Eviction Notice - You Got Served!

Finally - surgery.  Lumpectomy, sentinal node biopsy, and port placement.  Having been through each of these procedures before (albeit at different times), I thought, Let's be practical - I've got a holiday off work, let's do this all at once and get it over with.  I'm literally "shivering with antici......pation", wanting so desperately to have answers to the myriad of questions that continue to grow each day.  So we schedule all three procedures for yesterday and, well.......I'm glad it's over with, but what was I thinking?  Thank god for Vernors and pharaceutical intervention.

I received word late last Friday that my insurance had approved genetic testing, so the first stop of our day (dubbed "The Tour of a Thousand Pokey Things")  was the oncology center for the blood draw.  Instead of utilizing the lab they took us back to the infusion center, "Chair 11" (which is designated by a large, glittery Vegas-like arrow hanging from the ceiling).  I remember this chair from previous visits as the location where Neulasta shots are delivered.  I hadn't been back to the infusion center since my last chemo almost four years ago, and was quickly reminded of The Smell - medicinal, salty, Heparin-y, icky, that smell you can taste in the back of your throat, the smell you still smell in your dreams and nightmares.  It's a scent unique to the infusion center, and for some reason I felt tiny tears spring to my eyes, but only for a moment.  Got no time fo' dat, not on a busy day like this.

I was in the infusion center, it seems, because the nurse thought I already had my port and planned to draw the necessary blood from that.  Alas I did not, but she quickly poked me with a butterfly and we were off to the hospital to check in.

(Damn the "nothing to eat or drink after midnight" rule; I desperately needed some gum or rum, or even a good run, to get that tasty smell out of the back of my throat...)

The outpatient surgery unit now requires the patient to use warm, sticky wipes to clean and prep the entire body to reduce infection.  Luckily, I got to give myself the sticky-wipey-sponge bath, but then I stand there naked and wet, freezing and sticky, waiting to dry off just a little bit before putting on my gown.  Which then sticks to me everywhere anyway.  I put it on backwards first - easier to tie in the front, I figure they'll want it open with Lucy more easily accessible.  Except that Ethel kept peeking out, jealous again the Lucy was getting all the attention and hoping someone would take notice of her too.  So I peel the gown off my less-sticky body and put it on properly, having Ken tie me all up the back.  As I slide back onto the hospital bed I notice a little pocket on the right-hand side and, looking down, see Ethel winking up at me.  Damn you, broad - you really don't want a piece of this shit...

And so the action of the day begins.  First stop is the radiology department for an ultrasound-guided wire placement.  The radiologist who performed my biopsy a couple of weeks ago is present to once again stick stuff in Lucy - this time an ultra-thin and super-long wire to pinpoint the exact location of the mass to be removed.  The surgeon asked for this wire placement to help him locate the mass.  Instead of making an incision directly above the mass (which would leave a visible scar near the center of my chest), he was going in at an odd angle from somewhere between the mass and my nipple (which is the area that will be removed during mastectomy, so ultimately no scar will remain).  A few numbing shots and the radiologist inserts a needle into Jabba (this time I watched on the ultrasound screen - which was both creepy and fascinating), then slides the wire into the needle, and into Jabba.  In, also, goes some blue dye to mark the location, and out comes the needle.  I look down to see about 6 inches of wire coming out of my breast.  WTF?  I think the puppy-dog fear in my eyes belied my concerns; the radiologist smiled and said, "Don't worry, we'll wrap it up for you."  And that he did - coiled it around his finger, laid it on my breast, then covered the entire area in a plastic bandage.  

That's handy.

The wire inserted, I am whisked down to mammography, to squish Lucy (with a WIRE inserted into her, no less) in all directions to ensure the wire is where it needs to be.  That fun is followed by a trip to nuclear medicine for the sentinal node injection - except this time, I'm being blessed with two injections.

I've had this injection before, and I know what's coming.  The needle poke itself isn't the hard part - that's the "bee sting" they warn you is coming.  "Now you'll feel a little burning", says the PA, as he injects the radioactive solution into my breast.  Except that it feels like molten lava trickling down the needle and into my breast.  Last time I had this injection I vaguely remember levitating off the table.  This time I burst into tears and cried out loud.  Before I even realized it I was begging the PA stop.  Bless his heart he said he couldn't stop, and I knew that, and I didn't really want HIM to stop, I just wanted the pain to stop.  In 10 seconds the injection was over, but the hot-poker fire of pain remains, and I cry for another minute as I compose myself to prepare for the next injection.  I cry again, I levitate slightly, and it's over and done with.  I apologize profusely, blubbering and embarrassed and angry and feeling so, so stupid.  The nurse - her nametag indicates she's a student, and I felt really bad she had to witness my inability to endure a little pain - pats my hand and says, "No need to apologize, we should be apologizing to you for hurting you!"  The PA is already long gone, no doubt frustrated with my lack of control (I know I am). 

After all this fun we make it back upstairs to pre-op.  In my absence someone's decided to give birth, and my anestheiologist is busy with the c-section.  My surgeon has his hands in someone else, so we wait patiently for our turn.  And then suddenly everyone's on our doorstep, making introductions, shaking hands, explaining procedures.  

I've had a cold for a couple of weeks and I decide at that moment to have a small coughing fit.  One doctor smirks, and says cancelling surgery now would be like cancelling a colonoscopy after all the prep.  She warns me about the possibility of pneumonia as they'll be intubating me, and makes me promise to see a doctor if my cough becomes "productive". (Sister, I've got a WIRE in Lucy and molten lava coursing over to my lymph nodes, so I'm pretty sure that we're going ahead with this surgery, m'kay?)  

Our surgeon lifts up the mammogram films to ensure the wire is placed properly, and says, "I don't see anything."

I pull down the top of my gown (which has never been properly rebuttoned after all this fun) and point to the wire coiled neatly on my breast.

No, he says, I see the wire.  But the tumor isn't on the film.

He shows it to me, and sure enough - there's the wire.  And there's the little clip the radiologist left in my during the previous biopsy.  They're both there, on the film, as though they're hanging in mid-air.  There's nothing on the mammogram to indicate there is any tumor or mass or growth or anything in my breast.

I look at him quizzically, cocking my head to one side, saying, "What the hell?"  He picks up the other film and holds it to the light, and we both squint to scrutinize it (it's my boob, I get to play doctor here).  "There," he says, pointing to a faint haze, just slightly darker that the surrounding breast tissue."  That must be it."  I squint a little harder, and it's there, but barely, not really, just maybe...  I ask if that's what it should look like and he says no.  I tell him we saw it on ultrasound, I know it's there.  He knows it is too, seems more curious than concerned.  I've got joy juice in me by that point so I really don't care.  Hopefully he follows the wire down the rabbit hole and finds Jabba at the other end.  I just kinda want to get this show on the road.

I vaguely remember being whisked to the surgical suite and sliding over to the operating table.  I'm fuzzy by now but I remember thinking the table felt vaguely crucifixion-like, as my arms lay on the arm boards sticking straight out from the table, using "seat belts" to strap my arms and legs to the table.  The mask covers my mouth and nose, I remember one, maybe two breaths...

...and then I'm waking up in post-op, covered in warm blankets with a canula up my nose and that little blue cap falling into my eyes.  The clock across the way says 3:05...blink-blink...now 3:30...the nurse is poking me to wake up, takes the canula off, then puts it back in, takes off my cap, now the clock says "moooooo....", wait, almost 4:00...

I get the pain-scale question, I'm fuzzy but it's a 5, although I want to say a 6 but I feel like I should say 4 but what the fuck let's just say 5, no 6, then the Fentanyl brings it down to a 3...

I get the lecture about staying ahead of the pain, and it's then that I realize my entire chest is covered in puffy gauzy bandages.  From my right shoulder over down to my left side.  Ken comes back and explains that everything went really well. 

Portia is back (I'm reported," I say to my nurse...who crinkles her nose in confusion...really?  Ported again?  Re-ported?  Reported?  Sounded funny in my head...).  

The surgeon was able to find two sentinal nodes and remove them.  No visible signs of cancer but they're off to pathology for closer inspection.  "She won't be happy," the surgeon tells Ken.  The nodes were far apart so there are two incisions, one under my arm, the other farther down.  And he's wrong - I'm ecstatic and would be even with more incisions.  There was a good chance we wouldn't find sentinal nodes due to previous radiation to that area, so I'm feeling grateful and very, very lucky.  Even if one or both of the nodes contain cancer, the chemo I'm about to start should knock out anything left floating around.  This also means I'm very unlikely to need a complete node dissection when I have a mastectomy later this year, which lessens my chance of lymphedema and other complications.

And the wire did its job - Dr. F was able to find the tumor, hiding under a layer of scar tissue, a corner of which had grown down into the cancer and was actually calcifying.  We now know the tumor was 1.5 cm, the size originally estimated.

Jabba has officially left the building.

The clock strikes 5:00, and Ken helps me dress so we can get outta Dodge.  He is with me through all of this, never leaving my side.  He's allowed to watch (again, from the corner) the wire localization; he walks with me through the halls and waits during the mammogram; he stands near me during the injection (and offers his hand for squeezing, although I fear I would break it) and watches the screen when they scan me, 15 minutes later, to ensure the radioactive material is moving through my breast.  He wipes my tears, strokes my head, kisses me gently.  I always say I can do this by myself, but I'm not-so-secretly glad that I have him with me every step of the way.  He holds me close and tells me he wishes it could be him.  And I - I am so glad it's me and not him.  Sometimes, I just don't have words to describe how very blessed I am.

We should have the answers we need later this week, and genetic test results should arrive some time next week.  My oncologist wants me to wait three weeks from surgery to heal, so my hope is to start chemo on March 8th.  Next steps are Chemo School (maybe I'll get lucky and flunk out...) and meeting with plastic surgeons.  Yes - getting back to Livin'.

But for now, yesterday is behind us, and tomorrow is another opportunity to find gratitude in the moment.