Personal View

The view from the top

BMJ 1995; 311 doi: (Published 29 July 1995) Cite this as: BMJ 1995;311:336
  1. Sandra McGregor

    It took me two years to come to terms with my cancer and another to lay it aside. My cancer had changed me, it frightened me, and it made me angry, but after three years I had laid it to rest. Then once more my life fell apart. I was having an ultrasound when it became obvious that all was not well. The radiologist told me that he saw what he was sure was a recurrence.

    He touched my hand and said that he was sorry. I wanted to jump up and run away, but instead I talked about how strong I was. I could readily cope with chemotherapy. I had to get back to the department where I worked, I desperately wanted treatment as soon as possible. I telephoned my colleagues. I had to find a consultant. I needed help now. How could I be dying? I did not feel ill. I tried to listen to my body, but all I heard was my fear. I had my scan and was given a copy of the films to take to my own department for rapid reporting.

    I returned to work that afternoon and somehow I put one foot in front of the other, treated my patients, and pretended that all was well. A telephone call later that afternoon brought me back to reality. Another scan was required, the films were not very clear. For a brief moment I hoped, but then thought of the radiologist that morning. He had seemed so genuinely sad when he told me of my metastases that I could not imagine him making a mistake.

    I returned to work, psychologically intact, after a marvellous new year break when a telephone call from the head of department confirmed that my para-aortic nodes seemed to be affected. An hour later I handed over the management of my cancer to the radiotherapist of my choice.

    The following day I met the oncologist who emphasised the experimental nature of the proposed drug. He gave me his paper on it; my son wanted to read about it. A few days later he telephoned. He had digested the paper as best he could and concluded that if I was a white mouse with lung metastases I would be in with a fighting chance.

    Inside I was shaking, but the more I collapsed on the inside the stronger the mask on the outside. A liver scan two days later dimmed my prognosis. The doctor was almost sure that it was a cyst. I returned to work and acted normally because I did not know what else to do. The following day a bone scan picked up a hot spot in my ankle. With every test my prognosis seemed worse, but still I did not feel ill, so how could I be dying?

    A telephone call to tell of the necessary x ray examination now caused my mask to crack. I went into the staff room and shook. I cried inside. Bouncing back was getting more difficult. My suffering was mine and I wanted to take it and hide. We live in a society which does not encourage an admission of weakness. We are urged to be strong and to fight our cancer. No one is expected to fight any other disease so why can't we accept it and flow with the tide?

    An hour later I picked myself up, mentally dusted myself down, and went for the required x ray examination. A later appointment with the radiotherapist brought me my first good news. The x ray report was clear, the lesion in my liver did indeed look like a cyst and, provided no other secondaries could be found, a urologist would operate to remove my para-aortic glands.

    The following day I had more scans, but now I prayed. Until now my position had been so grim that I felt beyond hope. The way we accept our cancer comes from who we are, our past experiences, and our perceived future. Now I perceived a future. I had to wait four long days for these results. I will never again tell a patient not to worry—the results will be out soon. These days are endless, life goes into limbo.

    Five weeks after my initial scan I was in the operating theatre. This time I had no anger; I was too frightened to feel any other emotion. Yet still my mask was in place. For one brief moment I experienced what I imagine to be the peace of death. I realised that if I was approaching death I had to do so as myself, not as a wife or mother. I remembered voices while in intensive care. I saw no faces, but one voice told me that my life had been saved. I drifted in and out of sleep feeling safe and secure.

    Six days later the surgeon sat on the edge of my bed and drew me a diagram which gave me hope, not of a couple of years of life, but of a life itself. My para-aortic glands were seemingly quite clear, the tumour had recurred on the remains of my renal vein. I have never felt so much gratitude towards another human being. This man oozed confidence and I have responded to it.

    I returned to work three months after my operation, the physical damage took time to repair. Mentally I feel fine. I know that I have had secondary cancer and that some day it may recur, but I can live with that. I have learnt so much about myself, and if I do not die from cancer then it will have been a worthwhile experience. I only pray that if I do die from my cancer then I will be able to embrace death with serenity.

    My family all reacted differently. My husband now accepts that there are no guarantees and that life is transitory. My youngest daughter spent months creeping about the house, afraid to upset me lest any inbalance in the fine thread of survival could spark some kind of retribution and my cancer recur. My oldest daughter told me that on the morning of my operation she lay on her bed and could not imagine a tomorrow. But tomorrow always comes and somehow we survive.

    Every patient has a story to tell and as health care professionals we must allow patients the time and opportunity to share their experiences. The feeling of helplessness when we cannot alleviate suffering must be put into context. Often a touch of the hand, a smile, or simply being there, can bring a comfort that may never be expressed or measured.—SANDRA MCGREGOR is a radiographer in Glasgow

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