To Be Continued...

“This is looking a lot better,” says Mr Hadjiminas, examining my back. “Fantastic!” I exclaim, “So can I stop wearing that?” I jab a finger at the compression bra that is lying innocently across the back of a chair.

“What, and throw it all away just when we’re winning?” My face falls. “We could always put you back in the elastic bandage,” cajoles Mr H. I shoot him a sour look.

 “I’m going on holiday for three weeks. If it gets worse again, come back and see me then.”

“And if it doesn’t get worse?”

“Come back and see me in three months.”

“So, do I have to wear the compression bra for another three months?”

“Oh no, three more weeks should do it.”

“Oh thanks. Enjoy your holiday.”

Exeunt.

Another Jolly Day Out

I have neglected to mention this until now...

In the middle of all the drama in Australia I noticed a small lump on one side of the bridge of my nose. It grew larger. A few weeks ago I went to have it checked out by Dr Jonathan Leonard, a dermatologist. “Hmmm, it looks like a basal cell carcinoma.” My throat tightened, I gripped the arms of the chair. “Carcinoma?” I whispered. I told him that I have only recently been treated for breast cancer. “Well it is a cancer, but a low grade one. It’s not life threatening but you must have it removed. It’s very close to your eye so the procedure has to be done by a specialist.” He referred me to an Opthalmic surgeon, Mr Naresh Joshi.

Mr Joshi could quite safely be described as “Mr Jolly” He explained to me that the lump was quite close to my eye but, luckily, not so close that removing it would damage the tear duct. He further explained that it did indeed look like a basal cell carcinoma and that’s a good thing: “If it was a malignant melanoma you’d probably be dead in three months,” he added, gaily. But it will only get bigger, so it has to go. “We can do it under general anaesthetic or local. Which would you prefer?” I told him that I had two generals last year and was about to have another so I really would prefer it to be a local. “That’s fine, but it is best that we sedate you.” We agreed to defer the procedure until after Mr Hadjiminas had done the surgery on my back.

Today is the day. I have to be nil-by-mouth from 7.30 a.m. so I get up early and force down some toast, an apple and a nice cup of tea. As I’m getting dressed and planning the day it occurs to me that it might not be such a good idea to drive to the hospital if I am to be sedated. I call Justin. He kindly hauls his arse out of bed and is soon outside my door, avec automobile. He drives me to the Bupa Cromwell hospital.

Sedation, I had imagined, would be something like a Valium – to relax me so that I won’t flinch or leap from the couch as Mr Joshi comes at my eye with a scalpel. “Ok, we’re just going to give you some sedation,” says the anaesthetist and injects cold liquid into my hand. An hour later I wake up on a trolley. My hand is clasped around a tube of ointment. I look at it in drugged puzzlement. Someone must have tucked it into my hand whilst I was under. Soon Mr Joshi arrives. “We sent the tissue to the lab. It was a basal cell carcinoma but we didn’t get it all out so we’re going to have to do a bit more.” The theatre nurses wheel me back around to the anaesthetic room. An hour later I wake up again. Now there are two tubes of ointment on my lap.

Sheldon has been by to collect me but has gone away again. I call him and reschedule the pick-up.

Back in my room I order up an omelette, some soup, a round of sandwiches, a plate of fruit salad and a pot of tea. I haven’t eaten for twelve hours. My head clears and I take stock of my surroundings. The Bupa Cromwell, I observe, is not a patch on the Harley Street Clinic. The lobby is all marble and glitzy but upstairs it is decidedly dilapidated. The nurses are kind and professional but you can tell that they are very short-staffed. The phone in my room is out of order, the air conditioning cannot be turned off and the room is freezing. An engineer comes and lays some towels over the vents to try to rectify the situation. The bedside light switch doesn’t work. The foot end of the bed will not go up and down as advertised. The toilet roll holder falls apart when I touch it. I think I have become something of a hospital snob.

I don't want to stay here any more. I'm delighted when the phone rings. It's Sheldon, "Lily, I'm downstairs."

Carry On, Doctor

Back to the hospital. I feel I should simply move in here to save the running up and down. My chauffeur-du-jour is the lovely Carlton, boyfriend of my equally lovely friend Sheryl. These two have been together for ever and a day. I’m pleased to say that they’re to be married in December. Pleased for me, that is – I love going to weddings.

Nurse Diana is on duty today. She greets me with a big kiss on each cheek. Mr Hadjiminas extends his hand. “I can explain,” I blurt, pulling the big pink bandage from my handbag and brandishing it at him. “I took it off. It was squashing my new breast. I was worried that it might become permanently deformed.” Mr H looks aghast. “I’m wearing the compression bra,” I add, as if in mitigation.

“Well let’s have a look at you,” says Mr H. I strip to the waist and he prods my back. “Much better...” Rather than admonish me for being neurotic Mr H takes a conciliatory approach. “Maybe we can put some padding inside the bandage to support your breast?” he muses, “Or cut a hole in it?” He sits down behind me. The couch tips precariously in his direction. “Don’t get up!” shouts Diana, “Lily will go flying into the wall”

“Steroid,” says Mr H. Nurse Diana holds up an ampoule and a syringe. “Expiry 2014” she reads from the label. “What, so we’re using unexpired stuff these days?” comments Mr H. As he inserts the needle into my back I try to hold still but I can’t. My body is just shaking with laughter.

Nana to the Rescue

I wake up rested, sans elastic bandage. Oh dear. What have I done? How am I going to get the thing back on again?

With relief I remember that Nana is coming to clean the flat this morning. I will ask her to help me. In the meantime I’m going to have a long, long, hot, hot shower and wash my hair.

That's Enough of That

3 a.m. I’m hot. I’m sweaty. I’m itchy. I’m uncomfortable. Damn it, I’m wide-awake. Aargh. I rip the elasticated pink sausage-skin from my body.

Who ever knew that lying naked in a cool cotton sheet could be such utter bliss?

The Princess and the Pea

I’ve been asleep nearly all day. That’s because I didn’t sleep one wink last night. The big pink elastic bandage is lumpy, itchy, and hot. I feel this is shaping up to be a long week.

Elastic Fantastic

I’m back at the hospital, again.

Honoria has returned! Whilst I was away she gave birth to a baby boy, Francis. He is six months old already. Honoria’s face lights up when she sees me. I feel the same way. “Did you have a lovely holiday in Australia?” she asks. 

Mr H cuts me out of yesterday’s bandages. I’m free. But not for long. He produces a strip of soft pink elasticated fabric about 30cm wide. It has velcro fastenings on each end. “What’s that?” I ask. “You know when people have abdominal surgery?” says Mr Hadjiminas. I nod. “When it bursts, this is what we use.” Having planted that hideous image in my mind he then gets a giant needle and injects some kind of steroid into my back. Mr H and Honoria each take an end of the big pink binding. “I don’t think we’re going to get her into it,” says Honoria. “Oh, yes we will,” ripostes Mr H. Mental note: must cast these two in the Chemo Chic Christmas Panto. They pull and stretch it tightly around my entire upper torso. My breasts are squashed flat and, if that wasn’t bad enough, my stomach is forced downward creating a wobbly muffin top. Chemo Chic this thing definitely is not.

“We may have to do another steroid injection but keep this on for a week and see how it goes.”

Back at home it’s already beginning to irritate. Ben has come round for dinner. “Can you just unzip my dress and try to pull the velcro so that it’s not rubbing on my skin?” Ben obliges. He is like my brother but I can’t be asking every passer by to adjust my surgical appliances. And I still haven’t solved the problem of how to have a shower.

All Wrapped Up and Nowhere to Go

                                         La buena fama durmiendo ©Manuel Alvarez Bravo

Right-o that’s the bandages applied good and proper, I can hardly breathe. But at the same time there’s something comforting about being wrapped up all tight like a baby in swaddling.

It Feels So Old A Pain

I’m a bit down today. This afternoon I went to see Mr Hadjiminas for a check-up following last week’s surgery. I've had high hopes that my back will soon be smooth and healed. But it has started to fill up with fluid again. First Mr H removes all the sticky dressings as carefully as he can. It is just not possible to get those buggers off without a certain amount of theatrical wincing and ouching. He then drains the fluid with a big needle. That does hurt.

“I’m trying not to be despondent,” I say with a despondent sigh. “Good. It’s early days yet,” says Mr H. He wants me to go back tomorrow so that he can rig up some kind of pressure bandage. But it seems that I won’t be able to wash without removing it. “Do you have anyone at home who can help you to put it on nice and tight?” Well no, I don’t. Suddenly I get quite upset. I just want all this to be over and it’s not. I don’t want a visible reminder that I’ve had breast cancer. I don’t want to live with a constant low-level of pain and discomfort. I don’t want to struggle on my own and not be able to wash because there’s nobody to help me put my bandages on. I hate Nick for leaving me alone. I’m so disappointed that I allowed him to take the place in my heart and in my life that should have been reserved for someone decent who might have loved and cherished me.

Home, Again

The surgery went well. I am very relieved. Back at home now. Sleeping a lot. Let's catch up tomorrow...

Back, again

Summer is here but the swelling in my back has not improved. I’m finding it impossibly uncomfortable to sit in a chair or lie on my side in bed. Like Mr Hadjiminas said, it is time to deal with it. Tomorrow I am returning to the Harley Street Clinic for surgery. Wish me luck.

New Boobs for Old

Mum Skyped this morning with news of a breakthrough technique for re-growing breasts after surgery. Pretty soon the emails are coming in thick and fast from readers in Aus with more details.

Yes, you read that correctly. Scientists are carrying out trials to re-grow the breasts of five women who have had mastectomies. The idea is that they insert a little pocket of some synthetic material into one’s breast and then inject fat stem cells. The fat grows and multiplies until it fills out the pocket.

I suppose then that a person must subsequently stay off the chocolate éclairs for life or run the risk of developing one huge, obese breast.

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.

Dressing For Chest Drains

After the success of my corridor walk yesterday afternoon, Nick was keen to egg me on to higher achievements. He suggested that we aim to go out of the hospital today. I was excited by the idea. “We could walk down to the Providores and have tea,” I exclaimed.

“Only, what am I going to wear?” It’s interesting how quickly one falls out of the habit of getting dressed. Whether on holiday or in hospital I’m always quite happy to wear the minimum required. For the past few days I’ve been dressed only in my compression bra and a pair of stretch jersey shorts.

The physiotherapist came to see me a couple of days ago. She gave me a leaflet entitled Exercises After Breast Surgery. She told me that many women end up with a very restricted range of shoulder movement because they do not do their exercises after breast surgery. It was interesting to see that most of the illustrations in the leaflet were of much older women. It brought home to me the fact that being diagnosed with breast cancer before the menopause is still relatively rare. More than 80% of breast cancers occur in women over fifty. The leaflet illustrated five different breast surgery survivors doing their exercises: an elderly white lady, probably in her eighties, with long hair; another white lady in her eighties, with short hair; a lady of African origin, probably in her seventies, with short hair; a younger white lady, probably in her late forties, with shoulder length hair and, finally, a middle-aged man with a beard. I was impressed by the thorough inclusiveness of the leaflet designers.

Since the physio’s visit I’ve been assiduously doing my exercises. They’re quite simple, for example: brushing my hair, drying my back with a towel or raising and lowering my elbows to shoulder height. But I don’t think I could put anything on over my head. I will need an outfit that is comfortable and easy to don, that covers up the bandages and the compression bra.

I instructed Nick to bring a pair of black leggings and a voluminous white pirate shirt that buttons down the front.

Mr Hadjiminas visits every morning, always wearing a tailored suit. This morning he expresses great satisfaction with my progress, going so far as to call me his “star patient.” I think that great doctors are defined not just by their brains and technical skill but also by their ability to enrol patients in their own recovery. Mr H certainly fits my great doctor criteria. His enthusiasm in turn encourages me to make every possible effort to get back to vibrant health.

Flossie arrives. It’s more of a morning fly-past than a visit. She lingers just long enough to knock back a caffè latte and drop off her latest gift to me - a sparkly silver bat-winged top with a V-neck. Now I can guess what you’re thinking: “That Flossie has finally lost the plot. Tipped right over the edge, so to speak. You're in the hospital, not auditioning for Saturday Night Fever.” I hear you. When I open the bag I have to look long and hard at the sparkly silver top and then remember to close my mouth. But wait a minute. The top is loose enough to wiggle into without too much trouble, the batwing sleeves are not too restricting, the V-neck exactly covers the neckline of my compression bra. Flossie is a genius. She has discovered the perfect post breast surgery attire.

When Nick arrives he helps me into the silver top and leggings. It’s really a smart look. Then I regard the two tubes protruding from my waistband with drainage bottles attached. “The whole outfit will really be let down by that Pret a Manger sandwich bag,” I observe. Nick shoots me a look of excited triumph and then produces a black crocodile Bruno Magli handbag. Nick has been through my wardrobe and picked it out himself. The two bottles fit perfectly inside.

First Surgery

I had surgery yesterday

At 2.30 Nick and I arrived at the Harley Street Clinic. It is actually a whole bunch of Georgian Houses in Harley Street with the main hospital in Weymouth Street. A lot of the Georgian Houses seem to be connected by underground tunnels.

First, we went to see Mr Hadjiminas. Mr H injected me with some kind of tracer that will show him the way to the sentinel lymph node. I am learning lots of things in a very short time... We all have a series of lymph nodes under our arms. One of their jobs is to catch and filter out nasties from the lymph. The very first one that drains from one’s breast is called the sentinel node.

The latest fashion amongst breast surgeons is to remove the sentinel node and examine it to see if it contains any cancer cells. If the sentinel node is clear, then the cancer is unlikely to have spread any further. Hence it will not be necessary to remove all the other lymph nodes. And if the cancer has not spread, there is no need for chemotherapy.

Next, we went down into the labyrinthine basement for an ultrasound scan. I changed into the standard issue blue patterned back fastening robe and gown monogrammed with HSC. Fabulous with a pair of Marc Jacobs pumps. I guess they monogram the gowns so that, if one absent-mindedly wanders off into the West End, the staff at Selfridges will know where to return one to.

As we sat in the tiny waiting area we heard a most distressing wailing and crying coming from the ultrasound room. Nick and I looked at each other in alarm. Then a young woman and her husband appeared. She was clearly about eight months pregnant and her eyes were wet with tears. She sat down and stared at the floor whilst her husband held her hand. I was horrified to even imagine what terrible news they had just received. I wanted to say something or to give her a hug but it felt too intrusive. I tried some empathetic glances but could not catch her eye. We all sat silently in the tiny waiting area together, then my name was called.

Another jolly female doctor applied the goo and then the scanner head, searching for my sentinel node. We pointedly avoided mentioning the previous occupant of the couch. By way of making conversation the doctor asked me who my surgeon is, although the answer was right there in my notes. “Mr Hadjiminas” I replied. “You’re lucky” she said. “If I had to have breast surgery I would definitely want him to do it.” I can’t tell you how comforted I was by that remark.

Scan done, I dressed and we were shown through the subterranean corridors to a lift. It brought us out into the main hospital reception area. I booked in and we sat down to await a porter. My mind returned to the pregnant lady. No matter what one is facing, there is always somebody worse off. “Did you happen to find out what was the matter with that poor lady?” I asked Nick. “Oh yes,” he replied in a cheerful tone, “she just found out she is having a baby. She had thought that she had a growth in her stomach. She was crying and wailing with joy.”

The porter escorted us upstairs to a room. This was unlike any hospital room I had ever previously experienced. It was sunny and light with big windows. On the bed were slippers, a pair of paper knickers, a robe and a pair of pressure stockings. There were menu cards to be filled in. The bathroom was stocked with white towels and mini toiletries. It was like a very clean hotel room. And there was only one occupant – me!

Exploring the room and changing into the kit helped to keep my mind occupied. We ordered tea for Nick and switched the telly on. A nurse came in to do my observations. She swabbed my nostrils to test for MRSA. It is the policy of this hospital to test everyone on admission. If they find the super-bug up one’s nose they will either defer one’s admission or, if that is not possible, treat one in an isolation unit. Why don’t all hospitals do this?

Before we knew it, Mr Hadjiminas had arrived. One thing I’ve noticed about Mr H is that he loves getting me to take my top off. I stripped to the waist. Mr H produced a big black felt-tip pen and marked a circle on my left breast around the area where the MRI scan had shown the tumours to be. Then he drew a huge black arrow from my shoulder pointing to my breast. I looked at him quizzically. “They won’t let you into theatre without that” he said. It may have looked comical but I was greatly reassured by the thoroughness of the procedures here.

Soon, a very professional theatre nurse came to take me ‘downstairs.’ We waved goodbye to Nick as the lift doors close. I was trying to be all light hearted and cheerful but I felt sick. Then we were back in the underground corridors. As I walked with the nurse in my gown and slippers scenes of final walks in those death row movies came to mind. The Green Mile for example. Except, I reminded myself, this was a walk to save my life.