Part 3 - Treatment, the proposal

PART III

 

 

I

 

We saw a different doctor for the post-op meeting. He explained that he was going to re-cap the story so far, with the admission that some of it he knew and some of it he would make up for me to confirm or deny. I had thought this re-cap would cover from diagnosis until now. Instead it started from shortly after my birth – going over every illness and infection I had had to date. Broadly speaking, he got it right. And so he should have – he had my notes in front of him, by now a fairly bulky file of papers.

He needed to clarify a few other details, such as my plans regarding having children. I told him in no uncertain terms that I did not intend to have any, and that Steve had been cut off at the mains to further prevent this. ‘Noooo children’ he said, as he wrote this on my notes – in exactly that format. This note was soon followed by No Reconstruction and No Cold Cap. It all looked a bit negative.

He then asked why I had had a mastectomy rather than a lumpectomy. ‘That was what the surgeon advised’, I told him, ‘given the size of the lump in relation to my breast’. I  also hadn’t been given a choice, but it already felt like I was in trouble, so I didn’t want to mention that and potentially compound the situation.

 Then we got the technical detail. The tumour was 19mm in diameter. In medical terms this means it was a T1 tumour. It was surrounded by pre-cancerous cells making the total lump a diameter of 38mm. Because of the medical preferences about how much clearance there is around a tumour removal, if I had had breast conserving surgery (lumpectomy) he would now be sending me off for a mastectomy. And that would have been annoying. It’s not often one will have cause to say ‘well hurrah for having had a mastectomy’ with a tone of smug vindication – but this was one such rare moment.

What all this meant was that my local recurrence risk was low. Very low. So low, in fact, that there was nothing to be gained by having radiotherapy.

My recommended treatment was also dictated by the type of tumour. It wasn’t a hormone feeder, so tamoxifen (a tablet based treatment) was not going to be offered. More importantly, I could continue to use hormone containing face creams (collagen enhancing). It was heartening to know that my wrinkles would still be kept in check.

 So far, all the news had been quite positive. This was about to change. It was a stage 3 cancer. To give it its correct medical definition, this was a test of how ‘higgeldy piggeldy’ the cells were. Grade 3 was bad and increased the risk of recurrence somewhere else. It was also HER2 positive (I hope you’re keeping up here). This is a naturally occurring protein, but if positive rather than negative, it causes cancers to grow and spread faster. This again increased the risk of recurrence somewhere else.  The HER2 positive situation happens in 1 in 5 cancers. The ‘good’ news was that there is a dedicated treatment for this – herceptin. The ‘bad’ news was that this is given intravenously, every 3 weeks (like the chemo) – but for 18 cycles. Yup. That is 54 weeks of treatment.

Given my mix of lower and higher risk, and the increased risk of spread, he said that 6 cycles of chemotherapy would be offered. I was happy to accept the offer. Steve and I had discussed this at length beforehand and we had concluded that a few months of unpleasantness was a small price to pay for the knowledge that I had done everything I could to beat it. Otherwise, in the event that I did get another lump, I would always wonder – would this have happened anyway, or could I have stopped it. I would get two different types of chemo – all administered intravenously. The first 3 cycles would be FEC and the second 3 cycles would be taxotere. After some thinking aloud he decided that the last 3 cycles of chemo and first 3 cycles of herceptin could overlap – thereby reducing my treatment time by 9 weeks. The herceptin couldn’t start sooner as herceptin and FEC do not mix well.

The chemo would reduce my recurrence risk by around 30%. The herceptin would reduce it by a further 40% after the effect of the chemo was taken into account.

 He did say it was entirely possible that with no further treatment at all I would be completely fine and never grow cancer again. But they didn’t have a test for that.

And now for the joy of side effects. Herceptin, by and large had no side effects. Well, you could feel a bit rubbish after the first cycle – but I would be on chemo then anyway so already feeling moderately below average. Once the chemo was done with and I was only on herceptin there was no reason why I couldn’t re-join the human race and behave like a normal, healthy person.

Chemo, however, was a different animal. While making it clear that the management of side effects was now much improved, he said that symptoms could include nausea, being sick, constipation, diarrhoea (‘diarrhoea is common in the first week of each cycle’, he said ‘if you have it in the second week, you’ve probably got food poisoning’), hair loss, hot flushes, mouth blisters. None of which was on my Christmas list. This seemed very like the surgery situation – I was willing to walk into hospital in cold blood and this time round be intravenously administered with poison, which would make me feel rubbish. And then, three weeks later, I would return and get it done again. And again. And again. And again. And again.

I was also informed that chemo could cause menopausal symptoms. Things would most likely return to normal afterwards, only for me to go through it all again a few years later when I had the ‘real’ menopause. Nice practise run then.

He warned me about infection complications. This was where the greatest mortality risk lay – an infection that could not be brought under control. It was impressed upon us that if I was unwell, call them. If my temperature rose to 38 degrees, I would be in hospital and pumped full of antibiotics on a ‘administer drugs, ask questions later’ basis. Steve wondered if there was a way of attaching a thermometer to his willy in order to undertake rectal temperature checks on a regular basis. Naturally I was touched that he had my welfare so much to the fore.

Then we had a discussion about putting tubes into me for the treatment to be administered. As I had many many weeks of treatment and, by all accounts, chemo destroys veins, they couldn’t just hook up into my veins via a canular because by the end of the treatment my veins would be ruined and I would have an entirely new problem. Another consideration was that only my right arm could be used due to the lymph node removal from my left armpit (7 lymph nodes taken – not 3, which I had initially been told). So a more permanent line needed to be fitted into me.

Option 1 – Peripherally Inserted Central Catheter or PICC line. Less invasive to put in, runs internally up your arm and across to your chest. Needs to be flushed weekly at hospital.

Option 2 – Portacath. More invasive surgical procedure to implant a small box into my chest (titanium -  I hasten to add). Does not need flushing.

Hmm, weekly visits for over a year vs increased mugging risk by having precious metal in my person. It was a no brainer. Option 2 please.

Now came the moment we had all be waiting for. The removal of the dressing. I had been wearing the dressing for two weeks. Consequently it was now a bit tatty around the edges and coming away in places – so I had already had a sneaky peak at what lay beneath. A thin line of surgical sticky tape. Now that too came off. There were no external stitches, and an amazingly neat scar stretching from my former cleavage (or where it would have been if I’d ever had one) up into my armpit. I was immensely sticky from the dressing, and quite swollen still, such that it looked as though I still had a small breast. But when I pressed on the swollen bits, the fluid leapt across my chest, with a look and feel similar to when you play with a hot water bottle – moving the water from one of it to the other. I was so excited to finally see it that I called to Steve to pop his head around the curtain and look.

Fully briefed, and expecting a raft of appointments, we left, armed with a mountain of literature.

 With the dressing off it was an opportunity to take photos and issue them to the family. Bro the elder responded saying ‘I suppose I imagined the wound would be much worse, thinking rather stupidly that they would sever the breast, leaving a large round scar, but obviously it was more efficient than that’. I assume he used the term ‘large’ in its loosest sense. It was also the chance to have my first shower in two and half weeks, an indescribably blissful feeling.

The next day at work I wore my softie. It fitted a little better now that the dressing was gone, but was still a fraction big. I showed the rather small stuffed pocket so some of the people at work, and then gasped ‘oh no, I’ve just shown you my tit’.

 

II

 Now that the chemo was confirmed we could plan the fund raising heard shave, in earnest. The landlord of our trusty local – who shaves his head to a highly polished finish – had initially agreed to grow his hair for one month for each one who got shorn. Realising that this would quickly add up, he reduced it to two weeks. Then 1 week - with an early buy out option. The couple who run the pub are marvellous fun. The landlord has been shaven headed for 17 years. His wife liked him like that. So while she appreciated his magnanimous hair growing gesture, she was also concerned. So for a bit of fun we persuaded her to make him believe that she would get her head shaved. And to maintain this pretence until the day itself. He was mortified at the prospect. So the net effect was hilarious.

I registered the event with Breast Cancer Care (who  published the immense number of useful and informative leaflets I had, as well as offering an online forum and blog, burgeoning with helpful advice from other women in this situation), set up a 'Just Giving' page, added this epic to a blog and started the process of raising funds. It took off immediately. The generosity and kindness of friends and strangers was, and continues to be, very humbling.

When I first loaded the blog Steve had been concerned about the cover picture. 'It's quite high resolution' he said, 'there may be pervs looking at it who will zoom in'.  A few days later a friend of ours told me that she had wondered if the picture was of me, so had zoomed in. Just to check!  (It is me, in case you were wondering - what's more, it was taken a month before my diagnosis. The cancer is there, in that breast.), Looks like we'd found our perv.

 All that was remaining was confirmation of when my chemo would start, so that the date could be finalised. 

 

III

 

 A female friend was in the pub and had been French plaiting the long, wild hair of one of the male regulars. The plait was good. The overall look – on him – didn’t entirely work. The sight of my hair now presented greater appeal. She brushed it and ran her fingers through it. ‘You have amazing hair’ she said. ‘Fuck off’ I jokingly replied. After all, I wouldn’t have it much longer. She kept saying it, again and again. And she was right. It was amazing. Long, thick and wavy. She started plaiting. After a few minutes Jon whispered to me that she was crying. I reached round to hug her, and hugged her more closely when she had finished. She was enormously upset. ‘What’s the matter with you?’ her husband queried ‘she’s the strongest woman in this pub’ he said, nodding in my direction.

It was a strange situation to be in, but I suppose it was more difficult for the bystanders. After all, I couldn’t escape or hide. I couldn’t make it go away or pretend it wasn’t happening. All I could do was front up and face it head on with as much positivity as possible and enjoy the process on the basis that I didn’t plan to repeat it.

The tendon in my armpit was still very tight and pulled in a way which was visible, and interesting. Reaching for things was uncomfortable. Bro the younger had said that it didn’t really matter if I couldn’t put my hand up again given that I was no longer at school, and things could be moved from off the top shelf. But it was still frustrating, so I was hugely excited when – 3 weeks after surgery – I could take my T shirt off by myself. This felt like progress. It’s strange – the little things we take for granted.

 

I was still doing my daily re-hab exercises. I was almost at exercise three of the total of four. According to the exercise sheet, once I could do all four (the final exercise was a backstroke motion) then there was no activity that I couldn’t do, irrespective, apparently, of whether or not I could have done it before the surgery. I still had no feeling in my armpit or along much of the scar. This seemed to be normal, and there was no guarantee that sensation would return.

At rugby that week one of our friends asked how I was doing, and the arrangements with work. ‘Are you milking it’ he said. ‘I don’t think I can milk it any more’ I replied, gesturing towards my absent breast. He giggled.

I had started reading guidance from the BCC forum about dealing with the effects of chemo. There was a lot of useful stuff – use a soft toothbrush, change it every chemo cycle, avoid crispy or hard foods which might damage your mouth, don’t eat food you like as you will forever associate it with feeling nauseous. But there was also scary stuff about mouth blisters, the lining of your mouth peeling off, filling your throat with skin, oral thrush, nothing tasting right, being unable to have a crap for a week after each cycle. That night I had an unpleasant dream about having chemo. As is standard in dreams it’s all a bit odd. The drug was a thick, sludgy liquid that we all drank with a straw. As the cups were slowly emptied, some patients left the room to throw up, others sank to the ground with exhaustion. In the dream, I too was hit with fatigue. I woke up feeling sick, and the feeling lasted for some time.

I wondered if I would still recognise myself as the treatment progressed. Not just physically, but deeper than that, to what extent could I maintain my sense of self, my identity. And not just be a cancer sufferer, too tired and sore mouthed to feel like a person.

IV

The expected appointments started to come through. First I was contacted by the wig people, and then the surgical unit regarding fitting my portacath. The confirmation letter they sent included instructions for being under general anaesthetic. I had known this was a more involved procedure, but another general was a bit of a blow. And then there was the final appointment – from the oncology department. For 9.40am on 25 November. Gulp. Deep breath.

So, head shave party night was looking like Sunday 24^th.
 

There was a sobering moment when a friend of ours mentioned that she had been invited to a mobile mammogram screening, and now had the results. She had not been screened before, but was well aware of the highs and lows of my situation. I hope she would have gone anyway, but with an enhanced awareness of how it can all go wrong, she accepted the invitation. The screening unit basically amounted to a lorry trailer in Asda car park. The lady doing the screening positioned my friend and said to her ‘you have very firm breasts’. ‘Thank you’, she replied. There probably wasn’t much else you could say, and given that this information was provided by someone whose job it was to handle women’s breasts all day, every day, you kind of had to take her word for it. The results were posted out. I suppose, in the event of bad news, a trailer in Asda car park was not the appropriate venue. Her results were all clear, for which I was mightily relieved. But I wondered how many other women had started along this road since me. 

V

 For the third day in a row I woke early and lay in bed restlessly, for what felt like hours, before it was time to get up. Today was the last day in the office for 4-5 months – and it was a frosty morning. But it was nice to know that the threatened snowy winter would have no impact on me at all. My horoscope in Metro said ‘There may be a lot going on for you now’. No shit Sherlock! 

I had told a girl at work about the proposed charity head shave night, and that the landlord was getting in some pink tequila to add to the fun. ‘That’s a mistake’, she said, people will wake up the next day with a sore head and no hair and you may get some texts asking what happened’.  When I mentioned this to Steve he decided that we should get everyone to sign a humorous disclaimer, confirming they were of sound mind and sobriety when making their decision.

Once upon a time, before all this started, I slept on my tummy. It was still too uncomfortable to return to this position. It was also awkward lying on my wound side – which took several attempts to get comfortable and, bizarrely, hurting more in the seconds after I moved my weight off the scar. But I could lie on that side long enough to cuddle Steve – which we had missed when I was particularly immobile. Now I tended to sleep on my right side. Initially my left arm needed to be draped along my side, but in such a way that it did not rest on the scar, as it pulled too painfully if I put it on the bed in front of me. I had only recently been able to sleep comfortably.  

So, to know I was going to be having surgery now on the right hand side of my chest, to insert the portacath, immediately posed risk of more uncomfortable nights. And with a box in my chest for the next year or so, I would probably never sleep on my tummy again.

After a morning working from home we set off for the hospital. Mr Sutton was going to fit the device and told me that it could be done under local anaesthetic if I was alright with that. I most certainly was – but slightly annoyed that I had been fasting unnecessarily for a few hours. Also, it could be inserted on either the left or right side. His recommendation was the left.

 All gowned up and with a red label on my left arm instructing ‘nil by arm’, another lady and I were walked upstairs.  When I had the mastectomy, I was admitted into the theatre section of the hospital, but taken down to Day Surgery for the operation. This was now the reverse.

We were asked to sit down and wait for a moment. Being women, we immediately started nattering. She had also had a left breast mastectomy, but all her lymph nodes had been taken. Also, she was having radiotherapy after her chemo and then, rather depressingly, had to have more surgery to take additional tissue out. Her surgery had been one week after mine so we compared notes about stiffness and mobility. She asked whether my skin hurt. With everything else that went on I had almost forgotten that the skin on the top half of my left arm had been extremely sensitive to the touch, almost painful. It had now eased and was only very slightly sore. This seemed to be of comfort to her – to know that in another week, hopefully, her arm would also be less painful. I didn’t get the chance to ask if she had her chemo dates before I was summoned away.

The Theatre area was like a scene from the baddies lair in a 1980’s James Bond movie. There was a long corridor, peppered with people, dressed identically in purple theatre pyjamas, silently attending to their work around complex looking machinery.  We went into a room which contained purple clad Mr Sutton as well as another 2 purples, lingering awkwardly in the corner. These were students, come to observe, if that was ok with me. Mr Sutton warned me that he would be talking to the students throughout to quiz them and explain what was going on. ‘That’s fine’, I said, ‘provided you don’t ever use the words oops, or, that wasn’t supposed to happen’. ‘Oh, we never say oops’, he replied.  

I got onto the bed and, following a less than comfortable local anaesthetic injection, I was doused with iodine and then had surgical sheeting taped over me so that only the area of interest was exposed. This did mean that my face was underneath the said surgical sheeting – and initially the pungent aroma of the iodine was stuck under it with me. After a minute or two a nurse came round and lifted the edge so that I had a face to talk to.

‘This bit will feel a bit peculiar’, he said. ‘How do you know’ I asked him. Which seemed sensible enough to me. Apparently this was what patients had reported. It didn’t feel odd, just a pushing sensation. A lot of pushing. Quite hard, determined pushing. Mr Sutton explained that he was burrowing to make a space for the port to sit in. Then he needed to do something rather technical which basically amounted to passing a line through and into a blood vein. Once this was safely in place, he attached the port, put it into the space he had made for it. As he pushed the line through he warned that this sometimes caused pain, and I must let him know if I felt any. ‘Can you feel any pain’, he asked, as he proceeded. ‘Not yet, ‘I replied. ‘Don’t say it like that’, he smirked ‘there are students here. I’m meant to look whiter than white and you’re not in any pain because I’m very proficient at this’.

I giggled. And then winced. Because something hurt. ‘I touched an artery’, he informed me, having seen the wince. ‘They have nerve endings. I won’t give you any more local as that will sting, I’ll just avoid touching the artery again’. That seemed like a good plan.

Having got the line in place, it needed a quick x-ray to check it was in the correct location. Through my peep hole I could see the X-ray screen. The nurse even rotated the image so that it was the right way up, and one of the students went over to point out the various bits. He showed me thet space made for the port – currently filled with swabbing – and the line running under my collar bone, down to my heart.

 

Shortly afterwards, the port was fitted, sewn in tested and it was all done. He then asked me to move my right hand onto my chest and ‘feel my new friend’. It was a funny little lump. 

I went back down to the, not pleasantly named, ‘Discharge Lounge’ for a cup of tea and biscuits. The port was a visible lump, and looked a bit like an alien trying to escape from my chest.

 

Once again, sleeping was uncomfortable. Once again, I needed help undressing. Once again, I couldn’t raise my arm above my shoulder. I was extremely pleased that the procedure had been done on my left so that I still had one fully functioning arm. I consoled myself with the thought that the bruising would soon go, and I would regain the mobility I had spent the last 4 weeks trying to get back. But it did feel like a slight backward step. 

VI

The following day we went for my prosthetic fitting. As we sat waiting, Steve asked if I wanted him to come in with me. ‘Of course’, I said, ‘why wouldn’t I?’ ‘Well’, he replied, ‘you are choosing a part of your body’. I reminded him that he was entitled to a say in that.

The permanent prosthetic was made of silicone. I hoped it would therefore ‘cling’ to me a little better than the softie and not try to escape with such regular determination. I had heard of adhesive versions, which used denture glue, or something similar, to keep them in place, but this seemed a bit extreme. Being made of silicone, there was a risk of leakage if punctured or split. The nurse told me that if this happened, I should just put a plaster on it. So it would then look just like my old breast, after removal, and complete with plaster. The image made me smile. I decided that in some bras I would probably sew in a fixed filling, particularly those ones that tended to ‘lift and squeeze’. This works fine on a breast that is attached – but forces a prosthetic up, out and away, which was less than ideal. Camisole tops would certainly need something sewn in as their structure was not sturdy enough to house a prosthetic. I pondered an expansion of the existing mastectomy underwear business enterprise to cover evening dresses. Party season was looming and we had some black tie do’s lined up. Most dresses (and certainly most of my existing ones) were designed assuming the presence of breasts. Even with the prosthetic in place, if anyone stood near me it was quite obvious that something wasn’t quite right.

The prospect of a future filled with demure, sensible, Victorian style high necked frocks reared its unwelcome head. On the plus side, rather than just co-ordinate said dress with shoes and bag, I could now try to accessorise with a colourful wig as well.

 I tried on a variety of sizes. And shapes! The prosthetic had a nipple and was wonderfully wrinkly when it wasn’t being worn. After trying on about 5, we settled on one which was oval shaped rather than pointy at the top. 

That afternoon we had a lengthy ‘demystifying chemotherapy’ session, courtesy of Macmillan. This included a tour round the oncology ward and the chance to see the room that would become all too familiar over coming months. We were also shown the cold cap. Everyone laughed. It was very pink, with a chin strap, and a large tube running from the top of the head to a big piece of machinery that would blow cold air out. It could only be used if you had hair because if your hair had thinned or fallen out in clumps there was a risk of frostbite on the exposed parts of your scalp. The conclusion of most of the ladies present was that it would be uncomfortable, and you would look very very silly whilst being made so uncomfortable. 

We were also told about free therapies that we were entitled to, including massage and yoga, as well as being strongly advised to get our name on the list for the Look Good Feel Better make up session – where you got a goody bag of make up, worth around £250. One girl was concerned about getting the session before her hair had fallen out – in particular her eyebrows. The session would teach you how to proficiently draw them on. As individual hairs. ‘well’, I told her ‘you could always shave an eyebrow off if it came to it’. She had also had breast cancer, but had had a lumpectomy as well as lymph node removal. She also commented about the sensitivity of the skin down her arm.

The session had a lot of useful, and alarming information about dealing with stress and anxiety. They also explained the action of chemo on fast acting cells – mouth lining cells are replenished every 2-3 days and hence are attacked. Gut lining is replaced every 4-5 days, and are also, therefore, under attack. White blood cells live for 7-10 days, and the ones that are particularly affected by the chemo are those which mop up unpleasant bacteria. Brain cells are never replaced. Which was unfortunate. However, so that they didn't feel left out, there was the fun of chemo induced brain fog to look forward to.

To ensure that when we did have any energy, it was used on the right activities, they advised making two lists. One was all the nice things we wanted to do when we felt up to it. The other list was the dull, mundane minutiae of life, the things which have to be done and which we perhaps shouldn't waste our limited energy on. This was on the basis that if you felt ok, spent an hour and half ironing, and were then knackered, this wasn't the best use of your energy. Therefore, when a kindly friend or relative asks if there's anything they can do to help you say 'yes, I've made a list' - surely words to plant dread into any well meaning soul - and give them the second list. This seemed like a good way of making sure that either you got no visitors, or they never uttered those fateful words!

The importance of recognising and acting on any suggestion of infection was hammered home. They listed 14 signs of infection that we should be alert to. They then pointed out that 11 of these were also common side effects of chemotherapy. Well this was going to be interesting!

We were warned that chemo comes out the same colour it goes in – if your chemo is red, your pee will be red. If it is blue – guess what, blue pee.

For mouth health, the advice was to wash our mouths with saline fluid 3-4 times a day. Steve was delighted - immediately thinking of his self made saline solution.

The nurses provided a lengthy sheet of food that we could or couldn’t eat and directions about how many times in 24 hours it was ‘safe’ to throw up or have diarrhoea. In the event of the opposite problem, laxido powders were recommended as the final  option, the ‘unblocker of everything’.

Up until now I had always understood the awesome power of the phrase 'yes, dear'. Now a new force was with me. The cancer card. If, at any time, there was something I needed which is normally not possible for mere mortals - be it an urgent GP appointment or side salad that hasn't come from the germ ridden salad bar - the card is to be played. And here's how it goes: I am a cancer patient. I'm on chemotherapy and I need to have ..... I promise that I will never, ever make inappropriate use of that (with much crossing of fingers).

Then they made sure we all had forms to claim free prescriptions. For 5 years. This wasn’t all bad.

From information received in this meeting as well as from BCC, Steve and I started to compile a shopping list. Pineapple chunks, crystallised ginger, prunes, cabbage, mini milk lollies. I wish someone would take that to Ready Steady Cook and see what they make of it.

The next appointment lined up was with the wig people. It’s very strange picking parts of your person off a shelf, as separate entities. And very difficult to decide, when you actually have a choice in the matter. The wigs by and large all had fringes, to help disguise the wig line. It was tempting to play safe and keep something similar to my current style and colouring. But I wanted the opportunity to do something different. There was one, short, messy style which made me look the spitting image of my younger brother. I didn’t dislike it, but I couldn’t go round looking like bro. That would just be confusing. And also it did look a bit like road kill - or a guinea pig - when it wasn't being worn. I opted for a fairly dark, shoulder length one. It had a longish fringe that went into my eyes a bit and would need trimming.  As with all such things, as soon as I picked it, I worried about whether I had made a mistake.  It would take some getting used to – as with any change of style.

The bro the younger head wig had been so amusing that Steve took a photo which we sent round to friends and family. My father said it suited me - which is a good thing given that he has another child who looks just like that. Said child, bro the younger, replied that if I put a broom handle in it, I could use it to clean the kitchen floor. Shortly afterwards, this was followed by another email, which read:

'when I wrote that thing about mops this morning I was referencing my own hair and how many members of the family often compare it to a mop.

and then I re-read it after I sent it and thought maybe it sounded like I was mocking your wig. and then I thought hang on I sound like I’m mocking someone with cancer, my sister no less. and then I felt bad all day. 

sorry, didn’t mean it quite like that. I’m not the sort of chap who mocks people with cancer.'

 

I assured him that I had taken it very much in the spirit in which it had been intended.

The pain of the portacath incision still surprised me, until I remembered hearing the surgeon say 'could you pass me the dissecting scissor'. Steve suggested he may have had to cut through bits of tissue to make space for the port.  I hadn't been wearing my new prosthetic for a couple of days because the weight of it pulled uncomfortably on the new scar. So when I next took it out of its box to wear for a day out in London I looked at it for a few moments with a puzzled expression, trying to work out which way up it went. These things are more complex than they look and I couldn't go round all day with my breast on upside down. Perhaps I should have paid more attention as a child, when we attached plastic bits to potatoes to make a  'person'.  

VII

 Head shave day was here and, rather excitingly, it received mention in the previous day's local press. The trip to London had been well timed as I was now armed with an array of headscarves.  The last time I had such a dramatic cut was as a toddler when bro the elder and I were left unattended for 5 minutes, during which time he used the bathroom scissors to cut my hair which I had taken a full two and half years to grow. By all accounts, I sat there quite happily letting him remove chunks of my soft, fair, curly locks – which my mother collected into a bag and still has to this day.  Anyway, my brother – being only 4 or thereabouts – was not a proficient hair dresser, so I was left with a rather curious look. Apparently this distressed the other children at nursery so much that I had to go wearing a hat until such time as my hair had recovered itself. I could only hope that today’s cut would be a little more even and less distressing to nursery children.

We set off early to the pub to ensure we had time to blow up the balloons, put up posters and banners, arrange the barber chairs and set up the disco. And – more importantly – put out bowls of pink smarties.

The pub started to fill. I put my hair into bunches because I wanted them cut off intact as a keepsake, a reminder of how my hair used to be in case it grew back differently. It did, however, make me look like a 12 year old. My mother said I looked ‘sweet’ and should keep it like that. Hmm – I could foresee a problem there.

The appointed hour arrived and my requested tune, to set the tone for the evening (Always look on the bright side of life) started to play. Right – let’s get this done. I sat down, and a circle of people formed in front of me, armed with cameras. The two hairdressers stood either side of me, each cutting off a bunch, which they then held aloft in the fashion of a 16^th century executioner parading a recently severed head. As the first one was removed I called out ‘wait, I’ve changed my mind’. Then the gentle hum of clippers tickled my head. I had thought this part would be difficult – the public, much photographed de-hairing. But it was remarkably good fun, even before I was handed a medicinal whisky on the house by the landlord. Next to me, the other hairdresser was working her way through the first of the boys’ hair – a quicker process than mine. My hairdresser whispered to me that she thought I was very brave.

After a few minutes it was all over. I stood up and looked in the mirror. Why had I never done this before. It looked fantastic. I ran my hand over it – it felt strange. And fun. My mother thought I looked great, but also tinier and more vulnerable.

We had asked all head shave volunteers to sign a Declaration of Sobriety, confirming that they were of sound mind and mentally capable enough to make this decision. But once it got going, chaps were swept along with the tide (or bullied into it). As were the cutting girls who talked them into shorter grades cut and played around with some amusing hairstyles in the process. The photos of the event have as many pictures of horrified WAGS as stunned, shorn men. Then the DJ (who had also been done) rallied the troops saying that if we could raise £100 the barman would have his head shaved. Approximately 2 minutes later he was in the chair, and looked mildly unimpressed about it. Things started to get mildly out of hand when one chap volunteered for a chest and back shave. The following morning the landlord had to wash the floor about 8 times. Apparently hair clippings and sticky beer are not an ideal mix.

The pink afro wig I had bought was made good use of, and the girls amused themselves with pink hairspray.

Then came the moment of fun. We called forward the landlord and his wife. They both sat down. He couldn’t look, and sat with his back towards her. ‘Look, Look, I’ve got a bald streak right down the middle’, she called to him. He grimaced. She tapped his arm. Finally he turned around and saw her head of hair, fully intact and he realised he’d been had.

After the landlord’s cut, I took the floor for a thank you speech and handed him a basket of items he would need for coming months – curlers, straighteners, brush, conditioner. An hour later there was a distinct skinhead feel to the pub. My mother later remarked in an email ‘as so very many chaps agreed to have their heads shaved, albeit several were reckless, spontaneous actions, if there are any CCTV cameras near the pub which have recorded folk entering with heads of lustrous hair and emerging completely bald, it could be concluded that some cult is operating within those portals’.

A friend did a closing speech, to acknowledge what the evening had been all about, and handed me a book in which people had been writing messages of support all evening. I cannot relate here what was written in it. Suffice to say it aroused emotions. And continues to do so. With much bucket shaking, we raised over £800 in cash which was an impressive and stunning effort.

I hadn’t felt that drunk at the party, so the following morning my fuzzy head (internally, rather than externally) was a surprise. And not a pleasant one.

I took the bandage off my portacath wound in advance of it being used for chemo. It was a vertical cut, above the horizontal mammogram scar. Before long I would start to look like a noughts and crosses board.

From now on it was time to stop having ‘last’ days. Last day with two breasts, last day at work, last day with hair. Instead, things needed to become the first time.

First day of the rest of my life

First day rocking a bold (or bald!) new look that actually really suits me

First day of eating a lot more cabbage

First day of the beginning of the end

First day of chemo.

VIII

 

I wasn’t given a numbing cream, so putting the needle into my port was painful. And then the cocktail of drugs began, all washed down with a saline drip.

 

First, an anti emetic. Side effect – constipation.
 

Second, a steroid . Side effect – temporary tingle in the nether regions that makes one levitate a bit. It wasn’t a tingle so much as feeling as though a stinging nettle had been run along my bits, between my bum cheeks, up my spine and over my head. Apparently some people like the sensation. I can’t for a moment imagine why.

Third, two syringes of red chemo.
Fourth, cyclophosphamide. Side effect – diarrhoea

Fifth, fluorouracil. Side effect – temporary head freeze.

And that was it.

I was sent home with 3 different anti sickness pills and white blood cell booster injections. I hoped that the constipation and diarrhoea drugs would counteract each other so that the net effect was nothing out of the ordinary.

Three hours later the nausea hit.

 

Part 2 - Surgery

PART II

 

I

At 7.30 am we arrived at theatre admissions. It was fire alarm test morning, so there was a sign on the lift warning that it may stop momentarily between floors. Fortunately this didn’t happen. Steve waited with me until I was called in.

Dr Mansfield said hello to me and saw me shortly after my meeting with the anaesthetist. We confirmed which breast was being operated on, and she then drew on it, just to be sure. Left Breast Mx, SNB (sentinel node biopsy) and a socking great arrow. But at least there could be no mistake. I joined a small waiting room with other, similarly marked up ladies.

In order to allow the sentinel node biopsy to be undertaken during the operation, I needed to have a radiation injection. There was a delay in getting this done – following the fire alarm tests they needed to re-check the scanners and cameras before any patients could be seen. I had always been under the impression that radiation exposure could cause cancer. I had cancer and was waiting to be injected with radiation. It seemed a curious turn of events. Shortly after 9 am I was called in.  The nurse explained that the radiation injection would be made into the lump and she would then watch on the scan which node it drained into first. I was asked to confirm that I wasn’t pregnant, and sign a form to confirm that I was sure I wasn’t pregnant. Clearly radiation injections and pregnancy do not mix. The nurse warned me that the injection would sting. She injected near my nipple, straight into the lump. I wouldn’t say sting, so much as quite uncomfortable. And then more uncomfortable. Still the injection continued. And the pain of it increased. I clenched my fist and held my breath. ‘Not much more to go’ the nurse said. I suspected she was lying and I was now struggling with the significant discomfort of it. Finally it was over. She held my hand for a few moments, looking at me sympathetically and apologising. The pain was already subsiding. ‘it’s alright’ I told her ‘I shouldn’t quibble, this is nothing compared with what they’re about to do’. I was bleeding from the injection so she put a plaster on it. This amused me. The breast was going to be taken away and I wondered if it would be sent off to pathology with the plaster still there, stopping a redundant bleed. Or would they take it off during surgery. These things I would never know.

I was then mechanically fed into a large do-nut shaped camera. The sentinel nodes were identified and I was drawn on again to mark these up. The idea was that during surgery I would be injected with a blue dye – which would hopefully not cause any long lasting smurf-look effects. The combination of the dye and radiation would attach to any cancer cells and make them show up. If the lymph nodes had cancer cells, they would all be taken during the surgery.

Back on the theatre admissions ward I changed into the hospital gown, anti embolism stockings and put on my dressing gown and slippers. My clothes and overnight things were bagged and tagged, and put into a secure cupboard until I was out of theatre.

My period, which was two weeks late, was threatening to appear. Typical. My tummy groaned with pain.

I had a further meeting with an admission nurse who talked with wide eyes about the storm, and showed me the photo she had managed to take of the fork lightening.

Then I walked to theatre, and into the room where it would all happen. I climbed onto the bed. As my father said later, it was one thing to be wheeled into theatre having been pulled from a car crash. But to walk into hospital in cold blood, feeling fit and well and voluntarily go through this – well that was something else.

I lay down and gave the lump and my left breast a final feel. In that moment I suddenly wished I had named the lump, so I could say goodbye to it. Heffa for example. The anaesthetist I saw earlier put an oxygen mask over my face. Meanwhile another anaesthetist held my wrist to get a vein ready for a canular. I felt dizzy, almost sick and was close to trying to remove the mask. That was the last thing I remembered. I was out before the anaesthetic line was even in me. There must have been more than just oxygen in that gas.

II

When I woke up the first thing I did was feel my left breast – or rather, where it used to be. And felt tears roll down my face although I wasn’t aware of crying. My mouth tasted of chemicals and I needed a pee. They put a bedpan under me, which immediately meant I couldn’t go – lying flat on my back in bed. I tried again a few minutes later, when I was a bit more awake. The nurse said it was a very strange colour, and then asked if I had had a radiation injection. I said I had. ‘Ah’, she replied ‘that will explain why it’s bright green’.

The nurse told me that she had been through the same thing as me five years ago and that the main thing was to be brave. She also told me that your pee was pink when you were on chemo. She gave me a cup of water with a straw to drink. Gradually I started to come round and be more aware of my surroundings. A blood pressure monitor on my arm was taking a reading every minute. Also my legs were being similarly inflated and deflated in turn. As I came to, these things were taken off me. Then I was wheeled to the ward. It was 3.30. The surgery had been due to take around 2 hours, but I had no way to account for much of the day.

I saw my sister in law, attending to the lady next to me. I knew she worked at this hospital but the odds of ending up on her ward had seemed unlikely. She called Steve to let him know that I was out of theatre and on the ward. What I didn’t know until later was that Steve had called around lunch time for an update. He had been told I was still in theatre which the ward nurses found odd as the lady after me in the admission list was back. They then called him back to let him know when I was in recovery.

The surgeon came round before Steve arrived. She looked at the dressing and felt around it for swelling, then apologised for displaying the dressed wound to me before I had had the chance to familiarise myself with it, adjust to the physical change. But I already had been looking at it. I kept looking at it. Kept feeling it. I liked it. I certainly didn’t miss my breast – or the lump it had been incubating. It was neat, tidy, and strange.  She also confirmed that the lymph nodes had been clear. This was a positive thing. She had taken three out to send to the lab to be absolutely sure.

Steve sent messages round to family and work then came to the hospital. I was ravenous. I hadn’t eaten since around 8.30 the previous evening. I was brought a cup of tea on the ward but wouldn’t get food until dinner at 6. So I sent Steve to the shop to forage for biscuits. I ate two rapidly, and felt slightly queasy.

Steve received an email from my mother who claimed not to have heard anything. She uses Outlook Express and tends to write emails before receiving them. This means that incoming mails are received subsequently. Steve texted her to suggest that she check again, but he started re-sending them anyway. She later said that the emails did ‘eventually’ appear.

I received a very nice email from  bro the younger, which read:

‘Hey Thom.  I think I timed this so you’ll be in surgery because I tried and couldn’t think of any useful words to say beforehand. Certainly nothing original that anyone else hasn't said to you already. Whereas now it’s over, it’s happened. Some part of it at least, there’s a reasonable road ahead but nothing you can’t handle. You’re a Redman after all. And I’m utterly sure it has all gone well.

I heard about your party, it sounds at least like you’re dealing with this in a forthright and frank manner. Which is quite impressive in the circumstances. And not something everyone manages at all. I feel it will stand you in good stead as you face the coming months. 

I’m very sorry I’m not there to offer you any form of support. I’ve thought about sending completely pointless things like flowers and just given up because all I really want to do is take you for gins or give you a hug. But I can’t. 

You’ll just have to have faith that I’m thinking of you a lot and can’t wait to see you again next.

Lil’ Bro’

Dinner arrived. Soup, bread roll, chilli and cheesecake. I chowed down on it voraciously, with all the grace and dignity of a lion attacking a wildebeest. It was delicious, and much needed after 22 hours without food. Dinner time pills came round – I was offered pain killers but as I wasn’t in any pain, I declined.

Steve had called Jon and he popped in to see me as well. They were due to go out that evening to see the band that step child the younger’s boyfriend was in.

I was still attached to various pipes and tubes. The canular was still in my right hand, just in case. Although it was not connected to anything anymore. But the long attachment tubes were cumbersome and in the way. In my back was a local anaesthetic ‘block’ on a drip. This had been offered to me pre-surgery as an injection, to provide additional pain relief around the breast area. But they needed my consent because as the line went near my lung there was a slight risk and I needed to consent to this. But while asleep they had obviously decided to adopt a new route. And it meant I had to push a drip trolley around. To add to ‘luggage’ I also had a drain. Fortunately there was only one. I had been warned that I may have two, or even three. One was good. Although it was slightly unpleasant to have a blood filled bag hanging off me.

The boys left at the end of visiting hours, and then just four quiet ladies were left in the ward. It was nice to be in a small ward. Although it did feel a little like a female version of ‘Only When I Laugh’.

I wasn’t in any pain, but was starting to feel as though I’d been given a pretty thorough punch to the chest. Even so, I took the evening painkillers, just in case.

I had a pretty good night’s sleep, considering. But when I woke up, with the lack of movement during the night, I was quite swollen under my arm. The swelling must also have spread into my back as the drip near my spine was now very uncomfortable. It may have been providing pain relief, but was actually quite painful to have in me.

Also, my throat had become sore.  The piping that would have been in it during surgery was now bruising.

My period, having initially attempted an appearance, had realised that now was not a good time, and retreated gracefully, albeit painfully. All the drugs I was on, and still that hurt.

A doctor and the surgeon came round during the morning and confirmed that everything was looking ok, so I should be able to go home later that day. The swelling seemed normal and no cause for concern. Mid morning the pain doctor visited and took the drip out of my back. It was extremely painful having it removed – which surprised the nurse – although the swelling was probably pushing it against the nerve, making it sore. It was a narrow little tube, inserted 8cms into my back. Being separated from the drip trolley made me instantly more mobile.

The pain relieving effect from the drip would end in about 3 hours. So now I was to be watched closely, to see what pain appeared.

Bizarrely, even though my breast had now gone, this still didn’t feel real.

I took a photo and sent a ‘Gone’ email, with photo attached, to the family. Bro the elder was surprised at the neatness and angle of the scar. Bro the younger replied simply with

‘oh

my’.

III

After lunch I was allowed home, armed with exercises and a ‘softie’.  There were boxes of all sizes, some of which I could easily have taken home and put inside a cushion cover without anyone suspecting anything amiss.  The softie given to me was the smallest one they had. And even that one was a bit too big. A few days later I pulled some of the stuffing out of it to try and make it more appropriately sized.

Steve helped me to dress. It was the first time he got a good view of my new look. He liked my new appearance. And genuinely so.  In the following days he kept touching it. Before its removal we had both been confident in our lack of emotion about it, but to find that the reality was interest and excitement  was a reassuring surprise. I couldn’t understand how women felt self conscious or less sexy, less of a woman. Admittedly I am small of bust, but I was still the same person. My husband was the same man. My body, in all other respects, was unchanged. He had taken me on ‘in sickness and in health’. There was no reason why this should be a deal breaker or unspoken wedge between us.

The drain was uncomfortable. It was held in with a single suture but when standing, I could feel the pull of the equipment on that stitch.

On the drive home I developed a thorough appreciation of every bump in the road.

I had various body cast sculptures of me at home. One covered my front and now served as a permanent 3d record of my absent left breast. The second was a wrap around ribbon effect, starting on my right breast, going around my back and returning to the front around my hips. The left breast was absent, in a strangely prophetic way.

As the drain would be in for a few days and was, without being too graphic, unpleasant to look at I needed to devise a bag to cover it when we went out. We had a fabric bag from a previous Goodwood revival and with some cunning re-arrangement of the handles I created a handy shoulder drain bag. Should really have patented the idea – this will be in demand and copied worldwide.

We had to re-think sleeping arrangements. Normally I sleep on my tummy. That clearly wasn’t an option at the moment. But if I slept on my bag all the drainage pipes, bag and vacuum would be in the middle of the bed, between me and Steve. So I had to sleep on Steve’s side of the bed, and we put the chair next to me for the drains to go on.

We wondered if Tiggy, my remaining cat, would be confused. Usually she would jump up on my side of the bed, walk across the pillows and then sleep on the edge of the bed on Steve’s side. If she carried on as normal, I wasn’t overly sure I would be keen on this. There was too much risk she would lie on the tube coming out of me. In the event she parked up a little farther down the bed.

Following my night in hospital I had developed a lot of swelling. Perhaps foolishly, I had put the hospital bed virtually flat. Thinking this may have been a mistake, at home I piled up all the pillows so that I was in a more upright position. I had a better night’s sleep than expected.

As there was so much I needed to keep dry, and due to the restrictions of the drain, showering and bathing was difficult. So I stood naked in the bathroom while Steve sponged me down. Some areas got a lot more cleaning than others.

I looked through the wad of information I had been given by the hospital. There was a lot of information about blood clots – which was alarming. The list of factors which made you more likely to have a blood clot included:

-         recently had a long journey (yes – to and from Istanbul)

-         recent surgery (yes)

-         have cancer (yes)

-         you are over 40 (yes)

This wasn’t looking good. The signs to look for included pain in your back and breathlessness. I had both of those. In fairness, the pain in my back was residual bruising from the pain killer drip that had been there, and the breathlessness was primarily due to the swelling around my chest. But even so, it was unpleasant to be given extra reasons to worry. The leaflet suggested continuing to wear the pressure stockings during the night. I had kept these when I left the hospital – Steve seemed curiously interested in them.

A peculiarity I was noticing was the prominence of my heartbeat. This had been quietly pumping away behind an additional couple of inches of flesh. The surface was now much closer, and it was strange to have such a heightened awareness of it.

I started my daily exercises. There were 3 that I was allowed to do before the drain was removed. These were:

-         touch my shoulders and open my arms out straight to the side

-         touch my shoulders and rotate my elbows (that was a difficult one)

-         put my hands on the small of my back and move them up and down my spine.

It was a little different to the training sessions I had been used to, but curiously, just as difficult.

That evening we were due to go out to dinner, unless I didn’t feel up to it. Remarkably, I felt extremely well and had very little pain. More discomfort from the swelling than anything else.

I had been told by the hospital that I would get a daily visit from a district nurse. I had to keep the drain in until the volume of fluid over a 24 hour period was reduced. In the hospital this had been quoted as 50ml, but the paperwork I was given on discharge, including a copy of the district nurse referral, quoted 30ml. This seemed a little cheeky.

By 7.30pm the nurse still hadn’t arrived. We went out anyway. In the cool air my nerves prickled and sent the message to my nipples to respond appropriately for the temperature. The message was sent to both nipples, even though there was only one there to receive it. It was an incredibly strange sensation.

My drain shoulder bag worked admirably. No one in the restaurant would have been any the wiser. I put on a bra and tried out my softie – which at that time was still too big. The bra was uncomfortable over the swelling under my arm and when I put it on Steve laughed at the sorry looking empty pocket.

After dinner we popped into the pub. They were amazed to see me, and how well I looked. It had been shortly over 48 hours since the operation.

That night Tiggy slept on the chair with the drain. When I got up in the night to go to the bathroom and needed to lift it from round her, I expected her to run away. She didn’t. When I came back and put the drain back, I expected her to run away. She still didn’t. She had become a different cat since Dudley’s death, more friendly. Perhaps she knew I was ill. Or perhaps Dudley had given her some dying instructions to look after us.

The top I wore the next day didn’t sit properly on a lopsided chest, not helped by the fact it had horizontal stripes.

Steve washed my hair that morning as I leant over the edge of the bath. My mother was due to visit, primarily because there was a Quins game that afternoon. I wasn't going to attend, given my drain equipment, but was keen that Steve should still be able to. She brought an orchid, to join my burgeoning collection of flowers. Steve had called the hospital to chase up the nurse, and she arrived that afternoon to check my drain. I was tempted to direct her to the drain at the back of the house which regularly needs clearing out. She had only recently been told about me and was horrified that no one had visited me the previous day. As she was a temporary person, rather than part of the usual cluster, she assured me that I would get a visit the next day from someone who could then give me direct contact details.

Night times were getting a little easier, and Tiggy still slept on the chair next to me. However, the amount I was draining didn’t seem to be reducing markedly. It was uncomfortable and unpleasant, and the prospect of it being there for a few more days started to get me down. I lay in bed that night, propped up, on my back, stationary, invalided and in tears.

I was trying to ease off on the painkillers. So now I was getting occasional short sharp stabbing pains along the wound, but more troublesome was a nagging itch in the nipple which wasn’t there anymore. Nerves are a truly strange and peculiar thing.

My father then visited me and was also surprised at how well I looked. The new district nurse visited, and gave me contact phone numbers for the cluster. She looked at my drain with a puzzled expression, saying she hadn’t seen one like that before and asked if I had new bags. ‘No’, I told her. ‘I empty that one daily’, and tried not to show any sign of concern about her abilities, or lack thereof. She suggested putting me down for weekly visits until I pointed out that before next week the drain would be out anyway as it would have been in for 10 days (removal day was the earlier of either 30ml in 24 hours or 10 days since the drain was put in). So she put me down for another visit in three days time. So much for daily visits. Or even a nurse who had the faintest idea when I had had my surgery.

I managed to work quite effectively from home the next week, much to the surprise of colleagues at the office. But I did wonder if I had snagged the drain pipe during the night – I was starting to move around a little, rolling slightly onto my right side. It was now very sore. I was draining only 30ml, but my mobility was being reduced due to the discomfort.

The district nurse was due the next day but I called to see if I could have someone out sooner. Apparently not. The woman I spoke to also said ‘you’re not booked in for the drain to come out’, I explained that it was to be removed once I was draining 30ml or less, which I now was, but that this couldn’t have been pre-scheduled. Hence the requirement for daily visits I thought – but didn’t say. Having established that I wanted the drain out, she then asked ‘when would you like the appointment’. I felt like we were going round in circles. ‘As soon as possible’ I replied, ‘you’ve said you can’t get anyone out today and I already have an appointment scheduled for tomorrow morning, so how about the drain is removed then’, I suggested. This all seemed like an unnecessary amount of effort for something so simple.

The following morning I was still unsure if anyone would come, and if they did, that they would remove the drain. It was a morning appointment so Steve and I decided to wait until 12.30 before calling. At 12.29 a jolly ginger haired nurse who was as wide as a bus knocked on the door and announced that she was there to remove the drain.

Hurrah, with particularly shiny brass knobs on.

IV

I was a bit anxious. It had been there for a week, it was stitched in and I was concerned that I had started to heal onto it – which would make the removal potentially unpleasant. In the event, it was not at all uncomfortable. Steve did say that a lot more piping came out than he had expected – about 6 inches of it. When I mentioned to the nurse that it had been sore, she said that was usual once the drainage amount reduced. The drain worked on a vacuum, and once there wasn’t fluid to suck down, it would pull on flesh. No wonder it had been painful. And I was glad I hadn’t previously known that was happening.

With the drain out, finally I felt liberated. The next morning I had a bath. It felt amazing. And I could start my new exercises. There were 4 post drain exercises, and I had to master each one before I could move to the next one. The first exercise involved standing in front of a wall and walking my hands up, aiming to get my arms straight out above my head. It took 7 days. But what was more difficult was moving my arm parallel to my body. When my father phoned I explained my rehabilitation exercises to him. He had realised that the operation would need recovering from, but until I mentioned the lack of mobility in my arm he hadn’t fully appreciated how much recovery there was beyond the simple fact of the surgery.

With the drain out, I was now aware that my whole left side was slightly swollen. My left hip bulged slightly over my trousers and jiggled a little as I walked. Initially I wondered if I had put on weight, but my right side was still slim and firm.

I moved back to my side of the bed. We left the chair there in case Tiggy carried on sleeping on it. She did.

V

I went back to work. It was still too uncomfortable to wear a bra and I had to think about what I wore for the walk in and out of the office as I still couldn’t get most tops off without help. By the end of the week I was starting to use a bra again, and getting used to the softie – although it did have a habit of wandering out of the cup. I had now removed so much stuffing from it that I had enough to make a second softie.

The dressing was still on and the swelling under my arm was still sore. So I was particularly looking forward to the next appointment, where this was to be taken off and the next stage confirmed. It was difficult to know if the hard part was over, or just about to begin.