Surgery, Swedish style

I have no insights to offer at the moment, so instead I offer a play-by-play of my mastectomy and axillary dissection experience for those interested in the lurid details.  

Last Tuesday I got up at 3:45am (in itself a feat for me) and took my second “surgical shower:” you wash according to your regular habits; turn the water off; wash yourself from the neck down with a non-lathering surgical soap (active ingredient: chlorhexidine gluconate); turn the water on; rinse. You do this before bed and again in the morning before surgery. It’s a loathsome process but I’m grateful Swedish is so anal in their anti-infection procedures.

I couldn’t eat or drink before surgery, couldn’t put on any lotion or make-up or jewelry, have no hair to arrange, and my clothes would soon be exchanged for scrubs, so there wasn’t much to think about before leaving the house. Except food, but I’m obsessed with food so I did my thinking in advance. I’d packed homemade granola and a box of almond milk, unsweetened dried mangoes, homemade red lentil soup, homemade gingered chicken meatball soup, homemade spiced almonds, smoked salmon, two apples, a pear, tea, and a bar of dark chocolate from Layla.

I left the house at 4:15 a.m. and drove to the ferry, which I then lazily drove onto with a handful of other drivers and a few seriously hard-core bicycle commuters. (Bainbridge bicycle-ferry commuters are The Bomb. The hills on this island are not for sissies.) I reclined the seat and semi-snoozed across Puget Sound. Have I mentioned how much I love ferry commuting?

On the other side, I drove to Swedish, parked, locked my ridiculous food cache in the car and arrived at registration at 5:30 a.m. as instructed. My dad showed up an hour later to babysit my street clothes and make sure the doctors looked legit, and by 7:30 a.m. I was in the operating room inhaling my last breaths of consciousness and hoping the surgeon wasn’t as tired as I was. He held my hand as the gas mask went on my face, a gesture I found chivalrous and humanizing.  

A few moments or hours later, the bleary colors and sounds of the recovery room enveloped me. People in green bent over me and spoke; I spoke back. More green people wheeled me around on my gurney, down hallways and into elevators and down more hallways until I was transferred to a bed in room 305. Brian and my dad appeared, as did a nurse named Kerri.  

Kerri reminded me of someone I know and like, though I can’t place who. By the time two days was over, I was lobbying her to do a locum tenens stint in Juneau. All signs point to failure; apparently she really likes her home, her part-time schedule, her volunteer work, and her husband. Kerri and I talked a lot. Frighteningly enough, I can’t remember everything I told her, and I suspect I mistook the poor woman for my best friend, therapist and sister all in one. For her part, she valiantly tended to my drain (more on that later), measured my urinary output (she declared that I have a nurse’s bladder; I told her my obsessive fluid intake during chemo stretched my bladder), and pretended to be interested in pictures of my children.    

On surgery day, I had three goals. Or I should say, my medical team had three goals for me. Written on a white board on my hospital room wall, under the preprinted heading “Goals for today,” was the following:

Pain management

Urinate

Walk in hall

Being goal-oriented, I accomplished these with reasonable ease and went to sleep feeling I’d done a good day’s work.

The night was tolerable, given that I had to sleep at a 30 degree angle so gravity would pull blood and lymph in the right direction. The night nurse, Mercy, was quiet and gentle. Nonetheless, I was awakened four times: twice by Mercy for vitals, once by a young bearded apparition who claimed he was a surgical nurse and needed to check my drain site, and once by a woman who said she was a surgeon and wanted to see if I had any questions. I did not. Just about everyone asked, day and night, if I wanted drugs. I did not.

My surgeon visited in the morning. He enthusiastically pressed on my bandages to move fluids toward the drain tube. I will only say this was not pleasant. Even Kerri winced.

I ate exactly none of the carefully prepared foods I brought. In the end, the thrill of picking up an old-school corded phone and pressing 55555 to access all the free a-la-carte food I might possibly want overwhelmed my purist pretenses. Besides, what else is there to do in the hospital but get excited about the pending delivery of Seasonal Fresh Fruit Cup, Mediterranean Plate, Oven Roasted Red Potatoes and Bistro Salad? Hospital food has come a long way, baby.

Having fled the hospital the same day when I delivered Alder (residual trauma from a high-decibel night nurse after Rosie’s birth), only to regret my hasty return to dishes and a child and to-do lists, last Wednesday I dawdled at the hospital. My father was on Bainbridge and had brought a zillion-piece Lego City mining set that would occupy Alder for the rest of the millenium. No need to feel guilty, right? So I did more hall walking with Brian, more chatting with Kerri, more getting-trounced-at-rummy, and more a-la-carte ordering. Finally around 2 p.m., we said goodbye and left.

At least, we tried to leave. There was the slight problem of a dead car battery. Once we solved that problem with the aid of Carl from Maintenance, we went to Bartell’s Drugs, as I had signed up to send candy to school with Alder on Halloween for a class cookie-decorating project – yes, his school is surprisingly mellow about refined sugar and food sharing. Although I’m not a big fan of either, I find it endearing that the school is so blithely last-century about these things.  

The past week has been largely dominated by the aforementioned drain. WARNING: If you are squeamish, skip the next paragraph.

The drain is a clear plastic tube about 8 mm in diameter that relieves blood and lymph that might otherwise cause a fluid build-up. The drain begins under the skin. It wends its way around the area that used to be my breast and emerges from a hole under my armpit, where it is sutured in place. At the other end is a grenade-shaped clear plastic bulb. It's not particularly comfortable. Every few hours, or at least three times a day, we have to “strip the milk,” which means squeeze the fluid and clots down the tube into the grenade. We then measure and record volume, and flush the contents down the toilet. Thankfully, this has been Brian’s job. 

The drain remains until I produce under 30 cc’s of fluid a day. Yesterday I got below 175 cc’s for the first time, but it’s looking like I’ll have my little sidekick for a while yet.  

One woman on a breast cancer discussion board, who said she is HIV positive, wrote that she’s squeamish and almost passed out reading a description of how the drains work. For some reason the thought of this woman with cancer and HIV fainting over a drain made me laugh so hard I cried. The humanity of it all.

****

I'm now done with two of three components of my slash-burn-and-poison cancer treatment regime (all that remains is burning, a.k.a. radiation). The infusion nurse at my final chemo treatment asked me out of the blue, “How are you coping with the loss?”

I was momentarily flummoxed. “What loss?” I asked. It was the week of the three-year anniversary of John’s death and two-year anniversary of Ali’s death. What did it say about me on that monitor she’d been reading?

“Isn’t your surgery coming up?” she asked.

Oh, right. I was scheduled to lose my breast in 13 days. "It’s not that big a deal,” I said.

I seem to have a natural anesthetic when it comes to loss. Perhaps we all do. It wears off over time, but I suppose it protects us when the pain would be most acute, allowing us to function and laugh and begin to heal. Little by little, we let in the loss as we are ready and as time and new gifts and new strengths begin to soften the pain. Someday I may lament my missing breast, but for now it’s just kind of a science project on my chest, one I hope expunged the cancer from my body.  

At Walmart the Friday night before surgery. I am asking my friend Shona, "How did my life bring me here?"

Alder and Brian doing the pumpkin slinger at a nearby pumpkin patch.

Alder loves picking pumpkins, slinging pumpkins, carving pumpkins, making Halloween decorations, and decorating Halloween cookies. Just don't try to make him dress up.

 

Moments before Alder refused to go trick-or-treating. OK with me; I was two days post-op and dreading candy battles.