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.

DECISIONS, DECISIONS

Vegas did a number on me. (OK, it wasn't Vegas that did it — it was the possibility of needing a double mastectomy.) I am on edge, on the verge of crying, and short-fused. It's a bad mix. I need a solution. Fortunately, Dr. A. is true to his word; he calls Dr. C., the plastic surgeon, over the weekend and I am fast-tracked into an appointment  on Tuesday afternoon. My BFF accompanies me to take notes. 

I like the guy instantly. He asks me to begin with my list of questions because he says he can tell from what I ask how informed I am about breast reconstruction, and this allows him to tailor his answers specifically to me. I love the approach; it makes me feel more in control. He's also very easy on the eyes. (OK, so that's not why I chose him but it's not such a terrible side benefit, is it?) The night before my appointment, I comb through The 10 Best Questions for Surviving Breast Cancer (it’s more like 200 questions, actually) and create a long list. Dr. C. patiently listens and carefully answers every one of my questions. He spends nearly two hours with us. 

Though I have just met him, I decide that if it comes down to needing a bilateral, this is the man to make me look whole again. My BFF feels the same way. (Yup, she agrees he is adorable and the right guy for the job. It's good to have friends with your best interests at heart!)

The Possible Plan (should I need it): Immediate bilateral reconstruction using tissue expanders with a later surgery down the road to exchange the expanders out for silicone implants. (Silcone had issues back in the 1980s, but Dr. C. assures me they are very safe now and prefers them over saline because they are the most natural looking.)

I am thrilled to have my surgical team in place. Now I can focus on figuring out what kind of surgery I need so I can get this cancer out of me. I've been very patient up until today. Now I want it gone. 

The next day is my MRI. I am claustrophobic, so I have to mentally get past this. A technician has me lie face down, with my boobs hanging through holes in the imaging table. (Do the humiliations ever end with breast cancer?) The machine makes clanking noises while I stay perfectly still. I shut my eyes and imagine I am hiking on my favorite trail in the wide-open spaces. I keep my eyes closed the entire time. Fooled even myself; I nearly fell asleep.

I arrange to pick up copies of the MRI films two days later and then take them to my surgeon Dr. A., who gives me the bad news: it's clear from the MRI that due to the size of my mass (3 centimeters), a lumpectomy will, in fact, leave me disfigured. So one week after hearing that I might need one, I bite the bullet and give the go-ahead for Dr. A. to schedule a bilateral mastectomy. 

Dr. A. and Dr. C. will work side-by-side in the operating room; Dr. A. removing breast tissue and any necessary lymph nodes, Dr. C. starting reconstruction by placing tissue expanders under my pectoral muscle to keep my skin inflated while I heal (and eventually filling the expanders with saline over a period of months, then another surgery to swap them out for permanent silicone implants). And this is all going to happen in less than two weeks. 

VEGAS MELTDOWN

To put you in the mindset: I'm in Las Vegas with my two BFFs for a rhythmic gymnastics meet (the daughter of one of my BFFs competes). I am nervous about my upcoming lumpectomy, so this weekend is a welcome distraction. The first rhythmic event is tonight, and we're all really excited. After breakfast, we spend the day walking around The Strip and end our outing at Serendipity, where we wait 45 long minutes for their famous (and fabulous!) frozen hot chocolate. 

We return to our hotel to shower and change. And since I am the official "makeup artist" today, I also apply eyeshadow and lipstick and sparkles to my friend's daughter's pretty face. In the adjoining room, I hear my cell phone beeping. It's now 5:30 PM on a Friday night and my surgeon, Dr. A., has left a voicemail. This is very odd. I've got 10 minutes before we have to leave for the competition. I rush to call him back.

Good news/bad news. He has presented my case before the hospital's tumor board and has called to tell me the consensus is in: I need an MRI of both breasts before I can have surgery. And that's not all. Due to the location of the cancerous mass, my nipple must go. Which means more than half my breast must also go. Which means I likely will need a mastectomy — not the lumpectomy I am scheduled for in five days.

Dr. A. and I had previously discussed this very possibility at our last appointment, and I told him then that if I wind up requiring a mastectomy, I want a bilateral. Remove 'um both, remove as much future worry as possible. And give me some matching, reconstructed boobs. Now he agrees this is the best plan of attack, but the MRI will tell us precisely what we should do. So I need to get that scheduled. In the meantime, will cancel next week's surgery.

My head is swimming. My BFF knocks on the door to say we have to leave. I plead for five more minutes. (I realize this makes the kid potentially late, but I don't know what else to do.)

Dr. A. also adds that I need to see a plastic surgeon for a consultation. Can he recommend anyone? I ask. He gives me two names. But something doesn't feel right. I pause, then say, "If this was your wife, who would you send her to?"

"Does your health insurance let you go out of network?" Yes. "Then if it was my wife, I would send her to Dr. C. He's an artist. We've worked together before. I'll call and tell him about your case, but you give him a call on Monday." 

In the span of 15 minutes, I've gone from mentally preparing for a lumpectomy to probably needing a double mastectomy and a plastic surgeon. This is way too much to process.

Yet my little entourage awaits. So I swallow my fear, force back the tears and step into the hotel elevator. I smile at our little gymnast, but my BFFs can see there's trouble in my eyes. Somehow, we get through the next hour talking about routines and hula hoops on the way to the meet before leaving her with her coach and teammates. We have exactly one hour before the festivities begin. One hour to cry over my beer and dissect my need for a bilateral mastectomy in a nearby pub.

The next day is spent in a stifling hot, noisy gymnasium watching dozens and dozens of  girls perform complicated floor routines to very repetitive music. We are sitting in a crowd of parents and children — certainly not an environment where I can break down the way I need to. I probably should have stayed at the hotel and ditched the meet, but the thought doesn't occur to me until I'm already inside the crowded gym. Besides, it feels better to be surrounded by my friends than be alone with my thoughts. So I suppress my emotions and put on my  "everything's OK" game face. But everything is so not OK.

But eventually I crack. It happens before the final event. I have a hot flash and feel like I'm about to implode from the heat. I can't find enough air to breath, and can no longer hold "it" in. I leave the gym abruptly, wade through the throng of spectators and slip outside where the air feels cool. And I start walking. I pass a playground with seating, but there are kids playing, and I can't deal with their screams. It is I who wants to scream. 

I wander over to a senior center next door and sit down on a cold bench. I'm finally alone — and so numb and overwhelmed I can't even cry. I just sit there and stare into space. 

I needed this weekend away with my best pals before I head into surgery. And if I had waited until Monday to return the surgeon's call, I might well have had the carefree time I was envisioning. But once that fateful call was answered, all bets were off; I lost emotional control. And the road trip quickly morphed into an exceedingly stressful, solitary nightmare on wheels. I call my husband. I just want to come home.