I came across a lovely quote which struck a chord with me, and I remind myself about this whenever anxious thoughts about the future start to run away with me and am attaching it to this blog. I was anxious but having tussled with the truculent child inside me about 'consent' (who in their right minds would want to subject themselves to being chopped up on an operating table like a slab of meat, being given radiotherapy which sounds like it will hurt like severe sunburn or taking daily tablets to change their hormones, when they just had a little lump in their breast and felt fine?) the sensible adult won the argument and I turned up for my operation at The Royal Marsden.
All the good wishes and support from friends, colleagues and family have helped me through the waiting game and beyond. And all the gifts of organic carrot juice, cheese & chocolate brazil nuts, flowers, chocolates, pampering paraphernalia, photos, music, inspirational and motivational videos, chicken soup, cake, skin moisturisers and after-sun (for the upcoming radio-therapy), along with letters, cards, phone calls and messages have been fabulous. Oh, and at 8:30am on the morning of the op, to cheer me up, a cousin sent me a WhatsApp photograph of a beach in Woolacombe where she’d been staying. I told her I’d think of it in the operating theatre.
I love the language that the surgeons have used in letters to me. Using the right words to communicate has been really important in my work, I’m well aware of the impact of getting something wrong. Clearly the team at the Royal Marsden have considered this carefully too. In a letter prior to my surgery they confirmed “You wear a cup D bra and have generous sized breasts, which have some degree of ptosis”. This contrasts significantly with my own reflections about my breasts - they're no longer small, they’re saggy and somewhat pendulous... I'd no idea what size my breasts were in the past and now I know how to find a bra that actually fits!
Having spent 3 days in isolation at home and religiously using my futuristic decontamination wash lotion, on Wednesday 21st July I found myself waiting in the reception area at 7:30am with fellow anxious-looking masked companions. A woman with a loud voice called “All NHS day-patients, please follow me” and a crowd of us stood up and did exactly that. I chuckled, it felt like we were going on a guided tour as she led us down corridors and up stairs to the ward, and I had half expected her to hold up an umbrella 
and point out interesting sights en route. She didn’t, of course, a bit disappointing, but there was a further major disappointment to come before the op. More of this below.
On the ward a bed was waiting for me with a welcome pack; it included my new wardrobe of a gown, slip-free socks and compression legwear. I changed and didn't have long to wait. The conveyor belt at the Royal Marsden is slick and well oiled.
First of all I had visits from a nurse who took my history; the Anaesthetist; the Consultant and a fellow Surgeon who would be operating on me (they measured my breast and drew all over it with a dark felt pen); and I signed consent forms and had a cannula fitted. And next I was going to go to Nuclear Medicine for my sentinel lymph node localisation. According to their patient information leaflet this procedure was to be a nuclear medicine test to find the position of the lymph glands which drain fluids from my breast. You probably already know this from your mother's encounter with cancer but for me it was new. They were to inject me with a radioactive tracer (containing gamma rays) and, if this weren’t to work, the back-up plan was to inject me with a blue dye which was likely to discolour my skin for weeks to come (including my face).
In the days leading up to my operation my imagination about the Nuclear Medicine appointment had run riot with me. I was going to be transported into the future. I’d created a ‘Raspberry Blue Marble Sci-Fi cake’ with edible glitter on top, reflecting this stage in my life. It looked garish. [But after we’d eaten a few slices, my neurosis had overcome me and I’d panicked about the metal in the glitter which was now- too late - in my alimentary canal. It had dawned upon me that they were going to use strong magnets and x-ray machines during the operation to locate and check the lump a couple of days later. I’d known it was stupid but I still couldn’t prevent myself from picking up the phone and calling the MacMillan Nurses to get reassurance that this metal wouldn’t be sucked through my organs towards the magnet and cause internal bleeding during the operation. Of course, they reassured me, it would be fine. I imagine that they must have been laughing their heads off after they put down the phone … what an idiot! I told my surgeon about this on the morning of the operation and she smiled; I promised to share my cake recipe with her at a later date.]
So at around 9:30am I left the ward and followed a Health Care Assistant to the third floor, down a wide corridor and through a door with a large hazard warning sign in black and yellow. Think ‘The Lion, the Witch & the Wardrobe’ and you’ll get a taste of my anticipatory excitement at entering a new world. I was expecting to see staff wearing protective hazmat garb, flashing lights, futuristic equipment, lead boxes containing radioactive material and to hear geiger counters clicking away in the background.
But Nuclear Medicine itself was dreadfully disappointing, the corridor on the other side of the door was no different. The HCA left me outside the room where the lymph node localisation was to take place. She knocked and disappeared. When I entered I was struck by how familiar it was, it was just like a room in our GP’s surgery, but on a smaller scale. Boring! I was asked to sit on a large chair by a wonderful woman simply dressed in her dark blue nurse’s uniform. The most techy part of the procedure was adjusting the seat to the right height before she drew out a syringe from a drawer. And the solution in the syringe didn’t even glow in the dark. The needle was fine, it was jabbed into my felt-penned breast without seeming to need any precision location and the whole thing was over very quickly and far less painful than the anaesthetic I’d been subjected to prior to my Magseed insertion the week before. And I left the room blue-fee, sadly I didn’t even get a glimpse of the dye.
When I visited the Royal Marsden two weeks later for my dressings to be removed and to get the biopsy results from the operation, I shared pictures of my marble cake and the surgeon let me have a photograph of her (and her stained thumb) to post on my https://kathiescakes.wordpress.com/ blog. She told me that the blue dye in my cake was almost exactly the same colour as the dye would have been had they used it. It was probably fortunate for me that I didn’t need it … but still - it would have been a good tale to tell!
Within an hour I was climbing onto the operating table in the theatre in the bowels of the hospital. There was a magnificent huge light fitting erected above the ‘bed’; could have lit up a stage, no wonder they call the room a theatre. They adjusted the table to sit me up, rather than lie me down (maybe this was because of the ptosis?), and before the Anaesthetist did his magic, I shared with one of the surgeons how disappointed I was with Nuclear Medicine. She indulged me by passing over a magnetic wand so I could hear the clicks which indicated where the Magseed was located. I was strangely delighted. The Anaesthetist had a short chat as he hooked me up, asking me what my favourite drink was - “Gin and tonic?” “No, probably a cocktail”. He told me to imagine I was on a beach and that I’d had two cocktails. And there I was, on my cousin’s beach with my eyes closed, the world started swaying and swimming and I woke up in the post op room, feeling painful and cold. The nurse who had been monitoring me brought out some heated blankets from what looked like a glass oven and upped my painkillers to the maximum dose. First class treatment.
I don’t know how long everything took, but by about 4:30pm I’d been wheeled back to the day patient ward. They called the Consultant to visit as I was still bleeding but he concluded all was fine and I was given some pressure dressings. He was right. My operation was relatively straightforward and I'm now 80g lighter! I was discharged 12 hours after I was admitted and we got a taxi to Marylebone and a Chiltern line train back home. I’ve not been sleeping well; that night, despite a massive cocktail of painkillers, I only managed about 2½ hrs. Fortunately all I've had to do since then is nothing. And a Psychology colleague of mine reminded me that rather than ‘doing nothing’ I’m actually ‘healing’ - which assuages my guilt about my laziness.
On the Wednesday after my operation, with my sisters and daughters away for the wedding in Italy, a lovely friend came to stay with us for a week. It was good to have her. I had supported her 18 years previously when she had had breast cancer and was also treated at the Royal Marsden. There was something ‘right’ about coming full circle and sharing this journey with her again. She went home the day after accompanying Chris and me to my appointment for the biopsy results (covid-safe - they were sitting outside a pub listening in to the consultation on the phone).
The results confirmed that the surgeons had taken out all of the tumour and there were no cancer cells in the margins of tissue they removed around it. The lymph nodes were clear. The dressings were removed (I've talked about the Consultant Radiologist who drained some fluid off my breast in a previous entry). I was good to go.
I’ve been blessed.
I’ve started on my endocrine treatment and so far I don’t believe I’ve yet turned into a menopausal witch. My next Marsden appointment is on 20th August. They have offered me a ‘Prosigna test’; some of my removed tissue is being examined further in a path lab. https://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/treatment-decisions/testing-genes-breast-cancer. This shiny new test is offered to women whose lumps had oestrogen-positive receptors and who also had no lymph node involvement. They’ll look at groups of my genes and should be able to determine the likelihood the breast cancer will spread to somewhere else in my body in the next ten years. If my risk is intermediate or high we will discuss [preventative?] chemotherapy. I’ve also done a BRCA test and will discuss the results of this then too. It will indicate if the cancer can be genetically inherited and apparently has implications for all four of my children, not just the girls. From time to time I get overwhelmed, both physically and emotionally, but I feel pretty sure I can now face any future negative results if I need to. I reckon I’ve already been through the worst. Whatever the case I will still be having radiotherapy and will be continuing with my oestrogen-suppressing medication (5-10 years worth). The radiotherapy treatment will probably take place in a local hospital some time in early September.
