I marked time for the last week constantly, coming up to the surgery date. Along the way, my imagination got the better of me. Perhaps eight weeks is too long to think about breast cancer surgery? Three or four is about right, as it would have been originally.
I had closed the Dr Susan Love Breast book at last, thoroughly convinced I am having the perfect, most up-to-date treatment for breast cancer, as it is in New Zealand. After reading the stats on outcomes, I am all for this surgery, sentinel node biopsy and the radiotherapy. But too much technical reading can make you anxious and I was well on my way to that state with the date so close. I love coffee and although I only ever drink one or two cups a day, I had to quit because anxiety was ratching up higher and higher.
THE SENTINEL NODE MAPPING
The first appointment was the day before, to map my lymph nodes - and the description sounded like some kind of sci-fi/horror scenario in my over-active imagination; five radioactive injections around the nipple and tumour site, which sting as they go in, then lying under a large machine having my unsuspecting lymph nodes mapped for removal. It sounded de-humanizing and clinical.
The reality was this:
Arriving at a beautiful, large old Epsom Villa, the small reception area warmly lit inside and softly decorated, greeted by a receptionist who knew my name even as I walked in the door "ah, you must be Pauline". Already I was more relaxed. Whilst sitting on the sofa, a lovely, quite pregnant Canadian lass came out and said "come on through". She was the Nuclear Medicine Technician it turned out, she was casually dressed, not like a technician, nurse or anything like that.
The room was just a typical consultation room with a place to lie down, and in no time she giving me the rundown of what she was going to do. The casual calm of her demeanor was right on, just straight up and relaxed, but still very much in charge. I asked her quite a bit about the machine and how it worked, what she did, and wound up thinking she had a brilliant job. There are a lot of women who are doing these technical jobs, especially to do with breast cancer. She deals almost exclusively with mapping for melanoma and breast cancer. The node mapping, as she explained, makes life easier for breast cancer patients after recovery, so minimal lymph nodes are removed, most are saved, as they have an important filtering job to do in our bodies. The conversation was technical, casual and comforting, all at once.
Its turned out I only needed two, not five, injections - I thought she said "inductions" in her Canadian accent, but then I was looking at her six month pregnant form as I thought I heard that. She said in Canada they do four, in New Zealand two.
So two injections is now the norm, and they go in the quadrant of the breast where the tumour is, i.e. four segments to the breast, into just the relevant quadant. She asked where my mass was and I indicated. So she told me as she put the injections in what she was doing and said "a bit of pressure now" as the actual liquid went in. It is only shallow too, as that is where lymphatic paths are, just beneath the skin. It wasn't bad at all, kind of like heat that stayed longer than heat would, it was totally fine. Then I put the patient kimono on and sat with my partner in the lounge while the liquid worked its way thru my lymph nodes towards my armpit (axilla).
Fifteen minutes later I was taken to another room, a larger room with floral wallpaper, a hybrid MRI/scanner machine featuring, which is apparently the latest kind. These machines are not half as scary as they used to look. The scanner I lay under was the first part, and although there was the big round circle of an MRI scanner behind it, I was not going anywhere near that.
The scanner looked something like a photocopy bed about 10 cms above me, nearly a metre in length and less in width. It was explained to me it took a 100 seconds or so with it's lenses open (50 lenses she said), to pick up the gamma ray emissions and create the image. Two were taken, from two different angles, I was positioned a few different ways, then she wrote on me with a semi permanent sharpie and I was all done- all up about 35 minutes I think.
I was given photos of my lymph nodes to take with me and a letter confirming the contents. I like how patients are couriers for their own medical information in these proceedings. Makes perfect sense. I could have a good quizz too. . . now home and one more sleep before the big day.
Sentinel node notes to the surgeon.
THE HOOK WIRE INSERTION
Up early for the hook wire procedure, very similar to the biopsy I had eight weeks before, but just a needle put through to the tumour and a fine wire fed through that, piercing the middle of the tumour and pointing out of my skin so the surgeon can easily find, my not easily found lump.
As usual, I was curious about everything. I said I wanted to the see the procedure, so the monitor facing me was put onto the ultrasound channel and I could watch it all. They said most people do not want to see it.
The doctor did very well to make sense of the sludgy grey and white matter that makes up a breast. The tumour was hard to see, but he found it. He couldn't measure it and of course, part of the tumour is made up of the scar tissue which surrounds it, I think the body does this to try and halt its progress, but also there is reaction between the surface of the tumour and the surrounding area, putting this barrier around and making it a hard lump. How much is tumour and how much is scarring isn't known until its in the lab.
The area was numbed with one injection and the needle put through. The only real discomfort was the pressing of the scanner on my breast over the tumour, very mild and short lived. In no time they were pinning the wire across my chest with dressings to hold it in place to travel to the hospital nearby.
But before that I had to have another two mammograms, two views of the breast now with the wire in place. Since I was so interested in everything the doctor put my mammogram photos up on the lit board so I could see them. He also outlined the tumour shape with a red pen on a paper printout of the ultrasound, it looked like a nugget, with a very jagged, knobbly outline.
AT THE SURGERY UNIT
With another batch of transparencies and a letter added to my folder to take to the surgeon, my partner drove me to the Surgery Unit at Waitakere Hospital and I was quickly shown to a place to get into the hospital garb and put my overnight bag away, in a locker with key, which was pinned to my giant dressing gown. Then into the waiting area. It was about 10am.
Two older ladies were next to me either side, both in for hip operations with a different surgeon. We talked a while and wished each other well. Then I was alone in the waiting room. "Ellen" came and went on the TV.
Hours ticked by and I realized I was really hungry and feeling my rubbish night's sleep. Then a nurse took me into a room to do all the paperwork, and said the anaesthetist would talk with me next. After the paperwork she noticed I was wilting a bit and offered me a temporary bed. I took her up on the offer. It was now about 1.10pm. I asked around and found out my surgeon had four breast cancer operations to perform that day, and I was number 3.
Suddenly it was all on, my surgeon appeared at my bedside, but I thought he was the anaesthetist, dressed the same, but then I put my glasses on and said "oh hi, Peter!", a bit of an informal way to greet a surgeon perhaps, but he didn't seem to mind.
He gave me the rundown on the surgery and further treatment (I definitely need radiotherapy). I remember him saying up to 40% of patients need further surgery (re-excision) as the margins are not clear of cancer when the tumour is examined thoroughly in the lab. I said to him I was happy if he took bigger margins to possibly avert this and also as my right breast is larger. He acknowledged that then added he will equalize them (I thought wow - that would be good!). I began to hope for an excellent visual outcome and hopefully no further surgery. I can't get my head around that breast tissue can be manipulated, pushed into new places and made to stay there?!
I asked about getting the node results and he said if I wake up with drains I will know there was some cancer found in my sentinel node, if not, then the sentinel node would have been found to be clear, and very likely in my case to be so (and as it turned out).
Next the anaesthetist popped in, another Peter, and another marvellous human being as far as I am concerned. Explaining in detail how it works. I was really interested to know how they know when a patient is fully under, and he said they can tell from readings from sensors. He explained I would have something injected to relax me in the theatre and then propofol to put me under, then gas administered through a bell like apparatus in the back of the mouth to keep me under, as propofol is not long lasting, but has a clear after effect when the patient wakes up, vastly superior to the old days of chloroform. He measured my neck for a tube, if needed (emergency? not sure).
I walked through to the theatre and the staff introduced themselves, then I lay on the theatre "bed" and had sensors attached.
A trainee anaesthetist had a go at finding a vein on the back of my hand, but it blew. I could tell it wasn't going to work, it doesn't really hurt when they find a good way in. I was just starting to feel a bit anxious, that theatre setting can be unnerving. Then Peter, the experienced anaesthetist took over and quickly got the intravenous line in on my inner arm. I was given the mild sedative and it was like instant six glasses of wine, and very pleasant. I was being asked what I did for a living and answering back briefly.
Then I woke up.
LIFE IS BEAUTIFUL
I wasn't sure the surgery was done? Yep, I was in the recovery area, comfy in bed, checking to see if I had dressings. Yes. Drains - none - so a clean lymph node and just that one removed (yay), I was completely pain free and my going home bag next to me. The nurse asked what I wanted to do and I said "sleep". So it was a might as well go home situation.
I went to stand up and was wobbly as anything - but in such a good head space. I apparently had a slightly green face from the blue lymphatic dye they use to trace the nodes they injected when I was under. The surgeon had also put a long lasting local into the breast area near the end of the operation, so one wakes up pain free. How nice!
My partner was called, he was there in no time, along with my daughter. I was taken to the car in a wheelchair and home I went. My daughter said my face had gone blue now. I looked in the mirror when I got home and it was true, just faintly tinted.
Into my lovely comfortable bed and sleeping for three hours, interrupted only by not being able to keep any food or drink down. Each round of nausea came really quickly and was gone each time I retched up. I had been given two lots of anti-nausea drugs too. The nausea was usual for me, same as last year's operation, and no big deal at all.
Next a visit to the loo and holla! the bright cobalt blue wee, as expected, from the second lymph node tracer dye, which double checks the gamma ray dye, same stuff making my face blue.
Felt well, so thought I would take a first proper look at the surgery. The right breast had a large blue patch over it (this will be like this for a month apparently) and there are two dressings, one under my arm where the lymph node was taken out and then I saw, and it seemed miraculous - the surgeon had done as he had said and pretty much equalized my breasts. How he raised up the errant lower one which had the cancer, is a mystery, but there it was. A lovely pair much improved! The right breast still a tiny bit bigger, which is good if I need any further surgery, there will be still lee way for a good cosmetic outcome. I am rather stoked.
This surgery was NOTHING like the hysterectomy eight months ago. But its probably the reason why I worried so much about this surgery. I drastically under-estimated the recovery and pain of a full abdominal hysterectomy, so over-estimated this cancer surgery. I assumed the breast would be an extremely sensitive place to have surgery on, but its not really. An abdominal hysterectomy affects your entire body, walking, your core is impaired until it heals, little strength, with stomach muscles and all their layers cut through and re-attached - I literally couldn't even lift a sandwich for a couple of weeks after the hysterectomy and was not back to workable normal for three months. At six months I finally got total stomach strength back. So far I have to say, this surgery is poles apart.
I am actually quite high from the relief that it is over, and so manageable. Also minimally invasive, yet all the boxes have been ticked to treat my breast cancer, of course, with radiotherapy yet to come.
In two weeks I have a check up with the surgeon and the histology results of the tumour and node will be on hand. They will know everything there is to know about the tumour by then. I am pleased to know its at least five miles away from me, in some lab being coated in wax, to be sliced up, no longer in my body.
Once again, all thanks and praise to modern medicine and how its done, with humans in mind.