SURGERY DAZE

We’ve been up since 4:15 AM, Husband and I, and by 6 AM I’m laying comfortably in a bed on the second floor of the hospital, with an IV taped to the top of my hand (and yes, it hurt going in). My surgery is scheduled to begin in 90 minutes.

I feel very relaxed, considering. For the past four nights before bed, I have been listening to a meditation CD provided by Blue Shield (believe it or not) specifically designed to calm my pre-surgery jitters. It’s working. I employ the visualization techniques I’ve learned as I lay still —  in between the mind-numbing, repetitious medical questioning that’s been going on since I arrived this morning. 

Every person I encounter asks the same questions. What medications are you currently taking? Have you had any surgeries in the past? What are you allergic to? This gets annoying. Really annoying. It messes with my "relaxed" mindset. So I ask: Why the barrage of queries over and over and over again?

“Patients forget to tell us vital information,” the nurse explains. “And sometimes the info you give us gets entered incorrectly into the computer." Oh. So asking each time ensures everything is accurate? "Yes." OK, I get it. This labyrinth of cross checking and questioning is ultimately for my own good. But I don't have to like it. (This surgery is for my own good too; that doesn't mean I have to like that either.)

My anesthesiologist introduces himself. I let him know that Demerol and I are definitely not simpatico (it makes me terribly nauseous and dizzy). He says they don’t use Demerol anymore, but makes note of it anyway.

Finally, I’m wheeled down to a prep area on the surgical floor, where my husband and I wait in a large square queue of sorts with a dozen other patients having surgery this morning. All that is separating us is a thin curtain (like in an emergency room). You can’t see through the curtain, but you sure can hear through it! My hubby and I amuse ourselves by listening to the litany of complaints and problems and conversations on either side of our curtain.

My surgeon, Dr. A., stops by; he’s dressed in his blue scrubs. I make sure he knows how important it is that he take all of my breast tissue, on both sides. (The point in my choosing a bilateral mastectomy is to reduce my recurrence risk as much as possible; I don't want any tissue left behind that could house stray cancer cells.) He tells me not to worry. I like him and I trust him. He reminds me he is doing the sentinel node biopsy — he'll inject a blue dye near my tumor. The first (or sentinel) lymph node that absorbs the dye is removed and examined for cancer cells. If cancer is found, more nodes will be removed. If no cancer is found in the sentinel node, he likely won't remove any others. (In the not-so-distant past, women undergoing mastectomy were stripped of dozens of their lymph nodes, putting a heavier burden on the ones remaining and increasing the risk of complications like lymphedema.)

Major mental note to self: If I wake up from anesthesia and feel pain under my arm, my cancer has probably spread. (Little do I know that I won't be able to even feel my underarm; it will be completely numb — as will my entire chest and part of my back. Maybe for forever.)

As I am filing this shattering thought away, The Prince of Surgery (AKA my plastic surgeon, Dr. C.) arrives. It’s 7 AM and he’s wearing a dark blue suit, a crisp white shirt and a perfectly knotted tie. My initial reaction is to tell him how fabulous he looks. But I’ve got something else I need to get off of my, umm, chest.

  

I want to go a little bigger.

I know my breast cancer sistahs will howl with laughter when they read this; they are the only ones who can truly understand the phenomenon we have dubbed “boob greed.” But I need Dr. C. to know, in case going just "a little bit bigger” will alter what he is about to do right now. He assures me it will not. “There is plenty of time for that later,” he says. “Today, let’s get the cancer out and the tissue expanders in.” 

And on that note, he pulls out his black Sharpe and proceeds to mark up my entire upper torso, tracing the outline of my boobs and marking their position in great detail. When he's done, I look like a grade school art project gone haywire. (Makes me wish I had my camera.)

Dr. C. leaves my bedside and my anesthesiologist reappears. It's time. I kiss my hubby goodbye with tears in my eyes and leave him standing alone in the hallway as they whisk me away on my soon-to-be magic carpet ride.

But I’m not feeling it — the happy juice, I mean. I am completely, 100% lucid. I make idol chitchat with the nurse guiding my gurney as he makes a sharp left and then an immediate right, wheeling me straight into the operating room.

It’s bright, and very cold. A nurse asks me to slide myself off the gurney and onto the (quite narrow, I might add) operating table. This isn’t easy to do, especially since my arm is attached to an IV; then I realize they haven’t yet given me the “juice” — or they wouldn’t be asking me to “scooch.”

They place my arms on narrow extenders that swing out from the sides of the operating table. I close my eyes and visualize myself standing at the top of the hill where I love to hike. I breath deeply. I can hear voices around me. Then all falls silent.

NORDSTROM RACK

So what are you supposed to wear after a mastectomy? You can’t raise your arms over your head, so pullover tops are out; that means zip-up or button-down shirts are in. Most of the shirts in my closet are body-hugging pullovers with a lower neckline. (I never noticed that before. Funny, the things that pop up when your boobs are getting lopped off.)

I figure I'd better stock up on a few easy-on/off shirts. You know, just a couple of things to make me look presentable post-surgery. (As much as I’d like to wear my bathrobe to my plastic surgery appointments, I don’t think my husband will let me out of the house in it  — even though it’s the spa robe he bought me for Christmas, in the most dreamy shade of pale sage green.)

(copyright 2011 TheBigCandMe)

And so begins My Shopping Spree from Hell.

Since there's no need to spend a ton of cha-ching on these interim clothes, and because I still want to look quasi-cute, I head over to Nordstrom Rack. I comb through the store with all the determination of a tried-and-true shopper in search of a sale, leaving an audible trail of hanger click-click-clicks in my wake. I focus specifically on shirts and sweaters with buttons, snaps and clasps — though patterns, ruffles and layered materials also come into play. My strategy? Find anything that will distract the casual roaming eye from the fact that my chest is literally under construction.

The shirt selection is actually better than I anticipate, and this strikes a pleasurable (and familiar) chord in my psyche. There really is nothing quite like retail therapy. I’m rather enjoying my little shopping foray. I find myself falling — ever-so-slowly — into a kind of hypnotic trance as I sift through the sales racks. And it's taking my mind off my surgery. Eventually I look down and see an enormous pile of colorful shirts in my cart. Wait. What just happened here? I check the clock on my cell phone. I’ve been in this store for almost 2 hours. Whoa. 

I notice a dull headache coming on, probably because I haven't been drinking any water. My throat feels scratchy and dry. I hear a baby start to cry. Then a woman arguing with her teenage daughter. The noise level is crescendoing. The air feels stiflingly warm. I rummage through my cart and return just about everything I've taken painstaking time to select. I hang my returns in the general vicinity of where I found them and decide to keep seven items. I rush to the checkout and am floored to see there's a long line. Man, I really need to get out of here. 

My eyes start darting around the store, as if looking for a fire exit. A ringing cell phone startles me; a woman answers, talking rapidly in a language I don’t even recognize. I feel a swell of anger building up and just then, the clerk shouts out, "Next!" She smiles. I ignore her (though I do help her take my garments off their hangers).

  

I pay for the purchase, cram my credit card back into my wallet, grab the bag and make a fast dash for the door. Once outside and away from the crowd, I begin to feel like I can breath again. But I notice the air is still hot and heavy. I open my car door, roll down the windows, slide into the seat and start the engine. And then it hits me.


I am on the verge of having a panic attack. 

This realization floods my eyes with tears. But why so much anxiety? Why am I crying? Is it because I wasted too much time shopping when I should be doing the 100 other things I need to get done before my surgery? Or is it because I spent too much money on clothes I don’t really like, didn't even try on and will probably need to return because they won't fit or will look hokey or matronly or just plain dull?

It literally takes the entire 15-minute car ride home for me to realize what's really going on.

I’ve just been on my first Mastectomy Shopping Spree, buying tangible items to disguise the fact that in less than 48 hours, I will no longer have breasts. Dayum. If that’s not cause for a panic attack, I don't know what is. (The fact that I chose Nordstrom Rack to purchase shirts for my lack of a rack? Well, that's just good old-fashioned irony.)

GET THIS PARTY STARTED!

One morning, just days before my surgery, I am sitting in my BFF’s kitchen. But this is no ordinary catch-up, chill-out visit. It’s much more personal, educational, important — dare I even say enlightening.

BFF has invited her friend "E." to join us for coffee. E. is a breast cancer survivor. She had a bilateral mastectomy and reconstruction — the same surgeries I am about to have. The entire process, from soup-to-nuts, start-to-finish, took her nearly two years.

That is a very long time.

I’ve known E. for awhile; we see each other at holiday and birthday parties (she and BFF have kids close in age). But I have never had a conversation with E. about breast cancer. Not that I didn’t have an opportunity; I saw her several times while she was undergoing reconstruction, and although I always made a point of asking how she was doing, she always made a point of saying she was fine. I never got the vibe that she wanted to talk about “it” — particularly at a party. And since E. makes a sinfully delicious dirty martini (complete with huge, juicy olives stuffed with bleu cheese), she would always then say, “Want a drink?”

It was soon after my diagnosis (in the same phone call, if I recall) that BFF suggested I call E. But I never felt comfortable picking up the phone; not exactly sure why. Maybe it was because E. never seemed open to discussing BC. Maybe it was because I didn’t know her very well. Or maybe it was because I was the one uncomfortable about opening up. (When my plastic surgeon’s office gave me the cellphone numbers of two women who recently completed their reconstruction with him, did I call them? Nope.) I guess I was afraid to hear all the details — the good, the bad, and the very, very ugly.

But as my surgery date creeps closer, I begin to crave face time with someone who has walked this path ahead of me. I want to benefit from their hindsight. Thankfully, during one of my repeated rants in the midst of all this cancer crap, my BFF had heard me loud and clear and took action, just in the nick of time.

So here we sit, we three women, and now I can’t stop talking to E. about breast cancer! I ask her everything I can possibly think of regarding pre- and post-mastectomy surgery and recovery. My notebook is crammed with questions, from the most mundane (if I can’t bear any weight on my arms, how am I supposed to drag myself out of bed in the middle of the night to use the bathroom?) to the more technical (what size were your tissue expanders? Did your surgeon use a biologic?), to the absolutely, utterly personal (are those [surgeon-created] fipples? Wow!). 

E. answers every one of my probing queries. And slowly but surely, my pre-surgery jitters begin their final fadeout.

The highlight of my meet-and-greet that will forever be seared into my brain is the fact that E. shows me her boobs. Yup, she shows me the money, honey. And they look freakin’ fantastic!  Here's the thing: When a woman is about to undergo the removal of two of her most cherished (and visible) body parts, finding another woman who looks just like she hopes to one day is nothing short of inspiring. Seeing how splendidly medical science can piece us back together (after using their many weapons of mass destruction in the OR to tear us apart) is not just reassuring, it’s downright life affirming. It makes me realize I will get through this. I will look whole again. If E. can do it, so can I.

So after explaining her entire reconstruction to me in great detail (including her complications, which I obviously have blocked out because I can’t for the life of me recall what they are), she casually reveals her "booby" prizes: two symmetrical, incredibly natural-looking, 36DD “foobs.” And they are amazing.

I have been so focused on the deconstruction part of my journey that I haven’t really thought all that much about my reconstruction, even though it is occurring at the same time, on the same table. Today, in the safety of BFF's kitchen, I allow myself to go there. Not only does the experience with E. help soften the mental blow of my mastectomies, but it forces me to truly face what I am about to go through. 

(Copyright ©2011 Rennasus)

These two hours, spent over a cup of hot joe with a woman I hardly know while she shares her most intimate details with me, are not just a bonding moment or a necessary evil or even a way for me to face my internal music; it's all of those things. But more importantly, these two hours are about the sheer force and monumental power of sharing a life-altering experience with another human being who knows exactly what I am feeling, fearing and denying.

And it is this moment that makes me finally ready to climb aboard that hospital gurney and get this party started. Surgery, here I come!

RENN'S TOP 10 MASTECTOMY TIPS

I've compiled some tips and strategies that worked for me as I was preparing for and going through my mastectomy surgery. (OK, there are way more than 10 tips here, but you get the idea!) Maybe this list will help you — or someone you love.

1. CLEAN UP YOUR ACT  A clean house creates a calm and peaceful environment in which to heal. So get cleaning! (It will help take your mind off your upcoming surgery too.) If possible, arrange for someone to handle the cleaning and laundry for the first month after you're home. You won't be able to push or pull or lift anything over 5 pounds post-surgery, so housework is off-limits until your physician clears you for activity. And while you're cleaning house, free up some future brain cells by creating a list of all your logins and passwords for the many banks, credit cards, bill pay and other websites you frequent. Surgery + anesthesia = a recipe for confusion. The last thing you need to worry about is remembering all the important stuff that is currently in your head. Put it down on paper and keep it in a safe place. (Do not store it on a portable device!). I also made notes to myself about how specific bills were paid, just in case I forgot. (And I did!) 
2. RESTOCK THE PANTRY  Load up with high-protein foods and snacks like organic cheese, nonfat Greek yogurt, cottage cheese, tuna fish and peanut butter. Protein promotes proper healing (100 grams a day is optimal) and is vital to your recovery, so don't skimp! Make and freeze meals ahead of time that are simple enough for a child or other family member to prepare. Take a multivitamin. Drink water. (Lots and lots of water.) Place plates, glasses and pantry staples within easy reach on the kitchen counter. Say YES to offers of food from friends or loved ones. Don't be shy about telling people what you prefer to eat (low fat, high protein, no soy, etc.) If you’re lucky enough to have friends and neighbors who want to feed you and your family for an extended period of time, put someone in charge of organizing these meal deliveries (but not you). Mealtrain.com and lotsahelpinghands.com are free and help people organize meals for you and your family.
3. GET STRAIGHT WITH FRIENDS AND FAMILY Make sure you line up peeps to care for all the things you normally care for — your kids, pets, parents, plants, partner. If you live alone, ask a friend to stay with you for the first few days. Again, say YES when someone offers to help you — then assign them a task immediately. People always say "call me if you need anything," but as a patient, you will have more on your mind than finding a way for someone to help you. So here's my take on this sticky situation: If you really want to help, give me some options of what you are willing to do right now. Tell me you'll drop off dinner at 6PM on Tuesday. Tell me you'll take my kids to the movies. (And take my husband too!) Offer to clean my kitchen floor. Just don't ask me to call you from my recovery bed to ask for your help. Because I won't. 
4. GEAR UP THE LOO  Install a handheld showerhead in your bath, and place shampoo, conditioner and liquid soap bottles on the shower floor (because you won't be able to reach anything above your head). Keep an inexpensive plastic shower bench there too. Anesthesia is constipating, as are pain meds; take your Colace morning and night; if all else fails, Dulcolax will save your day. Before surgery, wash and color your hair, paint your nails, shave your legs and underarms. Important note: Post-surgery, use an electric (not a straight) razor under your arms. You will be numb — you won't be able to feel it if you nick your skin. And you don't need to risk getting an infection.
5. MAKE YOUR BOUDOIR COMFY Set up a bedside table with room for anything you could possibly need: drinks, eyeglasses, TV remote, meds, snacks, more meds, books, Kindle, notepad, pen, iPad, iPod, iTouch, cell phone, laptop (and chargers too). Some doctors suggest sleeping in a recliner after surgery. (Many people prefer it to sleeping in bed the first week or two.) Only you know yourself and what will make you comfortable; you may even consider renting a hospital bed. You'll find a neck pillow is handy to prop under your arms. A wedge pillow allows you to sleep on a slight incline (keeping your chest slightly elevated helps with lymphatic drainage) and makes it easier to get up and out of bed post-surgery. Find low-cost pillows like these at Bed Bath and Beyond.
6. GET RETAIL THERAPY Purchase PJ's with button-down tops (and pockets if possible), zip-front hoodies (their interior pockets are the ideal size for drains) and slip-on yoga pants. Oh, and a cute, colorful, light-weight robe for quick coverups when visitors come a-callin'. Go through your closet and pull out all the button-down shirts you own. You're going to need them. You won't be able to reach over your head for a few weeks to put on anything tighter than a large T-Shirt. You may need to go shopping for a few items to get you through the post-surgery phase. I went pre-mastectomy shopping at Nordstrom Rack (read about that experience here) but was not prepared for the emotions that went along with that shopping trip! Yowza.
7. SECURE SURGICAL STUFF Post-mastectomy, drains are put in your side(s) to allow your body to release extra fluid. These drains are thick — the size of a straw — and the part that hangs outside the body is more than a foot in length. At the end of each drain is a 4-inch x 2-inch bulb that excess body fluid drips into. If you are having a double mastectomy, that means you could have four of these drains dangling from your torso. You will have to pin them to your undergarments or tuck the bulbs and drains into something to keep them from hanging and being in the way. If you have a zip-front hoodie, check the inside lining — there are usually small pockets already sewn in that are perfect for drains! If it's too hot for a hoodie, consider buying a drain belt. I purchased one called the "Marsupial" at turnerhealth.com. It's a terry cloth belt with big pouches for the drains. There are items called pocket panties at postop-tions.com; and tlcdirect.org has camisoles with interior pockets. Worried about emptying drains yourself? Sometimes it’s not just a matter of squeamishness; it's painful to reach around and push the fluid down the tube. (The liquid must be measured and kept track of so your surgeon knows when to remove them.) Make sure someone shows you how to empty your drains before you are discharged! Get your prescriptions filled ahead of time (with easy-open lids — unless you have small children in the house). New Rx's that you may receive prior to your surgery include antibiotics, pain meds, and prescriptive antibiotic ointment. And while at the drug store, get a couple boxes of 4" x 4" gauze pads, alcohol and paper surgical tape. Be sure to save all your medical receipts for tax purposes. 
8. ORDER BRAS NOW Ask your surgeon what type of garment you will be going home in and/or need to wear once back home. Some docs prefer surgical bras or vests; others are fine with soft camisoles and sports bras; still others may want you in a compression garment. Each surgeon (and surgery) is different, so ask these questions well before your surgery date and make purchases ahead of time so you will have the garments at home, washed and ready to wear when you need them. Oh, and order two of everything: One to wear; one for the wash. My surgeon sent me home in a very plain, utilitarian (read: ugly!) white compression vest, so I bought a "fancier" beige vest online at contourmd.com. It's lacy and cut slightly lower in front so allowed me to wear a larger variety of shirts. As for regular sports bras which close in the front, the following are popular: Hanes Zip Front Sports Bra and Under Armour Endure Zip Front Sports Bra. I have both the Danskin Now High Impact Zip Sport Bra and the Fruit of the Loom Front Close Sport Bra but they no longer seem to be available — which is too bad because both were very inexpensive. You can find a ton of front-closure sports bra options at nextag.
9. TAKE THIS TO THE HOSPITAL Type up a list of all the medications you currently take, print out two copies, keep one with you  and give the other to a friend or family member. You'll be asked the same Rx questions repeatedly during hospital admission, and this will save you from trying to remember everything. Suntan lotion is great for masking the unpleasant odors that will waft from your body as you recover. (And waft they will; you cannot shower for upwards of a week post surgery.) Plus, suntan lotion will make you think you're at the beach. (Well, almost.) Pack an inexpensive eye mask to dim the bright lights of the big city hospital, and disposable ear plugs to help you catch a wink or three. And whenever someone brings you something to drink, ask them to open it (even if you're not ready to enjoy it yet)! Trust me, you won't be able to open it yourself. Nor will you be able to adjust your pillow or skootch yourself up, down or around in your hospital bed. So basically, anytime anyone is visiting you (nurse, friend, husband, whomever), think of things they can help you with. Important note: Consider asking someone to stay with you overnight during your hospital stay (at least the first night). I didn't do this and wish I had. When no nurses can be found and your pillow has slipped under your bum instead of your head (remember, you can't use your arms after a mastectomy), someone being there to help you whenever you need it can make all the difference in the world to your comfort level. If you are worried about feeling nauseous post surgery, talk to your anesthesiologist. (You'll have ample time to do this while they are prepping you.) He/she can take the necessary steps medication wise to help prevent nausea. Be very specific about your sensitivity to any medications (both Rx and OTC) and be firm about your desire to not feel sick! The meds exist to help you. (You don't have to suffer like I did here.) 
10. GO PHYSICAL, THEN MENTAL Reduce anxiety before surgery by taking a walk, a hike, a jog. Hit the gym and work those soon-to-be traumatized pectoral muscles. Do bench presses and lat pull downs. Try to do 100 pushups. You won't be doing any of these things again for a long while (and in the case of working your pecs, your doc may never want you to work them the same way again). Lastly, imagine a place you absolutely love and focus on being there as you are getting prepped in the hospital for your surgery. Incorporate all of your senses: Imagine the fragrance of the flowers or ocean, imagine hearing the birds or rustling of the trees, imagine feeling the wind on your face, imagine the flavor of your favorite food. And then imagine all the very capable doctors and nurses doing their absolute best in the operating room to rid your body of cancer and start you on a perfect path of healing. Before you know it, you'll be imagining a nurse calling your name — and your surgery will magically be over. Once you go home (after 2-3 days generally), remember to rest. You can't lift or reach or push or pull, so read, write, talk or watch TV instead. Take a nap every day. You'll recover quicker if you do.