Saturday, December 08, 2007

Picking a scab 'til it bleeds

I've had ten busy upbeat days since my ultrasounds came back clean and Professor Mokbel gave me the big post-treatment thumbs-up. I've had meetings, gone to dinner with friends, drank champagne on more than one occasion, lunched with colleagues, travelled to Barcelona and back again, and even had time to have a little operation somewhere in the middle of it all.

It has been ten days mainly filled with celebration. What I'm celebrating is the opening of a set of iron gates, in place since late March. I'm shedding the shackles of a constant cycle of treatment schedules, doctor's appointments and procedures.

But over the last two weeks, now the imminent dread of having breast cancer in my body is guaranteed to be behind me for now, I find myself picking at the scab of this disease and suddenly facing some really big questions.

And the funny thing is, where I was brimming over with emotion when in the midst of this disease and its treatment, I am feeling cool collected about these issues now. Having clear ultrasounds has given me the strength to tackle some issues head-on. Whilst I don't have any cancer, I have the courage to ask questions my cancer in a calm, measured way I've not yet experienced in myself when dealing with this disease.

One is a question I've wondered about but never had the guts to ask. Ever since diagnosis, the doctors have talked in terms of the threat of recurrence within ten years. I have a good, strong chance that it won't come back. A 96.2% chance in fact. Within ten years.

That caveat has haunted my peripheries. But I've never yet squared up to ask anyone what happens when you get to ten years. A yawning abyss where the odds are stacked against you? Or simply unchartered territory?

And what of kids? I didn't want them before cancer (at least, not then) and although I am reassured that it seems my fertility has come through this process relatively unscathed, I am still unsure, but feel myself leaning ever more to a position where I am actively determined not to have children. It sounds morbid, but how can it possibly be a responsible act, to bring a child into this world when you don't know what your chances are of being around in ten years time? Plus, if this thing is to recur, the most likely time period it will recur in is the two years immediately post-diagnosis. This rationale rotates through my mind perfectly calmly. I am not bitter, I just know increasingly that I would not want to do this, it would not be fair.

There are dark portents around as well, that bring me back down to earth after these few days of celebration.

This week, the office Christmas party affords me the opportunity to have some close chats with another colleague who has been off battling his own tumour over recent months. His situation and mine are wildly different medically speaking, but we share a very similar emotional experience. In a moment of anti-cancer vitriol, fuelled not least by the shots of sambuca that had just been handed round the table, he urges me not to trust my doctors, to push for all the tests I can even think of the names for, to make sure no cancer cell is left unturned.

His anger surprises me momentarily but makes me question the faith I have in the medical profession. I love and trust my doctors still, and I think they have absolute faith in the treatments they have prescribed me and the diagnoses they give with the information they have. But maybe, even in the cossetted land of private healthcare, they can't hand out MRI and bone scans like sweeties, so maybe I should push for more. After all, I was the one who first enquired about a portocath insertion. Maybe, if you don't ask, you don't get.

And I've been re-reading Dina Rabinovitch's book over the last week. I tell myself I'm just re-reading it because I first read it during the haze of chemo. But really, it's because she was diagnosed three years ago and died a few weeks ago. I'm scouring the pages for any similarities between our conditions. When she was given the all-clear post-treatment for her first cancer, was there any sign it would come back again so soon, and with such deadly voracity? I find no real answers, every tumour is so different. All I find is locks of my hair, trapped in the pages from when it fell out in chunks while I was first reading the book.

Finally, I come back to the UK late last night to find the news we've been dreading and the darkest cloud in this stormy rationalising yet.

A friend of ours has just died from metastistic melanomas.

Andy had a malignant melonoma removed six years ago - a dodgy mole to you or I - and was given the all clear after that procedure. Doctors check his skin for recurrence but there are no bone scans, blood tests, CTs or MRIs. They are only interested in the surface of his skin.

Then, a year ago, he finds a lump in his leg. The skin cancer has metastisized and over the last 12 months he has countless tumours removed from all over his body. We saw him in September. He was in a bad way, and deteriorated rapidly after this. He died at home on Friday.

I can't imagine what his wife and children can be going through and I am so angry at this disease which at best, makes old men and women of us, at worst, ruins families and leaves wives, husbands and children horribly alone. All Andy wanted over the last few weeks was to stay alive for one last Christmas at home. His children are not even into their teenage years.

I'm angry at the disease itself but I find myself more angry at the doctors who treated his original skin cancer. They made no efforts to check his body for any sign that the cancer had snuck away to brood and breed in his innards. For all I know the doctors may have been following standard practice. But in his individual case, they let him down. And that makes me want to spit and shout.

It also makes me want to ensure I am doing everything I can to make sure I'm not imagining my new found health. My cancer was stage 1, which means they think it has remained in the breast. But how accurate is the staging? And what if I'm in some tiny percentile of cancers that, say, leave the breast but don't leave any evidence behind on the lymph nodes to show their passage?

During my treatment, I've been in countless meeting rooms with specialists who could tell me these things. But you're so often overwhelmed emotionally, like I was just after diagnosis, or you're overwhelmed physically, like I was during chemotherapy. So for the first time, now treatment has ended and I have the courage an all clear gives you to deal with the answers, I have an appointment with the Professor where I can ask him all the questions. I feel bad, because it's ostensibly scheduled so he can check my portocath wound and remove the stitches, yet I will be ambushing him.

This is a man to whom I have become outrageously indebted. He has saved my life, no doubt about it. But I will ask him some uncomfortable questions. Uncomfortable for both of us.

What happens to my chances after ten years? Could the cancer have spread despite my lymph nodes being clear? Can I have any other scans to check the rest of my body? Have we done absolutely everything we can do? Are there any remaining options left?

I may be picking a scab that's best left to heal all by itself.

But I just want to make sure I know everything I can about the future, and that I will have done everything I can to ensure I have a future.

Be at peace, Andy.

1 comment:

Marie said...

I know several people who HAD cancer, and it hasn't come back. One of them is nearly 70!