Monday, 30 April 2012

The Final Chapter

I wrote the final chapter of my book today. In my head, at least. I went to the hospital in Hayle to have my reconstruction finished with a tattoo, and it brought a satisfying feeling of closure. It was also poignant, because the last time I went to Hayle it was to say goodbye to my friend Malina, a fellow breast cancer patient. She had been in St. Julia's Hospice, which is directly opposite the hospital entrance. Malina died in March; she was only 32. As I walked past St. Julia's and into the hospital, Malina was by my side. It was hard to be there with my luck, knowing how cruel hers had been.

I waited for Sarah, one of the Mermaid's breast care nurses, to collect me from the waiting room. I watched as familiar faces came and went along the corridor: there was the jolly porter who'd wheeled me down to the operating theatre for surgery, still chipper and smiling at everyone. And there was the other porter I knew, the one who DJs and loves Shakin' Stevens. I saw an advert for one of his discos in a pub window yesterday. Through the double doors behind me were the sterile blue operating theatres, where I've been both patient and observer. So many stories have been played out behind those doors. The stairwell echoed as I followed Sarah to the clinic rooms.

Sarah laughed when I told her how glad I was to be there. I took her a copy of the blog post I wrote about the Blush and the Bounty and gave her a bottle of rosé (I had looked for blush, but no luck). We lined up the bottles of tattoo ink and I took photos of her holding the wine. I undid my gown and Sarah began tattooing, noting with wonder the areas of sensitivity in my new breast. 

When I was inked and dressed, she gave me my discharge form. I walked out of the clinic and into the rain and said goodbye once more to Malina. I remembered a line from a book about Buddhism by Sylvia Boorstein. "We don't get a choice about what hand we are dealt in this life. The only choice we have is our attitude about the cards we hold and the finesse with which we play our hand." Malina managed to play hers so well with so little time, I thought; I am going to try and do the same. And then I walked to the car.

Friday, 20 April 2012

The Blush and the Bounty

Today a brown envelope plopped through my letterbox. I've been waiting for an appointment to have my breast tattoo touched up. This is a big moment as far as my reconstruction is concerned: it is the grand flourish, the embonpoint, if you will. For a true finishing touch, the pigments for nipples rival some of the best nail varnish names you can get. My nurse tattooist combined Diamond Blush with Burgundy Bounty when I had my first round of colouring. It was more uncomfortable than I expected: a good thing, because it meant that nerves had grown into the breast skin from my back muscle (I don't have implants). I have sensation there. My breast feels real.

After the initial tattoo in June 2011, the breast care nurse told me to wait for a few months to let the colour and the shape sink in: "it might take a few goes," she said. It's a fine art this, matching a fake nipple and areola complex with the original. Just now, after picking the envelope up off the mat, I wrote the appointment on my calendar (30th April). I might as well have been writing down an appointment for a manicure. This is a mark of how far I have come. I once felt like Frankenstein's monster: awkward, ugly, stitched-up. Today I feel like I've got myself back. My only question is whether the nurse will go for more Blush or more Bounty. I think I am going to take her a drink.

Wednesday, 18 April 2012

Sum Thinking

This week I went to the London Book Fair in Earl's Court to see and learn what publishers care about. I think publishers might take my book more seriously if I know something about their world and how to operate in it. But at times the fair is crowded and stuffy. It makes me feel intimidated and slightly insane. Nearby is a beautiful cemetery in Old Brompton Road, with heart-swelling architecture, old trees and swathes of spring flowers. The cemetery is a respite from taking my writer-self too seriously. You can walk down the long, straight, boulevard-style paths or you can follow labyrinthine trails that wind around the gravestones and tombs.
I went to the cemetery with a conversation I'd had earlier at the book fair on my mind. My friend Jakki has a short story on the wall in her office by David Eagleman. She says it's about someone who meets all their better or more successful selves after they die. They are the selves who achieved all the things you might have hankered for but didn't get, for whatever reason. I can't really do the book justice because I haven't read it and I am making it sound cheesy, god forbid. It made me think of another book I noticed at the book fair, Fuck It Therapy, by John Parkin. Pretty self-explanatory. Being in the cemetery was a reminder that we only get one crack at this life. We might as well aim high. Instead of feeling daunted by all the publishing mania at the fair, I went back to it in a buoyant mood. Then I ordered David Eagleman's book: Sum.

Sunday, 15 April 2012

Pain control

On Easter Sunday, my brother-in-law and I supported my sister as she gave birth at Pembury hospital in Kent. Until recently it was a depressing and foreboding huddle of Victorian institutionalism — it was originally built as a workhouse — but it is now a £225 million state-of-the-art ode to modern medicine. My sister had planned to take advantage of all that modern medicine had to offer, but she was forced to forego her planned epidural due to the speed of labour and the midwife's reluctance to medicate. It was traumatizing for her. I know that pain; I've given birth without drugs too, but I made a conscious decision to do so and it was that decision that enabled me to cope.

I found my sister's distress profoundly upsetting. The heat, sweat and anguish were palpable, and the delivery room claustrophobic. Though we were trying to encourage her, comfort her and hold her, it felt like we were trying to pin her down against her will. It made me think of Fanny Burney, a woman I am writing about in my book about the history of surgery, who had a mastectomy in 1811 with no pain relief; seven men in black held her down as the knife went in. There was no comforting presence to help Fanny Burney through her ordeal.

Hundreds of years ago we expected and witnessed pain on a regular basis, and not just in childbirth. I thought of paintings and drawings of surgery pre-1846, when anaesthesia was invented. The patients are being held down by multiple attendants, and their facial expressions are maniacal; some are struggling and trying to run away. Fanny Burney describes closing her eyes in horror during her 1811 mastectomy; you can smell the fear of death in her account.

In the delivery room, my sister had a terrified expression on her face and closed her eyes and roared to get through the pain. I thought I was going to faint so I sat on the sterile blue rocking chair behind my hardier brother-in-law. I stared under the bed at my sister's Josef Seibel shoes ("The European Comfort Shoe", I noted). The midwife kicked my sister's shoes towards me as they took the bed apart and put my sister's feet in stirrups. After a half-hour of serious pushing and an episiotomy the baby's head appeared, glistening with dark-gold hair. The extraordinary result - a boy! - came tumbling out into the world.

While my sister's experience was childbirth and Fanny Burney's surgery was a different case entirely, I got the closest glimpse I think I will ever get of what it would be like to endure surgery without pain relief. I'd not been at all worried about seeing anything bloody or unsightly during childbirth. I've stood in the operating theatre and watched my surgeon carry out a mastectomy. My stomach is strong. Yet I was surprised to find that being present in the delivery room watching a natural birth was harder than watching someone being cut open. It wasn't the blood that was difficult to watch. Seeing my sister in pain was frightful. Pain management, or the ability to control it, is such a given today. Before me was living proof that the invention of anaesthesia has transformed life beyond surgery. It has transformed our relationship with pain forever.