First things first in this blog: I want to make a further, albeit brief and general, comment about surgical routines, in so far as they affect the newly-presenting patient. Much of any detail concerning the immediate aspects of surgery is best left to the trained and expert staff on the ground at the given occasion. I have also come to learn that other specific and directly related problems arising concurrently or in the wake of an operation, are also much more satisfactorily dealt with, each in its own particular context if you see what I mean. Indeed, sometimes I have suspected – especially with very nervous or anxious patients – that such-and-such a difficulty might not have arisen at all; had not someone planted the seed of its merest possibility in the first place (which for the patient has thereafter rapidly developed into something resembling a firm probability).

How any of us cope in the longer run depends very much on what I have already from time to time referred to as, “individual differences” – i.e. the manner in which we uniquely perceive, interpret, react to and value ourselves in the world about us. It is also likely to depend heavily upon the degree and quality of support readily available to us, especially from a spouse, partner or other close confidante. It is also worth observing that what – in terms of self-interest in such matters – you feel inclined toward, is probably right for you.  For example, you may find it comforting, supportive and rewarding to talk to an individual of personal choice.  Alternatively, you may prefer to keep your thoughts and feelings entirely to yourself.  Nevertheless, it is well worth while just knowing that there truly are people out there who are both skilled and sensitive in helping to ‘tease out’ seemingly intractable problems. To this I would only add a word of encouragement to make use of it where available and where it suits your coping style.

In all things and as ever, it is the quality and consistency of care and sensitivity, harnessed to a relaxed and comfortable manner that will win through.  Over the years, I have been greatly assisted in my work by the dedicated support of breast care and stoma nurses and the like, all as I recall them now, of the very highest quality and calibre. They have made my task so much easier and the trust, which I have come to place in their consummate skill, has commonly come to be almost absolute. Even more to the point, they have given unstintingly of their considerable expertise, to the lasting benefit of so very many patients and their families. To have such wonderful people around who can so professionally yet so naturally and comfortably sort out sensitive and delicate problems concerning prostheses, lingerie, swimwear, stoma management etc., – all with a reassuringly professional and personal touch and where appropriate, humour – has made its own massive and invaluable contribution to the work that I have attempted and continue to seek to do and consequently, to my patients’ quality of life.

Of course, I am unable to completely guarantee that quite the same calibre of support will be to hand in your own case. Indeed, in some instances, I very well know that it may not be.  What I can assure you of is that it is likely to be near to hand, perhaps nearer than you think.  Moreover, there is an abundance of excellent and informative booklets/ pamphlets etc. available from CancerBACUP· and similar organisations.  I had the great honour and pleasure of knowing and meeting the late Vicky Clement-Jones, founder of CancerBACUP on a number of occasions. What an ambassador she was in the interest of coping and caring for cancer patients, as the ‘child’ of all her hopes and longings for their wellbeing amply bears out in proud testimony to a sensitive and altogether extraordinary lady. It was invariably such a pleasure and honour to know her.

Well, all of the above being so and in spite of whatever additional support is available and to hand following, for example, surgery, some patients just find even the concept of the entire experience to be traumatic in the extreme.  In some instances it is likely, as one stoma patient put it to me, “to constantly interfere with and radically change the way in which I now perceive myself”. Another woman, a recently diagnosed breast cancer patient who had undergone a bilateral mastectomy·· just kept repeating the words, “horrible and horrendous”, over and over again.  Also, and as we have already touched upon in our brief consideration of treatment options, we are becoming increasingly aware of the toxic side- effects such as nausea, vomiting and/or alopecia (hair loss) associated with certain anti-cancer agents used in treatment. This can and almost certainly does further complicate, confuse and dramatically disturb that natural and settled perception of the self.  Here, possibly more than anywhere, is where the hurt and offence of a doubtless well meant but crassly insensitive, “I know how you feel”, can be most virulent and wounding.