These days, Zagreb and some other Croatian cities and towns celebrate Pink Ribbon day. Every year I have participated in the traditional walk through the city, aimed at raising public awareness toward the importance of prevention and early detection of breast cancer as the crucial prerequisite for disease cure. Always the same scene: women from different patient groups and associations gather in front of the Croatian National Theatre, carrying banners with different messages; a top politician is invited to speak and, after grabbing the photo opportunity, the pink-ribbon parade sets on its way through the city. I remember the first parade I took part in, just after my first operation. I felt I had to be there – with that small ribbon on my collar I felt ready to start a revolution and change the world. But, looking at the people observing us curiously, deep inside I had an uneasy sense of being excluded, stigmatized… This time, the parade was headed by the Mayor of Zagreb, Milan Bandić, who walked with his ”pink ladies” all the way to the Ban Jelačić Square and drank coffee with us at the City Coffee House.
What is the final aim of the parade? What is the visible effect of this kind of appeal? What, if anything, changes within the health care system in terms of prevention and cure for breast cancer? These are the questions I did not ask. I had survived an operation, skin sparing mastectomy, with silicone implants placement during the same intervention (the worst possible option I allowed myself to have had done due my own lack of information), and 6 cycles of chemotherapeutic protocol that stretched over 52 days because the equipment broke down twice. I believed that my Cancer Odyssey was over, that it was just an inconvenient journey any man or woman experiences in their lifetime – little did I know the real journey into the unknown had just begun.
October 2001 – THAT diagnosis
That year the fall was late and the golden threads of Indian summer swept the streets. The city was full of people wearing short sleeves, moms pushing baby strollers, small children running around… “My God, when do these people go to work?,” I asked myself jealously, hurrying across the Zrinjevac Park.
October 8, 2001 – I’m sitting in my office after a class.
“Hey, roommate, why don’t you go home?” – the colleague with whom I share the office asks.
“C’mon, leave me alone, I have a breast ultrasound appointment at 8.30 PM and I don’t feel like going at all!”
“What is it with you all? Why are you so scared of cancer?” – he refers to the media campaign for breast cancer prevention that always takes place in October.
I pick up the phone to cancel my appointment. It’s still warm I could go for a cup of coffee. I put down the receiver without making the call.
Just before 8:30 I enter the doctor’s office. I go out to the balcony and start crying. The nurse kindly brings some fruit juice – no questions asked… I’m thinking: three days ago I submitted the research for my dissertation – I must be overworked. The conversation with the doctor relaxes me. In the middle of the check-up she suddenly gets up.
“Let me see if we had that last year.” – she speaks to herself while looking for the old ultrasound records in the other computer.
“Is it a cist?” – I ask.
“No.”
“Does it have clear lines?” – I ask hoping that it is a benign type of tumor.
“No.” – she offers a short answer and a serious look.
“Is it cancer then?” – I finally venture to ask.
“That I don’t know yet. We’ll have to run tests, like needle aspiration biopsy, but I certainly know that THAT is something we’ll have to operate on.”
“Well, what does she know?! It’s been only six months since my last ultrasound, the results of which were good.” – I think to myself. “Her ‘THAT’ does not even have a name, it must be a mistake. I’ll take a mammography test tomorrow morning.” – I conclude.
Today I know that the tears I shed before I entered the doctor’s office came from knowing what the matter with me was, something called premonition.
October 9, 2001 – mammography and needle aspiration biopsy are positive. “THAT” gets a name. It is called “breast cancer.”
October 10, 2001 – my operation date has been set. Happy wedding anniversary!
October 2009 – Marathon
I am still on my journey. No more do I have revolutionary feelings. I am running a type of my own marathon – constantly a step before “THAT.” Again it is Pink Ribbon Day. I don’t want to go. I see no point in participating, much less because of the way this day is marked. Croatian statistics data are discouraging. Breast cancer has been on a constant rise in the recent thirty years, with the age limit lowering. Unfortunately, the Pink Parades down the city streets are not sufficient to change the statistics, according to which as many as 2203 women were diagnosed with cancer in 2006 and 846 died despite the expensive medications. The lists of medications subsidized by the Croatian Institute of Health Insurance undeservingly includes certain medications, while the “golden standard” has to be paid by the patients themselves, which only rare “lucky” ones manage to do, most often with the help of their families. Since oncology teams still lack psychiatrists and psychologists, patients with malign diseases cannot get psychotherapeutic support. There is not a single institution offering palliative care and not a single hospice. In contrast, the town of Tuzla in Bosnia and Herzegovina, for example, has a clinic for palliative medicine, and even a children’s hospice. Information on clinical studies is most commonly transferred by word-of-mouth method among the self-searching patients, in spite of the legal requirement stating that all clinical studies carried out in Croatia must be published on the official web pages of the Ministry of Health. The Committee for Health and Social Welfare has brought a draft for the resolution on cancer in June 2009. As the President of the “All for Her” Association of women treated for breast cancer, I was invited to make comments on the draft resolution together with the representatives of other associations. Finally on September 14, 2009, the Croatian Parliament passed the Resolution on Malignant Tumors, inviting all relevant institutions – the Government of the Republic of Croatia, the Ministry of Health and Social Welfare, the Ministry of Science, Education, and Sports, the Croatian National Institute of Public Health, Croatian Institute for Health Insurance, all health institutions and government bodies to undertake all appropriate steps toward prevention, early discovery, and treatment, and other measures including rehabilitation and palliative care, with the aim of reducing the number of the affected and fatalities generated by malign diseases. I expect that the representative of our Association will be included in the working group for the National Strategy for Fighting Cancer.
I often remember Terry Fox, that brave young man. I remember him not only when the Terry Fox run is held; and this year in Croatia it was dedicated to help the research on the hereditary breast cancer. Running my own marathon, I find it hard to make even a mental list of all the steps I have undertaken, jumping incessantly over the hurdles within me and around me, motivated by a single simple human desire – to live to see one more October…