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.
Because, for most women, they only have a lump in the breast at the time of diagnosis (and for some, they don’t even have that), there are no physical symptoms. You don’t get tummy pain, or tiredness, or bloating, or weight loss. And our boobs just sit in a bra. They don’t ‘do’ anything. So to be told that you have cancer comes as quite a shock.
I take between 30-45 minutes to gently walk the patient through the next steps in the diagnosis and treatment of breast cancer. For some, it means more scans to help plan surgery. For most, it means consenting them for surgery, which can be quite complex, and for a few, it means discussing chemotherapy first. We slowly drip-feed information in bite-size chunks, as and when the patient needs and wants to hear it.
Most patients remember very little of what we tell them once they hear the word cancer, so the information is also given as a variety of leaflets / pamphlets / folders to read at their own pace, with follow-up calls from the breast care nurses to check in on them.
NONE of this applied to me, as I sat there in that ultrasound room. The second I saw the scan, I knew.
It was an obvious cancer.
And it was big (compared to the size of my almost-handful).
Instantly the following thoughts went through my head
I need a biopsy - I tell patients it doesn’t hurt, but does it?
Has it spread to my armpit? I know the consultant could feel some nodes
It must be lobular as it wasn’t seen on the mammogram
Could it be bigger than the USS?
Could it be on the other side?
I’ll need a mastectomy
What reconstruction do I want - I only have one choice
I’m a terrible reconstruction patient as I’m bony up top with no tummy
I’ll need chemo because I’m young - I wonder if they’ll do it first?
I have a clinic and an operating list tomorrow - how the hell am I going to cope?
I’ve already had 6 months’ off work this year - how can I take more?
How will I cope with the pay cut if I take more time off?
I really don’t want the menopause at 40
Will my coil need to come out before chemo?
They’ll do a CT if I need chemo - what if it’s spread?
My life had just changed forever.
Even though the biopsy hadn’t yet been taken, and nothing had been confirmed, I knew.
And the radiologist knew.
We both knew.
And just like that, a switch flicked on in my head. All sense of feeling and emotion was tightly locked away. I was matter-of-fact, down-to-business Liz.
I had to cope. I’m strong and independent and bloody minded. I had to cope.
I went into self-preservation mode, to protect myself and more importantly, protect everyone I know and love around me.
Because I knew too much. I knew the answers to all those questions and all the possible outcomes. And I couldn’t share that information with anyone. I didn’t want to frighten them - it was bad enough knowing myself.
It wasn’t really happening. It couldn’t be happening.