This xkcd comic strip, entitled 'Lanes', is one of the pithiest descriptions that I’ve seen of the situation that one faces after finishing active treatment for breast cancer. You don't know which lane you're in - and you won't see the turn until it's too late.
My sons tell me that the creator of the famed xkcd online comics used to work for NASA. It makes me feel slightly less stupid to know that - until his partner went through treatment - a scientist of this calibre had shared some of my misapprehensions about breast cancer. Like him, I’d previously thought that after the prescribed combination of surgery, chemotherapy and radiotherapy was completed, you would know one way or another if you would survive the disease. I hadn’t realised that on finishing these treatments there would be no way of telling whether or not the cancer would metastasise except....waiting. While it has no end date, the risk of recurrence is greatest in the first five years after finishing 'active' treatment. Throughout those five years, for many of us, treatment will actually continue – on a daily basis, in the form of a powerful little pill.
Women who (like me) had cancers triggered by oestrogen are typically prescribed medication to block the hormone from acting on any cancer cells that remain in the body. Every morning, when I take my Tamoxifen, I jot a note on a piece of paper. When a tablet may be playing a crucial role in saving your life, you don’t want to get confused about whether or not you’ve taken it.
Chances are that I’ll be producing lists like this for at least five years - quite possibly longer, as my oncologist may decide to continue hormonal medications well beyond that time.
Some women suffer dreadful side effects on Tamoxifen, and it carries risks including blood clots and uterine cancer (says she, with a bark of hoarse laughter), but I’ve been extremely lucky so far and have barely noticed a thing. I feel fortunate to be able to take it, as its efficacy is well-established and it’s one more weapon in the arsenal. But starting the day with an anti-cancer medication can really mess with a gal’s ability to get her groove back. The caution on the packaging (“May affect mental alertness - beware of driving”) is less than encouraging. And any desire to just forget about cancer for a while tends to be thwarted when each morning starts with greetings from a little white friend. “Good morning!” it chirps. “Just a reminder: there might be cancer cells in your body that are trying to metastasize right now! Don’t know if I’ll manage to stop them, but I’ll do my best. Have a nice day!!”.
Recently we went camping in Kakadu National Park, and explored scenery like this:
On getting home, I noticed that my Tamoxifen bottle was looking rather dirty and battered. And for the first time, the sight of it made me smile.
I've decided that this is just the way my Tamoxifen bottle should look. It’s not a bottle to be kept pristine in a medicine cabinet - I want it to be tossed into suitcases, kept cold in dust-covered eskies, dropped on the floor in the morning flurry. I'm hoping that my daily reminder of cancer will, as often as possible, be washed down with camp-stove coffee. And I’m thinking that the last pill of each year’s prescription demands a champagne and strawberry chaser.