Chemo cycle 1

This was the day I was really apprehensive about. In hindsight there were a lot of questions I should have asked, either at the time of the oncology appointment 2 days before, or by ringing the specialist nurse yesterday. But there’s a bit of me that didn’t want to bother anyone. I’d done a lot of reading on the internet about what to take to chemotherapy and how long to expect to be there, and thought it was enough. Now I think it would have been good if I had been told the following things before I left the clinic. Because I only had a couple of days to get my head around the reality of it all, I hadn’t got a list of questions to take with me to the appointment. Now I make a long list every time, so I don’t forget anything.

1) What to wear
2) How long will I be there?
3) What should I bring? Read More…

Information overload

Breast Clinic

On Wednesday morning, Dermot and I went to the Breast Unit to see my consultant, with all the results after the MDT discussion. This was a really nervous time for me, as I knew how bad things could be, depending on the various scan and receptor results.

Firstly, the CT scan showed that it hadn’t spread, and was confined to the breast - phew.
Secondly, the receptors were the right ones - ER positive and Her2 negative - phew
Thirdly, the MRI showed that my other breast was clear. However, the cancer was much larger than the lump seen on USS.
Finally, the pathology was complicated - I had a very busy breast full of everything, but the cancer was mixed ductal and lobular. The lobular cancer wasn’t a surprise to me - lobular cancers are usually occult on mammography, and are often larger on MRI than USS.

We were then told that I would be having neoadjuvant chemotherapy, before surgery, and would see the oncologist that afternoon. I would have my chemo at West Suffolk. The next decision would be for me to decide where I wanted the surgery. This was going to be very tough for me. Do I have it at home, in a hospital which I love , where my husband and I are well known, where I would operated on by a close friend and colleague I trust, with theatre staff that I have worked with for several years?
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The aftermath

Dermot and I drove home and rang our families. For me, it was a very surreal experience when I spoke to my parents in Scotland. It felt like I was talking to relatives about a patient, and not about me. They were shocked (to say the least), especially when I said that I would have chemotherapy first, which is always a scary word. I then rang my brother in the States, who came out of a meeting so I could make his day as well. Dermot rang his daughter and the rest of his family whilst I was speaking to mine. It was very, very strange. We were both matter-of-fact on the phone, but everyone we were speaking to was very upset, and some were crying.

Dermot’s daughter decided to come up from London to see us, and to stay for supper before going home. We spent the evening watching Peter Kay’s Car Share, which was just what this doctor ordered - crying with laughter about dogging, and Dermot got to spend some time alone with his daughter to let the news sink in. And then it was just the two of us.

Another very odd evening, without much sleep. I was struggling to come to terms with the fact that the large visible lump in my breast is a cancer, and I would have to live / see / touch / feel it for the next 5 months, as would my husband. I had already dissociated myself from my breast when looking in the mirror, but it’s still there, and still a part of me. Intimacy was going to be strange until we both worked out how to deal with it. Do you touch it? Do you ignore it? Who knew what the right thing was? Read More…

The waiting game

At that moment my consultant came in, and then there were 3 of us that knew. I then needed to have a biopsy. Now I do biopsies in clinic, and I was suddenly nervous. I tell my patients that the local anaesthetic feels like a nettle sting, that lasts for a few seconds. I then say that they might feel some pushing and pulling, but it shouldn’t hurt. I’ve never had local or a biopsy. What if I’d been lying to my patients all these years? The local was actually more of a burning sensation, but lasted for seconds, and I didn’t feel a thing. The biopsy gun makes a loud noise when it is fired, and although I was expecting it, it was still a shock. But no pain.

Then I went back to my consultant’s office, with my husband who had come down to see how I was getting on (no reception in the breast unit so I couldn’t text him). I was going to have an MRI, because the lump hadn’t shown on the mammogram, and they would try and rush the results through for that Friday (i.e in 3 days’ time).

Normally patients have to wait about a week for the results - firstly to give the path department time to process the biopsy and to look at it properly, and secondly, everyone has to be discussed at a multi-disciplinary meeting (MDT). This is where everyone involved in the treatment of breast cancer discusses every patient, so when the patient is seen in clinic, there is an agreed plan of treatment. I was going to be seen again in week’s time after the MDT, but getting confirmation of what we already knew would make all the difference. There aren’t many perks to working in the NHS or in being treated in a hospital where you’ve worked before, but I was glad of this one. Read More…

What learning curve?

As a breast surgeon, breaking bad news is fairly common, sadly, and although it takes a lot out of me, it is something I enjoy doing. I know that I do it well, and most of the time, I can get a little hint of a smile from my patients and their families before I leave them with the breast care nurses to pick up the pieces. For every woman I see who has to come back for a biopsy, whether I’m expecting the news to be good or bad, I tell them to bring someone with them. The main reason is because it is awful to tell someone on their own that they have cancer, and to see them leave the clinic, holding back the tears, and somehow drive home. To avoid worrying my ladies unnecessarily, I say that it helps to have someone to sit with you while they wait to see me, to remember what I say and to share the G&T with afterwards.

For a lot of women, especially those who have come through breast screening (i.e. had a cancer picked up on a mammogram when there is nothing to feel in the breast itself), the news is a complete shock, and this is unique to breast cancer. For people with bowel and lung cancer, for example, they generally feel ‘not quite right’ by the time they see the GP or hospital consultant, and are partly expecting to be told they have cancer. It’s rarely the case for me.

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It will be fine

I first found a breast lump in 2010. I was working as a surgical registrar in Luton. My husband had just proposed, and had taken 7 weeks’ holiday to sail the North West Passage in the Arctic - definitely no wifi or 3G there! Although I was working towards becoming a breast surgeon, all common sense went out of the window. I spent the night literally howling on my sofa, alone. It was obviously going to be a cancer, and I’d need a mastectomy, and my hair would fall out, and I wouldn’t be able to wear a wedding dress, and my fiancé would leave me, and I’d be dead in 2 years…. Not melodramatic at all then! Read More…
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