A Patient Record

Gillian Shirreffs has a Doctor of Fine Arts degree in Creative Writing. In it, she explored the relationship between object and illness, with specific reference to multiple sclerosis. In her creative practice, she uses fiction to navigate the world of illness and the essay form to examine hidden medical places and spaces. In this most recent piece, which has been pseudonymised, she uses narrative nonfiction to better understand the new medical situation in which she finds herself.

 

 

A Patient Record

 

TUESDAY 10th AUGUST 2021

 

The hospital didn’t go well. It seemed that everyone from the first doctor who examined me already knew, instinctively. Although that can’t really be true.

Perhaps I’ve been part of the family history clinic for so long that a detailed map of my breasts is part of our collective history, so the difference in my right one was immediately apparent.

The area was outlined in black pen, and I was sent to radiography.

The doctor – I only remember her first name, which was Valerie – walked me out of her office and partway down the next corridor until we reached a point from which it was easy to instruct me the rest of the way.

The radiographer was lovely, and I knew she knew. At least, I thought she knew something that was beginning to dawn on me.

I was then sent for an ultrasound. This doctor was also very nice, but she was in quite a lot of PPE, which was disconcerting. She told me her name, but I wasn’t listening. More accurately, I couldn’t hear. I was distracted by the room. By what I knew might happen there. I wish I had heard because I’d like her to have a name rather than just a job title as I write about our time together.

 

The doctor took a long time going over and over the area marked in pen, then the rest of my breast, then the adjacent area under my arm. I stared at the wall, pretty sure of what was coming. But it was still a shock. She explained that there were three abnormal areas: two in the breast and that a lymph node under my arm was also involved. She would have to biopsy all three sites. It would be a lengthy process. I felt immediately sick and asked if I could sit up.

 

Of course.

 

Of course, I could.

 

The atmosphere in the room changed. I had become human, and both the doctor and the nurse followed suit.

They told me it was normal to feel this way. They said other stuff I can’t remember. But it was all human stuff.

When I was ready, which was only a couple of minutes, the doctor returned to clinical focus, as was appropriate. She wanted to do her best job. I knew this.

She talked me through each process: the local anaesthetic; the loud noise of the instrument she would use (it sounded like an industrial stapler); the metal clip she would need to insert afterwards to mark the areas she had biopsied.

The nurse readied the instruments as I got my body into exactly the shape she needed. If I was to do two stars and a wish[1]… my wish would be that the doctor had code names for scalpel, blue needle, and long green needle. I’m thinking… jam sandwich, sausage roll, and broccoli quiche.

 

‘I’ll have a jam sandwich, thanks, Diane.’

 

‘I think I’m ready for a sausage roll.’

 

‘Not the mini broccoli quiche, Diane. I’ll have a family-sized one instead.’

 

But. We did it.

 

I’m guessing twenty-minutes per biopsy. So, an hour altogether. Diane holding my hand and telling me when to take nice long breaths. The doctor (whose name I never caught) explaining, warning me of each sharp sting and loud stapler noise. Me, talking about what I do, my project, Brodie, places I’ve lived. Whatever they asked, I obliged, slowly shifting from terse answers to stories intended to entertain as I became an old hand at it (Diane’s words). It did become harder at the end. It’s more awkward to have an area of your armpit biopsied, and more tender. Diane said a couple of times: I think you’re getting tired. Are you getting tired?

 

And then it was over.

 

I had to go for a second mammogram to ensure there was a record of where the clips were, for the surgeon, or in case someone needed to take more tissue.

After that it was back to the original doctor. Dr Valerie Something. I’m annoyed that I can’t remember her surname. She explained that it was not what she’d wanted to tell me. She used words like abnormal and diffuse. She told me cancer treatment wasn’t the same as it had been in the 1950s or even ten years ago, or five.

There was a knock at the door. A clinical nurse specialist came in. Anna, I think. Valerie explained Anna had a room next door and I would go in there next so that I could speak to her. Once we’d finished. Valerie told me about Mr David Walker. Anna would set up an appointment with him for next week. He would have the pathology results by then. He would be able to talk me through my treatment plan. I started to cry, and Valerie handed me a fistful of hankies.

 

I was in the right place. Things have progressed so much. David Walker is excellent. I should take someone with me. This is very important. Did I have any questions? Understandable that I don’t. I should go with Anna.

 

And then I was in Anna’s room (Anna? I think she was Anna). Did I want water?

 

Yes.

 

More than water. I wanted Anna to go and get the water. I wanted a minute. To process. To breathe.

 

While she was out, she made the appointment for me, too. Did I have questions? Did I want to talk?

 

I told her I was worried about how to tell my parents. They’re in their eighties. My dad lost his mum to this when he was thirteen.

 

I should keep it simple. I have something in my breast that shouldn’t be there. I’ve had biopsies. I’ll meet a consultant next week who’ll talk to me about my treatment plan.

 

I didn’t tell Anna that my parents are nurses (retired nurses, but still nurses) who probably need something other than: I have something in my breast that shouldn’t be there. (Me: A toy car? A teeny-tiny teapot?)

 

I got tired again. Anna continued to speak, but my mind had left the room already.

 

Anna told me I didn’t need to go back through the waiting room, which meant, like one of the wise men, I went back by another way.

 

FRIDAY 13th AUGUST 2021

 

It’s been a few days since the day in the hospital that didn’t go well. Other memories have floated to the surface. I suppose these are the ones that have less light, less heat.

One of the things I’ve remembered would have added a nice comic touch to my initial record, but it feels more truthful to write it here.

When I was in that first room with that first doctor at the beginning of that time that has stretched in length and breadth, like putty in my mind, but was in fact around two and a half hours, I was asked to take everything off from the waist up.

I did as I was directed.

There was now a curtain between us to spare my modesty, which might be a thought for another time. [Is the act of undressing more personal than the act of lying on a medical plinth wearing nothing from the waist up? Maybe so.]

The curtain was pulled back and there was a pause.

I could feel the pause.

I looked up into the face of the doctor whose surname I had failed to catch.

She looked confused.

I followed her gaze to my chest.

Unbeknownst to me, I had, in fact, failed to follow her instruction.

My chest was not naked. Instead, it was sporting a very comfortable bra.

I spluttered a laugh at the ridiculousness of it. A laugh that came from an area in my gut adjacent to where I’d later experience the desire to vomit.

I apologised. Leapt off the plinth. Took off the bra in full view of Dr Valerie Something and lay back down, excusing my error as nerves and explaining I’d chosen to wear comfy clothing. A bit too comfy, I quipped.

Dr Valerie Something just looked nervous.

 

Another memory I’ve been playing, and replaying, is the point at which the very nice doctor (whose entire name I didn’t catch), stopped rolling the ultrasound wand[2] and started to tell me what she now knew, because of the time she’d spent going over and over my breast and underneath my arm.

 

As I watch this happen, I notice that I am still lying on my left side, facing the wall. She tells me that thing she told me. The thing that made me feel sick. And I wonder if the memory has stopped being true. Had I, in fact, rolled back onto my back? It seems I must have. But in the memory as it has become encased in the amber of my mind, I’m lying on my side.

 

Is it that time stopped in the second before she said those words, leaving me trapped on my left side? Perhaps time split in two. One track follows her as she speaks, the other stays with me as I lie frozen on my side.

 

Or is it that I was still lying on my side as she began to speak? Was I facing the wall as she told me that there was something in my breast that shouldn’t be there?

 

I don’t remember being on my back.

 

In my memory, as I tell her I feel sick and ask to sit up, I’m lying on my left side.

 

Can this be true? And if it is, why would it be so?

 

And even if I was on my back (I must have been) why wasn’t I sitting up as she told me?

 

Is there an issue of time?

 

A lack of time?

 

Too little to stop partway through the ultrasound / biopsy continuum to have the person sit up?

 

To look them full in the face. [Your eyes meeting mine.]

 

To deliver bad news in a way that is less efficient.

 

To deliver bad news in a way that embodies care that is careful and kind.

 

MONDAY 16th AUGUST 2021

 

Six days after I was told there was something in my breast that shouldn’t be there, I got a phone call from Lesley at my GP surgery. She said that Dr Reilly, the doctor who saw me three days after I discovered the thing that shouldn’t be there, knew that I’d been to the breast clinic and wondered if I’d like to make an appointment to see her.

I said something similar, if not identical, to, ‘Yes. Thank you. That’s good of her. I would.’

Lesley said she would check for Dr Reilly’s next appointment. After a moment she asked if I could do the 10th of September.

I admit to being confused. I said something along the lines of, ‘I can’t see her until then? How long away is that?’

Oh. No. Lesley had got it wrong. That wasn’t the soonest appointment. Dr Reilly could actually see me on the 6th of September at 2pm. Would that be okay?

I said something along the lines of, ‘I don’t know. Is that appropriate? I’m going to find out on Thursday I have breast cancer. Is that the appropriate level of support from my GP surgery? I genuinely don’t know. I’ve never been in this situation before.’

Lesley didn’t engage with my question. Instead, she said she would pass my comments on to Dr Reilly. She also suggested she go ahead and make the appointment for the 6th of September.

‘Sure,’ I said. ‘That’s fine.’

 

TUESDAY 17th AUGUST 2021

 

One day after Lesley called, one week after I was told there was something in my breast that shouldn’t be there, I received a call from a Glasgow number. I wasn’t sure but I thought it might be the number of my GP surgery.

I answered and a female voice told me she was calling from the surgery. She then verified my name.

She didn’t tell me her name, but she did tell me she was a colleague of Lesley, who was off. Lesley had left a message for someone else to call me to tell me that she had spoken to Dr Reilly, who wondered if I would be available for a telephone appointment on Friday.

Yes. Yes, I would. Thank you.

 

This second phone call took place on the day I’m writing about it. All my other words have had a greater time lag.

 

I don’t know what to think or how to feel about this episode. It reminds me that in three days when I speak to Dr Reilly, I’ll have been told what is in my breast and in the lymph node that was biopsied.

 

I’ll know that thing that I don’t yet know.

 

I desperately want our conversation to be about the fact that this is something that can be treated; can be fixed. I desperately don’t want it to be about anything else and as I type these words, I have tightness in my chest and nausea in my gut.

 

WEDNESDAY 18th AUGUST 2021

 

Lesley phoned back.

 

Poor Lesley. Imagine having to make the call. Drinking a coffee first to stall, to galvanise. That’s what I would do.

 

Hi. It’s Lesley from Abercorn. I spoke to Dr Reilly and she’s able to fit you in on Friday.

 

I’m a little confused at this point because Lesley’s colleague had already covered this ground.

 

She’s not sure exactly when but she’ll try to do it before her clinic starts (did she say clinic?) unless something comes up. So about ten thirty. Or maybe eleven. Just depending.

 

I’m not sure of Lesley’s exact words, but this is the information they conveyed. And she sounded nervous. In that way when you’re forcing yourself not to sound nervous.

 

She ended our conversation with, ‘Take care.’

 

A WAITING ROOM OF DAYS

 

It’s eight days since I was told there was something in my breast that shouldn’t be there.

 

During this in-between time, I’ve experienced something that might best be described as fear. I’ve previously only known this feeling in very short bursts, like when one of the engines stopped working in the plane that I was travelling in from Dallas to Boise at some point in the early 2000s. We were over the Sawtooth Mountains when the pilot made the announcement. We practiced the brace position for the last half hour of the flight and landed at an adjacent airfield; the main airport being deemed too risky. A livestream of our descent and the ambulances and fire engines chasing us round and round until we came to a final stop was aired on the local channels, interrupting normal programming. If this feeling is indeed fear, it has an added quality this time around; it eddies and billows; unannounced it catches you in the gut, the throat.

 

When I was told that there was something in my breast that shouldn’t be there, I was also told this would be the most difficult time. Waiting. I was told that when I speak to Mr David Walker he will have a treatment plan, which will be better than this not knowing.

 

Maybe that’s true. Maybe the intrusive thoughts are worse than the knowledge to come. I’ll know tomorrow.

 

 

[1] “Two stars and a wish” is a form of written feedback that’s used in Scottish primary schools: the stars are examples of what the pupil is doing well; the wish describes an opportunity to improve.

[2] I don’t know if that’s its name but I’m choosing to google nothing that is even vaguely medical for fear of what I might see, so that’s the name with which we’ll have to go.

 

Gillian Shirreffs has a Doctor of Fine Arts degree in Creative Writing. Read her previous articles Subject-Verb-Object: Writing with and about Multiple Sclerosis and Making Space for the Patient’s Voice, as well as her series of essays, ILLNESS: A Narrative in Four Parts.

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