We Can Beat This

The best thing about having surgery is that you remember absolutely nothing. And, when consciousness begins to return it is at best sketchy. This is why I have no recollection of how I got from recovery to my room.

A private room... small, and with a shared toilet, but private. And with a view over a lovely garden! And flowers from Peter on the shelf. No pain due to copious quantities of morphine. I was painless with no worries. A phone call from my brother resulted in a few incoherent sentences about the flowers.

The drug induced fog began to lift slightly somewhere around 5:45 pm. Still no pain but I was becoming more aware and cogent... and feeling a bit peckish, or so I thought.

Dominican Hospital of Santa Cruz is a lovely hospital with a high quality professional staff full of kind and considerate people. Unfortunately their food is.... well let's just say... it sucks. It was probably to my advantage that I could not eat more than a few bites because what little I did eat stayed with me the rest of the night in the form of acid reflux. No pain from my surgery but I was miserable and unable to sleep until nearly 5am.

7 am: Acid reflux gone but now the pain began to settle in. And I needed the toilet but I was hooked up to so many lines and tubes I was afraid to move. A call for the nurse revealed I was not to use the toilet but had to instead use the bedside commode or a bedpan.

I might be able to spill my guts about my feelings, my illness, my hopes and dreams, but I do not use a bedside commode or a bedpan! Trying telling that one to your nurse and see who wins the argument. To make matters worse the nurse had to measure my "output" and post it not on a nice private chart but on a big white board over my bed. I had to go through this indignity twice before I was allowed to use a proper toilet. GRRRRRRRR!!!

30 April, 2010

Beep, beep. Beep, beep.

"Breathe Cathleen, take a breath".  The voice was insistent but not nearly so insistent as the annoying beeping that had forced me back to the brink of consciousness.

I'm breathing, ok? Just let me sleep a while longer. The beeping stopped and I willingly slipped back into sweet slumber.

Beep, beep. Beep, beep. "Come on Cathleen, breathe". Beep, beep. Beep, beep. "You have to breathe".

OK, OK... another breath. There, are you happy? What's the big deal anyway, breathing is as natural as, well, breathing. Turn that bloody beeping thing off and I promise I will breath. Just let me sleep awhile longer.

Beep, beep. Beep, beep. Oh bloody hell, I'm breathing! Are you happy? I'll keep breathing just to keep that damned thing quiet.

"Welcome back, Cathleen. You are in recovery".

30 April 2010.

Today is the day I have surgery to remove my left breast and axillary lymph nodes. Early to rise, and my brother Ray delivers me to Dominican Hospital before 7:00 am.

As I am pre-registered all I have to do is check in with admitting and they take me to a prep room where I am given the obligatory and unflattering hospital gown to change into and then tucked into a narrow hospital bed where I will wait for an IV nurse to set up my intravenous line. The IV nurse is expert at her job and when she is done I can't even feel the IV. Sometime after 10:00 am my Oncologist, Dr Poth, drops in to say hi. Soon after I am wheeled down to the surgery ward and left in a waiting area directly across from recovery.

The surgery ward is a busy area and there is plenty of action and chatter to keep my senses, which have now been slightly dulled with Valium, occupied. My surgeon, Dr Anane-Sefah, comes by and tells me he must mark my chest and I must confirm which breast is being removed. He asks me "We are removing your left breast, correct"? and I confirm this. He then marks a nice big X on my RIGHT breast and bounds off before I can protest.

In spite of my slightly dulled senses I am fairly sure this isn't right and I'm a little bit worried but then I think maybe the X means this is the breast NOT to remove so I don't want to panic yet. It isn't long before the plastic surgeon, Dr. Pletsch,, arrives. She opens my gown then looks at the X, and asks me, "We're taking the left breast, arent' we"? I nod yes, she shakes her head and mutters something under her breath whilst she rummages about for another marker and makes more marks on my chest, this time on the LEFT side.

I have a sense of humour this morning and find odd things to make very bad jokes about - chalk it up to the Valium. Unfortunately I have been waiting for at least two weeks to make use of the one quip I can actually remember and my opportunity finally arrives when the anesthesiologist asks me to confirm that I fasted. I reply that I got there as fast as I could. He smiles and shoots something into my IV port.

It is time for my surgery and I am wheeled down a hall and through double doors into a fairly large theatre with all the usual big lights and what seems like a lot of people for just one little surgery. I am scooted over to the operating table which is virtually as hard as a board. The plastic surgeon, who is short enough that she must need to stand on a box during surgery, begins to arrange my left arm and we chat a moment. But at that instant something else goes into my IV and I drift off in mid sentence. I think the anesthesiologist was worried I had more jokes up my hospital gown sleeve.

29 April 2010: This week has been a blur. While I am greatly relieved to have finally made my decision the stress of waiting for the big day is unbelievable. And there are so many appointments and tests and papers to sign and arrangements to make! I've had multi-country trips that took less planning than one simple surgery!

There are moments and even hours when I am strong and confident. But there are many moments when emotions - fear, anger, uncertainty - rage in me like a flood rushing against an already over burdened dam gate. I am tired and embarrassed of all the tears and so I often find myself bite my lip or pinch myself hard to force my mind off thoughts that will start the tears flowing again. And because it seems that every little thought sets me off that is why my lower lip and arms are bruised and sore!

Peter and I talk every day via Skype, usually for hours. I know he feels guilty he cannot be here for me and while I miss his warm presence terribly, even from a distance I am reassured by his strength and confidence in me. There is no greater healing force than love.

Tomorrow is the big day.

26 April

I will have a modified radical mastectomy of the left breast and removal of the axillary lymph nodes for dissection, final decision. (click here for more info on the importance of axillary lymph node dissection). I will also have a tissue expander implanted under the chest muscle so that I can eventually have the breast reconstructed with an implant.

The decision to go with mastectomy rather than just having the lump removed is a fairly complex one which I am just beginning to understand myself. But the bottom line for me is that since we already know the cancer has become invasive (left the tumor site and entered the lymphatic system), there is a very high chance the lymph nodes are now involved. With a lumpectomy the sentinel (first in line) lymph nodes are often removed but if they show involvement it usually means going back in to get more lymph nodes. Also, because my tumor mass had gotten so much larger after biopsy the surgeon wanted me to undergo chemotherapy first to shrink it if I chose lumpectomy. When I balanced all the scenarios out it didn't seem worth it to go that route so it's off with the breast and a new one in its place (eventually).

Surgery date has been approved for Friday, 30 April. I just want to get this thing out of my body!!!!

Additional breast reconstruction links (be warned, these links have very graphic before and after photos of breast reconstructions.) :
http://www.smartplasticsurgery.com/reconstruction/photos.html
http://www.breastreconstruction.org

21 April - An unbelievably emotional day. The stress of making  choices is weighing heavily on me now. Yesterday as I  watched a video on breast reconstruction at the Plastic Surgeon's office I was frequently  overcome with emotion - is it fear of cancer or facing the loss  of a breast or feeling very much alone in spite of  all the kindness of others. This is a lonely decision  no matter how much emotional support you have - and thanks to all my friends and family, and especially Ray and Kathy and my beloved Peter, I have lots of support

Today I called ALL of the doctors looking for answers to a myriad of questions. The GP is giving me a  prescription for anxiety. Dr Pletsch (Plastic Surgeon) recommends starting immediate reconstruction, Dr Poth (Oncologist) answered my question about the  possibility of radiation (not much chance if I opt for mastectomy but still possible)  and chemo is possible depending on the pathology  report. Dr. Anane-sefa (Surgeon) seems more confident I will  face chemo regardless. The thought of it terrifies me. I cried  myself to sleep in the afternoon.

No one can possibly understand the powerful range of emotions which take hold of a woman when she is faced with breast cancer unless it happens to her. There is something about knowing you have this disease that threatens the very essence of your womanhood in some primal way. I can't explain it and no one really can. It is something that just happens to each woman in her own way.

Some women, like myself, have a need to talk openly with friends and family and seek solace in the stories of others who have successfully overcome the Big "C". For others it is a solitary agony which they are unable, or unwilling to share. But the fact is that thousands of women are faced with all of these emotions and decisions every year and they survive. And so can I.

The technical diagnosis of my biopsy is Grade II infiltrating ductal carcinoma with a Bloom-Richardson total grading score of 6 (tubules 2, muclei 2 mitoses 2). There is focal ductal carcinoma in situ of high nuclear grade with focal central comedonecrosis and lypmh-vascular invasion at the periphery of the tumor. Results on the the paraffin block submitted for receptor panel essay shows I am ER positive and and Her2 negative.

Being the extremely nosy sort and wanting to know as much as I can, I have been doing research on the internet so that I can translate the diagnosis into lay terms. That it is high grade means it is an aggressive form of breast cancer. The term lymph-vascular invasion indicates it has spread, at least to some degree, into my lymphatic system. We won't know if lymph nodes are affected until they do surgery and further tests. ER positive means the cancer is dependent on estrogen and when I figure out what Her2 negative means I'll give it a mention.

What is certain is that I will be undergoing surgery for either removal of the lump or of the entire breast; I have a lot of decisions facing me but I am told I have time to do my research and ask questions. This seems such a daunting task and I am ever so grateful I have someone near and dear to me to help me cope.