Take a look at me now...

Day 120

General status update

FEC cycle 6, day 5

Anxiety level/insane euphoria (+/- 1-10,000): we haven’t hit insane euphoria again, which is very sad, because I LOVED being manic, but the mental energy from the Dexys has at least kicked in and made itself useful.

Fatigue/weakness: physically, still immeasurable; mentally, not so much now.

Pain in left arm: considerable – a nasty little souvenir from those last 3 doses of FEC which went straight into the vein, and not the PICC line. It’s also painful to extend my arm out straight. Deeply hoping all this is going to go away before I start swimming again in 2 weeks’ time.

Nausea demon: he woke me up at 6am this morning, and is fighting on to the bitter end, but soon he will be gone gone GONE.

Chemo Muse: she’s had me had at it today, despite the fatigue – there’s quite a lot of stuff she still wants to say before it’s time for her to depart.

Despair Demon: brooding in the airing cupboard again. I wish he wouldn’t keep messing up all the clean towels.

Chemo Brian: he’s been trying to persuade me to go and see Yoko Ono and the Plastic Ono Band at the Royal Festival Hall in June, having fond memories of her and John in their ineffably inane naked protest days. NO, a thousand times NO! I’m sorry, Brian, but there are some things life is definitely too short for, and Yoko Ono is one of them.

State of mind: this is the LAST TIME, this is the LAST TIME, this is the last TIME.

Hair: I look like a shaggy dog now, I really do. BUT I HAVE HAIR.

I haven’t been talking much about my breast, which is odd, really, given that this whole saga started the day I discovered it was trying to kill me.

No, that’s unfair.

It wasn’t my breast that that trying to kill me, it was the unwelcome invader that had taken up residence in my breast, my tumour, Mr Collins; the greedy empire-builder who had crept in unnoticed, set up base camp in my ductal tissue and was now looking to colonise my bones, my brain and my liver, given half a chance.

But my right breast is where Mr Collins chose to establish himself, and from the day I was diagnosed with cancer until after the operation to remove the tumour, it felt as if I was walking round with an unexploded bomb strapped to my chest.

We were not on good terms.

After the operation, the alienation from my breast continues in quite a different way; it becomes a source of both public and private humiliation. One of the things you have to get used to very quickly as a breast cancer patient is having to take your top off so that strange men (not always men, but in my case it usually is) can examine, manipulate and perform procedures on your breast.

I’ve just counted up the list of people who have spent time with my breast over the last seven months: the locum at my GP, the 2 consultant breast surgeons, Mr G and Mr H,  Mr H’s 3 acolytes (all male); and the mammographer and ultrasound doctor (female). All of these people treat me and my breast with decency and respect, and I have absolutely no complaints about their behaviour; the difficulty is more of a psychological one, arising during the regular check-ups I am given during the weeks following my lumpectomy operation.

At the Breast Care Clinic at Charing Cross Hospital, the consulting room used by Mr H is very small; there’s barely room for a desk, a few chairs, and the bed behind a curtain where you disrobe for examination. When I am there with Mr H and R, that’s as many people as the room can comfortably take. If you add in Mr H’s registrar, a junior doctor, and a medical student, then the room starts to feel very crowded indeed: me and five men, in front of whom I have to display my breasts, one naked and normal, the other recently mutilated.

I don’t like it at all.

In the weeks after the operation, my breast heals well; the spectacular black and blue colouring (black from bruising, blue from the dye) is an irrelevance and the only problems are in the first week, a slight build-up of fluid (seroma) in the place where the tumour was, which is painlessly aspirated with a needle by the junior doctor, and by the second week a hardness, an unyielding quality to the flesh in the same place, which Mr H assures me is perfectly normal, and will disappear in time (it did). The stitches, which are all around my nipple, are made with self-dissolving sutures, and so do not have to be removed; they gradually begin to remove themselves.

All is well, all is going according to plan.

By the time it comes to the third check-up, though, I am also having to deal with the high likelihood that I am going to have to undergo chemotherapy, and am both distressed and emotional, and it all just becomes too much. At this appointment I am accompanied by my sister, but she is away fetching coffee when I am called into the consulting room, where I sit down with Mr H and, as the registrar, the junior doctor and the medical student also crowd themselves into the room, I think ‘No – I really cannot STAND this’.

So I just say, quietly, ‘I’m sorry, but there are too many people in this room’ and immediately and without question the registrar removes himself, the junior doctor and the medical student, which is not good for medical education, but saves me from breaking down in public.

I should add that my permission was asked at the outset for other doctors to be present at consultations, and I agreed; Charing Cross is a teaching hospital, and doctors need to be taught. I just had no way of knowing in advance how difficult I would find it to be half-naked, and examined by several male doctors in such a very small space. Maybe if one of the doctors had been female, or we’d been in a larger room, it wouldn’t have made me quite so distressed and uncomfortable.

At home I just try to ignore my breast altogether, keep it covered with soft camisole tops and tell myself that I am leaving it alone to heal, but that’s not really it: I don’t want to look at it, and I certainly don’t want R to look at it. I can’t bear this new bit of reality just yet.

It’s tricky, though, in the bathroom each morning when I take my shower, but with looking away when I’m applying soap, and big enough towels, and assiduous not looking in the mirror, I can contrive to get through my ablutions without really looking at my breast.

Until the day I when I do.

Towards the end of October, nearly a month after Mr H removed the tumour, the bruising has almost gone, and I get out of the shower, dry myself off, wrap the bath towel around my waist and stand in front of the mirror, looking at my breasts, full-on, naked. This is the first time I have done this since the operation.

The breast is still the same size and shape as it was before but the operation has had the promised effect of lifting it, so that the nipple is a little higher up, although the difference is not enormous.

What is different is the livid line of stitching that outlines the areola of the nipple, making it look much larger than before, and quite different from the other breast. My breast looks as if it has been sewn together from two different parts. It reminds me of….

Last autumn in London there were newspaper adverts and bus stop posters everywhere for a film by Tim Burton called Frankenweenie, about a boy who conducts a science experiment to bring his beloved dog Sparky back to life, with monstrous consequences, a la Frankenstein; the adverts and posters all featured a striking image of the poor dog, very clumsily stitched back together, and this is the first thing that comes into my mind as I stand there in the bathroom and look at my cut-open and stitched-back together breast.

Something breaks inside me at this moment of looking properly at my breast for the first time, and I stand there with tears pouring down my face, sobbing uncontrollably. I must be making a lot of noise because R immediately calls through the bathroom door ‘Caroline! What it is, what’s the matter?’ I open the door without covering myself up and he, too, sees my breast for the first time as I point to it and howl 

‘Look what they’ve done to me, it’s horrible, it’s a FRANKENBREAST’.

I am completely beside myself, and R puts his arms round me, holds me close, strokes my hair and calms me down.

‘It isn’t going to stay like that,’ he says ‘it ISN’T GOING TO STAY LIKE THAT. Remember what Mr H said – the scarring will gradually fade, and by a year after the operation, you will barely be able to see anything at all. Your breast will look pretty much like it did before.’

Rationally, I know this, that it will get better, but all I can see now, as I look at it properly for the first time, is the mutilation of my once beautiful breast, one of the things about me that R particularly appreciated.

And this is a special part of the horror that awaits women who get breast cancer: not only the threat of death, which is bad enough, but the fear that the treatment will mutilate you so badly that no one will ever look at you with desire again, if you’re single, or the fear that your partner, if you have one, will turn his eyes away from you, unable to hide his repulsion, that he will never want to touch you again. If you can’t even bear to look at yourself, what kind of reaction can you expect from anyone else?

‘You’re still you’ says R ‘and your breast will be fine, it’s just being mended. The operation has saved your life, and your breast will get better again. And this means you will stay alive, and we will grow old together, as planned.’

Then he kisses it, and me, better.

R is really, really good at that.

*     *     *

 Postscript: that day was nearly six months ago now and, as Mr H has promised, the scars have faded a great deal, and the ‘stitching’ effect has gone. Mr H is an excellent surgeon, and my breast is looking relatively normal again. I no longer become distressed when I look at it in the mirror.

In a way, I feel guilty for even writing about this, because I know that I am very lucky to have kept my breast: so many women lose their breast, or both breasts, entirely, and have to suffer far worse things than I have had to.

 But I can only tell my own story, truthfully, and this is how it was. 

Sister Morphine

Day 102

General status update

FEC5 - day 8

Anxiety level/insane euphoria (+/- 1-10,000): we’re adopting this category to allow for the violent mood swings engendered by the steroids. For the last few days I’ve been essentially bat-shit crazy – albeit very cheerfully so - but keeping on with the steroids has significantly decreased the power of the chemo side effects, and lowered my distress levels accordingly. Steroid dose now being reduced, so am starting to calm down, which will probably be a relief to Matron Becky, who was somewhat startled to have been elected World Mum/Mother Goddess yesterday, although she says she’s definitely going to put in for a pay rise.

Nausea demon: very morose over our 5am breakfast, and only had one bite of toast. Worried about him.

Chemo Muse: she sent me off to bed last night at 11pm, saying that I REALLY needed to get some rest now, and I mustn’t think about staying up all night writing again. Odd.

Despair Demon: there were noises coming from the airing cupboard last night, when I got up at 3am to get a glass of water – it seems he had company. Hmmm.

Chemo Brian: he’s really happy because when I popped into TKMaxx yesterday whilst waiting for a prescription to be sorted at Boots next door, I found the ultimate sofa comfort blanket – a huge, soft grey, chunky Argyll hand-knit cotton throw. You can never have enough throws, and I love it so much I fully intend to buried in this one, although not anytime soon, obvs.

PICC line: gone, but not forgotten

State of mind: Still Dexy-energised; no moping

Hair: there

  

Previously on Chemo Nights: it is the 4^th October, 2012, the day of the lumpectomy operation on my right breast. After a 7 1/2 hour wait for the operation, punctuated by some fairly deranged behaviour on my part, headed off by a kindly anaesthetist, the last thing I remember is having my pathetically inadequate veins insulted by another, less kindly, anaesthetist as he struggled to find an adequate venue for his cannula - now read on…..

A breast lumpectomy operation (or WLE – wide local excision), although a fairly major piece of surgery carried out under a general anaesthetic, is normally carried out as a day operation; once you have come round and had some time in the recovery room you can go home the same evening, all being well, and this is what is planned for me.

It doesn’t work out quite like that.

Although I reported to the hospital at 7.30am, my operation doesn’t take place until late afternoon, and I start swimming back into consciousness as I am being wheeled on a trolley into a ward where I will be staying overnight. And this is where my introduction to the awesome power of pharmaceuticals begins, because for the next 24 hours I am buoyed from the after-effects of the surgery on a wave of - presumably - morphine, blithely unaware of what will hit me once I get home.

There is a big dressing on my chest, but I am feeling perfectly fine and insist on R calling my mother and sister so I can tell them exactly how fine I am because they will be worried (I was, apparently, pretty much incoherent, but extremely cheerful). My surgeon, Mr H, pops in to check on me before going home and I greet him with a beaming smile. After R has gone, I bond with the other inhabitant of the ward, a woman called Sheila whose very complicated mastectomy was the operation before mine, and we sit in our beds chatting until the early hours of the morning, exchanging life stories in that extraordinarily intimate way you can do with complete strangers in adverse circumstances, particularly when you are completely off your face with drugs; every now and then we demand more tea and toast from the nurses who, at about 3am, gently suggest that it might be a good thing for us both to get a little rest now.

Early in the morning Mr H appears again for an informal check on me, before starting work for the day, and says I will be able to go home later in the morning.

Mr H’s aftercare, I have to say, is outstanding, and will remain so in the weeks that follow. Of all the breast surgeons in the world, I’m very glad he was mine. 

Later I receive the official ward round from his registrar, a very good-looking Croatian or Serbian who is flirting with the equally good-looking female doctor who accompanies him. Part of his general charm offensive is to describe us surgically battered female patients as ‘lovely ladies’ which, when you’ve just had your once lovely breast mutilated or removed, is rather adding insult to injury; however, he’s a nice bloke, and a good doctor, and I’m still high from the morphine, so I close my mouth without actually uttering the words ‘Don’t patronise me, you t***er’, which is the response which immediately springs to mind

I’m pronounced fit to go home and a couple of hours later, after the admin is all sorted and various drugs prescribed, am finally allowed to do so. The taxi delivers us back to our little eyrie in Gurkha Towers within ten minutes and R installs me on the sofa with books, magazines, and a range of refreshments.  I call a couple of anxious friends, and then start tweeting, saying that I am safely home, feeling fine, and we are now on to the ‘relaxing and recuperating on the sofa’ part of the proceedings. It’s just like BigSisFo said – having a general anaesthetic is no big deal, the operation has gone fine, and I should be up and about in no time.

I have absolutely no idea, not even an inkling, of what is about to hit me.

Just champion

Day 70  

General status update

Fatigue/weakness: getting stronger every day. Tomorrow I will go to the hospital to have another blood test, and see if my neutrophils have recovered enough for me to have chemo this week.

Hair: It needs cutting, but that is not going to happen until after chemo, if there’s still enough left to cut.

Nausea demon: Has sent us a postcard from the Lake District, where he seems to be enjoying himself enormously yomping over the fells.

Chemo Muse: Sat me down this morning, and got me to work again – I feel all the better for it.

Despair Demon: kicked him out again, with the help of the Chemo Muse – hard work is the antidote to most spiritual ailments.

Chemo Brian: seems unusually riled by Camille Paglia’s assertion in the Sunday Times today that Rihanna is the new Diana; I tend to agree with R’s view that Camille Paglia is best left back in the nineties, where she belongs.

.

Anxiety level (1-10): my only anxiety at the moment is anything standing between me and FEC 4 on Thursday.

State of mind: improving

News from the Tramuntana Mountains: MamaFo rings, having lunched well (a few butterflied prawns, followed by a little foie gras with apple; she invented the high protein diet about 50 years ago, and remains a size 10) to say how much the title of yesterday’s blog post had made her laugh. She also observes that after 69 days of reading my blog she is now determined never to have chemo herself, should the eventuality ever arise. She reminds me that she is nearly 82, has been smoking for 60 years, and has yet to get cancer. ‘Hilarious, isn’t it, darling?’ ‘Yes, Mother’ I reply ‘Yes, it really is’.

The Men’s Final of the US Open is pushed back to Monday in 2012, because of inclement weather. I have a strong feeling that this match is going to be the one when Andy Murray finally becomes a Grand Slam Champion, something I have been waiting for ever since I first saw him play as a lanky, stroppy teenager back in 2005. He needed time to finish growing, become stronger, and sort out his head, but right from the beginning it was evident he had not only the talent, but that inner core of steel needed to become a Grand Slam Champion, and the US Open has always been his favourite tournament, on his best surface, the one he is most likely to win.

So Monday September 10^th is a big day for me, one I’ve been waiting for a very long time; it is also the day on which we are going back to Charing Cross Hospital to meet the surgeon who is going to operate on my breast. Before today, this has all been very theoretical; now, the wheels are beginning to turn, and I have to face up to what is going to happen to me.

The appointment is for 9.10, which is good, as clinics tend to run late as the day goes on; at the beginning of the day, we should get in and out reasonably quickly, and then R can go to work. At 9.15 a doctor calls us into an office, sits us down, and tells us that he’s very sorry, but Mr H, the surgeon, won’t be there for another two hours. He doesn’t explain why. We don’t have to stay and wait; we are free to leave, but should return at 11.15 am. We thank him for letting us know, and walk outside into the sunshine, debating what to do.

We decide to make use of the time by going to the Haven, the Breast Cancer Support Centre which is quite close by, in Fulham, so that R can see it for the first time. R hunkers down on a sofa and reads his book, while I browse in the library, but we’re both too tense to concentrate. By 11am we are back in the Breast Clinic waiting room, and 20 minutes later a man comes in whom I recognise as Mr H – I’ve already googled him. Google has informed me that Mr H is a highly experienced breast surgeon of about 50 who has worked in the USA as well as the UK, has an MPhil as well as all his medical qualifications, and a number of research publications to his name. He also has a private practice in Harley Street, and is Head of Breast Surgery at this hospital; on paper, at least, he sounds excellent.

After my bruising experience with Mr G, however, I am approaching this meeting with extreme caution, and a great deal of anxiety. I know surgeons need to be good at cutting people up, and putting them back together again; interpersonal skills are not part of the job description. But I’m damned if I’m going to let anyone else treat me with such blatant discourtesy.

I needn’t have worried – Mr H turns out to be as impressive in person as he is on paper; he is courteous, kind, and doesn’t feel the need to talk down to us. On the internet I found a list of questions that you should ask your breast surgeon when you meet him for the first time; top of the list is how many times he has done this kind of operation, but I can see that might not do, here. Operating on breasts is what Mr H does, and has been doing for at least 20 years, so we can skip the preliminaries. We ask about the cancer, and how they decide on the course of treatment: he has endless patience with our questions, which are many, and is crystal clear in his explanations. This is a man completely on top of his game, who is also personable, and taking pains to put us at our ease; he cannot be faulted.

My tumour is, they think, relatively small - about 1.4 cm. It is Stage II, which means that although it has invaded the breast tissue outside the duct in which it originated, it is still at an early stage, and its growth is relatively slow; it is not an aggressive cancer. They don't think it has yet spread to my lymph nodes, which are the first port of call after the breast when a cancer begins to spread. The operation Mr H will perform is a Wide Local Excision (WLE), commonly known as a lumpectomy. In the bad old days, a diagnosis of breast cancer automatically meant a mastectomy, however small the tumour, or early the stage; nowadays, though, they try to conserve the breast if at all possible. Mr H assures us that the cosmetic result in my case is likely to be very good, that the breast will not be notably different in size or shape, and that there will be little, if any, scarring.

He asks to examine my breast, as he needs to think about how to approach the surgery. I disrobe, and point to the location of the lump, just under the surface on the upper slope of my right breast. Mr H feels the lump with great care, and gazes at my breast, deep in thought. At this point it strikes me, very forcefully, that my life will literally be in this man’s hands: he is going to take a scalpel and slice me open to remove the lump of deadly mutant cells inside. My future is completely dependent on his skill. I’ve never had any kind of surgery before, and this sudden realisation of what he is going to do is shocking; my eyes fill with tears and I close them, so no one will see.

Mr H starts to talk about what he will do, his fingers moving over my breast to show me. He is a sculptor, I realise, a sculptor of breasts, and he talks like the craftsman he is.

‘What we’ll do’ he says ‘is make the incision around the areola, the edge of the nipple here, in order to minimise any scarring. Then, when we’ve taken out the tumour, we’ll move some tissue from down here’ – he touches the lower curve of my breast below the nipple – ‘up to fill the space, and then we’ll re-position the nipple higher up.’

Oh, Jesus Christ, he’s going to MOVE my NIPPLE. Please God, no, please don’t let this be happening to me.

Mr H continues, smiling ‘So, really, we’ll just be giving you a breast lift’.

What the F***? Did he just say a BREAST LIFT???

I gaze at him stupidly. ‘A breast lift? You mean like in cosmetic surgery?’

‘It’s not cosmetic surgery’ says Mr H,  slightly terse, ‘It’s oncoplastic surgery.’

‘Yes, yes, of course’ I say, terrified of having offended him. ‘I do realise that. Sorry – I was just a bit surprised.’

He continues: ‘But yes, the overall effect will be the same as a cosmetic breast lift. Afterwards, your nipple will be higher up on the breast.’

I am still finding this difficult to compute.

‘So afterwards it will look different from my other breast?’

‘Oh, don’t worry about that’ says Mr H ‘I can do the other one to match, later on.’

That afternoon, after R has gone to work, I google breast lifts, and discover that women apparently in their right minds, healthy women with healthy breasts, pay upwards of £5,000 to have this kind of surgery. It floors me. I read about the risks of the surgery, and the pain it involves, and how long it takes to recover, and I think ‘Healthy women PAY to have this done to themselves? REALLY?’

My immediate public reaction is to start writing cheery emails about wonderful my surgeon is, and joking about how I’m going to end up with the tits of a 22 year old, and how lucky is THAT?

Inside my head, though, I’m not doing too well.

In the late evening, it’s the tennis, and my chance to exult as Andy Murray roars through a titanic five set struggle to become Britain’s first male Grand Slam Champion for nearly a century. My heart isn’t in it, though, and we go to bed, but I lie there in the dark unable to sleep, my head full of what is going to happen on the operating table.

Eventually I give up and get out of bed, creeping out of the room as quietly as possible so as not to wake R. In the sitting room I finally stop trying to hold myself together, and sit watching the last set of the tennis with tears streaming down my face, trying to cry quietly.

I end up on the floor, curled up in a foetal position on the old Caucasian rug which is one of the few things I brought with me when I moved in with R. Andy Murray wins, achieves his life-time dream and weeps with joy, as R comes in and finds me on the floor, sobbing one sentence over and over again: ‘I don’t want him to cut me up, I don’t want him to cut me up, I don’t want him to cut me up.’

We both know, of course, that what I want is no longer of any importance whatsoever.

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.