THE DOCTOR’S GUIDE TO BREAST CANCER

Advice on how to deal with the diagnosis

We all have dates that mean a lot to us, such as birthdays and anniversaries. Mine is 24 July 2015 – my ‘cancerversary’ – the day I found out I had breast cancer. Most of us know someone who’s been affected by this disease, so why is my story unique? Well, I’m a consultant breast surgeon. I got the one illness I’ve spent years training to treat. I thought I knew what it would be like to have breast cancer, but I couldn’t have been more wrong. I was 40 when I was diagnosed and had only been a consultant for two years. I underwent chemotherapy, followed by a mastectomy and radiotherapy, and it’s fair to say cancer gave me some of the worst days of my life. Because I was a breast cancer surgeon, I thought I’d be prepared, but having cancer blindsided me. It didn’t help that, for most of it, I knew too much. However, having come out the other side (twice), I feel more empowered than ever. Now, I want to pass my cancer toolkit – gleaned from my unique perspective from both sides of the coin – on to you. LESSON 1 DON’T BELIEVE EVERYTHING YOU READ In 2015, I found a lump in my left breast but thought it was a cyst as I’d had one before. My mammogram was normal, but when the doctor put the probe on my breast to do an ultrasound, we both looked at the screen and saw a cancer – an ugly, irregular black mass with a dark shadow beneath it. In that split second, my life changed for ever. I used to tell my patients not to Google breast cancer. What I didn’t realise, however, is that it’s almost impossible not to. I had no idea there was so much information out there (much of it scary and inaccurate) and there were times when I couldn’t stop myself, hiding under the covers in the middle of the night so my husband Dermot wouldn’t see the light from my phone. I wanted to know how bad things could get – looking for comfort, solace almost, so I would be prepared for anything. But it’s pointless. The numbers don’t really mean anything. I still get bad days when I turn to Google, but thankfully, those are few and far between. Charging my phone downstairs at night also helps.

Dr Liz O’riordan spent her days operating on women with breast cancer. But when she received her own diagnosis, she became the patient. Here, she shares what the experience taught her

LESSON 2 PREPARE YOURSELF FOR CHEMO

My surgeon, a close friend, cried as she told Dermot and I the results. Then the breast care nurse and Dermot cried, but I was floating above them all, looking down. I was in denial. Part of me still is. I started chemotherapy within a fortnight and realised how little I knew about a treatment I regularly prescribe. I had no idea what I was about to go through. I was terrified. I knew you lost your hair, but I was shocked when a friend who’d had chemo told me my pubic hair would fall out first. I was barely eating due to severe sickness and a sore mouth. Chemo also affects your bowels and I got constipation. I used to prescribe laxatives to patients and look at them, grimacing. Now, it was my turn.

Still, there are some things that you might not have time to prepare for. I knew that one side-effect of chemo was infertility, but it hadn’t clicked that I’d be made infertile. Dermot and I were still deciding whether to have children. Because my cancer was large, IVF was risky and we had to accept, in front of our oncologist, in a matter of seconds, that we’d never have kids. It was only when I got home that I started sobbing, grieving for the child I’d never have.

LESSON 3 IT’S OFTEN HARDER ON LOVED

ONES

As a patient, you have no choice but to cope. I now think it’s almost harder on your loved ones. Dermot, who’s also a surgeon, said he felt impotent watching me go through treatment. Many women say they initially want their husbands to divorce them and find someone healthy who’s still interested in sex. I felt the same. Luckily, Dermot told me not to be stupid. I was concerned about him, though. Cancer was all about me – the cards, flowers and presents. Dermot needed some time just for him, where no one talked about cancer, so I’d text his friends and ask them to take him out to give him some space. Everyone asked what they could do to help and I had no idea – I’d never had cancer before. However, I now know that it’s easy to support anyone having a tough time. Send them a weekly text saying, ‘Hi. Just wanted to let you know I’m thinking of you. No response needed’. These messages mean the world when you’re having a dark day.

LESSON 4 TAKE OWNERSHIP OF YOUR APPEARANCE

Not shaving your legs or having to bother with your bikini line for six months was great – chemo gives you a free Brazilian on the NHS. The hardest thing for me, which happened at the end of chemo, was losing my eyelashes and eyebrows. I didn’t feel I looked like a woman any more. I thought I looked like an alien. So I stopped looking in the mirror. I didn’t wear a wig and instead bought some fabulous, Iris Apfel-style glasses with thick black frames (which also hid my missing eyebrows) – I wanted people to stare at me because of my amazing glasses, not because I was bald.

LESSON 5 YOU DON’T HAVE TO BE BRAVE – ASK QUESTIONS

It was hard being a doctor who was also a patient. I had lots of questions, but never asked them. I thought that because I’m an expert, I should know the answers. However, I now realise that most patients probably don’t ask half the things they want to when they find out they have cancer. I knew my surgeon was busy and I (wrongly) didn’t want to waste her time. Having cancer has made me reflect on how doctors and nurses sometimes persuade patients to have treatments without pain relief. I needed to have an injection in my tummy that would switch my ovaries off, and it’s a very large needle. Many of my friends had been given a cream, Emla, that numbs the skin, but the nurse told me I wouldn’t need it because it didn’t really hurt – but she’s never had it. Another time, during chemo, I woke up in terrible pain. When I saw my doctor two weeks later, she asked me why I didn’t call the nurse for help. I said I thought chemo was meant to make you feel rotten. I didn’t realise I wasn’t meant to feel that rotten! If you’re struggling, don’t pretend that everything is okay. Call your specialist nurse – they are there to help.

LESSON 6 NO CANCER IS GOOD CANCER

I questioned whether I should have gone back to work at all. But time is a great healer, and my inside knowledge can help patients. Now, I hold their hands as they’re going to sleep before an operation, instead of waiting to be called from the coffee room. I used to tell patients they were lucky if we found their cancer early. I now know no one with cancer is lucky. As a surgeon, I get frustrated with how little time I have to see patients and how much information I have to give them in one go. When giving bad news to someone who’s not expecting it, I want to give them a hug. Instead, I have to talk about consent forms and breast reconstruction. We’re taught that patients only remember two or three things we say, but after hearing ‘cancer’ everything goes in one ear and out the other. Although you are given a summary of everything the doctor tells you, it helps to go to the appointment with someone else, so they can take notes and ask questions on your behalf. Ask if you are able to take photos of scans and results so that you have a copy yourself. You could even ask if you can record what the doctor says on your phone so you can listen at home.

LESSON 7 CREATE A JAR OF JOY

I got the results of my mastectomy just before Christmas and found out that my cancer had grown during chemo and spread to my lymph nodes. I didn’t want to celebrate. The new year was looming and I needed to think positively for my own sake, as well as Dermot’s. So, I decided to keep a record of all the good things that were happening to me. I bought a large jar and put it on a bright-coloured plate in the kitchen

‘IT WAS HARD BEING A DOCTOR AND A PATIENT’