The Thousand Deaths We Die Before a Diagnosis

On breast cancer scares, the unbearable weight of uncertainty and the women for whom October is more than an awareness month.

"The CT scan found a cyst in the lower quadrant of your right breast," she said.

"What?!"

Your eyes widen. Wider than you ever imagined they could.

"But there's nothing to worry about," the doctor continues, almost immediately. "How frequently do you check your breasts? And when was the last time you checked?"

Your head is spinning.

You're trying to focus, trying to find an answer somewhere in the chaos of your thoughts, but your voice has deserted you.

When it finally returns, you tell her that you do check your breasts, although you cannot remember the last time you did.

"Like I said, there's nothing to worry about. CT scans sometimes pick up these things, and most of the time, they turn out to be nothing sinister."

She finishes with a reassuring smile.

But you can tell she's wearing her work personality. That carefully composed professional demeanour doctors must learn to wear when delivering news that could potentially change someone's life.

You wonder whether, beneath that reassuring exterior, she is genuinely worried for you.

Your eyes begin to well up, and this time, you let the tears fall.

"But doctor, the CT scan results from the previous day said my chest and breasts were clear. That nothing sinister was found."

You reach for your discharge letter and hand it to her.

She reads through it.

There's a discrepancy.

The first scan hadn't identified anything. The second one had.

She confirms this.

And suddenly, you feel a thump in the pit of your stomach.

Your life flashes before you. Not in the poetic, cinematic way people describe near-death experiences, but in a series of frightening, absurd and painfully ordinary thoughts.

You imagine your burial.

Would it be befitting? Who would attend? Which friends would cry at your graveside? Even the ones you haven't exchanged a hello or goodbye with in years?

You think about your children.

How would they manage without you? Who would comfort them when the world becomes too much? Who would love them with the same fierce, unreasonable devotion that only you know how to give?

Then your husband.

And, rather unexpectedly, you feel a surge of rage at the thought of another woman lying in your bed. Six months after your death, perhaps. Or even less.

Imagine that!

You're not even dead, and you're already furious at the possibility of being replaced.

It's irrational, perhaps. But fear rarely comes alone. Sometimes it arrives with anger, jealousy, resentment and an overwhelming sense of injustice.

Why me?

You haven't even received a diagnosis, yet your mind has already buried you.

"The nurses from the breast clinic will come and have a word with you shortly," the doctor says.

That was four days ago.

Nobody from the breast clinic has been to your bedside.

By day five, you're discharged.

You're on your way home when the phone rings.

"Hello, I'm one of the breast nurses at the clinic. We'd like you to come in next Thursday for a mammogram."

"Okay," you reply.

Just okay.

Because what else is there to say?

By now, the fear has congealed and hardened into something you carry everywhere. There is desperation, certainly, but also a quiet determination to fight whatever might be coming.

The next couple of days are mentally strangulating.

You are mostly pensive, lost in thoughts you cannot quite articulate. You jump at the slightest sound. Your mind wanders into places you would rather not visit.

You wonder whether there are other cysts hiding somewhere in your body, waiting to be discovered.

You question every ache, every sensation, every unfamiliar feeling.

There's disbelief, too.

And somewhere between the fear and the exhaustion, a niggling hope that whatever the scan has found is nothing sinister.

That perhaps, just perhaps, this will all amount to nothing.

Then comes mammogram day.

Your legs feel unusually heavy.

You are walking normally, or at least you think you are. In your head, every step feels laboured, as though you're dragging the weight of an entire world behind you.

The consultant examines both breasts.

"I can't feel any lumps, but you have dense breast tissue, so we certainly need to do a mammogram."

Your soul misses a few steps.

You swallow hard.

In the scanning room, the radiographer tells you they receive a lot of referrals from the CT scanning team. Incidental findings, she explains. Things discovered while looking for something entirely different.

Most turn out to be harmless.

There's a glimmer of hope.

You hold on to it.

The mammogram begins.

Your breasts are positioned, compressed, squished and squashed between the scanning plates. It's uncomfortable, but physical discomfort feels almost irrelevant compared with the battle raging inside your head.

And then, there it is.

A tiny dot.

Something small enough to appear almost insignificant on a screen, yet powerful enough to have consumed your thoughts for days.

You're told an ultrasound is needed to determine exactly what it is.

Another scan.

Another wait.

Another opportunity for your mind to rehearse the worst.

And then, finally, the words come.

"It's a simple cyst."

The doctor explains that these are benign, that they can sometimes disappear on their own, and that there is nothing concerning about what they've found.

Nothing sinister.

Nothing to worry about.

And just like that, the world begins to move again.

You break down.

You cry your eyes out.

Not the delicate, restrained tears you had shed in the hospital room days earlier. These are the tears of someone who has been holding her breath for what feels like an eternity.

You cry for the fear.

For the sleepless nights.

For the children you imagined leaving behind.

For the funeral you had already attended in your head.

For the conversations you thought you might never have.

For the life you had momentarily begun to mourn.

And perhaps, most of all, you cry because you get to go home with a different story from the one you had spent days preparing yourself to hear.

There is a particular kind of exhaustion that comes from fearing for your life.

The weight of it is difficult to explain to anyone who hasn't experienced it. The thousand deaths you die in your imagination before a diagnosis is even made. The crushing anxieties. The bargaining. The anger. The desperate hope that the future you had taken for granted might still belong to you.

And then there's the uncomfortable awareness that, while your story has ended with relief, countless other women are receiving very different news.

For them, the scans lead to biopsies. The biopsies to diagnoses. The diagnoses to treatment plans, difficult decisions, and a life divided into before and after.

Some will survive. Some will endure years of uncertainty. Some will lose their lives.

And many will have to find the strength to carry on with the ordinary business of living while navigating an extraordinary battle.

Today marks the end of Breast Cancer Awareness Month. For many of us, October has been a month of pink ribbons, awareness campaigns, fundraising walks and reminders to check our breasts.

But for countless women across the world, October is not simply an awareness month.

It is the beginning of a journey into a different version of themselves.

A journey they never asked to take.

As the month draws to a close, spare a thought for these women. For those awaiting results, those newly diagnosed, those undergoing treatment, those in remission, those living with advanced disease, and the families holding their hands through it all.

And for the women whose stories did not end the way mine did.

May we never become so accustomed to the language of awareness that we forget the human lives behind it.

To every woman fighting, waiting, healing or hoping: you are in my thoughts.