Friday, 27 July 2012

in remembrance

broken-hearted
broken-winged
flightless and breathless
dizzied and panicked
the heart beats faster in the bloodless chest

the future waits

waits

in a cell

sacrificed
on a hard table
to a blind blade
to shapeless cottons
to bacterial junctions
to a vase of roses and carnations wilting in the summer heat

teeth shudder
in the worried mouth
where words betray their silenced tongue
resurrected follicles
punctuate scarred arms
conversely
perversely
the skin round the eyes grows smoother each day
paper thin skin twitches
in remembrance

granite feet support
leaden legs
lactic acid lingers
each muscular stretch
a delicious pain
a reminder
of the one-toothed bite

the nails in this walking coffin
yellowed
striated
well-hammered
like the man on the cross
who died for my sins

Friday, 20 July 2012

farewell, little lump. no hard feelings, eh?

When I first met with the oncologist, he said I was a good candidate for neo-adjuvant chemo. I asked why, thinking it was something to do with my age or fitness or tumour-type.
"Because you haven't once said you want the tumour out right now."

He was right. It hadn't even really occured to me that it would need to come out. I didn't see it as an invasion or as the enemy. It was just part of me. My cells.

But the day had come to evict the small bundle of cells which threatened to overrun my body, multiplying exponentially until they had colonised my liver, my lungs, my brain and my bones.

I was nervous - frightened, even - of surgery. Of the physical act of being induced into unconsciousness and sliced open. But by the time I had had my last dose of chemotherapy, I was more frightened of not being sliced open. I am sure I felt my tumour recede each cycle around days 7-15. Sometimes I could feel a reduction in its size overnight! But equally, towards the end of each cycle, I was sure I could feel it growing again. From the morning of my last dose of chemo, the clock was ticking. I knew I needed time to recover from the havoc the drugs wreaked on my blood, my immune system and my psyche, but I also knew there would be only a small window of time before the thing started coming back to life.

The morning arrived. I sneaked a little milk into my coffee, against the 'nil by mouth' orders. It was all I could do to resist sneaking a bite of one of the glistening glazed doughnuts my sister-in-law had brought down from London. Unable to completely avoid temptation, I packed two into a plastic pot for later. If ever there was a day for comfort food, this was it.

I kissed each of my girls, arms lingering in sleepy hugs. They were excited to have a day with their beloved auntie, and I was relieved they would be safe and loved in my absence.

The drive to hospital this time was calm and, at 7 a.m., without the usual snarls of traffic on which I could blame our inevitable lateness. It seemed a surreal pinnacle for the months of preparation and suffering we had already endured. A fizz of anticipation bubbled deep inside me, and would erupt in inappropriate laughter many times throughout the day.

The surgical waiting area was busy. The atmosphere reminded me of a locker room; players waited nervously for their coaches to come in and call them to the sterile field. Relatives sat nearby, cheerleading from behind the lines. Lorraine Kelly commentated from the big-screen on the wall.

I was called. Rob and I were led to a patient transport vehicle, which would take me to the other side of the hospital to the breast care unit. "The hospital isn't insured to cover you to walk outside the main building," the driver explained.  We buckled up.

I was the only lady in the breast care unit at half past eight in the morning. I noticed the radiologist, who happens to be married to my surgeon, enter the building, head down and mug in hand. I wondered if she had driven in with her husband this morning, and if so, whether he was similarily entering the surgical unit, mentally preparing for the day ahead.

The first of many chuckles on the day.

I was called through for the first procedure of the day. The nurse introduced me to the radiologist, but she remembered me. The last time I had seen her I was crying and refusing her mammogram. This time I was smiling. I assumed the position - on my left shoulder, right arm raised above my head - and she ran the ultrasound over the lump. My nerves made me forget that sometimes it's more prudent to keep one's thoughts inside one's head; it seemed now was the perfect time to tell her that since she and her husband had both felt me up, it was kind of like we'd had a threesome. Inappropriate, yes. But I preferred to laugh rather than cry. She explained the procedure while I shivered in the cold air (this is just another of the myriad ways they torture breast cancer patients: the machinery needs to be kept cool, but the patient needs to be half naked). I turned my head away and felt the bite of the first needle. Moments later, the tiny doctor seemed to rise up behind me before driving a spike of wire through my skin, through my breast, towards the now-tiny tumour. I was impaled. The six inch tail of wire hanging out of my body was crudely taped down and I was sent for a mammogram to check its position. This wire would guide my surgeon to the lump.

After being impaled like a shish kabob.

Next stop was Nuclear Medicine. The name sent a shiver through me, but the sign outside the unit made me laugh again.


I was taken into the room where I would be injected with radioactive material and nearly fainted when I saw the machine.

"No one told me about that!"

It was a gamma camera. The nurse reassured me that it posed no harm. (Maybe it does. I haven't googled, for once.) I donned a gown and climbed up on the slab. A yellow wristband warning that I would set off geiger counters for the next 48 hours was applied. The second needle of the morning spilled a radioactive fluid under my nipple. The local anaesthetic I'd already had dulled the pain. But I felt sad for my boob. It was never my favourite. It was the runt. The smaller one. The one none of my babies preferred. But it didn't seem to deserve the many offenses it had suffered these last several months. As I massaged my breast to encourage the fluid to move away from the nipple as I had been instructed, I hoped it knew I didn't bear a grudge.

So happy about massaging a breast with half a foot of wire hanging out of it.

The camera's eye slowly descended towards my face. A moment of claustrophobic panic siezed my gut before I was distracted by the expanding star on the computer screen nearby. The star was the radioactivity in my breast, captured in real time riding the waves of my lymphatic system. With any luck, the particles would wash up on my sentinel lymph node. Twenty minutes of not-very-sensuous breast massage later, the sentinel node lit up like a twinkly little satellite.

Back to surgical admissions, radioactive and bionic. We were called to meet with the anaesthetist. No, I'm not pregnant. No, I don't have any allergies. No, I've never had a problem with an anaesthetic before. I meant to ask...could the surgeon take off this little mole in my armpit while he's digging around in there? He might have, if you'd asked earlier. But he can't do it without consent...you might complain afterwards that you really loved that mole.

My impression of the guy who'd put me to sleep was pretty good. He had bad breath, but I could tell he was quietly confident and careful. And human.
Back to the waiting area for a few more minutes. Tummy rumbling now - hadn't eaten for 12 hours. I leafed disinterestedly through a fashion magazine. One ad caught my eye - chemo chic seems to be in this year.


Rob and I followed another nurse up the corridor (not before I went for one last wee - I didn't want to wet myself on the operating table). I could feel my blood pressure escalating. The walls closed in on my eardrums. The corridor lengthened and narrowed under my feet. We stopped in front of glass doors which slid open with a whoosh.

"Here's the end of the line."

I turned to Rob. We embraced - not some wimpy half-hearted hug, but the full body no daylight kind - and exchanged sincere I-love-yous. I walked through the doors and turned back as they drew closed to say it reminded me of saying goodbye at the airport. I don't know if he heard me.

"So how old are your girls?"

Not for the first time during this fiasco, telling someone my daughters' ages broke me open at the eyeballs. But for the first time on this day, tears spilled forth.

Just like what always happens at the airport, my departure gate was the one furthest from the sliding doors. A chair waited for me outside Theatre 10. The nurse and I sat for a few moments before they were ready for me to enter. I walked into the large operating theatre, wondering if it was the same  one in which my eldest daughter had been born. I climbed onto the narrow table. I noticed four or five begowned, bemasked nurses gliding gracefully around the room, readying instruments, writing my name and details of the operation on the board on the wall, scrubbing wrists and fingers in the sink in the corner. A very pretty, smiling nurse stuck ECG suckers to my chest and back and fastened a cuff around my upper arm. I was shocked to see my blood pressure - 127/83! My bp has never been anywhere near that high. My pulse was 126 bpm. I cracked a joke about it being as good as a workout.

The anaesthetist with bad breath appeared and took my left hand in his. He remarked on the still lurid bruise in the crook of my arm, the result of a health care assistant's clumsy attempt to draw blood ten days before. His needle deftly and painlessly entered a vein on the back of my hand.

"Lie back. You're going to feel a bit fuzzy in a moment." His drug whispered through my bloodstream, and I was asleep.

                                 ------------------------------------------------------------------

I choked on thick air and coughed. That wire in my boob hurt so much. My hand rose to my face and found soft plastic. I pulled the mask away and spluttered again and winced. I realised it was over. It was over and I had missed it. I had been left out. They hadn't let me watch and my surgeon had never turned up to take the lump out. I wondered who had done it. I shivered and asked for more blankets. I felt sad that I had missed it.

Someone spoke to me, but I can't remember what they said. I watched an old man, still sleeping, roll through the recovery room. There was a space for me on the ward, but I needed to move off the operating trolley onto a bed. Somehow, wanting to show how okay I was, I pushed myself up to a sitting position and transferred myself across the gap between my trolley and the bed. I was taken down to the ward. Rob was there. I ate one of the doughnuts I had packed that morning, posted a reassuring 'I'm alive' to Facebook and emailed my mother.

Later, I walked to the bathroom, lifted my gown and looked at my insulted breast. The bandage was smaller than I had expected. And my breast was a bright greeny-blue. The final needle of the day had injected dye beneath my nipple, a dye which travelled through the channels of the breast to stain the lymph node most likely to be cancerous, enabling the surgeon to identify it and cut it out.



I felt okay.




Tuesday, 17 July 2012

i survived chemo and saved my lymph nodes

Just over a month ago I had my third and final dose of the taxing Tax. Docetaxel was pretty hardcore stuff; the first dose landed me in hospital with uncontrollable pain. Doses two and three were reduced to 80%. I was again unhappy with the dose reductions, in case they reduced the drug's efficacy, but kind of relieved in a way, as hopefully my risk for further complications brought on by this intense poison will also be reduced. Even with the dose reductions, I suffered some unpleasant side effects - feet that felt burnt, then peeled in sheets for weeks; twitching eyelids; yellowed and blackened fingernails; hypersensitivity to noise and light; impaired cognitive function and short-term memory problems and muscles that still ache as though I've done a heavy workout in the gym. But overall, four weeks on, I'm surprised and amazed by how good I feel. The human body's capacity for healing itself is absolutely incredible.

Yesterday, I was admitted to hospital for my surgery. I can proudly say that I was the first person at my hospital to have this particular surgery.

In February, my lymph node was biopsied and tested positive for cancer. Traditionally, this would automatically mean all my lymph nodes were removed along with the offending lump. Up to 70% of women who undergo this procedure - axillary node clearance - will go on to suffer problems with lymphoedema, frozen shoulder, cording and/or loss of sensation and strength in the affected arm. As an active woman, as a mother of young children, this procedure scared me almost as much as the cancer. Women end up permanently disabled. I cook, sew, garden, hammer nails into walls, move heavy furniture around, have cats and still carry my children in my arms; how was I to 'protect' my right hand and arm for the rest of my life? Something as seemingly innocent as a hangnail could trigger the dreaded lymphoedema.

Thankfully, I came across an article about a study that was published only last year. This practice-changing study found that for about 20% of women diagnosed with breast cancer (who have a small lump, positive but non-palpable lymph nodes, and who are likely to have further treatment such as radiotherapy to the armpit, endocrine therapy or chemotherapy) it was just as safe to NOT remove all the lymph nodes. In fact, in this particular study, the women who only had a sentinel node biopsy actually had a very slightly better prognosis. I took this study to my surgeon. He acknowledged it, but made it clear that the standard of care was still to perform a full node clearance on any node-positive patient.

However.

After lengthy discussion, he offered me an alternative. I could do chemotherapy first and see if it 'cured' my enlarged node. If, by the end of my chemo treatments, the node looked normal on ultrasound scan, they might agree to perform a sentinel node biopsy rather than a full clearance.

The sentinel node biopsy seeks to identify the first lymph node the cancer cells might drain to, with the idea being that if that node is free of cancer, the other nodes also should be. The surgery is much less invasive and carries a far lower risk of morbidity.

I agreed to this deal. I thought if nothing else, having my chemo neo-adjuvantly (before surgery) would buy me a few more months with a healthy, non-compromised arm. It would give me time to finish the many DIY projects around the house, with the further benefit of being able to see if the chemo drugs were having any effect on my tumour. And it worked on both counts. I got to see my lump shrink by half, and after only two treatments my lymph nodes looked normal.

A week and a half ago I met again with the surgeon. I would be the first person at my hospital with a lymph node that tested positive to be offered the sentinel node biopsy.

It pays to be a stroppy patient.