In my mind, Mr al-Dubaisi (his first name is Muhamed, but it might as well be Mr) is the father. This is down to his manner, rather than age: Mr Dubaisi has a two-year-old child, he is a young man himself really, but he has a formality that makes him seem older. He is the surgeon, the one who wields the knife, so maybe I see patriarchal echoes; Abraham, preparing to sacrifice his son. Who knows? The fact is, he has been calling me Dina ever since our first meeting, the night he diagnosed the breast cancer.
Peter Ostler, the oncologist, the one who decides the chemotherapy regime, is the son. He phones me and says, “It’s Pete” and generally calls me “you”.
And Dr Glenda Kaplan, the consultant radiologist - who confirms on a screen what the others are thinking - she, of course, is the mother, even though she always calls me by my married name. Soft-looking, she bustles about in a slightly scatty manner, only becoming fully focused as she watches what her scanner reveals on the screen. Because she is the mother, she is the one who acknowledges the fact that I have been writing about this process from the start - and because she is the mother, her asides reveal that she is pleased I’m doing something useful with my time, but should I really be writing about stuff I’m not qualified to discuss?
It is, above all, infantilising, to have a life-threatening illness. It has been more than a year now since I leapt - in one doctor’s appointment - from being all-singing, all-dancing mom, to being labelled with this mortal sickness that makes everybody lower their voice before they get to the end of the word: can-cer, so the second syllable comes out in a reverent hush.
At no other time, as an adult, are you so wholly reliant on other people’s knowledge and expertise. Summer a year ago, I didn’t know what chemotherapy was, except that it was a word loaded with fearsome overtones. “Turns out it’s something they inject,” I wrote the day of my first treatment.
For a year since, I have lived on the advice of others, veins coursing with drugs, operated on and left single-breasted, lying on a machine alone in a room pinpointed by radiation. The strangest time of all, though, was at the end of treatment. In April, my chemotherapy, surgery and radiotherapy all finished. As abruptly as the doctors pick you up, shattering your life into shards of space between appointments and treatments, they suddenly let you go, back into the community, the grown-up world.
April
I sit in a cafe in Hampstead in North London, near the Royal Free hospital, on the last day of my six weeks of radiotherapy treatment. I am sitting with my head uncovered. I have hair. The liberation of it, and also the coldness of it - I’m not wearing a bandana or a beanie. There’s a breeze, and my hair - such as it is - is standing on end. I feel both more free, and less intact - as if the world can see in to me somehow, in a way it couldn’t when I was sheathed in scarves.
The hair is still so short, I can just about pinch a piece between forefinger and thumb. It is, though, long enough to colour. My hair fell out and grew back twice in this past year, but this last time it came back grey, a grim colour. “I won’t be grey, I will not be grey, I don’t do grey.” I’d find myself conjugating the horrors of grey, without even realising I was talking to myself.
The hairdresser looks at me tentatively. “Obviously you’ve checked this is OK to do.” No, I say, I haven’t. “Oh well, this is all completely organic, purely vegetable,” she says. That’s fine, I say. As long as it gleams brown like conkers, touched with autumn golds.
I collect my son from school with my new hair. “Oh, I’ve never seen you without a hat,” another mother says chattily. “Your hair’s short,” a schoolboy says. Mutinously, under his breath, my son says, “but her hair is going to grow”. One of the other children texts me - “pls, Mum, can u wear hat 2 pik me up. Xxx.” Back to the Garden hospital, the small private clinic very near my home where I had a mastectomy, for a post-treatment mammogram - one of the letting-go rites. My skin where my breast used to be itches incessantly from the radiotherapy. I go through pots of aqueous cream, reaching for the tub, slipping my hand under my shirt to rub cream in even when there are people around. So I’m not looking forward to leaning my chest on to the mammography machine, and then I realise - oh, of course, they won’t be x-raying that side.
I haven’t seen Glenda Kaplan for some months, not since the original barrage of x-rays to diagnose where cancer was in my body. The mammogram is clear, Dr Kaplan tells me straight away. It is one of the maternal things about her - she gives good news at once, never waiting for protocol. Although, she says, “I’m worried about saying anything because I know it’ll appear in a paper in a few months.” She’s only half-joking. One of the surprises of this past year is realising - from their reactions - how very rare it is for doctors to read descriptions of what it feels like to be treated by them. They don’t know, for example, how various procedures hurt. It gives them a detachment that is almost tangible.
May
It is as I come out of the cocoon stage, doctors letting go, that I come bang up against a dilemma that must take all the detachment any doctor can muster. What do you do when you know there’s a life-saving drug available, but only the patients who can afford it can have it?
Almost without realising, my strength is coming back. Instead of slumping, one evening Anthony and I actually go out, to hear Michael Douek, senior lecturer and consultant surgeon, speak about “latest developments in breast cancer”. He says there are new results out, about a drug called Herceptin, which patients who are Her-2 positive, should be demanding, though it hasn’t been approved in the UK yet. I hear Douek long before Herceptin penetrates the media. Something about his very definite manner, his disparaging of cost considerations, the way he says, “whatever it costs I tell my patients to get it”, all coincide with a memory I have from the early days of diagnosis.
I remember Peter Ostler telling me I was not oestrogen positive. “But that’s the good kind, oestrogen positive, isn’t it?” I’d said then. “Well,” Dr Ostler replied, “don’t think of it like that, it just means tamoxifen doesn’t work for you.” And he’d added: “Your tumour is Her-2.”
The next day I phone Mr Dubaisi to ask about Herceptin. Part of the infant-nature of being a patient with a mortal illness is that you don’t really take decisions - what point is your decision-taking unless you too are a specialist in the field? But the introduction of Herceptin is so new, this time my phonecall is crucial. Because of the doubts over getting it licensed here, had I not asked, weeks would have passed until the subject was raised. But, once asked, my doctors acted at once - as a private patient I don’t have to wait for the NHS. Within days I’m on the first dose of the new wonder-drug, clear fluid, given intravenously. The children ask if it makes you lose your hair? Seven doses down, and not a side-effect worth mentioning, certainly no hair loss.
August
The uproar in the press is just starting to roll. Women campaigning for the drug that can save a thousand lives a year, but is not universally available. And once again, I hear the echo in my ears. Something Mr Dubaisi said at my last consultation with him. Anthony was fretting: what happens now? How do we know the cancer’s gone? Mr Dubaisi said various things, about how extra scanning can cause more anxiety than reassurance, about the symptoms to watch for - dyspepsia, back pain, unusual headaches - but as we got up to leave the room, he looked over, and he said something I almost didn’t catch. “Dina had a good treatment,” he said. The words hang in the air, and they are haunting. Dina had a good treatment. Not everybody gets the same.
Dina Rabinovitch is writing a book called Take Off Your Party Dress about life with breast cancer.
18 March 2021: this article has been edited to remove some personal information.
