When Dr Orla Smithwick entered the consulting room at University Hospital Galway in November 2015 her heart sank. Her eyes were drawn to the box of tissues on the table, the glasses of water, the breast implant on the window, and the brochure for wigs. "I knew immediately that I was in trouble," she says.
She and her husband Declan were waiting to see Mr Karl Sweeney, a consultant breast surgeon, to discuss a "highly suspicious" breast lump which she had discovered recently.
Orla, who worked as an emergency medicine consultant in the hospital's ED department, did not panic when she found the lump.
"I always had lumpy, bumpy breasts since I was in my thirties. I would find a lump and go and get it investigated." And it would always be harmless." She presumed this time would be no different.
"So I toddled off on my own to the symptomatic breast unit to see Karl who was one of my colleagues. I told him my story and he examined me." A mammogram, ultrasound scan, and a biopsy followed. She was not worried as she walked out of the unit.
But when she returned to get her diagnosis she was told the lump was "highly suspicious" and the consultant mentioned chemotherapy and radiotherapy. "He said to come back later with someone."
Orla, who previously worked in UHG, Portiuncula Hospital in Ballinasloe, and the Galway Clinic, was devastated by the news and just wanted to get out of the building.
"One of the nurses in the room asked if I was OK. I said I was grand. All I could think about was getting up the corridor, past reception, and going outside. I wanted to hold it together, I didn't want people to see I had got bad news. I stumbled down the step and had to hold onto the wall."
When she got to her car the "floodgates opened". "I don't know how long I was there. I rang my husband and told him I was in trouble. Then I drove home and got him to ring my colleagues."
She returned later with Declan, who is a doctor, to get a full report from the consultant. He confirmed she had an aggressive form of breast cancer which would require surgery, chemotherapy, and radiotherapy. Fortunately, it was confined to her breast. It was November 2015 and Orla, a mother of three who lives in Oranmore, was 50 years of age.
"My head was in a spin. I didn't ask any questions, I got such a land, a complete shock. I remember my husband was asking how long the treatment would take and he [the consultant] said a year. All I could think was how will I tell the children. They were 13, 11, and 10 years old at the time. They never had direct cancer experience before. At that moment in time I didn't know if I would live or die.
"I got them on the couch around me and said I had been diagnosed with breast cancer. I positioned them so I could anticipate their reaction. The youngest - I will never forget - shed projectile tears. There was this awful roar, so feral. My son (11 ) didn't cry. I told them what I had, what I knew, what lay ahead, and I said I would always tell them the truth. We cried for ages together. I believe it is better to cry it out than keep it in. I told them I was going to be OK. What caught me unawares that night was that my eldest daughter put up a broken heart on Instragam and we started getting text messages to see if she was OK. I had to explain by text to friends so that their daughters would not be worried. There was no chance to process the news."
The next few days passed in a blur. Dr Smithwick tried to maintain a sense of normality at home. She spent her time tidying the house. "I couldn't sit and think. I gave bags and bags of stuff to charity shops."
After her initial tears on diagnosis, she became angry. Really angry. "I wasn't sad, I was raging, I was ripping that I had got cancer. I would walk in the woods talking to myself. I could not see why someone up there came up with this plan. I'd been a doctor for 26 years. Would it not have been better to leave me working as a doctor? The diagnosis was completely unexpected but that is the nature of the disease. Once I started the treatment I realised the cards were dealt and I calmed down. But until my histology came back after the surgery I didn't know if I would live or die. I was not on regular medication before this, only a Panadol here and there for a creaky knee. But now I was leaving the pharmacy with two double bags of medicines."
She had surgery to remove the lump, which was a day procedure, followed by 20 weeks of chemotherapy and radiotherapy. "I had my first chemo session on December 23. It went OK but then later things went sour. I felt I was hit by a bus. That Christmas was completely framed by chemo. I chose to begin it at Christmas as if it was tough at least we wouldn't have to get the children up for school.
"I transitioned from being in control of my life to losing control for eight to nine months. I could not plan anything, you went from day to day. You would make an arrangement for the next day but then you would not feel well and have to cancel. You can feel very isolated. I missed the buzz of work, especially coming from working in a very busy environment."
Losing her hair and eyebrows was a major issue for Orla. "I always had long, blonde hair, it was a huge part of my identity. I lost huge self confidence when I lost it. I avoided looking in the mirror, I didn't recognise or want to see the person looking back at me. I got a beautiful wig of natural hair. But I absolutely hated wearing it as it represented everything that was wrong."
She had periods when she felt great and "could climb a mountain". "Other days I could barely get down the stairs".
She was deeply touched by the kindness of people, including strangers. "My friends and many colleagues were fantastic, they kept in touch. There was amazing camaraderie. I was in a queue in the supermarket one day and was wearing my cancer hat. Someone said: ''Hang in there, I've been there and came out the other side.' I got lovely cards, too. There might be just one line saying: 'We're thinking of you.' That's all it takes. Even months after finishing treatment I would get a card. It was lovely to get.
"One of the things I learned was that cancer is awkward. "It is like an elephant in the room, people are almost afraid to talk about it for fear they will catch it. They don't know what to say so they stay away. But it's OK to text someone and say: 'I don't know what to say.' A hug speaks volumes. Sometimes they don't think before they speak and you get platitudes, like: 'It could be worse.' How could it be? You have all the time in the world to think about what people say [when you are ill]."
With the benefit of time she believes that perhaps cancer was "a good thing in my life". "At the end of the day where I was [in my life] was the Bermuda Triangle. I was working in a very demanding and stressful environment with disrupted sleep [while on call]. I had three children and a dog to walk.
"Cancer got me to readdress my priorities. One thing I learned is that the only person who can look after you is yourself. I have to look after number one now. We as women are particularly bad at this. We have so many balls in the air. I never expected to be out [not working] this long. I don't know how I had time to work before! How were there sandwiches made and food in the fridge?
"I am fine now, I have nerve damage in my hands and feet - complications from one of the chemotherapy drugs - but that is the price I have to pay for being disease free. It can be transient but it was permanent with me. I'd like to go back to work and embrace new opportunities. The time off has given me space, a new perspective on life, and new interests and skills."
She urges women to be breast aware. "October is Breast Cancer Awareness month. One in eight women will be diagnosed with breast cancer in their lifetime so it is incredibly important if you notice an abnormality to act. Once you turn 50, go for a mammogram.
"I was always so busy before, I had no time to get involved in fundraising for charity but I always supported breast cancer research. I fundraise for them now. For me, that's a way of closing the circle."
The Galway Racecourse is partnering with the National Breast Cancer Research Institute to host a fundraiser for the Galway based organisation on Sunday October 28 called "Race in Pink". The institute is a charity which raises funds for the breast cancer research team led by Professor Michael Kerin.