Fighting cancer on both fronts
It shouldn’t come as a shock to hear Ann Ward say the word ‘boob’. They are after all what most people seek her professional advice on. Yet you expect a certain degree of formality and solemnity from a cancer nurse who is also a cancer victim. As Ann makes short work of her NHS lasagne it is soon clear that neither is on the menu, “I really celebrate now, I celebrate having survived and I am grateful for having survived.”
As she chatters for two hours about boobs, drugs and petty bureaucracy it is impossible not be caught up by the woman’s infectious optimism. For five minutes I wonder if an entire hospital canteen’s staff could actually be called ‘honey-bunny’. But when Ann uses the name for the tenth time I realise everyone is a honey-bunny in her world.
Her sunny disposition is remarkable given that she was diagnosed with breast cancer 12 years ago when only 44. But she overcame that devastation by taking up a post as a cancer research nurse only three weeks after learning her lump was cancerous. She has now been treating patients at the Royal Marsden in Chelsea, the country’s leading dedicated cancer hospital, for over a decade. Her latest projects are an investigation into the genetics of breast cancer and examining new techniques in the reconstruction of boobs - as we are now referring to them. This really is keeping your friends close and your enemies closer.
Ann first discovered signs of her cancer when she found a lump on her breast during a holiday in Greece. She thought nothing of it other than the result of a tight bikini top. But to be sure she visited a one-stop clinic where she was diagnosed. “Its amazing” she says, “In an hour and a half you have gone from being a perfectly normal person with a slightly irritating little thing on your boob to a person with cancer…its completely shattering”. Ann has never married and she went to the clinic and had a mammogram on her own, a decision she regrets a little in hindsight “I think I would have dealt with it better if someone had been with me, although it wouldn’t have made it any less devastating”.
This is one of many instances when Ann describes the battle against cancer as a partnership. Sharing the burden is the best way of coping with the devastating news in her opinion and she says that people do not pay enough attention to how relatives and close ones deal with the reality of breast cancer, “In one way its you and you’re on your own and nobody can understand it but in another way you are in a partnership when you get cancer. It is like dropping a pebble into a pond…the ripples will hit loved ones…”
Ann’s pebble hit her late mother with a ripple resembling a small wave. She was in her nineties and had just had a knee replacement. Ann says she felt almost guilty for the distress she was going to cause her mum, “I was diagnosed and I thought ‘what have I done to her’… in fact she was much tougher than probably even I was, she was very straight forward about it. But I could see the fear in her eyes that something was going to happen to me and she was going to be left on her own. This wasn’t selfishness… it was vulnerability. She was ill and vulnerable and then all of a sudden the one person she relied on was ill and vulnerable too.”
We now talk about the way a couple or a family deal with the invasion of the disease reflects their personal relationships. Ann details examples of couples who were planning to retire and couples where husband or wife may have been arguing or on the verge of separation. The dynamic and circumstances cancer produces for relationships is fascinating stuff to Ann and I realise she now has her professional hat back on.
Indeed she flits between her two personas – those of victim and healer – seamlessly throughout our chat. I suggest that perhaps there is often a grey area between the two and this must affect her thinking but she makes a point of separating them. She admits when she first started at the Royal Marsden she was still coming to terms with her own illness and that it was tough, “I had the most spectacular nightmares for the first few months… I decided that if I was going to keep my sanity I had to get my clinical hat back on and look at it objectively and say this is Mrs X, this has nothing to do with you. You have to have a professional no mans land and I needed to establish that line because it had got blurred, no doubt it had got blurred.”
In the same way she maintains this personal detachment in her work she feels her medical expertise gave her no significant advantage when she was told she had cancer. In fact it may have been an obstacle at times, “People always ask about your cancer as if you haven’t really got it. They think that because you are a nurse you always want to talk about it.”
Ann tells me she feels lucky. Lucky for still being here, lucky she did not face the horrors of chemotherapy, lucky she had a “huge bunch” of family batting for her and lucky she could use organisations such as the Bacup phone line and Breakthrough, the breast cancer support group. Such outlets were often not available to women in the past. She treats herself annually to one chocolate cake, a lapse into decadence that marks how glad she is to have survived.
But she still grieves for the life of a healthy person she has lost. The biggest shock of the whole treatment process was being instantly menopausal after beginning eighteen months of hormone replacement therapy. The majority of cases of breast cancer occur in women over fifty. Although single she had not completely ruled out having children, “I was only 44 and I hadn’t actually given up on the notion of having a child if I formed the right partnership, but the symptoms of the menopause, were dreadful…hot flushes…the worst menopause possible overnight. That was a tough 18 months.”
The ethical issue of treatment for breast cancer victims is still a thorny one. Ann believes which drugs you take should be decided on with the clinicians. Although drug companies still have an excessive influence on hospitals through their funding she says patients are still have the best choices they have ever had and that problems only arise when there is a lack of trust on the part of the sufferer.
Drawing on her experience Ann now avidly believes there is no formula for dealing with the trauma of cancer. Despite her positive attitude she says the worst thing you can do is tell a woman with cancer that being positive will alter the course of her illness, “if you’re emotionally unable to be positive and your cancer gets worse is it then your fault? That is a terrible burden to have.” We are back with professional Ann now and she is slightly more direct and will not talk of cures but only remission and always says to patients “you are as well as you can be.”
Cancer victims often ask Ann and her colleagues ‘why me?’ She just tells them it’s a mistake, “Cancer is a wrongly developed cell” she says, “Its like a shanty town, the bigger it piles up, the bigger the risk of it falling down.” But she keeps coming back to the theme of partnership. She was treated at the Royal Marsden and was so impressed they have yet to get rid of her. We finish up as she affirms once again that everyone needs to share the burden of cancer and that there is only your own way rather than the right way of fighting the disease.
Ann sees me to the door, for security purposes more than anything else, but she does call me honey bunny four times before I leave. I ponder if anyone can be that nice for that long really, and laugh briefly at the thought of her berating someone in the canteen for serving rotten Lasagne.
Greg Norman, November 2004
