TORIES TO CUT FUNDING TO HOSPITALS

It's official: David Cameron announced today that the Tories would definitely make cuts in spending on schools and hospitals, should we be fool enough to elect them. We have all been warned!

God knows, Gordon Brown is a dull man, but my instincts tell me he's a man of principle and commited to a socialist (with small s) ethic of free health care at point of need and accessible higher education for all - should they want it. GB has a son with cystic fibrosis, and Cameron, also had a child with special needs. It stands to reason that, with Labour (Labour!) paving the way for a two-tier health service by allowing patients to top up their drugs fund (something I'm still not quite over the fence about), the Tories will tighten the financial screws on cancer treatment even more. Part of me is frightened by this. Part of me rejoices that they are not elected yet, and, until they are, we still have access to a reasonable spectrum of care choices.

PLEASE, PLEASE DON'T VOTE THEM IN AGAIN! I made the mistake, when a naive 19 year old, still at university, and tired of doing my homework in the dark nights of the 1970s, of voting for Margaret Thatcher (just the once...but once was enough). She's a woman, I thought. She must care. But that didn't follow, no more than it follows that Cameron cares for universal health care in this country because of the recent tragic loss of his eldest child, cared for so well at NHS Trust St Mary's Praed St. Never again.

As a note to this: I worked once at an inner London cancer unit (The Middlesex Hopitai), checking in patients on reception in thr morning, typing up notes and doing clinic filing in the afternoons - as part of a summer temping job while at University in London. This place was really Dickensian - but, even then (Thatcher's Second Term), the moves were well underway to dismantle the good old systems of Matron bug cont/total ward managementl, et al. Then the private cleaning r came in - and we all know wherwe that has led us. There were no drivers for chemo patients (and chemo was GRUESOME in those days....) The patients had to wait all day for an ambulance to take them out into the hinterlands of Middlesex itself....The only entertainment was a woman who had had the roof of her mouth removed, and when she took out the prosthetic soft palate (can't spell medical words...), it sounded as though she was in an echo chamber. Used to please the punters anyway. After a day at that place, you'd have been thankful for Simon Bloody Callow and his inane drivel on the X Factor...
NEVER AGAIN!

CRAZY CUTS

A pop-up ad on my Tiscali mail page reads:

HAVE THE BREASTS YOU WANT NOW...AND PAY LATER.

And I'm sure there are plenty of takers in this crazy world who would put a bristling pair of new boobs on their wish-list for Christmas. (Credit crunch? what credit crunch?) Even as I write, the Tonight programme on ITV is running an investigation into those creepy-looking, pill-popping cranks who think it's their inalienable right to live to be 150. One anal-fixated, middle-aged male argues, in defence of the fifty plus supplements per day he's been taking for twenty years, that he aims to avoid 'the diseases of old age'. Is the unspoken one, the one that dare not say its name, a disease of old age? Try telling that to six year old with leukaemia or a twenty two year old with breast cancer and a two year old child to bring up.

Grotesque as they are, I feel mildly sorry for these cock-eyed opitimists who think cosmetic surgery can fix their lives. And what sort of life is one in which you feel obliged to 'restrict your calorie intake' (although the quack who came up with that popped his clogs at the not so ripe old age of 79) or spend your earnings on shed-loads of quackery? Imagine a society like that - a collection of grotesques in which old age doesn't begin untill you're ninety. I'm all for medicine fixing the body (it's fixing mine!), but not beyond its alloted span; and we would all do well to remember that the longterm tally for that is threescore years and ten. It's surely what we do in those alloted years that counts; but I guess I am giving this an unaccebtably moral overtone. Sad though, I think, that those eternal youth-seekers, fixated on 'eternal life', quite fail to see beyond the limitations of this world. It's materialism gone crazy - like a cancer.

The truth is, we are all dealt a certain hand. Some of us get cancer. Some of us don't live to get it because we die in road accidents or are murdered in the cradle by our parents. Do we ever get the breasts we want? The legs we want? The face we want? The height/weight/hair (curly or straight) we want? And when we pay to get what we think we want, we end up wanting something else entirely. That is, of course, those of us who can make those choices. (Credit crunch....what credit crunch?) If NHS funding for cancer care is the postcode lottery it is purported to be (though I haven't found it to be so here in my case....yet), and it came to the choice between spending money on breast reconstruction or some risky new life-prolonging chemo treatment, I think the choice is pretty obvious. In such a case, you'd get the breasts you want (for now, perhaps), but someone, somewhere would surely be paying later.

PINCUSHION AND BREAST CANCER CARE

All royalties of my latest novel, PINCUSHION (BeWrite Books, www.bewrite.net) will now be donated to Breast Cancer Care. I hope, one day, that more can be done to support women living with secondary breast cancer, especially here in Cornwall, where there is no support gorup funding to date.

NO MIRACLE CURES...

It is Breast Cancer awareness month, and the Tory Party are having their conference. David Cameron, their 'man with a plan' to lead Britain into better times, has pledged a 'say no' policy, predicated on a lack of 'miracle cures'.  To what exactly?  Gordon Brown may be a terminally dull and uninspiring leader, but the current parlous state of the economy has a Capitalist cause, its roots not in public spending but in the corporate greed of Cameron's cronies in the City. I fear a return to the 'values' of Thatcherism may prove toxic to the NHS, and to cancer patients in particular, reliant as we are on a tantalising, but increasingly expensive, cocktail of ground-breaking new treatments. 

Take my own treatment, Herceptin. It remains expensive, due perhaps to the monopoly of its developer, Roche Pharmaceuticals. But it is the NHS that has made it widely available to people like myself, an NHS I saw repeatedly holed in its bows by the forces of Thatcher. That was the era when 'private' companies took over the cleaning operations within hospitals. The legacy? MRSA. That was the era that saw repeated cuts to all kinds of services, based on the Iron Lady's sub-Keynesian theory that 'there's no such thing as society.' Margaret Thatcher called open season on any service that was public, rather than private. Hers was the era of the Poll Tax, with residents of Labour Councils (i.e. those dedicated to public spending) paying three times more than Tory bastions, like Westminster, run then by Dame Shirley Cohen, who absconded to Israel rather than pay back the taxpayer the money she had accumulated by selling off public housing and even public cemetaries!  (I was particularly unfortunate with my London Poll tax since my Camden (Labour) flatlet commanded a huge rate;  a mere fifty yards away in Westminster, they paid a mere £80 per year because their Council had no more public services to spend its money on!)  If Labour has messed up these last few years, it is only because it hasn't gone nearly far enough in rebuilding a Welfare State that was systematically dismantled in one short decade of Thatcher cuts and diktats. If Labour hasn't gone far enough to redress this balance by increasing taxation (such as the reintroduction of a supertax on some of the financiers, for instance, who have caused such havoc in the current economy), can we really expect Cameron, Son-of-Thatcher to  help us cancer patients? Don't be fooled by the shiny red cheeks and winning smile. 

In 1979, the first year I was able to vote, I fell for Margaret Thatcher's ralling cry during the Winter of Discontent. ('The British people can't bury their dead..') The great Tony Benn came to speak at my college at London University, and, to my eternal shame (mitigated, perhaps, by my youth and political naivety), I turned my back on him and voted Tory. Fast forward ten years, and the legend 'Third Term, Third Reich' appeared on the bridge at Chalk Farm. Fast forward to an era of greed and sleaze. And tax cuts, sure! 

I don't think I would have been alive today if the Tories had been in government. And, were I still living in Central London, there would probably be no public cemetary left in which to bury me. It's bad enough seeing cancer patients fighting for life-saving/prolonging drugs today.(Even today, the BBC has reported the shocking story of a young breast cancer patient's fight for Avastin.)  Tomorrow, if the Tories get in, I fear the lights will go out for good on the current Cancer Plan. 

A Man with a Plan indeed. We have been warned.

NICE ADVANCED BREAST CANCER DIAGNOSIS AND TREATMENT

HAVE YOUR SAY

The National Institute for Health and Clinical Excellence (NICE), the national organisation responsible for providing national guidance on promoting good health and preventing and treating ill health, is currently developing clinical guidelines on the diagnosis and treatment of both early breast cancer and advanced or metastatic breast cancer. These guidelines will help to shape how breast cancer care is delivered in the next few years and which treatments and care are available.

A draft of the guidelines was recently published and NICE is keen for people affected by breast cancer, or interested in breast cancer issues, to feed in their thoughts about the proposed draft. This is your chance to share your views on services and treatments and help inform a joint response from Breast Cancer Care and Breakthrough Breast Cancer. The charities are working together to develop a response to the guidelines, to help us make sure that our response represents the views and experiences of as many people as possible. The Advanced breast cancer guidelines are particularly important to the work of the Secondary Breast Cancer Taskforce and as members of the Reference Panel we would really like to hear your views on this guidance.

To inform our response, we would like you to complete a questionnaire on the topics outlined in the guidelines. The survey can be completed online at; http://www.surveymonkey.com/s.aspx?sm=5zNiZVqyJ95wSnzllJDy3g_3d_3d.

If you would like to read the draft guidance they can be found here: http://www.nice.org.uk/guidance/index.jsp?action=download&o=41615

The deadline for feedback is Friday 12th September 2008. Please return hard copies of the survey to Chris Quince, Policy and Campaigns Assistant, Breast Cancer Care, 5-13 Great Suffolk Street, London, SE1 0NS.

Please note that all responses will be shared with staff from both charities as part of our joint work on the consultation. However, all responses will remain anonymous.

BOOK RELEASE

COMING SOON....

6th September – PINCUSHION by Anne Morgellyn.

The latest in a series of psychological thrillers that chart the adventures of Louise Moon and her precarious love affair with brilliant but unconventional pathologist, Chas Androssoff.

Performance artist August Stockyard, attention-seeking heir to a media and property empire, dies in typically theatrical fashion, after making the bequest of adjoining houses to his pregnant girlfriend, Cressida, and to his former comrade-in-arms, Louise Moon.

But was August's demise simple suicide or was it the result of a kinky sex game that went wrong? Had he cleverly planned to shame his distant father and take revenge on his ruthless uncle, the obese and grasping millionaire who now had his eye on Louise?

Or was it a game from the grave, pitting Cressida and Louisa in a fight to the death as reluctant and mismatched neighbours?

Excerpt: http://www.bewrite.net/bookshop/excerpts/pincushion.htm
About the Author: http://www.bewrite.net/authors/anne_morgellyn.htm

All BeWrite Books are available from: BeWrite Books, Amazon, Barnes & Noble, Angus & Robertson and other online booksellers and to order from high street bookshops.

Print ISBN: 978-1-905202-82-9
eBook ISBN: 978-1-905202-83-6
Price: £6.99
Pages: 188

ALL ROYALTIES FROM SALES OF THIS BOOK WILL BE DONATED TO BREAST CANCER CARE.

We were healthy

Watched a very moving film about Theriesenstadt yesterday in which a ninety-eight year old Jewish pianist recounted the story of her survival as part of the prisoners' orchestra: We were given black water in the morning, she said, and white water at mid-day, and black water again in the evening, and yet we were healthy. Why? Because we looked forward to playing in the evening.

In the same film, a horrible nexus was drawn between the anti-semitic writings of Wagner and the use of music by the Nazis as a warped cultural tool with which to bludgeon the inmates of the concentration camps. (Primo Levi writes of how he will never get the music of the Lager - those infernal German marching songs, out of his mind.) Wagner believed that Jews had 'corrupted' the music of the Romantic period by their use of minor chords, and that their only hope within German society was to 'go under' (assimilation or annihilation?); yet it was Felix Mendelssohn who resurrected Bach's Matthew Passion! Perhaps this Nazi infiltration of the highest of the arts is an example of how a good impulse can so easily turn to bad - like a cell turning cancerous and setting forth on its interminable death march. For me, though, after watching the film, it was a message from the gods of the power music has to heal, minor chords or not. Beethoven felt it at Heilgenstadt, where it turned his mind from thoughts of suicide to thoughts of transcendence. And how Beethoven transcended! Wow! I was playing the Fifth Symphony - for the first time in years, as part of my current music studies. What a testament to healing that is, and what a powerful force for good.

CO-FUNDING FOR CANCER TREATMENTS

The issue of co-funding, which I understand to mean patients paying for part of their treatment on the NHS, has been much in the news lately. If I sat down and thought long and hard about it, I guess I would have to stick by the original guiding principle of the NHS: that treatment should be freely available to all at point of need. The problem is that it isn't. But should those who can afford to pay for part of their care, such as drugs like Sutent, or the one that's keeping me alive - Herceptin, continue to receive all other procedures, such as scans and bloodtests, free on the NHS? To allow this inevitably suggests a two-tier and therefore unequal system, and to me, as a socialist with a very small sss, that has to be wrong.

On the other hand, imagine (as I can only too well) a scenario where a potentially life-saving drug, trialled and used successfully in other countries, is refused to an NHS patient on grounds of cost. And imagine if that patient could pay for the drug by cobbling together the money for that, but not for all the other procedures. And imagine still further another patient who could afford neither the drug nor the other treatments, but got the other treatments and not the drug that was being bought by the person in the next bed...No, no, no... It's a moral minefield.

Why can't these drugs simply be made cheaper? I understand that there are research costs to recoup on the part of the drugs companies. But why are cancer drugs in Britain VAT rated (like children's shoes for God's sake)? Why are they more expensive here than in other countries in Europe? Why not more freely, more widely available?

All this went through my mind when I was waiting for my recent hysteroscopy down in Penzance, imagining the worst-case scenario of another heavy duty cancer treatment programme, based on the usual nightmarish number of variables (disease location and process, stage, prognosis, treatment options, etc.). The hysteroscopy showed nothing at all (in fact, I quite enjoyed the cosy cottage hospital atmosphere of the day-case ward and my pre-op visit from a charming German anaesthetist, who said he would 'proceed' away from my vocal chords, I having told him my breathing was fine because I sang...). But lying on the CT scanner bed last week, for my 6 month check, I was overcome by the sort of free-floating anxiety that usually assails me at the main hospital, where once you stray outside the oncology areas, you are subject to the usual waiting about and vague air of incompetence. What if, what if, what if...

The cure for that, of course, is life itself. Live it. Seize the day. I drove up over Dartmoor with my daughter last week, relishing the scenery of South Devon, so unlike our scenery in Cornwall, and against which I have always had my Cornish father's prejudices (I'm not a Devon person, was what he used to say - and he always went on about the parlous state of Devon's roads (Conservative mean farmers).  But last week, through my extra rose tinted cancer-survivor's specs, I saw Devon in a different light. Cricket on the lawn at Dartington; the clink of iced champagne glasses at the open air Shakespeare; the sun going down on the English meadows. 

I can understand people wanting to sell all they have to buy more time for that kind of thing. For life.

Ancient Healing

> Click the link below to view the icon of St Panteleimon,
> inspirational healer and martyr.
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http://www.iconograms.org/B75W90CT
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BLOCKED EARS

My ears have been blocked twice this year, once at Christmas, when I managed to unblock them myself with a bottle of Ear-ex; the second time in March, when they were affecting my singing so badly, I decided to go and have them syringed professionally. The nurse who unblocked them was the same nurse who did the Well Woman clinic; and she reminded me that it had been 8 years since I had last been in for a Pap smear. So, duly chastened, I booked myself in for one of those a week later.

To cut a long story short, it came back 'borderline' which, in the normal course of events (i.e had I not had breast cancer), it would have merely been reported but not investigated, other than by a repeat smear 6 months later. Because I take Tamoxifen, however, my GP decided to refer me to the colposcopy clinic at the hospital, where a beady-eyed consultant gynaecologist, Mr Das (what a wonderful name for a gynae guy!) picked it up. A colposcopy exam, he said, would not give him a 'robust enough' result. So he has booked me in as a day surgical case for a hysteroscopy and ultrasound under general anaesthetic. Talk about one thing leading to another...

It turns out that several of my women friends (none of whom has - or has had -  cancer) have had this procedure, some of them several times, either because it didn't work the first time or because findings were inconclusive. My friend Rosie wrote that both her 'procedures' were managed by an 'overwhelmingly arrogant man in a bow tie, who spoke to my left ear.' At least Mr Das looked me in the eye and said he wasn't worried, and it wasn't urgent. But if he wasn't bloody well worried, why book me in for this procedure in the first place?

My friend, Lindsey, to whom I scurried for some emergency reiki and psyching up last week, tells me it's because doctors these days are so afraid of lawsuits, they have to be ultra careful. My brilliant oncologist, who pulled down the smear result on his screen when I reported these unfortunate events to him, said he wasn't worried at all - even when I said Mr Das had seemed unequivocal in his dislike of Tamoxifen. 'You're doing well on it,' Duncan said. 'But if  Mister-Doctor Das wants to take a look, just let him. ' (Pregnant pause.) 'That's not what you wanted to hear, is it?', he went on. Well no, not exactly.  'If he finds anything,' said Duncan, as positive as ever, 'All I'll do is take you off Tamoxifen for a couple of weeks and monitor your hormone levels. And if you need to come off it, I've got other things I can use.'

Why is Mr Das making such a fuss about Tamoxifen? Because, it seems, from what I can make out as fairly inconclusive (and non robust) studies, there is a minor risk of endometrial cancer from prolonged Tamoxifen use - like 10 years. (I have been taking it for three.) More disoncertingly, those women in the studies who did present with endometrial cancer had it already! 

I've been debating with myself whether or not to have this procedure at all. I've just kicked the hospital visits into touch with my excellent Herceptin-at-home treatment, and now Mr Das has mounted a rear-guard action (terrible pun). Lindsey said any biposy - or curettage in this case 'creates a vacuum which has to be filled.' Well, that's one way of looking at it. I am probably due for a clearing out in that department. I was on  repeated courses of antibiotics after my daughter was born, thanks to a tear and lots of stitching up by 2 surgeons, who stared into my nether regions and said they couldn't 'see the apex'. Why is it always men who go into this field of medicine? You'd expect to find more women in gynaecology and obstetrics these days; but not, it seems, here in Truro. Are there an equal number of women, I wonder, treating men with prostate problems? (Bet the answer is a big fat no.) 

Anyway, if it needs looking at, I guess it should be looked at. On the other hand, if it ain't broke, why fix it? And, of course, I have shied away from going to get things checked before - and look where that got me (hairless and breastless.) 

Best get on with it then.

Earning a living with cancer

Breast Cancer Care's latest policy campaign, relating to employment and breast cancer, got me thinking about my own employment history with the disease. 

Strictly speaking, I wasn't technically employed when I was diagnosed, but I was self-employed and thus reliant on a number of part-time and short term contracts to keep me going - a tall order, always, for a lone parent with zero maintenance and a dependent child to support. Thanks to clever investment planning - not my cleverness, it has to be said, because I am a disaster when it comes to money, I had the right sort of insurance policy (thank you, Chris Davies of Newquay Investment Services who directed me to lifecare with Axa Equity and Law) which paid out within three weeks of my consultant sending in all the gory confirmations. This meant that I could jettison most of my jobs and pay off my house and still remain life-insured at a comfortable premium of thirteen pounds a month. At that time (three years ago), I thought I might not last long and I wanted both to see the colour of the insurance money and spend what I thought may be my last few years taking it VERY easy and enjoying myself.

But I survived, and this year, I have had to address the question that I might, just might, still have ten or more employment years ahead of me. I've never concealed the fact I have breast cancer, and it's been good to see that previous contractors are still willing to recontract me. This could, of course, be because the contracts are short term or part time - or that I have managed somehow, over the years, to make myself a sought-after commodity in certain education circles!  I have no idea what it is like for those seeking full time work in my position. But I suspect it can be tricky, which is why the Breast Cancer employment campaign is worth supporting. This issue doesn't just affect women (and men) with breast cancer - it affects anyone experiencing a chronic or life limiting/threatening condition. We need to stand up and be counted. WE AREN'T DEAD YET! We can still count!

Topic of Cancer: BREAST CANCER CARE EMPLOY CAMPAIGN

www.breastcancercare.org.uk/emply

BREAST CANCER CARE EMPLOY CAMPAIGN

Breast Cancer Care are launching a new campaign in May and June relating to best practice in the workplace for employees with breast cancer. The link is at

www.breastcancercare.org.uk/employ

Non-Cancer Types

Reading Amber's message about the definition of cancer personalities as types who can't say no to favours they don't want to do, or to put-up-ons in general regarding their time, expertise, even their bodies, got me thinking about the opposite personality type to this: the ones who don't give an inch. 

You find them in all walks of life, even in professions which are meant to be vocational (i.e. 'caring'). I've met  a couple this last year or so in local musical circles, and I shudder to think of all the little children taking music exams or auditioning before these asocial men (they happen to be men...) with zero people skills: an insensitivity that isn't so much chilling as cryogenic! I've seen grown women in choirs, women who have borne children, held down responsible jobs, passed serious examinations, quake in their shoes before the MD of a provincial choral society.  I used to think it was funny, until it happened to me. Then I slapped myself and reminded myself of what I have achieved, the rich life I have experienced beyond the limits of the cathedral cloister or rehearsal room. I thought about the personality type, and how these anally-retentive and charmless martinets are more to be pitied than feared - even though they probably don't get cancer! 

Having cancer readies you, and steadies you, to face pretty much anyone and anything. This is not necessarily a good thing, of course; and definitely not a state to be envied or sought after. But it is in many ways a privilege being able to laugh at what isn't important, or only important within a little kingdom in  limited locality. The wide world is bigger than that, and to survive, you have to learn to put yourself out there, in the top percentile. No one can give you permission to write or sing or make music, or make a fool of yourself. More often than not, it's the mediocrities in this world (the Salieris, not the Mozarts) who set themselves up as permission-givers (and often, too, by cowardly proxy); but once you learn to see them without their clothes (or on the loo), their power slips away. Although they probably don't get cancer...

My oncologist (a Mozart, not a Salieri - although I hope he doesn't die so young) rang me yesterday to put my mind at rest about the recent smear. An atrophic cell, which could indeed be down to the Tamoxifen, but no need to call for the heavy artillery yet. Duncan is in the right job for the front-line branch of medicine that is cancer. I'm so glad he isn't playing the organ in some cathedral or directing a loss-making choir. A physician, like a musician, should be an artist (even if that implies a certain open-hearted vulnerability). It's more than an ability or capability. It's a gift.

A Cancer Personality?

Amber Smithwhite sent me a copy of an article in this month's Mensa magazine, entitled: 'Is Life Really So Wonderful?" (Ghislaine Vaughan in Mensa, May 08)

Yes, it is - and it is to be hung onto and treasured for as long as it is given to us. But the comment on what may or not constitute 'a cancer personality' struck me with the force of truth.

Ghislaine Vaughan writes: "I once read a book about cancer in which the author, Bernie Siegel, a surgeon with many years' experience of talking to, operating on and generally supporting people with the disease, had come to the conclusion that people who get cancer have a certain type of personality. He even went so far as to suggest that you could tell whether someone was a likely candidate for cancer by asking them the following question, which he had found to be the bottom line: "If a friend asked you a favour and you didn't want to do it, would you do it anyway?" Apparently, if you say 'yes' to this question, you are far more likely to develop cancer than if you say 'no'.
It became clear from this idea that those with a cancer personality are in general far more likely to give up their own wishes in favour of those of somebody else. Bernie Siegel gives many examples of how his patients recovered or had long periods of remission when they were encouraged to pursue their dreams and aspirations, including one young man whose prognosis was bleak until he began playing the violin. He had always wanted to study music but had been pushed into a career as a lawyer by his family. As soon as he gave up law in favour of the violin, he got better."

All of which strengthens my resolve to keep up my studies in singing and piano and take my music diploma next year. I got ninety three percent in my last theory assignment, which was a boost to the morale in a week when I had an abnormal (well, 'borderline') smear result. I now have to have something called a colcoscopy - ironical, really, since the reason for putting off the smear test for so long, while I was undergoing treatment for breast cancer, was that I thought I really couldn't cope with any more humiliating poking and prodding. Well, now I think I can. And I will. Because it is worth it - it is. It's a wonderful life.

The P Word

Today I received some paperwork from the Healthcare at Home people, confirming that my Herceptin at home treatment is classified as 'palliative'. Three years ago, the p word would have set the world spinning for me, but now, I think, it frightens me less than a total discharge would have done - or do. Because I know now that one can never be totally discharged from this disease (it has such a nasty habit of biting back when least expected), palliative treatment, or care, which doesn't (necessarily) mean the end of the line but merely another means of living with the disease, seems a healthy way forward.

An acquaintance of mine also sent me a dog-eared newspaper clip, dating from 1983, about treatment choices, specifically whether or not to go ahead with a mastectomy in the case of the woman featured. She opted not to have the op, and my correspondent was wondering if she had survived. Twenty five years is a very long time in the story of cancer treatments, and many of the life saving (or life prolonging) drugs available readily now were simply unheard of then - like Herceptin, for instance. Before the discovery of this monoclonal antibody, there was no point in testing biopsy tissue to see whether women were Her2 positive or not - because, if they were, there was no treatment. Now there is, and I don't care whether is it palliative or not, as long as it works.

I remember sitting in the marble bathroom of the 5 star hotel in northern Spain where I was staying just before my operation and wondering whether I should go ahead with it after all. The chemotherapy (FEC) I had had over the previous eighteen weeks had taken out one lesion altogether and shrunk the other down to a size which made it feasible to operate. My poor right breast felt normal again. The puckering had gone, and so had the lump I could feel. As for the other rogue cells at large in my system, I knew removing my breast was not to going to have the least effect on them - their control was down to the chemo and the Herceptin alone. But still I went ahead, two days after sailing back from Spain. I went ahead because my doctors, Duncan and Alistair, had now decided it was 'worth it'. Surgery, though, was without doubt the worst part of the whole business for me, apart from the emotional shocks (disappointment in family members) which were nothing to do with the disease itself (although they may have had a lot to do with its progression). The surgery was bad because it was painful (at least in the aftermath) and ate into my daily routine (I couldn't drive my car for a couple of weeks) and - worst of all, it necessitated a week's stay in hospital, which meant, in theory, a total lack of privacy for me - a state of exposure I thought absolutely couldn't stand. In the event, though, I was only sharing with two other women in the bay after we had conspired to remove the old woman with dementia who kept us up all night with her complaining, and - worse - had a terrible, whingeing daughter who was visiting on the ward from 8 thirty in the morning till 8 pm at night and for some reason lit on me as the patient to badger. This ghoul (for that's what she was) haunted me throughout the day I was waiting to go down for surgery with her tales of people who had died (from breast cancer) and those who ended up with lymphodema. At last, I shook her off and hid in the chapel; but when the time came for me to change into the theatre gown, she stood over my bed and made a running commentary on the progress of my undressing to her demented mother (and father). Boy was I glad to see the back of her. I guess she's badgering someone else now. That's the trouble with whingeing hypochondriacs: they always live to tell another tale.

Still, maybe she chased me into the chapel for a reason. The Gospel was open on the story of the storm at sea in which Jesus (who is sleeping soundly as the sea is raging) admonishes his disciples with the question: 'Where is your faith?' I knew I would be all right after that. I just knew.

Herceptin at Home

Yesterday, my treatment came to me. I have always been wary of having it at home, thinking this must be the thin end of the wedge, the slippery slide to the hereafter that no one with cancer wants to get onto; but it didn't feel like that at all. In fact, my only regret now is not taking up Duncan's (my consultant's) offer to 'have it at home' in the first place.

The nurse, Sarah, was uniformly charming. The equipment came in a discreet black suitcase on wheels - thanks to the weight of the oxygen cylinder inside and the foldaway chrome drip stand. We set up straight away, me soaking my hands in my kitchen sink while Sarah moved the chair around. She found a vein within seconds and was in it even faster. I have never before had a 'flashback' (haemorrage) into the valve as fast and furious as that. Then we sat and chatted while the drug dripped in under its own pressure. The electronic pumps they use at the hospital are apparently only for monitoring. 'So they can go off and see to other people,' Sarah said. 'But you have me - my undivided attention, for the next two hours.'

It passed really quickly. I was warm, holding my hot water bottle, and completely stress-free in my own armchair with my feet up on the plastic cube. Sarah went out to look at my garden and said she was booking some time out there in the summer months, which made me visualise having my treatment under the trees, with the parasol protecting me from dripping sap.

Sara works for a private company that provides outreach nursing services to both the NHS and private sector - and I felt like a private patient in her care. The Herceptin bag came by overnight courier from Burton on Trent, and I was presented with my own smart blue file, containing the usual protocols, an emergency on-call contacts list, and a copy of Duncan's prescription. Sarah had a hand held gadget that printed out the treatment notes onto a label she stuck into the file. Cannulation attempts: 1, etc, etc. Tolerating it well.

If this is all I have to tolerate from now on, I can live with that.

I am living with that!

City of Light

On the haem clinic wall is a picture of Paris. It's the Champs Elysees, I think, because the Arc de Triomphe is visible in the background, although it could be a view from that boulevard in the 16th arrondissement, the other side of the Etoile, where my Serb friend, Lydia, used to live. I don't know where she lives now because she stopped speaking to me when I refused to see the Yugoslav civil war in Serb-delineated black and white. I know she married a fellow Serb in Paris, a composer, no less, who came to visit us in Cornwall twice and even composed a piano piece for me. They have since divorced.

Back to the picture: the foreground has buildings on the boulevard done in garish colours, with a cafe-terrasse down below. The right hand of the composition is carefully drawn in, but the left is an impressionistic mess - it could be a rainy pavement, it could be the cafe lights twinkling in the twilight. It could just be that the artist got tired, as patients get tired in the haem clinic, of sitting there and wondering what to do next. But it did its job in distracting me from the blood bags and the needles. It took me back, albeit in a sort of cynical, superior way, to Paris, where I spent so much of my life, first as a student at the Sorbonne and then in a variety of useless jobs. Actually, I spent a lot of time in Paris even before that. I've been doing nothing in Paris since I was about fifteen. I often think about going to live back there, but then I visit again and the same old ennui washes over me: Been There. Done That.

Still...Paris. In the Spring. Paris. Nuits de juin, dix-sept ans, On se laisse griser... (That was Rimbaud, not me, the enfant-terrible of a poet my tutor at University said he would have hated to have in HIS class...) Henry Miller is another notorious liver-in-Paris. (Alistair would not have wanted HM in his class either...) I remember so much about the place - those parties held by American, Jim Haynes, in his atelier in Montparnasse, trying to perpetuate the Paris of long ago, of writers and artists and no-hopers but determined livers nonetheless.

I wonder what it means to the others who see that picture every day? It's more evocative than the other pictures they've got up there, most, I suspect, donated by grateful patients. There are static views of Cornwall ( it's possible to make even the sea here static if you've got no eye) and the odd abstract. But Paris did it for me, even though the Champs Elysees has to be my least favourite part of the city of light. It caught the aspect of the entire city, something of its spirit. And in a haematology clinic in Truro on a Monday in February, that's saying something. That is succeeding in something.

Healing Waters

Just back from the hot springs of Budapest where there is always something new to discover. I first went there six years ago, which was three years BC (before cancer) and stayed at The Gellert Hotel, which put me straight in mind of the sort of old Soviet hotel I used to stay at when working in Russia before the capitalist revolution in the early Nineties. Because The Gellert was really showing its age last time we went there in 2005 (although the bathroom is forever etched in my memory as the place where I spotted the second lump in my right breast), we stayed this time at the Helia, an anodyne modern edifice opposite Margitsziget (Margaret Island). But I recognised the concierge there from The Gellert, so Cara and I were given an upgrade to a room set aside on a restful corner of the first floor, with views over the Danube and the edge of the spa complex. This beat the tram noise at the poor old Gellert though the thermal water in the baths was just as hot (up to 38 C) but clearer, less gaseous than the greenish soup with elderly ladies floating in it you get at the public baths. I wrote about the famous Gellert baths in the archive pieces (Crab and Fishes) so won't repeat myself now.

I didn't take any medical insurance, other than my standard cover that comes free for Cara and me through my banking package (if anything from a bank can ever be said to be free), and our E111 forms, of course. When we arrived, though, the driver who picked us up from the airport (recommended - see www.budapesthotels.com Airport Pickup Service) said there had been a demonstration that day about proposals to make Hungary's health service a paid for service. If this happens, I expect it will put an end to free reciprocal agreements with the NHS in Britain. But I didn't take out extra cover when I went to Switzerland either, in 2006, or Germany in 2007 - although I didn't anticipate any problems in either of those places. The most likely problems, relating to my cancer treatment anyway, would have arisen when I sailed to Spain in 2005, five weeks into chemotherapy treatment (and without my hair), or later that year, in Budapest, exactly a month after my operation. Travel insurance for people with 'ongoing' or 'prexisting' conditions like cancer is punitive - although I recently read somewhere that these punitive measures contravene disability rights legislation under EU law.

Anyway, Budapest. It's wonderful. Try it. Sod the insurance - just go.

Herceptin

Herceptin has been my bag for close on three years now. When opium was first synthesised, I believe they called the new drug heroin because, to the patients that used it to numb pain, it had a heroic quality; and in its purest form, uncut by flour or cement dust or milk formula or whatever else the crooks who deal it use, I expect it still has. Herceptin, anyway, is my heroine, at least for now.

I have my treatment, by intravenous infusion, every three weeks at the haematology clinic in the Royal Cornwall Hospital. The nursing team there are heroines of a different sort, battling with infinite patience against the unseen powers who make so many stupid, arbitrary and ever more impractical administrative decisions at this and so many other NHS hospitals in which the management culture is now a terrible blight. It's a culture predicated on a wish to curse, not cure. The latest decision thought up by this dictatorial crew of outrageously overpaid bureaucrats (whether or not they've got MBAs - and in a cancer clinic, who gives a shit about MBAs?) is to overbook the clinics and take on ever increasing numbers of chemotherapy and blood transfusion patients, without increasing the number of nursing staff or seats in the treatment rooms. By what rationale of time and motion or other redundant studies they see this working, God only knows; but for the cancer patients waiting for chairs, it means a longer wait; and for the oncology nurses, who start at 8am and work till six (or when the last late patient has finished...), it means no lunch or tea breaks. To perform their jobs as well as they do, in such circumstances, with such unfailing patience and friendliness and professionalism, it goes without saying that this team of nurses - Jo, Alice, Rachel, Yvonne, Cass and all their colleagues are something beyond exceptional.

Yesterday (thanks to Management), I waited forty minutes for my chair in the treatment room (and I was lucky - I got a recliner) and was cannulated at twenty to two by poor Alice, who hadn't had a break since clocking on. This time last year, I was having problems with my veins, it taking sometimes as many as 11 cannulation attempts (which means 11 pricks in the arm and hand) to get a line in; but, strangely enough, it's got better since last summer and now I don't worry about it nearly as much as I used to. It's not that the cannulation is particularly painful: a 'sharp scratch' is indeed all it is; it's the anticipation (will they spear a vein this time? will it be over soon?) that causes the most stress. I must now have had close to two hundred 'sharp scratches' - including all the spikes for blood tests, etc, and all in my long-suffering left arm and hand, the right one (my 'operated side') being out of bounds because of risk of lymphodema. I haven't got lymphodema though, and sometimes, it has to be said, they go into the veins on the right. They use the smallest gauge of needle (a paediatric cannula), which is fine for chemo drugs, including Herceptin, but not for CT scans, which require the contrast injection to be given at a faster infusion. But I have found a way around this, like today, by getting the radiographers to put the contrast in through my treatment (paediatric) cannula at a lower pressure. This meant I got away with only two sharp scratches this week - Alice's one failed attempt in my hand and her other successful 'scratch' infusing both Herceptin yesterday and revolting, metal-tasting contrast dye this morning, when they scanned my chest and abdomen.

That's treatment over now for the next four weeks because I am taking a holiday in Budapest on 10 Feb. It's allowed to take the occasional holiday from Herceptin treatment, but what this means in terms of future appointments is that my schedule will be out of synch - and this means more 'sharp scratches'. Usually, I manage to synch a three weekly Herceptin infusion with a three monthly clinic appointment, which means I can get away with one cannulation for both infusion and the dreaded blood test, it being more difficult to get blood out of me than Herceptin into me. But Budapest is more than worth that extra sharp scratch; and four weeks - a whole four weeks - away from the hospital, after all this time, feels like a liberation!

The Illusion of Pain

If the first and lowest operation of pain shatters the illusion that all is well, the second shatters the illusion that what we have, whether good or bad in itself, is our own and enough for us.

C.S Lewis, The Problem of Pain


For the three years I've been living with this condition I have experienced mostly human kindness and compassion, and this has been at its very best. At its very worst, I've had people avoiding me - and I can live without those people. But last Saturday, when I explained to the woman who recently moved to the house at the bottom of my garden and was berating me about the sight of my builders' heap - only exposed by her illegal felling of some ancient trees - that I was (a) not aware that the builder had left an old loo seat there, in view of her window; and (b) that I was not up to clearing the large items slipping out from under the pile of leaves because I was living with secondary cancer and tired easily, her response was:

I DON'T WANT TO KNOW THAT....

There then followed several abusive fishwife style charges, too silly and petty to mention here, although they left me reeling in amazement. My tendency (a bad one, since it always puts me on the wrong foot) is to feel sorry for such people because they are well, let's say, uneducated LOCAL people (Cornish peasants...) who probably haven't had a quarter of my advantages, etc, etc. But that's politically incorrect of me. Probably illegal even to THINK such things these days...(I hold my hand up, guvnor...) Probably some mental illness there - even if its only a pathological lack of compassion; but isn't that a definition of a psychopath? Oh God - and at the bottom of the garden, too!

Thing is, though, if you live with cancer, you can pretty much live with anything.

Chronicle

I have just posted three extracts from a treatment chronicle I began about a year ago in order to try and make sense of (or impose some kind of order on through the medium of words) my diagnosis and life-changing new status as Person Living With Secondary Breast Cancer. I have survived this treatment, and this disease, for more than three years since my 'official' diagnosis in March 05, because I let the lump fester a good three months before finally plucking up the courage to visit my GP after a 'fortifying' sojurn in a Budapest spa (see Crab and Fishes 1....). All I can say on this point is, Go, go, go to the doctor - whatever your fears, whatever your circumstances, because it was really my circumstances, rather than fear, that prevented me taking that first step onto what I already recognised as my road to Compiegne. Except, unlike poor queen Marie-Antoinette, I kept my head and lived to tell the tale. In fact, once war has been declared on it, cancer is a strangely fearless condition, really. The fear, in my case, was all for my daughter. She was just ten then, and I could not bear the spectre of social services coming in to take her away from me if I needed to go into hospital. But I needn't have feared that. It was all sorted out in the end.

So, in case anyone is interested, or might like to take some heart from my experience, the retrospective postings of this journey on this blog are:

Crab and Fishes 1
The Regimen
Hair and Other Losses

Hair and other losses

My hair came out after the second dose of FEC. I don’t know which of the three drugs was responsible for my baldness, or whether all three were equally responsible. I favour cyclophosphomide because it sounds like a poison, a weed-killer, perhaps; whereas of the other two, fluoricil could be a tooth-whitener, and epirubicin a jewel-red fruit squash that turns pee pink for a day. But they are all universally toxic to cells (like the sun which shines on good and evil alike); and epirubicin especially, when combined with trastuzamab (Herceptin) is toxic to the heart.
‘If you do arrest,’ Thea told me cheerfully, ‘we can always resussitate you.’
And if I arrested, what would happen to my daughter then? She was staying with my mother in the north while I embarked upon the nasty chemo regimen. I was unsure of how it would affect me, and consequently, my ability to care for my child while I recovered from each dose of poisoning. So I let her go, when my mother put it to me as the only option, without thinking too much about what it would mean to lose my little girl, because thinking about it too much would have made it quite impossible for me to wave her off at the station and go home to an empty house, bereft for the first time in ten years of my only child’s presence, her sweetness and her light. When I waved her off, I still had hair, auburn hair, down to my shoulders, although it badly wanted cutting. I had battled with Cara about it throughout our holiday in Budapest. She wanted me to let it grow.
The breast nurse, Janet, had told me about the cold cap, a ridiculous-looking blue helmet that is meant to minimise the risk of hair-loss through chemotherapy. It maximises the treatment time, however, because it needs to be worn for a bit before the drugs are infused, during the infusion, and, I think, for a short time afterwards. My objective was to spend as little time at the hospital as was possible in order to spend as much time as was left to me with my daughter. My hair was a small price to pay for this precious commodity of time, newly precious to me because I had wasted so much of it. Cara, I hoped, would understand.
‘And anyway, it grows back in six months,’ Thea said, ever cheerful, ever sure. ‘The wig lady’s here today. You can get a wig on the NHS. Why don’t I introduce you?’
On the advice of the wig lady, who clearly knew about these things, I went for a pre-chemo crop at an expensive salon with a chair that massaged my back while my hair was being washed and my head massaged. This was the only visit I have ever made to a hairdressers’ when I didn’t feel intimidated by the experience, made all the more enjoyable because the stylist was the first person I had chatted with in over two weeks who did not know I had cancer. A haircut usually lasts me about six weeks, although I figured that, this time, instead of the hair growing out of its style, it would probably fall out altogether, something I neglected to tell the stylist as I tipped her. My next cut was waiting in a box at home: a Raquel Welch ‘pixie’ wig, with a steel brush to groom it and its own special shampoo and conditioning bottles. I hoped it would make Cara laugh, because seeing her cry again, as she cried when she learnt of my diagnosis, throwing herself down on the hardwood living room floor and howling with an existential despair, while my mother went to phone a friend in the other room, and I stood there helplessly, was more than I could bear. That my daughter should come to know despair at the age of ten, because of me, caused me far more pain and grief than the disease itself. How I would get through this, I didn’t know. But I knew that I would get through it. I have breast cancer, I said to myself, as I opened my eyes the morning after diagnosis, knowing that it was going to be like this every morning now, for the rest of my life, ever walking beside me. I have breast cancer, but I will get through it. It was like a mantra.

The Regimen

July seventh, 2005. The haematology outpatient clinic at Royal Cornwall Hospital, Treliske. There are about sixteen patients, all hooked up to electric pumps. Half are getting blood transfusions; the rest, myself included, are having chemotherapy. But because of the news broadcast that is panicking us all -- clinicians, patients, nurses and auxiliaries, some of whom have relatives in London, some, like me, who have spent half their lives in the city and could walk that fateful bus route through Tavistock Square with their eyes closed, we seem to have blurred the boundary that usually marks off sufferers from non-sufferers (or those who may long-suffer us). We are all equal today, uniformly terrorised by the pressing understanding of our own mortality which has jumped out of the TV set in the treatment room and shaken us all to the teeth.. As the decimated bus in Tavistock Square is framed up close, we are all, this minute, entering an even playing field of fear and horror. This doesn’t make it any easier, of course; but it does seem to make our situations less exclusive, at least for today.
When I received my diagnosis, two weeks after Cara and I returned from the annual trip to the spa, and a mere twelve days after the GP had referred me to The Mermaid Centre (‘a one-stop shop,’ she said, ‘so at least if there’s anything nasty under there you’ll know the same day’), I thought I was falling off the edge of the world. The world hadn’t ended -- far from it; it was rather that I was being thrown out of it, and not with a bang but a whimper. At the same time, I had the slightly more uplifting thought that all this was an illusion, like the series of tests I had had that morning at The Mermaid Centre: mammogram, ultrasound, needle aspiration, cone biopsy. A series of illusions, one after the other. Throughout these tests, I was thinking of the work I had brought with me: a series of creative writing assignments done by external students at Exeter University, mostly of indifferent quality, and almost as tedious to endure as all these clinical procedures. But, increasingly, I grew all too aware of my surroundings (grounding, I think, is the pop psychologists’ term). I became aware of the radiographer’s blank expression and increasing taciturnity, contrasted with the warm touch of the clinic nurse who came in to assist the kindly, German radiologist who performed the ultrasound. ‘You are right,’ she told me, ‘moving the sensor to the top of my right breast, beneath the collar bone. ‘It’s nothing to do with these superficial skin infections.’
Then the surgeon arrived. ‘I’m Alistair,’ he said. ‘And this is going to hurt you, sweetheart. When I was a junior doctor, I never hurt anybody – but I didn’t get enough material and then the consultant had to go and hurt them. Now that’s me.’
He punched a fine needle into the area below my collar bone identified by Kirsten, the radiologist, and drew out his material. It didn’t hurt a bit, and I told him so. I liked his utter frankness and his Sean Connery-esque Scottish burr.
‘I’ll be back in half an hour,’ he said, grinning at me in a non-committal fashion. The Mermaid Centre has a cytologist on site – which is helpful to those lonely women in the consulting rooms, cowering in fear and anticipation. Needless to say, it was a long thirty minutes, in which I was hyper-aware of the white walls, the half drawn blind, the light breeze blowing in the through the window, the basin on the wall, the MRSA-fighting hand-wash, the needle mark on my chest, which was starting to throb a little, though still it did not hurt.
Alistair came back into the room with a woman dressed informally in a soft grey sweatshirt and trousers. It’s bad, I thought, because they’re bringing in the counsellor.
Alistair sat down next to me on the consulting couch and put his arm around my shoulders. ‘You don’t need me to tell you what it is, do you?’ he said. ‘You know what it is?’
I nodded. ‘The thing is,’ I said, ‘I’ve got a daughter. She’s ten. I’m a lone parent.’
‘And have you any relatives near by?’
‘She has,’ I said. ‘She has her father’s relatives in Hayle. Her father isn’t with us. He isn’t well.’
‘Are they decent people?’ Alistair said. ‘Can you trust them?’
I didn’t know what to reply. I had never had to trust them before – I had never had to trust anybody with Cara’s care. There had been only me and her: a symbiosis.
‘Well this is our problem now,’ Alistair said. ‘My problem, as well as yours, for the next five years. I’ve been to see my colleague, Duncan, just down the corridor there.’ He pointed through the window to what appeared to me as a blank wall. ‘The way we’re going to treat it is to give you some chemotherapy, over eighteen weeks. Duncan will tell you about all that. Then we’ll give you a month off in August before doing a mastectomy. I’d want my wife to have it,’ he added defensively, as though anticipating some protest on my part.
‘And who will do that operation?’ I asked. ‘Will you do it?’
‘Who the fuck else would do it?’ he said. I laughed.
‘You’re a four-letter man,’ I said. ‘I like that.’
He nodded. ‘Then we’ll give you some radiotherapy. You know, when I first came to this hospital, I had to send my fucking patients up to Plymouth for their radiotherapy. Couldn’t be doing with that. This is Janet, the breast care nurse,’ he said, indicating the lady in grey and getting up. ‘She can fill you in. Duncan, will see you tomorrow, nine o’clock, at The Sunrise Centre.’
‘Where…?’
‘Clinical Oncology, just down the corridor there. That’s where you’ll have the radiotherapy.’
I stared through the window at that blank wall. Alistair went out and Janet hovered. There was a box of tissues on the chair at the foot of the bed. I think she was waiting for me to cry.


Duncan drew me a diagram on a piece of paper and referred to the dots and dashes on it as ‘zapping the buggers’.
‘I’ve got plenty of weapons in my armoury,’ he said. ‘There’s a drug called Taxotere, one of the nastiest poisons we’ve got. We might start with that, although it might make you feel really rotten for a bit. The idea is to shrink the tumour down so we can operate.’
‘Alistair, you mean?’ I said. ‘Why can’t he do it now?’
‘The tumour’s too close to the chest wall,’ he said gently. ‘I’m proposing six doses of chemotherapy to see where that takes us. But before we start, I want to send you for a couple of tests – a chest X-ray. A CT scan and a bone scan, just so I can see what I am dealing with from the very outset. I wouldn’t want to get six months down the line and find we’ve missed something.’
‘OK. And when will this chemotherapy start?’
‘Next week probably.’ He smiled. ‘Oh, and if you agree, we’d like to send some of your biopsy tissue away for testing. It’s for a clinical trial we’re running, to see if you might be suitable for it.’
‘That’s fine,’ I said. ‘It’s no good to me.’
So I signed the consent papers, went for the scans, and looked forward to having a few days’ off from all this, over the week end, before Duncan zapped me with his monstrous regimen.
But he wanted me back before then. He had left a message with the bone scanner to call me over to The Sunrise Centre again. I knew why – not where, exactly, but why.
This time, Duncan had both his research nurse, Thea, with him and another breast care nurse, called Josephine. It’s bad, I thought. Very bad.
‘The bone scan was clear,’ Duncan opened. ‘But unfortunately, the CT scan showed some spots on your lungs.’
‘Metastases,’ I said, smugly citing the clinical word, because words are my job. My whole life, I thought, I’ve been obsessed with what Alistair might qualify as fucking words. And what are words, anyway? Just fancy parcels of received meaning.
‘You mean it’s spread? You told me before that with these drugs – this Taxotere, for instance, and all the rest, the surgery and the radiotherapy, that you could eradicate it, more or less, and I’d have the same chances as any other woman my age, I mean for living to old age…’
‘We can’t cure it,’ Thea said. ‘But we can treat it.’
‘Alistair can’t operate on my lungs?’
‘No,’ said Josephine. ‘It wouldn’t be possible.’
I looked Duncan in the eye. ‘I’m not bothered for myself,’ I said. ‘I mean, I’ve had an interesting life.’ A rich and exciting life by anybody’s standards. Running round the world like a headless chicken, interviewing people for American TV, so that people in the red-necked mid-West could switch on and gawp at those backward Europeans. I had a much more important life now, here in Cornwall, a life that was all my daughter’s.
‘Will I live to see my daughter grow up?’ I asked Duncan, rather fiercely.
‘Yes,’ he said, emphatically. ‘Yes. We’re talking years, not months.’
‘Years?’
‘Years.’


Years with cancer. I tried not to think how many. I had had forty six years without it; the number I had to look forward to with it was an unknown quantity. But then so is any calculation pertaining to the future, an unknown quantity rubbed in hard on 7 July 2005, in front of the TV set in the haematology clinic. Hooked up to drips, we patients are as desperate to hang on to life as the healthy people caring for us, terrorised by the news broadcast. I am hanging onto life by a line containing the product of outstanding medical research: the monoclonal antibody, trastuzamab (Herceptin). It costs twelve hundred pounds a dose, and Duncan, to whom I am eternally indebted, has put it into my treatment regimen, a mixture of three cytotoxic chemotherapy drugs, a hefty dose of steroids, which send me up high as a kite, and something the nurses in here call ’your cover’ – which has so far stopped me from being sick. I am hanging onto life here in the clinic in Cornwall, while up in London, a group of deeply disaffected, morally moribund, and mortally stupid young Islamo-fascists are blowing themselves to pieces and destroying, willy-nilly, innocent bystanders who happened to get in the way. A bit like cancer cells, really, spreading out in an undercover crab-like motion, seeking parasitically to block out and destroy all that is life-enhancing and life-affirming – all that is life. An anti-culture, a terrible blight.
But I have survived it – up to this point in time, which is the only point any of us really have. I am equal to it.

I am still here.

Crab and Fishes 1

March fourth, 2005, my forty-sixth birthday. I am fighting with my ten-year old daughter for the right to go topless in a Budapest spa.
This place is absolutely not about the body beautiful. Breasts come in all shapes and sizes here, except the uniform. There is not the slightest whiff of the footballer’s wife or silicone babe in the ladies’ pools and massage booths of the once grand and glamorous Gellert Hotel. Today, in fact, is pensioners’ day, and the local grannies bob about like pickled walnuts in the cloudy, sulphurous water, naked except for the well-bleached linen modesty aprons that flap uselessly about above their grizzled pubes. No one is paying the smallest bit of attention to my own well-lived in body, I assure my furiously embarrassed little girl; but I wonder, all the same, as I slip down my straps and climb into the icy plunge if it is noticeable, this strange, slight puckering on my right breast above a strange hard lump I felt there about six weeks before Christmas. There is only room for two in the plunge, and the other incumbent, a naked Austrian woman, looks challengingly at me, to see if I can stick it out. I last about ten seconds.
Cara is waiting for me back in the thermal, not realising that it is her whom the Hungarian grannies are talking about, for skulking too long in the 38 Celsius bath. I swim up to her (another contravention of the rules) and, still defiantly topless, submerge what my new Austrian friend would call my heart and lungs chakra in the dense hot water, hoping that its curative properties will disperse this strange contusion that is keeping me awake. It is possible to reach a state of beatific torpor in these baths, judging from the expressions of some of the women: a transcendent state, where past and present converge in great white hopes for the future. Most of them have been in here for at least an hour, which is fifty minutes longer than the maximum time recommended at this temperature. Cara is rosy as a picture-book apple, and I hate to imagine what the hot spring water is doing for my own face, though it is doing wonders for the circulation in my legs. Watching the clock, fixed high on the wall of green and silverfish grey majolica tiles, I wait out another five minutes before a white-coated masseuse, a relic from Communist times from the look and sound of her, comes to the steps to shout out a number at me. She wants some other hapless tourist, I expect, who doesn’t understand Hungarian; and I briefly consider taking her place, but am frightened of the close scrutiny I might attract perched up on the couch, beneath the harsh bright lights and expert, pummelling hands. There is a hospital on the floor above the spa, purporting to treat cardio-vascular problems. We pass it, Cara and I, as we ride up in the antique lift of the grand old hotel, in which we are thankfully staying, because to go to the effort of drying and dressing and turning out onto the cold March streets after the enervating sensation of the baths must be punishing indeed. A couple of ‘patients’ in hotel dressing gowns get on at the hospital floor; but Cara and I do not get out. Cardio-vascular problems, I guess, are not my trouble.
It is still there, back up in our room, as I peel off my swimsuit again beneath the same sulphurous waters of the bathroom shower. In fact, there is possibly more of it, for besides the hard, tight lump and the puckering, there is now what looks like a slight patch of inflammation beneath my collar bone. The mirror is steaming up, and my image is starting to melt, like one of the damned in hell in Michaelangelo’s Sistine frescoes; but I can see it in my mind’s eye.
It is still there.
It is always there.
It isn’t going away.