeks previously in my right breast.

The only thing lacking was the monocle.

Oh, and the exquisite manners.

The man who stood and called my name from the door of an office was already seated at his desk by the time I walked in and sat down -  alone, vulnerable and terrified (R was there with me for moral support, but had to stay in the waiting room).

Without deigning to introduce himself, he simply said ‘Well, your doctor has referred you with a suspicious lump, so I’d better take a look at it before you have the mammogram and ultra-sound and, if necessary, a biopsy.’

I removed my upper clothing, and allowed him to examine my right breast, but remember very little of our conversation over the next few minutes because my brain had dissolved into a red mist of rage that this man had not even bothered to tell me who he was.

The doctor, whoever he might be, duly confirmed the existence of the lump, deemed it worthy of further investigation, dismissed my concern about what might be a swollen lymph node under my arm as something they would look at with the ultrasound, and told me to return to the waiting room until I was called for my mammogram. I refastened my bra, rebuttoned my blouse, and stood up; my hands were literally shaking with rage.

The doctor looked away from me, and down at his notes; I was dismissed. I remained standing in front of him and said ‘Umm… what is your name?’

He looked up from his notes with the startled expression of a man whose pet Labrador has suddenly asked him a question, and drawled

‘G------’

The name he gave was one which can be both a given name and a surname, which confused me for a moment, and I said

‘Doctor G.?’

‘Mister’.

Consultant surgeons, of course, are referred to as ‘Mr’ rather than ‘Doctor’ in some kind of arsey-versey form of status attribution; I knew that.

Bugger.

‘Thank you, Mr G.’ I said, quietly, and left.

 

I don’t remember much about the mammogram, except that it’s much like having your breasts squashed, one at a time, between the two halves of a giant sandwich toaster; the next thing I clearly recall is lying on the bed in the room where the ultra-sound is administered, and articulating my extreme displeasure with Mr G.to the startled radiologist and attending nurse, both female.

Both of these women had introduced themselves as soon as I walked into the room.

‘I cannot believe how rude that man was’ I said, lying on my left side, with my arm held awkwardly above my shoulder, as the radiologist smeared the jelly for the ultrasound over my right breast.

‘He didn’t even have the basic courtesy to tell me who he is’.

Medics cannot, of course, join in patient criticism of other medics; but something about the exchange of glances between the doctor and the nurse made me think that perhaps Mr G., the consultant breast surgeon, was not greatly loved by them, either.

It struck me that Mr G. was, although extremely well-preserved, clearly in his sixties. 

‘He appears to have gone to medical school’ I added ‘in the era before they regarded empathy and interpersonal skills as necessary attributes for doctors.’

I calmed down gradually, as the ultrasound examination went on, and on, and on.

Before coming to this appointment, I had been reassured to read that 90% of breast lumps are benign, and most of those are simply water-filled cysts.

‘ I know you’re not allowed to make diagnoses on the hop, ‘ I said ‘ But is it possible to tell from the ultrasound whether it’s just a cyst?’

‘Oh, it’s not a cyst’ said the doctor, softly, as she continued her manipulation both of my breast and the computer screen onto which the ultrasound images were projected.

‘Oh, right.’

I did not enquire further, having the idea in my head that no truly accurate diagnosis could be made until a tissue sample had been analysed by the pathology lab. It had said on the Charing Cross website that they aimed to give you a diagnosis by the end of the day, if possible, but I presumed this would only be the case if your lump was obviously a cyst. Fibrous lumps would need to be investigated in the lab, wouldn’t they?

The doctor reassured me that the tiny lump near to my right armpit was not a lymph node, or anything else significant - good. The ultrasound examination moved on to my right breast, and was again lengthy and thorough. Then the doctor explained that she needed to take biopsies of the original lump, and another tiny ‘suspicious area’ which might be something, or nothing, in the same breast. She explained the biopsy procedure clearly, gave me a local anaesthetic, and took the tissue samples with painless efficiency, warning me ahead of time that the biopsy needle makes a clicking noise when it punches out the tissue sample, much like a hole punch for paper.

By the time it was all over, I had been lying on the bed with my arms in strange positions for about 2 hours, and was a little shaky. The doctor told me that the clinic would give me an appointment for the following week, at which I would be told the biopsy results.

‘Is there any chance I could have the appointment with a different surgeon?’ I asked. ‘Because if I’m going to be told I have cancer, I do not want to be told it by THAT MAN.’

The nurse, who had held my hand whilst the biopsies were being taken, and generally soothed me all the way through, said that she would go and have a word with the woman on reception to see if that could be arranged. She left the room just as Mr G. came in, to see why everything had taken so long. He stayed to speak to the radiologist, and I was sent back to the waiting-room again; it seemed there must be a final meeting before I could go home.

R was nearly frantic with anxiety, because I had been gone for such a long time; I told him not to worry, they were just very thorough, and we waited for the next summons, hand in hand.

Back in Mr G.’s office a few minutes later, this time with R sitting next to me, I was too tired and cross and confused to pick up on the finer points of what the man was saying, and how he was saying it.

Or, perhaps more importantly, what he wasn’t saying.

Mr G. smiled, inasmuch as a glacier can smile; it could equally well be described as a slight furrowing of the ice.

‘Well, you did have a bit of a time of it in there, didn’t you? It seems there’s a lump with a clearly defined ridge - we are sending the tissue samples for analysis, and will see you again in a week’s time.’

‘Not if I can help it ‘ I thought, entirely missing the significance of his slight stress on the phrase ‘with a clearly defined ridge’. As far as I knew, he couldn’t make a diagnosis of any kind yet, and it was well past time to get the hell out of there. I asked no further questions, and he volunteered no further information.

‘Thank you, Mr G.,’ I said, and we left.

Outside, I conducted a whispered conversation with the receptionist about the possibility of making my appointment for the biopsy results with any breast surgeon at all on Charing Cross Hospital’s extensive list who was NOT Mr G. She did her best, but it was holiday season, and cover was sparse; if I wanted to see someone else, it would have to be in 2 weeks’ time, not one.

And so I left, despondent in the knowledge that whatever fate the Gods were choosing to deliver to me the next week, their instrument of delivery would be none other than Mr G. 

 

As we walked back up the Fulham Palace Road towards home, hand in hand, the sound of Mick Jagger’s voice started to echo through my head:
 

 

 

Don't worry about a thing, 'cause every little thing gonna be all right...

Day 14

General status update

Hair: cowering, frightened, waiting for the axe to fall – but still attached.

 

Nausea demon: giving me the occasional poke in the stomach with his pitchfork, just for fun, but otherwise much concerned with the preparatory reading for his OU course – he settled on the Diploma in Counselling, in the end. I put it to him that surely tormenting was rather more in his line, and he blushed and muttered something about broadening his skills portfolio, which has a certain economic logic to it: he can start tormenting people first, and then charge them a fortune for advice on how to cope with it.

 

Chemo Muse: continues to be completely manic – am beginning to wonder whether she might be a Bacchante in disguise.

 

Sleep, lack of: so, so tired – tired but wired, a bizarre combination.

Fingertips: still a bit numb – am worried this may become permanent. It’s called peripheral neuropathy, apparently.
Toes still seem ok, though.

Heightened sense of smell: it’s like having a hearing aid in my nose, and not in a good way.

Anxiety level (1-10): can’t slow down long enough to be anxious, frankly.

State of mind: much improved after going to see the Hobbit this afternoon, my first proper outing since Day 1 of chemo. Ignore the critics, it is entirely wonderful: there is husky-sledding, only with rabbits, a very moving hedgehog resuscitation scene, and I cried at the end. What more could you possibly want from a movie?

 

 

(picture posed by a model, in 1910; these are NOT my actual breasts)

                                                                   

I always got on very well with my breasts, until the day I began to suspect that one of them might be planning to kill me. 

We had co-existed harmoniously ever since they first appeared, and they had never given me a moment’s trouble; it never occurred to me that this state of affairs might ever change. My breasts have never had to work for a living: I don’t have any children, so they have not been troubled by the exigencies of breastfeeding, and have until now led a fairly cosseted existence - I do like a pretty bra. They are a good size, a nice shape, and have functioned primarily as a source of pleasure.

 

From the moment I found the lump in my right breast, however, whilst soaping off the chlorine in the shower after a swim in the pool at the Charing Cross Hospital Sports Club, my attitude towards my breasts changed, radically. We became somewhat estranged, once I began to suspect that one of them was harbouring something potentially lethal - It felt as if I were walking around with a hand grenade strapped to my chest wall.

A video still plays constantly in my mind of that life-changing moment, three months ago now:

My fingers moving across the soapy upper slope of my right breast, the sudden awareness of something hard beneath the skin, that felt like…. a lump. Surely not? I’m not a lumpy person.

My fingertips running over my breast again, feeling the resistance under the skin. The undeniable presence of a small, but clearly discernible, lump.

 My fingers pushing it and prodding it, again and again. It wasn’t tender, it didn’t hurt, it was just there, the size of a Marks & Spencer wasabi pea, perhaps, exuding  lumpiness, having apparently sneaked in and taken up residence in my breast whilst my attention was elsewhere.

My first, insane, thought that the lump was muscle I had developed by swimming so many miles in the pool...

Yes, the process of denial began right there, and would continue for some time. I wasn’t unduly worried, or at least told myself that I wasn’t, knowing that in middle age women’s breasts tend to become more lumpy, and that 90% of those lumps are benign; that most breast lumps are harmless, fluid-filled cysts, or inert bits of fibrous matter. A friend had recently told me about how, whilst working in a remote part of Nepal, she was forced to fly back to London to have a breast lump investigated. It proved to be innocent, and she took the opportunity to stock up on marmalade and Marmite, before flying back to Kathmandu. She had found several other lumps over the years; all had proved to be benign.

Another friend, a legendary swooner in medical environments, often at other people’s hospital bedsides, had told me how she lost consciousness with her breast clamped tight in the mammogram machine:

 ‘It’s not much fun passing out with your left tit squashed inside a giant sandwich toaster’.

Her lump was ‘Just gristle, nothing nasty’.  Another false alarm.

Of course, I knew of people who had had breast cancer, but no one closer than two degrees of separation. It had recently struck me as odd that in spite of the fact that I was always reading about the disease in the media, I didn’t personally know anyone who had suffered from it. Given that 1 in 8 women in the UK will contract breast cancer at some point in their life span, usually at the latter end, it was inevitable that one day someone in my circle of family and friends would get it.

I had been confident, however, that that person wasn’t going to be me. For a start, I come from a long line of vigorous Fo women who have lived to their late eighties or early nineties, completely compos mentis and in good physical shape, without chronic diseases; I remember my maternal grandmother redecorating her own bathroom in her early eighties. None of them had died of breast cancer.

 In a lifetime of competitive hypochondria combined with general good health - Big Sis Fo and I have spent many happy hours over the years googling and discussing our various symptoms - breast cancer just wasn’t one of the diseases I had chosen to major in; it hadn’t even made the short list. I was pretty sure I had some kind of rare auto-immune disorder, not amenable to simple testing, and quite possibly the beginnings of a degenerative neurological wasting disease, but breast cancer wasn’t even on the agenda.

 Still, the lump didn’t go away, and you need to check these things out, so I made an appointment with the doctor. He took my history, examined me, found the lump, and told me that there was almost certainly nothing to worry about, whilst simultaneously writing out an urgent referral note to the Breast Clinic at the Charing Cross Hospital, which the receptionist faxed to them immediately. They would see me within 2 weeks, he said, and that is exactly what they did.