Lull

Yes, the pace of posts has slackened. I may be experiencing the calm before the hormonal storm (watch this space); however for the last few days I have been less in my head, and more just living, which has felt less surreal and more normal. I have started driving again, have had a piano lesson, and am turning my attention to both the research project and to Quaker business – as well as to co-housing matters. So it’s almost “as we were”, but with a slightly more health-conscious twist (I won’t go on at length about either my pedometer readings or my attempts to make low-fat, low-dairy cake).

It would be nice to think that things would now settle down and the whole breast cancer experience would be relegated to a filing cabinet somewhere well to the back of my consciousness. “The Psychological Impact of Breast Cancer” by Cordelia Galgut (CG), which I read last week, suggests that this is not likely to be the case; and even that the fear of recurrence becomes more pronounced as the years pass. And it is true that I am myself currently convinced that it is only a matter of time before They come for my other breast; and I just do not know how to begin to handle further invitations for mammograms. But – back to the book – I did not think it was consistently good, and found its perspective quite limited. The beginning is terrific: CG very ably dissects the historical and cultural attitudes both to breast and to cancer which give the term “breast cancer” such particular potency. This was brought home to me again when I heard two days ago that my sister’s sister-in-law (not known to me directly) is apparently “in a terrible state” and revising her will on getting a screen-detected diagnosis of breast cancer. We all (medics included) respond with atavistic fear to a word which used to denote rampant invasive disease and certain death but which does not always do so any more. We need more words.

The rest of the book, however, is an account of the CG’s own difficult experience, and her reflections on what helped her psychologically, and what didn’t. I had been hoping for a slightly less particular and more general and analytical approach, which would help me set my own experience into context. Maybe CG is right, and that experiences of breast cancer do not fit any psychological “map” (she maintains that the received wisdom about stages of grief is not a good fit for her). But I would have thought that looking at the research on trauma and loss might be illuminating. In what ways is losing a breast different/the same as the experience of the amputation of a limb or suffering a disfigurement, for example? What about shock and decision-making? What about medics as authority figures, and the imbalance of power in doctor-patient relationships? And, of course, there is no discussion of the psychological confusion resulting from finding out a bit too late about the questionable value of screening, early diagnosis and treatment. But then, as I have yet to find any one else who has recently faced this predicament, I wasn’t really expecting that.

But the book did make me feel grateful for my experience with the NHS so far (setting the screening programme aside for the time being, that is!!). CG was treated privately. The private clinic may have been less plastic and dog-eared than the one I go to, and I bet the waiting times were shorter; but she met with a lack of communication, tact, empathy, and sometimes with sheer callousness. Whereas the actual care I have received has been kind and responsive (if just a little patronising), and, I think, of high quality – witness my good recovery from anaesthesia, my minimal need for pain relief – and the neatness of my scar. So CG’s recommendations for quality of care (and she only published in 2010) seem to me to be a bit redundant. At least in the NHS where I am.

What’s more, the cost of the hormone injections I have so reluctantly signed up for (and this is not counting the accompanying pills) is as eye-watering as the jabs themselves are likely to be. At £400 a pop, they’d better be doing me some good. So thanks again to the NHS – stressed and creaking it may be, but it’s still free and available to all at the point of delivery. Let’s make sure we keep it.

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