Today is World Suicide Prevention Day.

I've just heard that today is World Suicide Prevention Day, so I'm going to belay the moving house shenanigans post for another day and go straight to my second chemo, which is related to today's theme.

The first week after my first chemo was spent lying on a couch and trying to get up enough energy to stand upright. This was a prerequisite to being able to eat anything, as I was not going to risk being sick while lying down. Also, I giving myself daily injections, and I suppose it is part of how bad I was feeling that giving myself injections was the high point of most days.

The second week after chemo I started to have more energy, to be able to eat better and to notice my hair falling out. I had it chopped short, hoping that this would contain the mess and make it easier to transition to no hair at all. At first it was just a few strands, then clumps, then I started to look like some kind of piebald pony with a horrible disease and I decided to get the rest shaved off.

I then discovered there is a big difference between short hair and totally bald. Instantly, I was marked as 'the one with cancer'. Everywhere I went, people would stare, though I suppose I should be glad only one person actually asked me, "What on earth have you done to yourself?!"

The third week was pretty much spent dreading going in for the next cycle of chemo. The first one had been traumatic because I hadn't known what to expect. Now that I knew what I was getting into - it was much worse. Knowingly going to hospital to spend hours lying helplessly on a couch letting them give me poisons which would make me even sicker... ugh! I found it increasingly difficult to imagine successfully completing the planned eight cycles. Days of vomiting, weeks of being unwell repeating for 24 weeks - it stretched out ahead of me, and I became increasingly obsessed with online research about survival statistics.

Yep, I did what I always tell my patients not to do, and started to listen to Dr Google. I wasn't surfing the internet so much as drowning in it. Every story I read, I wondered if this would be me? Every article I skimmed from the medical journals I wondered, will this happen to me? Every possible side effect, every tear-jerking personal memoir, would this be my story? Or this? Or this?

Too much information, too little fact, all spinning through my head at once, until one day I was crossing the bridge above the rail line near the station and I suddenly realised that I could take control of it all. I could make sure the worst never happened and (bonus) I would never have to face chemo again if I just drove my car off that bridge.

The thought seemed wrong somehow, but I couldn't put my finger on what was wrong with it. I pushed it out of my mind, but it kept coming back. I also entertained thoughts of running away to Queensland, or just pretending it away and 'forgetting' about all my appointments. But I knew that would not really work, it would not really end all the stress and sickness.

Besides, a lot of cancer cases end in death. There is no getting around the fact that quite a few people with cancer die of it - cancer has a bad reputation for a reason. I could go through all this agony, sickness and suffering and then die anyway. Surely it would be easier and cleaner to just get it all over with immediately?

Fortunately I have a very perceptive oncologist who did not believe me when I said that I was 'fine'. She told me I needed to see a psychologist. Then she rang me to see if I'd seen a psychologist. Then she asked the psychologist to ring me with an appointment and not to take no for an answer.

The psychologist was a lovely sympathetic lady with whom I did not connect at all. She had lots of excellent logical reasons why suicide was a bad idea, and which completely failed to convince me. (This is no reflection on her skills, we just didn't 'click'.)

I went back to my wonderful GP, who had no reasons at all and no logic but who just let me pour it all out and said "Yeah, this sucks." So at least I knew she was listening to me. She convinced me to take it one day at a time, one hour at a time if necessary, and to put down the internet and step away!

For me, the key was to focus on my life as it is in the here and now. 'Mindfulness' is the psychological term for it, but I could equally call it 'appreciating my blessings' and 'being grateful I'm alive today, regardless of tomorrow'. Whatever the name, it was something I had to learn and practice for myself - there was no magic bullet, or brilliant insight that anyone else could give me.

Cancer patients are expected to feel sick, to feel tired and (to a certain extent) to complain about those things. Talking about feeling suicidal was different, and much more difficult. So don't be surprised if this is the first you have heard of it. Somehow 'coming out' on that subject was harder than telling people about the cancer itself.

But I am eternally glad for the various people who came alongside me and listened, and let me lean on them - some will be reading this blog, most did not know at the time how important their small gestures and kindnesses were. Thank you all.

* * * 

I am now more than a year down the track from that point, but I won't quickly forget how it felt. Staring down into the dark well and wondering if that place is better than here.

Public Service Announcement: Suicide is always something to take seriously. Even people who appear funny, strong and otherwise to have it all together can be overwhelmed - the tragic death of Robin Williams has taught us that. If someone tells you they are thinking of killing themselves, seek help for them and support for yourself. Lifeline does both of these things: 13 11 14.

If it's Tuesday, this must be CT

So I told the various members of the family about the news from Tuesday, either in person or by email. I debated not telling my parents at all until they arrived back from Europe, but decided that it would be worse to come home to find me already bald and in the middle of chemotherapy, so email it was.

I am still not quite clear about how non-medical people receive statistics on this kind of thing. For my grade and size of cancer, the stats say five-year-survival is 70%. Does that sound like a good number, or not?

My MIL (mother in law) thought that meant that three-quarters are still alive in five years - that's good! I couldn't help thinking that meant that three in ten are dead at five years. I'm not sure if the difference is one of perspective, attitude or simply mathematical understanding.

So, I spent the next week being chewed up and spat out by the tornado of testing. I was CT scanned, bone scanned, x-rayed, renal tested and cardiac tested. If I had one of anything, it was tested and imaged to see how well it worked. Then the chemotherapy was designed to test it almost to the limits. I hope whoever did the calculations was careful with their decimal points!

However, one side effect of the testing was that I was radioactive for two days. I had to wean Benji, who was then 15 months old and breastfeeding eight times every day. But on balance, I decided that it was better for her to have 15 months of nutritious milk than another few months of milk contaminated with only-the-pharmacist-knows-what. It felt like the end of an era though, and also the end of my brief career as a breastfeeding counsellor. (I felt that my unspoken thoughts of "you think you've got problems!" was not a helpful attitude to take into the therapeutic space.)

My SIL (sister-in-law) took me to get my hair chopped off, and I told myself I was ready.

I don't think it is possible to be really ready for something like this. On Wednesday morning I took the aprepitant and dexamethasone (to prevent nausea) and within 30 mins of the infusion starting I had my head in a bucket. So they gave me metoclopramide as well. And prochlorperazine. And ondansetron. I just about rattled when I moved and still nothing - staying down, that is!

I was moved from the day chemo centre to the overnight ward and given an infusion of IV fluid to make up for what I was losing. There someone had the bright idea that I was sick because of high levels of anxiety, so I was given a dose of lorazepam. Then I was sedated and still sick. (No, you don't want to imagine that - it was not a happy combination.) Suffice it to say that I am never again eating cold beef and mustard sandwiches.

By the next morning (Thursday) I was well enough to go home and lie on my own couch.

Except for the fact that we were moving house on the Saturday.

With truly appalling timing, our landlord had decided to do some key renovations and had given us legal notice to get out. We debated appealing or fighting the order, but my chemotherapy plan was to have six months of chemotherapy. During that time I would expect to get progressively more tired and sick. So we decided to bite the bullet and move on the first weekend after my first chemotherapy.

Who thought that was a good idea, again?

The move, in retrospect, was hilarious and deserves its own post, so that's some fun for another day!

Thursday: Conclusion

After leaving them to clean up the carnage in the ultrasound suite, Dean and I went back upstairs to the surgeon's room. He said he would get the result from the samples in pathology, and come straight to his office to tell us.

Just after 5pm on that same Thursday, the day which had started a year ago with a normal ward round, the surgeon sat in front of us with a serious face. A "bad news" face.

As he spoke to us, I had a dissociative moment. My brain heard him say the expected words: it's a blocked duct.

And yet at the same time his mouth seemed to be saying a word that started with C and ended with -ancer. Impossible.

I shook my head and asked him to repeat what he had just said. With no change of expression, as if my request were completely reasonable and expected he repeated his sentence and this time both brain and eyes agreed: it's cancer.

He continued to talk to us for a further half hour. I presume he was outlining  the need for staging scans, possible treatment plans, likely scenarios for prognosis. I did not hear any of it. My mind was too busy buzzing with various disconnected thoughts:

He must have picked up someone else's file.

I'm too young to have cancer! 

I don't feel sick. This can't be true.

This is impossible. I'm a doctor, not a patient.

This can't be happening, I just want to go home and forget this ever happened.

We have to move house in three weeks!

Will I have to wean Benji? She's still feeding eight times each day!

Was it something I ate? Was it something I did?

Is this my fault somehow?

Will this also attack my daughters, sister, cousins, niece?

How long will I be off work? How much sick leave do I have?

How can I tell my parents, currently in Europe?

How can I tell anyone?

I've never smoked. I'm a good person! I don't deserve this!

I need to go home and pretend that my life has not just changed completely.

I presume Dean shook the surgeon's hand, thanked him, said all the right things. I didn't say anything.

I don't remember what I did that night.

I don't remember what I did the next day.

I don't remember what I did for the whole weekend.

I'm pretty sure I took the girls to the park and tried not to think about it.

I'm sure I thought about it anyway.

The only clear picture in my mind is pushing Zoe on the swings, as she shrieked and laughed, and wondering how long it would be before I could do this again, if ever.