A few years before being diagnosed with breast cancer, I did a writing course. One of the writing prompts was: "You have just been told you have cancer. Describe the doctor's hands."
How clever, I remember thinking. I thought it plausible you might focus on the doctor's hands as you reeled from the news.
As it turned out, my imagined scenario was a load of bollocks. I've had hours of meetings with the man whose hands, quite literally, saved my life and I have no clue what those hands look like. That's the thing about cancer, you have no idea how you'll respond until you're in the midst of it.
I was 37 the day my specialist, a gentle man called Michael, gave me the news.
"The cells are abnormal," he said in his no-nonsense German accent. Thank goodness, I thought. They're just abnormal, not cancerous. Then I took in the look on his face. "So what does abnormal mean?"
If I had been writing an imaginary scene, this is where I might make the main character sob or faint (or, you know, check out the doctor's hands). I'd show denial or anger - something to illustrate the emotion of that moment. But that's not how it was. The moment wasn't loaded with emotion. I still felt like the same person who walked into the room without cancer. Perhaps I was calm because we caught it early. One of the first things Michael said was: "I don't think there's anything inside you that will kill you." I hung on to those words like a lifebuoy.
I told Michael he must have the worst job in the world, giving women such awful news. He smiled and said something like: "No, you forget the other side of it. I see them come out alive and well and with a greater appreciation of life than they ever had before."
I was already beginning to understand gratitude. I was grateful to the two women recovering from breast cancer who asked me to interview them to promote awareness. Before the article was printed I did my first self-examination and found a lump.
Then I was grateful to the doctor at Mercy Hospital in Dunedin who did an ultrasound, while I waited on the results of my first test, a fine needle aspiration (FNA). It came back negative, because the lump I found wasn't cancer and disappeared after a few days. I might have left it there, except that Mercy Hospital doctor urged me to see a specialist even if the FNA was negative. She didn't like what she saw on the ultrasound.
I was still 7½ years away from mammogram screening. If that trickster lump hadn't resulted in a myriad of tests, I wouldn't have found out I had several small cancerous tumours in my breast. It would have been another year before they were big enough to feel. The cancer had spread to my lymph nodes. I don't like to think about where it would have been a year on.
So, gratitude. The downside was I had cancer. The upside? Through a random series of events, I knew I had cancer.
In my imaginary story I might have gone on to write about how this brave young woman now fought a courageous battle with cancer. But - and I know I'm repeating myself - what a load of bollocks.
I know the battle metaphor works for some people. Do whatever works for you. It didn't work for me. I'd lost people I loved dearly to cancer and I knew they didn't die because they didn't fight hard enough or weren't positive enough.
I didn't want to be in a battle. I put my trust in medicine. It didn't feel like a battle. If anyone fought a battle it was the brilliant surgeons, oncologists, radiotherapists and nurses. They fought with science and compassion. I was just along for the ride. I was positive, but because the medical professionals genuinely made me felt optimistic.
I joke that whenever I tell someone the treatment I had it sounds like a macabre version of The Twelve Days of Christmas: two minor and one major surgeries (left breast mastectomy and tram flap reconstruction), six chemotherapy infusions, 25 radiotherapy treatments, 17 Herceptin infusions, one nipple reconstruction and nipple/areola tattoo and 2958 Tamoxifen tablets (692 more to go).
I can say it now, in one little paragraph, and it gives me no anxiety. But at the time, I couldn't deal with all of that. How do you eat an elephant? One bite at a time.
I didn't think about chemo until I was done with the surgery. I didn't think about radiotherapy until the chemo was done. The treatment wasn't as bad as I feared. Nothing was easy, but it was all far worse in my imagination and sometimes I could see a funny side.
Before an appointment where Michael had to stick a needle under my nipple, I worried about the pain of the procedure. But what stayed with me was the absurdity of us attempting to hold a normal conversation after the jab, when for a full minute he had to massage my nipple, while we both pretended he wasn't massaging.
Yes, losing a breast so young is tough, but I had immediate reconstruction so it never really felt like I lost it. I went to sleep with a breast and woke up with a breast. It's just this one wasn't trying to kill me.
My plastic surgeon, Patrick, used an abdominal muscle and fat from my tummy to pad out the new breast.
"Think of it like filling a cushion," Patrick said. He is good at metaphors. I did lose the nipple - it had to come off, I didn't misplace it - but Patrick made a new one from my skin. "It's like doing origami," he said. I think Patrick might have had a misspent youth in the art and craft room at school.
You may be interested to know you can buy a stick-on nipple/areola. You can even get ones with glitter on them. But I feared it might come loose and work its way out of my shirt in a meeting or while I was out running.
Even the chemo wasn't as bad as I feared. The anti-nausea meds meant I didn't throw up once. Of course there were the bad bits: the steroids that made me feel wide awake when all I wanted to do was sleep, feeling generally odd and ending up with a week-long hospital stay for a mystery infection. But even that wasn't so bad. It is critical to get medical attention when your immune system isn't fighting back, but the only infection symptom was a high temperature.
I was put in an isolation room at Dunedin Hospital. It felt like a holiday, with a comfy leather chair and a flat-screen TV. All the meals were brought to my room and the doctors and nurses were funny, interesting and kind.
One nurse suggested I imagine I was on a cruise ship and pretend the air removal system hum was the ship's engines. Of course people don't prod you with needles on a cruise ship and I was eager to get off at the next port. But those first few days at sea were relaxing.
Losing my hair wasn't as bad as I feared, either. I shed a few tears then I figured it meant the chemo was working and I didn't feel like crying any more. My husband shaved it all off and I enjoyed faster showers.
I did have a good sob at times. I'd let the tears out and always felt better afterwards. However, if I could tally it all up, I reckon I did a lot more laughing than crying. I reconnected with family and friends and that felt good.
After a while the appointments died away. I got back into running and biking and normal life. All I was left with was my annual mammogram. Every December I freak out when that appointment rolls around. I'm still working on how to deal with that. But most of the time I don't think about breast cancer, even when I take my daily Tamoxifen pill (three more years of that to go).
Next month it'll be eight years since Michael told me I had abnormal cells.
No one would volunteer to get cancer, but the experience wasn't all bad.
It reminded me what was important - pick the cliche: family, friends, love, laughter.
I may not have noticed Michael's hands at the meeting where he gave me the diagnosis, but I remember his words. Greater appreciation?
- A new lump or thickening of skin
- Shape or size change
- Nipple discharge
- A newly retracted or turned-in nipple
- A red rash or flaky skin around the areola
- Dimples, puckering or dents, including on the underside of your breast
- Red and inflamed skin with visible pores or any change in breast colour
- Unusual breast pain
Ages and stages
Knowing the signs of breast cancer and what's normal in your breasts will give you the best chance of finding the disease early. Having a mother or sister with breast or ovarian cancer at a young age can increase your risk, so it's important to talk about and know your family history. It's also important to discuss a family history of cancer with your doctor and if you detect any unusual breast changes, see your doctor promptly.
Lifestyle factors such as regular exercise and a healthy body weight can reduce the risk of breast cancer.
Although not as common in young women, it can be more aggressive so it's important that women are breast aware and alert for changes from the age of 20.
Over this life stage, women start to experience changes to their breasts. Start having regular mammograms from 40, as the risk of breast cancer increases as you get older. Up to 45, you'll have to pay for a mammogram -from $110-$180.
From 50, you're entering the highest-risk stage for breast cancer. About 70 per cent of all cases are diagnosed in women 50-plus. You can increase the chances of early detection by having regular mammograms, being breast aware, and getting any changes between mammograms checked out promptly. Mammograms are free up to 69. Women over 50 are urged to have a mammogram every two years unless their doctor recommends otherwise.
Free mammogram screening ends at 69, but the risk of breast cancer is higher in your 70s than in your 50s.
Women are urged to continue to do regular checks and still have mammograms.
Source: New Zealand Breast Cancer Foundation