Chapter Twelve: Andrea a Survivor since Age 24

Chapter Twelve: Andrea a Survivor since Age 24

            I first found a lump in my left breast when I was twenty-three years old. I was in Germany at the beginning of a three-week holiday. I was in the shower. My first reaction was, “It must be a fatty lump.’ I kept checking each day. I would think, “No, I’m too young for anything other than a fatty lump, maybe a cyst, but nothing serious.

            I arrived home to London where I lived with two girls who were good friends of mine. One was a nurse. I told her about the lump, and we both agreed that I was too young for anything bad but also agreed that I should seek the advice of a doctor. I never needed one before. I was healthy. I was never sick. I had a very busy career. I worked in one of the country’s leading Maxillo-facial units called Queen Mary’s Hospital in Roehampton, London. I saw patients everyday with cancer, mostly facial cancers. There was no way. I was too young.

            My friend called her doctor. The doctor wanted to see me straight away. I kept thinking, “I don’t have time for this; I have patients of my own to see.” I went reluctantly and totally oblivious to my future. The doctor examined me and said that she wanted me to see a breast specialist. She was concerned. I took the letter she gave me and said that I would make an appointment to see this doctor in a couple of weeks when I could find the time. She looked me straight in the eye and said, “My dear, I want you seen today.” She knew where I worked and called the Breast Care Center at Queen Mary’s. I had to be seen by doctors I saw frequently around the hospital. How embarrassing.

            I watched the clock at work waiting for my appointment. I couldn’t concentrate on my work. My mind was racing and arguing with itself. “You should know better…. You’re far too young…. Stop worrying.” The time came and I took off my white coat and became a patient. I was nervous. My stomach was in knots. I felt sick. I sat in the waiting area with everyone else. Of course the doctors were running late. Finally my name was called. I was placed in a cubicle and told to take off my clothes to the waist and put on a lovely hospital gown. I hated being a patient. I wanted to be in control.

            The doctor came in after what seemed like an eternity. He flipped my gown open and palpated my lump while the learning eyes of a resident doctor looked on. While palpating the lump and not even looking at me, his stern voice said, “Any history of breast cancer in your family?” “He’s talking to someone else,” I thought. “He’s not even looking at me.” I was silent. Then I realized he was asking me. I felt like saying, “You can’t ask me that question. I work here. I see patients with cancer.” I realized with a sharpness I will never forget; he could ask me. I wasn’t too young. I was a patient. I replied loudly as if my answer would change things, “No! None at all.” It didn’t change anything. A fine-needle aspiration was requested that afternoon.

            Just two hours later, I was stripped to the waist again wearing the latest in hospital gowns with the left open at the front. I lay on the bed looking at the ceiling. I kept thinking I would wake up that it would be a nightmare. In came the nurse making pleasant conversation about the latest holiday spots. I knew the set-up—calm the patient down before the needle comes in. The needle went in and came out. It was bloodstained which I knew was not good.

            I waited the longest week of my life for the results. Benign! Nothing was wrong! I knew all along; I was too young. But there was still this large lump. What should be done about it?  he doctor watched and aspirated it for three months until he felt he must remove the lump under general anesthetic.

The surgery was scheduled for 12:00 noon on the first of November. I had to stay overnight in the hospital. That night was long. I watched the clock and listened as the eleven ladies slept. I watched the nurses working and listened to their conversations.

            Six a.m. the next day, I lay in bed wondering how I had ended up here in this mess. The surgeon was going to see me before surgery. Where could he be? As the time passed I refused to sign the consent form until I saw the surgeon. He was supposed to be the best. He ran a well-known breast clinic and was renowned for his work. Was I supposed to think myself lucky?

            I was looking at the ceiling when I heard voices. I looked up to see my surgeon, his assistant, and ten students at the end of the bed next to mine. I heard the surgeon discussing my situation. He told his students that I was a twenty-three year old with a large lump in my left breast that upon aspiration was benign. He told them a biopsy was to be performed and that he thought it was really malignant but time would tell. I felt sick and thought I was going to throw up. I hadn’t eaten for twelve hours but still my stomach felt as though it had something to give up. I sat bolt upright in my bed boiling mad. No one had said anything about malignancy; I thought my lump was to be removed completely not just biopsied.

            The doctor and his entourage came to my bed. He flippantly pointed to my gown and said to take that off. I told him I had a few things to say first. I told him I would not sign the consent form for a biopsy only. I wanted the whole lump gone. He said, “Don’t you realize how disfiguring that will be.” I said that I was aware of what could be done in terms of reconstruction. I was not having a general anesthetic for a biopsy.  Either biopsy under local or remove the lump under a general. Then I told him I would not remove my clothing in front of ten students. He told me it was a learning hospital. I told him I was not comfortable with twelve pair of eyes looking at my breast. No matter how many doctors look at your naked body, it doesn’t get any easier. The students stepped away from the bed and waited. The screen was pulled around, and the surgeon along with his assistant discussed what they would do. It felt as though I did not exist. I hated being a patient. (I think I’ve said that before.)

            They left and said they would see me in surgery. The students followed like ants. One of the female students turned and looked at me for a moment and then walked away with the others. Once they had gone, I noticed that one of the older ladies on the ward was crying. She looked at me and asked whether I would lose my breast. I replied cheerfully, “Of course not.” Her tears stopped and she was happy. I was not.

            My mother arrived. She caught the train from Cardiff and would stay with friends of mine. Everything would be all right now; no one could harm me now that my mother was there. My chariot came to take me to surgery. I kissed my mother goodbye and smiled. “I’ll be all right; everything is just fine,” I said. The corridors were long and looked funny from my angle. It seemed the ceiling was whizzing by. I arrived in the anesthetist's room adjacent to the operating room. The anesthetist was a kind man and full of high spirits. I went peacefully to sleep hoping quickly to have all this behind me. I had a life to get on with, a new job at a different hospital and a higher position. I loved my work and my patients.

            I awoke from the anesthesia. I wanted to know as soon as my eyes were opened what had happened. Did they take it all away? Was it benign or malignant? Yes, they had taken it all away and it was benign. All was well.

            I recovered and went home the next day. I stayed off work for two weeks and then started my new job in Salisbury. From the middle of November through December my hand searched my breast and what had been there before was there again. The lump couldn’t have grown that quickly. I contacted the hospital. I was told that no they hadn’t taken the whole lump and that the biopsy results were not as clear. I spoke with the plastic surgeon I worked with in the hospital to ask his advice. He sent for my records and examined me. He was very kind and gentle. He said, “If I remove the lump now, I would have to take the whole breast as the lump is so big and is invading the whole breast.

            I was referred to a breast specialist for an aspiration. The lump was aspirated and again I waited a long week for the results. During that week I felt the lump every day. I looked at myself in the mirror. How could this be? I was strong and clear in my mind. I wanted no more messing around. I wanted the lump gone even if it meant losing my breast. Whatever it was invading my body, I didn’t want it there.

            I returned for my results. The doctor said it was multiple papilloma. It looked like a bunch of grapes making up the tumor. Upon aspiration you could aspirate a benign part, but they needed to remove the tumor and then biopsy the whole tumor before discussing with me what it was. The doctor and I agreed that the person who was most suited to perform the operation was the plastic surgeon I worked with in Salisbury.

            After my meeting with the doctor was finished, his nurse took me to see a counselor straight away. I had to get back to work. I had a birthday cake to make and a present to buy. I was also on-call and had a lot to do. The counselor appeared and we talked for a long time about my options and about my feelings. I just wanted to get on with it.

            I left the hospital, bought the birthday cake and present and then returned to work. I put on my white coat and sat at my lab bench. My colleague looked at me and asked how it had gone. “Fine,” I said. “I need a mastectomy.” His face looked horrified. He took me into his office. Several of the nurses were there. Everyone was shocked and upset except me. I told everyone I was fine and that I would schedule the surgery on Monday. This was Friday. I wanted to drive back to Cardiff, which was about 110 miles, to talk to my parents.  My colleague wanted to drive me. I refused. I was fiercely independent

            The journey home to Cardiff that weekend is a blur. I honestly do not remember the two and a half-hour drive. I arrived home and called my colleague and told him I had arrived safely. I told him I would be back to work on Monday. My parents were surprised to see me. My mother thought I had come home for the weekend while my dad just looked at me and said, “It’s bad news isn’t it?” I told them we should go inside and talk about it. They didn’t know what “it” was but would soon find out.

            We sat down and I told them the news. My dad nodded and lowered his head. My mother was in denial. She said, “No. Watch it and see.” I told her I might not have time to watch and that my life was more important to me. We talked for hours, but time would not change what lay ahead of me.

            I returned to Salisbury on Sunday evening. Monday morning I was in my surgeon’s office scheduling my surgery. Dates were discussed. I needed it done as soon as possible. I didn’t realize it would be my life for the next five years. I was scheduled for surgery on Wednesday, 17 February 1992, in a private room, Wilton Ward, Odstock Hospital, Salisbury. That was two weeks away. I had a two-week window in which to think. Things were happening so quickly, too quickly.

            In those two weeks I did as much as I could I visited all my friends. I went to stay in London with friends. I went out to dinner, to a party, to lunch, shopping, everything. My brother came to stay for a weekend before my surgery. We went out into Salisbury shopping. I saw a cardigan that was very expensive. I bought it. I never would spend that much on one piece of clothing, but I was the one in need of spoiling. I loved that cardigan. I loved my life. I lived my life to the fullest. You can take my breast! BURN IT! I don’t want it! I want my life; I need my life; you can’t have my life!

            Tuesday, 16 February 1992. The night before my surgery I wanted to go to yoga, but my surgeon had other plans. He wanted to see me. I was due to have a left radical mastectomy with a TRAM flap reconstruction. My surgeon talked with me for an hour and a half. He wanted to change my surgery to a subcutaneous mastectomy and place a tissue expander in situ. They could then inject saline solution into the valve and expand me over a couple of months. Then remove the expander and use a silicone implant. I trusted my surgeon with my life. You have to. He was the best in his field. I worked with him and considered him a dear friend. He thought the TRAM flap would be too invasive considering my age. I was not married and had no children. Pregnancy would be too difficult after a TRAM flap. I agreed and accepted his decision.  (This meant I would keep the nipple.)

            I returned to my apartment. My mother had arrived. We went out for dinner and celebrated life. That night I slept quite well. I awoke at about six. My alarm clock woke me abruptly. I slid out of bed, secure warm bed, into the darkness. I ran a bath and immersed myself into the bubbles. I lay in the warm water with my body under the bubbles—out of sight but not out of mind. My stomach was churning. Butterflies wings were thrashing! As the bath water got cold, I looked at my wrinkled skin. It looked as old as my body felt. It was time to dress and walk over to the [hospital] ward. I was stalling and finding things to do that didn’t need to be done. My nails were still red. I needed to remove the nail polish from my finger and toenails. I never wore red polish until the last two weeks. It was as though I wanted to feel more feminine. I wanted to be in control. I wanted people to see that I was still a woman even though my breast was being taken away.

            I removed the nail polish and kissed my mother goodbye. We hugged. I picked up my bag and left.  She wanted to walk with me. I wanted and needed to walk alone. I had made this walk may times before but never to this end. I lived on the hospital grounds due to my job. It was only a ten-minute walk. I needed that time alone. It was 7:15.  I was supposed to be there at 7:00. I was late but in control. I felt calm and peaceful.  I entered Wilton Ward at 7:25. I was wearing my new cardigan. I loved it. It made me feel good. “Sorry I’m late,” I said to the nurse, “but I didn’t want to come.” I laughed and joked. What was wrong with me? Why wasn’t I crying? Why wasn’t I sad?

            I was taken to my bed. There was an operating gown lying on the bed and a pair of white long stockings. “Too bad these don’t come in black,” I joked. The nurse laughed, but I could see she wondered why I was so jovial.

            I put on the gown, opening in the back this time, and the white stockings, just in time to see my surgeon. I told him to sit on my bed and chat with me more about my surgery. I felt happy and ready to begin. It was now 8:30 and I saw a familiar face at the end of the ward. It was a tired, worried, searching, questioning face. It was my mother. We sat and talked. Each time we heard a trolley we thought it was mine.  At 9:45 the familiar sound of the trolley came again; it was mine. The porter was cheerful. I wondered if he knew. I climbed on the trolley holding tightly closed the back of my gown. I see another familiar face hurriedly coming onto the ward. It was my sister. We just had time to have a hug goodbye. I waved and smiled as I looked at my mother and sister who both had healthy breasts. My mother came after the trolley and waved as I disappeared into the maze of corridors to the operating rooms. I lay in the waiting area. My legs were now shaking. My stomach was in knots. My surgeon came out smiling. He squeezed my arm gently.  “You’ll be just fine,” he said. “I’ll see you in there in about ten minutes.”

            Now I lay in the anesthetist room. He was the consultant. He was the top man and reportedly could send you to sleep with his dreamy eyes according to the nurses. Well, he didn’t send me to sleep with his eyes.  They decided to use gas first through a mask and then anaesthetize me. It was horrendous. I was not in control. I hated it. The gas made me so that I couldn’t move or speak, but I was still conscious. They then inserted the anesthetic. I was fighting to speak. I wanted them to know I was still awake. Then came what I can only describe as an explosion in my head. I was asleep only I thought I was dead. My next recollection was awaking in recovery. I recognized my surgeon’s eyes. “Everything went very well,” he said.  “We made the right decision. You did very well. I’ll see you later.”

            I looked at him and said, “But I’m still awake. You can’t operate. I’m still awake. I fell back to sleep. My whole body was shaking. I felt a tight contracting pain in my chest on the left side. Warm blankets were brought, and I drifted in and out of sleep. I saw lights and heads all blurry, then nothing. I awoke again to feel movement and to hear noises—wheels moving, a ceiling moving quickly by. I saw my mother’s face by the side of the trolley. She touched my face. All was well. I fell asleep.

            I awoke in my room. I was still in and out of sleep. My sister was outside of my room. She wanted to see me but was worried how I would look. She came in and said I looked like my nana. I felt like Nana, blinking dead. She had died ten years previously. I smiled and opened my eyes.

            My recovery was very quick. I felt wonderful the very next day. My nurses came into my room singing and dancing to the latest pop song on the chart. I knew both nurses; I worked with them. This was the ward where my patients usually stayed. I washed and had breakfast. I walked up and down the ward dragging my I.V. and drains. I looked very elegant. My drainage bags were placed in a floral bag. The British are very particular about looking lady-like at all times.

            The next day my dressing needed to be changed. Two nurses and my surgeon’s assistant came in. I decided not to look. I lay on my bed with my eyes closed as tightly as I could. Slowly the bandages were unraveled. The nurses and doctor kept saying how wonderful it looked. “That’s easy for them to say,” I thought. “It’s not their body. I opened my eyes and slowly looked down. My eyes caught sight of my left side where my breast had been. “It looks like a balloon with all the air taken out,” I smiled. It looked really good even to me. I was relieved.

            When it was time to go I went to get my clothes and dress. I put on my bra. There was nothing on my left side. My mother and I stuffed some Dacron in a cover that my counselor had given to me. You could build your own breast to whatever size you needed.

My clothes were brought to me minus my cardigan. Where was my cardigan that made

me feel so good? It had been stolen. I was so upset. I kept wondering how anyone could steal a cardigan from someone who had just lost a breast. I needed the sweater to hide my Dacron breast.

            My recovery went very well. After a few weeks I went back to work. My tissue expander was inflated over a period of three months. The first injection of saline was extremely painful. The pressure was so bad I could barely walk. I was over expanded for one month when the expander was removed and a silicone implant implanted.

Same Battle—Different War

My implant was quite firm at first but softened after a few months. It looked very natural. I felt normal again. Whilst the sutures were being removed from my implant surgery, I mentioned to my surgeon that I had felt a lump in my right breast. He examined me and could also feel the lump. He suggested seeing the breast specialist for an aspiration. Previous to this I had done an extensive research on multiple papilloma.  My research found that all cases where large tumors that grow benign that start to change to malignant from the center out. This change is quite rapid and can afford a person her life. The cases reported were all bilateral and all in young people. I thought I was being paranoid and so went for the aspiration. The lump was multiple papilloma. I had to wait for my body to regain strength from the previous two surgeries.

In October of ’92 my second mastectomy was scheduled. My mother was very upset. “Why you? Why not me?” she said. I was now twenty-four, had a wonderful career, and was very healthy and active. I was a vegetarian, non-smoker, non-drinker, and exercised regularly. Cancer is not prejudiced. It strikes whomever, whenever, and at whatever age. I learned quickly to live with it, to deal with it, to get on with my life. It could take over or I could take over.

I was at work the day before my second mastectomy. I had a patient to see. She had breast cancer six months previously and was in her late thirties. We sat and talked for a while. She kept saying she was too young to have had breast cancer and asked me why she had to have it. She doesn’t know to this day that twenty-four hours later I was to have my second mastectomy—only eight months after the first. I felt for her.  I felt her pain and anguish. I left work and went to my apartment. My mother was waiting for me. She was my anchor, my rock.

I returned to the ward the next morning at seven. I was on time. I was in control. It felt as though my life had been rewound. I was playing it again. I bought myself another sweater but had learned not to take it to the hospital. I felt strangely calm. I’d been down this road before—same ward, same surgeon, same nurses, same room, same battle, different war.

When I awoke from the anesthesia there were several faces looking at me. I had taken a long time to wake up and my body was in shock. I was shaking and my chest was contracting in pain on both sides. Three lumps were found invading my whole breast. I was finally taken back to my room. I could smell my mother’s perfume. I didn’t have to open my eyes. I knew all was well.

My recovery after that was fine. I was expanded again. The tissue expander was removed and another silicone implant placed. Before my implants were placed, I wondered if people would know. If somebody hugged me would they bounce off me across the room? But they were fine. They felt natural and looked wonderful. You could never tell looking at me what I had been through. I told my surgeon. I now have two eighteen-year-old breasts instead of one eighteen-year-old fake and one twenty-four year old. This was wonderful; I felt whole.

Support Group # 12: Andrea a Survivor since Age 24

            Think about the similarities and differences in your cancer experience and Andrea’s. Since she wrote her story, she had to have the implants taken out because of constant pain. She had micro-TRAM flap surgery and has a very poor result. She has to wear two prostheses, one size 2 and the other size 7, to look normal. The doctor wants her to “go back under the knife” to get a better result. She says that she’d much rather be content with what she’s got that another elective surgery is not in her future. She is very vocal about the fact that she wishes she had tried prostheses first. She encourages everyone who is going to have a mastectomy to try prostheses first for six months.