12
November 16
St. Louis, Paynesville
In his homily Father Glenn offered several examples to compare to the gospel story in Luke 21:5-19 of temple destruction and persecution. One example, the sense of being adrift from job loss was so powerful I shuddered. The message seemed stark, but he emphasized hope,“Do not be terrified. God sustains us. Trust God will get us where we need to be.” In my days of questioning my purpose, this hit home. I lost a good chunk of my identity as a teacher when I started medical leave and had felt adrift, not wanting to assume the identity as a professional sick person.
2 surgeons, 2 markers, 1 body
The plastic surgeon’s exam rooms were the same size as most clinics, but the tenor was different. It was still medical with the usual smells of rubbing alcohol and bandaids; the usual visuals of medical waste bins, cotton balls and an exam table, but the focus on appearance was pervasive. In the next room over, Scott and I overheard a woman loudly complain that her augmented left breast sagged a bit more than the right. We rolled our eyes simultaneously. The appointment was already running late. I am sure the thin walls have now been HIPAA (Health Insurance Portability and Accountability Act of 1996) sound proofed. Finally, Dr G, upbeat and not in need of any plastic surgery, knocked and entered our room. He took a quick history, nodding after noting two childbirths then asked me to stand. I pulled up my shirt and he gently cupped all the “wobbly bits,” weighing the extra tummy tissue I’d acquired over time and from birthing them babies. I was in misery. Who knew I’d been harboring an entire set of boob replacements? He explained the surgery, risks, and recovery and we agreed to set up the surgery.
I was to wait ten long, agonizing weeks to have surgery because the breast augmentors hogged up time and surgical suites. Did you know they also hugged up the luxurious robes? When I had asked the doctor about this perk my friend had recently told me about, he sheepishly admitted they were for elective procedures only. Moments later he was sneaking me a robe and telling me to stuff it in my bog. He couldn’t find a belt, but the effort was admirable. I really felt my cancer should have allowed us to budge elective procedures, but knew the cash money trumped my malignancies.
December 19th.
On the night before surgery we had a going-away party. Ta-ta to the Tatas. We invited a few friends to dine with us at Hooters. If you are not laughing, please recommend this read to someone else. The perky suntan-nylon, neon-shorty-short-clad wait staff had no idea of our theme, which added to the fun. Ordering chicken breasts was never so fun! The restaurant shuttered its doors several weeks later, but I still smile when I drive by the location.
We were at the hospital’s surgical center by 5:30, prepping for the 10 hour surgery, IV placed, gown on when the plastic and general surgeon appeared. The general surgeon would perform the double mastectomies and the plastic would reconstruct the new set. I introduced them before opening my long blue gown as they advanced with their surgical markers. Plastics wrote in blue and general in black. As they marked up my chest and abdomen, they discussed the procedure but got a little heated when deciding where to start. I awkwardly cleared my throat to remind them I was still fully conscious. All marked up, I was whisked off to anesthesia.
Gradually, I awoke to a nurse describing my green-tinged urine compliments of the radioactive tracer dye. The first thing I saw as I was wheeled out of recovery was a poster with a crossed-out zero for no spread to lymph nodes held by Mack in his gray and red coat beaming at me with Ben in blue peaking in beside him.
From the plastic’s view, surgery was a success with both breast flaps alive and well in their new location. From the BMX view, surgery was a success with clear margins and no lymph node involvement meant I had early stage cancer, stage I. Many people had asked about my stage not understanding that until pathology examined the tissue microscopically during surgery, the stage was unknown. We celebrated the preliminary report that the samples examined during surgery were clear. To check if cancer had spread, radioactive dye was injected in my right breast before the BMX started. I asked what it was, and apparently most people do not inquire since the answer came back with a scowl,“technitium.” While I was in surgery, a geiger counter was used to find the lymph node that had the most uptake. This sentinel node and the next two most reactive were removed and taken to the lab where a pathologist examined them during the procedure for cancer. The plan was that if cancer cells were found in any of those lymph nodes, more lymph nodes would be removed, pathology would examine them and the process is repeated until no more was found. A week after surgery, the official report came back that no cancer was found in the three lymph nodes removed.
Scott, Mack and Ben stayed for a bit as I was settled in the surgical step-down unit, but the weather was getting back with the beginnings of a blizzard blowing, so I gathered hugs and sent them home by 7pm. The boys had gone to school and then gotten a ride with my parents to the hospital. Much later they both reported it was a terrible school day. In hindsight, we should have pulled them out.
It took a few minutes to assess my situation. I had pneumatic compression pumps on my legs to prevent deep vein thrombosis and a catheter that was apparently doing its job. I slowly pulled back my gown and snuck a peek. Bandages criss-crossed my chest like a classic Playtex bra but open in the middle. I could see stretch marks in the skin that had formerly been my tummy. Whoa, my belly button?! I wasn’t aware that it was a part of the surgery. It was at least an inch higher than the original and whipstitched in black thread. Every 15 minutes the nurse came in to gently poke each breast to watch for blood return. The stomach tissue had been harvested and the blood supply reconnected by the plastic surgeon in microsurgery. Four grenade-sized jackson pratt drains with clear tubing poked out from my waist and chest, draining the surgical areas, collecting blood and fluid that would otherwise pool in the surgical areas. I was generally not squeamish, but seeing the accumulations made me gag. My waist was bandaged from left to right hip bone where the football shaped tissue had been harvested. Harvested. The very word made me shudder; I preferred it in the garden sense.
Around 9pm, the nurse became concerned that the left flap was not getting enough blood return. Dr G was called back in and he determined that I’d need to go back into surgery to check for a bleed. He called Scott and reassured him that I would be fine and not to travel back while the anesthesiologists offered me the same cocktail. A small hematoma was found and I was under for only a short amount of time, but another drain was added, so I had five appendages to manage.
Apparently the blood loss from both surgeries took its toll with my hemoglobin dropping to 7.0 After three units were transfused, my hemoglobin gradually rose up to 11.0 in three days. A huge shout out to blood donors everywhere; I never felt so warm or had such rosy cheeks in my life as I did following the transfusions.
Thankfully, the pain was minimal and recovery was quick. A thoughtful friend, Anita, had a care package of tiny diet cokes to sip to ward off any caffeine withdrawal headaches and splashy fashion magazines to peruse. I ordered my favorite meal, grilled cheese and tomato soup, but I longed to be home with my family and my own bed and pillow. The boys came to visit every day and brought a tiny DVD player where we watched The Office together, all huddled around my bed to see the screen on my tray. The Office became a family favorite, but those first episodes were brutal when the belly laughs produced shock waves of pain in my long abdominal incision. Everyday brought a bit more freedom, longer walks, leg pumps discontinued, catheter removal, and longer times between nurses rounding so I could nab a few hours of sleep at night. On the second day, since it was nearing the Christmas holiday, the decision to close a ward was made and I was moved to another wing. We were there for three hours when that wing was closed and I moved back to the first room, but I didn’t mind since it broke up the monotony.
On the third day the rounding nurse said I would be able to take a shower. As soon as she left, I shuffled off to the shower. Most of me was covered in bandages and drains that could not get wet, but I wound tubes around me and did my best. I crawled back into bed to find the nurse surprised by my wet hair. “I was going to help you shower. If you feel that well, we’ll get you home soon!” The hospital stay was to be three to five days, but I got home early on the 22nd, briefly celebrating my birthday by myself with a hearty grilled cheese sandwich, tomato soup and a lovely cupcake.
The surgical note was multiple pages long explaining how the surgeon used the inferior epigastric perforatorartery and vein as a blood supply for the new tenants. The tummy tuck providing the donor tissue was a bonus, but was so tight it was a few weeks before I could really stand up straight. The drains were a constant reminder to proceed carefully as tugging on the tubing produced sharp zings. Otherwise pain was minimal and tolerated with the prescribed daily baby aspirin. Scott carefully emptied and measured and charted the output. The drains were removed when the daily CC’s dropped off. Feeling the tube sliding out and seeing the length was off putting, but the holes immediately closed up and healed quickly; best of all, it was liberating not to have the tubes and drain bulbs carefully concealed in my clothes. My hack was to wear oversized hoodies and cut holes from the inside to the kangaroo pocket then fish the drains inside. Stars aligned in regards to work as I missed the day of surgery and a day of appointments on January 4th, but the rest matched up to our holiday break. On post-surgical day 10 I was given permission to drive again and by day 15 I was back at work part-time. Despite wearing lots of oversized jackets, I still felt self-conscious, like everybody wanted to get a good look, not unlike the first day wearing a bra in middle school. Nobody wants to relive those awkward days.
A few months after the main surgical DIEP flap reconstruction was completed, the other stages could begin. Stage II included reconstructed nipples and amending the corners of tissue left by each hip, called dog ears. (Yeah, I always scoffed when the term “dog ears” was used but there was no other term used. How about hippy nubs or falibular malingulus?) During the first post surgical consultation, I was positively flummoxed when the surgeon breezily asked, “What size and color do you want,” while waving his hand over a selection of nipple samples. I had not given it a thought so I quickly chose the options as close to the original version as possible. I had healed completely but did not want to wreck too much time in the summer recovering so we scheduled for mid-August. August 18th. Our 19th wedding anniversary. The traditional gift was bronze, but I flew in the face of convention and went with nipples, a long lasting and unforgettable gift. The skin-sparing mastectomies created football-shaped incisions filled in with my old stomach tissue on each breast. Somehow the surgeon took the football shape and origami-ed them into nipples. I had these tattooed by the aesthetician over the course of a few weeks with the goal of having locker room-ready boobs so if anyone caught a glimpse they would not be scarred for life by the Frankenboobs.
Physically, I felt well following the short surgery except for the awkward plastic part of this plastic surgery. Apparently nipples are a challenge to keep, well, nipple-like. I was not going with a more obvious headlight model so did not want a lot of tissue filler that would be firm. To keep my new set from sinking, the surgeon lopped off the top of a syringe and sewed it onto the breast. I had to find some very padded bras to keep that under wraps. Thankfully, the plastic sections were removed before school started and for anyone considering DIEP Flap, this method is no longer used.
The final editions are “spectacular” as Sidra in Seinfeld proclaimed hers. Mine are my own tissue so they are warm and change with weight loss and gain. I also never had to have them replaced unlike implants. The loss of sensation is a major drawback, but that was a given with mastectomies. As some of the nerves regenerated, sensation improved. If I had goosebumps, I could see a map of where sensation ended based on where the goosebumps stopped as well. I compared it to the sensation in earlobes and joked that I worried I would end up aflame like Mrs. Doubtfire and need to put them out with hotpads. (If you haven’t seen Mrs. Doubtfire, stop reading and start watching. You need some humor and then would be able to understand my important cultural reference.)
There were many awkward moments in my trudge through breast cancerdom but before surgery pictures were among the worst. I completely fixed the problem by making my own Honky Tonk music during the post pictures. The poor nurse had to take many shots as she kept laughing at my attempt to make the photo shoot more wowza and less clinical. If there are next-level charts that nurses keep that are not official, I am sure mine has some interesting verbiage about my antics.
