Up to speed

Some housekeeping is overdue!

I have been remiss in caring for the bloglet, and with updating on news from my end.  The last thing I remember, I was packing bags on January 2 and heading for Bangkok for the additional and scary review with Dr W2.  Now it is January 13 and I am not sure what has been happening in between times.

That is not entirely true, actually.  Life has been happening.

As soon as I arrived in Bangkok, I swung immediately into the “preparing for the tests” mindset with the gritted teeth and clenched knuckles that accompanies and characterises that tense time.  I moved through the checks like an automaton and was spat out the other side in one day.  Exhausted, numb and emotionally drained.    The main things to check were the clottability factor due to the embolism and of course, the dreaded tumour markers. In a nutshell, I have been released back into the wide world again and will be reviewed again in another three months.  The cloattability is pretty stable which is fine, although I do have that checked regularly in Yangon too so was not hugely concerned about that.  It was the tumour marker which was stressing me.  The important thing about the markers is the trend rather than the individual result, so it is important to see this over a period of time and a number of tests.  I knew that a further increase would be the most worrying scenario and was very glad that although the markers are still above the reference range, they have decreased slightly.  So now we just have to see how a trend plays out over the coming months, but I do have some reassurance and can breathe out for now.

That gave me a day in Bangkok to do around a week’s worth of chores and tasks and before I knew it I was back at Bangkok airport waiting to board the return flight to Yangon, along with a number of friends and colleagues also returning after the seasonal break.  I arrived home without incident, unpacked, ate, went to bed all set for the first day back after my break.  And indeed, before very long the alarm woke me, I forced myself to get up in the pitch dark, put on my swimming stuff, and some warmer clothing and shake the dust off my bike in a return to my morning routine before work.

The days have thus been full, with the early start in the cool (and now even cold) Yangon mornings and intense activity at work so my first weekend has been very welcome although it has brought quite a backlog with it.  Hence a game of catch up and a need for bloggish housekeeping.

While I was in Bangkok, I took advantage of the superfast internet and uploaded a few photos.  I decided to change the background picture here, and decided eventually on this image.

Angkor Birthday

This is a photograph from my visit to Angkor (Siem Reap) in Cambodia last year, a wonderful adventure and a truly confidence building exercise.  I loved the ruined temples, and especially the way nature and the temples have evolved with tree roots holding the structures together in some places and dividing them in others.  I was continually struck and by the resultant impression of man-made and natural elements in complete fusion.  As well as being a photograph I like, it has particular happy associations and that is how I would like to set the tone for the on my background.  There are many more photographs on the sister (photography) blog.

As we move into 2013, I remain enthused by my three word mantra (focus, treasure and design) and am embracing the coming year.  I am taking the time to focus in on what I want to achieve and draw up clear goals for my year.  And in a beautiful and unexpected gift I received from a friend and colleague, I have the perfect reminder.  A pair of stunning Feisty Blue Gecko earrings, something to keep me focused, to treasure and of an intricate and precious design.

fesitybluegeckoearrings

So with a galloping account of hospital visits, early mornings, plans and goals, Cambodian temples and opal earrings, I trust that I am now getting back up to speed.

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In a scary space – the details of the past days

Pre-script/spoiler alert

As promised, here is the detail of this latest twist in the tale.  I particularly wanted to provide the previous short post, to share the news promptly that the investigative tests had been clear.  This is absolutely not intended to bring concern or suspense, but rather to document and probably moreover, process and offload, download and upload the events of this week.  Hence the “spoiler alert”.  There is no bad news in this post.

While I was waiting for the bone scan, I had two hours to wait after the radioactive dye was injected.  I sat down with my laptop and hammered away at the keys, just banging down what was going on in my head.  Looking back, it was just like being in an exam, that sense of purpose and pressure as the words flowed.  The following is what I wrote during that time.  I have tidied rather than edited, so it does come across as rather messy and lurches from big serious thoughts to the utterly trivial.  I did not want to re-work this apart from correcting errors and clarifying aspects which in hindsight might be inaccurate or unclear, because it is a snapshot of where my mind was right at that time, when I did not know.  I have added this pre-script and a post script to situate what I wrote while in that scared space.

I am sitting writing this while the radioactive dye does its preparatory work.  Ironic as I am “dying” to know what the bone scan is going to reveal.  Dying to know that I am not stage 4 and not in a inevitable process which will ultimately lead to my body dying.  And my mind, although not for as long as I can keep my hands on it.

When I am worried, I tend to retreat into myself.  Contradictorily I crave support and reassurance, but something inside me retreats and works through whatever needs to be worked through until there is at best reassurance and relief and at worst clarity on where I’m heading and what options there are.

And that is the space where I find myself right now.  Usually I don’t write about this, either on the blog to the wide (wide blogging anyway) world, but also not really to family, friends or colleagues either.  Since my original diagnosis in 2009 when I told hardly a soul, I have developed a slightly more “let’s not tempt fate” approach to follow up tests and usually share a concern or worry if I have one.

I approached the tests this time with a slight sense of complacency.  And that was thanks to the CT scan I had had in July at the time of the Pulmonary Embolism.  Dr W2 had reviewed that CT scan not just from the perspective of the clot, but also (and particularly I suspect) through his oncologist glasses.  He told me that the CT scan gave no indication that cancer was a factor in the pulmonary embolism and lung/ chest trouble.  What a huge relief that was.

And so this has been not so much in the back, but very much in the forefront of my mind.  If there was no sign of anything worrisome back in July, then surely things have a better chance of being ok through these results.  Surely.

Having the Big Annual Checks so soon after the PE episode added to this complacency for sure, although I would not be me if I was not anxious and worried about the checks.  That is the way I rock and roll.  I am the Worry Queen after all.

The checks had to span two days as the number of specialists (aka superheroes) I see increases with each extra bonus “thanks to freaking cancer” condition I collect as time wears on. So on Monday 8 October I presented myself at my second home, Counter No 2 so that the process could begin.  I had to ensure that the staff knew to take all the blood they needed for all the docs – I have a range of checks including the usual full blood counts, thyroid monitoring, glucose, kidney function, liver function, INR and clottery levels, hormone levels and of course the scary old tumour markers.  To name but a few.  A few phone calls confirmed the final count and several vials (felt like litres) of blood were syphoned off.  (And they seem to be surprised that I am mildly anaemic when I am constantly being bled?)

I then had a couple of hours before seeing Dr M, the latest addition to my A team – my cardiologist, who was enlisted at PE time.  That permitted time to run out and undertake a rapid procurement of a couple of new swimsuits.  All this daily swimming is resulting in perishing swimsuits so replacement was getting urgent.  Before very long I was back at the hospital and waiting for Dr M.

He was happy with my results, and paid particular attention to the  INR result (my blood needs to be in a specific range, knows as the therapeutic range) while I am on warfarin for PE.  The result sat comfortably in the range and he was happy with that and the reasonable stability of results since returning to Yangon.  He was very happy with liver, kidney, thyroid and the other results that he was interested.  He will review how long I will be on warfarin, but we are still talking at least 6 months.

As he turned the page for the final results (which he was also happy with), my seasoned eye sought out the tumour marker results, as I know where they are on the page, and I know the reference ranges by heart. (no pun intended, siting in a cardiologist’s office!)

The CEA was comfortably in range at 3.62, but my eye was caught by the CA marker which has a reference range from 0 – 22.  This one tends to vary a bit, although it did reach 26 once which totally freaked me out, but it tends to be late teens early twenties.  Yesterday the figure of 30.2 screamed out at me. Now of course I am no expert, and much as Captain Paranoia is instantly leaping around me, jabbing his finger at the number and generally “high-fiving” around the room, I knew that his mischief was premature.  I asked Dr M and he said that this was not his area of specialism and that Dr W2 and I should talk about this.

So that was the start of the worry kernel planted in my head.  Dr Google’s advertising campaign sprang into action and for once I ignored it. I don’t want to hear his unreliable scaremongering.  No point in adding to my sleepless night with more scary thoughts.  I know his tricks.  Unfortunately this is one of his super-busy bonus seasons with all the “awareness campaigns” so the fact that has given up on me for the time being is more likely to be an indication of how busy he is rather than a shift in my own mind!

Of course, the tumour marker nagged away at my mind all night and I did not have a good night’s sleep.  I also had my range of tests due in the morning, so was generally cranky and nervous.  I was scheduled for mammo, ultrasound of breast and upper abdomen as well as X-ray.  No CT scan thankfully, as I hate them, really hate them.  Unfortunately the instruction to fast for the ultrasound had not reached me, and I had provided my bloods the day before after fasting so was surprised to learn that I should not have had breakfast.  This prolonged the scanning timetable as I had to return later for the abdominal ultrasound.

Finally, the scans were all done, I was well and truly squished and scanned and waiting nervously outside Dr W2’s room.

Dr W2 is a hero. He was happy with the mammo, X-ray and ultrasound results and said I was looking good.  We talked about the warfarin briefly, and then I asked about the elevated tumour marker.  His words of response were:

“That is a concern I have”.

GULP!

Those are NOT the words I wanted to hear.  I wanted to hear his usual “pah”, with his reassurance that there was nothing to worry about. That is the deal – I worry, and he reassures.

Next was the physical.  This was a bit different.  More checks, different prods, including the lymph node areas.  And different questions.  Have I noticed any unusual pain?  When was I planning to return to Yangon?

I really didn’t like this change to the routine.  Alarm bells were clanging loud and clear.

After the physical I sat back down and he started to go through a plan.  He talked about the Femara switch and if that was working out ok. Then he said he wanted to re-run a CT scan.  Mainly for follow up of the embolism.  Oh the dreaded CT scans, how I hate them.  I had thought with all the scanning and monitoring of the morning that those bits were done. 

Then he hit me with “and I will send you for a bone scan”. 

A bone scan??  What The What is that about? 

I should know better, that if you ask a direct question, especially to Dr W2, you need to be able to handle the direct answer.  I don’t think I was.

Is that to do with the Femara?”  I asked, knowing that Femara is more aggressive in depleting calcium in the bones.

“No” he said.

“No, we need to see if there is any cancer in the bones.  With your type of cancer, metastasis to the bones is more common than in other cancers”.

GULP!

“ Once you have had the scans, then come right back and see me.”

I was utterly stunned.

Appointments were rapidly scheduled, and the CT planned and carried out a couple of hours later.

The bone scan cannot be done in my hospital so I have returned to Wattanoosooth Cancer Centre of Bangkok Hospital where they have the radiology facilities for the city. 

And that is where I am siting right now, after turning up this morning and being seen almost immediately.  The radioactive dye was injected gently into the back of my hand and I have been asked to return in 2 hours for the scan.  This is a living nightmare.

I knew I would need a bit of help with this.  I joke that blogging is my Xanax, but when push comes to shove and I am at my wit’s end with worry and fear, then Xanax is the only thing I can think of that will do the trick.  I had already left the consulting room yesterday, but knew I needed something to lean on so asked Dr W2’s lovely assistant if I could ask Dr W2 for some Xanax.  A strange interaction ensued as she popped her head into his room.  Yes he would give me one Xanax for the scans.  ONE XANAX???????  I need a wheelbarrow full to get me through the next few days I screamed silently.  I’ll give you a strip of ten, he said, seeing my face.  Success.  Plenty to tide me over.

But blogging or writing is still my Xanax and that is why I am sitting here right now, battering away at the keys while the radioactive dye does its work and I wait for the two hours before the scan itself starts.  I think the Xanax is probably doing its work too as I think it has taken the edge of the extreme nervousness about the procedure itself.  It hasn’t taken away the fear, though nor has it prevented my mind rattling all over the place and heading in so many directions.  I know that this scan is specifically to investigate whether or not there is any sign of bone mets.  My mind leaps from the optimism that this will be fine, that there is only one raised marker, no other signs or symptoms.  To the scenario that the cancer has metastised to my bones.  And onwards to the bonus scenario that whether or not I have bone mets, that might perhaps mean that other organs could be affected, which is even more frightening.  Perhaps there is an entirely innocent explanation to the marker.  But deep down, or not so deep down I know that markers are less reliable when report low levels rather than high levels.  A raised marker is less likely to have a benign cause than the reverse.

This takes me right back to the space I was in just over three years ago.  After Dr H had told me that I should have the “asymmetry” investigated in Bangkok.  I remember veering from “I’ll be fine, there’s no history of cancer in our family and it just can’t be” to “if this is cancer, I will not let it take me, I will fight it and win” (oh the naivety) to “this is cancer, there are too many “let’s get worried” boxes that are ticked by my presenting symptoms.  I am afraid, how long do I have?  I could be gone by Christmas”.  Oh this is all so startlingly familiar.

My head is in such a similar space just now.  Part of me is optimistic based purely n the fact that the “only” alert has come in the form of the raised tumour marker.  And hey, it is not THAT raised.  30 is not so high, it is not in the hundreds.  And it has been 26 before and gone back down.  And that was also in October.  Must be something to be with stupid Awarenss Month my friend and I “rationalised”.  Based on no rationale whatsoever.  A bigger part of me is facing the fact that there cannot be many benign reasons for the marker to be raised.  And that is where my mind keeps returning.

The thing that terrifies me, apart from facing acute treatment again, management rather than cure, no end of the treatment this time, is about my future.  I cannot see it being possible to continue working with stage 4 cancer, overseas and in humanitarian and development work.  So what on earth do I do?  We would, in all likelihood have to relocate to the UK, and after 12 years in Asia that would be a massive change, even without the prospect of investigating how to get treatment and care in place.  I would have to set up home again in the UK, and what about all the paperwork and documentation to ensure hubby J could also relocate.

It is all utterly overwhelming. What the on earth are my options, what am I going to do in every sense.

As my mind continues to hurtle in all directions, I try to stay in charge of it.  Undoubtedly this will continue, and intensify until I see Dr W2 again.  At that point I know there are likely to be a few possible scenarios

  • Bone scan is clear.  High fives. Tears.
  • Bone scan shows clear metastasis and we will be looking at diagnostic investigations to identify treatment plan. Get hubby here pronto and speak with family.
  • Bone scan clear but signs of other worrying stuff going on elsewhere in my body.  Needs more investigation.  Biopsy etc. Tensed jaw, questions, trying to remember the answers to the questions which I must not forget to ask.  Get hubby here pronto and speak with family.

How can I tell my family?  What words will I use?  How much should I forewarn them that this bombshell could be coming?  What do I do about the visitors we expect in 3 weeks time? What about all the Big Stuff going on at work, the major project just approved after two years work?  All the changes going on around us?  How can this be happening now? What about my new bike?  Can I ship it to the UK if needed?  How long will I still be able to ride the darn thing? What about my hair?  No point in booking the cut and colour I had planned.  And the birthday thing?  My mother died on her 65th birthday, and my step mother on her 75th.  Am I going to die on my 55th birthday?  How do I tell everyone if the scan results are bad?  When should I start to make a list of those to phone, those to email and start on that dreaded “bad news” blog post…….

If it is in my bones, then I am stage 4, pure and simple.  If I am stage 4 then we are talking treatment and management rather than cure.  Not beatable, but treatable.  And that is the thing.  Treatment of Stage 4 (from the little I know) is about management, finding the option which best delays or slows progression of the disease.  And that treatment just keeps on going as long as it works.  8 cycles of chemo felt like a lifetime back at diagnosis time.  But there would be no more being able to count down towards the end of chemo, this is quite literally chemo or other treatment for life.

Writing this, has helped somewhat to control my mind and organise my thoughts.  I am still overwhelmed and terrified but the two hours has almost passed as I have battered out my thoughts.  Writing and Xanax, working in harmony.

Time’s up. Now it is time, time to enter the scanning bunker and do the tests which will determine my immediate future.

Post script

I found the scan was much easier than a CT.  Perhaps that is in part thanks to the Xanax?  For half an hour I lay, swaddled in a blanket and my arms held in place by my side while the scanner moved around silently and unobtrusively around me.  I probably drifted off.  My mind was nowhere in particular.  I was in a very different zone.  I was a passenger.

After the scan, I was taken back to the changing area, but on the way the technician asked me if I wanted to take the report with me.  If so, could I wait for half an hour.  Of COURSE, I wanted the report.

I replied affirmatively, but emphasised “I will read it if I have it, perhaps my Dr would prefer to go over the results with me?”  However, I knew that I would take the report with me, and read it no matter what it said.  I HAD to know.

I returned to the changing area, which was actually a small bathroom.  I took my clothes from the locker and placed them on the side next to the sink.  As I removed the gown, I heard a brrr, brrr noise, and turned round just in time to see the automomatic soap dispenser beside the sink, happily dispensing soap onto my clothes.  I returned to the waiting area, shaking and with the remnants of liquid soap all over my blouse.

It did not seem like very long at all before the technician returned. I could feel myself struggling to keep it together as she handed me the envelope.

I repeated.  “I am going to read it”.

She said, it’s ok, you can read it and take it to Dr W2”.

Reading the words, seeing the result brought my guard down and I completely crumbled in the waiting area, weeping and clutching my reprieve.

This feels like a huge overreaction, now with the results and the reassurance.  I know that compared with so many I am hugely fortunate.  Not only did I have clear results, although the tumour markers will be monitored more frequently over the coming months, my nightmare was so much shorter than is often the case.  They might have four of the longest days of my life, but it was all done within those four days.  From the initial bloods, seeing four consultants, mammo, ultrasounds, CT scan, and review it took just over four days.  I cannot imagine the anguish that protracted investigations cause and I know I am lucky.

Of course there were no high fives in Dr W2’s office.  I know it doesn’t work like that.  More a sense of numbness, physical exhaustion and utter emotional depletion.

However, one comment on my last blog posting said it all.  “We get it”.  Yes, my results were clear, yes everything was done quickly but look at the emotional and psychological torture we go through to get there.  And there is no point at which we can say that we have absolute relief and reassurance.  Because it is only valid until the next round of tests and checks. Yes, as my blogging  friend said “we get it”.

That is my validation and reassurance of my reaction to this whole experience, and even although it has been over  only four days, it is massive and a Very Big Deal.

A Confession

It is the day after the checks.

I have been a bit silent in the run up to these checks, and there is a reason for that.  I have a confession to make.

I have been doing my usual waltz with the Captain (Paranoia) and had fleeting concerns about the usual aches, twinges lumpy bits and itchy spots.  But 2 weeks ago I woke in the night with a very strange pain near my scar area.  It felt like some kind of severe sting, and rather reminiscent of shingles-like pain.  Yes, it really was painful – enough to wake me up.  I hunted around to see what was causing this, and found a slightly raised area, which was extremely tender and painful.  It felt a bit like a very nasty sting, but there were no other marks or indication that it might be a bite or sting.  Just one isolated little spot of bother.

Of course, that made me worry but not unduly.  After all, living in a tropical climate, there were likely to be all manner of weird little beasties which could cause a bite.  But it lasted for a few days, and I could feel a tiny lumpy area.  Given its proximity to my mastectomy site and scar, and the fact that it persistently stung, the worry grew and I found myself consulting Dr Google about skin mets.  Dr Google kindly provided me with a variety of images, most of which did not resemble my little “wirple” but a couple did look frighteningly similar.  So then I started searching the Breast Cancer sites for more information.  There is not a great deal of  information about skin mets, but there is a little.  And the thing that freaked me out, was that there was a consistent description of one type of met as feeling like “a grain of rice”.  And guess what?  My little wirple felt just like a small grain of rice.  Uncooked of course!

I obsessively checked the wirple and willed it to go away.  Although it did start to ease a bit in a few days, it was still very painful so I dragged it off to see Dr H.  I knew my checks were imminent, but needed to have it looked at by a real Dr and not Dr Google.

Dr H had a good old look at it.  When I mention that she had a magnifying viewer on her forehead and a searchlight that could illuminate a large village, you will get a sense of the scale of this wirple.  She had a very thorough look and examination, and found nothing conclusive.  While it didn’t scream skin mets, nor could she totally discount it being something worrying.  She of course stressed that as a General Practitioner she would not be equipped with a great deal of oncology experience.  She then brought out a reference book on skin conditions and we went through this together, looking at the various example of skin mets from breast cancer.  Most of the images did not correspond to my wirple, but as Dr H said, she was not able to discount it.  She was glad that my checks were within 10 days and the Drs W and W2 could run their weathered eyes over the wirple.

So I left the surgery, feeling mildly better (because it was not a clear “OH MY GOODNESS THIS IS VERY WORRYING” finding) but still anxious.  And anticipating a biopsy in all likelihood to check it out further.

I settled into the routine of willing the days to pass so that I could get it looked at by the specialists, and willing the days not to pass in case it was nasty.  Sleep was highly evasive and I spent many hours trying to seek out puzzles and distractions, but without great success.  It was horribly reminiscent of the time between discovering the original cancer, and being diagnosed.

The thing that was most revealing though, was my reaction in terms of sharing this.  Similarly to the situation when I first discovered the limp, I found that I did not want to worry close ones.  It is bad enough lying awake worrying about your own stuff, without imposing it on others.  So I kept quiet about it with the exception of a few people back in Yangon.  And the rationale for sharing it with these people was based on the fact that I had hardly mentioned the original lump  to others, and the result was bad.  So if I did mention it – then perhaps the result would be ok.  I was meant to be planning home leave, but found it impossible to book anything other than my return ticket to the UK, just in case I was tempting fate.

Not mentioning it to family did mean that I was not able to blog about my worries.  And that was quite a revelation to me.  I have been used to the blog’s function as an outlet, and as a way of processing what goes on in my head.  It was very hard to keep quiet about this.  The fact the the laptop decided to choose that very time to crumble probably helped as it meant that blogging time was even more limited.  It made me realise that there is a hierarchy of priorities in communicating my worries.

So that is my confession.  I have been keeping a secret about the level of worry and fear caused by this wretched wirple.  Until Today that is.  And the reason I can finally talk about it is because I am in Bangkok and had my checks yesterday.

As always it was a long day, helped enormously by the fact that my friend and I had planned and schemed to have our checks together and support each other (read cancer rebels!)  We stayed in a suitably swanky place with spectacular city view.  Well, from the 41st floor you would expect good views, along with the vertigo.  And the inability to go out on the balcony that high up!

We headed to the hospital together and re-grouped between the various tests and appointments.  After the usual bloods etc, I saw Dr W2 in the late morning.  Sitting in the waiting area, was even more painful than usual knowing that he would look at the wirple, tell me how my blood work was and generally tell me how my future was looking.  The first thing he said was that I was looking well.  I told him about the wirple and he examined it.  His verdict was a wonderful “Pah – that is nothing”!  I said that I had been terribly worried, and he said it is absolutely nothing sinister.  He noted that my tumour markers were down a bit further (now well within the normal range) and all other blood work good.  He examined me carefully and found nothing at all untoward.  I sat back down at his desk as he shared his verdict.  “No relapse”.  No Relapse is NED in disguise.  and JUST what I had wanted to hear, fearing I would not.

So by lunchtime I knew that the wirple was a nuisance and not a major problem.  I headed up to the oncology ward to get my port flushed, and after a little obstinacy even the port cooperated and produced a blood return!  I asked the nurse not to put the usual plaster over the puncture mark to avoid aanother nasty reaction and she of course obliged.  The oncology nurses are indeed angels.

There was just enough time to scoot across to do some urgent retail therapy.  I should perhaps add that the day before the tests I had pre-empted my checks by indulging in a replacement laptop.  (Which is STUNNINGLY beautiful!  Really, it is.)  So I had to get a couple of “essentials” to make sure it was feeling valued.  Then I hurtled back on the sky train in time for my appointment with Dr W, the Surgeon.  He looks at things differently to the way that Dr W2 does.  Understandably, one looks through the oncology lens and one through the surgical lens.  Dr W2 floored me briefly when I told him I was planning to travel to the UK, by asking if I would be returning for my treatment.  My stomach went into free fall, when he clarified.  He thought I was returning to the UK permanently and meant care rather than treatment.  It’s amazing how the subtle change of a word can take on a completely different nuance.

He examined me carefully too, working at Twang Arm and again saying that my arm movement was still very restricted and the cording quite bad.  I think that he is keen to have a go at Twang Arm with his surgical instruments at some point but that it does not warrant its own surgery.  Again I dressed, and sat down at his desk.  He used slight different vocabulary as he wrote his findings “No recurrence” beside some interesting depictions of my scar and arrows pointing to various bits of Twang Arm and its obstinacy.

He asked when I had had my last mammo and I said that it would be a year come October, so I was expecting the Big Check to be next.  He agreed and ordered the necessary scans.  This time I will have an extra ultrasound of my liver for a treat.  He is not sure about another CT scan considering that I had an additional one at the 6 month point, so we’ll see what Dr W2 judges to be needed.

But that is for another day, for the time being I was released into the heavy, humid air and torrential rain to re-group with my friend who had been going through her processes.  It was late in the day when we collapsed, exhausted and emotional, ready to bubble.

Bubbling had been the pre-agreed strategy.  If the checks were not good – it would be appropriate to have some bubbles.  If they were good, then bubbles would be in order.  However, there was another clear bubbling activity.  We talked about how draining the whole process is.  And the fact that while it is an enormous relief to hear that the checks have this time been kind, there is not a sense of euphoria.  There is just a massive exhaustion and overwhelming desire to weep. We had had grand plans to eat somewhere decadent but that plan rapidly evaporated particularly given the exhausting day that my friend had had.

She of course had known about my wirple.  We have this instant communication when something crops up that only a cancer exposed mind can understand.  We both had different stresses and anxieties, but it was enormously helpful to go through the checks in sync.  This is something that we were able to do here, and I know that it is not possible in most places.  However, as I have mentioned before, our medical treatment is first class on the world stage of cancer treatment, but the softer side is not really in place.  So this support has been absolutely critical.

The day looked different in more ways than one than it had by nightfall, in every sense.

When I was in the lift this morning, the doors opened and a mother and young boy got in.  The little boy had a small backpack, with a bottle of water and probably  many other essentials for his forthcoming day in Bangkok.  I was suddenly taken back to the morning after my diagnosis.  I remembered looking at the people there and feeling a terrible sense of sadness.  I knew that these people were probably either on holiday, or business.  They were probably looking forward to the day ahead.  They had no idea that I had just been delivered the most life-changing message a few hours earlier and that I was in a completely different place to where they were.  I remember the isolation and feeling of fear, uncertainty and dread over what might be ahead.   But this morning, I felt a sense of kinship.  I too was looking forward to the day ahead and I could identify with the little boy’s excitement portrayed in his features.  I found that I was again in a different place to the one I was in after diagnosis, even though I could physically see the same building where I had been.

This means that tomorrow I am travelling to the UK, and so looking forward to seeing close ones.  I will try and avoid departure lounge gymnastics and do not dread going through immigration as I did last year when bald.

I am sorry that I kept you in the dark about the wirple, but I am very happy to be giving the confession and update that I am.