In the Wee Hours

Some practicalities first. Yesterday we received a phone call from the surgeon who had just left the MDT (multidisciplinary team) meeting. He said that the receptor status came back as ER ([o]estrogen receptor) and PR (progesterone receptor) positive, but HER2 negative. This means that it will, hopefully, respond to blockade of these hormones in Eva’s body.

Something he said to us last week was that, perversely, gestation and lactation have probably been a rich feeding ground for the cancer. The increased vasculature of the breast; increased presence of growth factors and cytokines (chemical mediators in the body); the juicy circulation of hormones.

(One could wax lyrical about the perversity of the tumour-laden breast feeding an infant, but let’s not. What has been, has been.)

In terms of treatment, the decision was made to pursue neoadjuvant chemotherapy before mastectomy. It’s nice to have a decision on that front.

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It’s 03:36, when sleep is scarce, the perfect time to never reflect too much on anything.

The last two to three days have been incredible. The outpouring of love and support and kindness and optimism and warmth have really bowled us over. I personally had not previously been able to relate to people’s appreciation for this very simple and natural human response to their difficult situation. I suppose my subconscious reaction was something along the lines of, my well-wishing is not really going to help your cancer/divorce/grief/loss, etc.

But how wrong I was. Cliches are wonderful because they are true. This has been a tidal wave that has lifted us and carried us. From feeling low, stuck in mud, slow and ponderous, lost, we now have hours of feeling like we’re being moved by a higher power, pushing us along with lightness and strength and hope. It is nothing short of magical. For this we are incredibly thankful. It’s life and energy where there is cellular mutation and fear of change and illness and distress. It’s goodness and healing to lumps and masses of the body and soul. We are indelibly marked and changed by this energy.

I do not want this blog to be a place for negativity, or a record of sadness. I want it to be a testament to hope and healing. But the surgeon did give helpful advice. He said that, in his experience, women with breast cancer who do not ‘do well’ are those who: a) adopt a passive-aggressive approach to their illness; B) those who are strongly religious and who accept illness as God’s will, who accept recovery as God’s will, and who accept death as God’s will. He stated that he was originally of a faith background, but wisely countered that with, ‘as I grow older, I realise the less I know in this regards.’ This solid surgical man spoke of the mind and attitude’s effect on the body’s immune response to relaxation and optimism as opposed to stress and anxiety. In my field of medicine, we know that chronic stress leads to various mental illnesses, and we can often see functional correlates on MRI scans as well as the clear psychological and physical symptoms of the illness. Stress can precipitate psychosis, anxiety, and depression. Lack of appropriate care in childhood can lead to disrupted attachment with a primary caregiver, which in extreme circumstances can lead to poor development of the dorsolateral prefrontal cortex in the child’s brain. This shit is real.

As he put it, ‘do not go into this with a burr in your soul.’

So, for the sake of expunging burrs and breathing in this discomfort, and not for the sake of voicing negativity…

We’ve received hundreds of beautiful, positive messages from people, each one a little nugget of gold just now.

But we received one negative one.

Both of us know on some level it was not intended to be negative, but instincts and emotional responses are pretty rapid and powerful at present. I had asked on social media if anyone knew how to make money from a blog, so that if/when my paid leave from my supportive work ran out I could possibly supplement my income. In response, a few well-meaning individuals mentioned other means of financial support (e.g. crowd funding, Go Fund Me) – which I had made no reference to, and all of which I have since deleted. The private message I then received went like this:

  • people don’t like crowd funding, etc, because others have done this who lied about cancer and have raised a fortune for themselves
  • people will be cynical if they think I am doing this for money, and it can appear that I am trying to ‘wring out every ounce of tragedy and emotion to make people feel sorry for [me]’
  • I have an ‘excellent lifestyle’ which many could envy, and blogs can be hacked by ‘envious people, with horrendous results’
  • the ‘normal’ way of coping with tragedy is family
  • ‘first and foremost’ I should be putting my faith and trust in my ‘Heavenly Father’ to provide
  • I could be trolled, which is ‘truly wicked and vile’
  • the trolls could potentially find where I work and where my children go to kindy

WTF?

I don’t want to dwell on the content of this message. This person states that they administer social media accounts and do fundraising for clients, so this was a purely professional communication.

When I received this message, Eva saw some kind of response in me without me saying anything. Damn, she knows me well. She said to me, ‘you’ve just got a message from so-and-so, haven’t you?’ This person has a long history of unfiltered, thoughtless communication which has caused us no end of stress. She, of course, read the message too.

The end result was like the wind turning and our ship which had been skimming along the surface of the water slowed to a standstill. Deflated doesn’t do it justice. I felt it, but I was most sad to see Eva’s response. Where the humour and cancer jokes and liveliness were present in good amounts, she became anxious and flat. She questioned her approach to how she was dealing with all of this. The language and religious fervour harked back to her own childhood and the obsession with appearances and how one presents one self.

I don’t want to go on. I am expunging, and making room for this. I’m breathing in to it. It demonstrated again to us how vulnerable we feel just now. And I understand a blog and social media posting about a serious illness can give a sense of being ‘okay’ with this. It is part of our way of dealing with it: head-on, out in the open, in your face, trying to verbalise and outline this maelstrom of emotions. And that is vulnerable and we do leave ourselves open to misunderstanding and people’s opinions.

This person has since apologised that it went ‘completely pear shaped’, but the damage was done to our day yesterday.

We are moving on from this, as this is the only thing we can do. We concentrated on the three practical, very helpful things that this person is also doing, for which we are truly thankful as they are part of reducing stress and discomfort during this period.

We’re breathing in and making room around the disappointment and hurt and anger and sadness. We’re opening up and being bigger than our feelings. We’re soaking in the love and goodness and optimism expressed by so many people. We’re basking in the practical care that so many people are demonstrating (meals, offers of babysitting, play dates – for our children, not us, although we will request the same – laundry, picking up shopping). It is a gathering force that is going to meet the disorganisation and exhaustion and fear and uncertainty of the coming weeks and months, and which we know is going to make it more than bearable.

It’s late spring here in Queensland. The sun is getting hotter and the vegetation is richer from recent rain. The sea is perfect. The subtropics are where our souls were designed for. It bathes us with warmth and light and beauty. We feel incredibly thankful for lives in a safe (for us) country. We are blessed beyond measure. Our suffering is a piss drop in the sea of humanity. It is Eva’s, it is ours, and it is real and sore. But we are safe; we are clothed; we are fed; we are free; we are citizens and permanent residents; we are employed; we have healthcare. Our pain is contained.

Breathe.

………………………………………….

On a lighter note, my multitasking is improving. Yesterday, as I was driving Mia to kindy (f*** off trolls, who are interested in knowing that) I had a good silent cry to this version of this song. Note quite sure what I was crying about but the floodgates are somewhat leaky at present. Mia was right behind me so couldn’t see. So I can now drive, cry quietly and wipe tears away, listen to music loudly, and communicate with a four-year old simultaneously.

For Eva, for whom music is painful just now. (Btw, I’ll stand by you. I’m not asking you to stand by me in this. I am not that emotionally dependent. Just to clarify. Geeze.)

Click the link for some good shit.

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Enid Blyton and the Surgeon

After the CT scan of Eva’s chest, abdomen and pelvis, the radiologist invited us in so he could talk us through the scan. I am becoming more aware of the advantages and disadvantages of being a doctor in this situation; this was a privilege for which I am very thankful – that we did not have to wait for a scan result to be emailed to a GP and for us to wait another few days to receive it.

We walked along the corridor, Luca sitting like a beatific Buddha on my arm, surveying the devoted uniformed radiology staff who were besotted with him. We sat down in front of the bank of screens. The radiologist introduced himself. Again, the tingling and nausea were contrasted with the silent emptiness in the depths of my abdomen; anxiety-screaming anticipation crashing into the dense darkness of unknowningness.

He spoke to us kindly for about 20-30 seconds. I have no recollection of what he said until he said, ‘the scans are fine, by the way.’

I let out some sort of groan of relief and threw my head back. I felt like I sort of collapsed a little, like I had only been maintained by muscular tension for the past days. I squeezed Luca on my lap. Eva seemed less affected by this reassurance than I did, though.

On reflection, I can see two things: firstly was how our agenda as the patient (and patient’s partner) differed from the doctor. I am immensely grateful to him for taking the time to bring us through and talk to us. But our glaring question was, what are we going to do for our family, and in particular Mia and Luca, if Eva has only a few months to live? His was more academic in that he wanted to reassure us by giving us a brief, well-expressed tour through Eva’s radiographic body.

Secondly, the difference in my and Eva’s reaction. As I said previously, I had catastrophised about the horrific CT reports I have seen. Even as he reassuringly pointed out groups of lymph nodes, the architecture of the lungs, the vasculature of the liver, the little pyramid of the adrenal gland on top of the kidneys – I waited with bated breath to see if he would stop or hesitate, seeing some oedema (swelling) or focal lesion that he had perhaps missed on first passing. My limited knowledge of oncology told me that if there was something on the other side of the diaphragm, it was game over. At least, that’s how I felt.

In this journey, I’m going to be straddling these lines: the husband of the patient, not the patient; the husband of the patient who happens to be a doctor, not the doctor. This disease is hers and she is bearing its full brute force. On one hand I’m an observer and external. On the other I am inextricably linked on deep levels, compounded by love and empathy and deep knowledge of this suffering person, and biologically as co-carer for our genetic offspring.

We left with somewhat lighter hearts, and the mood at home was definitely  easier that evening. We laughed with my brother-in-law and his wife. Eva even pulled the cancer card on me: ‘can you close the bedroom door? I’ve got cancer.’ This is the humour that will get us through.

The following day we turned up at the hospital to meet the surgeon. I had received a text from him that morning: ‘Hi Simon, I have to go to theatre for a few hours. Could we make the appointment for 10am. Sorry. I will leave the room open. Please come in and take a seat.’

John (not his real name) poked his head round the door. He was tall, and wore dark blue scrubs and pointed black leather biker boots. He was elderly (his medical certificate hanging on the wall said he graduated in 1967 which must place him in his early 70s), and he carried himself in a relaxed way. His eyes were bright behind silver glasses, and he looked tall and strong and was still a handsome man. He introduced himself, and then headed straight for Luca and spent a considerable amount of time with him first. This seems to be a recurring pattern at appointments thus far.

Over the next hour and a quarter, John was everything one could hope for in a surgeon. He was kind and thoughtful, a great listener, relaxed and knowledgeable. He was a very straight-talker, but philosophical and humble. He explained everything to Eva as often as she wanted, and in different ways. He drew pictures and timelines and scales. He examined her, and then looked through the initial ultrasound and mammograms with us. He walked around and engaged with our baby, and paid me no heed as I changed aromatic nappies on the floor. And what sold it was that he revealed some of himself to us.

‘I came back to Australia from a mid-life crisis at a breast and endocrine unit in the UK, and I preached breast conservation. And it pains me to advise a beautiful young woman like you, that you will need to lose your breast. There are multiple masses, and there is no way we can save anything. I don’t take this lightly, but if you were my daughter, this is what I would advise you. My daughter was in her forties when she got breast cancer, and she told me she wanted both breasts removed immediately. I told her to slow down and think about this. But I’m sorry, you need a total mastectomy.’

I had asked Eva on the way there how she felt about having a mastectomy (which we both fully expected already). She replied at this time she didn’t care, or about losing her hair with chemo. She knows that these feelings may change.

He hugged Eva and shook my hand. We came to the awkward moment where Eva and I had to lay our cards on the table about our recent downgrade in health insurance (essentially nil), and our inability to be able to cover many if any added health costs. John waved his hand.

‘I’ve had three wives, so I’m broke too. But it’s our duty to your family as part of the medical fraternity, and to a beautiful family who is experiencing this unfair tragedy, to treat you here. I’ll do you at the end of my private list, and you’ll be here as my patient on the public ward. That’s if you want me looking after you, that is.’

As a doctor in the public health system I have inadvertently held some prejudices towards the private sector. We had said from day one that we would be keen to be treated in the public system; it’s a known entity, ad removes some of the choice which in this case we found overwhelming. The last thing we wanted to do was to speak to lots of people about who is the ‘best’ surgeon. It reminded me of something I already knew: in the West, no matter in which country we live, the access to public healthcare is exemplary (with one glaring exception, perhaps). We’re privileged with the access to medical education and training, the centres of research, and the safety net for those who are uninsured.

But here was a man whose kindness and concern appeared to be the motivating factor for his practice. He was seeing us on a Saturday morning. We knew that the next time we could have been seen was 9pm on a Tuesday night.

I had already discussed some practicalities with one oncology counterpart at the local hospital where I am based. He too gave willingly of his time, talking me through the process and reassuring me.

Ultimately, where we are treated and by what system is completely secondary. We have been blessed that we have met a beautiful person who has invested in us personally already, who happens to work at a smaller, more easily accessible hospital close to our home.

Last night I continued reading The Enchanted Wood by Enid Blyton with Mia before bed. These words struck me:

Suddenly one of the people of the Rocking Land gave a frightened shout and clutched hold of a nearby tree. A strange wind blew with a low, musical sound. 

Now what’s going on?’ cried Moon-Face.

‘Get hold of a tree! Get hold of a tree! shouted the people round about. ‘When the wind makes that sound it means the whole land is going to tip up sideways and try to roll everyone off. Your only hope is to catch hold of a tree!’

Sure enough, the land was tipping up – not in bits and pieces as it had done before, but the whole of it! It was extraordinary….But not one of them could [catch hold of a tree], for they had left the wood behind and were in a field. Slowly and surely the land tipped sideways, and the children and Moon-Face and the old Saucepan Man began to roll downhill on their cushions. They were not bruised but they were very much frightened. What would happen to them if they rolled right off the land?

Down they went and down, nearer and nearer to the edge of the Rocking Land – and then, quite suddenly, Moon-Face disappeared! One moment he was there – the next he was gone! It was most peculiar.

But in half a minute they heard his voice, lifted up in the greatest excitement. ‘I say, I say, everyone! I’ve fallen down the hole to the ladder that leads to the Faraway Tree, quite by accident. I’ll throw my cushions up through the hole so you’ll know where it is. Roll to it if you can! But hurry!’

The outpouring of love and support and positivity the last days has been completely unexpected and overwhelming. It’s provided a the stability of a Faraway Tree in our Rocking Land. I had not understood until now how expressed kindness and care could be so powerful. There is something rather magical about it. Thank you.

 

Sleeping with Cancer

It’s three days since we received the diagnosis of Eva’s cancer. The first night was the worst. After returning from the doctor’s we maintained as much normality as possible for the kids, communicating the news to Eva’s brother and sister-in-law in a text message before we got home, then brief sentences. So much for their holiday and a relaxed time with their niece and new nephew.

That evening I was short on patience and instigated a consequence for my daughter not listening to me, far too quickly. I told her she would not have a story before bed as she hadn’t listened to me first two times, and then by the time I had counted to three on the third time. This resulted in a tearful four year-old sobbing in bed, crying to me that she would not sleep that night because she had not had a story. (This is a consequence we’ve only had to resort to about once prior, and is the most serious discipline conceivable to her). I sat there on the edge of her bed, wavering between feeling like an absolute shit, an authoritarian monster, whose daughter was about to lose her mother to cancer, and feeling irritated and annoyed at the drama on display before me. My mind quickly went in to overdrive and I imagined a similar scenario in six months’ time, after Eva’s death, where I would be there with Mia as she cried for her mum. Again, this gut-wrenching helplessness and sickening feeling consumed me. I was acutely aware of how my own shock and inability to process what was happening was being transferred on to my innocent daughter. I struggled to watch the scene unfold, and imagined this multiplied a hundred times over the coming months. Eva and I tag-teamed settling her over the next 20 minutes or so, both managing only limited periods of patience with her. When she woke Luca up with her crying, I stormed in and pointed out what she had done. She tried to suppress a sob, and then let it out and said, ‘I’m sorry, it’s all my fault.’

In that moment I was able to stop. I imagined the scenarios that could potentially play out over the next months: there will be stress and tension and low energy and fear and worry and anxiety. Patience will be stretched to the maximum. But our current vocation in life is creating a home and family for our children where we learn how to tolerate uncertainty and discomfort. We want to impart to them how we deal with uncomfortable emotions and feelings and to accept what they experience and then react proactively.

We rectified the situation with her and rolled into bed.

And then the night started.

There’s something surreal about lying next to the person that you’ve slept with for the last fourteen years, and realising that it is all the same yet so, so different. Now cancer lay with us. We held each other and I stroked Eva’s hair. That thick, dark hair. For the first time in seven years, I refused to sleep with ear plugs. I had a strong urge to be present with every sense over the next months. I want to be able to hear Eva’s breath. I want to hear when she is in pain. I want to hear when she is nauseous and vomiting. I want to hear when she’s crying. Our bodies were buzzing, adrenaline surging, and sleep came and went. At some point Eva sat up and I rubbed her back, and she lack back into my arms. To have your best friend sobbing into your arms that she is too young to die and she has only just started living life is the most difficult experience I have had in life. And I couldn’t say no, you won’t die. I couldn’t reassure her. I could only agree and hold and stroke and break inside. I could only just tolerate my own powerlessness and terror and fear and unfairness, and know, cognitively, that her suffering was yet more and deeper.

To quote a friend, ‘Fucky fuck fuckety fuck fuck! That sucks more than words can describe!’ Pretty accurate.

I think our over-riding thought at this point was, how bad is this? Each step during the week was such an unexpected blow, that it seemed entirely possible that things would keep getting worse. I imagined phrases from the CT reports I’ve read as a doctor: ‘widespread metastatic omental caking…infiltration of the portal vein…compression of the inferior vena cava from significant mediastinal lymphadenopathy…’ I feared that cancer would have spread as insidiously as it had first presented and we were simply waiting out a death sentence. My mind was running at a thousand kilometres per hour: will Luca remember Eva? What will I tell Mia if she asks me if her mum is going to die? How fucking unfair is this on Eva, a woman who has put up with so much in her life, that she is going to be robbed of this best part – her children’s growth and development – that she had worked so damned hard for?

The next morning we phoned the GP and received the result of the FNA (fine needle aspirate) which revealed that the axillary lymph node (which drains the breast) also showed cancer cells. This meant that it was not just confined to the breast. Still no-one could tell us how bad things were, what type of cancer it was, or what would happen next.

Two fortuitous things then happened: the first was that the surgeon that our GP referred us to the day before phoned us. His secretary offered us an appointment at 9.30am the following morning (a Saturday). We jumped at the chance, having no idea how we were going to manage to pay to see a surgeon privately.

The second was due to Eva’s tenacity. She was completely unwilling to wait until the following week to get more tests done to know how advanced the cancer was. She wanted a scan that day. I decided to call the radiology place where she had the biopsy done. They were able to schedule us for a staging CT (to stage the cancer – i.e. how extensive it was) that afternoon. We also booked an MRI of her breast for Monday.

Entering the radiology centre, the predominantly female staff cooed over our little boy. He gave cute chuckles and clucks, and people oohed and aahed. The discordance between what was happening around us and what we were experiencing internally was marked. The receptionist asked for Eva’s specialist referral for the CT; I said I was going to do it. They handed me a paper referral pad: ’36F, R breast invasive carcinoma. CT staging.’

I’ve prescribed antibiotics and anti-emetic medications for Eva before, but ordering my wife’s CT to assess whether cancer we had known about for 24 hours was actually elsewhere in her body, was a chilling experience. I felt somehow implicated in the diagnostic and management process, part of which I would usually have a comfortable degree of professional distance to buffer me from. I was aware of how closely it brought me into the process: we would potentially be left with devastating news without anyone to discuss it with, or any other option to discuss what the prognosis or ongoing management options were. It was a scary step, but one that was tempered by my obligation as her friend and husband; if there was a way in which we could arrive at the knowledge of advanced disease prior to that night, it would at least mean that the agony of not knowing would not be our bed-fellow for another night. It would mean we could imagine a little bit more Eva’s and our children’s immediate future.

 

When your cells don’t know s***.

‘SUMMARY: CORE BIOPSY RIGHT BREAST – INVASIVE CARCINOMA.’

Our eight-month old son cooed happily on the floor in the GP’s room. He held a colourful piece of plastic in his chubby hands, turning it. Eva, my wife, sat beside the GP’s desk. One arm was folded across her chest, the other hand supported her chin. There was silence.

I’m trying to remember if I knew what the result was going to be as soon as he directed us into his room. He stood quietly, with a kind smile, motioning us inside. I had never met him before but had spoken to him on the phone during which he was more jovial. He sounded South American; a gentle, lisping curve to his syllables. He had cared for my wife eighteen months before when she had stumbled into the surgery after a sudden increase in her two days of abdominal pain; a ruptured ectopic pregnancy. He had listened to us and spoken to me after the practice nurse inadvertently gave my four year-old daughter an unnecessary vaccination. He is a good doctor, because he listens.

‘It’s not the news we hoped for, I’m afraid.’

Eva had come to him about three weeks before about an enlarging breast lump. She noticed a pea-sized hard lump in June 2015, seventeen months before, one month after the ruptured ectopic pregnancy. A different GP sent her for an ultrasound, which showed no ‘sonographic abnormality.’ A month later she was pregnant again. Her breasts went through the changes of pregnancy, and then of lactation. I don’t know when we started talking about the lump; some months ago. Eva was intermittently anxious about it as it was growing in size. We relaxed every time we remembered the ‘normal’ ultrasound, and rationalised the massive hormonal changes she was going through. The day she noticed a change in the angle of her nipple in the mirror, she made an appointment with the GP. He thought probably a milk collection (galactocele), but ordered ultrasound, +/- mammography due to its increase in size.

Last Monday (six days ago), she had an ultrasound. After the ultrasound she could sense the ultrasonographer’s unease. She left to speak to the radiologist, who said that she should have the mammogram, and that she should return two days later for the core biopsy and fine needle aspiration (FNA). The reason she was given was because ‘it doesn’t fit into any category neatly.’ On Wednesday she returned, by herself, as we presumed this was our over-cautious western medical system that wanted to ensure the lump was benign in the tragically young, beautiful mother with two young children, one of whom she was still breastfeeding. I mean how twisted would that be, right?

Before the biopsy we welcomed her brother and sister-in-law who just arrived from Germany via travelling in Asia. There plan was to spend ten days with us, and especially to meet their nephew, Luca. At lunchtime we had to attend a pre-admission interview at the local state school which our daughter, Mia, had been enrolled to begin in two months’ time. We both came away from the interview (which was an informal getting to know Mia and her family chat, really) glowing having watched this incredible little girl talk with the head of prep with confidence, openness and genuineness, traits of which we were so proud to see in her.

We had some chat before the biopsy. Could this actually be bad news? We doubted it.

After Eva returned, she was her usual matter-fact-self – annoyed at the poor communication skills of the doctor. Whilst she lay on the table, right arm above her head and partially naked from the waist up, the interventional radiologist dropped in phrases such as ‘worrying’, ‘don’t beat yourself up for not coming sooner’, ‘98% of women beat it’, ‘hang in there’, ‘do something nice for yourself.’

I left shortly after to attend night shift as a psychiatry registrar. I blurted out to my two colleagues what he had said, and they told me to go home immediately. I decided to stay, partly as I knew there was nothing I could do, and my wife had my brother-in-law and his wife with her. The shift was a blur, but by the end of it I had settled back into the disbelief that this could be a bad outcome.

How could this beautiful woman, a 36 year-old devoted mother of a 4 year-old and an 8 month-old, an outstanding English literature teacher (her second language), living in this dreamy beach-side town in Australia, pursuing the life which we had been hoping for and creating for the last eighteen years together as best of friends, with no maternal family history of any cancer, and absent father who’s family history we knew nothing of, possibly receive a diagnosis of cancer?

We booked an appointment for the Friday morning, two days after the biopsy, to receive the results. On a whim, Eva phoned the surgery on the Thursday, and we were surprised to hear the result was already there.

I remember the cold of the air conditioning in the waiting room, a stark contrast to the Queensland spring day outside. The quietness of the place; the tap of the receptionist’s fingers on keys and her polite voice on the phone.

The rest of the consultation was a blur. I remember saying ‘fuck’ under my breath, and then walking over to Eva and cradling her head. She desperately tried to extract more information from the GP. As a doctor, I knew that he was very limited with what he could tell us at this early stage. The FNA was not back. The hormone receptor status was not back. The cancer typing had not even been performed. Eva asked him to repeat things, and I could see her analytical mind whirring to try and calculate what would happen in the days ahead. He recommended a private breast surgeon, but we said that we could not afford to go private due to our minimal private health insurance. He seemed somewhat surprised, and emphasised that it would be the fastest option, but he would also refer us through the public system.

He printed off the pathology report for me, and we left. I waved blindly at the receptionist, and we stepped out of the icy coolness into the humid, blanketing air.

Luca was on my left arm. I pulled Eva into me and she laid her face into my neck. I’ve seen her cry often, but these tears were different. These were the tears of a woman who had been hurt many times in her life, and now was being hurt on so many levels; a horrific diagnosis; an unknown future; and mostly, her role as a mother to her two children was suddenly precarious.

We took the elevator downstairs. I could feel my heart racing and the breathlessness rising. I could feel a hollowness opening up inside me that felt as if it contained the coming months of uncertainty. It was heaviness and lightness at once, a lack of substance and an anchor pulling me down from the middle of my abdomen.

I sent a message to a friend at work stating that I couldn’t do my next two night shifts. And then the sobs came. I was facing a cafe and a barber shop. I could feel my face scrunch and I realised I had been holding my breath. In that first reaching out to a friend and colleague, not caring about anything else but my family, I felt how much we were going to need others. I gasped and pulled my sunglasses over my eyes, and we walked towards the sea.