‘But it’s not determinative, of course,’ the doctor adds reassuringly. ‘If you’d like, we could check your hormone levels while we’re at it. And we can consider prescribing oestrogen if you continue to feel tired and low on energy. But we have to wait for the test results and the mammography first.’

‘So I should take hormones to feel better? And increase my risk of getting cancer . . .’

She trails off yet again. Suddenly, everything seems so hopeless. She’d been prepared to be admonished for her lack of stamina and she had agreed to subject herself to the torture of having her breasts flattened in that infernal machine. Hurt like hell, it did, but she’d been stoic about it.

But menopause? Oestrogen? It’s too much. Horrified, she realises tears are trickling down her cheeks. She begins to search through her pockets and gratefully accepts the tissue Ursula Lek hands her.

‘Are you worried about the mammography? I can see you were smart enough to get one this time. Do you know if there’s breast cancer in your family?’

Karen shrugs.

‘Grandma died of cancer, but I don’t know what kind. She died before I was born.’

And what about Mum’s oldest sister? she wonders inwardly. Aunt Pam who emigrated to Canada? Who died just a few months after John and Mathis. A vague memory – but hadn’t her mum said something about cancer?

Why have I never asked?

But she knows why. At the time, she’d been paralysed by her own grief, barely noticing what was going on around her. Hadn’t had it in her, hadn’t been able to.

And then she’d forgotten.

‘And I thought I felt something in the shower the other day,’ she admits.

So quickly and quietly it doesn’t have to be real.

But Ursula Lek hears it. Asks more questions, frowns, nods.

Karen watches her take notes with a sinking feeling in the pit of her stomach. Then the doctor looks up again and smiles.

‘I think you should hold off on worrying until we have the results. When did you last have a smear test, by the way?’

‘Don’t remember. I’m pretty good at sticking my head in the sand.’

‘Then why don’t we have the nurse book you in for that, too, so there’s one less thing to worry about? And I think we should check your thyroid function while we’re at it.’

‘That sounds expensive. I don’t think my bosses are going to want to pay f—’

‘I decide what tests are warranted,’ Ursula Lek cuts her off. ‘And if there’s anything there, which I doubt, it’s always better to know sooner.’

Karen shoots her a dejected look.

‘OK. Let’s do the smear test, too, then.’

‘And you’ll have to come back in six weeks to follow up on that fitness test.’