Dr Shah and Lady Stark

Sitting in the waiting room at Pinehill that evening I tried to remain calm. I’d been given the name of a Dr Shah; at the time I had no idea he was an oncologist; I’d had to ask the receptionist and when she answered me, she looked surprised that I’d not even looked him up. It was me, Mum and Andy sat there; we’d been in silence for most of the wait. It wasn’t long before a lady came out of the office with her husband, wearing a headscarf, looking a bit worse for wear. I tried not to look because I knew that was shortly going to be me and I was too angry to look.

It wasn’t very long before the door opened and a British-Indian man with a kind face came out of the room, Dr Nihal Shah. He called my name and we all automatically jumped up. I went straight into business mode; shook his hand, smiled, introduced myself and said it was nice to meet him. As we walked towards the consulting room – before we had even got through the door – he turned round and said “Your scan shows it is just in the breast”. Honestly I could have kissed him for that! I wish I could remember absolutely everything about this meeting and what was said, but I remember this more than anything in the world. My mum said “Ohhhh thank God for that.” quite audibly. Andy looked at me and squeezed my hand; said “See?” and that set the tone for the whole meeting. We had the news we wanted and now was the time to go through what we were going to do about it.

When we sat down, I realised there was someone else in the room; a lady. She wasn’t wearing nurse’s uniform. The first thing I noticed was that she bore a resemblance to Michelle Fairley, who played Catelyn Stark in “Game of Thrones” (my favourite TV show by far).

Dr Shah sat down and started to explain what they had found. The cancer was stage 3, invasive ductal cancer. This meant that it had started in the breast duct and started to invade the surrounding tissue. Dr Shah has a very approachable manner; probably the easiest / nicest person to have a meeting with. He said they had found that the lump was definitely a cancerous tumour – about 5cm across – lying transversely across the top of my left breast. The lymph node biopsy came back with some of the same cancer quite happily living there and hoping for an exotic, fancy trip soon. Given the size of the tumour, they wanted to do something called “neoadjuvant” chemotherapy – this just means they were putting me in for chemotherapy followed by surgery, rather than “adjuvant” – which is surgery first, followed by chemo. At the stage and size it was, it would have meant a mastectomy if we’d done surgery first, so this other route was the best way to conserve the breast and they felt that was possible.

I have to admit that was all Greek to me at the time. What the hell were lymph nodes anyway?! I think he could tell I didn’t really get that what I had wasn’t caught early; that actually it was thinking of going postal. He just said “We can’t leave it”. He explained that the cancer was also HER2 positive; there isn’t really much of a non-technical explanation for what that means (other than it means the cancer grows more quickly) so I’ll link you to the MacMillan page here to explain it. It meant that in addition to chemotherapy I would benefit from a “targeted” therapy called Herceptin, which only gives benefit to people who have this enthusiastic type of cancer.

While Dr Shah was talking, we listened. This was unknown territory for us. There were no interruptions whatsoever. He went on to tell me about the plan – FEC-T chemotherapy.

Step 1: FEC-ing Hell

The first step was to start chemotherapy as soon as physically possible. I was to have 3 cycles of FEC, a combination therapy involving 3 nasty drugs:

Stage 2: T and H

The T was for Taxotere, another nasty chemotherapy drug that would follow after the FEC. I feel sick just writing the drug names! Once I had started the Taxotere, I would also be given the Herceptin. Having Herceptin meant having about 18 or so treatments (basically a year’s worth). I’d need to have cardiac echo tests whilst on Herceptin to check that things are “ticking” over ok…..oh my god the dad jokes.

Stage 3: Surgery

They’d be keeping a watchful eye on the response of my cancer to these drugs. If I responded well, they would be looking to insert a titanium clip into my tumour so that if it was smashed to smithereens, by the time they came to do surgery they would know where the bastard was and be able to remove the affected tissue around the clip.

Stage 4: Radiotherapy

After they’d removed my squatter and all its nastiness, they’d blast it from here to Kingdom Come with some radiotherapy. Dr Shah didn’t linger on this one because it was going to come much later. I figured we’d cross that bridge when we got to it.

Stage 5: HORMONE Therapy

Ewwww. fuck. Considering what a total bitch I’d been during puberty and during pregnancy, anything that messes with my hormonal balance sends alarm bells dinging in my ears. My face did fall at this one but again it wasn’t going to affect me straight away. I decided I’d focus on what we had to do right now before fretting about this one.

What became very clear out of everything Dr Shah said that evening was that this was going to be no walk in the park. It was going to take AGES to get rid of this thing. I’d be putting my body through quite a long stretch of damage just to stay alive. But, they said, I was young, which gave me an advantage, since my body would be able to handle everything they threw at the cancer.

Chemotherapy Side Effects

Having explained what was going to happen, the conversation then went back to focusing on chemo. The nurse in the room was a lady called Harriet, a chemotherapy nurse specialist assigned to my case. She and Dr Shah began to talk me through the side effects. I’d be feeling very tired and “washed out”, there would be cosmetic side effects in that my hair would fall out. The drugs I was about to have are known to make you feel extremely sick. They would give me everything I needed to control the nausea and these days they give you enough anti-emetics that “most people don’t feel sick” any more. The key was to take the anti-emetics even if not feeling sick, because then it wouldn’t hit me at all. They would also be giving me steroids and an injection of white blood cell boosters, since chemotherapy can make you more prone to infection.

Harriet told me the chemotherapy treatment would be a bit of a trek away, in a village called Sawbridgeworth. They have a hospital there called the Rivers Hospital, which was where she worked. I was fine with that; it’d get me out of Stevenage and if it fixed my situation, I’d literally go anywhere.

They also talked very casually about if there were occasions where I did feel very sick, all I should do is call or text Harriet and let her know, then they could get me into hospital and push some fluids into me for a few days. I wasn’t used to casually being able to call or text my nurse (think that is a private hospital thing though), let alone having to go into hospital for any other reason than having surgery. I’d had plenty of operations by that point, but to my knowledge I had never been on a drip before. It was all quite overwhelming but reassured me that they were on the case.

Port Catheter

Dr Shah recom mended I have a port catheter fitted in order to save my veins, since I’d be having a lot of treatment. I had no idea what this was but agreed. Basically it’s an implantable port that is attached to a tube that goes into your vein, just above your heart. You can have it in your chest or in your arm; doesn’t matter really. But they’re stabbing the port rather than your veins.

As they wanted me to start chemotherapy that Friday (and today was Monday), they wanted to get me booked in to have my port fitted as soon as possible. Dr Shah asked me what plans I had that week and I laughed. What else did he think I’d be doing? I told them to ring me as soon as they had a date and time, then I’d go wherever I was sent. He said he’d call his colleague at Bishop’s Wood hospital – would I be willing to go to Harrow? Of course I would. OK, he’d ring me within 24 hours to let me know where to go and when.

Oestrogen and Fertility

The conversation finally turned to fertility. I had a question about this, since you often hear of people being unable to have children due to chemo and given the fact I was just married, I’d thought we were between children. Could I have any eggs frozen? He said there was a chance that the chemotherapy could affect my ability to have more children, but unfortunately they were not able to offer me the drugs I would need in order to produce the eggs that would be frozen. My cancer was oestrogen-receptor positive; this means that along with its high level of receptors to HER2, it REALLY liked oestrogen too. I could make it worse by attempting to freeze my eggs. Well, we have one child, I thought. Being alive for her is far more important.

I told Dr Shah I had a contraceptive implant in my arm; he told me that would also have to be removed. I had to avoid getting pregnant under all circumstances, but from now on I was not allowed to have any kind of hormonal contraception. I looked at Andy and chuckled; we were never very good at barrier contraception. Mollie was a morning-after-pill baby; I’m proud of her determination in that she was adamant she was going to join the world. So I’d have to sort that out with the GP later that week. I had a lot to do.

And another thing…

Dr Shah asked me whether I had Critical Illness cover. I had taken some out just after Mollie was born in 2012, to ensure she was protected should anything happen to Andy and I. He told me I would have grounds for a claim and that they would support me by providing whatever documentation is required to make the claim. With an invasive breast cancer, they’d be sure to pay out.

Let’s get on with it.

The meeting with Dr Shah ended on a very positive note. I could carry on working – start my new job – I could do most normal things like going to the gym; in fact he told me going to the gym is encouraged amongst chemotherapy patients because it helps with the fatigue. Yes! We had this problem; it needed sorting out and it was all systems go to get it fixed. I just needed to be flexible with appointments and make sure I was where I needed to be at the right time.

The lovely Harriet O’Toole, my chemotherapy nurse, saving lives across Hertfordshire and Essex. Having a bit of well-deserved down time.

Harriet gave me her number and told me to text her or call her if I ever had any questions at all. She said I’d meet another lady called Jan, who also worked with her in the same capacity at Rivers. As I became calmer and reassured by hers and Dr Shah’s advice, I relaxed a little and told her how I thought she looked like Lady Stark. She chuckled and said no one had ever said that before; had I read the books? I had to admit at that time I hadn’t. We’d had the Red Wedding in that latest season of Game of Thrones. She told me someone would be back much later in the books and I put my fingers in my ears – no spoilers please!!! OMG. Dr Shah had no idea what we were talking about so we briefly explained.

When we went home I was determined that this was going to get sorted out; mum and I were much more positive, so we told my dad the plan. They would help me all of this week; take me wherever I wanted to go and Andy would go to my first chemo session with me. Mum and Dad were having a party at their house for fireworks night the following weekend, so we would have something more immediate to look forward to.

When I went to bed that night, for one short evening, a few hours, I was able to feel that little bit less angry about having cancer. I could work. I could care for my daughter; the doctor knew what he needed to do about it and all I had to do was see Dr Selvadurai again to get my implant removed (possibly replaced with a copper coil), then turn up wherever Dr Shah told me to go. I might even get a little money out of it, to make sure the bills were paid if I had to stop working for a bit. I was apprehensive about losing my hair; I’d spent over a year growing it and I had always had long hair, all my life; I’d feel ugly without hair, but it wasn’t going to be forever.

Just a few months. I’d get through it and stay alive; I had to. Mollie was NOT growing up without a mummy.