Cast out the old year, seed something New

I lost a friend to cancer just before Christmas. She wasn’t old, lived healthily and did all the ‘right’ things but her encounter with the emperor of all maladies was shockingly brief. Just 5 months from diagnosis to death, treatment offered no respite. I attended her funeral yesterday and am still stunned. This year brought more than its fair share of rain and though I cannot afford to wish my life away – every day is a gift – I will be glad to see the end of 2015.

Cast out the old year, seed something new

2015 – A year of worry buried deep

A year of struggles, strife and grief

A year of friendship cut so brief

A year of making angels weep

The year will pass and trouble with it

The year will pass, it’s reached its limit

The year will pass, now almost through

The year will pass having taken you

2016 – New Year is edging ever near

New Year will vanquish harsh frontiers

New Year will cast aside old fears

New Year will keep your memory dear

 

Sentience

Like one, that on a lonesome road
Doth walk in fear and dread,
And having once turned round walks on,
And turns no more his head;
Because he knows, a frightful fiend
Doth close behind him tread.

    

Samuel Taylor Coleridge – The Rime of the Ancient Mariner

Sailing Away

Sentience is a blessing and a curse. Some days are more cursed than others.

I didn’t watch The ‘C’ Word. I followed Lisa’s Blog but didn’t have the necessary psychological flood defences in place to watch her story played out on television. A dramatisation and by all accounts a very good one, it might be better categorised as reality TV. It reflects the harsh reality of breast cancer where life no longer comes with a happily ever after guarantee. Some people with breast cancer do not survive. Some people with breast cancer die. Some of them are very young.

Survival has been playing on my mind a lot lately because there is no rhyme or reason to it. No-one knows who among us will outpace the frightful fiend, who might be forced to endure it to the bitter end or who might find themselves facing it on more than one occasion.  This is ambiguity on anabolic steroids and uncertainty reigns supreme. In this version of reality sentience is more curse than blessing. Lately it seems for every survival story there are multiple stories of an all too early demise.

As humans with a limited time on earth we must learn a crucial lesson – never take anything for granted. Health, strength, life itself, these things can all be taken from us in the blink of an eye.  Most people don’t need to think about mortality on a daily basis and that’s probably a good thing because life would be very depressing if we did. Those of us who do think about it – a thought pattern that is almost inevitable after a life-threatening illness – probably do ourselves no favours. Worrying about our own mortality doesn’t change the final outcome. This is another scenario where sentience proves to be more of a curse than a blessing.

So what of the blessings? Feeling the sun on our skin, watching grass grow, celebrating another birthday, anniversary, Diwali or Christmas are all blessings. Walking in the park, riding a bike, reading a book, those things are blessings too because life after cancer is difficult. It throws up questions for which there are no answers and searching for answers offers no reprieve. The simple act of waking up each day is a blessing in this reality, when you have no idea how many days are yet to come.

Small miracles are miracle enough

One month on from surgery and everything appears perfectly usual from the outside. In clothes it’s impossible to tell that my chest looks like the chest of a plastic doll someone once tried to saw in half. The latest scar remains red and fresh with the added benefit of some stuck-fast super-glue. Aside from that the healing process is going well. Skin knits together incredibly quickly.

I’d never heard the term ‘spitting stitches’ before this surgery so when I discovered a piece of blue synthetic filament protruding through my skin (not dissimilar to a nylon guitar string or thick fishing line) I guessed it had to be a wayward stitch. It was a few inches away from the scar which threw me at first. Then I realised the internal scar is bigger than the external scar and this piece of thread aligns perfectly with the joint between me and my newly introduced ADM pocket. Nothing to panic about.

There are all kinds of suggestions on Google as to what to do with a spitting stitch. Anything from phoning the hospital right away to pulling it out with tweezers or cutting it off as close as possible to the skin with nail scissors. I decided to keep it clean, apply a little antiseptic and leave well alone until my next consultant appointment. When I saw Miss M. she was hugely apologetic, as if it was somehow down to her rather than a failing in my thin and stretched skin.  “I’m sorry, this happens sometimes” she said, “if I can see it I’ll cut it off otherwise it will fall out on its own in time.” In a couple of minutes it was clipped short and disappeared back beneath the flesh where it will eventually dissolve. Miss M is very happy with post-surgery progress and my general level of wellness since our previous meetings. We won’t meet again until our usual annual check-up in September which means this summer will be mine to do with as I wish. The first in several years.

Strange sensations in my chest continue to confuse my brain. The pectoralis muscle starts to twitch and stretch each morning shortly before I wake. It’s completely involuntary and enough to stir me from sleep. There is no pain but its odd. Movement in my arm is almost returned to normal, no heaviness or pulling so long as I take care not to strain – no lifting or carrying heavy objects yet, no twisting, turning or driving. All those things will resume in time.

I don’t enjoy recovering from surgery, it always seems to take so long and much effort is required to rebuild lost strength after taking things ‘easy’ for several weeks.  I am happy for small miracles though – a problem-free surgery, clear histopathology and no signs of infection, implant displacement or rejection of foreign materials. I may look like some parody of a plastic doll, scars and all. I may be physically less able than I was before and my joints may never heal, but I’m well and that small miracle is miracle enough.

Celandine - the light bringer

Celandine – the light bringer

Cicatrix

  1. a scar left by the formation of new connective tissue over a healing sore or wound.
  2. a scar on a plant indicating the former point of attachment of a part.

We all gather scars, some more visible than others.  They mark the various knocks and scrapes we encounter as we make our way from childhood to old age. The grazed knee in the playground, the cut finger in the kitchen, the gashed hand in the garage – each serves as a reminder of our calamities and mishaps.

Yesterday the dressings protecting my newest wound were removed. It isn’t pretty.  Long and red it sports uneven edges, rough scabs and is filled with medical grade superglue.  Around it lies a fair amount of swelling and bruising, some blue-black, some yellow.  Tell-tale holes at the side of my rib cage (a modern vampire bite if ever there was one) signpost the point where the drains used to be. The complexity and scale of this surgery is easy to underestimate.

Once settled and healed I’m confident the reconstruction will be a good match for it’s opposite number. That scar has now faded to a straight, flat, thin white line. Little more than six or eight centimetres from end-to-end it is reasonably unobtrusive given it’s calamitous reason for being. Like the forty year old scar from a fall in the playground or the one in my heel (from treading on broken glass at nineteen), each cicatrix has its own story to tell, a series of events that led to its appearance and some lessons learned along the way.  An up close and  personal experience of cancer isn’t something any of us wants to learn from so prevention is definitely better than treatment as Angelina Jolie will no doubt attest. Surgery is a radical option but for some of us it’s the best thing science can offer right now.

I’m not a huge fan of Picasso’s art but one of his sayings is useful when reflecting on this experience: “Others have seen what is and asked why. I have seen what could be and asked why not.”  Being covered in permanent cicatrices, deconstructed and reassembled – none of it is pretty – but cancer and the chaos it creates is much uglier.

Written in the stars?

image

Constellation: Leo

I confess I don’t believe in horoscopes but every now and then something comes up that might just hold a smidgen of accuracy. Today my horoscope says: “This week you are reconstructing something that was once deliberately dismantled. It will be a positive process.”

Prophylactic mastectomy could easily be classified as something being deliberately dismantled. In this case a left breast. Immediate reconstruction with ADM plus an implant is reconstruction (of said left breast removed and reconstructed on Wednesday afternoon). This week’s horoscope begins to sound quite plausible. “It will be a positive process.”  That’s such an open-ended statement. Does ‘it’ relate to the dismantling, reconstructing, both or something else entirely – there are a host of physical and psychological processes going on right now but are they positive processes?

After giving this a lot of thought the only conclusion I can draw is yes.

This surgery had the potential to resurrect so much that was difficult, painful and confusing, negative even. Being diagnosed with cancer isn’t a positive life event; my previous surgery was cancer surgery and it caused significant disruption in my life and the lives of my loved ones.  We are still recovering from some of those problems. This time around the procedure was broadly the same but the reasons are different. The next steps won’t (with luck) involve any further treatment.

I can’t change what’s written in the stars, or more precisely, in my genetic code but limiting its potential impact is another story.  Taking action is a hugely positive process. It is not without cost but what value do you place on the chance to live beyond 50 years of age, to see your child grow up, meet your grandchildren, enjoy your retirement?

Women with two or more close relatives who develop breast cancer at an early age fall into the high-risk category. Those who’ve already experienced the disease face an increased risk of another encounter. I tick both of those boxes and my first encounter was aggressive and high grade. Very recent research indicates the risk for women with long histories of familial breast cancer may be as much as 1 in 3 rather than the typical 1 in 8. I tick that box too. For people like me undergoing prophylactic surgery may reduce the risk by as much as 90%. Of course it’s important to remain vigilant because risk-reducing surgery isn’t a panacea, it doesn’t make cancer an impossibility in the same way wearing a seatbelt doesn’t make everyone survive serious car accidents.

In life there are no guarantees – never were – we just kid ourselves that we’re invincible. However the benefits of this process, of dismantling and reconstructing, aren’t just physical. For me some of the most positive aspects are psychological. No more annual mammograms that leave me fretting over the reliability of results. No more second guessing self-exams that might or might not have uncovered another anomaly. No more thinking of my own flesh as a time bomb waiting to go off (again).

For more than twenty years I lived with a question that I was never able to answer to my own satisfaction. The question: “Have I done enough to reduce my risk of cancer?”

For the first time in a long time I am able to answer fully and frankly: “Yes. There is nothing more I or anyone else can do.”

Stumbling Blocks and Stepping Stones

“The difference between a stumbling block and a stepping stone is how high you raise your foot.”

“The difference between a stumbling block and a stepping stone is how high you raise your foot.”

The risk of developing breast cancer before the age of 80 is 21.1% for those with two affected relatives. Assessing my own risk is no case for Sherlock Holmes because at least five generations of women developed and then died from metastatic breast cancer before the age of 50. Wondering ‘why me?’ when I received my own diagnosis in 2012 seemed a little pointless.  A better question was when, not if and had familial breast cancer been better understood fifteen years ago, none of this might have happened. It did and I’ve learned how to accept and deal with it.

Failing to avoid breast cancer is one thing, being thwarted by genetic stumbling blocks and uninspiring statistics is quite another. My consultants say genetic aberration is responsible for the decimation of the female branch of my family tree. On that basis the obvious answer would be BRCA but as science continues to identify, breast cancer is far more complex than BRCA1 and BRCA2. I have neither of those genes.

In time scientists will discover the fault(s) in my genetic code. With luck, skill and more time they might even establish what to do about it. Until then retaining any unnecessary quantity of natural breast tissue seems akin to playing Russian roulette.. with a powerful handgun and live rounds in all six chambers. I’m not much of a gambler and I cannot change my genes however I refuse to live in fear of the century-long shadow breast cancer casts across my family. I know the choices are limited but they’re still choices and a key piece of my cancer-defence jigsaw just came into view.

On 11th March Miss M. and I have another date in the operating theatre. The final vestige of my female (physical) self will be exchanged for silicon and pig intestine over the course of around 4 hours. I  very much hope its the last in a long line of surgeries because much as I love Miss M., I have an increasingly strong aversion to hospitals. Genes permitting this will be an uneventful risk-reducing mastectomy followed by immediate reconstruction – no need to mess around with nodes, skin or chest wall.

It would be easy to regard more surgery, the recovery period, the possibility of complications and/or unwelcome discoveries as new major stumbling blocks obscuring my route to sustained wellness. I prefer to see it as a well considered life choice in circumstances that might otherwise favour cancer, not me. Deciding to have more surgery isn’t easy, it brings back memories that I hope in time to forget but right now, this is an important stepping stone.

Once the operation is over I move from living with an unacceptably high risk of developing another new breast cancer to living in the knowledge that I’ll have done everything possible to contain that risk. In doing so I improve my chances of staying cancer free. Even the tiniest of improvements is better than none at all.

Another year over…

The winter solstice passed by ten days ago and in the northern hemisphere, slowly but surely, daylight hours are beginning to increase. Tonight we usher in another New Year and in doing so set this one behind us. Another year over. In less than 6 months the summer solstice will mark a return to darker nights and the cycle – birth and death, growth and decay, dark and light – will continue. That is how our planet works.

At two points in my lifetime our family had five generations to celebrate Christmas and New Year, something of a rarity even in days when families were very large and women typically had children in their late teens or early twenties. Today very few of us remain and those who do are scattered over long distances across three continents.  Family is important to me and I would happily forgo all worldly goods for the opportunity to spend an extra year with lost loved ones, though a year would be insufficient because some were lost at a very young age. Young or old I know that parting again from those held dear would be far too difficult, something I would not relish for a second time so memories and photographs must suffice.

My oldest living relatives, my great aunt and great uncle, are 86 and 89 respectively. I was unable to visit during cancer treatment because I was chemo-pale and sickly, doing my best to avoid infections. They had experienced all that 17 years ago, immediately before they lost their only daughter and I couldn’t countenance this elderly couple bearing witness to the ravages of cancer treatment yet again.  A couple of years on and I’m largely recovered, pass for near-normal and have a functioning immune system. The Christmas break offered a good opportunity to visit and I found that Aunt and Uncle wear time well. They remain largely independent though they’ve both faced many personal health challenges in the last few years. They continue to live in the house they moved in to over half a century ago, the first house to be occupied on their street of brand new houses at the time.  Uncle tells me they are the last of ‘the originals’ on the street, they have seen many people come and go and he has lost his oldest friend in the last few months. Great aunt remains a country girl at heart, the Welsh lakes and mountains are never far from her thoughts and I am sure if she could, she would return there.  Though they’ve been married for 63 years I noticed Aunt continues to call Uncle cariad; he calls her cariad in return. Darling or sweetheart in Welsh. We talk of many things, of our lost loved ones and of those who are still here, of modern times and days gone by. Uncle gives M a bottle of beer and they discuss their favourite brews, he has a J2O for me because Aunt has told him I’m doing my best to take care of my health. We pet their dog (who is also very old at c17 but no-one knows his age for sure – he was rescued). We drink tea and remind Aunt and Uncle to keep warm in the cold weather, stay safe indoors.  The visit passes quickly and when its time to go Uncle takes my hand and says “keep looking after yourself, once there were lots of us but now there are few. We don’t want to lose any more.”  So true.

I wonder if there’s a point in our lives when we come to realise time slips through us quickly, more quickly than we might appreciate? If so, does the realisation change the way we view the world and go about our lives? Perhaps our experiences ordain when that point might be and make it dawn earlier for some than others, if at all?  As ever there are so many questions that seem to have so few real answers. 

Another year over and I think perhaps I have reached the point where I appreciate the value of time, how fleeting it is and how far beyond our control it lies. I also realise, and have done for a while, that I am free. Free from worrying about my pension, what other people think, how I look, whether my health will stay stable or my joints will ever improve.  I realise there is no time to waste which means enjoying the time there is, all of it, in whatever shape or form it takes. That is my mission for 2015, nothing more and nothing less.

To everyone who has followed Fecthis, liked and commented, thank you all – your encouragement and support is truly inspiring. To those who are facing cancer afresh or continue to live with it, I send fortitude, love and compassion. For everyone, I send wishes for happiness, well-being and peace in the year ahead. You are all amazing and you all deserve more time than human form allows.

Happy New Year

Happy New Year