Sunday, 28 February 2010

One egg ... or two?

Paula?” called a very slim lady in a blue suit, clutching a clipboard. “Apologies for keeping you waiting but you are next to see Dr Jordan", she said in response to my upheld hand.  "Which unfortunately means you are last” she admitted, as she turned on her heels to face the patient sitting opposite me. On hearing this news the woman grunted and retorted “Every time I have been here I have had to wait.”I am sorry about that, but it is a very sensitive clinic”, replied Miss Clipboard diplomatically.

I thought back to a conversation that I had with my friend Bubbles, just after I had my ultrasound. “Until you got this I have never really appreciated what it is like to have cancer and what people have to go through” she said. “You know one of the things that has struck me is the waiting.” “I know”, I replied. “Waiting at all levels. Waiting to be referred; waiting for tests; waiting for results; waiting for treatment ... waiting to be seen ...”

My appointment to see Dr Jordan was at mid-day on Friday. Aware that the clinic commenced at half eight I knew that it could now be running over quite substantially and that I might be kicking my heels and twiddling my thumbs for at least an hour. And although the hanging around can be a pain, especially when you are there for news or results, I appreciate that there is good reason for this. It is because like my oncologist, Dr Oh-so-luv-ver-ly (I am sure you remember him), Dr Jordan, my breast surgeon, treats every patient as an individual. It really matters to him that you understand what is going on, what the recommendations are, and that you are totally happy with proposals. He gives you all the time you need.

Did someone explain the ultrasound scans to you?” asked Dr Jordan, after he had greeted me warmly and offered me a chair. “Yes. The ultrasound chap got the scans out and put them up on the light board and he gave me the new dimensions of the lump.” “Are you OK with the results?” he enquired. “Well ... yes”, I replied. “I know that sounds odd, but now we know there is a small lump remaining I am hoping that you are going to be able to offer me the surgery I want?

He grinned at me. “Yes. I can now offer you breast conserving surgery.” “A lumpectomy?” I asked. “No” he replied. “No?” I repeated looking at him wide eyed. “No, I am going to suggest a breast reduction.” “A breast reduction?” I looked at him quizzically. “Yes. We will reduce the breast as we would with cosmetic surgery and take the lump at the same time. It will mean the breast will look much better and we can do the same to the other breast to match them.”

Sounds good to me”, I smiled. “You know how I feel about surgery, could you do them both in one go?” “I can do, but I would much prefer to wait and do the other one at a later date, as that will give the first breast the opportunity to settle down after surgery and radiotherapy. For the sake of waiting six months I would rather you had something that you are happy with for the rest of your life ... but it is up to you. You have right up to the moment that we sedate you to decide.” Mmmm ... one or two. Do I get it all over and done with all in one go ... tempting ... but am I putting all my eggs in one basket ...

What about your nipple?” he asked in a matter of fact manner. "Do you want to keep it, or not? And do you want chips with it? OK ... so he didn’t ask about the chips but it wouldn’t have sounded out of place. “I would like to keep the nipple. Thanks.”

Dr Jordan pulled a form from a file. “Now I will go through some potential risks of surgery and then I will ask you to sign the consent form. One of things that I need to forewarn you about is that if we go in and find more mischief than expected then we would need to make a decision there and then to do a mastectomy. Are you alright with that?” I smiled at he him wryly ... he knows that I desperately didn't want a mastectomy. “Yes”, I replied honestly. “We would have given the lesser surgery a go. If at the end of the day there is more cancer than we think then I would respect your clinical judgement to remove the breast.” And with that I signed the form ...

When are you looking to do the surgery?” I enquired tentatively ... after all he had previously indicated that it wouldn't take place until April.  "What about Wednesday? Are you free on Wednesday?" I gulped and nodded my head. Oh God, it sounded as if he was just inviting me out to dinner. “No. Wednesday is good for me”, I stuttered. “OK. I will get them to check theatre availability." Or should that be table availability?  "If it is not possible to fit you in this Wednesday then it will be a fortnight Wednesday.”

So I am sat here ... in anticipation of a telephone call telling me which day the surgery is to take place. Maybe in a few days ... or within the next couple of weeks ... either way ... I ain’t going to be waiting long.

Sunday, 21 February 2010

That was the week that was

The only thing that should surprise us is that there are still some things that can surprise us.
François de La Rochefoucauld

Surprises are weird things aren’t they? Unexpected events which can make you ... or others ... feel happy ... sad ... lucky ... unfortunate ... or maybe optimistic ...  Some have an impact that last only a few moments ... but others can be hugely dramatic ... life changing ...

Let’s take Nigel Page for example. He woke up at his home in Cirencester last Saturday ... as I expect he has done on innumerable occasions ... though he probably won’t for many more ... ‘cos on that morning self-confessed “white van man” Nigel logged on to his National Lottery account ... to discover he was Britain’s biggest ever lottery winner ... with a cool £56 million sitting in his piggy bank.

Recalling events Mr Page said: "I'd already checked my National Lottery account and had seen I'd won £55 on Wednesday’s Lotto when I decided to buy two Lucky Dips for the big EuroMillions jackpot on Friday. I didn't think about it again until Saturday morning when I was watching the news with my daughter and saw that there was one UK winner who shared the jackpot with a ticket in Spain. I logged on to my account and saw the Lotto win for £55 in my account and just below it was the £56m EuroMillions prize. I started shaking and couldn't speak." At a press conference later in the week, his partner Justine said: "It's an amazing amount of money. We could never have wished for this."

And, usually that probably would have been the most awaited press conference of the week ... but it wasn’t ... because a couple of days ago Eldrick Tont Woods, better known to you and I as Tiger, decided to stand before the world’s media and, for the first time, make a grovelling public apology for cheating on his wife Elin. During the rambling 13½ minute public confession the shame-faced sportsman admitted his behaviour was "selfish and foolish". “I thought I could get away with whatever I wanted to. I felt that I had worked hard my entire life and deserved to enjoy all the temptations around me. I felt I was entitled. Thanks to money and fame, I didn’t have to go far to find them. I was wrong. I was foolish. I don’t get to play by different rules.”

Now, let’s face it, although the reports of an incident, which took place a few months ago, where top golfer Tiger was found lying unconscious outside his mansion in the early hours of morning, after smashing his vehicle into a fire hydrant and a tree, all sounded pretty odd ... the fact it resulted in claims that for years he has been playing away from home was an unexpected revelation for most us. And then ... what went on to be even more startling ... was the news that it was not just one infidelity ... but that he had been victorious with at least a dozen birdies ... including a Las Vegas model, an Orlando waitress, a Manhattan socialite and an LA porn star. You gotta admit ... he’s got an awful lot of tiger in that tank ...

Soooo ... what made our world renowned pro-golf swinger so very appealing and attractive to possibly a vast number of different women? Eldrick Tont, the poker–faced, mono-syllabic maverick ... it certainly wasn’t his witty sense of humour and smooth charisma ... or his penchant for wooly tank tops and dodgy caps. Perhaps it was that array of golden trophies ... and that billion dollar fortune from winnings and endorsements? Mmm ... just possibly.

And despite his huge wealth and fortune, as Tiger walked with confidence and assurance to the podium, in front of hundreds of journalists, photographers and cameras, who were in turn going to relay his babbling confession, his every word and gestures, to millions across the world, there must have been, even if for just a fleeting moment, a point when he thought to himself “Surely, this isn’t real. Not in a million years could I ever foresee this happening to me.”

And whilst Tiger was beating his breast ... to emphasise the sincerity of his apology to his fans and sponsors ... oh and his wife ... I was lying semi-naked in a darkened room with a tall, dark, handsome man staring intently at mine ...

Yes, Friday was ultrasound day. From the moment they called me on Tuesday with the date and time I was dreading it ... for a few reasons. Firstly, it was at my initial ultrasound scan back in August that I realised that the huge Yukky Lump in my right breast was indeed malignant ... and not “probably just a cyst” which everyone kept repeating. That visit started off OK with Dr U, the consultant sonographer, being very polite and courteous and the assistant nurse chatty and cheery ... but as the examination progressed the atmosphere in the room completely changed. Dr U stopped talking and became very quiet and appeared really concerned ... I clocked how the nurse’s face dropped when she glanced at the screen ... and then she insisted on holding my hand ... even though I had said she didn’t need to. Nobody said anything ... my whole body started to involuntarily tremble with shock.  Oh my God ... it is cancer.  “Say something!” I barked loudly at Dr U “You are scaring me.” He replied matter of factly “I am going to numb your breast. I need to do some biopsies on the lump.”

After that first scan I walked out of the ultrasound room to where my friend Nit Nat was patiently sat waiting. "It is cancer" I whispered. “Why? What did they say?” she asked. “Nothing.” “Nothing?” she repeated. “Nothing, but I know.” And I was right.

Now, another reason I was anxious about this second ultrasound was that everyone – especially Dr Oh-so-luv-ver-ley and Dr Jordan – has been telling me how pleased they are with the way the Yukky Lump has responded to the chemo cocktails. It went from something that basically filled the bottom half of my breast – about the size of small orange – to something that could not be felt between treatments 2 and 3. However, as I have not been scanned since that first time back in August ... nobody could be 100% sure what has really happened ... I was afraid this ultrasound might reveal something unexpected ... show that the lump had only shrunk a little; or maybe not at all ... or perhaps it had even grown ...

Hello again,” said Dr U in a friendly manner. “Hello”, I said. Again? Oh dear does he really remember me? Why? Because I was the girl who had previously strolled in with what she thought was a little harmless cyst but walked out with a grotesque and aggressive malignant lump? Or is it because there are not that many patients who end up shouting at their sonographer ...

I see from your notes that things seem to have gone well?” I explained that it has not been possible to feel the lump since October. “Well, if you could lie down we can take a look.” I took the familiar position on the couch, as I did before, with my right arm crooked above my head, nonchantly observing the ceiling. Dr U was studiously silent as he rolled the probe across my gelled breast – every now again stopping and typing something and then starting again. Then he got up and walked across the room ... he flicked a light on to see or read something ... and then switched it off ... and returned to his seat. Oh God, no. This is it. He has gone back to check my notes. Something must be really wrong ...

You can sit up now,” he said. “Well, there is a lump.” “Oh right,” I croaked. “But it has shrunk dramatically,” he smiled. “I want you to go and have a mammogram and then when that is done you can come back here and I will write the old figures and the new measurements down so you can take them away with you. It is good news.

I did as I was told and sure enough when I returned he had written down the measurements of the Yukky Lump. “The figures on the top are the original measurements back in August, the largest being nearly 5cm. The figures underneath are today’s measurements, the biggest is now only 1.5cm.” “Where is it?” I asked, “is it deep into the breast?” “No, not at all, it is quite near the surface. Look I will show you.” And  he eagerly pulled out images from the first and second ultrasound and mammogram scans and secured them against the light board. He pointed to the two on the top, “These are from August – you can quite clearly see the lump. And these are from today.” “Is it behind the nipple?” I asked. “No”, he replied and pointed to one of the latter scans “it is below.”Why can’t I feel it then?” “Basically it has been beaten down by the chemotherapy, it is now just a small palpable mass.” “Will it be possible to do a lumpectomy?” I asked rather pleadingly. “We will all gather on Wednesday to discuss your results and then you will meet with Dr Jordan to hear what we feel are the next best steps.”I am meeting with Dr Jordan next Friday,” I chipped in. “Excellent” he replied as I opened the door and thanked him for his time.

You are going to have to help with this one,” said My Little Friend, when I spoke to her on the phone a bit later. “I don’t feel comfortable congratulating you on finding a lump.” “Well, the thing is”, I explained, “if they couldn’t see anything on the scan it didn’t necessarily mean that I no longer had cancer. Instead we would have to assume that it had fragmented, what Dr Jordan illustrated as ‘hundreds and thousands’, and if I that was the case then I would definitely have to have a mastectomy. However, now there is a definitive lump he may be able to do breast conserving surgery, a lumpectomy, so although it sounds a bit odd, for me it is good news.”

So I am currently sitting on tenterhooks until I find out on Friday what Dr Jordan and the posse think is the best way forward for me. Now, I don’t like to describe myself as a half-pint-empty kind of girl, ‘cos that makes me sound negative, and I don’t think that is necessarily true. But I do tend to curb my optimism ... to protect myself from mind blowing disappointment. So I am not assuming that because they have found a lump that Dr Jordan will say that a lumpectomy will definitely be possible ... after all it might be the wrong size, in the wrong place, it could be the wrong shape, or have the wrong flavour ... just the wrong ruddy something ... 

But on the other hand this is what we were aiming for in the first place ... for the Yukky Lump to shrink from the size of a lemon to that of a small grape ... a little lump that could be easily removed. So surely it isn’t wrong for me to have an open mind and positive thoughts that things might go plan?

Isn’t life about weighing things up and trying to tailor your hopes and expectations accordingly?  For example, you wouldn’t do the lottery if you really felt you had absolutely no chance of winning ... and let’s face it someone has to.

However, on the other hand, you might want to think carefully before putting a sizeable wager on Wicked Woodie’s willy not going a-wandering once more ...

Though ... as we all well know ... life is full of surprises ...

Saturday, 13 February 2010

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.

Sunday, 7 February 2010

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.