Happily, what I have written in these blogs about the ever-increasing percentage of cure or control over malignant diseases is no exaggeration. Yet, believe it or not, there are occasions when this welcome and increasing divide and contrast between – on the one hand – the historical perception of cancer as an illness leading to debilitation and death; and on the other, a more upbeat and optimistic approach, can itself lead to seeming contradiction and conflict. Nor is it by any manner of means as rare as you might think. Let me explain what I mean.

Dorothy was a 46-year-old stage two breast cancer· patient. She had coped extremely well; both with surgery and aggressive chemotherapy and for the past almost four years had been disease free. One day I received a telephone call from her surgeon, who told me that she had just attended his clinic, having made an urgent and unscheduled appointment to see him. Apparently, she was convinced that matters concerning her health had taken a decided downturn. No, she hadn’t been experiencing physical symptoms or problems as such but (so she had claimed) “just knew” that things were going badly wrong again.

Later that day, I telephoned Dorothy at her home and told her that her surgeon had mentioned her visit to his clinic to me. She jumped at the chance to come to see me and in fact did so the very next evening. On arrival it was quite evident that things were far from well. She appeared “edgy” and nervy and seemingly “awash” with a welter of ‘odds and sods’ of small-time anxieties. Apparently she had not been sleeping well for some weeks. At first we made little progress: that is, up to the moment that I said to her, “Dorothy, you’ve always been straight with me and I with you. There is something you are not telling me. You don’t need to if you prefer not to do so. However, I can only help if I have at least an inkling of what is going on. Why don’t you quite simply tell me what is troubling you and what it is that is ‘fuelling’ your very obvious concern?” And so she did.

It transpired that some four and a half years earlier as a hospital in-patient receiving anti-cancer treatment, Dorothy had overheard a conversation between her surgeon and a member of his ward round entourage. There is always likely to be a chance that any such snippets are going to be out of context and that is precisely what had happened to Dorothy on the day in question. In any event, she quickly forgot other shreds of the gleaned conversation but fastened onto the phrase, as she believed she’d heard it, i.e. “Five year survival time”. Now more than four years on, her surgeon simply could not be expected to remember what he had said and in what context. He only knew that what Dorothy had heard certainly didn’t mean what she thought it did and most assuredly didn’t apply to her..

Dorothy told me, “When I learned that I had cancer, I just thought it meant ‘curtains’. You see my mother died from breast cancer and a sister of hers too and now it seemed that history was about to repeat itself, this time in me”. She continued, “Funnily enough, the “five year” likelihood was actually quite reassuring. I thought; well there’s quite a lot that can happen in five years and even after four years it was still reasonably okay. But then a third and a fourth year came and went and now I am simply terrified. I wake up every morning expecting to find another lump in the other breast… and I imagine all sorts of things”.

Two days later, both Dorothy and I were in her surgeon’s consulting room and once again the issue of what she believed she had heard was raised and aired. Her surgeon was very surprised and hastened to reassure her that she was not only doing well but also every day moving to a point where she could be pronounced “completely cured”. Yet even as later I drove her home, she ventured a tentative, “So you don’t think then that he knows something we don’t? At that point I stopped the car, turned off the ignition and gently but plainly asked the question: “Have I – or your surgeon for that matter – ever sought to mislead you?” She replied that it was not so and so as firmly but as kindly as I could, I stated that I had taken matters as far as I was able, other than to again assure her of what her surgeon, her family and indeed, her body was telling her; namely that she was doing well, with genuine reason for optimism. It was only then that Dorothy said something, which in fact goes right to the heart of this blog. “When you’ve had cancer and have gone though all the ups and downs of treatment, trust – whether in your own body or in others – isn’t ever the same again” (C) SB).

*In  Stage 1 the disease is confined to the breast…In stage 2 the regional lymph nodes are involved…Stage 3 disease is locally advanced breast cancer where either the tumour or lymph nodes have infiltrated the skin or underlying muscles or other structures…In stage 4 there is obvious secondary spread…Stages 1 & 2 are potentially curable In Stages 3 & 4 the aim switches from cure to symptom relief. (Taken from “Breast Cancer: a Guide for Every Woman” 1995, Baum, M, et al. p47).