Here We Go

I have started taking the Tamoxifen today. I am still quite scared about it. Wish me luck.

Just Say No

All this emotional distress is not good for my recovery. I have made a decision. I’m not going to take the Tamoxifen. Not never, but not now. Amongst its side effects, Tamoxifen is known to cause depression. I don’t think that I can face being alone in Sydney, feeling sick, with a drug-induced depression on top of everything else.

Farewell but not Goodbye

I nearly left without saying goodbye. My head is full of visions of Love in a Camper Van and other forthcoming sitcoms starring Lily and Nick. The suitcases are zipped shut. The fridge is clean. Jamie is on his way over to lug the cases and drive me off to Heathrow.

I feel as though I’m wrapping up my year of cancer too. On Tuesday I had my final appointment with Dr Coulter. To make her day I wore a Bella Freud knitted dress with ‘GIRL’ written across the front. “Yes well, we won’t forget what you are, Lily,” said Dr Coulter, dry as ever. Yesterday I saw Mr Hadjiminas for the last time this year. “Your DNA test shows that you have both the pairs of genes that indicate that Tamoxifen will be good for you,”* he announced, beaming.

I already have the Tamoxifen in my suitcase. Dr Coulter suggested that I start taking it two weeks after I get to Australia. “At least have a bit of a holiday first,” she kindly advised. I intend to.

Mr Hadjiminas then drained some bloody fluid out of my back. “Bring a pot Honoria,” he cried, “there’s plenty here.” I tried not to wince. Mr H squirted the liquid into the pot. “At least a quarter of a pint. Terrific,” he pronounced with a satisfied tone. “I’ve read Your Life in Your Hands’ by Jane Plant, I told him. “I’m giving up dairy. What do you think about that?” “I’m the wrong person to ask,” Mr H replied, “I like cheese.” “What should I do if my back swells up again?” I asked. “Nothing. Don’t let anyone touch it,” shot back Mr H. “If it’s really bad you must see a plastic surgeon. Your chest wall is about this far from your lung,” he held his forefinger and thumb very close together.

I went around the hospital distributing Christmas cards. Bess and Karen gave me big hugs and showered good wishes on my head. So it just leaves me to wish you a very peaceful, happy Christmas and a spectacular year in 2010. This year was interesting but I'm not ready for another one like it. Thank you for being with me through the last few months.

I had always thought that when the chemo ended, so Chemo Chic would end too. But now I realise that the story is much longer. Chemo Chic is not just the tale of getting through cancer it’s about living life after cancer.

What happens next?

*I neglected to tell you about the DNA test that I had last week. Maybe I will catch up some missing parts of the story as I’m lying on the beach.

Go Ahead, Make My Day

“My question is this,” my tone is defiant, “if I don’t have cancer, why do I need to take Tamoxifen?”

At this moment Mr Hadjiminas has the demeanour of a man who has gone to ground. Holed up behind his desk. Hunkered down with ball point pen, flak jacket and helmet.

But I think I’ve got a fair point.

For some time now I have been agonising with this decision – whether or not to take Tamoxifen. Tamoxifen is a drug that is prescribed for those, like me, whose tumour is found to be oestrogen receptive. My oncologist, Suzy Cleator, strongly recommends Tamoxifen for me. She says that, after surgery, it is the second most important treatment for the type of cancer that I have had.

So why do I hesitate? Well, here are the possible side-effects of Tamoxifen: early menopause; nausea; hot flashes; weight gain; hair thinning; loss of libido; thin skin; vaginal dryness; skin rashes; strokes and deep vein thromboses; dementia; blindness and, most worryingly, endometrial cancer and cancer in the other breast of a more aggressive type.

And why do I need it at all? The cancer has been removed, first by surgery, then any lurking cell anywhere in my body poisoned by chemotherapy. Finally any tiny bit of tumour that thinks about rearing its head is currently being nuked with radiation therapy. Answer: I think that the reason is that, um, if the cancer were to come back and it is oestrogen receptive then this Tamoxifen will ensure that it doesn’t have any oestrogen to feed and grow upon. But if that is the case, why is breast cancer so much more common amongst women who have passed the menopause and are no longer producing as much oestrogen? Answer: I don’t know. And how common is it for the cancer to recur within five years, if one has already had surgery, chemo and radiotherapy? Answer: I don’t know. What happens if the cancer comes back after five years? Answer: I don’t know. How common are the various side effects? Answer: I don’t know. What are the survival rates after ten years for women having taken Tamoxifen along with chemo and radio as opposed to those therapies alone? Answer: I don’t know.

“Maybe it’s a belt and braces approach? Like an insurance policy,” suggests Nick. It sounds so simple – just take it, to be on the safe side.

It seems that I have a lot more questions to ask. But I don’t know who to ask them of. My oncologist Suzy Cleator has gone off and had a baby (congratulations to her!). My other oncologist Carmel Coulter has gone off on holiday.

So here I am bearing down on Mr Hadjiminas again, giving him both barrels of my panic and anxiety. I’ve brought Tessa with me for moral support. Poor old Mr H only has Honoria on his team. She is about eight-and-three-quarter months pregnant and can barely stand up.

“The thing is this,” explains Mr H, “If we had a big scanner we could put Lily in and say “there’s not one speck of cancer remaining in her body” then we certainly would never give you any Tamoxifen. But we cannot be sure that the chemotherapy got every single cell of cancer in your body.” He continues, “statistically after ten years we find that out of a hundred women similar to Lily, who have had surgery and chemotherapy, twenty-five will relapse. So in retrospect, we see that there must have been some cancer cells left behind in them.” I nod. Tessa grabs a pen and takes notes. “But with Tamoxifen for five years we might find that only eighteen women relapse.”

“So, um, that’s seven percent fewer?” I ask, calculating in my head. “Yes,” agrees Mr H, “I think it’s a significant difference.” “But if I’ve endured five years of hot flashes and itching skin, had a stroke, gone blind in one eye and got cancer of the uterus, I might not want to be alive,” I retort, with an air of empty triumph.

Mr Hadjiminas steeples his fingers. “The risk of cancer of the uterus is increased but it is still very small compared to the risk of recurrence of your breast cancer. And we would monitor you all the time so if you did develop it we would pick it up straight away.” “Yes, but I would still have the cancer,” I reply. “That’s true,” says Mr H, “but it is 100% curable.” I don’t want to ask him what the cure involves. “The risk of stroke in a woman your age is about one in a thousand. That would be doubled to two in a thousand. The same goes for blindness. The risk increases by 50% so it would go from maybe two in a thousand to three in a thousand. Macular degeneration is an old person’s disease. It’s unlikely to affect you.”

“Is there anything else you’re worried about?” interjects Honoria, “the early menopause perhaps? Some women worry that they will suddenly start to look old.” “Well yes,” I wail, “I don’t want to be old. I don’t want to look all wrinkled and fat.” “But you won’t” says Mr Hadjiminas. “But I’ve read that Tamoxifen thins your skin and so you start getting wrinkles.” “Where is the evidence?” cries Mr H. Did someone take a piece of skin from a woman taking Tamoxifen and compare it with another woman’s skin? No!” I love Mr H’s enthusiasm for his work. “Some women come back after taking Tamoxifen for five years and complain that they look older. I tell them - well you are five years older,” he concludes.

“What about this ER-alpha S118-P? I read that Tamoxifen is effective in people who have high levels of that but not in people with lower levels?” At this point I’m shooting in the dark because I left the article that referred to this on the dining table at home. I have no idea what ER-alpha S118-P is. “Where did you read that?” asks Mr H. “Science Daily,” I hesitate, “I think. Can you test for that?” “Yes, we can do a test,” he replies, “but the studies are not certain. And if you found you had a low level, would you decide not to take the Tamoxifen?” “Oh I don’t know,” I reply wearily, “if I had a high level, I might decide in favour of taking the Tamoxifen.”

By now my head is spinning and I don’t think I can absorb any more Tamoxifen information. I ask Mr Hadjiminas to have a look at my back. It has filled up with fluid again. It’s painful but more than that I find it very distressing. Mr H says that if it hasn’t settled down by next week he will give me a steroid injection. I don’t even ask him what the side effects of that might be.

I change my mind about Tamoxifen twenty times a day. I talk about it all the time, to everyone. It spills over into my thoughts and dreams. On the one hand is the undeniable cool logic of Mr Hadjiminas’s approach: try it and see. On the other hand is my deep and instinctive terror of this drug. The jury is still out.

Daisy arrives for our singing lesson. Afterwards I feel relaxed and revived. She asks me how I am and I tell her about my dilemma. I run through the arguments for and against. I give her all the angles. “It comes down to this,” Daisy states flatly, “do you feel lucky?”

A Couple of Tips

Here’s a tip. If at all possible, schedule your radiotherapy for the mornings. The drag about having all my radiotherapy appointments in the late afternoon is that delays often pile up throughout the day. They keep me waiting for nearly an hour today. I top up the pay by phone parking three times. To pass the time I play pinball on my iPhone. I switch the sound off so that the receptionist and the other cancer victims can’t tell that’s what I’m doing. Then I forget to switch the sound on again so I miss loads of calls.

Tomorrow is an important day for me. I’m going to see Mr Hadjiminas to talk to him about Tamoxifen. Because I have several appointments back-to-back, Jamie offered to drive me to and from the hospital. And because I get all tongue-tied and forget to ask important questions and then forget to write down the answers, Wanda offered to accompany me to the appointment with Mr H. Whilst playing silent pinball today I miss two calls and receive two messages. The first from Jamie telling me that his car needs three new tyres, so he won’t be able to drive me after all. The second is from Wanda telling me that she has been called back for an acting audition, so she won’t be able to accompany me after all. Oh well.

Here’s another tip. Don’t deal with the Department of Work and Pensions yourself. Their aim is to have one pulling a plastic bag over one’s head or leaping from an upper floor window as swiftly as possible. It’s a cynical strategy to reduce the numbers receiving sickness benefit. They don’t care if they have to employ four people full-time to harass one night and day with multiple letters and endless paperwork. One of the readers of this blog, Lesley, wrote to tell me that the DWP obliged her to attend a “back to work” interview whilst she was in the middle of chemotherapy. When she dragged her ill and exhausted self down to the Job Centre they told her that she didn’t have to do the interview after all. They tried the same trick with me but I refused to go. Apparently the DWP are pulling this kind of malarky all the time nowadays. It would be laughable if it weren’t grotesque. The fact is that this kind of nonsense puts real people’s real health and wellbeing in jeopardy.

Anyway, my advice to you is to get an advocate to deal with them on your behalf. The people at the MacMillan Benefits Helpline* are brilliant. Kerry from MacMillan called me this morning to tell me that someone from the DWP had finally got in touch to tell her that the fifty page form that they sent me last week was all a big mistake. You may recall that when that one landed on the doormat it provoked a near-hysterical meltdown from me. Anyway there is no need for me to fill it in. Furthermore they will now address themselves to the issue of my mortgage interest payments – after only three months of doing nothing on that front. So why did they send the fifty page form in the first place? The French have a word for it: “boh!”

*0808 801 0304

Quick Catch-Up

As I write this Nick is landing in Sydney.

Last night I said goodbye to Nick at Paddington then stood on the platform watching the Heathrow Express slip away westward. I thought that I might cry but I didn’t. I have learned that crying often happens when I somehow feel that I’m being deprived of something. But I know that I will see Nick again. And quite soon really.

Being with Nick has taken up a lot of my time and attention. I’m alone again. It seems like a good moment to catch up on where I am with treatment and future plans.

Money continues to be a worry. But so far, everything has worked out somehow or another. So perhaps I should desist from worrying. It doesn’t contribute anything to the situation. I feel compelled to tell you that the Department of Work and Pensions (DWP) have been unfailingly unhelpful. Since the beginning they have bombarded me with paperwork. Last month I received seven separate letters from them in a two-day period. Last week they sent me a fifty-page form asking me for all the information that I have already given them. They assessed me as fit for work when I was recovering from surgery and having intravenous chemotherapy. I have had to fight them every step of the way for my benefits and it has been exhausting. Six months of illness has generated a file of paper three inches thick. Each of their mad missives necessitates a telephone call, a long period on hold, an inane conversation with yet another person who doesn’t know what they are talking about and cannot help and finally a wait of indeterminate length until someone more qualified calls one back. Or, sometimes, does not. During that time one cannot leave the house nor even use the phone for fear of missing the call and having to start the whole hellish process over from the beginning again. It is not the kind of help one needs when one is ill.

The Inland Revenue, by contrast, have been marvellous. In July I contacted the Inspector of Taxes to explain my situation. After waiting three months I received a letter in reply. The inspector informed me that, as a writer, I am able to spread my earnings over two years. Thus, at a stroke, I halved my tax bill.

When the chemotherapy ended I thought I was fine and fit as a flea. With hindsight I can see that I was actually quite sick and very weak. In the past week or so I’ve begun to feel stronger, although immensely tired. Yesterday was my twelfth radiotherapy session, out of twenty-five. So I’m nearly halfway through. Since I injured my back a couple of weeks ago there has been quite a lot of fluid collecting there. I’m quite distressed about that. It feels like I’ve taken a step backward. Parts of my arm, back and breast are still numb following the surgery.

On the whole I’m really pleased with my progress. I tolerated the chemo very well. Although I felt sick and all my hair fell out, I did not have to be hospitalised at any stage. As previously noted, my hair is growing back rapidly.

The radiotherapy is really causing me very little bother.

My concern now is whether or not to take Tamoxifen. This is such a big and complex issue that I’ve been avoiding writing about it. Every day I change my mind five times before breakfast. I am swayed in one direction then the other each time I read something new or get another opinion. However, I am gradually marshalling all the information I need to make a decision. I will soon write a long piece dedicated solely to Tamoxifen and tell you everything that I have found out.

In the meantime I think about what else the future might hold. It's only twenty-six more days until I leave for Australia.

Running Late

Yesterday I posted a lot of advice about how to relax in a stressful situation.

Today I have a series of back-to-back appointments at the hospital.

First, I’m to see Mr Hadjiminas. Since helping to move Flossie’s bed, fluid has again started to collect in my back at the site of the surgery. Next I have a massage. Oh heaven. I’ve been looking forward to that since I booked in three weeks ago. Then I have an appointment to see Dr Coulter. I’m nervous about that because I intend to ask her lots of questions about side effects of radiotherapy and Tamoxifen. My final stop is for radiotherapy.

With such a schedule, I guess it’s unrealistic to expect zero hitches. Mr H’s clinic is running late. By the time Honoria calls my name it’s already time for my massage. Nick asks the receptionist to let them know that I may be 10 minutes late.

Mr Hadjiminas is full of smiles for me and handshakes for Nick. Once the niceties are complete, I disrobe behind the screen. Mr H prods a finger into the wobbly cushion of fluid on my back. “Ouch,” I say “Hmm,” he replies, “I think we will send you down to see Dr Butler, she can get a better look at it on ultrasound.” “What, now?” I gaze helplessly from him to Honoria. “Yes, now,” replies Mr H in a firm tone. “But I’ve got a massage booked,” I wail. Honoria promises to call the therapist to see what can be done. Mr H fills out an ultrasound form. Then it’s “goodbye” and “see you next year” to Mr H. Nick and I jump aboard the lift to the basement.

As we arrive the receptionist is on the phone. I hand her the form as she replaces the receiver. “Ah, Miss Lily,” she says. “They’ve just phoned to say that you should reschedule your massage for another day.” “Oh,” I squeak. I feel as though they cancelled Christmas. I keep my chin up and try not to pout as we take a seat in the tiny waiting room. But Nick can tell. “Breathe darling,” he says, “in... two... three... four... hold... two... out... two... three... four...”

A woman sitting opposite pipes up, “Hello again. How are you?” I look at her blankly. “I sat with you the last time I was here,” she says, in an encouraging tone. “I don’t think so,” I reply, without caring how churlish that sounds. I’m not doing very well here. Nick squeezes my hand. “Anyway, how are you going?” Nick asks the woman. She looks at him blankly. “Are you well? Are you having treatment for cancer?” he persists. “Oh,” she replies, “no, it’s my husband. He’s having the Cyberknife.” “The Cyberknife?!” Nick’s eyes light up. “What is it?”

The woman launches into an enthusiastic eulogy about the miracle of Cyberknife. How it can zap tumours in hard to get places that surgery cannot reach. How her husband can get up and go straight home after the procedure. She tells us that they have travelled from Newcastle to come here and that this is one of only a few Cyberknifes in the world. It seems that this lady’s husband has been suffering from liver cancer. Following surgery the cancer returned last year and they were told that nothing could be done. They decided to do their own research and learned about this new technology. At that time the nearest Cyberknife was in Turkey. Yes, that’s right. There is also one in India and one in Malaysia. As usual, the UK follows on the heels of the developing world when it comes to cutting-edge medicine.

So, they travelled to Istanbul only to be told that the treatment could not go ahead. They were not given a reason.

Then they heard that there was a Cyberknife in London, at the Harley Street Clinic. They argued the case with their health insurance company, who agreed to pay up. That was fortunate because it seems that a course of Cyberknife treatment costs in the region of £22,000. It’s sad to say, yet predictable, that Cyberknife is not available on the NHS.

Half an hour passes by with us deep in jolly chat about fantastic linear accelerators and the sorry state of the health system. I glance at Nick. “I’m due to see Dr Coulter in five minutes.” I gasp in a tone of rising anxiety.

Nick strides out to have a word and in the next moment a nurse calls my name. I’m ushered in to see Dr Butler, the ultrasound doctor. She runs her magic seeing eye over my back and pronounces that I have fluid build-up from under my arm right down to the small of my back. “But what is it?’ I ask. “Oh it’s just kind of... juice,” she pronounces. She inserts a needle to siphon it out. Breathe... two... three... four. It’s no good. My back goes into spasm. She withdraws the needle and we start all over again. As Dr Butler begins to draw off the fluid she looks over to the nurse. “Can you get me a bigger container?” she asks. Breathe... two... three... four... “This isn’t juice,” says Dr Butler, “it’s blood. You must have haemorrhaged into your back.” Breathe... two... three... four...

Eventually I dress and rejoin Nick in the waiting room. The nurse pops her head in. “Can you wait? Dr Butler wants you to take a sample of the blood to Dr Coulter in case she wants to have it tested.” “Oh Nick, I’m so late,” I wail. “Don’t worry, I will go up and tell them.” Once I’ve got the pot of blood tucked safely in my handbag I walk up to the main reception desk on the ground floor. Nick isn’t there. “He’s gone up to the second floor waiting room,” the receptionist informs me.

I insist on wearing my new down coat from Uniqlo at all times, even though the temperature in the Harley Street Clinic is usually about the same as it is in Dubai. By the time I’ve climbed upstairs from the basement to the second floor my spindly legs are buckling beneath me. I collapse into Nick’s arms and he brings me a plastic beaker of iced water. We wait. And wait. “Oh no, now I’m going to be late for radiotherapy,” I gasp. I’ve completely given up on the breathing by now. Nick leaps to his feet and heads to the desk. “There we go,” he says, “they’ve rescheduled your radiotherapy.” How I’m going to manage to make it to all these appointments alone I have no idea. At last my name is called.

Dr Coulter is no fool. Yet she has a very caring, almost maternal side to her nature. She can tell that I’m stressed and incoherent. She talks to me in a calm, soothing tone. First, I hand her the jar of blood. “I have no idea why they’ve sent me this. Your blood is perfectly healthy,” she pronounces. Smiling, she pops it in the bin. “Yes, well,” I reply, “I’m concerned about side effects. I’ve heard that Tamoxifen can cause other cancers.” “It is true,” Dr Coulter replies, still smiling, “that Tamoxifen doubles the risk of cancer of the uterus.” My face falls. “But the risk is very small to start off with. So, the general occurrence of cancer of the uterus is about a half in a thousand. With Tamoxifen that risk becomes one in a thousand.” “I went to a talk by this woman called T.S. Wiley who wrote a book about bio-identical hormones. Have you heard of those?” I ask. “I’m afraid I haven’t,” replies Dr Coulter. “Anyway, she said she wouldn’t take Tamoxifen.” “Oh? And why not?” asks the kindly doctor. “Well, I can’t remember. At least, she didn’t really say. But she said that you should get in touch with an oncologist called Dr Julie Taguchi who wrote the book with her.” I am surprised that Dr Coulter immediately acquiesces to that suggestion. “Of course. We can email her. This has to be your decision,” she says.

Anxiety Busters

I had hoped that the end of chemo would coincide with the end of my worries and cares. What with everyone going on about how radiotherapy is such “a walk in the park” and so on I had imagined myself and my slightly pink breast, bathed in rainbows, tiptoeing through the tulips hand-in-hand with Nick, pausing here and there only to pluck a fresh chocolate éclair from the trees.

So I’m a bit surprised to find myself regularly breaking down in tears with Nick having to calm my frenzied bouts of anxiety. Of course money is always a worry for anyone dealing with a serious illness. Those of us who are self-employed don’t even get sick pay. Social Security payments won’t cover the cost of organic groceries, let alone health insurance, home insurance, petrol, parking, new roofs, clothes, phones, broadband, Hermès scarves and a thousand other daily expenses. So, like many people, I’ve borrowed and gone into debt to get through. I am very lucky that my sister Miranda has been able and willing to bail me out.

Another source of anxiety is the prospect of long-term side effects of the various cancer treatments. A quick google will throw up endless opinions that both chemo and radiotherapy cause other illnesses. Many of these are simply scare stories. God only knows who originates them and for what possible reason. But then there are solid concerns too. Last week I read about long-term side effects of radiotherapy on the website of Cancer Research UK. Apparently it can cause fibrosis that leads to hardening and shrinking of the breast. It can also trigger Lymphoedema.

I was quite taken aback. I feel as though I had not been fully aware of these possibilities. I don’t know how commonly it happens. Tomorrow I will be seeing Dr Coulter, my temporary oncologist so I will be able to find out more and report back to you.

But it was enough to start the little hamster of anxiety running on its wheel. Pretty soon my mind has worked its way around to the big looming unknown: Tamoxifen. When it comes to this drug, opinions are polarised. According to Suzy Cleator, Tamoxifen is the most important treatment for Oestrogen Receptor positive breast tumours (the type that I had) after surgery. Many in the medical profession swear that it’s a wonder drug that has changed the outlook for breast cancer sufferers. According to many in the alternative camp it is a destructive and misogynistic treatment that wicked drug companies have sold to credible doctors for their own greedy ends.

The inescapable fact is that Tamoxifen is known to cause blood clots, strokes, cataracts, hot flashes, headaches, fatigue, nausea, vomiting, dryness of the vagina, itching skin, rashes and cancers of the uterus. I still have a lot to find out and a lot of questions to ask. But I sometimes feel that I will inevitably have to make a decision between a disease that may kill me and a drug that may kill me.

The thing that really gets to me sometimes is that a few months ago I was told that Mr Hadjiminas had completely removed the tumour from my breast. The more I learn the greater seem the risks associated with what I had understood to be a ‘belt and braces’ approach.

I’m telling you all of this because you too may be feeling anxious about chemotherapy, radiotherapy or Tamoxifen. You are not alone. I will write more on the matter in the future. But even those who have studied and researched for many years disagree. We simply must do our best to inform ourselves to a point where we feel comfortable with whatever decision we take and then embrace the unknown. In the end, there are no wrong decisions.

Although the situation is disquieting, indulging worry and fret makes no positive contribution. On the contrary, it increases our stress levels. Here is a roundup of all the different techniques I have used for alleviating anxiety.

Breathing. This is obviously a good idea, yet I forget to do it. When anxiety strikes I find myself all tangled up, holding my breath or breathing out when I should be breathing in and then gasping for air. Then I remember to take a minute or two just to calm myself with controlled breathing. Count slowly to four then breathe in for a count of four. Hold your breath for a count of two. Breathe out for a count of four. Hold your breath for a count for two. Breathe in for a count of four...

Singing. No need for talent, just grab a hairbrush and put on an Abba cd. Dance around the living room warbling, wailing and screeching your head off. It creates harmonious resonance in the body and floods the lungs with oxygen. Singing in the car is a fantastic stress buster.

Crying. Don’t hold it in. Go to see a weepy movie and have a good old cry. I always keep a pocket packet of tissues in my handbag these days.

Walking. Don your trainers, or socks-n-crocs if your toes are sore, then hit the streets. Walk slowly and with a rhythmic pace. As you walk try to simply release any thoughts that come into your head. Use this simple mantra: "let go". Think l-e-t as you breathe in. Think g-o as you breathe out.

Yoga Nidra. Put some dolphin music on if that’s what floats your boat. Or Mozart. I listen to a wild soundtrack called ‘Wind and Rain’. Lie on the floor in Savasana. That is on your back with your legs apart, your arms resting palms up at about 45 degrees from your body, your neck extended and your chin tucked in slightly. Savasana literally means ‘corpse pose’. Begin to breathe regularly from your diaphragm. Close your eyes and as you breathe bring your attention to your third eye, the place between your eyebrows. Now say your Sankalpa out loud, three times. Sankalpa is something like a positive affirmation. This is my Sankalpa: “I am happy. I am healthy. I am whole. I am sexy. I am prosperous. I am loving. I am loved. I am FREE.” Next scan your body, checking for any tension or contracted muscles. Start with each finger on your right hand, the palm, the back of your hand, the forearm, the elbow, the upper arm, the shoulder, the chest, the side, the waist, the hip. Repeat on the left side. Next scan each leg from the toes upward, in turn. Scan your spine, neck scalp, ears, face and throat. Relax any areas of tenseness that you feel. Next, imagine your body to be very cold, as if standing in the snow in bare feet, then feel your body to be warm, as if sitting on a sunny terrace. Then feel your body to be very heavy, sinking into the floor. Then light as a feather, hovering above the carpet. Next, imagine yourself walking in a lovely place – somewhere that is special to you. Feel the earth beneath your feet, the breeze on your face. See the sunshine, smell the flowers. Find a comfortable rock beneath a tree with a wonderful view of your world. Now repeat your Sankalpa three times again. Bring yourself back to now by wriggling your fingers and toes and then having a lovely stretch.

Oh, there are lots of strategies but I’m tired now. That should be enough calming measures to keep you and I both sane for today. More later.

And So the Chemo Ends

So at last, I’m off to Harley Street for my final chemo session. I get up late, as usual, then stagger about getting dressed and making cards for the nurses. I like to print my own photographs as cards for special people.

Nick Skypes: “I just want to tell you that I love you and I hope it all goes well today.” I have to say I’m feeling very emotional.

I have been thinking about an appropriate gift for the nurses. I know that they get inundated with cakes and chocolates. Yet it’s difficult to think of another gift that they all can share. I recall bringing them a bunch of flowers once to cheer up their front desk. They thanked me but the flowers were quickly ‘disappeared’ without ever being unwrapped. I guessed that they must have fallen foul of the no flowers rule that is often in force in intensive care units, chemo units and such places. Apparently flower pollen can cause infections. In the end I’m not imaginative enough to think of any alternative gifts. Paul does a lovely gift box of mini macaroons. Four of each in six different colours. They’re elegant and merely a mouthful. As much a treat for the eyes as for the stomach. If I had the energy I would go up to Harrods and get the Ladurée ones that Iris is always raving on about. But I haven’t. Anyway, the ones from Paul are pretty damned delicious.

Macaroons on board, I pop up to Daunt Books and buy cards to replace all those that I left on the table at home. I don’t admonish myself anymore. It’s just chemo-brain.

The unit is quiet today. I’m thankful for that. I don’t feel like being surrounded by drama on the last day. Nurse Cara does my observations: weight, blood pressure, temperature and oxygen saturation. Nurse Karen looks at my feet. "Crocs n'Socks will soon be on the runways," she observes.

Karen wraps my arm in a heat blanket to aid the manifestation of a vein. The veins in my arm are pretty well worn out at this stage. But I’m truly thankful that at least one of them has held up to the end. I haven’t had to have a central line installed in my chest, as I’ve seen many have. All-in-all, I feel that I have had a pretty easy ride of it with chemotherapy. I have read, heard and seen some real horror stories. It’s been difficult and miserable at times but never intolerable. I haven’t suffered major organ damage, I haven’t been admitted to hospital, I haven’t had to have a blood transfusion, my fingernails have not fallen off. What more can one ask for?

With a few inadequate words of thanks, I hand over the macaroons. With eloquent and gracious words of thanks, nurse Karen accepts them. Then she gives me a big hug. One might get the impression that this is the most beneficent gift that they have ever received. I am sure it is not.

The chemo itself is uneventful. Sandra comes by and gives me a deeply relaxing reflexology treatment. I will miss those. Karen offers me a macaroon. I recline in the big armchair, eating a macaroon and having my feet rubbed. “It doesn’t get much better that this,” I remark. “Well you could have George Clooney bringing you a glass of champagne,” observes Sandra. “You’re right,” I sigh, “I knew there was something missing.”

Finally, the chemo is finished. Nurse Karen unplugs me and it’s time to leave. She hesitates a moment before applying the mini plaster to the spot where she removed the needle. “We just have to be a bit careful,” she says, “sometimes people have gone off and then come rushing back with blood pouring down their arms.” “I’m sure that won’t happen,” I say. “It’s never happened before.” I put on my jacket and hug them all. I will be happy not to have chemotherapy anymore but very sad not to see these nurses. “Goodbye, goodbye,” I have to blink back tears. Then, as I reach for the doorknob, I feel a trickle on my hand. I rip off my jacket and throw it to the floor. Blood is pouring down my arm. I rush back in for a final dose of care and attention. It’s a psychosomatically induced blood spout, I’m certain of it.

My last stop is to see Suzy Cleator. It may be difficult for you to comprehend that one can be genuinely pleased to see an oncologist. But I am. She has become a good friend to me. She is heavily pregnant now and will soon be stopping work, so the end of my chemo treatment is an appropriate moment to hand me over to the new oncologist, Dr Coulter.

Suzy confirms my opinion that I have tolerated the chemotherapy very well. I have to say that that is very much due to her expertise. The weekly regime of Taxol has been a big success. I hand over her card and start to choke up again.

Honoria pops in. She is heavily pregnant too. I will, however, be seeing her again. In two weeks time when I come for radiotherapy ‘planning’.

Suzy raises the subject of Tamoxifen. It’s a hormone therapy that she is recommending that I take every day for the next five years. I shift uneasily. I’ve read and heard all sorts of conflicting things about Tamoxifen, many of them quite scary. Of course I haven’t got any of my facts straight. “I am concerned about the side effects,” I say, in an embarrassed tone. “It is highly recommended for you. Your tumour was oestrogen receptive. So if there’s still any lurking about the Tamoxifen stops it being fed with oestrogen. You can try it, and if you find it too difficult you can decide to stop,” says Suzy. “I’m worried it will cause bone loss,” I reply. “Tamoxifen has a bone protecting effect,” Suzy rejoins. “Oh, I don’t know. Of all the therapies, this is the one that I feel most uncomfortable with,” I say, unconvincingly. Suzy clears her throat, “Of all the treatments for breast cancer, surgery is the most important. The next most important is Tamoxifen. Then chemotherapy, then radiotherapy.” I study the floor. “I think the best thing,” says Suzy with one of her indulgent looks, “is to discuss this after you’ve had the radiotherapy."

She sure has learned how to play me.

I wish both Suzy and Honoria all the best with their births, bid them goodbye and leave.

Then I step out into Harley Street and into my future.