Dionne smiles through breast cancer
Dionne Davis allowed journalist Adam Dudding and photographer Lawrence Smith to tell her story as she underwent a breast reconstruction.
There's a woman on the operating table - the still centre of a murmuring huddle of surgeons and scrub nurses.
For a moment it's hard to figure out which end is legs and which is head - both are covered with sheets of plasticky blue cloth, leaving only a section of torso exposed - but then the shapes fall into place.
Roughly where the belly button should be, a large triangular flap of skin and fat is being painstakingly peeled back from the underlying sheets of muscle.
At the other end of the torso, another surgeon has delicately dissected down through layers of red chest muscle to reveal a few centimetres of a stark, white rib.
The operation has been going for about an hour; seven and a half to go. The woman's name is Dionne Davis, and by the end of today part of the flap of skin and fat will have been relocated to the right side of her chest and remodelled to form a new breast, replacing the one that was removed two years earlier.
The surgeon working on the tummy flap is Meredith Simcock. She has done around 1500 breast reconstructions in New Zealand and abroad.
She's the person who convinced Davis it might be good to talk to a newspaper about the experience of losing a breast to cancer, then getting one back. Simcock wants to raise public awareness of the availability and value of breast reconstruction, especially among women who had a mastectomy in the past, didn't get a new breast at the time, and perhaps don't realise reconstruction is still an option.
Davis is happy to do it. She thinks her story can help others, perhaps inspire them.
So on a Tuesday morning in late January, 10 days before Davis undergoes her breast reconstruction at Auckland's Middlemore Hospital, a photographer and I go to her home in Sandringham.
It's a lovely house, with a pretty big garden for a city suburb, plenty of art on the walls, and the unmistakable sign of a resident toddler - raisins all over the floor.
Davis's husband, Kris, a freelance sound recordist, is at home too, in case Samuel, aged 17 months, doesn't sleep exactly when hoped and interrupts the interview, which, naturally, he does.
Davis was 43 years old, and 10 and a half weeks pregnant, when she found a lump in her right breast in February 2012. She figured it was some harmless pregnancy-related thing but Kris pushed her to see a doctor. The doctor sent her to a specialist the next day.
Davis is a management consultant with the global company Hay Group. She travels a lot in New Zealand and abroad.
The day she got her diagnosis she wrote in her diary into the small hours, recalling her dazed state as the specialist recited words like "tumour", "lymph nodes", "chemo", "pregnancy", "decisions".
"My only thoughts were this isn't me," she wrote. "I have too much to do . . . I don't have time to have cancer. It doesn't happen to me. I'm a Jewish princess. I don't do cancer." The specialist said the cancer was aggressive but treatable, though pregnancy changed the available options.
"The first decision I had to make was whether I wanted to keep the baby. Because I'd had a couple of miscarriages beforehand, this was really important. There were a few heavy moments of, well, do we just have an abortion?" In the end, though, "I really wanted to have this child, and I thought, I could do this."
Being pregnant meant the mastectomy was delayed until the 14th week of pregnancy. It also meant the breast reconstruction had to be a separate operation at some point in the future.
Radiation therapy had to wait until after Samuel was born but, remarkably, the first of Davis's two courses of chemotherapy was done while she was pregnant.
"You can't drink when you're pregnant. You can't eat cheese. But you can go under general anaesthetic, and you can undergo chemotherapy - the placenta basically protects the child."
Could the delayed operation, the reduced choices, have affected the effectiveness of her treatment?
"To be honest, at the time I didn't want to know. Being the positive person I've always been, I didn't want to see any red lines." It's a year since her last chemo.
"I like to call myself "cancer free", because that's the only way my mind can deal with it. People ask about my prognosis, and remission. But that word remission to me has always meant ‘you've still got cancer', and I don't want to say I've still got cancer."
Davis was raised in Essex in the UK. She came to New Zealand for six months backpacking in her 20s and never left. She met Kris seven years ago and they married in 2009. She has a strong, beautiful face and big white teeth. When she turns on the full force of her Essex accent for comic effect you can't help thinking of the English actor Sally Hawkins.
When they first took off the gauze dressings after the 2012 mastectomy, she cried.
"I felt completely mutilated. So scarred, so unattractive, so not me . . . I spent a lot of time looking in the mirror." Her right arm often swells up because of the missing lymph nodes. Sometimes she gets tingling sensations as if there's a breast there, but can't scratch it: "I have a phantom boob."
She has a swimming costume that makes it look like she has two breasts, and wears a prosthetic under clothes, though there was the day when she was slightly high on steroids and forgot to put it in.
"It was like, ‘Oh my God. I've forgotten my boob!' Still, you get used to it.
"Now, I see myself with two sides. I have my ‘athletic' side - my Sporty Spice - and then I have my more feminine side."
"I've always been quite comfortable with my breasts, so I've had to get really comfortable with not having one as well.
"If anything, my husband's the one who's found it hardest. Men seem to be more visual than women. Kris was used to seeing me with two very nice breasts, and suddenly instead there's a big scar straight across my chest." Arguably, it was tougher losing her long, straight, black hair to chemo, and that when it came back it had a tight "chemo curl".
"You can hide the breast with prosthetics and clothes, but everyone sees if you have no hair, no eyebrows, no eyelashes, no nothing! I had a free bikini wax."
A new breast will mean she'll be "whole again, or as whole as I can be".
She'll be ticking a box: "This is how I started, and this is how it's ending - I've got my two breasts." Reconstructions come in many varieties: silicone implants, relocated tissue from various sites on your body, or a bit of both.
Davis says her operation, in which belly skin and fat is remoulded to form the new breast, is the "Rolls Royce" operation, in that you end up with a breast that looks, feels and acts most like a real breast (though nerves don't survive the move, so the bottom half of the breast will be numb).
There will be big scars on breast and stomach, but there is a bonus: "I'm going to have a flat tummy, which I've always wanted." She has avoided tanning her stomach all summer for fear of ending up with a weirdly two-toned breast.
The worst bit will be the long wait for the stomach to fully heal. She won't be able to pick up Samuel for four weeks at least.
"I'd love to know what's going on in his mind. If anything, he probably thinks, ‘Who's that woman over there with two breasts? Isn't that weird? My mummy‘s only got one and she's normal."
After the interview the photographer, Lawrence Smith, turns the sitting room into an ad hoc studio, and Davis undresses. She has shown friends and close family the long, sloping scar that slices across the flat space where her right breast used to be, "but I don't walk about the room and say ‘Boom! Here's my scar'.
"I have had a friend who said ‘Can I have a look at it?' and then said ‘It's beautiful' - and actually meant it."
She has already had some photos taken for herself - a slightly crazy photoshoot where she wore a fur and a hat, and lay about in dramatic poses. She was still pregnant, "so I had the big belly as well as the scar".
She and a friend also made casts of both breasts before the mastectomy. "They're upstairs. I had this vision I was going to make jelly moulds out of them."
Smith is planning on something rather less exotic - probably some moodily lit photos involving tasteful placement of hands and draped cloth. All the same, Davis has some reservations.
She's doing this interview to show "that you can be diagnosed with an aggressive breast cancer, and you can be pregnant, and have a baby, and live to tell the story." Photos, though, might pigeonhole her.
"I want people to see me as me - facilitator, management consultant, person, mother, daughter, whatever - not as, ‘oh she's the lady who's shown her scar'.
"I do not want to be called the cancer victim, because I am not a victim." Reservations or not, she's a great photographic subject - relaxed and co-operative, and so smiley that Smith occasionally asks her to try a more serious expression. Samuel wanders in mid-shoot in his nappy, so she scoops him up for some topless mother-and-son shots.
A week and a half later, early in the morning, Davis is sitting in a waiting area in the Middlemore Hospital labyrinth, wearing a hospital gown and hat and compression stockings. Her friend Teresa, the one who helped her make the breast moulds, is holding her hand.
Davis is jokey and jittery, chattering about what kind of herbal tea she'll drink after the operation, and showing off the thick pen-lines on her chest pointing to the surgeons' targets. I feel uncomfortable intruding on these last anxious minutes and don't ask any questions, but there's something Davis wants to say anyway.
"I was having some concerns after our photoshoot. Lawrence didn't want me smiling. It was all ‘don't smile, don't smile'." She worries the photos will tell a story of a miserable "before" and a happy "after".
"I've always been really positive, and the last thing I want portrayed is, ‘It's this really serious thing, but now she's had the operation it's all fine.' Because it was fine before too - you know what I mean?" I do. I assure her that among the hundreds of photos Lawrence took, there will be plenty of cheerful ones too. She seems relieved.
A couple of hours later, Davis is on the operating table. The four surgeons and two scrub nurses surrounding her stand so close together their heads almost touch. Beyond Davis's feet, two anaesthetists monitor a jumble of machines and screens.
On Davis's belly, Simcock is using a blunt electrically charged scalpel that cauterises as it cuts. As she moves the scalpel along the line of separation, tiny high-voltage sparks arc and buzz. When the surrounding muscles start twitching, Simcock quietly asks for a little more muscle relaxant to be added to Davis's anaesthetic cocktail.
Guided by pre-operation scans, Simcock is looking for the half-dozen tiny blood vessels that supply the belly skin. She will then follow one or two of them down through the stomach muscles to an artery running deep below. When the stomach flap is transplanted to the chest, the long, dangling artery will come too, ready to be re-attached to another artery fished out from the chest cavity and given a new job. The two arteries, just a few millimetres wide, will then be joined end to end with hair-fine stitches.
Its high-wire stuff, but Simcock says the surgeon's motto is "always have a lifeboat", and she has one. For reasons of symmetry skin is removed across the full width of the tummy, but only half of that is needed to make the new breast, and the other half is discarded. If the blood vessels on the left aren't good enough, Simcock can always look on the right.
Meanwhile, microsurgeon Alessandra Canal has reopened the mastectomy scar and dissected down to a short section of rib that will be removed to allow access to the chest artery.
Canal marvels at a blood vessel she's found. Through her head-mounted binocular microscopes, it looks enormous.
"It's beautiful. It's a beautiful blood vessel." I am in the operating theatre for just half an hour in the early stages of the operation, but it's surprisingly draining. There is something very intense and alien about watching people digging beneath the skin of another human, yet there is a curious tenderness to the way Simcock and Canal and their colleagues prod and cut and pull.
By late afternoon, Davis will have a new breast - the top a pocket of chest skin with former stomach fat tucked up inside, the bottom sculpted from belly skin.
A few days after the operation, Davis sends a brief, chirpy email to say she now has "a very perky new accessory", though it feels a bit weird after two years of having nothing there. She is busy learning how to stand up straight again - "such a simple task u may think . . . !"
We've made rough plans for a follow-up interview and photoshoot five weeks after the operation, but Davis is hard to track down. When we finally speak, worrying news. She's just found a new lump in her armpit while showering. The biopsy shows it's cancer again. She's booked in for surgery in a few days to whip it out. Oh.
A month passes. Davis emails again: "We need to catch up."
On the morning of the reconstruction, Davis said she didn't want her story to be a hackneyed journey from Sad to Happy. Now, there seems more danger of the journey going in the opposite direction. What was meant to be a story about breast reconstruction. has turned into one about cancer.
We speak on the phone a few times. I say if she wants to abandon the story, that's fine. She probably had more important things to worry about.
Davis says wants to stick with it - to share her story, to raise awareness. She's just written a Facebook post about the new lump, in which she quotes from The Shawshank Redemption: "Better get busy living or get busy dying", and then writes: "I'm all up for the living part." So a couple of weeks later, back to Sandringham for the follow-up interview and photos.
Davis is looking great - energetic and healthy - apart from a sniffle she's caught from Samuel.
She can still remember how it felt during the month between the reconstruction and finding the second lump.
For Davis, and for Kris, there was a sense of heightened positivity. With the return of her breast, the last box had been ticked. This was the year when everything was going to be fine.
The operation had gone well.
"Allesandra said to me I had the most amazing connective tissue. She said, ‘you'll never sag, never wrinkle, amazing'!"
She was in hospital five days. Her stomach was corseted by a huge dressing, but the breast was on display from the get-go. For two days its temperature was checked every couple of hours, to ensure blood vessels had connected properly, and the breast was covered in gold foil to keep it warm.
"I felt like a Roses chocolate".
Once home, "I was very proud to be showing a breast versus a scar. People could be slightly horrified by the cruelty of what happened to me, but showing a breast is quite different." There's no nipple yet - it will be a relatively minor procedure - but Davis is in no rush.
"For me it's quite good not having one. I've got quite ping! nipples," (she demonstrates with pistol fingers), "especially in cold weather. Now I've got only one Ping!, which is a bit awkward, but quite funny really." Apart from being a tad perkier, the new breast is a good match for its partner. "Wear a bra and you wouldn't know the difference."
As warned, it took weeks for her stomach to heal. There are hundreds of internal stitches, and the bellybutton was rethreaded through a new hole further up her stomach. With all that skin and fat removed though, "my tummy looks great. The problem is I need to get new clothes, because my clothes don't fit." Friends tell her she looks fantastic.
"People say, ‘You've had a breast reconstruction, that's amazing - so are you clear now?' Well yes, I am, but I don't know for how long. The prognosis - it's a tricky one." Unusually, the second lump was of a different kind from the first - "triple negative", rather than "estrogen positive", and her oncologists say there is currently no benefit in more radiation or chemotherapy, though she is still taking the breast cancer drug tamoxifen. The lump came out easily, leaving just a small scar in her armpit.
"They've called it a ‘regional recurrence'. It's in the same place, so the thought is that it's just the last node that was left. I have to keep that in the back of my mind - we've got it all now; we didn't get it all last time, but we've got it all now.
"After this, my chances of it coming back in the next 10 years have doubled, from 15-20 per cent to 30-40 per cent. But the way I look at it, that's still a 60-70 per cent chance of it not coming back.
"Because there's no treatment as such, it's about me being healthy and living each day, and doing my detox and taking my herbs and eating vegetables. Luckily I like broccoli." The last couple of months have been "more than hard" for her and Kris.
"It's broken us, in some ways. It's taken the rug from under our feet."
"I'd been to see my oncologist. I was driving near Auckland Grammar School. It must have been about 3.30 and all the kids were coming out, and I had a moment: Am I going to see my son becoming a spotty teenager, dragging his bag home from school, yelling ‘Muuuuum, where's my lunch?'
"Even closer than that: coming out of Greenlane Hospital and seeing a four-year-old child with his mother, and thinking, ‘Am I going to see my son at four?' I have moments. It hits you in the guts. I've had conversations about death. I never had that in my mantra. I was always going to be here forever."
Even when talking about such dark things, Davis is extraordinarily composed - dry-eyed, funny, upbeat.
Yes, she says, that is a brave front to some extent - probably only Kris gets to see the unvarnished version - but the positivity is real.
"If I had given up hope the chances are my body would do the same thing. I'm realistic, but also determined that I'm going to do whatever I can to keep going. I've always been very positive, very determined."
Any regrets about getting the breast reconstruction?
"Oh," says Davis. "That's a tricky one." For a moment, her eyes well up. "It depends who you talk to. If you talk to the surgeons, they say having the reconstructions had no bearing on the fact that this has come back.
"I get emotional, because potentially I think it may have done. My acupuncturist or other people could say having a thing down your throat for eight hours stops the immunity function kicking in, which stopped me fighting what was going on. But surgeons would say it was already there."
Davis's father is a pharmacist. She has a food science degree. She knows the difference between empirical evidence and the claims of alternative medicine. Is there any scientific evidence to say reconstructions may be risky?
"No. And this why I have to let that go. I'm really happy that I got this done. If I hadn't, would I have been less aware of having another lump come back? I may not have noticed it for longer. This happened within a month - a really short period of time for it grow. Boom - it happened."
Smith takes photos of Davis with her new breast. Once again, Samuel crashes the party and ends up in half the photos.
A few days later, I call Davis back. Smith has shown her some of the photos. What did she make of them?
"I was looking at the before ones, and going ‘My God, I was a podge-fest.' I looked older than I do now, and I had a really deep tan." And the after pics?
"I think I look bloody good." What about the new breast specifically. How does it look through a photographer's lens?
"Overall, it looks amazing. Lawrence tells me I should stop looking at the details.
"I saw a little pucker underneath, where it's not completely round, where my bellybutton was. Most people don't see it, but I do.
"It's like a little koru - which is new life. New life and a new beginning, and it's on my breast. When you've had a life-threatening illness, or a heart attack or something, people end up having to relook at their life . . . I've had to do that, and I'm still doing it."
Sunday Star Times