I’ve Never Seen Kabul And I Never Will

Insomnia. 

One of those blessing/curse maladies that afflicts 30% of the adult population at any one time (according to an article published in the Journal of Clinical Sleep Medicine). Insomnia is defined in the report as ’difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and in some cases, nonrestorative or poor quality of sleep’ (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978319/). I am fine with initiating sleep. I’m so tired most of the time I could sleep standing up, and almost did in a queue in TK Maxx earlier. But staying asleep has been a bit of a problem for the last six weeks or so.

At first I put it down to stress about the charity area at Victorious Festival and figured that the regular pre-dawn waking cycle would pass once I’d ticked off the to-do list of tasks I was engaged in. As I was reading the entire collection in the Game of Thrones series at the time, when I woke up and couldn’t calm my brain from generating further items for the to-do list, I just got up and read whichever volume I was on.

Since the festival I have been in constant pain with pregnancy related SPD, so once I’m awake, I can’t get back to sleep mostly due to not being able to get comfortable and having painful Braxton Hicks contractions. This is apparently normal the more pregnancies you have, and for those not in the know, SPD (symphysis pubis dysfunction) is when your entire pelvis is not correctly supported by the ligaments around it – which have been softened by pregnancy hormones and are pretty much letting your skeleton flop about where it likes – and it hurts. It hurts when you move, when you walk, when you bend down… and standing up from a lying down position involves intricate planning, repositioning, and much gritting and gnashing of teeth. 

But it’s not just the SPD keeping me awake. It’s the impending medical menopause I’m about to undergo in a few months, and the pervading thought that I’m a bit Jon Snow.

I was reading Khaled Hosseini’s new novel at 4.30am the other day and there was a simple description of Kabul in the post-Taliban era, and I was struck with the overwhelming feeling of smallness and insignificance of my own self. I know where Kabul is. I know lots of news stories about it. But I will never know it personally. I will never walk around it and experience it. I won’t know what it smells like, how hot it actually is, how the dust gets under your contact lenses. I’ll die without knowing this. I also won’t know what it feels like to be in space, at the bottom of the ocean in a submarine, or landing a passenger plane at LAX. Although I have a degree, a post-grad qualification and am not stupid, there are such an overwhelming amount of things I’ll never know or touch or see or taste, there are places I will never visit and people I will never meet, there are things I’ll never learn to do… It’s enough to keep you awake at night. And it is.

In December, two weeks after little Ava Elizabeth Hanks is born, I’m going to be starting on the post-breast cancer treatment that I’ll be on for the next ten years. Tamoxifen blocks or interrupts oestrogen’s actions on other cells. As my cancer was hormone positive (ie: it consumed high levels of both oestrogen and progesterone from my body like a baby consumes milk) Tamoxifen will help reduce a recurrence, help stop a new primary breast cancer in the other breast, and give me a better chance of being around to see my kids grow up by not giving a new tumour the food it needs to grow into anything significant. I’ll also be on monthly Zoladex injections for two years, and that is the kind of scary part. Zoladex works by entirely suppressing all hormones and will effectively put me in a state of medically induced menopause. I’m going from pregnancy to menopause in the space of two weeks, and every time I’m awake at 4am, I’m accutely aware that this is actually the end of my younger self.

I’m going to be middle aged. Soon. And I still haven’t done so much.

Don’t get me wrong, I’m not complaining (too much). The medication is for my benefit, I am well aware of that. But it’s still daunting. My mum was 58 when she went through the menopause (something I tried to tell the consultant gynaecologist at QA when I went to ask about IVF if I chose to have chemo, and he informed me that at ‘my age’ I was unlikely to conceive naturally anyway. Again, here’s my middle finger on that one Mister). I am going to hit it at 42, and it will start almost exactly 2 years (bar 1 day) from the date of my original diagnosis.

I went to the Breast Clinic yesterday for a quick service to ensure there was nothing sinister going on that I am missing with my weekly checks. I also wanted further ammo for the obstetricians on why I don’t need to be induced at 38 weeks gestations ‘just in case’. Since the early days of diagnosis I’ve not really had to go out to the back corridor of the Breast Clinic, I’ve been treated in oncology which is 2 floors below. I was sent round to sit on the sofa outside my breast  care nurse’s office and suddenly the word ‘cancer’ was everywhere. I mean everywhere.

I was on the edge of a full on panic attack looking at the MacMillan notice board, the huge bunch of fresh flowers, the sign telling people how they can donate and support the breast clinic – and it was  exactly as it was when I was there before. I noticed those things in the same order, wondered who paid for the fresh flowers, realised the information about donating was aimed at people who might be dying and might consider leaving something in their wills, and absorbed the sickening realisation that I had cancer.

Had cancer.

This time Lisa-Marie wasn’t there with me, the urge to run away was easier to overcome, and I hadn’t just been crying in front of a surgeon. I did still have a strong desire to get really fucking drunk though. I don’t know why this all came as such a surprise; whether it was the resurfacing of memory brought on by place, or whether I’ve just become so accustomed to cancer now that I don’t consciously think about it so much and reminders are a sudden slap upside the head. I think about the medication I’ll be on soon, usually at 4am when the pain in my back and hip make it impossible to sleep. But I seem to have separated that from ‘cancer’ in my mind, with ‘cancer’ being what I had and ‘treatment’ being what I need now.

I am worried about the side effects of the upcoming treatment, primarily because even the ‘common’ ones (more than 1 in 10 people are affected) include pleasant ailments like hot flushes, vaginal dryness, mood swings and nausea (Tamoxifen), and hot flushes, headaches, acne, depression, bone pain, tingling of the fingers and toes and weight gain (Zoladex). That’s before you get into the less common but more severe side effects, so it’s a pretty daunting prospect, this necessary medical menopause. Obviously HRT isn’t an option – it’s the hormones that are the problem. How I’m going to cope with this and a newborn baby is what’s keeping me awake at 4am once my back has disturbed me. 

I’ll probably never dive off the Great Barrier Reef, visit Da Nang or be a size 10 again. But at least I’ll be able to drink wine again…