15. Barre (it is harder than it looks)

On Saturday morning I went to Barre at a friend’s house.  This exercise class is tough and really effective – imagine pilates on speed, small movements, three or four rounds of a plank, plies and crunches all whilst tucking your core.  Barre this will take you to a place where you can “Strengthen your body and empower your mind”.  I’d like you to say this phrase out loud in an American accent and then shout “AWESOME”.  Whenever I hear this word I immediately think of the Lego Movie as everyone is AWESOME when they are part of team.  I don’t feel AWESOME during Barre as my legs shake so much, but our instructor, assures me this is a good thing.  I don’t feel AWESOME doing the rounds of plank and am ashamed to say got so frustrated with myself about not being able to do it properly that started to cry and then said it was sweat running in my eyes.  Not only was I an impatient patient, I was impatient with myself……come on… it is only a flipping plank!

After the Barre class, our instructor invited us all to stay for a cup of coffee.  As we sat in the kitchen four of us opened up and talked about issues we were facing – a child causing worry, bereavement, work, cancer and  the weight of expectations … a couple of us cried and it was cathartic.  The theme of kindness comes to the fore again.

Tip:  don’t underestimate your worth to other people.  It is in the face of adversity that you start to appreciate how others perceive you.  You may be going through a tough time and putting on a brave face – so are others, we are all good at keeping our defences up when sometimes we just need to let them down.

14. Something looming on the horizon

Later that week I received another letter inviting me to attend a pre op assessment. Suddenly surgery seemed less of a far off country and something on the horizon.

This required more cover to be set and impacted my year 11 class.  As a teacher and as a senior teacher you are only as good as your last set of exam results.  I wanted my class to excel as I had real faith in them that if they worked hard, did their homework, focussed in lessons they would out do their predicted grades. They are a good bunch of young people and have a variety of backgrounds.  One was a refugee from an war torn country, several were young carers, one was predicted a level 7 (Grade B+ in old money), some were predicted grade 2 based on their performance at primary school.  Differentiation was a key word when planning and delivering learning, made more difficult by a new GCSE syllabus which reminded me of O level content.

I mentioned to them that I would not be in their next lesson but that they would be doing their end of unit assessment.  One wag said that I was obviously off shopping (this young man told me he didn’t need geography GCSE as he would be working for a family member  and that maths and English were more important… emm no, in today’s climate of education students are measured on their performance of eight GCSEs and it is the progress they make rather than the ultimate grade which is the key).

I stopped in my tracks and said no actually I wasn’t popping into town to have a bimble through the shops but I was going to Derriford as I would need an operation in a couple of weeks.

Students are for the most part straightforward and were concerned about how long I’d be off, why I’d be off and who’d be teaching them whilst I was off.  I was up front with them and said that I didn’t know as it depended on any follow up treatment required, “what like chemo, miss” –  yes exactly and I told them I didn’t know how long I’d be away for as it depended on what was found in surgery.  Then it was back to business – how were meanders formed.  Later that day a homemade card had been pushed under the door of my office from one of my students.  She’d written “you never know how strong you are… until being strong is the only choice you have”.  Inside she’d written:

Dear Mrs O, I am sorry to hear you have cancer, I’m so glad it’s going to be treated.  Thank you for being an amazing teacher you have taught me everything including respect.  Your strength in this situation has amazed me and inspired me to handle any situation with strength.  Thank you miss, kick cancer’s butt and good luck with the operation.  

This is something I will treasure as this student has plenty of woes of her own yet could be this considerate.  Please GOD let this student exceed her target grade as she deserves it!

13. No sugared pill

Back at school the following Monday I was pretty glum.  I spoke to my Head Teacher and the head of HR and told them I was disappointed that my plan wasn’t going ahead.

I then re-read the letter Mr X had sent my GP, it was clear I had got the wrong end of the stick and misinterpreted how to think things through.  The letter stated that the best option was a skin sparing mastectomy and to place a breast implant into the subcutaneous pocket to optimise cancer treatment and give options for a delayed reconstruction.

It didn’t mention my plan.

I became more anxious than I’d been before and left a message for the breast care nurses.  You phone an answer phone number and leave a message and they phone you back.  I was in school, in my office when the nurse phoned back.  She was gentle and I told her I just didn’t understand why the surgeon wouldn’t do a bilateral mastectomy so she explained again that surgery carries risks and the priority had to be to remove the cancer.  I didn’t feel as if I was being a brat in not getting my own way but what I considered safe and they considered safe were a country mile apart.

In teaching and in geography teaching in particular we plan ahead and mitigate for risk in the classroom and out.  Every fieldwork or visit has to have a risk assessment, what could we do to minimise the impact of disaster and increase the safety of our students – it didn’t matter if you were doing an urban transect, analysing coastal defences or studying the velocity of a river you have a responsibility to identify potential hazards and solutions so that everyone stays safe.  I felt I had a further responsibility to my year 13 A level students and got frustrated with some of the group when they didn’t bring their work in to be marked.  I decided to tell them that my time was limited and if they wanted me to get their work assessed and returned to them for improvements they had to get it in as I wasn’t going to be in school for several weeks.  One asked why and I just told them in a matter of fact, no drama way “I have cancer and need surgery”.  They looked shocked and I wondered if I should have sugared the pill but they are young adults and needed to understand why I had to have their essays in order for them to maximise their marks and prepare for public exams.

12. Great Expectations

My next appointment was arranged for when we were in Prague so I had to phone Mr X’s secretary and re-arrange.  This again is a wake up call as the NHS does not pander to your diary!  The next available appointment was the 7th November which was a week later than suited my timeline.

It did give me a chance to apply the GROWTH coaching model which I used in school to my medical situation.  One Saturday afternoon I sat down and sketched out the

Goal:  to remove the cancer;

Reality: the type of cancer;

Options:  do nothing (not keen… will have shortened life expectancy),  left mastectomy and sentinel node biopsy (not keen as do not want a future cancer diagnosis) so the best option in my opinion was left mastectomy, sentinel node biopsy to see if cancer was in the lymph system and right risk reducing mastectomy.

Will:  I would request a double mastectomy and immediate reconstruction using acellular dermal matrix and an implant – great plan, positive psychological benefits and it looks good – I can argue the case, it makes sense one operation – problem solved.

Tactics: high protein diet to help healing, keep up the exercise and start mindfulness (last bit was a stretch as I couldn’t sit still long enough).

Habits:  keep avoiding dairy – be fit for any follow up.

I was so pleased with this plan that I typed it up, added diagrams and printed it out in colour.  Mr X was going to be impressed!  I continued to research the pros and cons of using this acellular dermal sling and found an interesting technique introduced by The University Hospital of South Manchester’s Nightingale Breast Cancer Centre which reduced potential problems with pectoral muscle detatchment.

Not only was Mr X  going to be impressed by my solution,he was going to be able to further impress all his colleagues by performing this amazing surgery – removing my cancer, introducing a new technique to Derriford and most importantly in my mind… a one stop shop for me.  Surgery done, cancer over – boom!

Goal 2

I was so pleased with myself that I virtually skipped to the next appointment.  As we were called in to meet Mr X I barely let the poor man sit down before my breast cancer folder was out and I insisted I talk through my plan.  He looked surprised and the breast care nurse looked very surprised.  I carried on.. pointed out the diagrams, the shape of implant and then the piece d’reistance… the research from Manchester (on an A3 sheet, also in colour with lots of diagrams).  There! Plan shared, lets move on and set a date.  Mr X folded up the A3 sheet and handed it back and said that it was obvious I’d thought about this – you bet! I felt very pleased with myself.  I did look over at the breast care nurse who looked agog and I said “don’t all your patients do this”.  It was a resounding “no”. Mr X gently told me that we needed to the “safest thing” which was the left mastectomy and biopsy and that we needed to crack on as I’d been let go long enough.

Safest thing, safest thing… were they ALL mad.  How could only removing the left side be the safest thing? Surely the cells and tissue in the right breast was the same as the left? Surely whatever had caused the cell abnormality in the left was lying latent in the right waiting to spring into action and cause more tumours and possibly escape into my bones or elsewhere.  It was pointed out that there was a multidisciplinary team which had discussed my case and that actually they did know what they were doing and I should go with it.

So much for the GROWTH  model.  The next step was to arrange a date, pre op assessment and nuclear medicine.  They would write to me.  I held it together as I left the office, walked out of the clinic and then at the stairwell floods of tears streamed down my face.  They continued all the way to the car, out of the sodding impossible car park, on the main road towards Tavistock to get some lunch, through lunch, all afternoon and evening.

Tip:  Don’t be surprised if your plan is not the same as the surgeon and multidisciplinary team.  Expect to not have control… it is a hospital not a school.

11. Need to know basis

In the meantime I had kept colleagues in school informed on a need to know basis and Facebook changed this.  My head teacher had told the leadership team about my condition as I found it difficult to be evasive,  I’m intrinsically an honest sort of person, and I just couldn’t commit to certain things as I didn’t know if I’d be in school or not.

My classes were a great distraction and I love how no two days are the same when you work with 1,400 students.  School was busy, we were pulling together as a geography and as leadership team, we’d had a review and were devising rapid improvement plans, the coaching team was in it’s infancy, there was professional development to organise,  colleagues needed support, students needed to be chivvied into learning – teaching is great, being on the leadership team is better.  I have my own office, with my name on the door, school was helping me to thrive.  I’d confided in one of my colleagues whose wife had dealt with breast cancer and he was a real source of support in a low key totally positive way. Out of school I became manic about fitness and how often I could go to the Life Centre to do a spin class, total toning, body combat or a barre class which a friend taught at her home.  I’d lost weight and I was fighting fit… I was going to kick cancer into touch as I was going to be as match fit as possible.

Tip:  try and get yourself as fit as possible as it will help you in your recovery.  Going to the gym or classes is a great way to release endorphins. 

10. October – breast cancer awareness month

October is breast cancer awareness month.  I had become very aware of breast cancer and although I had told friends and family I decided to announce to my virtual friends on Facebook that I had managed to get this wretched disease.  This is what I posted:

“This month is national breast cancer awareness month. Unfortunately, I have been diagnosed with this disease so life has been a bit of a tail spin since 29th August. However, family, friends, colleagues, my school and the NHS have been fabulous at helping Nick and I through a turbulent time and what is likely to be tough few months after surgery. All and any offers of help and support gratefully received. LADIES – I have been very fortunate in an unfortunate way in that the sort of breast cancer I have (invasive lobular carcinoma) was picked up early by a routine mammogram as there are no lumps or bumps – if you have an appointment, MAKE SURE YOU GO! Look out for my book – it won’t be called “Dear Cancer, Love Victoria” a la Victoria Derbyshire but…”F**k Off Cancer, I don’t have time for this sh*t, so s*d right off, how very dare you, get lost…. Mrs O” This will be my one and only post about this – just wait for my book at Waterstones!”

The response was overwhelming and supportive.  Facebook and social media do come in for a hard time but I found it easier to tell people in this way.  That idea of kindness as a recurring theme comes back as people were sympathetic and thoughtful.

At the beginning of October I received a copy of the letter Mr X had sent my GP.  It was a very well written letter and it brought the issue into sharp relief.  I’d been fooling myself as I thought that if I turned up at the various meetings in my suit, name badge, school bag and looked professional then really the cancer didn’t belong to me.  The letter with the diagnosis and plan laid everything out in black and white.  It came as a shock which sounds naïve.  Although I’d been listening in the appointment I don’t think I really heard or understood.  The communication recognised that I’d requested a bilateral mastectomy, despite the disease only being on the left side, the potential problems with mastectomy and sentinel node biopsy, the dreaded radiotherapy word and how that could make a hostile environment for reconstruction, risks with implant based techniques and how surgery would be arranged after meeting again.

This letter was a real wake up call, the positivity I’d felt after meeting Mr X had dissipated.  The only silver lining was that I thought I had a degree of control about what sort of surgery would happen… geographers don’t carry out surgery as a general rule.  Dear Nick didn’t understand why I was sobbing uncontrollably in the kitchen as I read and reread the letter.  He thought I was “over it” and said so as I seemed so together…… “over it.. I sobbed, it’s hardly started”.

Tip: don’t be hard on yourself, cancer diagnosis is a roller coaster – seek someone to talk to e.g. in Plymouth we have the Mustard Tree.… someone who you can tell everything to without worrying about them worrying about what you are saying.

9. Meeting the surgeon

“An appointment has been arranged for you to see Mr X, consultant plastic surgeon, please allow additional time to get to Derriford Hospital as roadworks can cause delays”.

Back on the conveyor belt, next stop Primrose Breast Care clinic.  I had been into school, taught a couple of lessons, walked home and then given myself an hour to drive the three miles to the hospital and find a parking space.  Soon enough we were scouring the Birchfield car park for a space, once we’d negotiated the 45 degree slope to get the yellow parking token. Who designed this? Did it win an award for worst designed car park in Plymouth?  Who thought it was a great idea to have to drive up a 45 degree slope, apply the hand break and faff about to get the token.

Onwards past the smokers under the don’t smoke sign, many wearing pyjamas and dressing gowns, past Marks and Spencer’s food hall, though the concourse of the hospital, up the stairs to the clinic, where once again we signed in and sat down on one of the lime or orange chairs.  There is an eclectic mix of reading materials available, women’s magazines such as Grazia and Hello and a huge number of journals about steam engines – presumably to help put all the husbands and partners at ease.

We were called in by the Breast care nurse who we met on 29th August, into the same office as previously where a very young looking consultant met us.  Mr X explained I was a good potential candidate for an immediate reconstruction following mastectomy.  He asked to examine me and Nick and I trotted next door where I was given a purple cape to wear once my top and bra came off. As the Strictly season had started I announced I was ready for the Paso d’oble so Nick and I were laughing at least not least as he acted out like a bull whilst I swished the cape.   Only my breasts were examined, not my mental health.

Once again, I had to lie down, top off, my breasts were prodded, ummm no lumps and no bumps (were they really sure I had cancer?).  Mr X then measured the distance from sternum to each nipple – my goodness my breasts were amazingly symmetrical, 24cms from sternum to nipple on both sides, base width 16cms on both sides, height 13cms on both sides –  not bad I for an old bird. He then asked if he could take photos… fortunately not for his Facebook page as I asked but for the before and after.  Once I was dressed he then explained a variety of options and gave us a lot of information to think about which was all seemed very positive – I really did have cancer though as the MRI had confirmed it (as if the punch biopsy and ultrasound hadn’t).

I’d read, highlighted and put post it notes in the reconstruction booklet I’d previously been given and although I was listening I’d already decided that a reconstruction using acellular dermal matrix would be the best option for me.  This is where material from cows or pigs is used as a sling to support the implant and the pectoral muscle is placed over the top to make a secure pocket. We agreed to meet in a couple of weeks after I’d had time to think about it, I informed him and the breast care nurse that I’d be unavailable during half term as I was going to Prague for my “mental wellbeing” – for goodness sake! We were going to Prague as it had been booked before all this breast cancer nonsense and we wanted to go, stay in a nice hotel, eat some interesting food, drink beer* stooge about and have some fun with our friends from Italy who were coming to meet us. I didn’t appreciate that there is a timeline – it is the NHS timeline and if the patient goes over a certain number of weeks there are consequences.  I volunteered to write to someone in authority if it helped and attend the multidisciplinary team meeting the next day to argue my case but I wasn’t required.

*No alcohol and no dairy as the cancer is oestrogen positive so I cut both out of my diet.

Tip:  Take notes or get your friend, partner, husband to take notes to ensure things are not lost in translation and to help you hear as well as listen.