Continuing directly on from last week’s posting, “relief”, is a likely response, in that the tumour has been removed and as one might say, “Is no longer part of me”. Such feelings at such a time can be both real and profound. “Just the thought of that alien and ‘living thing’ inside me made me so that I could barely so much as lie still in my bed at night. I didn’t care what they did to me. I just wanted it out and well away from me for ever”: so said a woman – a civil servant – who, over the years, had justifiably gained the reputation for a ‘calm head’ and sense of control under utmost pressure. “But what”, maybe you are asking – “does guilt have to do with such surgery?” Over the years I have seen many patients who have elected to have breast conservation (that is, to save as much of the breast as possible by having only the cancerous tumour, or lump, removed: hence the term, lumpectomy) or breast reconstruction·, where it has been requested and considered to be in the patient’s interests to proceed.

One young woman who was well satisfied with “the job they have done for me”, as she put it, was doing very well physically and up to a point, also emotionally.  She had returned to work at her profession and to renew her involvement with her wider, as well as the family’s, social circle.  Yet in spite of constant professions of “I’m fine”, she was always keen to make another appointment to come to see me.  I knew there was something. However, “patience” truly “is a virtue” at some times more than others; and I realised that she knew me well enough to tell me of any such concern in her own good time.

Then one day as she was leaving the clinic, my secretary – who also by now knew her well – simply remarked on how good she was looking, following it up with  “Will you be wanting another appointment?”  At this, my patient ‘dissolved’ into a ‘flood’ of tears.  She spoke incoherently about her “selfishness” in always seeking another appointment and for a while, was well nigh inconsolable; all this, whilst my concerned and perplexed secretary attempted to comfort and calm her down.

As luck (or whatever) would have it, she had been my last patient in that particular session.  Within 15 minutes, she was back in my room and this time she simply launched into a veritable tirade of verbal self abuse, ending with a troubling account about the burden of guilt she was – and had for some time been – carrying.  The sum of it was as follows: the mother of her little daughter’s best friend was also a breast cancer patient. Seemingly, she had had a “simple mastectomy” (an operation which involves removal of the breast but not the lymph nodes or muscle). However, and for a variety of reasons, breast reconstruction had not been an option open to her. Moreover (and according to my distressed patient) her friend had an ill-fitting prosthesis and, as she put it, “Not the means that say, we have and have been able to use to good effect”. She continued, “Every time I see her, my heart bleeds for her” and then, once again dissolving into tears, she added, “And I have Tom and he is marvellous, whereas poor Jean…well now her husband has left her altogether and she has to struggle on with her two children alone”.

I can only hope that somewhere in these recent postings, you may have found help in the form of information and encouragement, as you pursue your own personal journey forward.  In my next blog, I intend (among other things) to 1. Take a closer look at some of the well-documented psychological and emotional problems that can arise and 2. Make brief reference to simple but effective strategies and modes of approach, which can help to reduce and alleviate their associated problems.