ONE YEAR AGO
My work diary for 26th March 2014:
10.30 am Meeting with Help The Hospices
2.30 pm Breast clinic
"Ah, you are in today!" my manager smiled, bumping into me at lunchtime. I'd been out all morning at that meeting in Central London.
"Yes, but I'll be out and about this afternoon," I said vaguely. "I've got a few things to do in the hospital."
She didn't ask further and I didn't expand. I had briefly mentioned my lump to my sister, and we had assured ourselves that this was going to be a cyst-busting exercise. I hadn't told anyone else. What's the point of worrying people needlessly? So I let my manager think that I'd be off doing research-type things around the hospital. I'd make up the lost work time some other day.
I wasn't quite ready at 2.30 pm. I was working on a research proposal and had hit upon a brilliant article that made me re-think my methodology. No matter: there was bound to be plenty of waiting involved. I went downstairs and across the road to the breast clinic, housed in its own separate building, with the brilliant article and a notepad in my bag.
The breast clinic waiting room: plenty of waiting indeed.
A busy place with its own little coffee shop. All sorts of people coming and going (mostly, but not exclusively, women of course), people's name being called, people's name being announced bright and clear on an electronic name-calling board. I sat there hoping that my name wouldn't be flashed up like that, to be seen and studied by all and sundry - what else can you do in a waiting room - but most of the time, I cocooned myself in the world of research methodology, getting rather excited about my new ideas.
I was sitting there as a professional, part of the hospital system. That waiting room was simply an extension of my office. I'm not like the others in the waiting room, surely. I'm not clutching an outdoor coat or a How to get here leaflet.
I certainly wasn't worried. Illness only happens to patients, not to staff. The work badge in my handbag, surely, would protect me from all that.
First of all, the consultant. [This was going to be my surgeon, but I didn't know that then.]
She prodded for a split second and announced, "Ah yes, there it is. Small. Clearly defined. Mobile."
(Exactly like my GP had said, and in the same reassuring tone of voice. Small and clearly defined and mobile is promising, apparently.)
"Go and have a mammogram first, then an ultrasound, then come and see me again."
Second, the mammogram.
Never a pleasant affair, but I've had one before so I knew what to expect.
[Chaps: thank your lucky stars that your private parts don't have to be squeezed and squashed between two plates, flattening them like a pancake.]
Third, the ultrasound.
The radiographer was very jolly, waving me in.
"Your mammogram looked fine," she beamed at me.
The ultrasound (similar to what you get in pregnancy) started in an equally jolly mood. I craned my neck and she explained what I was looking at on the screen, presumably just in case I would mistake my ribs for a massive tumour.
And then there it was, a clear darkening. She looked, readjusted her jelly-covered probe, looked some more.
"Does it not look like a cyst?" I asked, but I knew the answer already, because a cyst is a clear and distinct closed sac, and this looked neither clear nor distinct.
"No, it's not a cyst," she said. "It is quite a small mass, but dense, with rough edges."
She went to get the consultant from next door. They both looked at the screen. Hm. Not sure. Better take a biopsy, send it to the lab.
[Looking back, this is when I knew it was cancer. Really. Dense mass? Rough edges? Needs a biopsy? Clue, clue, clue. But I didn't spell out this strong strong suspicion of my diagnosis. My diary continues thus...]
Still, I couldn't see myself as a patient and I couldn't help being the professional, chatting away about my work. It's always an interesting conversation with doctors and nurses treating me or my relatives: What do you do? I'm a nurse, I do research, I write, I wrote a book on how to break bad news.
(I keep thinking that next time, I won't tell the staff that I'm a healthcare professional, but when it comes to it, I always do, because otherwise I'm turned into an ordinary patient, and that won't do.)
The healthcare assistant, new to the job, got all excited about my explanations that we had produced a picture book about breast screening and cancer treatments for people with learning disabilities. We had someone in last week, it was really difficult, she had autism, she couldn't cope with the mammogram. How come my very own hospital doesn't use this book in its breast screening department? We chatted cheerfully whilst I tried to ignore the small matter of the biopsy, the cells being taken out of my lump.
(For the record: a biopsy under ultrasound involves more poking around than I anticipated, and the grabbing of breast tissue makes such an alarmingly loud noise that being shot at springs to mind.)
I asked the radiographer about the mammogram. How come there's such an obvious mass but the mammogram looks fine? It's to do with the density of your breast tissue, apparently. Because the mammogram is a picture of the whole breast, not just a slice of it, it's difficult to see any thickly clustered cancer cells if the normal cells around them are also fairly thickly spread. Especially if, as may be the case, the normal cells look very similar to the cancer cells.
[I'd never heard of this before, a very obvious lump that is invisible on the mammogram. It didn't reassure, but I discussed this with the radiographer as a matter of interest, nothing to do with me, really, just something to store away and bring up in conversation: Did you know that...]
The consultant again.
"Come back next week, 11.30am, we'll have discussed your results in the team meeting beforehand."
I am completely with it. I have understood the implications of this not being a cyst. I know it could still be a benign lump, it could, it could easily be. But I also know that it might not be.
It might be cancer.
I ask her: "If it is cancer, what will happen next?"
I have to go to Holland, see my mother, take my son to a rowing camp in Amsterdam, collect my older daughter who is staying with my sister, perhaps give a lecture on how to break bad news (although I don't alarm her with the topic of my lecture). I get my diary out, put it on her desk, show her how busy I am.
She says: "Whatever it is, we will sort it out. It is very small, only 1.2 cm."
[I can still hear her say that. Whatever it is, we will sort it out. A very clear indication that the consultant herself thought it was cancer, without saying so. Oh, I knew, really, but the knowledge couldn't breach the barrier in my brain.]
I nod. I leave. Thank you very much, see you next week. All this has taken several hours. It is now past 5 pm.
And then, on my way back to my office, I can suddenly feel my skin prickle with tears trying to push their way out.
That bizarre feeling that everything around me is so very clearly outlined and I am not part of it. Here I am, walking past our reception desk as I have done so often before, but it is a different reception desk and the receptionist is a different person. The world contracts and expands around me. I feel as if I am falling off the edge of it. I am beginning to shake uncontrollably.
What I need, I realise in my state of sudden distress, is someone to tell.
So I knock on my manager's door. She rushes towards me, away from her computer, when she sees my face, Oh no, what's up? Thank goodness for this wonderful person who is lovely and supportive and a nurse to boot, so I don't have to worry about protecting her.
I sink into a chair and cry all over her office.
To be continued...
My work diary for 26th March 2014:
10.30 am Meeting with Help The Hospices
2.30 pm Breast clinic
"Ah, you are in today!" my manager smiled, bumping into me at lunchtime. I'd been out all morning at that meeting in Central London.
"Yes, but I'll be out and about this afternoon," I said vaguely. "I've got a few things to do in the hospital."
She didn't ask further and I didn't expand. I had briefly mentioned my lump to my sister, and we had assured ourselves that this was going to be a cyst-busting exercise. I hadn't told anyone else. What's the point of worrying people needlessly? So I let my manager think that I'd be off doing research-type things around the hospital. I'd make up the lost work time some other day.
I wasn't quite ready at 2.30 pm. I was working on a research proposal and had hit upon a brilliant article that made me re-think my methodology. No matter: there was bound to be plenty of waiting involved. I went downstairs and across the road to the breast clinic, housed in its own separate building, with the brilliant article and a notepad in my bag.
The breast clinic waiting room: plenty of waiting indeed.
A busy place with its own little coffee shop. All sorts of people coming and going (mostly, but not exclusively, women of course), people's name being called, people's name being announced bright and clear on an electronic name-calling board. I sat there hoping that my name wouldn't be flashed up like that, to be seen and studied by all and sundry - what else can you do in a waiting room - but most of the time, I cocooned myself in the world of research methodology, getting rather excited about my new ideas.
I was sitting there as a professional, part of the hospital system. That waiting room was simply an extension of my office. I'm not like the others in the waiting room, surely. I'm not clutching an outdoor coat or a How to get here leaflet.
I certainly wasn't worried. Illness only happens to patients, not to staff. The work badge in my handbag, surely, would protect me from all that.
First of all, the consultant. [This was going to be my surgeon, but I didn't know that then.]
She prodded for a split second and announced, "Ah yes, there it is. Small. Clearly defined. Mobile."
(Exactly like my GP had said, and in the same reassuring tone of voice. Small and clearly defined and mobile is promising, apparently.)
"Go and have a mammogram first, then an ultrasound, then come and see me again."
Second, the mammogram.
Never a pleasant affair, but I've had one before so I knew what to expect.
[Chaps: thank your lucky stars that your private parts don't have to be squeezed and squashed between two plates, flattening them like a pancake.]
Third, the ultrasound.
The radiographer was very jolly, waving me in.
"Your mammogram looked fine," she beamed at me.
The ultrasound (similar to what you get in pregnancy) started in an equally jolly mood. I craned my neck and she explained what I was looking at on the screen, presumably just in case I would mistake my ribs for a massive tumour.
And then there it was, a clear darkening. She looked, readjusted her jelly-covered probe, looked some more.
"Does it not look like a cyst?" I asked, but I knew the answer already, because a cyst is a clear and distinct closed sac, and this looked neither clear nor distinct.
"No, it's not a cyst," she said. "It is quite a small mass, but dense, with rough edges."
She went to get the consultant from next door. They both looked at the screen. Hm. Not sure. Better take a biopsy, send it to the lab.
[Looking back, this is when I knew it was cancer. Really. Dense mass? Rough edges? Needs a biopsy? Clue, clue, clue. But I didn't spell out this strong strong suspicion of my diagnosis. My diary continues thus...]
Still, I couldn't see myself as a patient and I couldn't help being the professional, chatting away about my work. It's always an interesting conversation with doctors and nurses treating me or my relatives: What do you do? I'm a nurse, I do research, I write, I wrote a book on how to break bad news.
(I keep thinking that next time, I won't tell the staff that I'm a healthcare professional, but when it comes to it, I always do, because otherwise I'm turned into an ordinary patient, and that won't do.)
The healthcare assistant, new to the job, got all excited about my explanations that we had produced a picture book about breast screening and cancer treatments for people with learning disabilities. We had someone in last week, it was really difficult, she had autism, she couldn't cope with the mammogram. How come my very own hospital doesn't use this book in its breast screening department? We chatted cheerfully whilst I tried to ignore the small matter of the biopsy, the cells being taken out of my lump.
(For the record: a biopsy under ultrasound involves more poking around than I anticipated, and the grabbing of breast tissue makes such an alarmingly loud noise that being shot at springs to mind.)
I asked the radiographer about the mammogram. How come there's such an obvious mass but the mammogram looks fine? It's to do with the density of your breast tissue, apparently. Because the mammogram is a picture of the whole breast, not just a slice of it, it's difficult to see any thickly clustered cancer cells if the normal cells around them are also fairly thickly spread. Especially if, as may be the case, the normal cells look very similar to the cancer cells.
[I'd never heard of this before, a very obvious lump that is invisible on the mammogram. It didn't reassure, but I discussed this with the radiographer as a matter of interest, nothing to do with me, really, just something to store away and bring up in conversation: Did you know that...]
The consultant again.
"Come back next week, 11.30am, we'll have discussed your results in the team meeting beforehand."
I am completely with it. I have understood the implications of this not being a cyst. I know it could still be a benign lump, it could, it could easily be. But I also know that it might not be.
It might be cancer.
I ask her: "If it is cancer, what will happen next?"
I have to go to Holland, see my mother, take my son to a rowing camp in Amsterdam, collect my older daughter who is staying with my sister, perhaps give a lecture on how to break bad news (although I don't alarm her with the topic of my lecture). I get my diary out, put it on her desk, show her how busy I am.
She says: "Whatever it is, we will sort it out. It is very small, only 1.2 cm."
[I can still hear her say that. Whatever it is, we will sort it out. A very clear indication that the consultant herself thought it was cancer, without saying so. Oh, I knew, really, but the knowledge couldn't breach the barrier in my brain.]
I nod. I leave. Thank you very much, see you next week. All this has taken several hours. It is now past 5 pm.
And then, on my way back to my office, I can suddenly feel my skin prickle with tears trying to push their way out.
That bizarre feeling that everything around me is so very clearly outlined and I am not part of it. Here I am, walking past our reception desk as I have done so often before, but it is a different reception desk and the receptionist is a different person. The world contracts and expands around me. I feel as if I am falling off the edge of it. I am beginning to shake uncontrollably.
What I need, I realise in my state of sudden distress, is someone to tell.
So I knock on my manager's door. She rushes towards me, away from her computer, when she sees my face, Oh no, what's up? Thank goodness for this wonderful person who is lovely and supportive and a nurse to boot, so I don't have to worry about protecting her.
I sink into a chair and cry all over her office.
To be continued...
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