The Choice

by Bernadette Bohan

  ‘You have two options,’ he said, getting out a piece of paper on which he started to draw a diagram. ‘Number one: we remove the breast, you have radiation therapy but no chemotherapy. Number two: we remove the lump with a 2cm margin around it, you have twenty-five radiation sessions and six months of chemo. The drawback is that if there are any cancer cells in the margin around the tumour we would have to go back in and remove the entire breast.’

  We discussed these options at length, and I realized that I was to be allowed to choose.

  ‘My instinct,’ I said to them both, ‘is to have the whole breast removed and be done with it. What do you think, Ger?’

  ‘I don’t know, Bernie, it’s your body. I think you need to spend a few days thinking about this.’

  ‘That’s right. Whatever you decide, we’ll operate on Friday. Go and see your oncologist on Thursday to discuss it and see what he thinks.’ There was not much time – this was already Tuesday. We left the surgeon’s office, me clutching the little drawing he did for me. I still have it in my desk, a little reminder of that fearful and uncertain time.

  When I got home I called my friend Siobhan, who I knew had had a mastectomy eight years earlier. I outlined my two options to her. ‘Why don’t you come over for a cuppa and we can have a good chat about it then,’ she said.

  She is an incredibly positive woman, and had obviously recovered well from her bout with cancer. We chatted about her operation, and how she came to make the decision, but when she opened her blouse for me I had to stifle a gasp of horror. A thick white scar slashed diagonally across the space where her breast had been. It looked unnatural, painful, wrong. The skin was puckered, and even eight years on it looked ugly and deformed. I lowered my eyes. Mother of God.

  ‘Perfectly OK, isn’t it?’ Siobhan commented. ‘I’m totally happy walking around the house naked. My husband calls me his Amazonian woman after those female hunters who cut their right boobs off so they can use their bows and arrows properly.’

  ‘What about going swimming?’ I ventured to ask.

  ‘Oh, well I usually go already changed. I’ve got a prosthesis, a falsie, and a special swimsuit. And of course there are changing rooms so I don’t offend anyone when I get changed afterwards. It’s not a problem.’

  The fear of cancer killing me was greater than the fear of losing a breast, but as a woman I just couldn’t bear the idea of looking like this, of feeling like a freak, of always feeling I should cover up rather than risk horrifying or embarrassing anyone. I was grateful for Siobhan’s honesty and willingness to show me her scar. I just hoped that my oncologist would recommend the other option.

  ‘Statistics show absolutely no difference in recovery rates,’ was what he did say. He was back in his office, incongruously glowing with health after his long break. I knew him well, but was in no mood for idle chit-chat about his holiday. I felt weak, pale and exhausted after days of going over the two options in my mind.

  ‘I’m worried that if I have the lumpectomy there will still be cancer cells in the margin and then I’m back where I started, except I’ll have had an extra pointless operation.’

  ‘It can be very distressing for women to lose their breast, in my experience,’ he said thoughtfully. ‘We know that it is primary cancer – as yet there are no secondaries, although we will have to take away some lymph glands. I have to say that, given the identical recovery rates, I’d recommend a lumpectomy. But this is your decision.’

  ‘What would you recommend if it was your wife?’

  ‘Lumpectomy.’

  I was enormously relieved and reassured to hear this, and to think I did not necessarily have to lose the breast. So I opted for the lumpectomy, and the operation was set for the very next day. I would have three weeks to recover, provided the ‘margin’ was clear, then the chemo would start, with the twenty-five radiation sessions when the chemo was well under way.

  This was it then, I thought, as we drove home from the hospital that day. I was going to have to be strong. It was a cliché, but I knew now why people talked about their ‘fight’ with cancer. It was my enemy and I was going to have to confront it with all the weapons in my armoury.

  If you have read this far you will know by now the kind of woman I am – no health freak, no scientific genius, not even particularly well educated. Just an ordinary Irish woman faced with the terrifying possibility of dying before my children grew up. Someone who loved life and wanted to hang on to it. The one thing I could do was read, and read I did from that point onwards as if my life depended on it. I read selectively at first, avoiding books on chemotherapy and radiation because I was not yet ready to know about the gory details. I took it one step at a time, absorbing what I could. I started to find out about lectures and talks, and I began to make notes; the notes became a file and the file became a library. The mass of information I was accumulating was in some ways mind-boggling and in other ways mind-expanding, but my need to understand what was happening to me – and what I could do about it – was overwhelming.

  Every few weeks from that point on, Richard would repeat to me our special battle-cry, ‘Battle-stations, Mum!’ and although I would ask him not to whack me on my arm again, it made me feel so tough.

  It was a toughness and inner resilience I would need over the coming months more than I could ever have imagined.

  Chapter Fifteen

  Cruel and Unusual

  ‘If you’re really lucky I’ll give you my underpants too,’ quipped Ger.

  He and I were in the hospital waiting for the nurse to come in and start to prepare me for the lumpectomy operation. My friend Grace had come with us and had kindly offered to collect a load of Ger’s shirts to take home to iron. She was pretending to complain about them – some of them were pure cotton and took ages to press properly. The silly, nervous banter between them took my mind off what I was about to undergo. Then the nurse appeared with a gown for me to put on, and briskly set about making me ready. I started to shiver even though it was not cold.

  I was not only nervous, I was bone tired too: I had been up late the night before making a dress for Julie. She was to be the flower girl at my nephew Darren’s wedding, and I knew that if I didn’t get it finished before my operation I might not have the strength in my arms afterwards. ‘Leave it, Bernie,’ begged his fiancée Lisa. ‘You’ve enough on your plate. I’ll buy a dress – we’ve still got a couple of weeks. Please don’t worry.’ But I was determined: I had the material – clouds of beautiful cream chiffon and wine silk for a sash. Sitting in our kitchen that afternoon looking at Julie, and knowing what was ahead of me, I realized that making the dress would stop me from breaking down in front of her. So while Richard played with her, I knocked sparks out of my machine and sat up late sewing dozens of tiny wine-coloured silk flowers onto the prettiest little dress you could imagine.

  As I lay on the trolley the next day, waiting for the nurses to take me down to the operating theatre, it was a vision of little Julie trying on her dress that morning that I held in my mind. ‘Oh, Mama,’ she had breathed, scarcely able to contain her delight. ‘I will look like a real fairy.’

  ‘That’s my girl,’ said Ger to me as I was wheeled into the operating theatre. He was trying to smile encouragingly, but what I read on his face was fear.

  Hours later, I was aware that I was coming to. I heard the soft noises of the ward, and the bleeping of the machines. A television was on somewhere. I was sore under my left arm but I didn’t want to dwell on that right now. I lay there for a bit, just thinking. Gradually I opened my eyes, and the first thing I saw was Ger gazing down at me with such a tender expression. What was this doing to my poor man? I wondered, feeling terrible for giving him all this worry.

  ‘Hello there,’ I murmured. He smiled and reached for my right hand, giving it a little squeeze. We were silent for a time, until I stupidly asked him what he was thinking. Poor love, he wasn’t going to tell me the truth – that here he was, looking at his little wife
who could be heading for an early grave.

  ‘Your breath stinks,’ he said. Good old Ger, I thought, deflecting gloomy thoughts as always.

  ‘Have you seen the surgeon?’ All I could think about was the all-important margin around the lump, and whether it would be found to contain any cancer cells.

  ‘Yes, he’s doing his rounds. I expect he’ll be along later.’ And he was.

  ‘Tell me,’ I said urgently to him when he reached my bed, although I was still woozy from the anaesthetic: ‘Was the margin clear?’ He smiled sympathetically.

  ‘There’s time enough for that. We won’t have the results for a few days. You concentrate on getting better. The operation went as well as could be expected.’

  Huh, I thought to myself. I won’t be able to recover from this operation if I have to be rushed back in for a mastectomy. So each time the surgeon appeared on his rounds I asked him the same question. I was obsessed with this damn margin.

  Over the next few days I was inundated with visitors. I was glad to see them, but I was in too much pain to talk much. It’s a funny thing, being in hospital. People want to see you, or at least they want to show you that they care enough to come and see you, and in a way you want to see them too, except you don’t want them to see you looking awful and you’re not really up to small talk. It is such an artificial environment that after a few minutes they run out of things to say and you wait for them to go so that you can go back to the strange half-life of the ward: a parallel universe in which you lie helplessly while needles are put into your arms or legs, and drips are taken out and monitors monitored, and all you have to do is watch the clock and wait for the results of whatever test or operation you have had.

  I did want to see the kids, though, and my heart leapt when I first saw them walk into the ward. Julie ran up to me and flung her arms over the bed covers. Too late I realized that just next to where she was standing was the bottle collecting the blood draining from the incision. Before I could say anything she cried out in disgust, ‘Mama, you’re bleeding!’

  ‘I know, pet, don’t worry though – it doesn’t hurt. It’s just where I had the operation – that blood needs to come out to stop it getting infected. It’s helping me get better.’

  ‘Oh, OK.’ She accepted my explanation without a murmur, and busied herself with laying out some cards and pictures she had been making me. I hoped this image of dripping blood wouldn’t stay with her.

  ‘Can’t you sit up, Mama?’ she asked. I tried, but my arm was still hurting too much. The skin around my breast, and under my arm where the lymph glands had been, was clamped with staples rather than stitches, to seal the skin after the surgeon’s knife had gone in, and the tightness meant I could hardly move my arm. The physiotherapist had been in several times to try to get me to do some exercises: I had found them almost impossible but I knew I had to keep trying. It took weeks to regain full mobility in that arm, and in fact my underarm is still sore from the scar tissue. For a long time it felt like I had pins and needles, and I would shake the arm as if to get the blood moving again, to get the feeling back. It never came back entirely – I am still numb on the back of my arm where the nerves were cut. It is something I have just had to get used to.

  It was my oncologist, in the end, who managed to get me the results of the tests on the margin around the excised lump. It was clear of cancer cells, thanks be to God. I felt I had come very close to the wire this time, but the knowledge I had made the right decision on the operation made me feel good.

  I arrived back home to find the house full of flowers. Everywhere I looked there were vases, jugs, bowls, crammed with roses, lilies, gerberas, peonies and many flowers I did not know the names of. They were absolutely beautiful and smelt heavenly, and I felt strengthened by all these good wishes – but it reminded me of a funeral parlour (or perhaps I am just not used to getting flowers!). The doorbell went constantly, and the phone was rarely quiet, with people offering support and asking if there was anything they could do. Neighbours, friends, parents of my children’s friends – these were the people, I knew, who would be at my funeral. I know it sounds morbid, but these are the kinds of thoughts that come into your head when you are told you have cancer. It was not just me – countless people have told me of this feeling that they can picture their funeral. During days like these, when I was too sick to be involved in day-to-day life, I was acutely aware of the love with which I was surrounded, and I know how fortunate I am to have felt this.

  A few days later my entire arm inflated like a rugby ball. This was a fairly common condition called lymphodoema – a swelling that often happens to post-operative patients – but I had neither been warned about it, nor was I prepared for the pain. When my friend Patricia called in to see me that day I remember saying, ‘Christ, will you stick a pin in this arm? I have got to relieve this appalling pressure.’ She didn’t do that, but she did call the hospital for me.

  ‘The sister on duty said to come back in if it doesn’t improve. Apparently lots of people get this and it does get better eventually.’ Not much help from them, then.

  Patricia was so kind to me that day, for when she realized I was in utter agony she spent the rest of the day gently massaging the arm. I found eventually that if I raised it up I did get some relief, perhaps because the fluid drained back. The next day it was back to normal, and all the pain of the previous day had evaporated into thin air.

  This was just as well, because Grace had promised to call to help me pick out something to wear for Darren and Lisa’s wedding the following weekend. We tried to find something that was light enough for the warm summer weather, but that also covered enough of my arms so as not to show my stitches. I could barely lift my arm with the staples holding the incision together, but we managed to find something in the end. My nephew Darren is very special to me, and his wedding was the best I have ever been to.

  I felt like the belle of the ball. Everyone said they wanted to dance with me – nephews, cousins, in-laws, the lot – and Sarah never left my side all night. We had such fun; I had never been in so much demand! Ger and I were dancing at one point when Richard came up and gently took over. What a gorgeous feeling it is to dance with your son – this boy you have held as a baby and watched grow into a strapping lad, and now a fine young man. I was so made up over this, so proud. If my life had ended then and there I would have died the happiest woman in Ireland.

  I was getting a glass of water, hot from all the dancing, when Deirdre came up. ‘Look at you!’ she exclaimed. ‘No one can believe how well you are doing.’ Of course, this is why I was suddenly Miss Popularity: I was the person with the death sentence, and this was their last chance to have a turn on the dance-floor with Bernadette.

  ‘Oh, for goodness sake, I’m not dead yet, you know,’ I laughed. I made light of it, but it was indeed a strange place to be in. Pushed into the limelight despite myself, set apart from the others by my illness, regarded as someone slightly special, slightly marked, a ticking time-bomb waiting to go off. The person about whom others said, ‘There but for the grace of God …’ and felt lucky to be themselves. Oh feck it, I thought, putting all this out of my head. I might as well get on and enjoy myself. Occasions like this were going to be few and far between, for my chemotherapy sessions were due to start soon.

  The lymphodoema had been painful, but nothing in my life so far had prepared me for the unimaginable cruelty of chemotherapy.

  ‘Mama’s got to go into hospital again today, pet,’ I explained to Julie one morning.

  ‘Will you be back after school?’ she asked.

  ‘No, Mama will be staying in hospital for two days, but don’t worry, you’ll have Dada and Richard and Sarah to take care of you.’

  As I stood at the nurses’ station at the front of the now familiar ward later that day, waiting for them to allocate me a bed, I saw a woman who was pushing a drip on a stand. She was shuffling along to the lavatories, making very slow progress. I smiled as she trundled past
me, and she stopped. She had thin mousey hair and almost transparent skin, and she could barely lift her head up.

  ‘I’m Eileen,’ she said. I think she could see I was terrified, and in her own way thought she could make me feel better, even though she herself was so sick. ‘My family is coming in to see me – you might see them, three fine boys! Tell them I’ll be back in a few minutes.’ I told her I had three children too. Before she went into the toilet she said softly, ‘You’re going to be fine. Good luck, love.’

  Just then my oncologist entered the ward, and I heard him speak to her. ‘Please,’ I heard her plead, ‘don’t give me any more chemo, I can’t take any more. The last lot almost killed me.’ She can’t take any more chemo, I thought. Look at the state of her, poor woman. And here I was, about to embark on my first session. It did not exactly inspire me: it filled me with dread.

  To prepare me for the first chemotherapy injection I had a shot of steroids. These were really trippy, making me hallucinate – I saw people becoming taller and wider as if I was looking in those weird mirrors you see at theme parks. I shrank away from the walls as I imagined objects falling down on me – I was frightened and alienated. Then a nurse approached wielding an enormous needle – at least it seemed enormous to me – attached to a huge vial of clear liquid. She had surgical gloves on, and I found out later why. This chemical is so toxic that if it is spilt on naked skin it will burn a hole right in the flesh. If it accidentally drips onto the floor it is treated almost like a leak of nuclear waste. This was what was going directly into my bloodstream, in three separate injections, taking half an hour in all. This was what was going to kill the cancer cells – and a lot else besides. This first session I treated in a fairly matter-of-fact way, but the time I came in for the next ones I started shaking the moment the needle went in, for I knew what was ahead of me.