Lightning does strike twice by Jacqui Martin
“I can’t confirm without a biopsy, but I have been doing this job for 20 years and I’m certain that it is malignant”.
Those few words would forever change my life. As I lay on the examination couch, my heart racing, I found myself replaying the events of the last few weeks in a state of utter disbelief. How was this even real?
* * * *
Boxing Day[i] celebrations have long been a favourite in our home. I love to have the family over for a buffet meal. We all play silly party games, and my dad, who is a little merry as a result of a large after dinner port and brandy, regales the children with funny stories that have all of us in stitches.
This year however would be a truly special year...
After a few years of exams, visa screenings and interviews I had been offered a top job as a Scrub Nurse[ii] in a prestigious US hospital and me, my husband Andy and our three children Mike, Tom and Sam were preparing to fly out on January 1st. After months of packing boxes and giving away our non-shippable goods, everything of value in our lives was in a container on a cargo vessel bound for Texas. My husband’s business had been closed. I had resigned my NHS[iii] post after 16 years of service, and we were living out of suitcases in a furnished rental house, eagerly awaiting New Year’s Day and our New beginning.
My parents had retired to France and had just returned to the UK from a winter stay in Cyprus to spend the Christmas holiday season with family, and see us off on our new adventure. I had been in a flurry of preparation for Boxing Day lunch since 8am that morning, and as 1 pm approached I heard my youngest Sam, jump up at the window, and excitedly shout ‘Grandad and Grandma are here!’
Leaving the dinner preparations, I went to answer the front door.
At 6 feet my father John, stood tall and was of athletic build. Indeed, he had excelled in cricket, tennis and Golf in his youth. His habit was to always dress smartly with shirt and tie, something we often teased him about. He carried himself with all the quiet dignity he had held in his working life as a senior manager and a local preacher. Dad always had a happy smile, providing hugs, supportive words of encouragement and had a mischievous sense of humour that the grandchildren adored. In every sense he was the much loved and respected head of our family. To me it was simple; he was my lovely Dad, as tall and handsome as the day my mum had fallen in love with him; the rock I could depend upon and someone whose love never failed.
I knew how blessed I was to have him as my dad.
The stooped figure walking up the garden path could not have been further removed from the father I knew and loved. His face ravaged by weight loss, his colour ashen, his expression etched in pain with every step he took.
I looked at my lovely Dad with a sinking feeling – as a nurse I knew that look all too well.
“Dad!” I cried rushing to his side, “whatever is the matter you don’t look well.”
The boys, who had come bounding to greet grandad and throw themselves at him en masse for his hugs, stopped dead in their tracks with looks of alarm on their young faces.
“Is Grandad ok?” they whispered.
Seeing Dad visibly upset my husband took them to play into the lounge to play with the Christmas gifts Grandma had fetched from the car.
As I helped my dad into the kitchen and onto the nearest chair, my mum followed and Dad in typical fashion muttered, “don’t make such a fuss. I will be fine, just got a touch of tummy pain.”
“I’m sorry Dad,” I insisted, “that’s more than a touch of tummy pain. Have you seen a doctor?”
Dad raised his eyebrows with that I am not going to discuss this look, when my mum broke down in tears, obviously upset. While dad continued to attempt to minimise what was happening, my mum went on to explain. “Your father went to the Doctor 6 months ago, and was told there is nothing wrong. He had some blood in his motions, and the Doctor told him it was probably related to the Ibuprofen he took. But he’s not been well for months; off his food and has obviously lost a lot of weight. I am very worried.”
Dad shot mum a cautionary look, “Don’t make a fuss Gwennie,” Dad interjected, “We here to see the family, not talk about me. The Doctor said there is nothing wrong”.
Never in my life had I put my foot down and taken charge of a situation and overruled my dad, but in that moment, I knew without a shadow of a doubt that what dad had was far from a reaction to Ibuprofen. He was in serious need of help.
“Dad,” I said, “I love you, but I need to get you to a hospital to see a Doctor now! I am very concerned you are seriously ill’.
As Dad moved to protest, one look at my face warned him that this was not just his daughter, but a nursing sister[iv] speaking. All at once he crumpled, overcome with the pain and effort of trying to maintain a semblance of normality.
I had spent majority of my nursing life within the operating theatre (OR), and as a result had become friends with several of the surgical and anaesthetic teams. But this was Boxing Day, a public holiday in the UK, and I knew trying to get hold of someone would be difficult. Desperate, I broke my own unwritten rule, and directly contacted a senior surgeon friend at home.
“Mr. Jones, I know this is unprofessional, and it’s a bank holiday, but I am begging you, can you please see my father? I will pay for an emergency consultation - I am seriously worried.”
Mr Jones knew I was leaving the country in just 6 days. As I explained my father’s symptoms, his concern grew.
“Don’t worry Jacqui,” he said, “I have known you long enough to know you would not call me unless it was serious, and your father sounds in a poor state. I will have my Registrar[v] meet you in the ‘Emergency Room’ to check your dad out. I will set off to drive in, once he has made his initial assessment.”
By now Dad had lost all fight and pain had taken over. Meek as a lamb, he allowed himself to be helped into my car and I set off, trying desperately not to break the speed limits on the 6-mile journey to the hospital. True to his word, shortly after check-in, the Registrar came down and examined my father. Bloods were taken and a CAT scan organised. Waiting for the results felt like an eternity but in reality, it was only a short time before the Registrar came to speak to us.
I heard the words I had been dreading…
“John has a large tumour in his bowel, which appears to have ruptured the bowel wall. Mr Jones is on his way in, but John needs emergency surgery to have a large section of his intestines removed. At this time we do not know the extent of the tumour and he may need a colostomy. He will need to be admitted to the High Dependency Unit (HDU) for 48 hours after his surgery. I should warn you, there is a high probability that this is a malignant tumour.”
As a nurse it always amazes me how in times of stress patients can find a moment of absolute inner calm and clarity, and Dad, scared and in pain as he was, looked calmly at my mum, then turned to the Doctor. “Well, let’s get on with it. Where do I sign?” He turned back to Mum and giving her one of their special smiles reassured her. “Everything will be fine love; you will see.”
I do not know how we slept at all that night. Mum came back home with me to be closer to the hospital, and I tried my best to reassure her as we sat late into the night talking about everything and nothing, praying for Dad and waiting for the phone to ring. The call came in the early hours of the morning. The surgery had been successful; a bowel resection had been possible, and Dad was stable and comfortable on HDU. Praise God.
“You can come in and visit any time after 10 am.” the nurse told us. Tired and emotionally drained we turned off the lights at 3am, and although it would be even longer before my brain stopped whirring, I finally fell into a fitful few hours’ sleep.
[i] Boxing Day – Celebrated in the UK on the 26th December this public holiday has several historical influences. Within the Western Christian tradition it is the Feast of St Stephen and from the early medieval period was the day the churches opened their poor boxes ( known as Alms boxes) and distributed money to the poor. From the 15th C onwards it became customary for the wealthy to grant their servants the day after Christmas off and present them with a box containing a gift and some left over Christmas food. This tradition was officially attested in the 17th C and finally in 1871 during the reign of Queen Victoria a statute established ‘Boxing day’ as an official public holiday.
[ii] Scrub Nurse – Operating Room Nurse (US). In the UK, the role of scrubbing at the theatre table was predominantly performed by a Scrub Nurse; a Registered Nurse who led a theatre team. Increasingly this role is now shared by Operating Department Practitioners.
[iii] NHS -The National Health Service is the Government funded healthcare system in the United kingdom. It provides health and medical services to everyone living within the UK and is free at the point of use.
[iv] Nursing Sister- Equivalent to a US Charge Nurse with additional supervisory and administrative duties.
[v] Doctor / Registrar/ Consultant/ Mr – All graduates with a medical degree in the UK adopt the title Doctor. A Registrar is an experienced middle grade doctor with at least five years post-graduation speciality training and a further post graduate fellowship in Medicine or Surgery. A Consultant is the most senior specialist doctor who has years of senior experience and is a member of either the Royal College of Medicine or Royal College of Surgeons. Within the field of surgery these consultants have traditionally adopted the title Mr or Miss.
[ii] Scrub Nurse – Operating Room Nurse (US). In the UK, the role of scrubbing at the theatre table was predominantly performed by a Scrub Nurse; a Registered Nurse who led a theatre team. Increasingly this role is now shared by Operating Department Practitioners.
[iii] NHS -The National Health Service is the Government funded healthcare system in the United kingdom. It provides health and medical services to everyone living within the UK and is free at the point of use.
[iv] Nursing Sister- Equivalent to a US Charge Nurse with additional supervisory and administrative duties.
[v] Doctor / Registrar/ Consultant/ Mr – All graduates with a medical degree in the UK adopt the title Doctor. A Registrar is an experienced middle grade doctor with at least five years post-graduation speciality training and a further post graduate fellowship in Medicine or Surgery. A Consultant is the most senior specialist doctor who has years of senior experience and is a member of either the Royal College of Medicine or Royal College of Surgeons. Within the field of surgery these consultants have traditionally adopted the title Mr or Miss.
* * * *
Although I am an experienced nurse there is little that can prepare you for the shock of seeing a loved family member on a High Dependency Unit. Dad suddenly looked smaller, and even paler amongst the white sheets and pillows. He appeared to have tubes coming from everywhere: leading from his chest, his arms even his nose. A high flow oxygen mask supported his breathing. At his bed side the tell-tale catheter bag. He was surrounded by banks of pumps administering his vital pain medications and fluids. An overhead monitor displayed the trace of each heartbeat and each breath in a mesmerizing pattern. Lights flashed and alarm bells echoed around the room. It was overwhelming but necessary to keep my dad alive.
Mum moved gently to kiss his forehead. “Good morning my love,” she said.
Dad opened his eyes in reply he gave her a weak smile and gently touched her hand. It was hard not to cry at this intimate scene. My parents had recently celebrated their ruby wedding anniversary and had hardly ever been apart in all those years. They drew strength from each other and their deep faith. I knew my dad was a fighter and was now out of immediate danger, but incredibly lucky to be alive.
Reassured by Mr Jones that the surgery had gone well and dad was making progress, I left Mum with him and returned home, turning my attention to the matter of our impending emigration which by now was just 4 days away.
“I cannot possibly leave with Dad in HDU until I know he is out of danger,” I told Andy “I’m going to call the Hospital in Texas, explain what has occurred and ask for a 2-week delay. I am sure they will understand.”
So, I picked up the phone and placed the call. The head of Human Resources, Tina, was lovely and after I recounted the story of the last few days, I did not even need to ask the question.
“Jacqui,” she said “of course you must stay until your father is in a more stable condition. It’s not a problem, if there is anything we can do to help here please let us know. I will inform your department head. Please keep us updated.”
I could not help but smile. Her reaction and support had just confirmed that my choice of this job and life opportunity had been the right one. I followed this up with a call to the airline and was able to change our flights. My anxiety was relieved. I would spend two more weeks at home ensuring Dad was making good progress, and be able to leave the UK without feeling I had abandoned him and mum at the worst possible time.
The next few days fell into the same routine. Dropping Mum at the hospital, visiting Dad who was now chatting a little and making progress and fielding the never-ending number of phone calls enquiring as to how Dad was doing. It was truly humbling to hear so many stories from so many folks who had genuine love and concern for my dad.
However, as the end of December drew closer there was a change in Dad. He had been moved to the surgical ward, but his demeanour had changed. He was short tempered and very dismissive; the nurses described him as being difficult, and that was just so out of character.
“It’s to be expected,” the Doctor explained, “John has been through major surgery and been told his tumour is cancerous so will need chemotherapy.”
However, I felt there was a further factor behind this behavioural change that they had not considered.
“My father has been smoking since he was 14 years of age,” I explained to the Doctor, “cigarettes, then cigars and of late a pipe. He has now gone 4 days without anything and been told the worst possible news. I’m not surprised he is climbing the walls. Could you consider nicotine replacement therapy or something else to help him?” Mr. Jones agreed and prescribed supportive medication.
As a family however, we would just have to tough it out with Dad’s short fuse for the time being.
Throughout the whole experience Dad had always been insistent that we travelled out to America as planned. “This is your big opportunity love. I will be okay. I do not want to hold you back.” I had not told him we were delaying our flights; however, I could delay no longer. He immediately looked pained.
“Don’t worry,” I said, “we are still going Dad. It’s just a two-week delay. I want to be sure you and Mum are ok and sorted.” Dad took my hand and looked into my eyes with deep love and tenderness. I could not have loved my dad anymore as he simply said, “Thank you.”
Fighting back the emotional lump in my throat, I kissed both my parents and left them alone together.
As I was leaving the hospital I bumped into a former colleague, Sue, who was the breast care specialist Nurse. Noting my distress, she suggested we went for a cup of tea before I drove home. I told Sue about Dad and my plans for the new life in the US. As I was talking, Sue interrupted me.
“Jacqui. That’s the third time you have rubbed your left breast in 5 minutes are you ok?’
“Oh I’m fine. I think I’ve pulled a muscle packing all those boxes for America.”
“Well, that’s a strange place to pull a muscle! Perhaps you should it checked out?” she replied.
I laughed “You’re just fixated Sue. My boobs are fine.”
But Sue would not give up. “Look,” she said, “you are here another few weeks, surely it won’t hurt to get it looked at?”
I confess, I thought it was a fuss about nothing, but I agreed to go to my family doctor the next day, as Sue had planted a niggling doubt in my mind.
* * * *
I had known Doctor Roberts since he was a medical student so had a good rapport with him.
“I wasn’t expecting to see you,” he said, “I thought you were on the way to the US?”
“Don’t get me started,” I gave him a brief synopsis of the previous week’s events.
“Crikey, I’m so sorry,” he said, “what can I do for you?”
“Well, I think I’ve pulled a muscle in my chest packing all those boxes,” I replied, “I wouldn’t have bothered you except Sue the breast care nurse has a bee in her bonnet about boobs” I joked.
“Had you noticed any lumps?” he asked, “any problems with your nipples?”
“Not at all” I said, “I’m sure my husband would notice if something were amiss!”
Doctor Roberts remained silent as he examined me. When he finally spoke his words surprised me.
“I’m not sure what going on Jacqui, but there is an irregular area in your left breast. It could be mastitis. However, you are only 39 and there is a protocol we have to follow so I am sending an urgent referral to the breast clinic at the hospital where you will be reviewed by the team.”
I confess, I was more exasperated than alarmed.
“For goodness’ sake, how long will that take? Its Friday tomorrow, then the bank holiday. I’ve already delayed my move by two weeks, and with everything going on with my dad. Is all this necessary?”
All the way home in the car I kept thinking what a fuss about nothing. I will have plenty to say to Sue when I see her.
Over the next few days, our wedding anniversary, mum’s birthday, and New Years Eve came and went. I pushed the referral to the back of my mind and had told Andy if I did not get into clinic the following week, we are going on that plane regardless.
The first day after the holiday the phone rang. It was Sue.
“I could cheerfully murder you!” I said, ‘’what a performance.”
Sue replied in a professional tone.
“We have your referral for an appointment a week from today at the breast clinic. You will have a mammogram, an ultrasound of your breast and the Consultant will examine you. We will be able to tell you fairly quickly if there is a problem.”
Doing a mental calculation, I quickly realised that that appointment would fall after our rescheduled fights.
“I’m sorry Sue,” I said, “this date is after we are due to fly out. I really cannot delay my job any longer. Apart from anything else, we have no income since I left my job in December. We are coming back over in April, perhaps I can come then instead? It’s only 3 months away, and I am not worried at all. I honestly wish I had never said anything.”
I heard Sue’s deep intake of breath.
“I know what you are saying Jacqui; but I will feel much better knowing you have been seen. Just leave it with me and I will see what I can do.”
Some three hours later Sue called back.
“Can you be down here in 20 mins?” she asked, “we have a cancellation for this afternoon.”
“I’m on my way!” I replied’ “Thanks Sue. Sorry I have been a bit snappy, it has just been an awful week with Dad and now all this. I’m feeling a little frayed at the edges.”
“No worries,” she said, “I’ll see you later.”
* * * *
As I walked through the main entrance of the hospital that afternoon, I remember thinking with an ironic smile, I really cannot get away from this place.
Sue was waiting for me, “Hello trouble.” she said with a smile.
She led me into the examination room, and introduced me to the Consultant Mr. Hamid. There is a certain air about a consultant you cannot miss, particularly when they are meeting their patients in clinic. Personable but professional, Mr. Hamid was no exception; Egyptian and in his early 40’, smartly dressed in a designer suit and smelling of expensive aftershave. He was also handsome and thankfully possessed warm hands. He greeted me warmly, made a quick examination of my breasts, and began to take a history.
“I’m convinced this is a pulled muscle in my chest from packing boxes,” I said, “I’ve been packing and shifting for weeks. I don’t think there is anything wrong with my breast, and I’m so sorry to have to take up your time, especially as you have such a busy clinic. But, Sue and my doctor seemed a little concerned and wanted to be sure everything was ok before I emigrate to the USA.”
Mr. Hamid just smiled.
“Well let’s just check you out. I want you to pop to x-ray with this form and get a mammogram done. I will see you back here in a short while.”
I set off to x-ray and seemed to run into everyone I knew. Surprised to see me still there, I explained to those who had not heard about Dad how I had delayed our departure.
“As for me, big fuss about nothing I think.” I said, “Can’t stop; I’m due in X-ray.”
I had never experienced the joys of a mammogram before, and I am not exactly small in the breast department. If you have never had a mammogram, the process is not unlike turning your breasts into the filling of a sandwich, as you stand with one wedged between two plates of a machine, which applies increasing pressure to get the breast tissue as thin as possible. And, just when you think, right, this needs to stop now, that’s hurting - it releases, and the mammogram is over. Its uncomfortable but not unbearable, and over in seconds.
“All done,” the radiographer told me, “If you go back to the clinic, the doctor can access the images.”
Well, that was easy I thought, and off I trotted back along the corridor to the breast clinic.
I sat in the waiting room watching other ladies accompanied by husbands, mothers and friends come and go. Some appeared nervous, others quite tearful. I remember thinking it must be really awful to have found a lump, and have to go through this. I am so glad there’s nothing like that wrong with me. Never once did I consider I belonged in this clinic or that I shared these lady’s experiences.
After fifteen minutes or so, Sue called my name and led me into the room to see the consultant radiologist, who would perform the breast ultrasound.
It was both surprised and pleased to see Dr King whose wife was a close friend from theatre, sitting at the ultrasound machine. As I lay down on the couch for the examination I was relaxed, with someone I knew, and the atmosphere was friendly and chatty. He asked “How are you? How is the family? All ready for the big USA move? How’s dad doing?”
I filled him in on progress and we talked amiably, laughing as we reminisced of old times, old friends, and hospital politics.
I could see Dr King’s monitoring screen, and after he had spent several minutes on my right breast, he moved to the left.
The room suddenly stilled.
I watched as he outlined several small dark areas on the screen.
“What are they? Is it mastitis?”
Dr King sat back in his chair, a serious expression on his face.
“I can’t confirm without a biopsy, but I have been doing this job for 20 years and I’m certain that there is a malignancy.”
To be honest my, immediate reaction was visceral.
“Are you having a f***** laugh?” I exclaimed.
One look at his face, and a glance at my friend Sue, who was fighting to stem her tears and remain professional, told me this was not some sick joke, and as Sue began to set up the equipment required to perform the biopsy, I began to babble…
“I can’t have cancer. That’s my dad. He’s on HDU. I’m going to America. I’m fine. I breast fed, I eat broccoli…”
And then the tears and shock took over.
“Jacqui,” said Sue gently, “have you got Andy’s number? I’m going to call him.”
The biopsy was done in no time, and a shortly after, Andy appeared looking extremely worried.
As he held me and fought back his own tears, Sue began to tell him what had been found.
“The moment you called me, Sue, I knew it was serious,” he said, “What happens next?”
Mr Hamid joined us. I sat numb as he explained the process that would be required to remove the lump that had been detected.
“Obviously we will await confirmation from the biopsy, but I want to be ready and I will put you on my list for lumpectomy next week,” he said.
However, as he completed the consent form my mind focused on something else entirely.
“Oh my God. How am I going to tell my Mum and Dad?”
* * * *
In the end, Andy and I decided we would wait for the result of the biopsy. It was the hardest few days of my life. Waiting for results, trying to ‘act normal’ and hide my own anguish from mum and my children. Plus visiting dad who seemed even more depressed and taciturn.
“Won’t be long now, until you fly,” he said, “no need to hang around now, I am on the mend. Doctor says I can go home in a few days.”
“That’s great Dad” I smiled.
Within 48 hrs I received the phone call I had been dreading; hormone positive breast cancer was confirmed; the lumpectomy would go ahead the next week as planned.
My heart sank.
In the space of few days, my life and planned future had been turned upside down. I had no job, no house, no possessions, and no income. And facing one of the biggest fights of my life. Worse, I had to tell my parents and family who were already dealing with the worst experience of their lives.
As I lurched from control to breaking down in tears, I cried out in prayer, “Why me? I really do not understand what is going on God?” I searched for words of comfort. All I could do was trust He had a plan for my life, but at that point, I was pretty sure the plan stank!
* * * *
The next day I contacted Mr. Jones my dad’s surgeon to tell him what had occurred and my concern of the impact this news would have on my dad’s recovery.
“I am so sorry Jackie,” he said, “I cannot believe this has happened. But if you want my professional opinion, you need to tell your dad. Physically he is recovering, but he is still struggling psychologically. I know you are concerned that this might make him worse, but he is your dad, and this might be just what gives him something to fight for, rather than dwelling on his own situation.”
Considering what Mr Jones had said I knew I couldn’t hide from this any longer. We were due to fly in 48 hours…
I told mum that night. She was understandably shocked and upset, but agreed, keeping this from dad was not the honest thing to do. We were a family who shared all our ups and downs and were the stronger for that.
“We will get through this together love. It’s in God’s hands now,” she said.
As I walked on the ward the next morning dad looked surprised and a little cross.
“What are you still doing here?” he asked.
I looked into his loving face.
“There’s something I have to tell you Dad….”
I don’t remember what I said or even how I said it, but I will always remember the expression on my dad’s face and his reply.
“Well now, you have taken taking after your dad one step too far.”
As my heart and tears broke, Dad pulled me toward him, embracing me in an all-encompassing, reassuring hug, and kissed the top of my head as he had when I was a child to make me feel safe.
“Daddy, I’m scared.”
When Dad had first become sick, I had given him some bible verses that he kept in his pyjama pocket. Clasping my hand Dad now read those words from the bible.
‘As I was with Moses so I will be with you. I will never leave you nor forsake you.’(Joshua 1:5)
“Come on love,” he said, “we will beat this together!”
