A glamorous blonde sweeps into the room, all floating scarves, armed with a bag of tricks to while away a weary day. “May as well sing it as cry it,” she announces to those around her. “Keep the sunny side up.” A younger woman beside her in the bay purses her lips and says nothing.
And you look good doing it,” says another woman supportively.
“Bit of auld makeup,” she says dismissively, her defiance bullish in the medicinal hush.
An officer about to go over the top into the No Man’s Land that is a breast cancer diagnosis, twinned with the early weeks of a global pandemic. Something that looks so terrifying, so ludicrous, written down that it’s almost funny. You might as well sing it as cry it — she is quite right about that.
A sudden diagnosis comes down like a suffocating blanket over the head.
I think I’ll be going back to work that wet, grey morning at the end of November 2019. I have three young children. A dog. A man is coming to service the boiler. Christmas is coming too. There is barely a moment to spare. Then a medic draws her probe across my breast to reveal — even to an uninitiated person like me — an unmistakable tumour, almost toadstool-like, with a sinister swoop to its formation, clearly hell-bent on worldwide domination. Unignorable, at long last. And my world bottoms out.
“I shouldn’t be telling you this but I’m not going to lie to you. You’re going to need surgery,” she advises urgently. But of course, I already know by now, so I say thank you and I mean it.
I always thought that things would be different when you hear the word “cancer” for the first time. The funny thing is, I don’t actually remember them using that word. At least, not at first, and by the time they do, I don’t really notice. Instead, they speak of invasive ductal carcinoma. Stage one. Grade two to three.
It was one night last summer when I was struck by something about the structure of my ribcage that I had never noticed before. Instead of lying flat, it seemed to curve snugly up in one spot, towards the centre. Curious. I shrugged it off but something brought me back to that place again and again, exploring with a fingertip this feature that must have been there all along. Because if it was a new thing, I’d realise. Of course I would.
I was only 44 and there was no breast cancer in my family. I exercise. I do all the things they advise you to do to prevent breast cancer. This was clearly a non-event.
I put it off. And I can’t explain that now.
I carry the letter of referral from my GP around with me for a long time before I actually get around to doing anything about it. When it gets a bit ratty from being bashed around my handbag, I transfer it to my bedside locker to keep it safe. I’m going to send it off. Of course I am. But I don’t have any stamps right now and I can’t seem to find the time to make it to the post office because I really am pretty busy. These really were my excuses.
A whisper starts inside me that something is wrong, though.
I start to feel tired. Weirdly tired. Even if I have an easy day, I go to bed as exhausted as if I’d had a mammoth one.
And then one night, in October, I get a fright. The lump has grown. There is no denying it now. It is time to wise up. I find the letter again and smooth out the creases, and put it in an envelope. Again, for reasons I cannot quite explain, I still don’t post it right away. I carry it around for another week or so. But the voice inside me has turned to an urgent scream by now and, eventually, I go down to the post office to purchase a stamp and, finally, push it down into the post box almost with a sob of relief. Then I wait.
When the oncologist asks if I’d felt any different during this time, I mention the tiredness but add that it was probably nothing. She shakes her head, saying, “The longer I do this job, the more I hear that.”
Playing chicken with a potentially lethal tumour. No, not something I could possibly recommend.
After my diagnosis, I try to go back to my normal life for a bit as I wait for them to come up with a plan. But it’s impossible now that breast cancer is my constant companion. It’s now bigger than anything else in the room. And it’s certainly bigger than sleep.
In some ways, perhaps, I was “lucky”. My treatment began just as Covid-19 was creeping into the country, unbeknownst, at the end of December. I was in the system by the time it took hold. Plenty of people were not so fortunate. And this is scary. From the moment a tumour is known about, there is a rapid acceleration, a palpable sense of urgency. You have become a problem to solve. Not just for one person. For a whole team of people. You are their job. And there may not be much time to waste. But if the tumour is not known about? What then?
Seamlessly and without my knowing, I acquire an oncologist, a surgeon and a radiologist. As time goes on, a cardiologist joins my squad, just to keep an eye. And a physiotherapist. Not to mention a host of skilled cancer nurses. All incredible, talented people driven to do their best to give their patients the best possible fighting chance. They’ll understand perfectly if I say I hope I never have to see them again. Aside from the check-ups, of course..
“Just have it in your head that next year is going to be a write-off,” advises a medic kindly on my first official appointment, preparing me for the onslaught of treatment. How much of a write-off it was to prove for all of us.
Part of the consolations of illness — and, believe it or not, there are some, perhaps even many — is the dazzling wave of kindness that engulfs you like a tsunami, buoying you up, leaving you breathless.
The friends that step up to the plate with a slew of text messages, consoling phone calls, lunch dates and comforting coffees as you attempt to digest this bizarre new reality, and mercifully distract you from the fact that life has just taken a sudden violent swerve into a ditch.
Theoretically, being sick while not actually feeling sick messes with your concept of reality. You’re being told that you are sick — and that medics will need to do battle on several fronts, trying all the weapons in their armoury, though all the while reassuring you that your prognosis is “excellent”. But you feel well. You feel normal, in fact. And then you start to wonder for how much longer you will feel normal, because it’s beginning to dawn on you that, any day now, the treatment will probably start to make you feel as sick as you actually are. And that’s a scary thought to try to wrap your head around: the anticipation of illness in the bid to make you better.
A plum stone of grief, hard and jagged-edged, has settled in my diaphragm. I can’t seem to shift it.
It’s coming up to Christmas and I expect to feel as lonely and as isolated as the year when I lost my mother very suddenly, again in the month of November, to an undiagnosed heart condition at the age of 49, and found it unbearably sad to be amongst festive crowds of shoppers.
But this time, when I watch the vast crowds milling on Grafton Street, I realise with a jolt that among so many people, there are bound to be hundreds of us, maybe even thousands, all suffering in our own way. Not just poor me, poor all of us. Now hardship makes me feel like I belong more to humanity, not less.
I am greedy, soaking up the Christmas spirit like I have never seen a festive season before; I am hyper-aware, even noticing the swirls of the bark on the tree on O’Connell Street.
My oncologist at St Vincent’s Private Hospital in Dublin is Professor Janice Walshe. She’s a bit of a superstar on the Oncology Day Care ward, combining supreme expertise and skill with warmth, compassion and humour. Not to mention style — which is not to be overlooked as a cheering-up mechanism when her patients are feeling gloomy.
When she asks when I had first noticed the lump, I say it was the summer. “But that’s very strange,” she exclaims. “It should have been growing much faster than that.” I say nothing because something inside me had told me that I was running out of time, not that it was too late. But, yes, that does sound pretty crazy.
A lesson, courtesy of cancer: worrying and procrastinating are way worse than doing something about it.
Of course, I ignore this as I embark on a habit more toxic than any hardcore chemo drug. I awaken every night — due to fear at the start, and then due to the uneasiness and agitation from steroids and chemo drugs — pick up my phone, and I start to Google, fuelling my worry almost to the point of frenzy. Occasionally, I find things that give me hope, but I zone in on the fearful stuff to the point of sheer exhaustion. I can’t help myself.
I start off basic because I really don’t have a clue about any of this. What is hormone-positive, HER2-positive breast cancer? Stage one breast cancer, prognosis? What are the side-effects of breast cancer treatment? Can I live a long life after breast cancer diagnosis? Night after night, I come up with endless new search possibilities.
As the months go on, I’m getting prompts about fresh articles in The Lancet about cancer trials and prospective new drug regimes. My phone thinks I have changed career.
“Nobody admits to Googling but everybody does it,” a nurse shakes her head grimly.
The only thing that makes things better and eases the worry, is — no, not to stay off Google, of course not — but to start forensically researching the good stuff. The positive steps I can take. The things that might help to stop this thing from coming back. And if not, well, at least I’ll have done my best. And so, now I’m taking cod liver oil, magnesium and vitamin C. I eat more cruciferous vegetables and I drink more green tea. I’m trying to fast at night for at least 13 hours. I’m running. I’m attempting to meditate — but it’s hard. All these things have been linked to breast cancer survival. They might help, or they might not.
I have two scars, fast-fading, almost invisible, but those aren’t the scars that bother me. In fact, I’m almost fond of them. Two darts in a vintage piece of clothing skilfully remodelled by the surgeon to bring it up to date. He seems a bit taken aback when I tell him that he did a good job but I mean it in an artistic sense, not medically.
The scar that can still make my stomach flip is the tiny pinprick from the biopsy on that very first day, when everything started to go wrong and I felt like I’d been gutted with a spiraliser, even though they’d barely laid a finger on me.
The numbness of disbelief had already begun to set in and so when the doctor withdrew the biopsy needle, saying, “Sorry now, I know that hurt,” I genuinely hadn’t felt a thing.
A week later, I am sitting before my new surgeon and I am stunned at the things he is saying. I would need chemotherapy, surgery and radiotherapy. I would be on Herceptin for a whole year. All this for one tiny lump? And afterwards, I would need to take a drug for five years called tamoxifen to try to stop it from ever coming back. My reply is shrill: “Five years?” He seems surprised that I am surprised.
Breaking the news to my children is the hardest thing I’ve ever had to do.
Two sumptuous silk pillowcases arrive in the post. A lumpy package from London bearing a trio of new books. A lavender spray to charm sleep. A huge pot of homemade chilli delivered to my door, complete with a bag of rice and tortillas. So many beautiful bouquets of flowers. A magazine I mentioned once in passing, slid silently under my doormat. A bounty of gifts and of kindness.
In my last week in work, I had returned to my desk to find a lovely journal with a hard silk-print cover, with the instructions that: “Writing is medicine for the soul.”
So, for the first time in a long time, I begin to keep a diary. Maybe it is the pretty pink cover that makes me feel that it is too nice to fill with a relentless catalogue of gloom. And besides, life as a cancer patient is much more than treatment. It actually turns out to be a year that is enjoyable in many ways. I find myself skimming over the bad stuff and noticing more and more things that please me — like the fact that the cherry tree I had planted a few years ago is, at last, deemed sturdy enough by a blackbird to use as a perch.
But some bad stuff creeps in nonetheless. “Pure chemicals. I am putrid. Disgusting. A broken cadaver washed in by a low tide, my bed a tangle of rotting bladderwrack.” I mean, you can imagine.
The first chemo session on December 30, 2019, comes as a body blow. I enter the ward feeling relentlessly chirpy, thinking I am coping like a trouper. But a nurse understands me more than I do myself. “Oh, you’re so hyper,” she sympathises, placing a comforting arm on mine.
I don’t lose my hair because I opt for the cold cap, which freezes your scalp. I do, eventually, lose a toenail. My eyes stream and I feel very weak for about 10 days each “round”. And then I spring miraculously back to life for the last week, before going through the cycle all over again. Sharing the experience with other patients one day, we settle on a word that best describes chemo: “miserable”. Not unbearable but not easily borne. Nothing shockingly bad but just a series of things you would much rather do without.
The mantra everyone hears is: “You’ll get through it.” And, you do.
The addition of the pandemic ball into the juggle of the hospital regime is barely perceptible, it seems to happen so gradually. The patients in the chemo ward don’t start to wear masks straight away. In fact, masks seem a little rude, at first. Like we don’t trust the hospital staff, or something. But by early March, fear looms large and everyone is already weary. Lockdown comes almost as a relief. And now everybody in the hospital wears a mask. Talk with other patients dries up to a trickle because it’s too hard to make yourself understood without facial expressions. My sisters can’t accompany me to the chemo sessions anymore. No visitors are allowed. That’s the saddest fallout.
We hear they are moving all of the cancer patients over from the main hospital to St Vincent’s Private to keep everyone safe from Covid. This sounds like things are going to get much busier. Instead, fewer and fewer people seem to be on the oncology day ward and the atmosphere is one of growing unease. In the unfamiliar new silence of the hospital, one day, I hear someone cry out.
One night, with two chemo sessions still left to go, I get a phone call from my oncologist. They are bringing my surgery forward because of Covid. It would be next week, on April 1, almost two months ahead of schedule. “I just want it out,” she says of the tumour.
The last two chemos are cancelled. But as it turns out, chemotherapy didn’t seem to work for me anyway. There was “no discernible effect” on the tumour, the examination afterwards revealed — a comment that leaves me in turmoil.
Once I get into hospital for the operation — a lumpectomy and sentinel lymph-node removal — I’m told that I’m very lucky. Amid the frightening unknown of the first lockdown, this is the last day they’re carrying out surgery. The corridors are eerily quiet as I’m shown to a room with a view over the Dublin Mountains. It feels like I’m one of the very few in here — and it turns out that I am.
I do feel lucky, but I am also petrified. As I’m wheeled into the operating theatre, I’m shaking uncontrollably. “I’d be the exact same in your shoes, the exact same,” the surgeon reassures me, with immense kindness, while also making me laugh.
Keen-eyed over her mask, the anaesthetist takes one look at me and says, “Don’t worry, I’m going to give you something nice. In fact, I’m going to give you two.”
Finding room for cancer is easy — everything in life shrinks away until all that is left to focus on are family and hospital treatment. It’s a minimalist experience. Throw in a pandemic and those horizons shrink even further, until life reaches the scale of a scene in a snow globe. Peaceful, yet fearful. Cosy, yet claustrophobic. But you can get used to anything. Even cancer. Even a pandemic.
And it wasn’t just the patients, obviously, who were affected by this. A nurse says she was walking with her family on the beach one weekend and she was telling them, “Isn’t it lovely.” “But it wasn’t lovely — I just wanted to be on my own in Brown Thomas, spraying perfume,” she says briskly, to cascades of understanding laughter. Turns out the worst thing about a blockbuster pandemic — so long as you don’t succumb, that is — is the monotony.
After the operation, I feel a weight has lifted. It’s gone. I don’t look much different. I won’t be getting any more chemo. The worst, hopefully, is over.
The radiotherapy a month later isn’t so bad, either. Then I start to try to concentrate on getting better. I start to walk longer and longer distances. Progress is slow but steady as I build myself back up. I start feeling good again. Two funny little chunks of new hair appear at the front. Turns out I did lose quite a bit after all.
In November, a year after it all began, a mammogram comes back, reported “normal”.
Mostly because of lockdown, I buy a treadmill and start to use a fitness app. I settle early on a nice, positive hill-climbing audio programme with a San Francisco-based trainer called Leah, who says things like, “Don’t let up on me here — you have come so far.”
She speaks to me. “It’s time to start thinking ahead. What’s on the other side of this mountain for you?”
Health, I answer silently. I go back again and again to her, even though there are plenty of other options, but I find her comforting.
Weeks go by and then I mention the app to my sister when she tells me I’m looking much better these days. “Oh, one of my friends from San Francisco is a fitness trainer on that app,” she says, interestedly. “Oh yeah?” I say. “Yeah, Leah,” she tells me.
And then, at last, comes my final Herceptin infusion in the middle of December. The blood-pressure check leaves tiny little haemorrhages on my right hand. With immaculate timing, it appears my body has had enough.
The click-clack of an elderly man’s chemo infusion. Almost peaceful, lulling. His face is written across with pain. And yet, as he closes his eyes, he smiles.
This place can be cosier than you’d think. The soft, confidential hush of talk between nurse and patient. The worst of life’s frights are dragged out into the open and examined in the glare of the overhead lights on the Oncology Day Care ward.
The soup is terrible today. The tea too strong. But this is a celebration. Private festivities for one. I’ve made it. This far, at least.
