The Grim Reaper pops in for a nightcap

General status update

Radiotherapy, day 39 – come back chemo, all is forgiven! 

Lungs: looking likely to get me before the cancer does, right now.

Radiation burns: slowly starting to heal after two weeks of hell.

Nausea demon: Oh god, I miss him – I miss him SO much. Nausea schmausea: at least he didn’t burn me or make me cough uncontrollably for days on end. And he was very sweet-natured, really.

Anxiety level/insane euphoria (+/- 1-10,000): someone give me some more Dexys – PLEASE. Even if it does turn me into an American football player – I DON’T CARE. Prednisone is good for my lungs but it DOESN’T MAKE ME HAPPY.

Despair Demon: he’s been trying to make our liaison permanent. Fighting him off as best as I can in my severely weakened physical and psychological condition.

Chemo Muse: telling me firmly that the only way now is UP – through reapplication to writing, since swimming is off the agenda until the burns have all healed and my lungs have recovered.

Chemo Brian: looking rather anxious, frankly.

State of mind: calm, resigned to my fate. Ready for whatever comes next. Hopefully just breakfast, but this IS the darkest hour before the dawn.

It’s 4am, and the Grim Reaper is sitting on the sofa with Chemo Brian, drinking the last of R’s Laphroaig. Sorry, R.

I’m lying here listening to the increasingly alarming noises in my lungs – always my weakest point, cancer treatments always get you at your weakest point – and contemplating the Three Last Things which, in my case, are likely to be a glass of Armagnac, a can of ice cold diet Coke, and a packet of Maltesers.

It’s been a bugger of a week, beginning with the continuing torment of the radiation burns, which has been so bad that at first I didn’t really notice the coughing.

Until I was coughing so much, that is, that I was choking and we had to go the A & E, where I was admitted and put on a nebuliser to pump steroids into my lungs. That was Friday morning, and I spent the day in hospital being treated before being released back into the wild clutching a big party bag of more steroids. The oncologists are divided as to whether this is a condition caused by the radiotherapy - radiation pneumonitis – or simply an asthma exacerbation in my generally weakened, immune-suppressed state, but it doesn’t really matter what the cause is, as the treatment is the same in either case: my lungs are severely inflamed and require massive doses of steroids to try and calm it all down before my airways close up entirely and I cough myself to death. 

Literally.

The other danger is if it wakes up some dormant bacteria and develops into pneumonia.

I spent the whole of Friday night awake and still coughing, so the treatment didn’t seem to be working, but during the course of Saturday the coughing became slightly less incessant. Now, though, at 4.30 am on Sunday morning, my lungs seem to be talking amongst themselves, and they are NOT HAPPY. I’m not coughing quite so much, but from inside my chest are coming crackling, hissing, wheezing sounds, the like of which I haven’t heard since I was in hospital in Ankara with pneumonia five years ago, an episode which nearly killed me.

Pneumonia is the patient’s friend, you know – it’s not an unpleasant way to go. And five years ago I was quite ready to go gently into that good night, having been on my own for a very, very long time after the death of my former husband (from a chemo-related lung infection – spooky, huh?). At that point I was very tired, quite loosely tethered to the world, and perfectly prepared to give up without a fight, but the Grim Reaper had an appointment in Samara with someone else that night, and passed me by. 

It’s different now, of course: there is R, who surrounds me with love, and I have so much to live for.

I suppose I’d better make a bit of an effort.

ps: remember, my current condition is NOT caused by the cancer - it's caused by the frigging treatment.

Nuclear half-life

General status update

Radiotherapy, day 29 

Radiation burn: getting worse before it gets better.

Nausea demon: he brought me a bunch of tulips the other day – he doesn’t like seeing me suffering like this. We talked nostalgically of all those dawn breakfasts together during chemo, when I was at least able to sit up.

Radiation demon: this is light duty for him, as he’s only torturing one breast rather than the whole body, so he’s got plenty of time to do Sudoku as well.

Anxiety level/insane euphoria (+/- 1-10,000): I would give anything for a few Dexys and a big surge of unnatural chemical exuberance right now, but unfortunately they don’t prescribe steroids for radiation burns.

Despair Demon: has set up camp in the airing cupboard once again, and keeps reminding me that this is my punishment for regarding radiotherapy as a mere formality after chemo. I wish he’d just sod off back to the Infernal Regions and leave me alone.

Chemo Muse: itching to get back to her new role as my swimming coach, and currently filling in the time by reading Ian Thorpe’s autobiography. She says I’m never going to be a champion swimmer because my feet just aren’t big enough.

Chemo Brian: very understanding about me spending so much time lying on the bed at the moment, rather than joining him in my usual position on the sofa.

State of mind: low – have to keep reminding myself that all this unpleasantness derives from the treatment, not the illness, and that soon it will be over. And then I can start taking the frigging Tamoxifen.

Legend relates that St. Lawrence, depicted above in a painting which may or may not be by Caravaggio, was martyred by being tied on top of an iron grill over a slow fire that roasted his flesh little by little.

I’m beginning to know exactly how he felt.

Since the final dose of radiation, a week ago, I have continued to burn, and the pain and discomfort on, under and around my breast has increased. It is red and raw and acutely painful, and as the layers of skin burn off I feel as if I am being very slowly flayed alive.

 This is a situation in which having a D cup breast is a distinct disadvantage, since the weight of the breast exacerbates the problem. The only way I can be comfortable is to lie down, breast bared, back slightly arched, with my arm extended above and behind my head on the bed at full stretch.

This improves things a great deal, and is said to be the best way to help the breast to heal, but it considerably limits my range of other activities. Aloe vera gel helps to cool and soothe it, but the breast will continue to burn for another week, apparently, as the radiation continues to work for two weeks after the treatment has finished. Only then will it begin to heal, and there is nothing else that can be done, so for now I must simply be patient and lie on the bed in the backstroke position, the swimming pool once again a distant dream.

I thought I had my life back, but I was wrong.

Going for the burn

General status update

Radiotherapy, day 15 

Radiation burn: nasty, painful and Very Red.

Fatigue/weakness: considerable, but different to chemo fatigue in a way I can’t quite describe.

.Anxiety level/insane euphoria (+/- 1-10,000): ratcheting up again, because after the radiotherapy comes Tamoxifen, the wonder drug with accompanying wondrous side effects. Allegedly.

Despair Demon: has made a sudden reappearance as I approach the end of radiotherapy treatment, mystifyingly.

Chemo Muse: she’s very happy that I’ve started writing again

Chemo Brian: he politely averts his eyes when I lie on the sofa topless to let the air soothe my irradiated breast

Nausea demon: having a whale of a time working for the Russian oligarch’s wife in Knightsbridge, but still comes round for a cup of tea from time to time. Says he is there if I need him once I start taking the Tamoxifen. He sends his love to you all.

State of mind: weary, very weary

I wake up this morning weeping, in pain because my nightie has adhered to the radiotherapy burns under my breast; pulling it off hurts like … well, you can imagine. I continue weeping at the hospital, while I am being nuked for the last time, then at the café where I go afterwards to have a cup of coffee and regroup, and then at the bank.

After that I give up and go home.

Yes, we’re back to the old routine: early morning unpleasantness and existential despair. My post-chemo trip to the Aegean was lovely, thank you, but it now seems a very long time ago. The morning after I got back from Ayvalik – Tuesday 21^st May - I was straight back to the hospital to start my radiotherapy treatment, consisting of 15 daily doses over 3 weeks.

The expression always used about radiotherapy is that after chemo it is ‘a walk in the park’, and that is broadly true: nothing can compare to the up-front, in your face horror of chemo. Radiotherapy, however, is nasty in its own way, and that nastiness sneaks up on you all of a sudden after the radiation has been working away quietly in your body for a couple of weeks: it’s what can very accurately be described as a slow burn.

The treatment itself is not at all unpleasant: before it starts there is a ‘radiotherapy planning meeting’, during which they put you in a big scanner, take lots of measurements to ensure you will be nuked in precisely the right spot, and put a couple of tiny, permanent tattoos on the breast. Then when you come for treatment every day the tattoos help them guide you into the right position under the radiotherapy machine. The radiation itself is entirely painless and lasts for only a few minutes: most of the time at each appointment is spent lying on the table whilst the radiologists make minute adjustments to your position: the whole process is reassuringly precise down to the last millimetre.

In case you’re wondering why I have to have radiotherapy after I’ve already had chemo, it is because the two treatments target different things: the chemo is a systemic treatment, to mop up any stray circulating tumour cells which might have escaped into my bloodstream, while the radiotherapy is a local treatment just on my right breast, to kill any cancer cells that might remain elsewhere in the breast tissue after the surgery to remove the tumour. You can’t have a lumpectomy and keep your breast without having radiotherapy: otherwise there would be a very high risk of the cancer recurring within the breast.

The main side effects of radiotherapy are what medics call ‘skin reaction’ and I call ‘burning’, and fatigue, both of which develop gradually as the radiation builds up in your system. The side effects peak two weeks after the last dose of radiation: you keep on cooking inside for some time after the treatment has finished.

I start to burn on day 10.

That evening, giving my breast its daily inspection in the bathroom mirror, I notice that the skin is turning red on its underside, close to the crease where the breast meets the rib-cage.  I have been applying aloe vera gel several times a day to protect the skin, on the advice of a friend who had recently done so and managed to get through her radiotherapy without burning, and am hoping for a similar result. I have also been spending a lot of time lying around topless, as air on the irradiated skin is meant to help. Over the next few days, however, the skin becomes redder and begins to feel very sore.

By Friday, day 13, it is quite painful and seems to be starting to blister, and I want a professional to take a look at it.  My cyber cancer buddies at other hospitals have been given assistance once their skin broke down, so I ask to see the radiotherapy nurse, who takes a look at my breast and then, essentially, tells me to stop wasting her time.

‘There is no MAGIC CREAM’ she says, with a certain amount of scorn in her voice, the words ‘you idiot’ hanging unspoken in the air. ‘Just keep on doing what you’re doing, and see how it is after the weekend.’

During the weekend the fatigue starts to set in as well, not helped by being unable to sleep very well because of the pain from the burn, and the difficulty of finding a comfortable position to lie in. Emotionally, I start to fray at the edges: three weeks of going to the hospital every day for treatment has taken its toll, and I can’t get very excited about my treatment finishing on Tuesday, because I know the radiation goes on working after the treatment is finished and that the burning may get worse: I imagine my breast turning into a horrible festering mass as I continue to burn.

Bu Tuesday morning I’m starting to melt down: it has been nine months of applied horribleness, with the hideous shock of diagnosis followed by surgery, chemotherapy and now radiotherapy: slashing, poisoning and burning. The assault on the body is constant, and it does horrible things to the mind. I’m just so very tired of it all now.

At the hospital, I lie down on the table for the final dose of radiation, and pull down the hospital gown to expose my breast. A trainee radiologist is in charge of putting me into position, and her supervisor tut-tuts, saying ‘Be careful! Look how sore the breast is’ and then to me ‘I think you should see the nurse afterwards to help you with that.’

‘I saw the nurse on Friday’ I say ‘and she told me to bugger off, more or less.’

‘We’ll find you another nurse, then,’ says the radiologist. ‘Your skin really needs looking at.’

Finally I am in exactly the right position; the radiologists all leave the room, the machine begins to click and whirr around my breast for the last time, and I start to cry, undone by the kindness of the radiologist. Tears stream down my face but I can’t lift my hand to brush them away: radiotherapy treatment is all about not moving one iota. Today’s soundtrack is vintage Motown, and as Marvin Gaye sings ‘I heard it through the grapevine’ I try desperately to stop my chest heaving as I cry, in case this makes the radiation go to the wrong place.

The radiologists come back in, and I am allowed to move again. As I sit up, clutching the hospital gown to my bosom, one of them says ‘Congratulations, Caroline, you’ve finished your treatm…..’ her voice trails off as she sees that I am in tears.

One of the radiologists hugs and comforts me, and another says ‘No! You should be HAPPY – you’ve finished all your treatment.’

‘I’m sorry’ I say ‘It’s just that it’s all been a bit much. Nine months of treatment. I am happy really – really I am.’

Somehow, I end up seeing the same nurse, and am tempted simply to leave, but my breast hurts too much. This time she is marginally more pleasant, concedes that the skin has now broken, cleans the wound and puts on a dressing.

I ask how long I should keep the dressing on.

‘That depends on how much it oozes’ she replies, and gives me a pile of dressings to take home.

Afterwards I walk up the Fulham Palace Road into Hammersmith to do some errands, but the tears continue to flow, so I give up and go home.

Treatment is over.

Yay.

In swimming goggles, no one can see you cry

Day 134 

                       

General status update

FEC cycle 6, day 19

State of mind: I went swimming today, so …’ecstatic’ pretty much sums it up

Anxiety level/insane euphoria (+/- 1-10,000): today I have the insane euphoria WITHOUT the Dexys – how good is that?

Fatigue/weakness: tired after the swimming, but in a good way. That makes a nice change.

Nausea demon: he LOVED his surprise party last night, especially the Pimms and home-made macarons (salted caramel and rhubarb flavours, to die for, thank you again Christina and Jecca, my Scottish macaron-making friends). Pimms was a new experience for him and I explained that it is a particularly English drink, and will probably not be available at his next gig chez the Russian oligarch. I told him he is welcome to pop round here for a glass; we will always be glad to see him so long as he is OFF DUTY.

Despair Demon: he’s fading round the edges, starting to look a little insubstantial. He’ll be hanging on in there for another couple of days in case the tooth extraction works out badly, but he knows he’s on the way out now.

Chemo Muse: we had an EXCELLENT time at the pool today, although the other swimmers must have wondered who I was talking to. Probably just as well they couldn’t see her jumping up and down by the side of the pool with that head full of snakes writhing about, though. I wonder if she’s ever considered having a perm? Can you perm a cranially-attached viper? She has them highlighted, but I think that might just be paint.

Chemo Brian: we had an EXCELLENT nap on the sofa together after I came back tired out after the swimming.

I’m not a great one for war movies, but there’s one I saw as a child that always comes to mind when thinking about endurance and delayed gratification: it’s called ‘Ice Cold In Alex.’  Set in north Africa during the Western Desert Campaign of World War II, it stars John Mills as Captain Anson, a transport pool officer leading the crew of an Austin K2 ambulance as they drive across the desert back to British lines, whilst trying to avoid the troops of Rommel’s Afrika Korps. Anson motivates himself by thinking of the ice cold lager he will order when they finally reach the safety of Alexandria - the 'Alex' of the title.  When they finally get there, that glass of Carlsberg is the best thing he has ever drunk in his life.

‘Going for a Swim at the Charing Cross Sports Club’ isn’t quite as snappy as ‘Ice Cold In Alex,’ but the mental process has been pretty much the same for me as for the tired soldier negotiating all sorts of obstacles and dangers in the heat of the desert (the film was based on a true story): you get through what you have to get through by keeping your head down and motoring on, but one of the things that helps you keep going is that image in your head of what it’s going to be like when the nightmare ends and you can just STOP, and then do whatever will make you feel better.

My ‘ice cold beer in Alex’ equivalent was thinking of the moment when I could get back in the swimming pool, push off and glide freely through the cool silky water, feel my arms and legs moving properly again and re-inhabit my physical self in a way to do with health and pleasure, not ill-health and pain.

That moment came this morning and after swimming a few lengths I had to stop for a minute, not because I was too weak to continue, but because I was crying and my swimming goggles were misting up from the inside.

I’ve cried a hell of a lot during the last eight months - which have featured an abundance of very bad news, pain, unpleasant and invasive medical procedures, fear and despair – but today I was crying tears of happiness, knowing that the worst of the cancer treatment is now over, and that I am free to swim and get strong again.

Cancer no longer owns me, and I’m starting to reclaim my life, and my self.

Once my goggles were demisted I got my head down again and went on to swim 22 lengths in all, which is 550 metres - not bad for the first time back in the water. I didn’t overdo it; I just kept swimming, slowly, until I started to feel a bit weak. It’s left me very tired, but it’s a healthy tiredness, the tiredness of physical effort. It’ll be a while before I’m back to swimming 2 miles at a time again, but it’s a good start.

And now I’m going to sign off for the time being: tired but happy, getting stronger both mentally and physically every day, and looking forward to the future again. 

I’d like to thank all the staff at the Charing Cross Hospital for their dedication and patience in treating a very reluctant and sometimes less than compliant patient, and in particular the wonderful Rebecca Johl – aka Matron Becky/World Mum/Mother Goddess/PICC line Wrangler Supreme – Matron of the Chemo Day Ward on 6 East, who transformed my chemo experience for the better once she became involved in my care. Becky, I am eternally grateful. You will get your reward in heaven, but in the mean time I will fulfil my promise to bake cakes for the chemo ward in due course.

My partner, R, has suffered along with me during chemo in a very real sense, as will be evident to anyone reading the blog. He, too, is physically and emotionally exhausted, and has done so much to look after me – whilst also juggling a full time job and other family responsibilities - with very little support coming his way, as often happens to carers. Now it’s my turn to look after him, and I will. Thank you, R. You are the best of men.

My family – particularly MamaFo and BigSisFo – have been mercilessly mocked on the blog throughout but are still talking to me, and were a huge support in every way, as were my stepfather and stepsisters (and my other sister whom I am not allowed to mention on the blog). Thank you all.

Many friends have been incredibly generous in finding ways to cheer me up with visits, outings, and lovely presents, which I’m sure I didn’t deserve, but enjoyed hugely nevertheless: thank you Clare Paterson, Gill Carrick, Kirstie Hepburn, Andrea Gillies, Emma Beddington, Fiona Laird, Henri Hunter, Lynette Szczepanik, @Madame Nottingham, Christina and Jecca Maxwell, and Sasha Wilkins (aka  Liberty London Girl  fashion, food and dog blogger supreme). I’ve a horrible feeling I’ve missed someone out, and if so you are fully entitled to come round and berate me. 

My Ayvalik friends have been cheering me on with emails and lots of photos to remind me of what I'll be seeing again soon in the Aegean - thank you Dor, Tara and Bridget, and also Jed in the UAE.  I will see you all very soon at the Camel Barn. 

My American friends Jen Fishler, Glenn Pence and Janet Paraschos have all been regular, very cheering commenters on the blog, something which was much appreciated.

Finally, a very big thank you to all of you have been reading the blog – old friends and new, real life and virtual, Twitter and Facebook, fellow cancer and chemo patients, medics and bioethicists -  for keeping me company on what has been a rather gruelling ride, for sponsoring my chemo and, most of all, for sending me so many messages of support all the way through, via so many different media – every one of which helped me to keep going with the chemo when I wanted to give up which, if I’m honest, was pretty much all of the time. You helped me get there, and I am extremely grateful for that. 

Thank you, all of you - I'm a very lucky woman  xx

And I really can't finish this post without a final blast from Bruce...so here you go:

Moving on

Day 133 

General status update

FEC cycle 6, day 18 

Fatigue/weakness: it’s all a bit random now – I’m getting stronger, but there are still days of being completely wiped out.

Nausea demon: completely oblivious to his surprise leaving party preparations, because he’s spent the whole day with headphones on, chanting tables of Russian irregular verbs. Which, it turns out, are very pretty:

жаждать: жажду, жаждешь,жаждут

стонать: стону, стонешь

жаждать: жажду, жаждешь,жаждут

дремать: дремлю, дремлешь, дремлют

Despair Demon: looking depressed – his job is going to be so much harder once I’m out of the house and exercising properly again.

Chemo Muse: she has track suit, whistle, a peaked cap and trainers that glow in the dark – so, all set to go as my new swimming coach tomorrow.

Chemo Brian: since he is intent upon accompanying me to Ayvalik, we’re going to have sit down and have a serious talk about Turkish drug laws.

State of mind: We’re all going to the pool tomorrow, pool tomorrow, pool tomorrow...

When you’re first diagnosed with cancer it is unreal: you think they must have made a mistake, that this is a bad dream from which you will soon wake up, and then everything will go back to normal. That phase finishes – at least it did in my case – once the treatment begins, and they start performing unpleasant, invasive and sometimes painful procedures on you, after which there is no more possibility of denial. For me, that was on October 3^rd last year, the day before my lumpectomy operation, when they injected radioactive dye into the nipple of my right breast without any anaesthetic; I still flinch every time I remember both the pain and the way the shock of it blew away my denial, forcing me to face up to the fact that the cancer was real, and there was no escaping from the many months of treatment to come.

At that point the enormous psychological and physical impact of the cancer and its treatment becomes, if not your whole reality, then the overwhelmingly dominant feature of it: I have often thought that being diagnosed with, and undergoing treatment for, cancer is like undergoing a strange kind of assault course, in which you are what is being assaulted, mentally and physically, for an extended period of time. Chemotherapy treatment in particular is an 18 week toxic endurance test which ravages both body and mind, and more or less puts you under house arrest with its combination of crippling fatigue and the very real danger from acquiring any kind of infection in your immuno-suppressed state.

Writing this blog is what has saved me from going completely demented during the last 18 weeks of chemotherapy treatment: I started it the day before the first dose of FEC, at which time I was still deeply reluctant to have chemo, and fairly crazed with anxiety about what was going to happen to me, and have published a post on the blog every single day since, without fail, although some posts made in extremis were fairly brief.

The posts averaged about 1000 words a day, though, and total word count is now around 140,000 words, which is half as long again as my DPhil thesis, which took several years to write, not 18 weeks – this Stakhanovite work rate can only be attributed, I think,  to the extraordinary mental energy and focus that the Dexamethasone steroids gave me. I can’t find any other explanation for it.

There was a fair amount of medical drama going on throughout the chemotherapy treatment, as well as the day to day torment of the side effects, so I was never short of things to write about, and the daily discipline of putting it all into a coherent narrative, and meeting my self-imposed midnight deadline, gave me a task to do, and a sense of purpose, and prevented me from spending too much time lying on the sofa feeling sorry for myself and sobbing over the Pity Of It All.

Many people have told me that reading the blog has proved helpful to them, which makes me very happy; in addition, the ‘Sponsor My Chemo’ drive has now raised £1,500 for The Haven Breast Cancer Support Centres, which I’m also extremely pleased about.

To be honest, though, I started the blog for entirely selfish reasons, to try and make bearable something which I not only perceived to be unbearable, but had spent twenty years swearing I would NEVER do, after the death of my former husband from a chemo-related infection. Never say never – look where it got me.  

And it worked brilliantly for that particular purpose: writing the blog every day became my project, my homework, the thing which enabled me to distance myself from what I was going through. I couldn’t get away from the cancer and the chemo, but writing about it somehow enabled me to remove myself from it, for some of the time. I had an extremely bad time, physically, during the chemotherapy, including some unfortunate occurrences at the hospital, but writing about it made it mentally bearable, more or less. 

Now, though, I am in the last week of the last chemo cycle and as FEC finally lets me go, it’s time for me to let go of the daily writing of the blog. Its job is done, and I’m tired of the daily deadline. There is more treatment ahead – 3 weeks of radiotherapy in May/June, and then 5 years of taking the hormonal drug Tamoxifen – but with the end of chemo and my release from its chemical prison, the cancer and its treatment will no longer be playing such a dominant role in my life. I need to leave it behind now, and get on with my life again.

There’s going to be a period of convalescence –it takes 4 to 6 weeks for the chemotherapy drugs to leave your body, although the fatigue can last for months, and the radiotherapy treatment will cause more fatigue – but I hope to be properly physically fit again by the end of the summer. I was told breast cancer takes a year out of your life, and so it has proved.

Tomorrow, when I plan to get back into the swimming pool again for the first time since the chemo started, will be a hugely symbolic day for me: I will be moving on, both physically and mentally, free at last from the chemical prison, and that also seems the right time to make my final daily post on the blog. I will keep the blog going, and continue to post on an occasional basis, but the unbroken narrative of Chemo Nights will end tomorrow, on Day 134.

It’s time to move on…

Goodbye to all that

Day 132 

General status update

FEC cycle 6, day 17

Nausea demon: We’re giving him a surprise farewell party tomorrow night, as he starts his new job in Knightsbridge providing Pregnancy Nausea Services to the wife of a Russian oligarch on Monday. He’s spending most of his time in his room now, doing an online Russian course – he’s getting tutorials via Skype from a woman in Smolensk.

Anxiety level/insane euphoria (+/- 1-10,000): wondering if I could persuade them to give me some Dexys with the radiotherapy treatment as well, but thinking that it’s unlikely.

Despair Demon: he’s not going anywhere, of course.

Chemo Muse: busy reading manuals on swimming coaching in preparation for our new project, also starting on Monday. She’s also bought a whistle, which is worrying.

Chemo Brian: currently absorbed in reading about the history of Ayvalik, and trying to get his head round the Greek-Turkish Population Exchange of 1922 – ‘This is HEAVY, man’ – Yes. It was.

Fatigue/weakness: the really interesting question is how far I will be able to swim on Monday, when I get back in the pool for the first time. I used to do 128 lengths (2 miles). No idea what to aim for on Monday. Maybe ‘aiming’ for anything is not a good plan: I’ll just get in the water and see what happens.

State of mind: slowly adjusting to this strange new post-chemo world, as the final cycle draws to an end.

During two weeks out of three, during chemo, the routine was the same most mornings: after being woken at somewhere between 4 and 6 a.m. by nausea, I would get out of bed quietly, so as not to wake R, walk to the other end of the flat and sit down at the dining table to take all my meds: the Ondansetron, Cyclizine and Domperidone for the nausea, the Omeprazole for the stomach pains, the Dexamethasone for everything, and sometimes the Lorazepam for

the anxiety and dread. 

The Lorazepam was especially useful on the days when the next dose of chemotherapy drugs was scheduled, to take the edge off the fear and loathing as we walked down the Fulham Palace Road towards Ward 6 East at Charing Cross Hospital, where the latest infusions of the FEC drugs – Fluorouracil, Epirubicin and Cyclophosphamide – were waiting for me in their yellow plastic HAZCHEM bags.

All the boxes of medication were kept piled up on the window sill next to the dining table;  I would line them up on the table each morning and take the prescribed dose of each one, washed down with pomegranate juice in a probably futile gesture towards putting something health-giving into my body at the same time as I was ingesting all these drugs to deal with side effects of the toxic FEC trio. This was followed by tea and toast, because you have to take the drugs with food, and the chemo and the Dexys made my body want CARBS.

That was then: this morning I woke at 8, untroubled by nausea, and as I sat at the table a little later it occurred to me that it was time for the drugs to go.

I don’t have to take them anymore.

I gathered up all the packets of pills and put them away in the bathroom cupboard, and the window sill is empty now, except for a small wooden penguin. It’s possible I might need some of them again – radiotherapy treatment can also cause nausea, although probably not on the epic scale of FEC – especially the Omeprazole, because the damage the FEC has done to my stomach may take some time to settle down.

Still, my early morning rendezvous with the Nausea Demon and a heap of pills are now over.

I don’t have to do that anymore; IT’S FINISHED.

Slowly, day by day, FEC is at last starting to let me go, and I'm finally starting to believe that there is life after chemo.

You‘ll believe a cat can swim…

Day 130 

General status update

FEC cycle 6, day 16 

Fatigue/weakness: Am trying to get out and walk a bit every day; after every outing, I’m still completely exhausted. It looks as if building up my strength again is going to be a rather slow process.

Nausea demon: I stopped taking the tablets, and he reasserted himself. It’s TWO WEEKS since the final dose of FEC. This is unsporting, and ungentlemanly, and I told him so.

Anxiety level/insane euphoria (+/- 1-10,000): I’ve just remembered that I’m going to have my semi-root-canalled tooth extracted next Wednesday, which is starting to make me very anxious indeed. I truly feel as if my body has taken enough punishment for now, but I don’t think I dare delay it. Oh, God.

Despair Demon: he’s focusing on the whole tooth extraction issue now – needles, injections, pain, possibility of infection – there’s plenty to play for.

Chemo Muse: I shouldn’t overdo the resting, in her opinion, as the Devil makes work for idle hands and the Despair Demon IS Satan’s ranking representative here in my chemo- and drug-addled mind, after all. Yes. Good point.

Chemo Brian: he’s happily occupied reading guidebooks to the north Aegean at the moment.

State of mind: moving on, thinking ahead – forgetting about chemo, thinking about my cat.

Before I moved to Turkey in 2006 I lived in Oxfordshire, and had the best, most euphonic, address in the world - Cricket Cottage, Church Lane, Charlbury. It was just as lovely as it sounds: an old cottage made of honey-coloured stone, 200 yards from the church, and overlooking the cricket pitch down at the bottom of the hill, on the other side of the River Evenlode.

One day someone knocked on the door and, as I went to open it, my cat Ollie performed his party trick, which was to take a flying leap at me from behind, and land on my right shoulder; this was rather startling when he first began doing it, but I soon learned to recognise the little squeak he emitted just before landing, and could now withstand a flying feline scapular landing a tergo without breaking stride, which was why I answered the door to the man from Thames Water with Ollie perched, parrot-like, on my shoulder.

Just why the man from Thames Water was calling is lost in the mists of time, but his main point of interest turned out to be Ollie, anyway.

‘That’s a beautiful cat’ he said ‘It’s a Turkish Van, isn’t it?’

‘I’ve absolutely no idea’ I replied. ‘The vet gave him to me a few weeks ago; he was a stray in need of a home. What’s a Turkish Van?’

When the vet rather forcefully rehomed Ollie with me, he hadn’t been beautiful at all: he was scrawny and sad and howled a lot, and all his fur had been chopped off because it had got matted while he was a stray. It was some weeks before the fur grew back and he metamorphosed into an extraordinarily beautiful creature with long, silky white fur and a sweeping auburn fox brush of a tail.

‘Turkish Vans are swimming cats’ he said. ‘They’re pedigree cats, and they like to swim.’

I laughed, as he was clearly having me on.

‘What do you mean, ‘swimming cats’? Cats hate water. Everyone knows that.’

‘Turkish Vans love the water. They come from Lake Van in Turkey, and they swim using their tails as rudders. I’m not joking. Look it up. And your cat is definitely a Turkish Van.’

Later, I looked it up, and he was right. Turkish Vans do swim, and Ollie was very definitely a Turkish Van – he looked exactly like the one in the photo used to illustrate the breed.

And the reason that I’m telling you this story is because yesterday someone posted on Facebook this wonderful photograph of a Turkish Van going for a swim, and pretending to be a Retriever -

- which reminded me that Ollie still hasn’t been for a proper swim, 16 years later. He did get into the bath and splash about one day, when there were just a couple of inches of water in there, but I never got round to taking him down to the river for a dip; there were always people walking their dogs down there,  and it might have been a bit stressful for him.

When I first went to live in Turkey in 2006, to teach at a university in Ankara, I left Ollie behind for the time being, in the hands of a house-sitter, as I didn’t know how things would go. A year later, it was clear that I was going to be in Turkey for some time, and I persuaded the long-suffering BigSisFo to bring Ollie out to join me in Turkey, his ancestral home.

It is a thousand times easier, and cheaper, to export a person than a cat, and the difficulty of organising the vaccinations and permissions and inspections and certifications defied belief, but eventually BigSisFo and Ollie arrived at Istanbul airport (cats couldn’t be flown into Ankara, of course, so I had to hire a guy with a minibus to drive me halfway across Turkey to collect them).

BigSisFo was clutching a big fat folder of Ollie-related documentation, and it is entirely characteristic of the Turkish approach to customs and excise that she was able to walk through the ‘Nothing To Declare’ channel – by mistake – pushing a trolley loaded down with a great big cat carrier plastered with labels saying ‘LIVESTOCK’, without being stopped and asked to show a single one of those hard-won certificates.

Ollie adapted well to living in a first floor faculty flat in Ankara, but when two years later we moved to the Aegean and the Camel Barn, he was happier still: not only do the house and barn offer a great deal of space, but there is a sunny courtyard with an olive tree which serves both as scratching post and means of access to a sunny balcony and the roof terrace, the sunniest place of all. The place is also protected by high stone walls, which makes it difficult for the nasty street cats to get in and bother him, so Ollie is king of all he surveys.

After we’d been there for about a year, I remembered the whole swimming thing, and had a brilliant idea: it was July, and exceedingly hot, so why not provide Ollie with his own little swimming pool in the courtyard, and see what happened?

I went off to the hypermarket to see what I could find, and this is what I came up with:

Pretty nifty, no? And a little diving-board for him, and everything.

Would Ollie go in it?

Would he b***ery.

You can lead a cat to water, but you can’t make him dip a paw in it, much less jump in. Maybe he was too old – this was four years ago, but he’s 18 now, so he was pretty ancient for a cat, even then. Or perhaps Turkish Van cats have to learn how to swim as kittens – who knows.

After seeing that photo of the swimming cat yesterday, though, I think we might get out the paddling pool and give it another go on the upcoming trip to Ayvalik.

Very gently.

Ollie is very, very old now, although he’s still fit enough to climb the olive tree every day to go and lie in the sun. Bridget, who’s looking after him, says he’s getting thinner and more fragile, although he’s still eating, and healthy. He’s one of the main reasons I’m making this trip to Ayvalik, and delaying my radiotherapy treatment so to do. I haven’t seen him for a year, and I miss him so, and if I don’t go now it might just be too late ever to sit on the balcony with him in my lap again.  

Ollie’s too old to bring back to the UK and endure quarantine, and he’s very, very happy where he is, so I have learned to live without him (and I've got R now, obvs, although he's WAY too big to sit in my lap).  But I’m going to get spend a couple of weeks with him now, possibly for the last time, his warm weight in my lap every day as I read and he snoozes, in the dappled shade of the olive tree, or on the balcony, or high up on the roof terrace beneath the heat of  the Aegean sun.

                               And here is Ollie keeping R company as he reads, on our last trip to the Camel Barn

Pause for breath…

Day 130 

General status update

FEC cycle 6, day 15

Fatigue/weakness: I’m getting a little bit stronger every day, but an essential expedition to the Passport Office in Victoria today to get my passport renewed in time for the Ayvalik trip left me wiped out, and too tired to finish the blog post I was writing for today… so the blog is on pause until tomorrow, but here’s something beautiful to look at instead:

                        This is a celebrated view over the Ayvalik archipelago and the Aegean from a hill near Ayvalik

                                                   called Şeytan Sofrası, or 'The Devil's Dining-table

It ain’t over till the fat lady swims…

Day 129 

General status update

FEC cycle 6, day 14

Fatigue/weakness: getting a little stronger every day, and I hope to be back in the swimming pool on Monday. Just 5 days to go.

Nausea demon: getting demob happy.

Despair Demon: every time I catch sight of myself in the mirror he hisses ‘look at you – you’re SPHERICAL’

Chemo Muse: she can’t wait for me to get back in the pool again, as she rather fancies herself as a swimming coach.

Chemo Brian: he abhors all forms of exercise, except exotic horticulture and baking enhanced brownies; it’s just occurred to me how well he would get on with my mother.

State of mind: resolved on pursuing the Path of Righteousness asap (see below)

Last summer, before my cancer was diagnosed, I was swimming about 5 miles a week and possessed, in addition to quite sensational triceps, a clearly discernible waist; over the last eight months of cancer treatment this has been replaced by what can only be described as a circumference.

Thus, very visibly, has my lifelong delusion that ‘cancer makes you thin’ been dispelled. Weight loss only happens, apparently, if you get to the terminal stage; treatment for early stage cancer, and in particular breast cancer, has quite the opposite effect, adding the third element to the Breast Cancer ‘hey, let’s TOTALLY destroy this woman’s self-esteem as well as trying to kill her’ Trifecta:

1) mutilation

2) baldness from the chemo

3) significant weight gain

My oncologist warned me before the chemo started that I would probably put on a stone during the treatment, and she was right. No one seems quite clear why it happens, but the weight gain is probably a multi-factorial phenomenon, with various contributing causes, including:

1) carbohydrate cravings caused by the chemotherapy drugs (or as the nutritionist at the Haven put it ‘chemo makes you crave JUNK’);

2) general increase in appetite caused by the steroids they give you to ease the side effects of the chemo;

3) metabolic changes caused by the chemo drugs increasing fat storage on the body;

4) inability to exercise as normal during the 18 weeks of chemotherapy treatment

5) comfort eating because you are just so utterly miserable during chemotherapy treatment, and beyond caring about the consequences.

I got off quite lightly with parts 1 and 2 of the Breast Cancer Trifecta: my breast is in pretty good shape now after the lumpectomy, and the Cold Cap stopped my hair from falling out. On the other hand, I’ve put on so much weight around my middle that I look like a watermelon with legs - a giant watermelon with a little head perched on top.

And before you say ‘Oh, don’t beat yourself up about that, you just need to recover slowly and gently and worry about the weight later’, you need to remember one very important fact: being overweight is a very significant risk factor for breast cancer recurrence. Fat makes oestrogen, and breast cancer cells – my breast cancer cells, anyway - feed on oestrogen; I keep hearing in my head the remark of a friend’s oncologist that ‘body fat is the third ovary’.

Excess fat also stimulates the production of IGF1 (Insulin Growth Factor 1), and thence glucose, which cancer cells also love to feed on, so every pound of excess weight not only puts a strain on your body, but also provides a selection of hors d’oeuvres for any surviving CTCs (circulating tumour cells) out on the razzle and looking for a snack.

Had I expanded into the shape of a butternut squash, rather than a watermelon, it would be much less worrying – it seems that excess weight carried around the stomach is particularly dangerous, but around your hips and thighs, less so.  So here I am, at the end of my chemo treatment, wondering if I’m one of the 92% of women with my type of cancer for whom chemo doesn’t work, and with my body perfectly primed to be a MacDonald’s for circulating tumour cells.

It’s a truly sobering thought.

You can’t spend all your time obsessing about whether the cancer is going to come back after the doctors have done their work, but you can try your hardest to prevent it from doing so; from everything I have read on the subject the single most important thing I can do to lower my risk of a recurrence is to reduce my body weight, and that goes hand in hand with resuming regular and vigorous exercise as soon as possible, and eating a diet high in vegetables, fruit, pulses and whole grains, and low in refined carbohydrates and animal fats.

My prognosis is that I only have a 1 in 10 chance of the cancer recurring within the next ten years; read the on-line breast cancer forums, though, and you are struck by how many women posting there have seen their cancer come back within a year or two of their initial diagnosis and treatment.

That terrifies me.

There has never been a greater incentive to pursue the path of righteousness, and that path is paved with swimming, spinach and chickpeas.

If the fear of death doesn’t give me sufficient incentive to stay on the straight and narrow, then nothing will…

ps Apologies to  shinester, Deborah and Jen- some comments you made on earlier posts have only just showed up in the comments moderation box, I have no idea why, so they have just been very belatedly published.