Following on from my most recent blog, there is a central point needing to be made before we go any further; and one which should be taken on-board by all healthcare staff and patients alike. It is that whilst the various anti-cancer treatments are themselves likely to ‘dot in and out’ of the overall care and management strategy, the psychological, spiritual, social, occupational and wider community implications/ramifications of a cancer illness are, in some form or another, a reality of every conscious (and unconscious, i.e. as in sleep) moment of time.

Major surgery, where needed, may well entail hospital in-patient status, the likely aim being to remove the entire tumour whilst, as far as is possible, leaving healthy tissue in tact.  Whether this involves tumours of the breast or colon, or (in much rarer cases) bone and connective tissue, the surgeon performing the operation is, as we have already noted, likely to be a specialist in his/her chosen field of surgical expertise. New methods and techniques for imaging tumours are now significantly improving the specialist’s essential skill of distinguishing between cancerous and normal tissue. And it goes almost without saying that he/she will be assisted and supported throughout the operation and post-operative treatment stages by a team, each member of which will, of course, possess the necessary expertise in their own discipline and field of activity.

One of the most important and disturbing aspects for the recipients of some forms of anti-cancer surgery is (as we have already seen) where it results in an altered perception of “body image”. Of course, the impact of any such change is likely to be subject to “individual differences”. This means that what one individual might come readily to terms with, another – especially in the initial stages – may find difficult to accept, much less manage. Consequently some may well feel tormented and troubled in ways that are hard for others to even begin to imagine, much less understand.

For one thing, let me ask you: how can I as a man, understand in any meaningful way what it is like to lose part of or the whole of the female breast?  Add to such loss a mixture of spurious and conflicting emotions such as grief, shock, offence, anger, guilt, or indeed, relief (to name but a few) and it quickly becomes evident to anyone on the outside that we cannot remotely begin to imagine what it is truly like to be living another’s life right now. Also, allow me to pause for a moment to explain to you precisely why, in my account of “mixed emotions” cited above, I have made specific reference to the ones, which indeed I have.

We have noted previously that “loss” of a sense of normality and self-regard (as is frequently the case where a colostomy has been performed or the removal of part of or the entire breast) can form a genuine cause for grief. (The word “colostomy” comes from two Greek words, namely “colon”, meaning large bowel and “stoma”, meaning, mouth or opening).  And make no mistake about it, grief – caused by a loss affecting the perception of the whole self – is very real and can for a time be immensely powerful in terms of its impact.

“Shock”: well this amounts to the outcome of a conglomerate of complex feelings, directly and indirectly associated with an event or occurrence, often sudden and totally unexpected and thus unprepared for. As one patient put it to me, “In the early days following surgery, I used to wake up in the night just hoping that my breast would have been restored to me”. Shock on this level can indeed have strange and otherwise unimaginable effects. On the other hand, don’t loose sight of an important point touched upon in an earlier blog in this series, namely that shock represents nature’s way of preparing us to adapt to loss. In reality, it allows us to ‘buy time’ whilst the blow is being sustained and managed at a somewhat deeper level.

Most of us are familiar with feelings of “offence and anger”.  But then again, are we?…really?…and on such a scale? A man who had undergone an amputation of his penis – and who I came to know well and to respect greatly for the immensely courageous and spirited way in which he endeavoured to cope – told me: “When I first saw the surgeon who had done this to me, standing by my bed smiling, I wanted more than anything else in the world to punch his ‘lights’ out for doing what he had done”.  And his wife – who wonderfully and unfailingly supported and encouraged her husband throughout – told me, “It didn’t end there. The outrage and anger were so strong that to begin with, I had to telephone and change appointments so that my husband would be seen by another consultant or by the departmental senior registrar instead”. (To be continued next week).