Woman's Hour - Abi Dare, Breast Surgery, Coronavirus

Episode Date: March 4, 2020

Abi Dare has written a novel about house girls in Nigeria. It's called The Girl with the Louding Voice. The main character is Adunni who's 14 and has been sold into domestic servitude. She becomes a victim of rape, abuse and poverty but more than anything, she wants an education.Coronavirus is dominating the news. There's a risk that the TV, radio, and social media coverage can be scary for children. So how do we reassure them, and how do we get the message across that what they do can protect themselves as well as others?After mastectomies the aim is to make breasts look and feel as they did before but sensitivity tends to suffer. We hear about the changes women can expect and what treatments are available for women here in the UK from London breast surgeon, Dr Ayesha Khan. We also go to California to hear from Sarafina Nance who's an astrophysics PhD student in the US. She's leading a campaign to increase understanding of sensitivity and what can help. She talks to Jenni about an experimental nerve-preserving procedure she herself received in the US last year. Women Beware Women is a Jacobean revenge drama about patriarchy, predation and the manipulation of young women. It's on in London and seems very relevant to our #MeToo era. The play features Tara Fitzgerald. She comes into the studio to discuss whether her character, Livia, is just a comical minx or a woman who both controls and destroys lives?

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petrozzella, and from the BBC, this is Extreme Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2, and of the risks we'll take to feel truly alive. If I tell all the details, you won't believe it anymore. Extreme. Peak danger. Listen wherever you get your podcasts.

BBC Sounds. Music, radio, podcasts. Hello, Jenny Murray welcoming you to the Woman's Hour podcast for Wednesday the 4th of March. Good morning. Coronavirus leads the news on radio, television and in print. How do you reassure your children when everyone is talking about it and how can they best protect themselves. The Girl with the Louding Voice, Abideh's novel tells the story of a Duni, a Nigerian girl who wants an education but is sold into domestic slavery. And a contemporary production of Thomas Middleton's revenge tragedy, Women Beware Women, Tara Fitzgerald on her role as the twice-widowed Livia. Now those of us who've had a mastectomy know that the sensation in the breast and nipple too,

which we've been used, has a tendency to be there no longer. Indeed, when my surgeon suggested reducing my remaining breast to match up with the one that now had an implant, I refused. I didn't want to lose all possibility of pleasure on both sides. Even now, 14 years on from my surgery, when reconstruction techniques are of a high quality when it comes to appearance, there's still often a lack of feeling. Well, an American student who had a prophylactic double mastectomy when she was 26 is now heading a campaign about new techniques where sensation might be retained after the operation. I'm joined by Dr. Ayesha Khan, who's a breast surgeon at the Chelsea and Westminster Hospital in London,

and from California by Serafina Nance. Serafina, how did you come to have a double mastectomy when you were only 26? So thank you so much for having me on. So my dad was diagnosed with stage four prostate cancer when I was 23. And shortly after being diagnosed, he was asked to do genetic testing. And after he tested positive for the BRCA2 mutation, his oncologist suggested that I get tested. And I indeed tested positive

shortly after. And so that genetic mutation gives me an 87% chance of developing breast cancer throughout my life. And so when I was 25, I started getting my routine screening MRIs. And after my first MRI, something and it was benign, but the stress of having to undergo those MRIs every six months and waiting for test results and kind of waiting for this inevitable breast cancer um I suggest I I decided basically shortly afterwards that it was time for me to move forward and go ahead and get a mastectomy. And how did you discover that you might lose all sensation even if you had really good reconstruction? Yeah, so when I started researching my surgeon and what type of reconstruction I wanted and just kind of how the process was supposed to go, That was one of the shocking things that I learned.

And honestly, not everybody was talking about it, which was even more shocking. You know, I am a PhD student. I do a lot of research during my job. And so I knew sort of what academic journals to read and how to comb the literature. And that's sort of what I learned. But I was shocked that that was not, you know, emblazoned on every single reconstruction page of, you know, you can expect to lose sensation when you have the surgery and so I sought surgeons that were you know of course really well trained and and doing good work and that was one of the first questions that I asked. And Aisha why is it hard for surgeons to preserve feeling when they do a mastectomy? Good morning. Okay, so I'll just explain the slight science behind it. So when a surgeon's performing a mastectomy,

essentially they're trying to remove all the breast tissue. On top of the breast tissue is a layer of fat before the skin, and it's in this layer of fat where all the sensation nerves run. So if you imagine you're trying to remove the breast tissue, but essentially trying to keep that fat, there's often a fine line between that, particularly if a patient has cancer and you want to remove a rim of normal tissue around it. It's not always possible to leave that layer of fat completely intact. And also different women have different amounts of fat in that layer.

Some women can be quite skinny, but actually have a really good layer of fat underneath their skin before the breast tissue and other women have a very thin layer of fat. And it doesn't always correspond to her BMI and how large she is automatically. And it's important to note that there are two distinct cohorts of women having mastectomy and reconstruction. The first are those with an established cancer diagnosis and whom we have to be very careful to not only remove the cancer, but also to remove a margin around it. And also, and the second cohort are people like Serafina, who actually don't have a cancer diagnosis, but have a very high risk of developing the disease for whom it's quite different. But why hasn't it been a priority for surgeons to look at in the past? What might we do about this? How might we advise women about it? So breast surgery has evolved significantly over you know the past few decades

and this cohort of women having surgery for risk reduction has increased dramatically in the recent past so previous to that the focus was cancer we need to treat the cancer and we need to reconstruct the breast and try to make it look as normal to the woman as possible. That was the main focus and our reconstruction techniques to do that alone were evolving. And I think partly it has also to do with how society perceive women and how society want women to look perfect. And so when patients come to clinic, they ask about, well, how's my breast going to look? Is it symmetric? Is it going to be symmetrical? And we talk about sensation loss. And a lot of women accept that as part of their cancer treatment. But, you know, five, ten years later,

when they go on to live beyond their cancer, it then occurs to them, well, actually, I'm fine from my cancer. You know, I feel as though I'm back to a normal life. My reconstruction looks good, but my sensation is not coming back. So, Rufina, I know you went to a surgeon in San Francisco who's pioneering a new technique what did it involve? So she's a uniquely trained surgeon in that she does both the mastectomy aspect of the surgery and the reconstruction typically there are two separate

surgeons that perform both surgeries and because she has a sort of unique training, during the mastectomy portion of the surgery, she does something called nerve preservation. So those nerves that are in the layer of fat, she is highly conscious of preserving them to the extent that she can. And if they are unable to be preserved, during the reconstruction portion, she works with a nerve surgeon who's coincidentally her husband. And they do nerve grafting where they actually reconnect the nerves. And so for me personally, one side has nerve preservation and the other side has nerve grafting. So what exactly have you got now? We're what, four, five months on from your surgery?

How much can you actually feel? So on my right side, which is the side that has the nerve preservation, I honestly can feel 100% of my breast. The nipple part and the areola part are a little bit numb still, but, um, the rest of the breast is, is basically feels totally normal. Um, and then on my left side, it's about three quarters of the way there. Um, and so the way that nerves regenerate and heal, we expect for that sensation to continue to come back with time typically over the time scale of about a year. Aisha how likely is a woman to find such a technique

in the United Kingdom? So at the moment the nerve repair techniques that Serafina had are very experimental so to explain that I'll just say there are two broad types of breast reconstruction, where one is the implant reconstruction. And the second is where you use tissue from elsewhere in your body, typically the abdomen to reconstruct the breast. And there has been a fair amount of work in America and also the Netherlands looking at preserving the nerve when a woman is having a reconstruction using her own tissue like her abdomen. What Serafina had where she had preservation or nerve grafting with the implant reconstruction is very, very new. And there's only one published study reporting on this and it's very early with very small numbers.

In the UK, the main step towards trying to preserve sensation has been a shift towards trying to do nipple-sparing mastectomies like Serafina had. And that procedure alone seems to improve a woman's sensation after surgery. So we did a study at the Royal Marsden a few years ago looking at breast sensation after mastectomy and reconstruction and this was without any form of nerve repair being performed and we found that in up to 57% of women, approximately three years down the line, they had normal sensation and at least one quadrant of the breast so so if if a woman knows she's going to have to have a mastectomy what sort of

questions should be she be asking of her surgeon well the first question is you know if if sensation you know first question is what if she has cancer or doesn't have cancer. If she does have cancer and, you know, is very worried about her sensation, one way to try and improve sensation after surgery is to aim for a nipple-sparing mastectomy. That is not possible in all women with cancer because the cancer is too close to the nipple. Also in women who are having it as a risk-reducing surgery, it may not be possible depending on other factors like her breast size or whether she's a smoker and any other medical problems she may have. But at least ask the questions.

And it's something that surgeons in the UK are discussing anyway at this stage. Dr Ayesha Khan and Sarafina Nance, thank you both very much indeed for being with us. And if you've had a mastectomy, or you know you're going to have to have one, let us know what you think about this. Would you do anything to retain sensation in your breast? You can drop us an email,

or of course you can text us or tweet. Now, Abby Dare was born and raised in a middle-class family in Lagos in Nigeria. Eighteen years ago, she came to live in the UK and she's just published her first novel, The Girl with the Louding Voice. It tells the story of Aduni, a 14-year-old girl who longs for an education, but like many others in Nigeria, is sold to become a domestic house girl. Here, she goes to a church reserved for girls in a similar position. Why am I not following my madam into the church? I asked the woman after the door has swallowed Big Madam inside of it. The woman stretched her lips into a quick smile. Don't worry, you'll be fine. Follow me, this way. We cut to the far, far back of the church. We reach a house. It is the

first time I see a grey house in Lagos that make me think of Ikati. It has no paint or door or window. Beside it is another small house. I smell the peace before I see the round edge of the white toilet bowl, the broken brown tiles on the floor. It looked like they just builded this house anyhow and throw it to the back of the church after they finish using all the money for the fine church in front. That's where the housemaid service happens, she say, covering her nose with her hand,

the red of her pointed fingernail pressing into her cheek. There's a problem with the toilet flushing system, but that's on the queue to be fixed. Hopefully should be sorted out before next Sunday. Anyway, have a seat with the rest in there. The preacher will be here soon. I step inside, see about five girls sitting on the floor, their head down. They all look the same age of me, 14, 15. All are wearing dirty dress of Ankara or plain material with shoes like wet toilet paper, tearing everywhere. And they all look sad, lost, afraid, like me. Good morning, everybody, I say, trying to smile, to see if I can talk to one of them, to make a friend. But nobody's answering me.

Good morning, I say again. My name is Aduni. One of the girls look up then, hook her eyes on me. There is no kindness in her eyes. She say nothing. But with her eyes, she seem to be saying, you are me. I am you. Our madams are different different but they are the same

Abby what does a louding voice mean so for Adani a louding voice is her way of saying I want an education her mother tells her that this is what we give her a voice and so it's a way of saying I want to be heard I do not want to be silenced. I want to create a legacy where girls like me can be educated as well. So it's all encompassing. Nat, as we had in the extract you read, you've written in a kind of dialect with broken English. Why did you make that decision?

I wanted to reflect some of the housemaids that I saw growing up. I spent nearly 20 years in Nigeria, and it was quite common to have young maids, young girls, who weren't speaking very good English. So I wanted Adunit to navigate her own language, the English language, and to smell her smells, to see what she was seeing, and to really portray this character in the best possible way. What concerns, though, did you have about the way a Western reading audience might read it? I did have slight concerns when I was writing it but I was writing for myself at first I thought okay I'll write this book hear the story understand this girl first and then I put it into a competition a Bat Novel Award competition and it won that so I think that was totally unprepared for.

And so winning that gave me the assurance that the story could be understood and that everyone would be able to appreciate that. So that allayed my concerns. Now, she does suffer sexual abuse. And when it comes to sex, these young women seem rarely to have any kind of choice. How common are the experiences you put Aduni through? When I was growing up in Nigeria, the nearly 20 years I spent there, one thing that was quite common was seeing young girls that were not very well treated, who were maids. You could see them being physically abused. Now, when I started to

write the book and did my research, I found that it was quite common as well that these young girls were sexually abused by the people, especially the men in the house that employ them. And I wanted to reflect that in the story to show that this is something that these girls do suffer. So it's quite common as well. How much did you go back to Nigeria to do your research and check that nothing had changed since you were living there? So I try to go back every year. So I wrote the book over the course of three years,

and when I was writing the book, I went back quite often and speaking to people and seeing even on social media, seeing the stories shared, the articles that I read or documenting this abuse. So it's all there to be seen and to be absorbed, sadly. How conscious are you, though, of in a way fueling some of the stereotypes that exist around africa what i tried to do was to try and show the two extremities so there's a there's a there's a stereotype of poverty but i show aduni leaving rural nigeria where there is poverty to where she goes to lagos and she lives in a wealthy family and sees that

they educated women that there is wealth, extremes of that. So I try to have a nuanced view in the story and to try and balance what has been put out there and portrayed out there. Now, she does, as we heard, meet other housemaids in Lagos and learns that her experience is far from unusual. But what are you hoping your readers will take from her story? So apart from shedding a light and joining the voices that have been speaking up against domestic labour for young girls,

I'm also hoping that we take away from the story Adunis' courage, her resilience, her spirit. She has a fighting spirit. She's a young girl that believes in her dreams and believes her voice should be heard. And I hope that Ruedis can take that away, that the belief in yourself that you can fight for your dreams. But would you describe what happens to her as domestic slavery? Would you be as strong as using the word slavery? I believe it's a form of modern day slavery,

child labour. When I was doing my research, I saw a lot of articles that classified it as that, having a young girl under the age of 18, working in a family in a confined space, was defined within those realms. Now, you've peppered the book with lots of facts and statistics about life and culture in Nigeria. Why did you feel it was important to add those to her story? I was trying to show Denise, trying to satisfy her curiosity, actually. So as she goes through the book, she wants to be educated. She gets to speak better English as the book carries on. But also she wants to be educated about the environment. And I thought it was a great opportunity to show Nigeria as well, the beauty, the challenges, our story through those facts.

What was your own life like in Nigeria? It was great. I had a good childhood. I went to some of the best schools and I really had a wonderful time growing up in Nigeria. But there were things that I saw growing up that I had questions about, such as the patriarchy and the housemaids having young girls working more than, so there are 15 million children out of school in Nigeria, 60% of that are girls. And I wondered why that was the case. Abide, thank you very much for being with us. And I will just repeat the title. It's The Girl with the Louding Voice. Thank you very much.

Thank you. Now still to come in today's programme, a modern interpretation of Thomas Middleton's revenge tragedy, Women Beware Women. Tara Fitzgerald on her role as Livia. And the serial, the third episode of Lamb Produces, The Leopard. Earlier in the week, you may have missed Cathy Sullivan, the first American woman to walk in space. And on Monday, how do women serving a prison sentence keep in touch with their children? Don't forget, if you miss the live programme, all you have to do is catch up. You download the BBC Sounds app and search for Woman's Hour and there you will find us.

Now, the front page of every newspaper and the lead of every news bulletin yet again has the word coronavirus. And this morning, the first words spoken to me when I arrived at work were, are you scared of the coronavirus? So how are children coping with the deep anxiety from which everybody appears to be suffering? How can we reassure them and get them to put it in perspective? Well, Professor Trudy Lang is director of the Global Health Network at the University of Oxford and joins us from there. Emma Citron is a consultant clinical psychologist. Emma, what's the best way to reassure a child that actually they probably won't be affected? I think sticking to the facts is always a good starting point, Jenny. So just letting them know what we know so far and keeping them abreast of the facts. I think the worst thing to do is to try to hoodwink them or

gloss over that. So that's a starting point. And then just to point out, you know, we're not expecting an Armageddon here. We're not expecting to fall off a cliff. We're just expecting to manage and tackle and deal and then going on to quietly reassure them really. We have had an email or a text maybe from someone called Alice who said my five-year-old is very worried having nightmares and thinks we might all die. He thought he would catch it by being bitten by a fox. So I think he half heard something about live markets and filled in the blanks, but he is enjoying singing happy birthday with his hand washing. I mean, that is real extreme anxiety, isn't it? It is. And I think whenever there's something in the press or something going on in the world, it does have this effect on some people. It's recognising that anxiety,

even being prepared to take a child to the GP to discuss it and get a referral if the anxiety stays high. But I think in the first instance, it's a question of trying to present the balanced argument, presenting them with a different narrative that isn't just all about doom and gloom and catastrophe because I think that's often what the headlines highlight. Trudy, we have been told that overall the illness is much less common in the under 20s. Why and how do we know that that is definitely the case? Yeah, good morning Jenny, thank you. So, and it follows nicely from what Emma just said.

So my role in this is a researcher and I'm working with colleagues around the globe to address these unknowns. And what we can also do is help understand the data and put it all in context, which is I think exactly what we've just heard. Yeah, and I'm also a mum, so I'm busy myth-busting with the children and trying to put this all in context. So absolutely, we know from the data that's come out of China, because we're making a lot of progress actually in answering many of these questions and understanding the data, we know from the figures in China that less than 1% of children,

less than 1% of those infected have been children, and none have died. And the majority of the burden of the disease is, of course, still in China. But we have to plan for more transmission in the UK and that's what the politicians have to do. But we do need to keep it in context with the very low numbers we're actually still seeing now. What myths are you busting down with your own children?

Well, I think exactly like we've just heard, they come out with all sorts of things, and they dramatically inflate the numbers sometimes, too. So I think just understanding the facts and putting them in context. Hardly any children have been infected, none have

died, and that I think it's also trying to explain to them the difference between the job of the politicians who have to plan for the worst case scenario but actually we can that's maybe the job of us as scientists and researchers to try and then

put those steps in context and explain it into the reality of the numbers which are nothing like that as yet and may not become that bad either. But what would you say to them about their worries about their mums and dads and possibly their grandparents? Yes, exactly.

Because, of course, it's the older generations that are assumed to be most at risk. And that's where the government and Public Health England and everybody's working to really make sure that the most vulnerable part of the population is absolutely safe and so that's where we're trying to make sure that everybody does the hand washing if possible. We try and avoid situations where those people in the population can be protected and that's why everybody has their part to play but keeping that in context the real risk to the individual is low

extremely low to children but we do need to make sure that if it does pass through the population in high numbers and that's an if that we can look after the most vulnerable and a lot of that is about the hand washing and trying to make sure that everybody doesn't get ill all at once And how easy is it to communicate the advice about hand washing without encouraging obsessive compulsive disorder?

I think this is a very interesting one, Jenny. I think for those people, adults and children who have OCD, obsessive compulsive tendencies, this is not great, this news that we're getting, because clearly it's feeding into that aspect of their mental health. I don't think it's going to trigger OCDs in children or adults, but I do think that it's going to exacerbate those symptoms for people that already have an underlying disposition. Trudy, how much should we be advising them that social media maybe should be avoided? Because it can't necessarily be trusted to be giving them accurate information. I think this is a good question more of a parent than a scientist, but exactly.

And it's looking, I always talk about looking for reliable sources of information and what they're looking at. And I think the fact that this is the same here, that they just need to think carefully about what they're reading and perhaps check it with other sources like the BBC or trusted sources outside of what they've read on their Instagram feeds perhaps. And what do teachers need to watch out for? Because it seems to me when this virus is so much talked about, it might create a reason for bullying somebody. Have you washed your hands? Your hands are dirty. Where do you come from? Have you been in touch with it? That kind of thing. What should teachers be looking for? Well, I think teachers should be keeping an eye out for that,

particularly down ethnic roots or people, you know, with even Italian roots or whatever it is. I think there is a real danger of that, actually, of people being stigmatised in that way. I think teachers are very good at weaving into sort of talk time, class time, general discussions, which cover a variety of topics like the environment and other sources of possible anxiety. And teachers need to be aware of bullying potential and also of the anxieties of the youngsters and how that's being triggered by the stuff that we're hearing about in the media.

And just finally, Trudy, how would you explain the importance of the hand washing? And it not just being about protecting yourself, but maybe about protecting others? Yeah, I think I'd also start with saying that it's such a good prevention step for any infectious disease, including the normal flu. So it's something that children should be encouraged to do anyway. So perhaps it's been a useful step in just introducing that. I've spent most of my career working in Africa and trying to prevent infectious disease spread, and hygiene and hand

washing is central to that as well. So it's a sensible educational step that we can put in. So maybe that's a helpful context to put it in as well. Emma, how surprised have you been at some of the stories where we've heard that kids have not been taught to wash their hands before they eat or when they've been to the toilet. That certainly wasn't the case when I was young. I think it's horrifying. I think we've got a little bit too relaxed and I think the professor's right in that respect. So there have been some useful lessons that have come out of this and I think it's really nice to emphasise the positive and the proactive and what can kids actively do to make a small difference, because that empowers them and makes them feel that they can actually do something, which I think is good for their mental health too. very much indeed for being with us and we would like to hear from you as well. Let us know how your kids are coping with it and how willing they are to keep on washing their hands.

Now somewhere between 1614 and 1620 Thomas Middleton wrote a Jacobean revenge tragedy about the power of the patriarchy and the manipulation of young women, called Women Beware Women. A contemporary production of the play is being performed at the Sam Wanamaker Playhouse in South London. Tara Fitzgerald plays the wealthy and twice-widowed Livia. The Lizard Texera is the young bride Bianca, who is raped and traumatised by the much older and powerful Duke. Here, Livia suggests to her that she'll soon get over it.

Are you so bitter? Tis but want of use. Her tender modesty is seasick a little, being not accustomed to the breaking billow of woman's wavering faith, blown with temptations. Tis but a qualm of honour twill away. A little bitter for the time

but lasts not. Sin tastes at the first draft like wormwood water. But drunk again tis nectar ever after. Tara, she sounds so evil. How would you describe Livia? Well, I don't know. I wouldn't describe her as evil. She certainly wouldn't describe herself as evil. I think she's a woman... I mean, she's an extraordinary creation. I'm slightly allergic to sort of the black and white description

of characters in general. Certainly if you're playing them, I think you have to find some sort of empathy for them. But she certainly behaves in an immoral way, or she sets her own moral standard. And she's operating. She's an operator. She's a pandras.

A pandras? Yes. She's kind of pimped for the bloke. Exactly, exactly. But it's also a very particular world. You know, it's a godless society that they're in, and the worship is for very different things and I think that's what Middleton's trying to say.

So, I mean, I did find her unpleasant, I have to admit. I saw you the other night. What appealed to you about her? What did you find in her to care about? Essentially, in the end, I think whatever the writing is, and by that I mean whatever period it is and whatever genre, I think most people, and I think this in life, most people are looking for love.

And I think that's what motivates, finally, if you like, that would be a character super objective or a person super objective we want to make money because we want to be loved we want to achieve some sort of notoriety because we want to be loved I think that's what it is with her I also find the depth and the honesty

or the brutality of Middleton's writing very interesting. You know, it feels very modern and spare. Yes, he feels very unafraid to look at what we would say is darkness in characters. Now, she does have power in an era when clearly women didn't. What allows her such a relatively powerful position, even though she does do an awful lot for her brother to facilitate his way into misbehaving? Exactly. I mean, and that's to do with her love for her brother

and her desire to please him. But I suppose she comes from a very good family, you know, and she's extremely wealthy and she's independent in her own right, even within this sort of patriarchal society. She's far more independent than most women because of her private wealth, because she's twice widowed. So she's double, double money.

Yeah, she's inherited from two former husbands. Why would you say Middleton would have gone into this idea of saying women should beware women? I suppose it's the last... It would be the idea that the traditionally safest place, you know, the nurturing space, the home, is not safe. I suppose the idea of a, I mean, it's sort of paranoic in some ways, isn't it? Early paranoic writing his writing reminds me more of those sort of slightly schlocky 1970s thriller horror films i i think of those quite a lot in his writing um but i think probably yes where

where should we be safe safest with the the ideal woman the the mad You know, if she turns on you and if she is the whore, what's left? The production is very funny at times and there's music and there's dancing, there's actors actually being the chess pieces in a game of chess. But how comfortable are you with lightening an interpretation of incest, rape, forced marriage?

Well, I think, personally, it's a sort of fine line. You know, at its best, it functions, you know, it slips between the two. So you have these very unpalatable realities being slightly sardonically viewed and humorously delivered because that's a way of taking those unpleasant truths, I think.

But it's a very fine line. It's a bit... He asks you, to my mind, asks you to ride a bit of a unicycle over a tightrope, you know. How relevant do you find it for today? Very relevant. Very relevant. What is evil, you know?

How do we deal with women being non-traditional or pervasive in a way that we can't quite bracket? What happens if we culturally do turn on ourselves in that way? And also still being able to laugh somehow at ourselves in recognition. You know, like the Joker, the film The Joker, I think, that asks you, it asks some very difficult questions, but it asks you to laugh in self-knowledge. You've become a director. Yes, I have.

Gone behind the camera, three short films. What's it like to move in that direction, away from the front and be behind the camera? I love it. I really, really love it. I mean, I love acting. Ideally, I'd always do both, if I'm lucky enough. But to be able to, firstly, to not have that gaze on oneself, to be able to look at others and to study and to also to encourage and nurture creative talents, you know, in all departments. I find that fascinating.

And I love, I love actors. I love actors. I love actors too. But what difference does your experience, long experience as an actor, what difference does that make to the way you direct? Well, I hope there's a sensitivity and I hope there's an understanding and I hope, I mean, for my mind, all any of us need is encouragement. You know, that's what gives people confidence. And if you can find a way to do that for people to access their innate skills or their very particular skills, then that's part of the job.

And I think Greater Minds, the mind said something like, it's 80% casting with directing. And I think that's true if you really get people. And the same casting the net wider in terms of technicians and creatives if you get those jobs right people who are really pro the project then that's a lot of your job done the right person for the job yeah Tara Fitzgerald thank you very much indeed for being with us and women Women, as I said, is on at the Sam Warner Maker Playhouse in South London. Thank you.

Thank you. I was talking to Tara Fitzgerald. We had a lot of response from you on the discussion about breast sensation after surgery. Jill, in an email, said, Loss of sensation can also happen after minimally invasive heart surgery. Jill in an email said loss of sensation can also happen after minimally invasive heart surgery. I received a new heart valve 18 months ago using this method. The scar is only a couple of inches long and down the outside line of the breast so it doesn't show but sensation has been decreased and at times the breast is quite uncomfortable. My GP said this was due to nerve damage and internal scar tissue

and couldn't tell me when or if it would ever resolve. Mary, in an email, said the sheer mention of loss of sensation is so taboo for patients and indeed doctors, many of whom are men. I'm a breast cancer survivor and have lived with this taboo too. It's hardly even something you can tell the girls over a cuppa. Catherine, in an email, said, I had a double mastectomy and reconstruction 11 years ago.

I was 37. I found it very distressing to lose sensation, particularly in my nipples. Along with cancer treatment and the psychological trauma, it contributed to a loss of interest in sex, which was depressing for me and for my husband. I would say to women, don't suffer in silence. It's possible to recover psychologically and to enjoy sexual feelings again, even with a changed and imperfect body. And then our discussion about reassuring children about the coronavirus.

Dot, in an email, said, My nine-year-old is pretty worried about coronavirus. They've been learning about effective hand-washing at school. Unfortunately, he's become obsessed with hand-washing and his hands are now chapped and cracked and very sore. On the plus side, he tells me that school sounds like one big birthday party now, as all the children are singing happy birthday as they wash. Someone who didn't want us to use her name said, just listening to coronavirus and washing interview and want to say a quick i have ocd and for me it's not as the interviewee says i feel reassured that my hand washing is helping me

be safe and has been right all along and sarah said listening with interest to the discussion on children and anxiety around coronavirus. My youngest child is only seven. I try calmly to reinforce the importance of hand washing to both my children without filling them with fear. It's a fine line. Well, thank you for all your responses. Do join me tomorrow if you can. We'll be discussing TikTok. It's become a huge success on social media. It's a free social media app where users create, share and watch videos. So why is it so popular among teenagers? And what do parents need to know about it? Join me tomorrow, if you can.

Two minutes past ten. Bye bye. Hi everyone, Russell Cain here. I've got just a few seconds to tell you about Evil Genius, our hit podcast, two and a half million downloads in 2019, top ten, where we take people from history, Gandhi, Margaret Thatcher, John Lennon, and detonate fact bombs

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Subscribe to Evil Genius on BBC Sounds now. I'm Sarah Treleaven, and for over a year, I've been working on one of the most complex stories I've ever covered. There was somebody out there who was faking pregnancies. I started, like, warning everybody. Every doula that I know. It was fake.

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