She walks into the consultation room the epitome of composure. I thin-slice her. That first 10 seconds telling me more than she wants me to know. The way she jumped from her seat when I called her name, the adrenaline quickening her responses in the age old fright or flight response. The sleeves rolled up in spite of the snow outside, the mere hint of perspiration on her upper lip.
Everyday I am amazed at this; the composure, the brave face that people show the world. And then, once you have let them in, and shut out everyone else, they open up. They will share their secrets, their fears; sometimes saying them aloud for the first time. They scare themselves with their honesty. They want putting back together, the way they were yesterday, last week, last year. Without these intrusive thoughts and fears. They want you, their doctor, to make them feel normal. To tell them everything is going to be ok.
“I’ve found a lump”, the beautiful 29 year old tells me. Only the tears belie her now.
She was in the shower a couple of days earlier and noticed it. I go through the standard line of questionning: is it painful, is there any swelling to her breast, under her armpit or round her collar bone, has she noticed any discharge from her nipple or inversion,any skin changes…..we go through the motions, the answer always a resounding ‘no’.
I examine her and find a smooth lump, mobile under the skin. I smile, it feels like a benign fibroadenoma. What would be expected in her age. She is clearly terrified of breast cancer. Everything is reassuringly normal but still something is nagging away at me with this one.
Now the NHS is driven to some degree by protocols, guidelines, treatment algorithms guided by evidence and best practice. Based on this I should not be referring this lady at this present moment in time.
But I do.
Why? Well I will probably never know the answer to this, why this lady and not others I have seen with the same story? In short I think the answer is two-fold gut instinct and Coppafeel!
I am ashamed to say I had not heard of this charity until a couple of weeks ago. And it was Surgical Dad who drew it to my attention whilst reading about epigenetics, how gene expression is about more than just DNA. In this book it spoke of Kristin Hallenga, and her identical twin, Maren.
Kristin was diagnosed with metastatic breast cancer at the age of 23 back in 2008. A diagnosis in someone so young being rare which led to a significant delay in her initial diagnosis.
Whilst a diagnosis of these proportions would usually cause people to retreat into themselves, to look for solace in routine, be amongst family and friends. Kristin had other ideas. Why hadn’t she been aware of the importance of self-examination? Would this knowledge have re-written the course her life has now taken?
She writes about her journey eloquently. How her story is not to be told as one of tragedy but one of success. She wants to educate the young people of Britain about regular breast examination, to have the courage to speak up if something is wrong, to reduce the stigma associated with cancer and ensure it does not claim lives needlessly due to late diagnosis. Less than one month after diagnosis Coppafeel! was born, it’s message and reputation far far reaching. Kristin being the brain-child, she has penned her own story with an inspirational 360 spin!
I am not on commission to promote this charity but I do wholeheartedly endorse the essence behind it’s creation. The safety net provided by Kristin to others.
And because of this I saw another brave young lady back this week, a certain 29 year old who has just finished her first course of chemotherapy.
So I’ll bid you adieu with the words of Ralph Waldon Emerson ~ When it is dark enough, you can see the stars.