They are such blunt instruments, doctors. So it is no surprise that it is on my birthday - a sunny, warm Friday, at five in the afternoon, the hospital waiting room cleared, the week’s urgencies sorted, the dozy weekend settling over the wards like a mushroom cloud - that my oncologist, Peter Ostler, calls Anthony and me back into his office. And he has a colleague with him.
I know what the presence of “the colleague” means as loud and clear as if he were wearing a black-edged placard round his neck saying “Death Row”. I can’t even look at the colleague while the doctors speak to us. I look at Ostler, and I know in my eyes there’s an accusation of complete betrayal: how could you let this happen to me? I put my trust in you. I do not think he could look more upset, but I am unrelenting. When his colleague, David Mills, speaks, I look away, out of the window, hum underneath my breath like a recalcitrant schoolgirl. Because he is the personification of the bad news. There has never been the need for “a colleague” in the room before.
They are not good at giving this news, the news of metastasis - they are as bad as I am at receiving it, in fact. They say, “Well, it is what we feared. It’s no longer local, there are signs of lymph nodes in the abdomen and the chest wall.” But while they discuss options they also joke with each other, trying to ease the tension, segueing into a double act, about how one has been to Florida while the other “stayed here doing all the work”. Anthony, lawyer, literary critic, husband, can’t get over this. Later, he keeps on repeating it, his shock at their gauche-ness, their way of dealing with us: “Do they think we care about their work trips?”
And he is the one who is surprised that Muhamed al-Dubaisi never rings. “I would have thought the surgeon would phone us,” he says to Ostler the following week. Ostler shrugs his shoulders, says these are always difficult ones to call, knowing how to manage these times for patients, but it’s not a sign of lack of concern.
It was on our son’s sports day, coinciding with my 18th dose of Herceptin, that the red blotches came back again, just three months after Al-Dubaisi’s second attempt to surgically remove the breast cancer. By lunchtime the next day I’m on the phone to his secretary. Could you just let him know I think the cancer’s back? The anxiety is intense. I know as soon as I see his face that the cancer has indeed reappeared, its third manifestation. No biopsy required this time to test it out. He just had to look. “I am happy to operate again,” he says confidently, the last words we hear from him. Is it only in retrospect I hear a hollow echo in those words?
When we go back home I tell the children, and they say, “Isn’t that a bit soon?” It never crosses my mind not to tell the children, though everybody is taking GCSEs and A-levels and driving tests. There is no screaming or crying any more when they hear this kind of news, I don’t see them talking in whispers. But their anxiety shows over the next few days when they text regularly: “Have you had your scan yet?”
The scans are the staging process, as I now know it is called: the CT, the MRI, the bone scan, the machines that say the cancer is local, and curable, or that it has spread. The hospital scanner breaks down so the CT scan to check where the cancer is gets delayed. It should have been Thursday we heard the bad news; instead it’s Friday. My birthday. My girls are at their father’s for the weekend, we have Anthony’s children, his mother and a family friend for dinner in a few hours. We’re driving home, and I’m saying to myself, think calmly, think what’s best for the children - don’t get fixated on your promise to them to tell them what’s going on as soon as it happens. Like doctors and patients, I have my own communications hurdles.
I break the promise. I don’t tell the girls as soon as I hear the news myself. I say to Anthony, let’s not disrupt the contact arrangements for this; it makes it all too urgent. Let’s not tell anybody for a few days - just us. “Like during the divorces,” he says, “just each other to rely on.”
When Anthony and I were going through our respective tortured divorces, we had a daily mantra, which went like this: “Just imagine the worst thing possible happening, and it will happen.” It was a way of facing down trouble, not being taken by surprise. Like a microcosm of the battle between parenting gurus over the past century, we have these different parenting styles, Anthony and me. He doesn’t do “Parenting” with a capital P, and hasn’t, I don’t think, looked at a parenting book in his life. I’ve read them all, and have absorbed intravenously the notion that consistency is incredibly important to children. They can come through anything if they know that you will always tell them the truth.
But actually, it’s good, breaking my rule on this occasion - the promise to tell them everything as soon as it happens. Because Friday night feels like the end of my life, but by the next morning I feel lighter. I look in the mirror, and I don’t see a dying person. I think the doctors gave us the news in too desperate a way, their brows too gloomy, their eyelids too hooded.
I have symptoms, sure. I feel nauseous - like pregnancy - so I can’t face making meals. I sort this out by subscribing to the Guardian’s good-food plan, Eat right, a canny move as it turns out. Each week my computer offers up a week’s list of menus, and a shopping list, which I order from an online supermarket straight away. I think the change to our suppers is so remarkable everybody will comment.
I notice the children eating up. But nobody says a word. It’s exactly three weeks and two days till one daughter says, “I really like this food you’re making, what is this?” (Marinated Quorn, as it happens, that night.) The Eat-right missives work on many levels. I feel I need to eat to keep strong, and the meal plans trick the nausea, by constantly varying ingredients. I could not, these days, stomach making, or swallowing, my ideal healthy meal of fish and green vegetables every night. So I’m cooking food for multi-examined students, somebody else is doing the thinking for me.
While this is going on, we are making calls. We speak to doctors in the US - at Johns Hopkins, at Sloan-Kettering, at Tulane - and in Paris; doctors who phone me from their mobiles with information and comforting messages. Don’t be frightened, they say, there are many options. This is a crucial phrase, and it’s not one my doctors used. It’s a difference in style.
Does it change the outcome, this difference in style? Doctors who make follow-up calls after one has heard bad news? Doctors who are always available by email or mobile phone? Will it make my life longer? I don’t know, but I can feel that it makes me more confident, takes some of the fear away.
I get this attention because one of Anthony’s clients makes a couple of phone calls, and suddenly the best minds in the business are contacting Ostler, a process he takes in good part mostly, becoming irate only when a French doctor suggests radically departing from his prescribed regime, and there is an outraged yelp of, “Not a breast specialist is he? He does lungs I think, and - what else? - kidneys?”
But, and this is the interesting bit, the treatment options do not vary greatly. Two years ago when this all started I didn’t know one cancer doctor from another. I went to my GP and did as she said, making an appointment with the first specialist available. I am treated at Mount Vernon in north-west London, privately mostly, but it’s a local NHS cancer hospital. And on the day I hear my bad news, the reason Mills is in the room is actually not because he’s the angel of death, but because he’s the man in charge of medical trials. He may in reality be the angel of life.
The drug I’ve just started is called Omnitarg (pertuzumab), and I’m waiting to start Tykerb (lapatinib). They sound like our son’s Bionicles, the newest toy in our house, many millions of little pieces which, after following complex 69-page booklets, build up into fighting creatures called Visorak, Hordika, Metro Nui and Omnitarg. No, Omnitarg’s the drug. But the point is that here at Mount Vernon, the least glitzy of hospitals, I’m offered this year’s wonder drug, just as - I now know - I would be at the world’s best cancer centres. There is a certain comfort in that.
18 March 2021: this article has been edited to remove some personal information.
