I’ve realised that I like to have bad news told by a consultant who is friendly but can keep a straight face, definitely not by somebody who looks or acts sad.
It is because I want to focus on the news, the questions I like to ask and I’m very keen to keep it all together and stay in control. I’d rather cry in my own space.
As a clinical nurse specialist I have never been keen to either give the patient a hug or to put an arm around them, unless the patient initiated it herself. If I discuss bad news with a patient, I don’t remember looking sad but just very serious. But everyone is different, some patients probably do love a hug and an arm for support. As a professional it is important to try to make an estimated judgement about this.
“The news came like another bombshell”
Over the last weeks I have been listening a lot to the podcast: You Me and the Big C, where three young women discuss their life with cancer on a weekly basis. All kinds of topics related to cancer are discussed and professionals are invited into their show. Rachael Bland, a former broadcaster, initiated the podcast. She died of triple negative breast cancer in 2018, aged 40 after living for two years with the disease. I recommend this podcast to anybody who is in some way affected by cancer.
Today I saw both the surgeon and my oncologist to discuss the histology results. All 20 lymph nodes that were removed had cancerous cells and the tumour in the breast had grown an extra centimetre from the original size, making it three centimetres. The news came like another bombshell. On top of that I was told that one of the margins is not clear, which basically means that there are still cancer cells left close to one of the edges of the healthy tissue. This means that ideally I need another operation to take more tissue away, called an re-excision. If I remember correctly, it happens to 1 in 7 patients.
I recall when I started as a clinical nurse specialist, that I had a woman who had a re-excision after a lumpectomy. She phoned me after her second operation about her results. I had to tell her that unfortunately the margins still were not clear and that she needed a mastectomy. She was very cross and filed a complaint about me. It is very rare that a mastectomy is needed after a re-excision, so I can understand that she was shocked and disappointed by the outcome.
Regarding my treatment, we are waiting for the outcome of the CT scan to see what the best course of action is. The options could be re-excision first or possibly proceeding with radiotherapy straightaway. They will also check on a marker (PDL1) to see if I am positive for this, which happens to 1 in 4.
If I am positive they can give me immunotherapy, which can give me perhaps quite a few months extra. If not it will be a trial and chemotherapy tablets (capecitabine), which probably won’t do much for me.
When Jean and I came out of the consultation I just cursed and cursed, what awful news, again it could not have been worse. We cried, I texted family, friends and colleagues and then we had a few glasses of wine. Wine is definitely on the menu again, I won’t restrict myself anymore.
Ingrid Fuchs is lead clinical nurse specialist, Avon Breast Screening, Southmead Hospital, North Bristol NHS Trust