Earth Angels, Vogue

Being diagnosed with cancer can seem like a situation beyond hope. But there are people who make it their life’s work to help, to encourage, and to heal. Bettina von Hase relates how she came to meet them.

There was a time when I lived in The Little Boltons, off the Fulham Road, and every day I would take the No 14 bus that passed the Royal Marsden Hospital. I would steal a glance at its imposing red-brick structure as we went by, and think at that moment: “I hope I don't end up in there one day.” Well, I did. Perhaps I was magnetically attracted to it, in the way we are to the things we fear the most. In my case, I was diagnosed with Stage II breast cancer at St Mary's, Paddington, on March 3 last year. Since that day, my life has changed. I am different. I look different, I feel different, what I eat is different, what I wear is different.

I have also met with different people. Doctors, and most memorably the nurses with whom I spent so much of my hospital time, who have helped me confront and treat my illness. What began a year ago is by no means finished, but without the nurses' help I could not have picked myself up and carried on. For someone who had never been ill, never been for a prolonged hospital stay, it was a sobering but oddly familiar experience to put my life into their hands, especially for me, as I had nursed in the past. (My mother, who had been a young nurse in World War II, had insisted that after our A-levels my four sisters and I did a three-month nursing course organised by the Order of St John.)

The origin of the word "nurse" is derived from the Latin nutrix, or "nursing mother". Nutrition and nourishment share the same root. The maternal or nurturing instinct is still seen as an intrinsic part of the nursing vocation — "nurse" and "mother" remain closely linked. The Latin word for breast is mamma, like mother; a heavy irony then, that in German breast cancer is called mammakarzinom (mammacarcinoma)— the breast and its nurturing aspect turned against you and your own body. For me, a nurse in her uniform symbolised authority and compassion, with strong associations of childhood, probably because of my mother’s brilliant care when we were ill. I now had the chance to observe the real thing from the patient’s perspective.

The start of my life's transformation happened the moment I was diagnosed, when I felt Volume One of my life slam shut, and Volume Two hopefully open. Once you know you have the "big C ", a lurking fear is always at the back of your mind. The first six weeks after my diagnosis were spent in high anxiety. I researched doctors. told family and close friends, and obtained first, second and third opinions before finally making the decision to have the operation at the Royal Marsden. It had all started with a visit to my GP, so I was on the NHS track, and the more I researched the more convinced I became that there was no need to go private. The people at the Marsden are experts on cancer. It is their raison d'être, and you feel it the moment you walk through the door.

The first person I met there was my surgeon Gerald Gui. I trusted him and liked his quick intelligence in interpreting other opinions I had sought, both in the UK and the US. I knew I wanted him to perform the operation. By the time I’d packed my case for the Marsden, I was as prepared as I was ever going to be. Oddly enough, I thought about my wardrobe quite a bit before I went in: the kind of dressing-gown I wanted to wear, the slippers, the scent. This may sound superficial, but it was both a distraction from the fear. and a matter of real importance to look tidy when vulnerable.

I arrived on the Ellis Ward, the NHS ward at the Marsden, at 2pm the afternoon before my operation. I did not feel ill, yet suddenly here I was in the unfamiliar role of patient. The word patient comes from patior — I am suffering — and some are more patient at suffering than others. Retired QC and author C M Clothier captures the vulnerability of a patient in his essay in the Oxford Textbook of Medicine: “To lie down in the presence of others in a strange place, to get undressed in the middle of the day. to give specimens of urine or blood, all on the orders of those who remain upright, are acts of submission. The arrival in hospital is accompanied by feelings of anxious apprehension, fear, isolation and general mental turmoil...”.

It is those feelings the nurses have to deal with. I was welcomed by the ward sister, Diane Carey, who showed me to my bed. Two of my four sisters accompanied me, and then left me to have an early night, helped by a sleeping pill. The next morning Mr Gui arrived early to mark both my breasts with medical felt-tip lines and measurements, which looked like strange tribal decorations. He took photographs for reference, and by chance I had my camera there, too, so he took some with mine. The photos were startling: the last goodbye from my left breast, the one that contained a 3.3cm tumour. After an eight-hour operation, I was wheeled back into the ward.

Over the next few days I met four women who made such an impression on me that, seven months later, I went back to find out more about these talented nurses: Amy Barrow, 23; Melanie Byrne, 35; Rolyn Alvarado, 32; and Laura Woodward, 26. There are 721 nurses at the Marsden, looking after 40,000 cancer patients a year, 2,471 of them with breast cancer in the last year. The Royal Marsden School Of Nursing trains 75 per cent of cancer nurses in the UK. There are 18 on Ellis Ward, each doing shift work for 37 and a half hours a week. I met quite a few during my 11 days there — but I got to know these four better than the others, largely because I had to stay longer than intended. The first two days were fairly easy. But then the trouble began.

This did not come from the breast that was operated on, but from a bad reaction to the general anaesthetic, and then to the painkillers, which caused violent nausea and dizziness. That was when I met Rolyn for the first time. She is originally from the Philippines and her doe-like presence and calming voice soothed my jangling nerves. The way she removed my bandages with a delicate touch was at once expert and respectful. It communicated to me that I was a human being who needed looking after, and I promptly relaxed and fell asleep. Amy, a blonde and vivacious livewire, came in with a colleague the day after. There was something immensely cheering about these two nurses, looking so smart in their blue-and- white striped uniforms.

I was feeling so ill I could hardly move, and they cracked jokes to make me laugh. But they also instinctively knew that I needed to move beyond feeling sorry for myself. Their goal set for me that day was to have my first shower since the operation – a logistical nightmare if you have three drains attached to your body. I have read about the issue of highly-qualified nurses being “too posh to wash”, but not this bunch. They did not mollycoddle, but encouraged me to do things for myself — a crucial step in recovery. They knew how easy it was to sink into bed-ridden mode.

I met Melanie from Manchester on the night shift. She is one of those nurses who knows that night-time can be the most difficult, when one's anxiety and pain levels rise. She brought me painkillers and found the time for words of reassurance before ensuring I was comfortable for the evening. It does not take much to calm a patient, but the skill is in knowing when to say something and when to leave someone alone. Laura, a bubbly brunette from Coventry, included injecting light touches of humour She was on duty my last two days, when I was already imagining a life outside the hospital. But it was not that easy to leave. It is astonishing how quickly one becomes used to being nursed and taken care of, even enjoying the lack of responsibility. No wonder my brother-in-law Nick made a slip of the tongue on a visit and called it the Royal Marsden Hotel.

The atmosphere inside the Royal Marsden is cheerful, however incongruous that may sound. It is not what I had imagined when I was sitting on the No 14 bus all those years ago. Everyone in the hospital either has cancer, or is related to or friends with someone who has cancer, or works in the fight against cancer. This collective energy is a powerful tool against a powerful disease.

It is also the deciding factor in motivating these nurses to choose what is now a graduate profession. For the ones I talked to it was more of a vocation. With pay grades ranging from a starting salary of £19,166 to £31,004 (for staff nurses), no-one is in it for the money. It was unbelievably refreshing to meet four young women who do not want to be singers, actors, models or footballers' wives. I could not do their job — I know I do not have the courage to face what they face every day, despite the pay-off that they are doing something worthwhile. A cancer ward is not pretty. It is filled with despair and pain. These nurses hold it together, and have authority and a sense of responsibility well beyond their years. They are articulate speakers about their jobs, proper role models.

After an initial three years' training, are all doing further courses at the Royal Marsden — a Bachelor Of Science in Cancer Care, diplomas with stand-alone modules like the foundations of chemotherapy or communications. They have also often been confronted with the disease on a level. Melanie's and Rolyn's mothers had breast cancer; Laura's sister was very ill from a brain turnout "There is such diversity in nursing — you have so much choice", says Amy. "The word cancer is still such a taboo. people think, 'Oh, it's life threatening'. You take a deep breath when you hear it. But it's an umbrella word for a host of diseases," she says.

They all acknowledge that being on a cancer ward is rewarding because it gives them more time with patients and they become increasingly involved in their lives. “Fear is a big thing,” says Rolyn. "The question, 'How long have I got?' — how do you deal with that? When patients die young, that really affects me, or when they have young children. Just to be there, it is the only support I can give. You have your cry, but you don't let the patient see it. You have to move on, otherwise you won't be effective for other patients." Laura says the nurses learn coping skills in these situations: "I use humour, otherwise I would just cry all the time. " Melanie, who nursed her mother, always look at the patient and think, this could be my mother. my father or me."

When asked what they do to de-stress, the talk turns to shopping. They mostly socialise with other nurses, because they understand each other's lives. Rolyn likes musicals; Melanie goes clubbing; Laura whacks a few golf balls on the driving range or goes to the pub with friends. "I give so much of myself to work that days off are very precious to me" she says. Amy is married to a physiotherapist and is a youth leader at her local baptist church. "We're all, at some point in our lives going to need other people's help," she says.

I had already arrived at that stage, and recently found out that I am still there. I pay regular visits to the Medical Day Unit, where I get outpatient treatments from staff as inspirational as the nurses Of Ellis Ward. I have to be optimistic, and they have played a crucial part in my approach to this life-changing illness. In Clothier's essay, there is a concluding tip for patients, who should "recognize and appreciate human kindness when they see it and be grateful for it whether or not they are paying for their treatment". At the Royal Marsden, that is not difficult.