Why me?! - Why not..?
Why me? Strangely enough, this is one question I have never asked myself, nor anyone else, for that matter...
Working in a hospice, I have had the privilege of caring for many wonderful people who have not been as fortunate as I appear to be, and though I consider myself to be extremely lucky, it doesn't mean to say the last few weeks have been plain sailing. To be told you have Breast Cancer is a blow in itself, but being advised that having a mastectomy is the best option is almost worse than the diagnosis.
"It was little more than a niggle which finally sent me to consult my GP."
It was little more than a niggle which finally sent me to consult my GP. Our practice had finally employed a permanent doctor, rather than the steady stream of Locums we had grown used to. It was my first appointment with Dr Patrick Horwood, and although young, he was extremely pleasant and very thorough, and didn't hesitate to refer me for further investigations. For that, I owe him a deep debt of gratitude. I have since spoken to several women whose GP's were reluctant to refer them for any investigations, and it was only by their determination that they were subsequently seen at the Breast Clinic and treated. I myself, had delayed seeking medical advice for several weeks as I did not appear to have any of the signs of Breast Cancer that I knew could have indicated a serious problem. My only concerns had been a tender area on the outer side of my breast, a vague discomfort and two tiny, tiny lumps close to my nipple - which, incidentally, proved to be nothing. If anything, I suppose I thought I might have a mild infection, or small abscess.I was extremely fortunate to get an appointment with Mr Peter Jones that same afternoon and, on examination, even he suspected nothing serious. Thankfully again, though, he chose to send me for a mammogram, which was to be followed up by an ultrasound. The mammogram was nowhere near as bad as I was expecting, causing minimal discomfort for only short periods. Then, as I was waiting for the Radiologist - Dr Pippa Mills - to carry out the Ultrasound, a nurse asked me to sign a form consenting to a core biopsy. At the time I thought this was a little unnecessary as this particular procedure had never been mentioned, and there was no real lump to biopsy. I was surprised, therefore, but still not particularly worried, when a biopsy was indeed taken, and only mildly concerned when I was told that I would need further tests several days later. What I didn't know at the time was that the mammogram had not been normal!
I went straight back to see Mr Jones, and it was only after he had called for Anna Matthews - the Breast Care Nurse - to accompany us that I began to realise that things were not quite as straightforward as had been expected. My fears were confirmed when the possibility of a condition called DCIS (Ductal Carcinoma in Situ) was mentioned, and I was given several leaflets to read on the subject Even so, until the results of the biopsy had been obtained there was no actual proof and I was determined not to let my worry show. At least, not on the outside....
It would be irresponsible of me not to admit that I was scared, but I consider myself to be an optimistic realist. And whilst I tried to look on the bright side, and managed to do so for most of the time, I knew, particularly because of the people I nurse, that optimism itself, isn't always enough.
"I, personally, would hate having to tell anyone that they were suffering from Breast Cancer, but it was done with such compassion, with plenty of words of reassurance that the prognosis was excellent."
I, personally, would hate having to tell anyone that they were suffering from Breast Cancer, but it was done with such compassion, with plenty of words of reassurance that the prognosis was excellent. Sue Jones, who works in partnership with her husband Peter, showed me my mammogram indicating multiple areas of DCIS, and I was sorely tempted to try and dust the tiny salt like grains from the film, wiping away the incriminating evidence that proved a mastectomy was warranted. I now feel rather silly to have even contemplated such a ridiculous thought, but then to make matters worse, my eyes began to smart, and the tears started to well. "But what about my husband?" I sniffed, "he loves my breasts!"
Again, I was reassured that this was a totally normal reaction, but I still feel rather embarrassed thinking about it now. Though what I said was true, I realise that I am more than just a pair of breasts. Ironically, I was always complaining about them. From an early age I was well endowed, but after two children and decades of gravity, they weren't exactly page three standard! Yet strangely enough, I suddenly developed a great affection for them - particularly the one that I was going to lose. As the song goes, 'You don't know what you've got 'til it's gone...!'
Radiologist, Dr Ali Sever, carried out a prone table biopsy on my breast. The procedure was painless, though not particularly dignified. By this time, I thought I was back in control, and managed to make light of things. After the samples had been taken, pressure was applied to my breast, and Dr Sever took great pains to tell me this was to prevent unnecessary bruising. At this point, shamefully, the tears welled again. The idea of taking such pains to minimise unnecessary bruising to a breast that was soon to be removed seemed frankly ludicrous.
My treatment to date has been wonderful. My Consultants, my Radiologists and the Nurses who have looked after me - each has offered tremendous support and kindness during somewhat difficult times. In the past, when my own patients have made similar comments and offered words of gratitude, I have always been surprised. To my mind, such standards of care is what we, as members of a caring profession, should be offering our patients as a matter of routine. Yet it's only when you're on the receiving end do you actually come to realise how important even the smallest gestures can be.
A follow up appointment with Mrs Jones proved only what she - and I - had suspected. The second biopsy showed more of the same, and meant without doubt that a mastectomy was the only option. It was suggested that I underwent a reconstruction of my breast at the same time, and I readily agreed. It seemed silly to undergo two operations when it could all be done at once, even though it would mean more complex surgery and a longer period of recovery. To me, it was like killing two birds with one stone, and I never like putting off 'til tomorrow what could have been done today!
The surgery was arranged for the following week and during that time I admit to being on an emotional roller-coaster, especially the first few days. I think I now know how a manic-depressive must feel! At this point, I feel I really ought to apologise to any of the women shopping in Maidstone on or around May 3rd. I'd gone into town to buy the necessary items for a spell in hospital, but to my horror, I found myself staring at passing women's chests, trying to see which, if any, might have had a mastectomy. In hindsight, knowing what I now know, it was a futile exercise, proving only that we come in a wide variety of shapes and sizes and ultimately, the wrong size boobs in the wrong size and style of bra look pretty gross regardless of the fact they may be entirely natural!
"Amazingly, I slept well the night before my operation, and from the time I woke, any apprehension had disappeared. I had come to accept that there was no sensible alternative, and I was absolutely positive I was in the very best of hands."
Amazingly, I slept well the night before my operation, and from the time I woke, any apprehension had disappeared. I had come to accept that there was no sensible alternative, and I was absolutely positive I was in the very best of hands. The hardest part of the day was leaving my beautiful dog - who I would not see for nearly a week, followed closely by my husband and children, who at least I would be seeing the following day.
In the anaesthetic room, I did succumb to a few tears. It was as though I was saying goodbye yet again, only this time it was to my breast, and would be for good. I joked that if things didn't work out as was hoped, I'd already chosen which of the rooms at the Hospice I would prefer, and had made a provisional booking with my Ward Manager! In retrospect, I believe it was probably a way of expressing my fears without actually voicing them. Also, maybe there was still the thought that if you expect the worst it will never happen? Thankfully the moment passed, and after Mrs Jones had finished playing noughts and crosses on my back and chest with a black felt-tip pen, I drifted off to sleep....
BIONIC BOOB - THE FIRST FEW MONTHS
I awoke in the anaesthetic room several hours later and could remember clearly where I was, and what had happened. I was immediately asked if I was in any pain, and though I'd like to say I wasn't, at that particular moment, on a scale of 1-10, it was a 10.1 wasn't too proud to admit it, and so I was quickly given a pain killer which not only worked very quickly, but was also extremely effective. It's difficult to talk about pain, as levels vary from person to person, but as far as I'm concerned, those were the only few minutes that I experienced any real pain. After that time, taking the painkillers as prescribed, I can honestly admit to suffering only mild to moderate discomfort.
I was back in my bed at around six pm, sipping water soon afterwards, drinking tea and eating a sandwich before midnight! The only down side was that I had trouble sleeping that first night - most unusual for me! I can only assume it was a side effect from the anaesthetic because I certainly wasn't anxious, upset or in pain. Luckily, it must have been a fairly quiet night for the nurses as I had long conversations with an Italian Staff Nurse who, I was quick to discover, possessed a sense of humour similar to mine!
Morning eventually arrived, by which time I had already become quite proficient at negotiating my wound drains and drips as I travelled to and fro the bathroom. I was even able to have a wash, change into my own pyjamas, hot-brush my hair and apply a light coat of make-up before breakfast. I decided I didn't want to appear too well, however, because although I felt really good, I didn't want to risk losing the sympathy vote - I'm only human after all - and I had just undergone major surgery!
I was visited almost daily by Jenny White, the nurse who had assisted Mrs Jones during my operation, and much to my delight, I discovered she would be the one who was to tattoo my new areola. She showed me scores of photo's of her work, and was she not such a truly gifted nurse, I guarantee she could have a very salubrious career as a body artist!
The drips came down the following day, but the drains had to stay in a few days longer. Though inconvenient, I was actually quite attached to them, literally and figuratively! I carried the little bottles around in my daughter's 'Morgan' bag, which looked really cool alongside my pink and white striped pyjamas. Having heard several horror stories surrounding the removal of drains, I was rather apprehensive when the time came for the first of the three to be taken out. Shame on me! I really should have trusted Sue Jones when she assured me it wouldn't hurt. It didn't. All I'd succeeded in doing was to terrify the poor nurse assigned to the task.
I was in hospital for a total of 5 nights, and found I was able to do more and more each day. I personally think that the sooner you try and do things for yourself, the better, but there again, everybody's different, and I don't believe anyone should feel guilty if they don't feel like running a marathon for the first few weeks.
The night before I was allowed home, I became very tearful, and although I had been expecting 'post-op blues', the anxieties that surfaced came as a bolt out of the blue. I was suddenly fearful about facing the outside world with my new breast. It was as though I believed everyone who saw me would be able to see through my clothes to the scars beneath and be repulsed, and even those who knew me and were aware of what had happened, would treat me differently. Suffice to say, no-one could see through my clothes -1 don't usually wear see-thru' tops - and with very few exceptions, no-one has made me feel anything but good about myself. I do believe that we, as a nation, have a tendency toward being far too self-critical, and if we saw ourselves as others do, we may be much kinder to ourselves. (That's probably enough amateur philosophy for now!)
My husband and children have been incredibly supportive throughout, and my daughter, aged 12, was only too happy to take over the role of nurse! As lovely as she is, I did experience a moment of trepidation when she informed me she was going be my 'Named Nurse' when I got home! I was also worried that my illness might adversely affect my teenage son, particularly as he is in his GCSE years at school. Like most boys his age, he doesn't always share his thoughts , but I was determined that the whole family should be kept fully informed with what was happening to me, and in our case, it worked extremely well. I'm not doubting that it was a difficult time for them all, but I firmly believe ignorance can create unnecessary fear.
I had many lovely cards, flowers and gifts whilst I was in hospital, but within days of being home, my house resembled a florists. So many people have been so very kind. It's difficult to feel sorry for yourself when you're surrounded by so many people who genuinely care. Yet in spite of this, there were occasions when everything became too much, and I'd sink into huge bath of self-pity. There were several occasions during the first few weeks that I would look in the mirror before going to bed and sob, unable to decide which I hated most. My new 'boob', or the old, droopy one! Suffice to say, come the morning, I realised neither were really that bad, and felt extremely guilty knowing my family had witnessed my moment of anguish, which I'm sure they must have found distressing. Fortunately, these times were few and far between, and as the weeks passed, my new 'boob' gradually stopped feeling as though an alien creature had embedded itself in my chest.
As the saying goes, time heals, and six weeks and two days after surgery, I attended a Charity Ball in London, wearing a long, black, strappy dress. There was no way anyone would have been able to guess I'd had a mastectomy and reconstruction such a short while before! Unless, of course, the straps had broken and the top slipped down. Then perhaps, a few of the other guests may have had an inkling!
"There was no way anyone would have been able to guess I'd had a mastectomy and reconstruction such a short while before!"
My recovery to date, has been swift, and I was able to return to works seven weeks after my operation. Once again, I been very lucky with the support I have received from my colleagues at the Hospice in which I work, and I have benefited greatly from their expertise and understanding about my illness. The only problem that hasn't managed to resolve as yet, is the fluid that keeps building up on my back. Known officially as a seroma, more affectionately a hot water bottle, mine still keeps filling up, needing to be drained on a weekly basis. Once again, this is nuisance value only. The procedure is completely painless and takes a matter of minutes. I am assured it will stop eventually, but I think I'll ask for a tap soon if it doesn't!
The next step, which we expect will take place in a few months time, it to have a nipple constructed, (obviously mine had to go ) followed by a the addition of the areola which will be tattooed to match the existing breast. Strangely, when I was first told that these procedures would be offered, I wasn't entirely convinced they were justified. A perk -yes, essential - no. All I was initially concerned about was ridding myself of the cancer, praying it had not spread, and hoping it wouldn't come back. Now, however, many weeks later, the psychological boost it will give can't be ignored, and I'm now looking forward to having it done.
I still consider myself to be very fortunate. The cancer doesn't appear to have spread, so the only treatment I need following surgery is the drug Tamoxifen, which I may need to take for five years. After three weeks, I can't say I have experienced any major side effects, and if it reduces the risk of further problems, the few I have experienced are most definitely worth it!
I really can't say that the events of the past few months have changed my life dramatically. My marriage is as strong as ever - maybe even stronger. Most of the time life goes on as normal, and it's often only when I catch sight of myself in the mirror following a bath or shower that I'm reminded, and even that doesn't bother me much now. I'm convinced that following the 'finishing touches' in a few months, I will notice even less. The scars are fading quickly, and are hardly visible in places. I'm sure I'll never be entirely free of the thought that maybe, one day, the cancer will return, but thanks to the skill of Sue and Peter Jones and their team, the visual reminder will fade along with the scars.
Tracey Byatt 2005
