My MRI scan was all clear. The most fantastic news after two weeks of tense waiting. I was given that information over the phone before attending the Breast clinic to get the results which gave me back a bit of control and made attending the appointment a lot less stressful. With a clear MRI and CT we knew that the they hadn’t found evidence of cancer anywhere else in my body so we could now focus on the breast lump and lymph node and finally get things moving. I was able to take Dan with me to see the consultant which helped and at least gave me someone to have a chat to whilst we waited to be seen. As before he came prepared with his trusty notebook and pen, ready to take down any important information that we may need later.

The waiting room was quite full when we arrived, a mix of women of all ages, shapes, sizes and cultures. Most on their own but a few couples like us. You are only allowed to bring someone with you to significant appointments, usually at which “news” of some sort will be given. The tension on the faces of some of the couples was obvious. Looking around that waiting room made me realise how indiscriminate cancer is and how many people are affected. One minute going about their normal lives and the next thrown into a world of chaos. No one is immune.

Two nurses sat at the reception desk behind their protective perspex screens. Instructions on the screen asked you observe social distancing and to stay behind the line marked about a metre from the desk. With your mask on, standing a metre from the desk and with a Perspex screen to penetrate, it wasn’t easy to announce your arrival, and here began the rather comic episode. The nurse couldn’t hear you so you had to step a bit closer to the desk which resulted in the nurse getting quite riled and pointing at the sign whilst asking you to please step back . Worse than the crime of getting too close was that of producing your appointment letter and trying to pass it to the nurses through the perfectly positioned, post box sized gap at the bottom of the Perspex screen. This always resulted in the enormous agitation of the nurses who then shouted back at you that they didn’t need to see the letter in a voice that suggested that you may have just tried to pass them something like illicit pornography. This was made all the more hilarious as all appointment letters from the Breast Clinic were headed “Please bring this letter to your appointment” in bold. By this time the entire waiting room had put down their phones and books and were watching you instead.

You were then asked to confirm your name, date of birth, address and finally why you were here whilst the entire waiting room of patients listened in to you shouting out your answers. You could see the discomfort rising in every patient that went through this process but none more so than in the case of a lady that day who must have been in her 80’s, very frail but immaculately turned out in her Sunday best, wearing her mask and desperately trying to convey the information she was being asked without being overheard. You could see she was suspiciously eyeing the waiting room as she gave her address, I can only assume she was checking that no one was making a note of it ………. maybe with the aim of nipping out of the hospital to burgle her house whilst she had a mammogram??

The situation got even worse when they asked her for her date of birth. At first I though that maybe she had forgotten it she became so flustered desperately searching her bag for something. In fact her reaction was one of complete and utter horror. There was no way in the world this lady was going to announce her age to a waiting room of strangers, the very thought of it! her indignity was palpable. She finally found a pen in her bag and something she could write on and was able to write her date of birth down. OMG she was going to try to post it through the gap in the perspex screen!! the entire waiting room held their breath ………. the nurse accepted the scrap of paper. With the information exchanged and all COVID safety rules breached, she had reached the final stage of the check in process. A decent sized queue of patients had now built up behind her. “And are you here for a mammogram or a consultation?” shouted the nurse. “Mammogram” responded the lady as the last shred of dignity she walked in with was torn off her. “Oh” said the nurse “in that case you will need to check in with my colleague” and pointed to the nurse sat at the desk next to her. You could feel the sharp intake of breath from everyone sat in the waiting room, surely they are not going to make this lady go through the whole checking in process again?………….Yes they did.

I watched this comedy scene play out time and time again as each new patient arrived, Dan and I assessed the situation from our seats in the corner of the waiting room. What would McKinsey make of this if they were asked to undertake an inefficiencies audit? They would have an absolute field day. How can the nurses go through the same routine with each and every patient every day and not realise that with a few small tweaks to the process things could run so more smoothly giving them back what I am sure would be valuable time in their day not to mention sparing patients the ordeal. Where to begin? maybe ask the patient at the start why they are here to ensure they are at the correct desk to begin with? Or maybe even have a sign above each desk so that patients can put themselves in a queue behind the right reception desk to begin with? No funding for signs I guess? I decided that once my treatment was over that would be my gift to the clinic, two large signs “Mammograms” and “Consultations”.

We were called in to see the consultant before I could give the matter any more thought. I really liked him. No nonsense and straight to the point as ever. He immediately put us both at ease which is no easy challenge from behind a mask. He was delighted that the scans had come back clear but reminded me that he hadn’t expected anything else. That morning he had discussed my case at the weekly meeting of medical minds (my terminology obviously, it is actually called something far more technical but I rather like MoMM) and the general consensus was that we now get on with the surgery ASAP. No reason to delay and he had a slot in his diary the following week. He mentioned that there had been some discussion about how the surgery is undertaken given that my lump was in the upper inner quadrant on my breast. The worst place because the scar may then be visible if I was wearing a low cut top. I am sure he didn’t actually say this but the message I came away with was that some young upstarts at the MoMM had suggested the possibility of using some newfangled surgical methods given the location of the lump but his view was that we “don’t mess about”. We get in now and get the lump out. He reminded me of a WWI battle commander, planning an attack, pacing the command room with a handle bar moustache. I was strangely comforted by that and his no nonsense approach. I told him that at 49 my low cut top wearing days were probably drawing to a close (at least the kids will hope that is the case) so I was happy to go with his recommendation, get the bugger out and get it out quickly.

Dan was furiously scribbling notes as he ran through the details of the surgery. I was lucky that my surgery would be a lumpectomy rather than a mastectomy, the removal of just the lump rather than the whole breast. He would perform wide incision surgery on the breast to remove the lump which he suspected was of a decent size (about 4cm in diameter) and would then perform a grade 2 clearance of the lymph nodes in my arm pit up to my shoulder. They would check the lymph nodes removed to see if any more of them were cancerous in addition to the one they knew about. If they discovered cancer in a certain proportion of my nodes (everyone has a different number of lymph nodes……. who knew!!!) they would need to go back in and undertake a full clearance of all of the nodes in my right arm. He seemed pretty confident that wouldn’t be necessary and to be honest, at that stage I had no idea really what your lymph nodes do other than some vague recollection of GCSE biology lessons and something about draining. He didn’t seem at all concerned about their removal, reassured us that he had performed these procedures many, many times over his many years of practice and made a final comment about how he had undertaken more procedures during his own professional career that the total number undertaken by all of his fellow experts at the MoMM put together. Their suggestions that morning had clearly annoyed him.

And with that we were ushered off to the comfy consultation room for a sit down with one of his nurses to run over the fine detail around the surgery. More booklets were produced, I was given a rather odd home made bag on a long strap that I was told I could carry my post op drain in if I needed one. I don’t know what I found more offensive the thought of having a drain or having to carry it around in a bag made of a slightly dubious lilac floral material but I accepted the gift graciously. She then gave us what felt like never ending information about the possible after effects of surgery; pain, discomfort, nausea, bruising, swelling, infections, haematomas, loss of sensation, scarring, stiffness, something weird called cording where tight cord of tissue develops down your arm causing pain and restricting movement and something hideous called a seroma which is a collection of fluids in the body, likely in my case to be in the arm pit which should eventually just be reabsorbed by the body. Nice!

We then moved on to the risk of developing Lymphoedema, more leaflets required for this one and I was given a card to carry in my wallet that I could produce to people advising them that I was at risk. This would be a risk for the rest of my life. Lymphoedema is a swelling of the arm, hand or chest caused by a build up of lymph fluid in the surface tissue which occurs as a result of the damage caused to the lymphatic system by the surgery. This swelling can occur at any time, weeks, months or even years after surgery. I was advised that post surgery I would need to take care of my right arm. No blood pressure to be taken on that side, no bloods or injections and I was to avoid getting sunburnt, insect bites, cuts or injuries of any sort on that arm. My mind boggled at how you actually do that in practice but I thanked the nurse for her time and took the leaflets to add to my ever expanding “cancer” filing at home. As we wandered back to the car I put all of the after effects information we had been given in a box in my mind marked “not going to happen to me if I can help it” and we headed home.