The next day, Sam had an appointment with her consultant first thing in the morning so that they could get it over and done. She'd been given her results over the phone the previous evening after she'd convinced her consultant that they could discuss the results in more detail in the morning and the newfound tumours were in fact cancerous as well. She had just been let into the room and had sat down beside her husband whilst the oncologist got her file up on his computer and had a look at her recent scans.
"Okay, now the purpose of today's meeting is for us to discuss your options Sam. We could–"
"Sorry to interrupt, but I've already made my decision." Sam admitted.
"Oh?"
"Yeah, I'd like to opt for a double mastectomy." She stated. "You know as well as I do that chemo and radio therapy isn't likely to work on the new tumours given the fact that it didn't work last time, and it'll just make me sicker again. A double mastectomy is my best option isn't it?"
"Well, it's obviously a personal decision. It can be followed by emotional distress and there is an unfortunate truth in that, because you'd be choosing to have the double mastectomy, the costs of the operation wouldn't be covered by the NHS I'm afraid and you'd have to go private."
"What? So they'd rather spend thousands of pounds on drugs for chemo when they won't even work?" Sam protested. "That makes no sense! The operation is so much cheaper."
"I know it doesn't make any sense, but as a doctor you know the NHS isn't negotiable – that's the rules."
"It's fine, we can afford it." Tom stated as he gave Sam's hand a squeeze.
"And the cost of implants, should you choose to have them, or breast reconstructions would also be down to you."
"If that's what Sam wants then we'll manage but I think she needs some more time to think on that." Tom stated as he had gathered from her uncomfortable facial expression that had arisen from the conversation that she hadn't put an awful lot of thought into the aftermath of the operation – she just wanted the dangerous tumours out of her body.
"Well, it's something you'll need to decide before the operation because if you want implants in the future, we'd be better off leaving Sam's skin intact rather than removing excess skin, and we could fill the chest cavities with what're basically bags of saline to maintain the shape of her skin."
"Okay, we'll think about it." Tom stated. "So what happens now then?"
"Well, I can give you the details of a local private clinic which specialise in cosmetic surgery for those who have had parts of their body removed because of burns, cancers or injuries and you'll have to contact them and make an appointment. Once you do, give them my name so that I can send over all of your notes, scans and history and it'll go from there. Now however in the meantime, I'd like to put you on tamoxifen. It's a hormone therapy and it will hopefully either slow, or halt the growth of the tumours to prevent any further developments. You need to take one tablet, once a day with a glass of water and take it at the same time each day. It may make you feel a little bit nauseous so taking it with a meal could help to prevent that. It can cause a couple of side effects: hot flushes, nausea and indigestion and weight gain. It can also affect your periods because you are essentially changing the hormonal balance in your body and for that reason you'll need to use a form of non-hormonal contraception since it's not safe for you to become pregnant whilst on this medication." He explained.
"Can it affect fertility?" Sam asked.
"No. Whilst on the medication, you shouldn't try for a baby because it can cause certain birth defects however it's safe to have a baby a couple of months after stopping the medication and there's no known effect on fertility." He explained.
A lot of people in the ED knew that the day before, Sam had an appointment to find out whether her treatment had worked or not and a lot of people had gathered in the staffroom at the beginning of their shift in order to hear what would hopefully be good news but their faces fell when Tom entered the staffroom first and he was holding his wife's hand.
"Oh here we go. Is this the bit when you trick us into thinking it's bad news when actually you got the all clear?" Fletch, who was down in the ED on a referral, joked.
"Fletch don't." Tom warned quietly as he knew the man meant no harm. "You wanna explain?" He questioned Sam as she stood a step behind him with her eyes down on the floor.
"No, you do it." She muttered.
"Okay um, it's not good news. Sam's cancer has spread and the chemo and radiotherapy haven't been much help." Tom began. "But my beautiful, strong wife has made the incredibly brave decision to have a double mastectomy rather than go through chemo and radiotherapy again and again." He stated.
"Are you going to have reconstruction?" Fletch asked solemnly.
"I think she needs some more time to think things through." Tom replied.
"Right come on you lot, get on with your work." Zoe ordered to clear the staffroom. "Sam, I'm so sorry. Just let me know when the operation is and I'll book you and Tom off for however long you need."
"Thanks." Sam replied as she forced a smile to the woman who was had been very lenient and understanding with her time off of work – she could give less than an hour's notice on the morning of her shift that she wasn't feeling up to coming in and Zoe would get a locum in whether the board liked it or not.
"Are you sure you want to work today? Because I'm sure I can get cover in if you're not up to it."
"No, I've been thinking about this all night and all morning. I just need a distraction." Sam stated.
"Alright, well I'd better get on." Zoe stated before she excited the room and left Tom and Sam alone.
"Can we get a takeaway tonight?" Sam asked as she walked over to her locker.
"Yeah sure, if that's what you want." Tom nodded. "What do you fancy?"
"Mixed starter for two and the set meal D from the Imperial palace?"
"Chinese it is then." Tom concluded. "What do you want to do for your birthday at the weekend?"
"I'm happy with a night in and a good film. I don't want to do anything special."
"Okay. Come on, get your scrubs on. First one in cubicles gets the extra spring roll."