1. Of breasts and mothers

Seven days ago, I lost my right breast to cancer.

Three days ago, I lost my mother.

There is no doubt in my mind which of these is the significant loss. One is only skin-deep; the other touches my soul. I have not focused much on my missing breast. I have focused everything on my dying mother.

That feels like a long road travelled since the day, just over two months ago, when I was given a diagnosis of breast cancer. It’s been a bumpy road where each time I got my head round the new view, another twist changed my outlook afresh.

The small breast lump that everyone (including doctors) thought was an innocent cyst turned out to be cancerous. The operation to remove the lump and spot-test one lymph node brought a smiling surgeon to my bedside: all went well, the cancer was out and the lymph node looked fine.

Two weeks later, once everything had been properly peered at through a microscope, the now non-smiling surgeon had to tell me that the breast tissue actually looked rather dodgy, so best to take the whole breast off. And alas, that happy looking lymph node did have some cancer cells lurking in a corner, so all the other nodes should come out too.

I was flabbergasted at this bad news and could only nod tearfully. Yes, of course, mastectomy on 30^th of May. Fine.  I had a week to get my head around the fact that my cancer wasn’t as well-behaved and well-contained as we thought.

During that week, my sisters and I started worrying about our mother.

We had worried many times before, but things sounded so much more serious now.

My mother was 84. This strong woman, who had raised three daughters single-handedly and thought a 60-mile cycling trip was a lovely day out (even in her late 70s), had been increasingly frail during the past few years. Now in a nursing home, she was visibly fading.

My mother and me, just days before I was given my cancer diagnosis in April 2014

What if she died when I was incapacitated by surgery? She lived in my native Holland. I live in London with my husband and three teenage children. My mother’s sister died when I was in hospital with the lumpectomy, and there was no way I could make it to the funeral. They don’t hang about in the Netherlands. People are buried within a week.

So I travelled to Holland to talk to my sisters about end-of-life choices and funeral plans, just in case, and to visit my mother briefly.  Then, on the day I was there, she took a significant turn for the worse. I am a palliative care nurse. I recognise the signs.

I could see that she was dying.

If you had to choose between staying with your dying mother, or putting the North Sea between the two of you in order to have life-changing and potentially life-saving surgery, what would you choose? I sat in my mother’s room with my sisters and the family doctor, devastated by this choice. “Am I right in thinking”, I asked the doctor, “that if I have my mastectomy the day after tomorrow, there is a good chance I will miss mum’s dying?” Yes, he said. You are right.

I rang my surgeon there and then. She is everything a surgeon should be – competent, clear, honest, good at communicating, and compassionate. “Don’t worry,” she said. “You have a bit of time. I will put you on the surgical list for 10^th June instead.”

I decided to return to London briefly, not to prepare for a hospital admission, but to pack a proper suitcase. I had only brought a clean T-shirt and a pair of underpants in my hold-all. I was still recovering from the previous surgery and had travelled as light as possible.

This time, I packed not only a better supply of underpants but also a funeral outfit. Best be prepared for all eventualities.

On what should have been Mastectomy Day, I was sipping a cup of coffee, looking down at my breast which I had been so sad to say goodbye to, but which now suddenly seemed to be outstaying her welcome. I flew back to Holland with a suitcase full of funeral music and a heart full of emotions that did not have a name.

That week, spent at my dying mother’s bedside, was one of the most difficult, beautiful and meaningful of my life.

My sisters and I grew ever closer. We talked and talked and talked, we cried, we laughed, we hugged, we sent each other off to have some breathing space.

I shared my nursing skills with them so we could all care for my mother with tenderness and competence, and without fear.

And we sat with our mother as a lifetime of experiences, worries, fears and love worked its way to the surface, emerging through her muddled speech and troubled eyes. We had moments of heartbreak at our mother’s struggle to accept that her life was ending. We had moments of indescribable bliss as she worked her way towards trust, relaxation and infinite love for us, her daughters: brief glimpses of heaven.

During that exhausting but important week, the 10^th June crept ever closer. My mother was clearly dying, but she did not find it easy and it took her a long time. It was devastating to sit there leafing through the diary again and again, calculating how soon we could have a funeral in order to fit it in before the mastectomy, or how late we could have it in order to give me time to recover in London and return to Holland… When would she die? How long could I postpone this operation? How long did I want to postpone it?

My mother was the only person in the world whom I had protected from knowing about my cancer, because for the past few years her brain had been unable to process complex new information, unable to put worries into perspective. She was now drifting in and out of the here-and-now. Her overriding concern that week was for me (“Is Irene alright?”) and my children (“You mustn’t leave them on their own”). She was hugely comforted by my presence, but disconcerted at the same time: why wasn’t I with my own family? Shouldn’t a mother be with her children, always?

In the meantime, my friends and family agonised about my health. I cried with my sisters about these impossible choices. There was my love for my mother and sisters and my desire to be with them on this journey towards her death; and there was their love for me and their need to see me off on my own journey towards ensuring a long and cancer-free life.

In the end, when I spoke to my surgeon again who said I had to make a decision (go ahead with the operation on the 10^th June, or postpone it for another week), I knew I had to say goodbye to my mother and trust that all would be well, for her, and for me. This woman, who had survived hardships for the sake of her three children, now needed to know that her grandchildren were safe, loved and cared for. If she had known about my cancer, she would be insistent that I went back to London for treatment.

The mastectomy was no longer a devastating operation. It had become something that had to be fitted into the diary. I was almost looking forward to having it done, so I could focus again on the more important business of family bonds.

I said a heart-wrenching but beautiful farewell to my mother on Sunday evening. We both knew this was the last time, and I felt that she was sending me home with all her love and a blessing. (No sign of confusion now.) I flew back to London on Monday. I was on the operating table on Tuesday morning.

Back on the ward, I could not bear any gaps in the curtains around me. I could not cope with the day-to-day chatter coming from the other beds. I needed to crawl into my own little hole. I hated the thought that people would see my tears and assume that they were for my lost breast. I could look at my bandaged empty chest without distress (on the contrary, I almost felt relief, as if I was finally the shape I was meant to be, evidencing the positive choice I had made).

So if one of the kind nurses or doctors asked how I was, post-mastectomy, I was fine. But if they asked how I felt generally, I choked on my tears: “My mother is dying and I had to say goodbye to her.” That was my overriding emotion.

I have never felt more vulnerable in my life, never in more need of care and support. Here I was, having nursed my mother all week, and now so weak I needed others to nurse me.

My first recovery week has been focused on being with my family, rejoicing in being back with my husband and children, phoning and emailing my sisters several times a day.

Yes, I have stood in front of the bathroom mirror in my full glory, and called my husband so I could cry on his shoulder at the stark sight of the new one-breasted woman I have become. Those were tears of loss, but not only of loss. Underneath the bandages I could see signs of hope for the future: hope of a life lived because of the choices I have made. Those choices were made out of love, for myself and for my family and friends.

And when my mother died at last, she died peacefully, with one of my sisters at her bedside who held me on the phone, across the sea, intimately close. All was well.

Now, when I look at my chest, I do not see emptiness.

I see the fullness of life and the bonds of love stretching far beyond death. I don’t know how all this will be in the future, but for now, the loss of my breast, the loss of my mother and the sustaining love of my family are intrinsically linked.

The steri-strips are gradually falling off, revealing my long flat scar. I look at it now, I trace its length with my fingers, and I am almost grateful.

I may have lost a breast, but it is the loss of my mother that has truly marked me.