Friday, 28 March 2008

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.

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