All in One Day: three stories from medics and carers working at Christmas

For many of us work is winding down and we’re getting ready for the fun and festivities of Christmas. Even if we don’t celebrate, some time off comes as a welcome break at the end of another busy year. Food, holidays, gifts and sales have become synonymous with the season of joy and goodwill but contrary to the adverts on TV, over-eating, over-spending and over indulging aren’t what Christmas is really all about.

This post shares three short stories from medics and carers who’ll be having a very different kind of Christmas. After reading this I hope like me you’ll spare a thought for everyone who epitomises the true meaning of Christmas, “giving up one’s very self to think only of others…”

The Nurse

“I know I can’t make them love their baby. I know I can’t ignore a baby at risk. And even though I know it’s absolutely the right thing – because it isn’t safe for a child to be there – I still feel bad for all of them. Removing a child is a last resort and a whole panel is involved. But the parent(s) blame me anyway, and when that happens it makes me feel like I failed.”

After working with a young mother, her on/off partner and their very young son, The Nurse assessed the home environment was unlikely to improve. Domestic abuse and extensive drug use surrounded the teen mum. By default, it surrounded her young son too. On a grey, wet December day The Nurse took part in care proceedings – something she finds stressful but all too frequent in her type of role – knowing her evidence might lead to removal of the child, possibly for fostering or adoption. Two previous children had already been placed in care. “When the meeting finished, she (the mother) was emotionless about her son. It was if he didn’t exist. Afterwards she mouthed “you did this” and the look she gave me, it was withering. I know I did the right thing, but I just keep asking myself what more could I have done?”

The Carers

“We’ve worked every Christmas and New Year for over ten years. It’s difficult to get cover at Christmas, but peoples’ care can’t suddenly stop. We work because our clients still need washing, dressing and breakfast. They need a friendly face who’ll arrive again at lunchtime, make sure they’re clean and make sure they take their medicine alongside lunch. Then we’re back again in the evening, wash and change the client, and get them safely tucked into bed. Put the dirty laundry into wash so it’s ready for the morning, make sure the client is settled, turn off the lights and then head home. If we’re lucky we’ll be back by 11pm.”

The Carers work from today until New Year’s Day without a break. They’re out on the road at 6.30am every morning, get a couple of short breaks if they’re lucky and their shift ends around 10.30pm. They visit multiple clients with a range of care needs. “This job doesn’t suit everyone. Sometimes clients can be difficult because of their illness, sometimes they’re very confused or upset. There’s a lot of poo to clean up as well, but you just get on with that! Very often we’re the only people some of our clients will see this side of the New Year. So it might mean finishing after midnight, but we give some extra time. No one wants to feel alone over Christmas, do they.”

The Medic

“What an afternoon: one person has chest sepsis, another person had a huge upper GI bleed and nearly arrested, another has critical stenosis of their cartoid arteries. None of them will be well enough to go home for Christmas. I felt completely frazzled at the end of my shift today, and this afternoon really impacted my mood. Working in a major hospital is rewarding but it’s also challenging and this all happened on the ward, not in A&E. We are short staffed, which doesn’t help.”

The Medic’s ideal Christmas this year would be a peaceful one with as little stress as possible, a chance to unwind, sit down for more than ten minutes to eat lunch, and catch up on sleep. “Yesterday I had to tell a family their loved one was dying and probably wouldn’t make it to Christmas. Everyone thinks it’s a happy time of the year, but it isn’t happy for everyone. Inevitably some of that stays with you.”

Reflections: seven years on

This time seven years ago I was readying myself for the first of numerous major surgeries following a grade 3 HER2+++ breast cancer diagnosis. Back then I wasn’t sure if I’d still be around now. Thankfully I am.

So how are things?

I can’t lie, the journey has been tough at times. I assumed, opportunistically, that after treatment I’d bounce back and be able to do all the things I was able to do before. The oncologist hinted as much, the oncoplastic consultant surgeon was more realistic.

I can do many things, not all, and it isn’t a simple case of the ageing process as I gently head towards 49. There are lots of frustrations, but in spite of everything I love life more than ever and feel enormously grateful to be here. In 2012 that wasn’t a given. As I approach the last few days of my 48th year it seems appropriate to pause for a moment and take stock, now the whole situation is less raw.

Would I take the same course of action again?

This is easy to answer because there wasn’t really a choice. Grade 3 and HER2+++ don’t make for a great combination. If anything I’d have liked shorter gaps between the initial suspicious findings and formal diagnosis, diagnosis and surgery, and surgery and adjuvant therapy. It was almost 7 months until adjuvant therapy commenced, outside the NICE guidelines. It felt like a long time, long enough for any distant cancer cells to take hold. I didn’t want that.

I wish I’d known more about the challenges of surgery and how long it would take to regain my upper body strength (I’m still not as strong as I used to be). I remain glad that I opted for the more radical surgery, because choosing a conservative option may well have seen me going through it all again about now.

What was the most worrying moment?

Although cancer runs in the maternal side of my family – it wiped out the vast majority of my female relatives – I quickly realised just how little I knew about it and how complex it is. As soon as I was diagnosed I wanted it out of my body. I didn’t realise how much biopsy-ing, testing, imaging and investigation takes place before decisions about appropriate surgery, neoadjuvant or adjuvant treatments can be made.

The results of the MRI scan were by far the most worrying event for me because it “lit up like a Christmas tree.” I thought it might be too late even though I’d seen the Dr straight away. I had countless sleepless nights worrying that I’d die at a crucial stage in my son’s life leaving him motherless, homeless and unsupported. I love my family, I really didn’t want to leave them alone and destitute.

Was treatment hard?

On reflection, I think it was. It took 18 months+ and knocked the stuffing out of me. At the time I didn’t realise quite how big a toll it took. I kept pushing myself forward, trying to be “normal,” getting on with life as best I could. But life was far from normal, and normal didn’t include me.

I didn’t feel seriously ill pre-diagnosis even though I was seriously ill. At some points during treatment I wondered what else or how much more I might need to endure. At times I felt extremely ill. The lowest point came when I had to inject myself with granulocyte colony stimulating factor, to combat low white blood cell levels which increase the risk of serious or life-threatening infections. At night the pain in my bones was unimaginable yet still I carried on. That pain is still unlike anything I’d experienced before or since. So yes, treatment was hard but the alternative doesn’t bear thinking about. I’m still here and as far as we know, cancer-free. It was hard but it was worth it.

What else happened?

Having cancer taught me a lot. Psychological lessons included learning my body was no longer my own. I couldn’t trust it and felt trapped in a shell that might break into a thousand hopeless pieces at any moment. Coming to terms with my own fragility and unpredictability took time. Physical lessons involved treatments designed to obliterate the disease that also obliterated my joints, my thought processes and my hearing. Although cognition has improved a little, my joints and hearing are permanently damaged. C’est la vie. Emotional lessons centred on relationships. People who promised to stand with me simply vanished into thin air and that was very hard. Thankfully strangers and acquaintances came closer, they became friends and remain loyal friends today.

More difficult and painful than any other part of this journey was the continuing loss of friends who were also fellow cancer patients. Some older, many younger, these were people for whom surgeries and therapies did not prove successful. There are so very many of them, not ones or twos but tens and tens. My heart gets a little more broken every time I remember friends and loved ones who have died of this spiteful disease, and think of those who are dying now as I write this post. Cancer still kills.

What next?

I don’t plan or daydream. Life is too uncertain and time is too precious for maybes, tomorrow perhaps or one day. I love my family more than ever and make the most of every moment with them. When they’re happy, I’m happy and nothing else matters. I enjoy my work, still thrive on pushing boundaries and encourage my colleagues to do likewise – why spend time in a job that feels like drudgery? I’ve taken control of things I can control (diet, exercise, rest) but I’m relaxed about it, not a zealot. Spending an extra hour in bed when I’m aching or tired isn’t going to kill me, and cancer won’t return just because I drink a glass of wine or eat a decent steak every now and then. I find beauty all around me and spend as much time as possible creating environments where nature can do its thing. In nature I find solace.

I’d like to stay cancer-free and live for a few more decades because life is good this way. But I never take anything for granted.

21 scars and all out of love for sloth

Just when I thought it was reasonably safe to put the operating theatre behind me…

2 out of 4 news scars, 21 in total

a bunch of symptoms showed up with plenty to contemplate. Upper right quadrant pain before breakfast, at random points through the day and resistant to over the counter pain-killers. An intermittent feeling of fullness beneath the ribs or a hard area towards the sternum, with pain, sometimes radiating to the right shoulder blade. After a run-in with grade 3 HER2 positive cancer, metastases couldn’t be ignored. The only way to find out was further tests. At the end of last year yet more blood tests and another ultrasound ensued. There are protocols around ultrasound and the sonographer isn’t usually at liberty to say anything but on this occasion he was more forthcoming and said the liver looked normal. I guess he knew no-one wants the thought of liver mets hanging over them like the darkest of dark clouds.

The source of the problem was identified quite quickly and completely non-invasively: a large gall stone.

Fast forward six months and there are four new scars to add to the previous seventeen littered around my torso. Although these are small in comparison to some of the cancer-related scars the after effects of gallbladder removal (laparoscopic cholecystectomy) have been more painful and recovery seems slower. Perhaps it’s because my body was already a human pin cushion and there’s only so many holes that can be made through a single belly button without repercussions? Strangely the scars in the area where the gallbladder used to be don’t hurt and the one in the midline, just below the sternum, is barely noticeable but the belly button and whole lower abdomen is another story. Maybe that’s because it’s been used before for other surgeries or maybe it’s because this surgery involved pumping carbon dioxide into the area leaving my whole abdomen distended like the alien in alien autopsy. Almost a week on and it is still out of shape.

In the recovery room where it took some time to recover (and was a little worrying at first) they showed me the offending gall stone. Just one but of sizeable proportions and certainly enough to have caused all the previous symptoms. The consultant came to visit on the ward and said “it was nasty in there.” I’m still not sure exactly what he meant and didn’t have the heart to tell him it felt pretty nasty living in here post-surgery too. It’s the one time when I’ll gladly declare opiates have been my friend.

Since parting company with the gallbladder and its unwelcome occupant all the unpleasant feelings and malaise thought to originate from there have gone away. Early days but with luck those problems are gone for good. As for the scars, they are healing well. (That purple stuff is medical super glue and it flakes off in 5-10 days.)   One of the worst things about surgery is recovery. It can’t be rushed which means being careful, nothing strenuous and giving things time. But time is precious and aside from piling on pounds when I sit around, every day spent in inactivity feels like an opportunity missed. It’s frustrating. Twenty-one scars in a 30 x 50 cm area is more than enough so hopefully this surgery is the last. Precious days are passing and I’m all out of love for sloth.

Scar Tissue, Tattoos and “Are we there yet?”

“Are we there yet?” The question anyone making a long journey with a small child is sure to have heard. You don’t expect to hear it asked in many other situations but breast cancer is one where the thought occurs even if the words remain unspoken.  Pre-diagnosis I heard many media stories about how we no longer need to be afraid of  breast cancer, how treatable it’s become and how many more women survive these days. Bearing in mind none of the women in my family have survived I try to look on the bright side and hope these stories are all correct. I’d heard that treatments had moved on, surgery was less debilitating and with the help of pink ribbons the world was now full of courageous cancer warriors – previvors, survivors and thrivers.

Until I was faced with aggressive breast cancer, a type that brings a high propensity to metastasise, I had  not heard that diagnosis, surgery and treatment may well take over a year. I had not heard that diagnosis itself requires multiple steps which can (and did) include many false starts, lots of potentially conflicting information and significant additional stress. Post diagnosis I had not heard that surgery and surgical revisions, follow-up treatments and regular check-ups can extend for a minimum of half a decade – and that’s if you happen to fall into the ‘best case’ scenario.  Nor had I heard via any popular media sources that in the case of those  diagnosed at Stage 4 (or the 30% of us who go on to develop mets in spite of treatment), the journey is never complete. Check-ups, treatments and various surgeries just keep going until we ourselves come to an end. “Are we there yet?” takes on a whole new meaning in this realm.

My own breast cancer journey has been tracking along for over three years now. We are still moving forward yet still unable to answer the “are we there yet?”  question.  Major surgery is complete and I am in remission as far as we know but only time will tell if that will remain the case. Meanwhile there are a number of minor things to tackle including surgical re-work to address unintended consequences arising since the original reconstructions.  When these revisions happen depends on waiting lists, beds and Government spending reviews but in the meantime there are highly recommended ‘finishing touches’ designed to help me believe that life is as it should be.  This involves the creation of an illusion of a more normal appearance, but in truth there is nothing normal about any of this.

It is at this point that the scars and tattoos become relevant. Post-surgery, chemo and Herceptin I am the owner of a Barbie-esque chest that is almost as unnatural, shiny and pink as Barbie herself. Were it not for the scars running across the front of mine (and the vampire bites – double drain scars that adorn either side of my rib cage) my torso might be that of a plastic toy. Fortunately the vampire bites are not obvious and there’s little to be done with them in any case. The same is not true for the front facing scars and on top of all this (no pun intended) is the small issue of absent areola/nipple complexes. You won’t be surprised to learn that this tends to give the game away.

At first I didn’t think the whole Barbie/nipple thing bothered me. I was glad to be alive and still am – glad and alive. I didn’t plan to show my chest to anyone other than the person I married so missing in action areolas and nipples felt like no big deal.  But having lived with pink plastic mounds for three years I’ve come to realise the absence of those oh so common breast adornments and the obvious scars that took their place serve only to remind me of things I’d rather not dwell on.  Additionally there’s the small issue of any activity involving communal changing rooms, taking one’s top off or the dreaded but inevitable accidental reveal. Being an outdoor type that’s easier to achieve than you might at first imagine.

So after much deliberation I took my consultant’s advice and engaged in the process of additional fakery – to help disguise the fact that both breasts are completely fake.  A fake to hide a fake is pretty clever stuff but in real terms it consists of multi-pigmented tattoos designed to give the appearance of an areola/nipple complex. There is no need for more surgery to reconstruct fake nipples and as they’ll never be or behave like the originals I couldn’t see that they serve any purpose other than being there.

As with all things breast cancer the tattooing procedure is a multi-stage process and requires more than one treatment. Before commencing work the nurse tattooist gave me some anaesthetic cream. This has to go on an hour in advance in the hope it will numb the area.  On reflection I should have realised it wouldn’t be terribly effective because the same stuff is used by my dentist and never works. I normally end up with multiple doses and have to wait much longer than normal before it kicks in. So the tattoo process was not pain free and although it was reasonably quick it had me wincing and silently chanting ‘I hope this is worth it.’  The nurse did offer to stop but when you’re a third the way through that doesn’t seem like a viable option!

At the end of the process there was some blood. This was followed by more bleeding and weeping afterwards.  It’s fair to say that the area was quite sore for a few days and a little tight and swollen.  Scabs formed then became itchy and began to fall off. I left them alone because picking would cause pigment loss and possibly lead to an infection.  About a week out from the tattooing process the scabs were all gone and the resulting pigmentation is reasonable if patchy in places. This is why the procedure requires more than one attempt.

Looking closely at the scar tissue it seems the pigment struggled to take in the sharp edges of both scar lines. Incidentally this area was hyper-sensitive when the tattooing took place.  Peering less closely and looking from a small distance the scars themselves are much less noticeable and hidden by something that passes as an areola/nipple complex.  Although this is the first attempt it’s probably good enough to fool anyone who might catch a glimpse in a communal changing room – as long as they don’t stare!

The next tattooing episode will happen in about 6 weeks time when the skin is properly healed and the big question is… Is it worth it?  On balance I think it is. After breast cancer nothing is ever the same so something approximating normal is about as good as it gets.  I now know what to expect during the next round of inking and will slap the anaesthetic on well in advance. Once the soreness and scabbing subside I can look forward to having two very respectable forgeries in place of the torso of a badly treated Barbie doll.

I had to think about this long and hard because I am tired of hospital visits, surgeries, re-work, worry, stigma and prejudice. But my consult (who is a miracle worker as well as a thoroughly lovely lady) was right. Looking more normal is helping me feel more normal and that is the ultimate placebo effect.  If you’ve had surgery and are thinking about areola/nipple complex tattoos the following articles may be useful. Nancy’s post gave me the inspiration to try this for myself and like Nancy I am happy with the result

The Oncologist

Tomorrow I’m heading back to see the oncologist.  A quick recap: he is studious, often serious and I was told some people find him rather terse. He also came highly recommended on the basis I could cope with a scientist who holds a passion for his subject, has considerable clinical trials expertise and presents the facts in a sans-sugar-coating, say-it-as-it-is kind of way.  It’s true he wouldn’t be everyone’s cup of tea because small talk and social pleasantries aren’t his thing. I knew I could live without those but the same could not be said for a well-constructed third generation treatment regimen designed to tackle very aggressive HER2+ breast cancer.

When I was in active treatment I made it my mission to find some way to make the oncologist laugh every time I saw him.  Despite the various cancer shenanigans and associated torments I managed to retain at least a smidgen of my naturally playful, sometimes mischievous (in a harmless kind of way) spirit. So tomorrow I’ll be in his office finding another way to make the man who averts death smile and laugh because let’s face it, 12 hours a day 5 days a week managing various forms of cancer is hardly fun, even if your success rate falls in the upper quartile.

I haven’t been back to the hospital for some time now and if it weren’t for the follow-ups I’d avoid going back there at all costs.  It’s the place where my life switched from relatively stable to completely FUBAR in a matter of moments. It’s the place I associate with a tranche of memories I’d happily erase if permanent amnesia happened to be available in tablet form. It’s a place where the staff are brilliant, my treatment was excellent and as far as I know all traces of the mutant cells terrorising my body were eradicated. Unfortunately it will always be the place where cancer and me were forced to become far too familiar with one another. That acquaintance lasted much longer and caused far more damage than any of us is led to believe so I might just have to strangle the next person who says breast cancer is an easy cancer, the best kind of cancer or anything that remotely infers treatment and recovery is a walk in the park. Oops… I lost my playful spirit for a moment there.

Thankfully my oncologist chose to be an oncologist instead of an actuary, a computer programmer or an astrophysicist. For that I will be eternally grateful. For cancer I will not.

It wasn’t an accident…

 

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Someone I used to work with died last week. We weren’t close and hadn’t kept in touch but it  was still sad and shocking to hear the news. He was young, super fit and healthy just a couple of years back when we worked together. A clean-living triathlete.

When I found out I thought maybe he’d been involved in an accident, some kind of traffic collision. In the city it’s one of the more common causes of premature death. Or maybe one of those completely out-of-the-blue heart conditions, the kind that take people during marathons and football games.  In the moment between hearing the news and hearing what happened, an accident is what I expected to hear.

It wasn’t an accident and what I’m about to say will sound strange. In spite of the trauma, an accident might have been easier.

He was diagnosed with lymphoma in July and spent the past few months in a hospice. Nine months from diagnosis to death. His world and that of his family undone in the space of three seasons; autumn, winter, spring. His wife and young daughter must be devastated and I can’t help thinking it’s really sad. Sad for him and sad for them. They’ll have some gruelling memories to deal with before the good ones find a way back in.

24 hours ago one of our news channels made a big deal of cancer survival rates. The report was positively beaming about 50% of people in England and Wales now living for ten years post-diagnosis. Cancer no longer needs to be seen as a death sentence is what the story said. The same story reported a one in two chance of living (dying) within 10 years of diagnosis as a vast improvement on the 1970’s position. Back then 24% could expect to live for 10 years.

News of a co-workers death from cancer in less than year just one day after this inappropriately upbeat national TV story seems hopelessly ironic. I don’t deny the numbers reflect some progress for the better, but I can’t shake the thought that creeping from 24 to 50% ten-year survival during the course of almost 45 years is extremely slow. Life threateningly slow. The kind of progress that earns a ‘must try harder’ comment on an end of term report.

It wasn’t an accident that we invented the large hadron collider, wi-fi, hybrid cars and protease inhibitors in the last 25 years. We verified the existence of dark matter and down-graded Pluto to a dwarf planet too. But when it comes to cancer we’re supposed to be pleased by a 50% ten-year survival statistic that’s taken 40+ years to achieve? It’s a statistic that means 50% of people, including my ex-colleague, still can’t expect to see their kids grow up, have kids of their own or spend time with their grandchildren.

Misguided, 10 Myths & Missing the Point

Those of us unlucky enough to be on the breast cancer merry-go-round know all too well that the Media has a strong role to play in raising awareness. It has an equally strong role in conquering a number of misguided, often serious misrepresentations of the truth.

Sadly much of the Press around breast cancer either sexualises or trivialises the disease by portraying it as an “easy” cancer from which we’ll all almost certainly be “cured” and go on to live long, healthy lives. (Myth 1).  A short detour into the land of all things pink and plastic is nothing more than a minor inconvenience for which we receive plenty of help and support (Myth 2).  Post-treatment we’re duty bound to be happy about our good fortune and can celebrate how incredibly lucky we’ve been since developing the “best” kind of cancer (Myth 3).  We’re cured (Myth 4) so can spend plenty of time flaunting freshly reconstructed, completely flawless (Myth 5) new “boobs” that are sure to be the envy of all our friends.

This quick, simple and largely painless path from diagnosis through surgery, neo-adjuvant or adjuvant treatment (Myth 6) and on into the realms of pretty-pink, happily ever after la-la land (Myth 7) is one I’m sure my friends with breast cancer all recognise and are, like me, so very pleased about. Breast cancer is a highly desirable form of cancer and of course we’d wish for it because it’s better by far than other types of cancer. We’re very “lucky” don’t you think? (Myth 8)

No. I’m sorry to disappoint but this is not a disease anyone should ever wish for.

Unfortunately the Media recently helped perpetrate another misguided appeal that misses the point about cancer by a country mile. An advertising campaign for pancreatic cancer helps further the myths that breast cancer, or prostate cancer for all the guys out there since breast cancer is an exclusively female disease (Myth 9), is a “good” kind of cancer.  It’s so good that it’s obvious we’d all chose breast, skin or prostate cancer given chance to select from the smorgasbord of available human cancers running rampage through our world. Those kinds of cancer are so much better for us should we feel the need to acquire some form of the disease (Myth 10).

Having lost a colleague and friend to pancreatic cancer several years ago I understand the stark reality of that particular form of this insidious disease. There’s nothing good about it and survival rates are low because it’s often discovered late, when locally advanced or already metastasized to other areas of the body. When diagnosed early the outlook for pancreatic cancer is often very poor and I fully agree that further research, better diagnostics and improved treatment regimes are all desperately required.

However I also have a long standing, close-up and personal relationship with breast cancer so will offer thoughts for those – including advertising companies and the Media – who might think it’s “easy,” “curable” or presents a “better choice.”  I urge you to consider the following then tell me that you’d wish to have breast cancer (or any other cancer that might be worth wishing for) if you’re given a choice:

  • You BRCA negative but you’ve lost at least five generations of women in your family to breast cancer, all before the age of 50. Each woman lived healthily pre-cancer, went through extensive and life-threatening treatment yet still developed metastasis within a few years of initial diagnosis… Will you choose to invite this disease into your life or the lives of those in your own family?
  • You never met your Grandmother, she died of breast cancer when your Mother was 5 years old. As a teenager you watch your Aunt (in her 30’s) go through surgery, radio and chemotherapy. A couple of years later she’s in palliative care, steadily succumbing to brain and bone metastases that eventually break her hip causing unimaginable pain for the last few weeks of her life… Does this sound like a better option than other forms of cancer?
  • At 23 you see your Mother endure surgery, radio and hormone therapy. She then faces surgery and chemo for secondary liver, ovarian and bowel cancer. You’re sitting at her hospital bedside, she’s encountered yet more side effects and as you talk a treatment induced blood clot drifts into her lungs. Panic ensues and you’re ushered away. Some time later, you’re unsure how long because your head’s spinning and your heart threatens to break through your ribcage, you hear the words “I’m sorry.”  In your final moments with your Mother she’s desperately gasping for breath and has time to realise something’s terribly wrong. Decades later that image, the noise and the violence of her death are indelibly etched on your psyche… Are you going to vote for breast cancer now?
  • You’re 41 have a teenage son and partner to support. You worked your socks off for over 20 years as you’re the only source of income. Despite regular screening you’re diagnosed with aggressive, invasive HER2+ breast cancer. Your life disintegrates in a matter of months, long-term friendships, your livelihood and your son’s mental health all dissolve. You undergo gruelling treatment for 18 months that causes persistent side effects and no guarantee of success. Your family knows this as well as you do…. Can you imagine finding any of this easy?
  • You begin rebuilding knowing you’re at high risk of recurrence in the next 3 years, need to make it past 5 years and even then the spectre of breast cancer can resurface with a vengeance 20+ years later. You avoid looking at your mutilated body, your confidence wanes and though your hair’s back your scars remind you that you’ll always be a cancer patient. The physical scars are ugly, the psychological scars are worse … Answer honestly, are you still going to wish for breast cancer?

I think you’re going to say no.

No sentient being wishes for hell on earth and that’s exactly what breast cancer is, creates and leaves behind.

Perceiving one form of cancer as more desirable, easier, curable or survivable is misguided. It completely misses the point because there is still no cure for cancer and that includes breast cancer.  It is not a disease to wish for under any circumstances and the sad fact is that men and women across the globe die of breast cancer every day.  As with most forms of cancer if it’s diagnosed late the prognosis is poor but even when diagnosed early (node negative), breast cancer can creep on via micro-vascular invasion taking hold in the brain, bones, liver, lungs or skin at any point.  Treatment is no less gruelling than for other forms of cancer and contrary to misguided Press stories success isn’t guaranteed. Statistics have improved thanks to increased awareness and earlier diagnosis but far too many lives are cut short, often young women in their 30’s and 40’s.  Irrespective of type, cancer is a complex illness and outcomes depend on a myriad of interdependent factors including age, genetics, chemical and environmental considerations most of which remain poorly understood. Geographical location and cultural norms also have huge implications for diagnosis and survival, something Doctors in many African and Asian countries know only too well.

It’s unlikely people like Claire, Cancer in My Thirties or The Sarcastic Boob would wish for breast cancer given any choice in the matter. My Aunt and Mother are no longer here but I’m 99.99+% certain it wouldn’t have made their wish lists either. Unsurprisingly I did not wish for it (it came anyway) and I would never wish it for anyone else. As a sentient being I know what a god-damned awful disease this is, what it does, its consequences and all the things it ruins, breaks or takes away.

Wishing for one form of cancer over another is sadly misguided, misinformed and missing the point. Happily ever after breast cancer remains a myth in too many cases so please think very carefully. A wish for breast cancer is not the same as a carefree, pain free, cancer free life. The treatments are very challenging and you may still end up with just a few months to live. The seven point truth is this:

  1. Cancer, including breast, skin and prostate, is a killer.
  2. There are significant outcome implications based on where in the world you live.
  3. Incidence rates are rising.
  4. We are all in need of a cure.
  5. Prevention must be our ultimate aim.
  6. Cancer research requires improved funding and continued support.
  7. Many more will die before cure or prevention become global norms.

Snowdrops in Fresh Pastures

Thoughts among the flowers

I love flowers.  All colours, all species, scented or unscented.  It makes me happy when I see buds on the plants outside the window because I know in a short time the garden will be awash with blooms.  I was lucky enough to receive some beautiful flowers recently so the house is surrounded by blossoms inside and out.  Flowers buoy my spirits simply by looking serene and picture-perfect, the work of Mother Nature at her very best.  If they smell nice that’s a bonus and the bouquets in the house smell delicious.

Though I am far from picture-perfect (and definitely not delicious) I remain reasonably tranquil, so much so that the newly qualified nurse who carried out my pre-op assessment was amazed at my lack of concern regarding tomorrow’s surgery.  She was a nice person, kind and empathic.  She frowned about my experiences, they corrupted her sense of right and wrong.  This happens to too many good people she said.  I reminded her cancer doesn’t stop to consider whether you’re good, bad or indifferent, it just happens and we have to get on with it.  My way of dealing with it has been to generate some space, a gap between the me who exists today and the me who went through all that crap.  The little distance I’ve created – as much as a completely different life, 4″ scar, bad joints, skin, nails and hair allow – is enough to categorise that as past.  She was inspired by my positivity and resolve.  I smiled.  I never had any other choice.

She asked if I was worried about another operation… how did I feel about a further invasion of femininity after enduring numerous procedures, major surgery and follow-up treatment for months on end.  I smiled again and laughed. At this point she might have considered I was a little insane, shrugging my shoulders like an unruly child who is yet to gain a sense of mortality and would pay it no heed when she did.  No, I am not worried and I won’t be a quivering wreck in the morning.  After all the things that have happened  there’s nothing much left to fear.

I know I should probably be just a tiny bit concerned.  Reason tells me so because there are always risks with general anaesthetic, infection and such. Surgery doesn’t bother me though – like breathing it will happen and I’ll know nothing much about it. As for femininity, it doesn’t feature as highly on my list of priorities as avoiding cancer, keeping clear of more chemo, or facing an imminent death.  With those things on my priority list femininity gets demoted into the ‘nice to have but not essential’ category.  I always knew there’d come a point in my life when my aptitude for logic and unerring pragmatism would prove useful.  Looks like I’ve finally found it.

 

No gloss or glamour just grit and determination

One of the (many) challenges of breast cancer treatment is the extraordinary change that happens to our bodies.  Not just the obvious changes – missing breasts, scars, hair-loss if chemotherapy is part of the treatment regime – but the unexpected changes too. Weight changes, skin changes, fluctuating energy levels, tinnitus, dry nails, altered metabolism, neuropathy. The list goes on.   The physical transformations are accompanied by psychological changes too; stress, anxiety, depression, PTSD.  Even the most relaxed people can find it difficult to stay permanently upbeat when the whole world seems to be caving in around them.

In spite of the sea of pink, in spite of all the hoopla about survival rates*  and in spite of the endless fighting-talk about cancer warriors, battles and survivorship there is no gloss or glamour about breast cancer.  This isn’t a Disney blockbuster complete with pink princesses, an assortment of vertically challenged helpers and a handsome prince who’ll undo the evil spell and save the day.  It’s more like a Hammer House of Horror production.  Zombies – rogue cancer cells resistant to initial medical intervention – might re-establish themselves in a multitude of locations anything up to twenty years after treatment, possibly even longer.

There’s no Disney is this realm.  All we have, all we ever really have is the grit and determination to make it through diagnosis, surgery, chemo and/or radiotherapy into whatever future lies beyond. That future is not the one most of us anticipate.   Regular medical check-ups, long-term side effects, living in a body that no longer feels like your own, mulling over the question no-one can adequately answer…Will it come back?  Gloss and glamour don’t see us through these things. Just as cakes in a French patisserie look so much better than those in my locale, underneath all the icing and decoration they’re not much more than eggs, sugar and flour just like the cakes in my local supermarket.  Gloss and glamour can sometimes help us feel better about ourselves  – when we look good/healthy/almost normal on the outside it allows us to more easily blend in with the rest of society. But it doesn’t take away what’s on the inside – scars, reconstruction (or not), pain (physical, emotional or both) and whispering niggles that pervade the recesses of the mind.

What if some zombies remained…

What if they reawaken…

What if they take control?

French Patisserie, gloss and glamour galore

French Patisserie, gloss and glamour galore

  It seems there is no easy solution. From the point of diagnosis we’re on the cancer conveyor belt.  For some of us cancer is slow-moving and discovered early.  Treatment, whilst challenging, typically doesn’t involve chemotherapy and its long-term implications for health – the risk of cardiac issues or a second malignancy at some point. There’s a very good chance people who discover a slow-moving cancer will go on to lead a long and healthy life.

For others the cancer is more aggressive, fast-moving and difficult to treat.  Higher grade hard-to-treat cancers tend to affect younger women and several of these sub-types have greater propensity to recur.  Many of my blogging friends have these kinds of cancer.  For others still, the cancer has already broken free of its original starting point via lympho-vascular invasion.  Many people are familiar with the concept of cancer spreading via the lymphatic system.  It also spreads via the vascular system – our blood.  Treatment for individuals with metastatic cancer is life long and although its possible to live with metastases for a number of years, the average is a meagre 26 months.  During the life-span of this blog – 7 months – I’ve already mourned the deaths of cancer blog companions.

As Dr Suzanne Herbert stated in the 2011 article ‘A pink ribbon race, years long’ (NY Times)

While the pink-ribbon campaign has raised awareness about breast cancer, it masks a relentless killer.  People like the pretty story with the happy ending…   you always hear stories about women who ‘battled it’ and ‘how courageous’ they were. Cancer doesn’t care if you’re courageous. It’s an injustice to all of us who have this. There are women who are no less strong and no less determined to be here, and they’ll be dead in two years.

Despite ongoing discussion about the usefulness (or not) or mammograms and the associated potential for over-treatment, the fact remains that our ability to screen cancer is limited and our capacity to predict whose cancer will metastasise is, at present, totally inadequate.  What is clear is that anyone who discovers inflammatory, or high-grade HER2 positive / triple-negative breast cancer will need treatment. These sub-types are not slow-moving and have a much higher propensity to break free of the breast to take up residence in bone or other organs.  Unfortunately hormone sensitive, seemingly small and innocuous cancers can also develop zombie-like characteristics, reawakening years after initial treatment concludes.

For many – possibly the majority – of breast cancer patients the future is by no means certain.  This disease can rear its ugly head again years or even decades later and there is no gloss or glamour when, as Dr Herbert puts it, a relentless killer is in our midst.  25 – 30% of breast cancers go on to become metastatic. Metastases are incurable.  Personally, I’d rather risk over treatment now than take a ‘wait and see’ approach.  In my case wait and see would severely curtail the remaining years I might expect on this planet. Cancer may go on to do that anyway but at least I and my loved ones know I went through treatment, lots of treatment, rather than leaving things entirely to chance.  If I’d relied on the clear mammogram result in December 2011, ignored the small dimple and almost impossible to distinguish mass discovered in May 2012 the chances are that by December last year the cancer would’ve set up home elsewhere.  Just twenty weeks after a clear mammogram, the cancer I discovered had already made its way into the surrounding lympho-vascular system and sat 1mm beneath the skin.

I support the view that women shouldn’t be afraid of their breasts, that confusion exists about the implications of  DCIS and whether or not it will go on to become invasive hence its treatment is open to question. I agree that our current screening methods fall short in far too many instances and the sea of pinkness surrounding breast cancer trivialises a life-changing disease for those who are unlucky enough to be over-treated and for those who are unlucky enough to die irrespective of treatment.

Prevention is better than cure but since we know no means to prevent cancer at this time we are forced to rely on detection, treatment and attempts to cure, no matter how crude those processes may be.  Cure does not equal relative five or ten-year survival in the eyes of anyone with breast cancer and whilst predicted ten-year survival is good, in my view it’s still not good enough.

Relative Survival (%)
1 Year 5 Year 10 Year
Sex 2005-2009 2005-2009 2007*
Female 95.8 85.1 77
*The ten-year survival rates have been predicted for patients diagnosed in 2007 (using the hybrid approach).
Note: Survival for one and five years is for England only and for ten years is for England and Wales  (Cancer Research UK)

The photo below on the left is one of my rare attempts at gloss and glamour – I was never particularly good at it but if an occasion arose I scrubbed-up reasonably well. This was an in-laws wedding, before the spectre of breast cancer entered my life.   The picture on the right was taken yesterday  345 days into life in the shadow of breast cancer. Surgery, reconstruction and six rounds of chemotherapy have all come and gone and I’m still a cancer patient.  Part way through herceptin, awaiting further surgery and possibly facing Tamoxifen for 5 years or more.

The events of the past year mean I rarely contemplate gloss or glamour for any occasion these days. Waking up each morning and reconvening herceptin (currently suspended due to side-effects) is excitement enough.  The cancer patient look – moon face, spartan hair, a tiredness that’s etched deep into my eyes and skin – is also impossible to disguise, irrespective of gloss and glamour.   Grit and determination have long-since become my only mantra.  Without them I doubt I’d have reached this point whilst avoiding a major infringement on my sanity.

sarahs wedding   today p

*Survival has improved for some, for others it could be termed lies, damn lies and statistics.
  • According to statistics from NCI’s Surveillance, Epidemiology, and End Results (SEER) program, the 5-year relative survival for women diagnosed with inflammatory breast cancer during the period from 1988 through 2001 was 34 percent, compared with a 5-year relative survival of up to 87 percent among women diagnosed with other stages of invasive breast cancers.
  • A 2007 study of more than 50,000 women with all stages of breast cancer found that 77% of women with triple-negative breast cancer survived at least 5 years, versus 93% of women with other types of breast cancer. Another study of more than 1,600 women published in 2007 found that women with triple-negative breast cancer had a higher risk of death within 5 years of diagnosis
  • Breast cancer treatments such as Herceptin that target a marker called HER2 have dramatically improved outcomes for women with this type of cancer. But nearly half of these cancers are resistant to Herceptin from the start and almost all of them will eventually become resistant. Research has shown that women with HER2-positive breast cancer have a more aggressive disease, greater likelihood of recurrence, poorer prognosis, and decreased survival compared to women with HER2-negative breast cancer.

This body may be mutilated and knackered but boy is it resilient!

My friend Maurice at Duck? Starfish? but…23  inspired me to write about resilience following his comment on my ‘side effects’ page.  Please visit Maurice’s blog because not only will you find excellent writing, you’ll also learn a lot about Newfoundland and see that Maurice, the folks he works with and the communities in places like d’Espoir, Francois and Burgeo must be pretty resilient too.

Dictionary definitions of resilience say it’s the ability to spring back or rebound.  In the case of illness or adversity, it is the ability to recover quickly.  I am not sure how long my recovery will take, I am told anything up to 18 months to be on top form again so I think perhaps there is another angle on resilience.  For me being resilient also means enduring difficult circumstances, keeping going in spite of everything and having a steely resolve to overcome chaos and crap on a regular basis.

Finding out you have cancer or any life threatening illness is, of course, a shock but with cancer you often don’t realise you’re sick because early on there may be no adverse symptoms of the monster within.  In my case I felt well, I had energy and I was physically quite strong.  I had been more tired than usual but decided that was just my long-term relationship with pernicious anaemia.  The only sign of cancer was a rather innocuous looking dimple that in turn lead me to discover a lump the size of a broad bean.  At that point I didn’t really feel unwell.

Broad beans, shelled and steamed

Broad beans, shelled and steamed (Photo credit: Wikipedia)

When I found out I needed surgery followed by chemo my world turned upside down.  The one thing I didn’t want to face under any circumstances was chemo… chemo-induced complications killed my Mum (and 16 years on I have not been able to forgive it for taking her away from us when she was only in her 40’s).   What if it killed me too?

On the other hand, I know what untreated cancer does to people and animals and there’s no road to happy ever after if it’s allowed to take control.  My first call for resilience came when facing the prospect of chemo, before my surgery had taken place, before I knew what havoc cancer cells were attempting to play inside a body I knew I could no longer trust and before my FEC-TH regime had even been prescribed.

My next call for resilience came with surgery.  Breast surgery for medical reasons is not the same as breast surgery for cosmetic reasons.  Operable cancer means surgery is mandatory.  You can’t change your mind and tell the surgeon “you know what, put the scalpel away because I’ve decided I’m happy with my breasts just the way the are.” To be completely accurate, it’s possible to refuse any form of medical intervention but in the case of cancer that means it’ll take hold… no happily ever after if that’s the case. For me, surgery was the only choice because death by cancer is something I’d very much like to avoid.

I’d never experienced any major surgery previously but the thought of it didn’t bother me unduly because I just wanted the ELB (evil little b*stard) out.  As it happened, the surgery itself and the post-operative recovery period were less challenging than I thought they might be.  My body recovered quite quickly.   It took a little longer to make peace with the psychological impact of this surgery and it called for more resilience because I had to learn to like myself again, scars and all.  I had to accept that this (mutilated) body is all I have to live in so I might as well appreciate it.  This appreciation had to extend to the blob of silicon and 6″x 4″ piece of pig intestine now residing in my chest too.

An article in Psychology Today says “Resilience is that ineffable quality that allows some people to be knocked down by life and come back stronger than ever. Rather than letting failure overcome them and drain their resolve, they find a way to rise from the ashes. Psychologists have identified some of the factors that make someone resilient, among them a positive attitude, optimism, the ability to regulate emotions, and the ability to see failure as a form of helpful feedback. Even after a misfortune, blessed with such an outlook, resilient people are able to change course and soldier on.”

Undergoing 5 months of chemotherapy called for resilience; the challenges it presented came in the form of side effects that made me go from looking and feeling relatively normal to looking and feeling abnormal and unwell.  Looking like a cancer patient can change the way you think about yourself if you let that happen… you simply have to get used to the way other people look at you.  Choosing not to be defined by the chemo-chic look takes quite a lot of steely resolve; dealing with side effects definitely requires some resilience. If you want to read about side effects take a look at that page, it describes what happened to me.  Fortunately not all of these things happened all of the time but several of them happened most of the time.  I tried hard not to let this get to me; sometimes I succeeded and sometimes I didn’t.  I worked on the basis that a positive attitude is half the battle.  I can be pig-headed at times as well as pig-chested – I wasn’t about to let cancer screw my life up and make me miserable every waking hour.

Until recently I’d anticipated going through chemo would be the biggest overall test of my resilience and ability to endure.   I think that assumption was incorrect because the post-chemo limbo land is now calling for a fair amount of resilience. When you go through chemo you expect to spend some time feeling unwell, to have some side effects and be less able than you were before the poisoning treatment began.  Once it’s over you expect to feel better. Coming through chemo and still feeling a shadow of my former self a month down the line is a real challenge.  I want/expect/feel compelled to do things. Simple things like going for a long walk, running up and down stairs or exercising on the cross-trainer and bike.  My mind is immensely willing but my body states in no uncertain terms “I don’t know what the hell just happened but if you think you’re going to make me run for 10 minutes you can think again sucker!”

Dealing with the frustration this causes and the feelings of being inadequate/weak/somewhat pathetic require more resilience.  It would be very easy to let this period of post-chemo alienation drain my resolve, to move from frustrated to angry and then from angry to despairing.   Fortunately as Psychology Today points out, being resilient means having the ability to regulate emotions and see failure (in this case my knackered body) as a source of helpful feedback.  My body is knackered because it’s had a tough time and I know I cannot expect the things I asked of it a year ago at this very moment. That would be both unfair and unwise given all this 5’9″ frame has endured.  Once again I find I am learning to like myself as I am, to accept there are things I cannot do right now and in time that will change. Normal service will be resumed when the body is good and ready.

A mutilated and knackered body is all I have to live in and I appreciate it very much.  It has an amazing ability to endure some very adverse situations.  I hadn’t realised how much resilience resided in me, physically and psychologically, until I needed to use it in earnest.  That said, I hope I never have to call on it again.