It's Monday. My mother and I set out just before lunchtime. On the way, we stop at my favorite natural food store—The Natural Gourmet in West Concord, just off the Rte 2 rotary, beyond the jail. I throw back a cup of chicken barley soup and eat a good-size portion of tabouli—fresh, crunchy and delicious—and feel restored.
We find the Faulkner Hospital easily. It boasts a beautiful atrium lobby, with dizzying amounts of vertical glass that bring the sun in and set the lobby all a sparkle. It’s an awfully nice way to meet your fate.
The elevator takes us up to the fifth floor and we head down the hall to Dr. Pitts’ office. We check in, take our seats. The receptionist is talking on the phone with friends, then with family members, then with a young woman who has stopped in to steal a peppermint lifesaver and say hello. She—the receptionist—begins to tell her how she drank too much over the weekend and made herself throw-up to feel better. Nice. No wonder she was a little cranky the other day on the phone.
There’s a jar of scented cinnamon apple oil on the desk that fills the room with a biting synthetic perfume scent. It grips my throat the minute I sit down and I launch into a coughing fit that won’t quit. I remove myself to the hallway, where I finish filling out the questionnaire. I come back in and write down my questions for Dr. Pitts: Lifespan of implant? What can I expect long term? How many follow-ups and where? Timeline? Drain—how long? Recovery—what can I expect in terms of activity and energy levels? Next surgeries?
Ok. I’ve met with Dr. Pitts. And I like her very much. She came in and whisked us away to her lovely office. I got all my questions answered, and more. But before I get to that, I’d like to tell a Third Eye story.
A few nights ago, I have this dream. Dom and Luke are with me. We’re in the car and it’s loaded up with luggage, etc. I’m not sure if we’re moving, or just going someplace for a visit. We arrive in an open, airy parking lot. Trees abound. But there are no other cars in sight. It’s late spring, I think. Warmer. We got out of the car without jackets, trusting in the gentleness of the weather. Luke scurries off to a large brick building off to the right, and says he’ll be “right back.” Dominick and I open the hatch, remove a few bags, boxes. Can’t remember, but definitely a bit of unpacking going on. Suddenly, two women approach us from over the grass beyond our car. They are smiling, as if they have been expecting us. The one in the front has light colored hair tied back in a ponytail, and the one behind her has blonde hair, but her face is less clear. Wearing big smiles, they put their hands out to welcome us.
I’m a little mystified. I’m not sure why they’re there. I’m not even sure why I’m there, but I’m waiting for Luke to come out of the building, and so far, he hasn’t shown. Dom stands by my side. The two women seem sisterly, or are friends, or they work together, or all three. They are talking to me but I’m not getting it all. I notice that the one who has reached me first, the one with the darker hair, keeps looking at my left breast as she talks. I’m not even sure she’s aware of it. I’m thinking to myself, “This has something to do with my cancer.” It seems they have come to take care of me, or I’ve traveled a great distance to come to them for care or help. But still, I wonder, where is Luke? I call him on my cell phone; he doesn’t answer. Does he even have a cell phone? I run into the building and search every floor for him, calling his name. I realize I don’t even know what room he is in. I am worried, frantic. I can’t find him. And what is this building? It dawns on me that it is some kind of a dorm. Am I bringing him to school? Is he starting high school? Finally, he emerges. “Luke!” I am exasperated. “I’ve been looking all over for you. You said you’d be right back!” He laughs, grins devilishly. The women have disappeared, I think. The dream ends.
As soon as I sit down with Dr. Pitts today, I notice something within the first few minutes: her eyes keep flickering over to my left breast. For a second I wonder if I have spilled something on my sweater, then I realize she’s sizing me up, quite literally, as an artist would size up a bowl of apples, grapes and cherries before starting a still life. (And Dr. Pitts—if you’re reading this, I understand this. This is what you do. It’s your job: “Just how small is she? What will this surgery be like for her?” Yadda, yadda.) It doesn’t bother me, really, but then I realize: She’s the woman from my dream. And the blonde? That’s Dr. Specht.
I am reminded of a dream I had about a week or so before Dominick was born; in my dream, my baby (actually, he started out as a girl in the dream, and then by the end, was a boy, so I knew, too, that all the family predictions about him being a girl were wrong-‘em boyo) has an infection in its left eye--goopy and red and filled with pus. I am worried, but at the end of the dream, it has resolved, and the she baby has been recast as a happy, smiling, beautiful baby boy. About a week or so later, I enjoyed an easy labor and Dominick, my second healthy, beautiful boy, was born. But by the time we took him home from the hospital, he had an infection. In his left eye. Ointment—and squirting breast milk into his eyes—cleared it up. To this day, that eye still gets a bit troubled when he has a cold.
Her office is pretty—bright sunny big windows, gorgeous pink flowering bush (azalea?) and an orchid sit on a ledge. She shows us photos of her “work,” just the boob reconstructions. “Nice work,” my mother comments. Later, she takes boob shots of my girls. I tell them to smile for the camera. So, did I tell you? I’m going to get a tattoo. Not the lizard tattoo I mentioned in an earlier post. But an areola tattoo. Confused? Let me explain.
***Warning: what follows will be explicit. If you get squeamish, apologies. ***
Dr. Pitts gives me the full scoop. There’s a good reason why the breast surgeon did not. Little by little. Take small bites and chew your food well. Easier to digest. Otherwise, much discomfort, a feeling of fullness and overwhelm, and heartburn.
Reconstruction is a fairly long procedure. At the time of Monday’s surgery, Dr. Specht, the breast surgeon, will biopsy and remove and sentinel lymph node (which they’ll identify with help from contrast dye IV), and send it out to be biopsied right away. If it is negative and cancer-free, then she’ll continue with the mastectomy, leaving the rest of the nodes alone. If not, then she’ll remove additional nodes in addition to the breast tissue. The mastectomy consists of making a longer re-incision over my last one and removing as much breast tissue as possible. This includes the nipple and surrounding areola, the red circle around the nipple that provides a visual target for hungry babies. I’m hoping she’s able to get it all, that the nodes are perfectly healthy, that the margins are absolutely free of cancer, and radiation will not be deemed necessary, and not having chemotherapy a viable choice.
After Dr. Specht completes the mastectomy, Dr. Pitts, the plastic surgeon will use the same incision to insert an expander (a small squishy bag of sorts) underneath the muscle, being careful not to damage my pecs, which is a good thing, since I’ve worked very hard to build them up over the years (!). She’ll fill the expander just a bit with saline to start to stretch the muscle and skin in order to ready it for a larger silicone implant down the road. She’ll stitch me up, insert a drain (more about that later) under my left arm, and see me the next day before I am discharged (though there’s always the chance that I’ll stay an additional night, and in fact, many health care providers are pushing for this to be the norm—see post on the Breast Cancer Protection Act).
The drain sounds fun! They’ll instruct me on how to measure the fluid and empty the drain before I’m discharged, post-op. I can’t wait! I haven’t had to mess with a drain since my cat Chubby—who died about 6 years ago—had a bad abcess. It’ll be cool! A long tubey thing coming out of underarm area that continually fills up with fluid—and fluid that I actually get to measure (just like in science lab! Cool!!) and then drain. The perfect middle school science project: “Drains are our friends.”
I’m not looking forward to the drain at all. I am terrified of the drain.
Once the dreaded rain is removed—about a week after surgery—I return to see Dr. Pitts, Dr. Specht, and the oncologist (I have yet to meet with one at MGH, but Sridhar and Dr. Specht are pointing me in the direction of Dr. Paula Carr and Dr. Jerry Younger, who was my grandmother’s oncologist) in another week, around April 3. I’ll get a thorough check up, Dr. Pitts will fill the expander up a bit more, and the oncologist will talk to me about a treatment program (wouldn’t it be nice if the surgery—if cutting out the cancer, and then some—were enough!).
At this point, I’ll need to see Dr. Pitts once a week for fill-ups (gee, the price of saline these days!), something I was hoping to have done locally (or in Springfield), but cannot (the Springfield doc said no, drats). It’s a simple ten minute procedure that hardly warrants a two hour (each way) car ride, so we’ll have to figure it out. Over the course of several weeks, Dr. Pitts will get the expander filled enough so that the left breast is the same size as the right breast by the time chemo starts. Again, I am hoping this doesn't take too long--given the smallness of my breasts, it shouldn't!
At some point, I’ll have my first chemo treatment (and this I can have done locally, by a wonderful oncologist here, Dr. Katz)—or not (there’s still a wee chance I won’t have to, or could choose not to)—and start on Tamoxifen, which will shut down my ovaries, and usher me into the nether world of menopause (more delights!) rawther quickly. Can you say hot flashes?
The actual “exchange,” a day surgery in which the saline expander is exchanged for a softer, more comfortable and aesthetic silicone one, would wait one month until after my last chemo treatment is done.
Nipple construction happens two months after that. Yes! Nipple construction! A friend asked me if the nipple will be fashioned to look like my younger, 20-year old nipple or my older, 42-year old nipple, which, slightly-knobby and large, looks as if a couple of hungry-boy toddlers had sucked long and hard, for six years, and even gave it a few loving chews (I've earned them nipples, just as I've earned every wrinkle on my face!). I didn’t know the answer, but I figure she won’t make the new one look too new. In any case, she’ll have to use a lot of Sculpey to make the new nipple look the one I’ve got now.
Yes! Tattooing! What else do you think gives the nipple and dart board its genuine pinkish-red color? Sharpies? I ask Dr. Pitts if I could have a pinkish red lizard tattooed around the nipple instead. That'd be cool, don't you think?
After the initial mastectomy, I’ll be unable to resume “normal” activity for about six weeks. No lifting. No working out. No bringing my heart rate up and breathing heavily (I guess that means only G-rated movies). The exchange surgery isn’t as drastic, but still requires about four weeks of recovery time. It looks like I’ll be doing a lot of walking, which is the recommended form of exercise. If anyone out there wants to join me on some walks, I'd love it. I hope to squeeze in my 25th reunion from Exeter—April 25-27—before chemo starts. I promise not to dance til I sweat and have to jump into the Exeter River to cool off, but I will have to do something out there on the floor. And when this is all said and done, I will regale, revel, delight in the freedom of movement and choice healing will bring.
I'll end with another Irish blessing from my friend Jean, who reminded me that since the day of my surgery, March 17th, is St. Patrick's Day, and I'll be having it done in Boston, she told me to "make sure your surgeon doesn't walk into the operating room with a foamy green drink." !!
"There are good ships, there are wood ships, there are ships that sail the sea, but the best ships are friendships, and may they always be ..." Thanks, as ever, for your friendships and love. I hope you are all doing well. I'll check in again before the surgery.
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