Oh Lucille (Leonie Elliott) … our hearts are breaking for her in this episode. I am grateful to the show and its writers for shining the light on mental health, especially for how it affects healthcare workers. Even with the best of intentions Cyril (Zephryn Taitte), Phyllis Crane (Linda Bassett) and all of the others who love her cannot alter the course of her sadness. And that is the reality of depression; as much as want to, or try to, we cannot will someone we love out of depression. The homesickness for Jamaica and her family, coupled with her recent miscarriage, and inability to conceive, with the added news that her very recently married sister is now pregnant is all too much for Lucille to bear. Thank goodness for friends like Phyllis and partners like Cyril who go to great lengths to ensure Lucille gets the help that she needs. I hope that she is back in Poplar soon!

As a healthcare provider, I really appreciated Sister Veronica’s (Rebecca Gethings) response to Sister Julienne (Jenny Agutter) when Sister Julienne said “it’s never a burden to love or to give”. Sister Veronica’s response of “that doesn’t mean it isn’t tiring” was spot on. We as health care workers don’t often stop to take stock of the toll that our work takes on not only ourselves, but our families, our relationships, literally everything we do. And it’s really ok to step back when you find yourself in a situation where you have so little left, because you really cannot give what you don’t have and realizing when you have hit that points means you are healthy, not that you are a quitter or weak. We would have far few health care worker suicides and burnout if we did a better job of teaching that concept to future healthcare workers.

The storyline of Mrs. Reynolds brought me back to the patients for whom I have cared for who were diagnosed with breast cancer during pregnancy. A diagnosis of breast cancer is devastating at any time, but none more so than when a woman is carrying a child. In the case of Mrs. Reynolds, she is at the point where the baby is term and can safely be born before treatment is begun. But what happens to a pregnancy when the cancer is diagnosed long before the baby is due to be born? The type of cancer Mrs. Reynolds is called inflammatory breast cancer which accounts for less than 6% of all breast cancers. It is very aggressive and tends to develop in women at a younger age than other types of breast cancer. Recall that Mrs. Reynolds said more than once “I didn’t have a lump”, which is characteristic of this type of breast cancer. The changes typical of this cancer are manifest in the skin of the breast itself and Include a discoloration of breast tissue, dimpling (as Mrs. Reynolds described) such that the skin of the breast looks like the skin of an orange. The woman may feel heat from the affected area as well. Whereas Mrs. Reynolds had only radiation available to her for treatment, today this would be treated with chemotherapy (except in the first trimester), mastectomy, and radiation after the birth of the baby. I don’t know if we will see Mrs. Reynolds in an upcoming episode but the prognosis for inflammatory breast cancer is not promising.