With ... or without you

I keep thinking back to my last holiday - my final BBC vacation – a week in France in May. Once again we stayed in La Palmyre, near Royan. It is a village on the Atlantic coast about half way down on the left hand side (yes I did get my geography O’level ) about an hour below La Rochelle and hour or so above Bordeaux. I have mentioned it before ... in the Pigeon Poo story ... which apparently is one of the most popular blogs on here ... and you call yourself friends ...

La Palmyre is a wonderful place ... early on in the season it is quiet and quaint. At that time of the year the weather can be delightful, but it can be a bit temperamental ... which is why we left it until the last minute to ensure we weren’t going to endure seven days of wind and rain ... which we didn’t. The sun shone and I enjoyed doing all my favourite relaxing things ... reading, bathing and taking photos. I watched the boys jumping in and out of the warm swimming pool. I cycled lots ... along the maze of tracks which follow the great stretches of desolate golden beaches. Sometimes these were planned intentionally longer trips, which incorporated lunch, eating freshly caught moules at a restaurant overlooking the sea, and then there were other trips which weren’t supposed to be quite so long ... but we got lost. At least twice I cycled a minimum of 20 miles ... and had no idea that I was so poorly. I returned from my short break relaxed and re-energised ... with some colour in my cheeks ... and absolutely no inkling that within weeks my world was going to be blown apart ...

As I drove to the hospital on Wednesday I saw a single magpie. I was so disheartened and apprehensive of my appointment that I couldn’t even be bothered to swear or make a rude gesture at it. It was exactly six months to the day that Dr Jordan, my breast surgeon, had informed me that the lump in my breast was indeed cancerous and that I wasn’t going back to France, on the holiday that was due to commence the following day. It was mid-August and on that occasion the waiting room was heaving ... full of nervous patients ... all perspiring from the stuffy humid heat ... and from the anxiety of waiting to possibly hear absolutely devastating and life changing news. And on returning once more that was one of the things I was dreading the most ... the waiting ...  As it turned out this time I was the only patient there to see him ... and I went in punctually.

“How are you?” said Mr Jordan holding out his hand. “O ... K... ,” I said hesitantly. “You don’t seem too sure about that?” he enquired. “Well I am nervous.” “Of what? Of me?” he asked somewhat surprised. “Well ... not you ... but being back here ... bad memories ... and we are going to talk about surgery ... I have never had surgery before ...”

"I have looked at your records and Dr O is absolutely delighted with the response you have had with chemo.” “Yeah” I replied, “it disappeared really early on ... between the second and third chemo.” “Brilliant news” he said. “Now, we are not sure how the lump has shrunk. “It may have ...” and he pulled a piece of paper across his desk “shrunk like this” and drew a series of decreasing circles across the page ... “or it may have done this” and he drew lots of little dashes which looked like ‘hundreds and thousands'. I nodded ... I knew what was coming. I knew from the moment, way back in November, when Dr Gillies said “They can only do a lumpectomy if there is a definitive lump.”  From that point I was pretty sure that a mastectomy was probably on the cards.

“Now”, said Dr Jordan, “I think we have three options and they are ... do nothing. Absolutely nothing. We just monitor you to make sure it doesn’t return. Or ... the second option is that we do a lumpectomy ... but it is going to be pretty radical to remove the whole area of the tumour ... and I can’t guarantee that I will capture everything that is sinister ... it will be hard to identify clear margins. Thirdly ... a mastectomy.” Yep ... he said it ... the dreaded ‘m’ word ...

I sat back and considered the options. Jeez ... wasn’t the first one tempting ... just swanning out of that consulting room ... into the sunset ... no surgery ... no rads ... I could cancel my sick note and strut back into the office on Monday morning; I could plan for the rest of the year ... book holidays without worrying that they are going to coincide with treatment or recovery ... just go back to my lovely ticking-along-life. But realistically ... no ... as tempting as it is ... I know within a few weeks I would start to worry ... every little bump and ache would be threatening and scary. And, even if they monitored me, what would happen if that Yukky Lump reappeared ... even if it was quite diddy in comparison to the original orange-sized one ... then I would have to go through all this again ... the testing ... the diagnosis ... giving up work and my social life ... because of chemo and surgery ... the hair loss ... the weight gain ... the horrific side effects. Nope, no action is seriously appealing ... but I am going to resist temptation.

“Do you mind if I take a look?” asked Dr Jordan. I nodded. “Do you mind if Alison, the student medic, has a look too?” I looked at Alison and shrugged. “No problem. Quite used to stripping off these days ... come along ...” Honestly, if I had charged a £ for everyone who has a look or has copped a feel of my boobs over the last 6 months then seriously it would have paid for me to have the treatment done privately. Now, understanding how the system works I fully appreciate that although it would have cost me several thousand it could still possibly be Dr Jordan doing the surgery ... as consultants often swing between the public and private sector ... the only difference would be that he would be wearing posh scrubs ... probably with a colourful hand-embroidered crest on the chest ... rather than the standard NHS issue. Oh ... and that I would be served up a copy of a Tory tabloid with my brekkie ... probably the Daily Tale ... and if I was good girl a little red wine with my dinner.

We walked through to the examination area of the consulting room, along with the Breast Care Nurse, and all three of them inspected my rather impressive cleavage. “The impact of the chemo looks really good. Do you mind turning around?” asked Dr Jordan, and then proceeded to pinch an inch of flesh on my back. “Mmmm .... do you mind if I take a look at your tummy?” So I twirled and unzipped my skirt. He poked about about a bit and said “Nah ... not enough fat there.” “Jeez, are you joking? You ain’t looking hard enough!” I laughed. “Well, we could be talking about reconstructing a pretty big breast,” he replied. Ooh ... touché ...

I dressed and returned to the seat beside Dr Jordan’s desk. “Now .. I would recommend that you go for the third option, a masectomy. With delayed reconstruction.  If you agree I can’t offer you an inplant ... as they don’t make them large enough”.  I smiled weakly. “So ... I would suggest that we do a Latissimus Dorsi where we ...” I nodded my head and mumbled “I know.” He stopped and looked at me quizzically. “You seem despondent”, he said, really concerned. “Well ... it just seems ironic ... the chemo has killed off the cancer ... but because the lump has fragmented or disappeared then you are recommending a mastectomy. Surgery where I will wake and be faced with only one breast.” Dr Jordan picked up his pen again and pulled his earlier drawings across the desk. “I wish all my patients were like you. The important thing is that the tumour looks like this” and pointed to the smallest circle on the page “or like this” and gestured towards the ‘hundreds and thousands’. “I know”, I replied. “I totally appreciate that. I really do.”

And I do ... let’s face it ... six months ago I walked into that consulting room with a 6cm grade 3 stage 3b malignant lump . That is as grim as breast cancer can get. The next stage? Stage 4 ... secondaries ... maybe a life threatening tumour in my liver or brain ... To be honest I was really dancing with big-bad-boy cancer. And, although the ultrasound won't take place until next week, when we will get to know what is going on with Yukky Lump for sure, everybody seems to believe that things have gone well.

But ... as much as I am totally grateful for all that ... I am never ever going to be in a position of waving my hands in the air ... and hooting a huge cheer at the news that my surgeon has told me that he recommends three lots of surgery. A mastectomy in April ... coming around from surgery and only having one boob ... rads in May ... reconstruction in the autumn ... and reduction on the other breast maybe before Christmas.

You know what really gets on my tits is when people flippantly say to me “Ooh a free boob job ... lucky you” as if I am going to come out of this with some kind of gratuitous perk. ‘Cos I am certainly not. With the best will in the world, and Dr Jordan would totally agree with me, if I go with his recommended surgery triathlon I will end up with two completely different shaped and much smaller heavily scarred breasts which won't be symmetrical, one of which is going to have no nipple and very little sensation, and on top of that gashes across my back and under my armpit. Sadly, I ain’t gonna suddenly look like some kind of super model.

The other thing from my appointment on Wednesday is I just didn’t realise or appreciate that my life would still be on hold for so long. Naively, over lunch back in October or November, I said to my manager, Mr Campbell, that I was hoping to go back to work in April. I think I now have to make it clear that it could be April 2011 ... and am wondering if I can get a season ticket for the car park at the hospital.

As I got up to leave, Dr Jordan shook my hand and said “We will meet in a couple of weeks. In the meantime I want you to think about your options and work out what you want. It is really important to me that you are totally happy that you have made the right choice before surgery. I will also put some thought to you ... see whether I can come up with other options which would suit you better.” Hey, what a trooper he is. Let’s face I can’t ask for any more ... why would I want to be treated privately?

For a long time I have wanted to return to La Palmyre. I had this dream of going back there in the early summer, thinking that by then my treatment would have been all done and dusted, and I could draw a line under the previous twelve months. In my vivid imagination I felt I had a great holiday last year ... but afterwards I had taken the wrong turn. My vacation had finished ... and as I departed I had veered right ... down Breast Cancer Care Path, instead of taking the left fork towards Nicely Ticking Along Life Lane. But ... if I went back this summer I could rectify that ... say that was the year that was ... and move on, along the correct track. But I was adamant that I wasn’t going to return before my treatment was complete, especially if I needed to have a mastectomy with delayed reconstruction. If I went with only one boob then the consequence of this would be me sitting on the sun lounger dwelling on the fact that “This time last year I had two boobs. Look at me now ... sitting here with only one ... this year has been totally crap ...”

But ... having spoken to Dr Jordan, and taken on his comment that he wishes all his patients were like me, I have thought about this some more. You know, I could return to La Palmyre this May or June ... and there would be nothing to prevent me having the relaxing and re-energising holiday that I so totally deserve. If I end up with the mastectomy, which is looking pretty likely, I might temporarily have only one boob but I can still do all the things that I enjoy so much. I can still play with the boys, swim, cycle, read and take photos.

Yes, I could sit there on that lounger and mull over the fact that my body is not the same as it was on my previous trip. And I could mourn my loss ...

But then again ... I could savour the moment and say “Yes, this year I do only have one boob ... but this year I don’t have cancer.”

Which is something I had last year.

I just didn’t realise it.