DABDA

I was filmed for the BBC yesterday for a documentary that doesn’t yet have a release date. I’m not 100% sure how much I’m allowed to say about the programme so I’ll keep it exceptionally brief. However the presenter and interviewer has a terminal prognosis and they had just finished the upteenth cycle of chemotherapy. This is in part why there’s no release date because it’s finding time for them to film mid cycles. They’re also young like me.  

What I took most away from the chat yesterday, is that the presenter, after 1 year of fighting the disease, had come to acceptance. The show is planning some very outlandish things to show this, and when this was mentioned it really hit home that I had a long way to go on the road before I’d doing anything like that. I realised yesterday the diagnosis and it’s affect on me is far far too raw. Only this weekend I started to think what does it actually mean to me. Anyone who has seen me over the last few days has been subject to me discussing this. The trigger was the realisation that I can’t drink alcohol as GSK advise it may interfere with the Dabrafenib. This probably isn’t known but would you take the risk!?

Then I was thinking how can I date anyone, “so what do you do?” “erm well I have stage 4 cancer”, it’s hardly flirting. Talking yesterday with the presenter this seems to be a harsh reality that they went through. It’s also a reality I don’t think Brits talk about. I’ve never really been one for planning, happy to go with the ebbs and flows of life, but this is ridiculous. 

 The title again is a bit nerdy, it stands for Denial, Anger, Bargaining, Depression and Acceptance. I could never remember all five in an exam. It’s the Kubler-Ross five stages of grief, which can happen in any order. For me it would be interesting to meet other doctors in the same position, but I personally feel our profession denies us the chance to be in denial (repetition intended). From the glimmer of the clinical nurse specialist in dermatology badge I’d made the diagnosis, made my own prognosis and had my own ideas about treatment. Fortunately I only knew about BRAF inhibitors, the monoclonals (pembrolizumab/ipilimumab) were new to me and their efficacy was pleasantly (understatement of the century) surprising.

We didn’t discuss anger yesterday, the show wasn’t about grief at all but our emotions were definitely the elephant in the room. I can’t really see myself getting angry, but I may, I’m sure people do. I guess I’m annoyed at how unfair it is, but I’m not angry at anyone else. 

It could be very easy to get depressed, talking to the presenter it seemed that they’d had a few low points but they’d carried on through this stage, not allowing themselves to be bogged down in it because they are a very driven person. I guess I’m in the same boat, at least I hope. I’m not sure how much time I have I don’t want to spend it all in bed. 

Again almost by mistake we talked about bargaining and it was basically listing more and more outrageous people we’d have sex with for a cure. 

I’m not really sure how I’ll get to acceptance when I don’t know what it is I need to accept. Do I need to accept; the end? A reduced quality of life? Or an adjustment to my career? Some weird side effect in return for a cure? The day was very successful firstly it was enjoyable and interesting being on TV, better than last time which involved waving outrageously at the commonwealth games whilst Usain Bolt was doing a lap of honour. We spent two hours the next day to see ourselves on iplayer only to realise we’d been cut out of the highlights. Secondly and actually more importantly it gave me an insight into another cancer patient’s journey to acceptance, one day hopefully I’ll get there.

Additional point:

 They also said the line “I proved the doctors wrong when they said I’d be dead within…” a line which I’ve always disliked as a doctor and I like even less now, quite simply it sounds too negative. The Prof wants me to respond to treatment very well* but when he’s given me any idea of prognosis it’s his best guess from all the papers he’s surely written and read and the patients who’ve been under his care. It’s a guess that is there to be helpful, it empowers people to use what time they have left in the best way that they please. 

 *they’re are signs that this may be the case my LDH (lactate dehydrogenase) a measure of cancer activity has fallen from 1234 on admission to 171 which is now normal

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