Anna Donald: Tests

Test results can be nerve racking. They turn a complex stream of life into a binary event in which your fate seems to hang in the balance. I was especially nervous about my latest CT results. They would reveal whether the small cancers in my head had been zapped by recent whole brain radiation. Or not.

I don’t exactly know what ‘or not’ means, but the idea of blobs of breast growing in my brain (what is my breast doing in my head?!), impervious to radiation or drugs, sounds like something out of a sci-fi movie I’d rather not be in.

Then, a gift when I least expected it –  the radiology staff in a scanning unit which supplies Sydney’s Royal Prince Alfred Hospital were so lovely – down to earth, prompt, optimistic – that the morning was transformed. My mother and husband had lunch, coffee, and waited calmly for the oncologist appointment. Although I didn’t have the nerve to look at the scans before seeing him – my scan reading is decidedly ropey and neuroanatomy was always something I was grateful other people were good at – I stopped being a jibbering wreck.

I am always grateful for this kind of cheerful professionalism in hospitals, where people are so busy and patients often so challenging. I encountered exactly this attentive kindness and competence in a wide range of staff in the NHS at University College Hospital and in my local surgery. It always impressed me; as a former Chief Executive I appreciate the work it takes to achieve. As a patient, let me assure any managerial readers that it is worth it. It takes all the awfulness out of potentially traumatic experiences.

And…the results were pretty good. The head was OK (yay!). So were the bones. The cancer had advanced a bit in my lungs – I have a cough – and more so in my liver, where two lumps of cancer had doubled in size. My oncologist has changed a hormone treatment rather than Go To Chemo and Do Not Pass Go. I’m not knowledgeable enough about the course of metastatic disease to know how to think about this decision. A relief? A reprieve? An opportunity? Maybe my oncologist can tell me. We all need metaphors to live by.

  • Tom

    [quote]Test results can be nerve racking. They turn a complex stream of life into a binary event [/quote]

    Well said. Food for thought.

  • Sharat Kolke

    I really appreciate the way you are looking at things.Your blog is an eye opener. As a practising physician, it has changed my outlook towards my patients and their illnesses.

  • Trish Greenhalgh

    Keep writing this stuff – I’m getting my students to analyse your illness narrative! This will be a unique resource that will provide an evidence base of what it feels like to be on the wrong side of the skew normal distribution. Hope the writing itself proves therapeutic and that the colunmn goes on a long time.
    lots of love

  • Richard Smith

    Does anybody know about the course of metastatic disease in an individual patient? Can anybody enlighten me? My suspicion, Anna, is that you know as much as anybody and more than most.

  • Thank you Anna, for putting words to what you’re going through and enabling us all to continue learning from you! We miss you. Lots of love. Ceilidh.

  • Dear Anna,
    I happened to know you are writing the blog in BMJ when I was attending its editorial advisory board meeting this week in London. I’m very sorry for not having asked you “Quel est ton tourment?” before you tell us what you are going through. For now I would keep listening to you. As you know I’m a survivor of the stroke (a rupture of the cranial AVM) for 22 years. In addition, I had a bout of AMI on 3rd July 2006. I once thought I’d already passed the point of no return. But a few minutes later (I believe) I heard the voice saying “Survive!”, which made me realise there still remained a room for me “here.” Life is worth living. I wish you a very good luck!

  • Sandy Oliver

    Dear Anna
    You’re turning your experience into a gift to us – describing so eloquently how the dry evidence-based approach is woven with the craft and the considerate attitudes of individual practitioners into what we appreciate as professional care. What a contribution to our collective learning. Thank you. I’ll keep reading.

  • Sam

    Thank you Anna, for so beautifully describing what you
    are going through. Your blog is so personal, I feel as
    though we are chatting over a coffee. It does make me
    smile that as well as coping with cancer, you still
    find time to teach and inspire the rest of us. Thank you.
    Sam xx

  • Viv

    “but the idea of blobs of breast growing in my brain (what is my breast doing in my head?!)”

    – It’s these brief asides, Anna, that get to me the most. They speak volumes.

  • Mel Bartley

    Dear Anna

    As always, you write brilliantly, even under
    such duress. You are an example of resilience
    to us all.

    best wishes


  • simon

    Anna, it is great to hear from you, though I am sorry to hear of your troubles I suspected it was the reason for your disappearance. You were very kind when I needed it, and I wish you well, and if that is not possible then better will do. Meanwhile I enjoy your amusing and thought provoking notes and trust you enjoy writing them.

  • Dear Anna,
    Thank you for your honesty and hopefullness and make sure you maintain both. Your blog is obviously a great way to help others be they students, practising doctors or patients. It is a testimony of courage and I hope that it helps you as much as it does others!
    Love and prayers,

  • Henry McQuay

    Hang in there Anna. Surprises happen, as I see repeatedly from the other side. With our very best wishes, Henry and the Bandolier team.

  • Thelma

    I’ve just had what I thought was a scary time with primary breast cancer diagnosed on screening. Fortunately all went well with removal and pathology and I thought I’d been courageous. Not a bit of it. Your courage – even just the courage to write this blog never mind the courage required waiting for scan/pathology results – is fantastic. You give hope and help.

  • Jocelyn Cornwell

    Hello Anna
    Our conversation last year about your experience as a patient in the UK continues to inform the Point of Care, our programme that is about improving patients’ experience and humanity of care. Thank you for sharing the details that make a difference, and your insights into the management/organisation lies behind them. It is just great. Jocelyn

  • alison holmes

    Hello Anna
    Read blog by chance- and will follow.
    love and all best wishes

  • Imtiaz Liaquatullah

    Dear Anna,
    Came across your blog while surfing the net.
    Keep writing.
    It is an encouragement and a beacon of hope for all those cancer patients who feel they have come to the end of their journey.
    I shall visit your blog regularly.
    Imtiaz Liaquatullah

  • Dr Helene

    Anna: you are an inspiration on several levels, but I suspect you may not appreciate just how much. Thankyou for writing about the doctor-patient experience. I too have been there, although I am mostly ‘just’ a doctor now; and it is a disturbing and uncomfortable place to be, with a foot in both camps. Please don’t ever feel helpless: you are making a difference to a lot of people.

  • Anna Donald

    Dear Anna,
    Another connection….my daughter was born at UCH in 1966.
    From the ‘other’ Anna Donald.

  • Suzi Granger

    Anna,A friend of mine in Australia referred me to your blog – and is sending me the SMH article. At the beginning of the year I went for a holiday to Australia – and after a week was diagnosed with ovarian cancer metastissed in liver and spleen!! So my 5 weeek holiday turned into a six month stay. My friends were absolutely marvelous and the staff at the hsopitals too!
    However, very early in the peice I realised that I had to
    be in control of my “illness” so I read just about everything I could lay my hands on – my first book was Deepak Chopra’s Qantum Healing – and altho I had read this many years ago – this time it all made sense to me.
    So I started a journey if you like of my healing – watching the results of the scans and the blood tests – and also totally changing my diet (I too went to Ian Gawler in Sydney) and what I want to share to you and everyone – is that this is a process and a journey we are on – and for me it has been an opporotunity to change my lifestyle -not just by eating better – but by really looking at who have I been in my life – and what do I want my life now to be about! I read life affirming books, listen to tapes and strongly hold a belief that having cancer does not equate with death – and yes, I have weepies, and just let it all be part of my process.
    I am going to start a blog over the next week or so for all my friends family and communities here in Colorado, Australia, and the UK. they have asked that I do this so I can share with them as they say they are on this journey with me.
    Thankyou for so openly sharing and opening up the space for people to be authentic and share what theya re really feeling. I hope I can become aregular reade rof your blog
    Suzi Granger