On 9 October, my surgeon called me to the hospital to give me the bad news: the cancer was found in one of my lymph nodes.

There it was: despite the hormone therapy, despite a full bilateral mastectomy, despite the prayers and good wishes and hopes, my personal nightmare was not over.

I mention the date because on 9 October, I was completely absorbed in another, much bigger nightmare.

It was day three of the war in Israel, and, like so many other Jews around the world, I was glued to my phone, texting my loved ones, and loading and reloading the news.

Even in the hospital waiting room, I asked the receptionist to turn up the volume on the television as an Israeli mother begged for her kidnapped daughter to be returned to her. I cried.

And then I cried again when the doctor gave me the news, and I cried again when she told me that I would need radiation, which has an 80 per cent chance of damaging my implants, meaning there will likely be more surgeries down the road.

“And chemotherapy?” I asked. Of all the treaments, it’s the one that scares me the most. Maybe it shouldn’t. Maybe I’m just being a baby. But the duration (six months!), the toxicity, and the long list of side effects (infections, anaemia, hair loss, weight gain, bruising, mouth ulcers, brain fog) overwhelm me.

The surgeon didn’t say yes. She didn’t say no. “Did I tell you about Oncotype testing?” she asked.

When I nodded, remembering also that she had told me that the hospital wouldn’t pay for it, she added: “You’re the patient I’ve been waiting for. I’ve been trying to convince the administration to change their policy for years. I need you to fight them to pay for it.”

The Oncotype DX Breast Recurrence Score Test was developed for people diagnosed with early-stage, oestrogen receptor-positive, HER2-negative invasive breast cancer—precisely my situation.

It can provide important and highly accurate information about the behaviour and activity of the cancer. Vitally, it indicates the likelihood of its return and whether and whether I would benefit from chemotherapy.

Most NHS trusts pay for patients to get the test because without it the default is always chemotherapy. A mile and a half down the road from the Queen Elizabeth hospital where I’m a patient, Sandwell and West Birmingham NHS pays for their patients. But not my trust.

It’s a postcode lottery. The test costs about £3,000. This is very expensive for me as an individual. For a trust, however, it can prove a saving as each cycle of chemotherapy costs around the same, and without this testing, I would definitely undergo six cycles of chemotherapy.

The only problem was this: I didn’t want to fight. I was tired and sad. I just wanted to cry.
But what choice did I have?

“OK,” I said, my voice meek and utterly without cheshek, “I’ll fight.” In the car, I imagined my letter: “My name is Karen, and I’d like to talk to the manager.” Oh, what good would it do? I cried.

Of course, my surgeon was right. She had been arguing on behalf of theoretical patients for years, and no one had listened. Now here I was, an actual patient, and an educated and articulate one.

If I had to pay the sum, I could. What about those who could not?

I was the patient she had been waiting for.

When I got home, I prepared a cup of tea, sat down, opened my computer, and composed my letter. I made a strong case, I believe, highlighting the potential quality of life advantage for patients, economic benefit for the trust, and the issue of equity.

I signed my name at the bottom and immediately sent my missive to everyone I thought might be of use: the patient relations office at my hospital; my MP, and the MP where the hospital sits, and two other MPs I happen to like; my surgeon and her boss and her boss’s boss; and the chief medical officer.

Bounce messages poured in. I wondered how many weeks I would have to wait for an actual response. I gave the process a three-day limit. It was Monday.

By Thursday, I decided, if I had no answer, I would call the hospital and pay.

I need not have worried. The following day, my surgeon called. The hospital medical director had read my letter. He called it a “masterpiece.” He would pay for my test. I couldn’t believe it. Neither could my surgeon.

And there was more. “We’re going to pay for all the patients,” she declared triumphantly.

They changed their policy. Because of my letter. I cried — again! But for the first and only time in October, I was crying happy tears.

A victory.

Since then, I have received my Oncotype score. It’s given me the information I was after, and the information, on the whole, is positive. Something of a victory, too, though a small one, less clearcut. I still have a decision to make.

I guess it’s all part of a long battle.