Everything in moderation

Once again, my wonderful friends have come up trumps as I have received a lovely flurry of DVDs to entertain me during my periods of convalescence. However, looking at the selection in front of me I wonder whether they were worried that my Sex and the City box set was leading me astray... encouraging my Samantha-like flirtatious quips and inciting my already developed shoe fetish ... and that I needed to indulge in a more sophisticated and cultural viewing experience as most of them are bodice ripping romantic classics. I know they mean well ... but if I really am that impressionable I am not sure of the consequences of me indulging in hours of films featuring bosom heaving women in frilly garters and long flowing dresses and men running around in breeches or jodhpurs .... I might have to ration my viewings ...

Anyway, I decided to kick off my movie marathon with The Duchess. Now, if you haven’t seen the film then that is OK, as I am going to provide one of my infamous RSGP quickie summaries. Here we go:

Starring Keira Knightly and Ralph Fiennes, The Duchess is set at the end of the eighteenth century, and is based on the true story of Georgiana Cavendish, the Duchess of Devonshire. From a moderate background, at the age of 17 Georgiana married the Duke of Devonshire, who was much older than her. She was a much loved fashion icon, but society also mocked her as a ‘failure’ for reproducing girls and not giving her husband the male heir that he so desperately wanted. He was a cold and distant man and who was blatantly unfaithful throughout their marriage, and although he wouldn’t allow Georgiana to leave him he happily moved his mistress, who happened to be her best friend, into their home. She in turn had a passionate and doomed affair with Earl Grey, who went on to become Prime Minister. Bright, intelligent and witty, her beauty and charisma made her name, but it was Georgiana’s extravagant tastes and appetite for gambling, politics and love that made her infamous.

There are positive and negative aspects to the film that I won't detail, but what I will say is that it does make you reflect on how times have changed, how the opinions and views of society have altered so much over the last couple of centuries.

There was a particular scene in the film which I found both enjoyable and thought provoking. The Duke and Duchess were hosting a banquet for the political party that he supported. After dinner a member gave a party political speech on freedom which Georgiana listened to with some interest. Afterwards, he sat down and asked her what she thought. She replied that if she were to vote – not that she could – that the Whig party would not get her support. He asked her why and she said that she didn’t believe that they were fully committed to the concept of freedom. He replied that the party would like to see the vote extended and she retorted “To all men?” and he laughs “Heavens no. But certainly to more men. Freedom in moderation.” To which she replies "Freedom in moderation? Either one is free or one is not. The concept of freedom is an absolute. After all, one cannot be moderately dead, moderately loved, or moderately free. It must always remain a matter of either or.”

Which got me thinking. Like cancer. Surely, you either have it or you don’t?

Well, according to the February 2003 edition of The New England Journal of Medicine that is not the case. An article which appeared in it describes the following.  In May 1998 a woman with polycystic disease received a renal transplant at a hospital in Scotland. The operation went well, but in November of the following year she had a routine mammography which showed a lump in her left breast. A biopsy specimen was performed and breast cancer was diagnosed – though the tests showed that this and another lump found near the transplanted kidney were secondary tumours related to skin cancer. However, none of the health professionals that saw her could find the primary site, the melanoma, and sadly six months later she died.

Shortly afterwards a second patient who had had a kidney transplant in the same hospital developed the same symptoms ... and once again no original tumour could be found. The doctor, which had cared for both patients, could not believe the coincidence and decided to do some investigations, including checking the register of transplanted organs. From this she was able to identify that the two kidneys given to the patients had come from the same person. The records showed nothing untoward and the donor’s general health had met all the usual requirements – no HIV, hepatitis or cancer. Still puzzled the doctor decided to check the Scottish database for patients with melanoma ... and sure enough eighteen years earlier the donor had been operated on for a tiny 2.5mm skin tumour. She had received follow ups for fifteen years and had been declared ‘completely cured’ a year before her death – from an accident – not from cancer. However, although she had been deemed ‘cured’ of cancer she continued to carry micro-tumours in her body but her immune system kept these suppressed and they did not grow. Though when her kidneys were transplanted to people whose immune systems had been weakened, so their bodies would not reject the new organs, the micro-tumours rapidly grew. Fortunately, due to the investigative work of the doctor, the second patient had the kidney removed and he survived.

I am off to the hospital on Wednesday ... and I will admit I am not looking forward to it. I am returning to the Breast Care Unit where Dr Jordan, my breast surgeon, hangs out. It was there, exactly six months ago, that he told me that I had breast cancer. I am not really sure what will happen at the appointment but I am assuming that he will once again send me for an ultrasound so we can see for sure what effect the chemo has had on Yukky Lump. We know it has shrunk dramatically since diagnosis – going from 6cm to something that couldn’t be felt after chemo number 2 – and that was well before Killer Chemo went in on the attack - but I am still feeling nervous. I am not expecting it to have disappeared totally ... and ironically if it has then that in itself causes problems  with the surgery.  However, if it has reduced in such a way that I can have the lumpectomy that I so desperately want, rather than a mastectomy, then that would be good news. Maybe down to a cm or so.  Now that's what I would call cancer in moderation.