Wake Up, Everything is Green Again

Despair and renewal in my first year of breast cancer

It was August, and I was lying topless and exposed on a leather medical bed, looking at a blurry black and white ultrasound screen. The Dutch doctor ran a cold instrument over my left breast.

‘Where in England are you from’ he asked, using one hand to capture images on the screen.

‘Manchester’ I replied.

‘And why did you move to Holland?’

‘For an adventure, I suppose’

James squeezed my hand and leaned over to take a closer look at the screen.

‘Ah, England. I love Cornwall. I’m going to Cornwall on holiday in a few weeks. We like to go sailing. Do you know what a tumour is?’

I hesitated. Yes, I thought I knew what a tumour was. I looked at James.

‘Here we can clearly see a tumour in your breast. Do you know what that means?’

‘Does it mean, cancer?’ I asked in my smallest voice.

‘Yes, very good, it looks like it is probably breast cancer. I will now do a biopsy to collect some cells but I can see from the size and shape, and the clear outline — here, do you see the clear outline?’

I could see the clear outline.

‘I can tell you that I think this is definitely a tumour’

‘How definite are we talking?’ asked James, who likes clarity.

‘I would think 90%’ said the doctor. ‘In my experience. Has this come as a surprise to you?’

It had come as a surprise to me, yes. The last time I was in for an ultrasound was less than a year earlier, watching my unborn son dance around alien-like on the black and white screen. Now here I was, looking at the dark mass that threatened to separate me from him forever.

‘Yes, quite a surprise’ I replied, trying to remain polite. Two days ago I had been to see our GP to get a breast examination. I hadn’t been worried, really, as my breasts had been ebbing and flowing since I stopped breast feeding six months earlier and I assumed that the cellulite-like dimpling on the underside of my left breast was just a result of that. I had a day off work and in the spirit of ticking a few things off my life admin list, I’d decided to make an appointment. And now here I was, two days later, being told by a doctor who was going to Cornwall on holiday — sailing, no less!- that there was a 90% chance I had breast cancer. It was a Friday. I would get the biopsy results by Tuesday, he said. I should try to have a nice weekend.

That afternoon James drove us to the beach and we kissed the tears away from one another’s cheeks as the wind whipped my hair around our faces. Thunderous clouds rolled across the sea and windswept sand snapped around our ankles. We’d been watching a programme about Vikings days earlier and it felt like this ominous weather was Thor banging his hammer at the injustice of it all. Inside, my own hammer was banging hard as I tried to make sense of the fact that this could be it. My life over before I’d ever really gotten there. My baby. My poor baby.

‘For an adventure’ is why we’d moved to this country. Like anyone, we were seeking something. Something better that we already had. This could not be it. It just couldn’t.

Spring

I felt the shift in seasons far more keenly that year. It was as though I was wearing a filter over my eyes that dialled up the saturation of my vision; everywhere I looked the world was green and vivid and bursting with promise. I told James as we cycled to the train station one morning that I felt as though I was seeing the world through new eyes, like a falcon suddenly unmasked. In a way, I was. Our six-month-old son Jasper cawed gently and waved his little arms from his seat between my handlebars, and I leaned down to kiss his biscuity head.

Maybe it was because three weeks earlier we’d been ravaged by the Beast from the East — a Siberian snowstorm that had turned our world white and cold again just as winter had been starting to retreat. One last surprise attack before spring could finally arrive. In early March the canals in Amsterdam had frozen over, and I nervously joined the crowds of delighted people walking and skating across the ice and under bridges.

It had been a long, difficult winter. But a few weeks after the snow retreated, Spring finally arrived. All of a sudden, in a fanfare of colour, as though making up for lost time. I noticed the forsythia appear first, its tiny, bright yellow flowers radiant against the blue skies. And then the Magnolia blossom, like little pink lanterns balancing delicately on twiggy fingertips. As the temperatures slowly climbed, Chlorophyll leaves oozed from their woody burrows like handkerchiefs from a magician’s sleeve. Daffodils and tulips burst up through the thawed-out ground, and luminously green grass crawled over everything. In our neighbourhood of century-old terraced houses, the blossom trees lined the streets like excited bridesmaids laden with confetti. Spring was here.

As I walked to work along Amsterdam’s canals, I took a photo of the haze of green leaves floating around the Elm trees and the new grass poking up through the spokes of parked bikes. I posted it on Instagram with the caption ‘Wake up, everything is green again’.

Summer

Before the storm

There was a moment in early summer when I noticed that I was truly happy. Not a temporary happiness caused by an exciting incident, or the kind of fragile happiness you feel during a holiday when you’ve shelved your worries for a week or two. But a deep, balanced, stable sort of happiness that you only feel when all aspects of your life are somehow working together in harmony. I was in the kitchen listening to the radio and painting an old church bench we’d bought from a local elderly couple. Jasper slept sweetly upstairs, and every so often I’d hear his little sigh on the monitor as he rolled around in dreams. The sunshine poured in from open windows, its cosy warmth lined with a little breeze that floated in from our courtyard garden, in which my recently planted Passion Flower, Wisteria and Nasturtiums were growing and climbing abundantly over cobbles and bricks. Our house was small, but perfect for us. Work was going well. James and I were happy together every day. At weekends, I would cycle along canals and through medieval streets to my yoga class, and in the evenings we’d sit in our garden and read books, drink wine, close our eyes and listen to the blackbirds while swifts danced through the sky.

Still, something about the notion of this happiness troubled me. I didn’t trust it. If this was it, if we’d already arrived, then where would life go from here? A shadow was looming on the horizon, and even though we couldn’t see what it was yet, we could both feel it. James had been feeling a growing sense of unease about our health since Jasper came along, as though this new life’s dependence on us had suddenly called our own mortality into question. We were no longer the carefree buds dancing at the end of the branches. We were the branches now. And the branches needed to stay healthy, eat well, cut down the drinking. I would sometimes think about the faint dimple I’d recently noticed on my left breast. But then the thought would float away on the breeze.

The summer grew oppressive. It was as though someone had started turning the heating up and forgotten to stop. At night we lay awake in our stifling bedroom, sweating into the sheets. By day I would bring Jasper’s bath downstairs and let him splash around in the cold water. At weekends we’d cycle or take the bus to the beach near our house, searching for sea breezes to break the oppressive heat. Mornings in Amsterdam were hazy and rose-scented, as though the flowers themselves were sweating their perfume into the streets. Pollen lay idle in the dormant air.

I had some holidays to take, so in August I booked a week off work. I looked forward to not standing on stifling trains, and to giving myself some time and space to write while Jasper was at daycare. I also planned to get on top of my life admin, starting with a trip to the doctors. The dimple on my breast was still there, and closer inspection had now uncovered what felt like a lump. I couldn’t stop thinking about it.

I got an appointment for the Wednesday morning. The night before the appointment, James and I slept on the floor in the living room because our bedroom was just too hot. Halfway through the night I started feeling sick, and then began vomiting. I assumed it was just the heat, or a bug that Jasper had brought home from daycare. When the morning came, I had hardly slept and had spent much of the night crouched over the toilet, so with 15 minutes to go I called the doctors to cancel my appointment. I would rearrange it for when I was feeling better — only, I knew that I probably wouldn’t. After all, I thought, it was likely to be nothing.

In a twist of fate that I will appreciate for my entire life, the doctor didn’t answer the phone. It just rang and rang for five minutes. And with time pushing on, I had no choice but to haul myself onto my bike and cycle down to the surgery. It was only a minute from our house by bike, so I got there just in time for my appointment. Outside the surgery, I crouched on the pavement with my head in my hands while a wave of nausea passed over me, and then I pulled myself together and went inside.

The doctor examined my breast and said that she could feel a lump deep inside. It could be a cyst, she said, but I’d need a mammogram to make sure. She rang the hospital to make an appointment for a screening in two days’ time. As I left her room, she held my hand and told me that I should take somebody with me to the screening, just in case. Her concern unsettled me, but I wouldn’t allow myself to worry over what might be nothing. My body had been through so many changes in the last year and I knew that cysts and clogged milk ducts postpartum were common. I was young. I had no family history. I’d just had a baby. Life could not, would not be so cruel. That evening the air in the house was too heavy, so we took a walk around the neighbourhood. On our way back home the oppressive summer heat shuddered and shattered into a million rain drops, and we huddled in a doorway and waited for the storm to pass.

On the Friday morning, with Jasper safely dropped off at daycare, James and I headed to the hospital for my screening. It began with an intake and physical examination by a nurse specialised in breast care. After that, I was sent for a mammogram and told that if the mammogram showed anything concerning then I would be given an ultrasound. And if the ultrasound showed anything concerning, then the doctor would take a biopsy. All of these things, of course, happened. As the morning wore on, I was called into more rooms, and the nurses looked at me with increasing concern. I felt like the soldier in The Tinder Box, who travels through chambers guarded by monstrous dogs with successively bigger eyes. Our belief that it would all be nothing grew smaller and smaller with each stage that passed, until I found myself lying on a bed being told by an ultrasound doctor with eyes the size of the Round Tower that he was 90% sure the black mass on his screen was a tumour.

This wasn’t how the morning was supposed to go. I was sent back to the breast care team with my newly discovered breast cancer to find out what would happen next. I would be sent for more scans. The biopsy results would be back in a few days and would give us the first clues as to how aggressive the cancer was. Then we’d find out if it had spread to any other parts of my body. If the cancer was oestrogen positive, then I could have hormone therapy as part of my treatment. I had no idea what this meant, what any of it meant.

It’s a funny feeling, going from not having cancer to having cancer in one morning. To go from having a long future ahead of you to not knowing if you have one at all. To go from painting a bench in your sun-soaked kitchen to discussing chemotherapy and surgery and radiotherapy and losing all of your hair. We cycled home from the hospital in a daze as thunderous clouds gathered above us in the sky, and then got in the car and drove to the beach, where the sea flung itself angrily at our feet as we shouted into the wind.

We had to wait a week to find out whether the cancer had spread from my breast, and what my prognosis would be. Each night we lay in bed listening to the electrical storms raging outside, thunder booming all around us as lighting startled the black sky. In that week, a parachute fell over my world. It covered the ground all around me until only James and Jasper and I were left standing — three figures clinging together under the silk. Nothing else mattered. As my world closed in, my possibilities closed down. I was never going to write that book. We would never have that house in France. I might never see my friends in England again. My life, which just a few days earlier had consisted of both my past and my potential, had been suddenly reduced to the here and now. My current position in the race was where I might remain, frozen. I might never see my son grow up, never see my husband grow old. My baby wouldn’t remember me. I was already a ghost.

After the storm

In truth, I knew absolutely nothing about cancer. I didn’t know that breast cancer, especially if caught in the early stages, is almost entirely treatable. Nobody at the hospital had thought to tell me that I might be okay. That I could get through this and live on. That it would be a rocky road ahead, but at least it would be a road, and most roads do at least lead somewhere.

A week after my initial scans, I had a phone call from my nurse Aukje. The CT results were in. The cancer had not spread. It was contained in my breast and I would need surgery, probably radiotherapy, and possibly chemotherapy. I laughed and then cried with relief. A week ago the news that I had cancer had shattered my world, but now the news that I had a treatable kind of cancer was elating. We practically danced to the hospital to meet the doctor and find out more. He seemed confused to see how happy we were considering I still had cancer and it was still serious, but to us it was as though my life — our future — had just been handed back to us in a gift-wrapped box. We could deal with anything as long as I was going to survive.

Suddenly there were a lot of decisions to make. Would I have a breast-sparing lumpectomy or a full mastectomy? Would I opt for nipple-saving surgery? Would I freeze some eggs in case chemotherapy made me infertile? Each question raised three more. In the end I decided to have my entire left breast removed and reconstructed with an implant at the same time. During the operation they would remove a lymph node to test it for cancer cells. The lymph nodes had looked clear on the scans, but without looking at them under a microscope it was impossible to be sure. The doctor told us there was a 60% chance that I would need chemo after surgery, but I clung onto the 40% chance that I wouldn’t. I decided not to have any eggs frozen. I would be on hormone therapy for the next ten years (or the rest of my life, whichever came first), so I would need to come off that for a year if we wanted to try for another baby. We decided that it was more important to make sure that I was here for Jasper for as long as possible, than to risk my life trying for another.

I was booked in for surgery on 17 September, more than five weeks after my diagnosis. There were a few weeks of summer left, and I spent them attending hospital appointments, making choices, having tests and scans and examinations — all the while knowing that there was a tumour in my body that was trying to kill me. I was measured up for a breast implant. I browsed catalogues of nipple tattoos. A second lump was discovered, investigated, and dismissed. My vocabulary became infused with cancer terminology. I thought in grades and stages and pathology. Macro or micro metastases. Invasive or non-invasive carcinoma. Recurrence and survival rates. ER and HR and HER2. Tissue and bone and sentinel nodes. I was tested for the BRCA gene mutation to see whether the cancer was genetic. It was not. It was just, as everybody kept telling me, bad luck.

Three days before my surgery, I boarded a train to The Hague alone. I wanted to find some peace and focus my mind before the next stage of my journey began. I walked for miles through coastal dunes and along the beach, accompanied by a cool wind that whipped its way along the shoreline, extinguishing any last glowing embers of summer as it passed. On a deserted part of the coast, high in the dunes overlooking the sea, artist James Turrell has built a huge spherical crater under the sky called Celestial Vault. At the centre of the crater is a stone bed, like a sacrificial altar, which reclines gently to one side. Nobody was around, so I lay down on the cold stone with my feet raised above my head and my arms at my sides. All was silent but for the distant roar of the waves and the faint cry of seagulls. The biggest sky I have ever seen arched above me like a colossal dome painted in billowing clouds, and I lay there for a long time in the stillness, feeling tiny yet somehow exceptional. Like the mouse and the mountain all at once.

In late September, a month after my diagnosis, I went for surgery. As I was wheeled into the operating theatre, the anaesthetist asked me how I was feeling and I told him that I was strangely excited. The surgeon frowned and said that I still had a long, tough road ahead. It was the last thing I remember hearing before I closed my eyes.

Autumn

On a cold but sunny day a week after my mastectomy, I went back to the hospital for the results of my lymph node biopsy. During the surgery they had removed the sentinel node — the closest lymph node to the tumour — to test it for malignant cells. If cancer cells were present then it would certainly mean chemotherapy and radiotherapy. And unfortunately, the test results were positive. I had macro metastases, which meant that the cancer had spread to the lymph nodes, but the cells were just about too small to show up on a CT scan. Because they had only removed one node, they couldn’t be certain that it hadn’t also spread to others. Based on my age and this new information, I had a 72% chance of still being alive in five years. If I had chemotherapy and radiotherapy, my chances increased to 90%. It was a no-brainer: I would take the chemotherapy. How could I ever face my son again if I didn’t.

I would start with four sessions of the heavy chemo combination Adriamycin Cyclophosphamide (AC), also known as the Red Devil due to its chemical red colour and particular evilness. After that I’d have 12 weekly sessions of Taxol, a milder drug with more cumulative side effects. In total I was looking at five months of chemotherapy followed by a month of radiotherapy.

At that point, I decided to tell people my news. So far I had only told close friends and family, but with half a year of debilitating treatment ahead of us, I wanted to share it with my wider circle. Partly to excuse myself from any social expectations in the coming months, and partly because I wanted to raise some awareness. I wanted to tell as many women as possible that breast cancer can occur in your thirties even if you have no family history. That a lump isn’t always the first sign — mine had been a dimple. And that, though rare, postpartum breast cancer is a very real, very cruel thing, and something that I had never, ever heard of before.

What I hadn’t counted on was the overwhelming inpouring of love and support I received after sharing my news on Instagram. Hundreds of messages from people I hadn’t spoken to in years. Flowers started arriving on a daily basis. A constant flow of thoughtful care packages turned up containing books, candles, cosmetics, clothes, food, headscarves, personalised jewellery, make-up. A knit-your-own-lobster. A Lego Millennium Falcon. Some friends got together and recorded a podcast to make me laugh. My best friend made a patchwork quilt to keep me cosy. A personalised game. Home-cooked ready meals for the days when we were too weak to cook. A subscription to a meditation app. Relaxing field recordings of birds and French campsites. Spa vouchers. So many beautiful cards containing loving messages of encouragement and support. I was stunned. As somebody who has trouble remembering my family’s birthdays sometimes, I was blown away by the sheer thoughtfulness of other people. I made a promise to myself that from now on I would give more. Do more. Be more. It was a lesson from the universe — one of many that I would learn during this process. People are really, really kind.

As my first chemotherapy session arrived, so did autumn. Its butterscotch rays were everywhere. Peering through windows and illuminating branches of thinning trees. Skimming over rivers and ripples and turning everything to gold. As the leaves tumbled from boughs, our street became a dragon’s cave; luxurious piles of gilt, ruby, topaz and amber lined the cobbles and gathered in corners, glowing in the lowering sun.

The day before my first round of chemotherapy, I planted some tulip, daffodil and crocus bulbs in the garden. I had a sense that I myself was heading underground for the winter, and the flowers would bloom as my treatment was ending in spring. Nothing could be more symbolic. Tulips had always been my favourite flower, and the national symbol of the country in which I’d chosen to call home. But now, they were my champions.

As the trees lost their leaves, my hair began to fall away from my head. Just a few strands at first, and then clumps and fistfuls. I knew that baldness was as inevitable as the seasons changing, so rather than suffer the excruciating wait as my hair fell out I decided to take back a little bit of control and shave it off. The only clippers that we had in the house were James’ beard trimmers, so one evening in mid-November I put on some red lipstick and asked James to do the deed. It was funny really. I had expected it to be an emotional experience but all we wanted to do was laugh. When it was all gone, I was relieved. This was it now: shit was real. Shaving my head felt like a huge leap forward in facing up to what was actually happening to me. The very act of it took me an inevitable step closer to the finishing line, even though really I’d only just begun.

As the autumn turned from gold to grey, the greedy winds ravaged the trees for every last leaf. Chemotherapy drugs raged through my body, destroying cancer cells but also healthy ones. That’s what it does. It chops down the entire forest, so that only the healthy trees grow back again. My immune system was laid as bare as our desolate garden, and viruses began to take hold. Throat infections. Stomach infections. Two weeks in bed with pneumonia. I developed a violent anxiety around anything to do with needles or hospitals or the colour red, and the idea of being injected again made me physically gag. The night before my fourth scheduled chemotherapy I vomited and cried out of sheer dread. I thought about giving up. My white blood cell count dropped too low to safely receive chemotherapy and my final round of AC was put on hold until I recovered. I sobbed with relief at the hospital when the doctor told me I was too weak for chemo and would need a break for a week or two. I went home and curled up under my patchwork quilt. Outside, the late autumn winds howled and rattled the trees, but the trees had nothing left to give.

Winter

In mid-December the winter’s first snow fell and covered our world in a clean stillness. The dead leaves clumping together in mulchy corners were erased by white. Only the hardiest plants punctured the crystal quilt that had fallen over our garden. As Christmas approached, I grew stronger in body and mind. But we wouldn’t be able to travel home to the UK for Christmas due to my treatment, so we started to make preparations for a quiet celebration together — just the three of us. We bought a small tree and scattered it in stars. I covered my bare head with Santa hats and reindeer antlers and novelty wigs, and pushed Jasper through cold, fairy-lit streets. On New Year’s Eve our dark skies exploded in colour and chaos, and we held Jasper in our arms and gazed out at it all with wonder, knowing that something had shifted, something was being left behind.

In early January I moved onto the second part of my chemo regime. The new drug, Taxol, would be given weekly for twelve weeks, and would have more gentle, but cumulative side effects. As the treatment began, I fell into a rhythm of rest and flow. Each week the treatment would knock me further down: two steps forward, three steps back.

We walked across frozen parkland and along the black river, lined by sleeping Weeping Willows. Willows are medicinal and contain a form of mild aspirin in their sap, and I thought of their healing powers as I tiptoed past the dormant trees. Natural pharmacies, closed for winter. Ducks and geese navigated silently between patches of frozen water. Stripped of their lashes, my eyes stung and watered in the wind.

As the world was sprinkled over and over again in white, the seasons began to play a gentle tug of war. In between spells of snow and ice the Willows began to bud. In February I held their sinewy tentacles in my hands and ran my fingers along the tiny catkins which were quietly sprouting in their thousands. Spring had been gathering its troops in silent places while nobody was looking. Winter was retreating.

I started to feel the first sparks of creativity returning. On my good days I baked brownies. I painted cards for friends. I wrote. I embroidered. It was all very Edwardian, but every tiny act of creation soothed my soul. And then, something unexpected happened. In February, my hair started to grow back. A few downy, dark hairs began to cluster above my ears, and my recently smooth scalp grew coarse and bristly. It was such a slight growth, but it was something.

As the weeks passed and I slowly ticked off my chemo sessions, I thought often about the bulbs I’d planted in the garden. I lay awake at night stroking the sparse new hairs on my head, thinking about those secret tumours buried in the silent ground, waiting to become something beautiful. The crocus tips had already started cautiously poking their heads above the soil, but I didn’t want the tulips to bloom early, before I was ready.

On Valentine’s Day, the first crocuses flowered. I sat by the window all day, watching the little purple blooms open themselves up to the idea of spring, spreading their new petals as the sun moved over the garden and then closing them again in the afternoon. I, also, was allowing myself to feel cautiously celebratory. My physical health was noticeably declining again now, but the end of chemotherapy was in sight and I could sense the light creeping back in. My life, though altered, was starting to solidify around me again in the form of plans for the year ahead. I was opting back in. RSVPing yes. Booking flights, ferries, hotels. My future was becoming clearer with each passing week. It was a different future to the one I’d had before, marred by uncertainty, check-ups, more surgery, scans and risk. I would be on hormone treatment for years to come. My body and mind would be altered forever. But our life was returning, I could feel it.

My last round of chemotherapy fell on 20 March: the first official day of spring. It was a grey day, but arriving at the hospital I was greeted by a pink froth of cherry blossom which had appeared on the trees outside the entrance in the week since my last visit. I felt like a marathon runner being presented with flowers at the finishing line. The chemo session itself was as unremarkable as any of the 15 that had gone before it, but those blossoms were all the celebration I needed to remember how far the year had taken me.

It took a few days for the realisation that I was all done with chemo to sink in. That the distant horizon we’d looked out at back at the start of all this was finally here. In the garden, bright yellow tubes were beginning to uncurl at the end of the daffodil stalks. Each day they became more formed, growing in strength and colour as I quietly waded through the post-chemo fog, like beacons guiding me somewhere. It might be a while before I figure out where. What’s certain is that my 36th spring on this earth will be the most significant of my life. Like the earth, I am going into the new season with a renewed appreciation of life. I’m battle-shaken, scarred and slightly scared, but grateful for this chance to heal and renew.

Cancer comes back, everyone knows. Except, when it doesn’t. And I will only find out what life has in store for me by living every moment of it. As my body slowly heals and my hair grows back and the seasons are replaced over and again, the risk of recurrence will hang over my head like a sword, catching the light and making everything shine.

The photo at the top of this page was taken (by James) on 16 September 2018, the day before my mastectomy.