“Oh, hell,” I said, “That’s not a cyst, is it?”
The radiologist was sympathetic but non-committal – we’d have to wait for the biopsy results. But I could see the opacity with its nasty little claws on the screen as well as she could. It was a cancer, and the mammogram we were looking at was mine.
At a stroke, I experienced that sudden transformation from a perfectly healthy woman who had never been in hospital in her life into a “cancer patient”. The week that followed was the longest of my whole life. Nightmare videos played in my head……………myself bald and cachectic and wired up to drips…………my own funeral………. All the patients from my practice who had died of aggressive breast cancers paraded through my mind – it was only later I realised that the reason I remembered them so well was that there had been so few of them. I didn’t remember all the healthy-looking ladies who had been successfully treated and trooped in and out for their tamoxifen prescriptions year after year.
My initial reaction to the news that yes, it was a tumour, was a crazy sort of relief, because it was a yes, but…………..yes, a cancer, but very small with no sign of spread. I had been extremely lucky. It was picked up incidentally when I presented with a huge painful cyst that was so sore that I couldn’t ignore it. The cyst was benign, but the check mammogram had shown the tiny tumour in the other breast, far too small to feel. My GP told me later that I wouldn’t have been called for screening for another 30 months. After all the worry I felt almost euphoric, reinforced by the relentlessly positive attitude of the Breast Clinic staff……….if you had to have cancer it was a good one to have, eminently treatable, more to be regarded as a chronic condition than something that killed you.
I had never heard of DCIS – ductal carcinoma-in-situ – but over the next few months I was to learn that things were not quite as straightforward as they had initially appeared. The first wide local excision got rid of the tumour and the sentinel node was negative, but the DCIS proved harder to oshift. I spent the next few months shuttling in and out of the ward and travelling the roller-coaster of emotions of hope, anxiety and disappointment. In between I worked in the garden and thanks to the glorious weather produced a fantastic crop of flowers and veg………..it seemed paradoxical to be on sick leave when between operations I felt fine and had such a healthy sunburnt glow. What people couldn’t see was the tearing grief and pain of gradually realising that I was going to lose my breast, the thing I had dreaded from the start. I had just lost my mother, a few weeks before getting the diagnosis, and it just seemed too cruel – but there was no alternative. On September 11th 2006 I had a right skin-sparing mastectomy with immediate latissimus dorsi reconstruction – my preferred choice from the available menu of mutilations and carried out with the utmost skill and care, but I still broke down and cried bitterly on the trolley waiting to go into theatre. My breast looked perfect – it wasn’t hurting me or making me feel ill, and to have to say goodbye to it for something I couldn’t see or feel seemed too much to bear.
I learned a lot about the management of post-operative pain in the next few days. LD recon is a painful operation because of the location of the back scar, and although the new boob looked lovely once the swelling had settled, the pain was excruciating and I developed a deep hatred for the four drains, especially the one that sat on a nerve and poked it hard every time I tried to stand up. The feeling of liberation when the last one came out was worth all the pain. Even the development of a spectacular seroma that sloshed like a hot-water bottle and required the draining of nearly 500ml of fluid didn’t lessen my enthusiasm for not having tubes hanging out of me and being home.
I eventually stuck my nose suspiciously into Maggie’s Centre. The breast care nurses had almost literally frog-marched me across the road to introduce me to the staff, but I was adamant that I didn’t need to go there so I stood rigidly in the doorway, then sidled up to the leaflet rack and picked up a few of the less frightening-looking pieces of literature and escaped before anyone could speak to me. That was for people with real cancer – I just had mild cancer and was going to be “fine”. In reality, I didn’t want to be confronted with people more ill than me with the same disease. I managed to keep up the pretence of being fine until the day I realised that I really, really was going to have to have a mastectomy…………then I stumbled through the door of Maggie’s and let them take care of me.
People asked whether being a doctor made it easier. Perhaps it did in some ways. The hospital environment felt quite familiar to me – it was my own old hospital from junior days and I had fond memories of it, so it felt a bit like being back home. My partner on the other hand was terrified by all the wires and tubes, and wanted me out as soon as possible. Being able to understand medi-speak deprives you of the woolly blanket of denial – fortunately post-op I was too ill to know how ill I was, but I did dimly understand that if they were taking me to HDU it was because I needed to go there. Most of the staff were completely professional and treated me with normal courtesy – the shocking hostility that some healthcare professionals display towards vulnerable colleagues did not manifest itself until I went back to work. I also discovered that many people’s reaction to the news was to tell me about their friend who had breast cancer, had a terrible time with the chemo and then died, which for some reason I didn’t find terribly helpful.
I still think I was lucky. The new breast looks great, and since the muscle graft still has its nerve supply I can flex it, which makes for an interesting party trick. Of course I still have occasional attacks of panic and terror in the night that the cancer might come back, that I might die. But the fact is, I will die – but probably not of breast cancer, and at any rate – not today.