Part 2 - Surgery

PART II

 

I

At 7.30 am we arrived at theatre admissions. It was fire alarm test morning, so there was a sign on the lift warning that it may stop momentarily between floors. Fortunately this didn’t happen. Steve waited with me until I was called in.

Dr Mansfield said hello to me and saw me shortly after my meeting with the anaesthetist. We confirmed which breast was being operated on, and she then drew on it, just to be sure. Left Breast Mx, SNB (sentinel node biopsy) and a socking great arrow. But at least there could be no mistake. I joined a small waiting room with other, similarly marked up ladies.

In order to allow the sentinel node biopsy to be undertaken during the operation, I needed to have a radiation injection. There was a delay in getting this done – following the fire alarm tests they needed to re-check the scanners and cameras before any patients could be seen. I had always been under the impression that radiation exposure could cause cancer. I had cancer and was waiting to be injected with radiation. It seemed a curious turn of events. Shortly after 9 am I was called in.  The nurse explained that the radiation injection would be made into the lump and she would then watch on the scan which node it drained into first. I was asked to confirm that I wasn’t pregnant, and sign a form to confirm that I was sure I wasn’t pregnant. Clearly radiation injections and pregnancy do not mix. The nurse warned me that the injection would sting. She injected near my nipple, straight into the lump. I wouldn’t say sting, so much as quite uncomfortable. And then more uncomfortable. Still the injection continued. And the pain of it increased. I clenched my fist and held my breath. ‘Not much more to go’ the nurse said. I suspected she was lying and I was now struggling with the significant discomfort of it. Finally it was over. She held my hand for a few moments, looking at me sympathetically and apologising. The pain was already subsiding. ‘it’s alright’ I told her ‘I shouldn’t quibble, this is nothing compared with what they’re about to do’. I was bleeding from the injection so she put a plaster on it. This amused me. The breast was going to be taken away and I wondered if it would be sent off to pathology with the plaster still there, stopping a redundant bleed. Or would they take it off during surgery. These things I would never know.

I was then mechanically fed into a large do-nut shaped camera. The sentinel nodes were identified and I was drawn on again to mark these up. The idea was that during surgery I would be injected with a blue dye – which would hopefully not cause any long lasting smurf-look effects. The combination of the dye and radiation would attach to any cancer cells and make them show up. If the lymph nodes had cancer cells, they would all be taken during the surgery.

Back on the theatre admissions ward I changed into the hospital gown, anti embolism stockings and put on my dressing gown and slippers. My clothes and overnight things were bagged and tagged, and put into a secure cupboard until I was out of theatre.

My period, which was two weeks late, was threatening to appear. Typical. My tummy groaned with pain.

I had a further meeting with an admission nurse who talked with wide eyes about the storm, and showed me the photo she had managed to take of the fork lightening.

Then I walked to theatre, and into the room where it would all happen. I climbed onto the bed. As my father said later, it was one thing to be wheeled into theatre having been pulled from a car crash. But to walk into hospital in cold blood, feeling fit and well and voluntarily go through this – well that was something else.

I lay down and gave the lump and my left breast a final feel. In that moment I suddenly wished I had named the lump, so I could say goodbye to it. Heffa for example. The anaesthetist I saw earlier put an oxygen mask over my face. Meanwhile another anaesthetist held my wrist to get a vein ready for a canular. I felt dizzy, almost sick and was close to trying to remove the mask. That was the last thing I remembered. I was out before the anaesthetic line was even in me. There must have been more than just oxygen in that gas.

II

When I woke up the first thing I did was feel my left breast – or rather, where it used to be. And felt tears roll down my face although I wasn’t aware of crying. My mouth tasted of chemicals and I needed a pee. They put a bedpan under me, which immediately meant I couldn’t go – lying flat on my back in bed. I tried again a few minutes later, when I was a bit more awake. The nurse said it was a very strange colour, and then asked if I had had a radiation injection. I said I had. ‘Ah’, she replied ‘that will explain why it’s bright green’.

The nurse told me that she had been through the same thing as me five years ago and that the main thing was to be brave. She also told me that your pee was pink when you were on chemo. She gave me a cup of water with a straw to drink. Gradually I started to come round and be more aware of my surroundings. A blood pressure monitor on my arm was taking a reading every minute. Also my legs were being similarly inflated and deflated in turn. As I came to, these things were taken off me. Then I was wheeled to the ward. It was 3.30. The surgery had been due to take around 2 hours, but I had no way to account for much of the day.

I saw my sister in law, attending to the lady next to me. I knew she worked at this hospital but the odds of ending up on her ward had seemed unlikely. She called Steve to let him know that I was out of theatre and on the ward. What I didn’t know until later was that Steve had called around lunch time for an update. He had been told I was still in theatre which the ward nurses found odd as the lady after me in the admission list was back. They then called him back to let him know when I was in recovery.

The surgeon came round before Steve arrived. She looked at the dressing and felt around it for swelling, then apologised for displaying the dressed wound to me before I had had the chance to familiarise myself with it, adjust to the physical change. But I already had been looking at it. I kept looking at it. Kept feeling it. I liked it. I certainly didn’t miss my breast – or the lump it had been incubating. It was neat, tidy, and strange.  She also confirmed that the lymph nodes had been clear. This was a positive thing. She had taken three out to send to the lab to be absolutely sure.

Steve sent messages round to family and work then came to the hospital. I was ravenous. I hadn’t eaten since around 8.30 the previous evening. I was brought a cup of tea on the ward but wouldn’t get food until dinner at 6. So I sent Steve to the shop to forage for biscuits. I ate two rapidly, and felt slightly queasy.

Steve received an email from my mother who claimed not to have heard anything. She uses Outlook Express and tends to write emails before receiving them. This means that incoming mails are received subsequently. Steve texted her to suggest that she check again, but he started re-sending them anyway. She later said that the emails did ‘eventually’ appear.

I received a very nice email from  bro the younger, which read:

‘Hey Thom.  I think I timed this so you’ll be in surgery because I tried and couldn’t think of any useful words to say beforehand. Certainly nothing original that anyone else hasn't said to you already. Whereas now it’s over, it’s happened. Some part of it at least, there’s a reasonable road ahead but nothing you can’t handle. You’re a Redman after all. And I’m utterly sure it has all gone well.

I heard about your party, it sounds at least like you’re dealing with this in a forthright and frank manner. Which is quite impressive in the circumstances. And not something everyone manages at all. I feel it will stand you in good stead as you face the coming months. 

I’m very sorry I’m not there to offer you any form of support. I’ve thought about sending completely pointless things like flowers and just given up because all I really want to do is take you for gins or give you a hug. But I can’t. 

You’ll just have to have faith that I’m thinking of you a lot and can’t wait to see you again next.

Lil’ Bro’

Dinner arrived. Soup, bread roll, chilli and cheesecake. I chowed down on it voraciously, with all the grace and dignity of a lion attacking a wildebeest. It was delicious, and much needed after 22 hours without food. Dinner time pills came round – I was offered pain killers but as I wasn’t in any pain, I declined.

Steve had called Jon and he popped in to see me as well. They were due to go out that evening to see the band that step child the younger’s boyfriend was in.

I was still attached to various pipes and tubes. The canular was still in my right hand, just in case. Although it was not connected to anything anymore. But the long attachment tubes were cumbersome and in the way. In my back was a local anaesthetic ‘block’ on a drip. This had been offered to me pre-surgery as an injection, to provide additional pain relief around the breast area. But they needed my consent because as the line went near my lung there was a slight risk and I needed to consent to this. But while asleep they had obviously decided to adopt a new route. And it meant I had to push a drip trolley around. To add to ‘luggage’ I also had a drain. Fortunately there was only one. I had been warned that I may have two, or even three. One was good. Although it was slightly unpleasant to have a blood filled bag hanging off me.

The boys left at the end of visiting hours, and then just four quiet ladies were left in the ward. It was nice to be in a small ward. Although it did feel a little like a female version of ‘Only When I Laugh’.

I wasn’t in any pain, but was starting to feel as though I’d been given a pretty thorough punch to the chest. Even so, I took the evening painkillers, just in case.

I had a pretty good night’s sleep, considering. But when I woke up, with the lack of movement during the night, I was quite swollen under my arm. The swelling must also have spread into my back as the drip near my spine was now very uncomfortable. It may have been providing pain relief, but was actually quite painful to have in me.

Also, my throat had become sore.  The piping that would have been in it during surgery was now bruising.

My period, having initially attempted an appearance, had realised that now was not a good time, and retreated gracefully, albeit painfully. All the drugs I was on, and still that hurt.

A doctor and the surgeon came round during the morning and confirmed that everything was looking ok, so I should be able to go home later that day. The swelling seemed normal and no cause for concern. Mid morning the pain doctor visited and took the drip out of my back. It was extremely painful having it removed – which surprised the nurse – although the swelling was probably pushing it against the nerve, making it sore. It was a narrow little tube, inserted 8cms into my back. Being separated from the drip trolley made me instantly more mobile.

The pain relieving effect from the drip would end in about 3 hours. So now I was to be watched closely, to see what pain appeared.

Bizarrely, even though my breast had now gone, this still didn’t feel real.

I took a photo and sent a ‘Gone’ email, with photo attached, to the family. Bro the elder was surprised at the neatness and angle of the scar. Bro the younger replied simply with

‘oh

my’.

III

After lunch I was allowed home, armed with exercises and a ‘softie’.  There were boxes of all sizes, some of which I could easily have taken home and put inside a cushion cover without anyone suspecting anything amiss.  The softie given to me was the smallest one they had. And even that one was a bit too big. A few days later I pulled some of the stuffing out of it to try and make it more appropriately sized.

Steve helped me to dress. It was the first time he got a good view of my new look. He liked my new appearance. And genuinely so.  In the following days he kept touching it. Before its removal we had both been confident in our lack of emotion about it, but to find that the reality was interest and excitement  was a reassuring surprise. I couldn’t understand how women felt self conscious or less sexy, less of a woman. Admittedly I am small of bust, but I was still the same person. My husband was the same man. My body, in all other respects, was unchanged. He had taken me on ‘in sickness and in health’. There was no reason why this should be a deal breaker or unspoken wedge between us.

The drain was uncomfortable. It was held in with a single suture but when standing, I could feel the pull of the equipment on that stitch.

On the drive home I developed a thorough appreciation of every bump in the road.

I had various body cast sculptures of me at home. One covered my front and now served as a permanent 3d record of my absent left breast. The second was a wrap around ribbon effect, starting on my right breast, going around my back and returning to the front around my hips. The left breast was absent, in a strangely prophetic way.

As the drain would be in for a few days and was, without being too graphic, unpleasant to look at I needed to devise a bag to cover it when we went out. We had a fabric bag from a previous Goodwood revival and with some cunning re-arrangement of the handles I created a handy shoulder drain bag. Should really have patented the idea – this will be in demand and copied worldwide.

We had to re-think sleeping arrangements. Normally I sleep on my tummy. That clearly wasn’t an option at the moment. But if I slept on my bag all the drainage pipes, bag and vacuum would be in the middle of the bed, between me and Steve. So I had to sleep on Steve’s side of the bed, and we put the chair next to me for the drains to go on.

We wondered if Tiggy, my remaining cat, would be confused. Usually she would jump up on my side of the bed, walk across the pillows and then sleep on the edge of the bed on Steve’s side. If she carried on as normal, I wasn’t overly sure I would be keen on this. There was too much risk she would lie on the tube coming out of me. In the event she parked up a little farther down the bed.

Following my night in hospital I had developed a lot of swelling. Perhaps foolishly, I had put the hospital bed virtually flat. Thinking this may have been a mistake, at home I piled up all the pillows so that I was in a more upright position. I had a better night’s sleep than expected.

As there was so much I needed to keep dry, and due to the restrictions of the drain, showering and bathing was difficult. So I stood naked in the bathroom while Steve sponged me down. Some areas got a lot more cleaning than others.

I looked through the wad of information I had been given by the hospital. There was a lot of information about blood clots – which was alarming. The list of factors which made you more likely to have a blood clot included:

-         recently had a long journey (yes – to and from Istanbul)

-         recent surgery (yes)

-         have cancer (yes)

-         you are over 40 (yes)

This wasn’t looking good. The signs to look for included pain in your back and breathlessness. I had both of those. In fairness, the pain in my back was residual bruising from the pain killer drip that had been there, and the breathlessness was primarily due to the swelling around my chest. But even so, it was unpleasant to be given extra reasons to worry. The leaflet suggested continuing to wear the pressure stockings during the night. I had kept these when I left the hospital – Steve seemed curiously interested in them.

A peculiarity I was noticing was the prominence of my heartbeat. This had been quietly pumping away behind an additional couple of inches of flesh. The surface was now much closer, and it was strange to have such a heightened awareness of it.

I started my daily exercises. There were 3 that I was allowed to do before the drain was removed. These were:

-         touch my shoulders and open my arms out straight to the side

-         touch my shoulders and rotate my elbows (that was a difficult one)

-         put my hands on the small of my back and move them up and down my spine.

It was a little different to the training sessions I had been used to, but curiously, just as difficult.

That evening we were due to go out to dinner, unless I didn’t feel up to it. Remarkably, I felt extremely well and had very little pain. More discomfort from the swelling than anything else.

I had been told by the hospital that I would get a daily visit from a district nurse. I had to keep the drain in until the volume of fluid over a 24 hour period was reduced. In the hospital this had been quoted as 50ml, but the paperwork I was given on discharge, including a copy of the district nurse referral, quoted 30ml. This seemed a little cheeky.

By 7.30pm the nurse still hadn’t arrived. We went out anyway. In the cool air my nerves prickled and sent the message to my nipples to respond appropriately for the temperature. The message was sent to both nipples, even though there was only one there to receive it. It was an incredibly strange sensation.

My drain shoulder bag worked admirably. No one in the restaurant would have been any the wiser. I put on a bra and tried out my softie – which at that time was still too big. The bra was uncomfortable over the swelling under my arm and when I put it on Steve laughed at the sorry looking empty pocket.

After dinner we popped into the pub. They were amazed to see me, and how well I looked. It had been shortly over 48 hours since the operation.

That night Tiggy slept on the chair with the drain. When I got up in the night to go to the bathroom and needed to lift it from round her, I expected her to run away. She didn’t. When I came back and put the drain back, I expected her to run away. She still didn’t. She had become a different cat since Dudley’s death, more friendly. Perhaps she knew I was ill. Or perhaps Dudley had given her some dying instructions to look after us.

The top I wore the next day didn’t sit properly on a lopsided chest, not helped by the fact it had horizontal stripes.

Steve washed my hair that morning as I leant over the edge of the bath. My mother was due to visit, primarily because there was a Quins game that afternoon. I wasn't going to attend, given my drain equipment, but was keen that Steve should still be able to. She brought an orchid, to join my burgeoning collection of flowers. Steve had called the hospital to chase up the nurse, and she arrived that afternoon to check my drain. I was tempted to direct her to the drain at the back of the house which regularly needs clearing out. She had only recently been told about me and was horrified that no one had visited me the previous day. As she was a temporary person, rather than part of the usual cluster, she assured me that I would get a visit the next day from someone who could then give me direct contact details.

Night times were getting a little easier, and Tiggy still slept on the chair next to me. However, the amount I was draining didn’t seem to be reducing markedly. It was uncomfortable and unpleasant, and the prospect of it being there for a few more days started to get me down. I lay in bed that night, propped up, on my back, stationary, invalided and in tears.

I was trying to ease off on the painkillers. So now I was getting occasional short sharp stabbing pains along the wound, but more troublesome was a nagging itch in the nipple which wasn’t there anymore. Nerves are a truly strange and peculiar thing.

My father then visited me and was also surprised at how well I looked. The new district nurse visited, and gave me contact phone numbers for the cluster. She looked at my drain with a puzzled expression, saying she hadn’t seen one like that before and asked if I had new bags. ‘No’, I told her. ‘I empty that one daily’, and tried not to show any sign of concern about her abilities, or lack thereof. She suggested putting me down for weekly visits until I pointed out that before next week the drain would be out anyway as it would have been in for 10 days (removal day was the earlier of either 30ml in 24 hours or 10 days since the drain was put in). So she put me down for another visit in three days time. So much for daily visits. Or even a nurse who had the faintest idea when I had had my surgery.

I managed to work quite effectively from home the next week, much to the surprise of colleagues at the office. But I did wonder if I had snagged the drain pipe during the night – I was starting to move around a little, rolling slightly onto my right side. It was now very sore. I was draining only 30ml, but my mobility was being reduced due to the discomfort.

The district nurse was due the next day but I called to see if I could have someone out sooner. Apparently not. The woman I spoke to also said ‘you’re not booked in for the drain to come out’, I explained that it was to be removed once I was draining 30ml or less, which I now was, but that this couldn’t have been pre-scheduled. Hence the requirement for daily visits I thought – but didn’t say. Having established that I wanted the drain out, she then asked ‘when would you like the appointment’. I felt like we were going round in circles. ‘As soon as possible’ I replied, ‘you’ve said you can’t get anyone out today and I already have an appointment scheduled for tomorrow morning, so how about the drain is removed then’, I suggested. This all seemed like an unnecessary amount of effort for something so simple.

The following morning I was still unsure if anyone would come, and if they did, that they would remove the drain. It was a morning appointment so Steve and I decided to wait until 12.30 before calling. At 12.29 a jolly ginger haired nurse who was as wide as a bus knocked on the door and announced that she was there to remove the drain.

Hurrah, with particularly shiny brass knobs on.

IV

I was a bit anxious. It had been there for a week, it was stitched in and I was concerned that I had started to heal onto it – which would make the removal potentially unpleasant. In the event, it was not at all uncomfortable. Steve did say that a lot more piping came out than he had expected – about 6 inches of it. When I mentioned to the nurse that it had been sore, she said that was usual once the drainage amount reduced. The drain worked on a vacuum, and once there wasn’t fluid to suck down, it would pull on flesh. No wonder it had been painful. And I was glad I hadn’t previously known that was happening.

With the drain out, finally I felt liberated. The next morning I had a bath. It felt amazing. And I could start my new exercises. There were 4 post drain exercises, and I had to master each one before I could move to the next one. The first exercise involved standing in front of a wall and walking my hands up, aiming to get my arms straight out above my head. It took 7 days. But what was more difficult was moving my arm parallel to my body. When my father phoned I explained my rehabilitation exercises to him. He had realised that the operation would need recovering from, but until I mentioned the lack of mobility in my arm he hadn’t fully appreciated how much recovery there was beyond the simple fact of the surgery.

With the drain out, I was now aware that my whole left side was slightly swollen. My left hip bulged slightly over my trousers and jiggled a little as I walked. Initially I wondered if I had put on weight, but my right side was still slim and firm.

I moved back to my side of the bed. We left the chair there in case Tiggy carried on sleeping on it. She did.

V

I went back to work. It was still too uncomfortable to wear a bra and I had to think about what I wore for the walk in and out of the office as I still couldn’t get most tops off without help. By the end of the week I was starting to use a bra again, and getting used to the softie – although it did have a habit of wandering out of the cup. I had now removed so much stuffing from it that I had enough to make a second softie.

The dressing was still on and the swelling under my arm was still sore. So I was particularly looking forward to the next appointment, where this was to be taken off and the next stage confirmed. It was difficult to know if the hard part was over, or just about to begin.