Rural patients already face a tougher road to treatment, simply because of the distances they must travel for healthcare. Mandi Byrne had a more literal roadblock – floods.

When high water levels and washed-out bridges caused road closures, she panicked about missing her radiation sessions. She even looked into hiring a helicopter to get from her home in Parkes to the hospital in Orange, 100km away.

The diagnosis

Mandi’s husband, Tony, found the lump in her breast.

“I sort of knew it was there, but you don’t really pay attention. I had another one in my other breast that was a similar size and I thought it was a normal, lumpy breast,” she says.

“But when Tony felt the lump, it was hard. I jumped out of bed and rang the doctor, I realised it had grown from 1cm – 3cm in two weeks.

“I got in to see him that day, they heard the urgency in my voice. It’s hard to get a doctor’s appointment here, you normally have to wait three weeks, but they looked after me.”

An ultrasound, mammogram and biopsy quickly followed before she was diagnosed with breast cancer.

The treatment

Parkes and Orange are 100km apart, about an hour’s drive. While Parkes has medical facilities, most of the specialists and major medical procedures, including initial chemotherapy and radiation, are done in Orange.

Mandi was referred to a surgeon, who advised a mastectomy.

“I had this feeling of being hit by a train. The specialist was talking at me and I couldn’t understand him. In the middle of the conversation, he said he could refer me to an oncologist because my cancer would probably respond to chemotherapy. So why were we talking mastectomy?” Mandi says she wondered.

“I was totally confused about what to do. Thank God his secretary gave me (McGrath Breast Care Nurse) Di’s number. I knew she existed, everyone knows Di. I got in the car, rang Di and saw her the next morning.

“In that time, she’d referred me to an oncologist, they’d discussed my case and had a plan. When I walked in, Di asked, ‘What can I do for you?’, I said, ‘Tell me what to do.’ And she said, ‘Our team believes the best way for you to go is to have chemo first.’”

Mandi’s chemotherapy shrank the tumour, she then had a lumpectomy and radiation. The cancer hadn’t spread to her lymph nodes, so she didn’t need a mastectomy.

“I had the gold standard of results. Chemo shrunk the tumour and killed everything in the tumour,” Mandi says.

“Having a lumpectomy instead of a mastectomy was so much better. If I hadn’t spoken to Di, I would’ve gone ahead with a mastectomy without knowing there were other options.”

Undergoing cancer treatment during the floods

Six weeks after her lumpectomy, Mandi started radiation.

Di and the Cancer Council had set her up with a house in Orange, so she didn’t have to travel for daily treatment. She’d come home for the weekend, and then the floods hit.

“We’d had a massive amount of rain, five inches overnight on Sunday, and all the roads around Parkes were closed. It was November 14, it had never happened before,” she says.

“The bridge over the Billabong Creek was half washed away and the Manildra road was badly damaged by floodwater. Even the road to Dubbo was also closed due to flooding where we could usually do a three hour loop to detour.

“I rang Di, she said if need be, I could miss a couple of days of radiation, but it made me anxious.

“I have friends with a trucking business and asked them about helicopters, because they were going everywhere around here. Their friends had one, it would’ve been $700 to take me to Orange. I was booked in for standby that afternoon, but after lunch the road opened to Dubbo. It took three hours rather than an hour, but I got to the hospital at 5.15pm and they did my radiation session.

“The thought of missing treatment was stressful. I know you’re not supposed to miss any. I got to Orange and stayed there, for the remaining two weeks of treatment. Although I was really looking forward to taking a chopper, I’ve never been on one before!”

McGrath Breast Care Nurse Di Green’s role in Mandi’s recovery

It’s not hyperbole to say that Di played a significant role in the course of Mandi’s treatment.

Without Di, Mandi would have followed earlier recommendations to undergo a mastectomy, instead of the option of neo-adjuvant chemotherapy, which ultimately resulted in less invasive surgery.

“Di’s in your corner and she doesn’t take any nonsense. It’s all about us,” Mandi says.

“Di just organised my whole life. She’s a proper angel. Nothing was a problem for her.”

When Mandi got Covid and her temperature spiked, Di swung into action.

“She phoned ahead, told casualty that one of her girls was coming in and instead of waiting, I was seen straight away,” she says.

“The process was all so smooth; she just organises every single thing every step of the way. I cannot emphasise that enough – she holds your hand the whole way through it.

“Without Di, I couldn’t do it. I would’ve been a quivering mess on the floor. I don’t know how people with different cancers get by, because the service McGrath Breast Care Nurses provide is just so good.”

McGrath Breast Care Nurse, Di Green

Di Green, 54, has been a McGrath Breast Care Nurse for 11 years at Parkes Health Service, NSW. She looks after a 40,000km square area including the towns of Parkes, Forbes, Condobolin, Trundle, Tullamore, Tottenhan and Peak Hill.

Di Green was one of those people who knew exactly what she was going to be and when she finished year 12, she went straight into her nursing training at Bathurst.

After working in various nursing sectors, she found her groove in community nursing.

“I really loved that, because you got a chance to see the whole picture of the person. You’re not just doing a shift on a ward with six other patients,” she says.

“One day, I went to a lady that had breast cancer to change her drains. She was so distressed because she’d been given a copy of her pathology and didn’t understand it. I didn’t either. I’d never felt so inadequate in my life, so I decided to do a weekend course at Wagga Wagga on breast cancer and what that entails.

“There was no position for a breast care nurse, but a local surgeon found out I’d done a graduate certificate and told patients there was a breast nurse in Parkes. My manager said that if I could get my other patients done, she was happy for me to see them. She helped contact the McGrath Foundation for a position and I went on to do my Masters.”

One of the challenges of being a McGrath Breast Care Nurse in a rural area is that Di does it all, from wound care to being a lymphoedema-trained nurse.

“Working in a regional area you have to wear so many hats because you want your patients to have the best treatment possible. Local physios do lower body lymphoedema management and I do upper body, so people are seen quicker,” she says.

“In smaller areas, such as Trundle, Tullamore, Tottenham, and Peakhill, they only get a physio once a week. The resources just aren’t available.”

She believes it’s a privilege to look after the community, “Patients are experiencing a sudden trauma when diagnosed with cancer and this than affects what they are able to take in when having that first specialist consult. My role as part of their treating team is to continually ensure after they have had time to process information given to them they understand their options so they make an informed decision.”

“I feel like I direct traffic. If a patient is travelling 100km or more [for treatment], the least I can do is make their journey smoother by ensuring their treatment windows are met, and bumping up their appointment if needed,” she says.

“During the floods that was an issue, I was making phone calls all day to make sure everyone knew where they were supposed to be and how to get there. Bridges were washed away and it affected everything, blood pathology couldn’t get through and people couldn’t attend important medical appointments.

“Our chemo here in Parkes had to be cancelled one day, there was no pathology for a few days and we were trucking it across to Forbes in a fire truck.

“There was lots of coordination. One lady was flooded in and the chemist was closed due to the flooding, so she was unable to refill her endocrine medication. It was really hard for them.”

When it came to Mandi, Di’s main role was providing organisational and psychosocial support.

“She was concerned about being at risk of missing her radiation appointments, I reassured her about the timeframe and kept the radiation oncology team updated,” she says.

Di also played a crucial part in ensuring Mandi knew all her options.

“Women should know all their options before any treatment. Going to Google can be so dangerous because you’re not taking in personal circumstances. I ask them what they want, get an idea of where they’re at and allay any fears,” she says.

“I take it really slow and build a rapport with them. I always say, ‘I work for you. I may be funded by the McGrath Foundation, but I work for you and your job is to make sure I know what you want.’”

“Our Breast Multidisciplinary team ensure patients always get a high standard of care.”

While Di has never gone to the Pink Test in a professional capacity, she did sign up as a volunteer under her married name, thinking she would fly under the radar.

“My husband lives and breathes cricket, so I bought tickets for our family so they could watch the cricket whilst I went to volunteer under my married name so they wouldn’t know it was me,” she says.

“Then Glenn walked into the room, I backed into a quiet corner, but he saw me and said, ‘Di, what are you doing here?’

“I wanted to experience the day, but not as a breast care nurse. Some of the girls saw me and invited me to take out the silk with Jane’s face on it. It’s something every breast care nurse should experience.

“Unfolding that silk gave me chills, knowing this all began because of her. It shows you how one person can make such a difference. It’s something I’ll never forget.”

The support of a McGrath Breast Care Nurse is a free service, no matter where you live. To find your nearest McGrath Breast Care Nurse, visit mcgrathfoundation.com.au/get-support/find-a-nurse.