Sympathetic response?

    I saw “The Wolverine” the week before last, a movie I’ll never forget. And I can say with a fair degree of assurance that my singular viewing experience does not match up with that of any of the gazillion others who have seen this movie.

     The film wastes no time launching our mutant hero on his journey. A few minutes in, he lunges his gigantic metal talons into rowdy hunters. Not long after, his comeuppance comes via blades and arrows. With the first major attack on our hero, I felt a sensation of warmth on my side, then running down my back. Was I so engaged in this story that I empathized to this degree? Hugh Jackman’s blood filled the screen, and my body responded.  (After a mastectomy, you have absent nerves that still give off sensations. Sometimes when I drink water, it feels to be running down my side.)

     In the theatre, I put my hand under my arm and ran my fingers down my shirt. My fingers were sticky and soaked. It was too dark to tell with what, but it didn’t take long to realize the site of my drain that had been removed three days prior had chosen this movie moment to spring open. 

    Let’s just say I missed about 30 minutes of the film. I’ll admit “The Wolverine” is not my kind of movie anyway. I only went to stay abreast (no pun intended) of what the mainstream masses are drawn to. Movies, walks, reading, music are part of moving beyond my story, which I’ve been relishing the past couple of weeks. I’ve been doing anything but think about what I’ve gone through on my medical journey. Apparently, though, my body is saying this story’s not over yet. 

    Two days ago, a week and a half after “The Wolverine”, I arrived at the plastic surgeon’s office for my weekly fill, anticipating another 50 cc of saline to be added to my muscle expander. I sat down in the waiting room and felt wet under my arm. It was a hot day and I was perspiring more than usual. In the examining room, it became clear it wasn’t sweat. The timing was good, and the doctor massaged the area to remove the excess fluid. “Wow, there’s a lot,” he said, as I gushed like a little spring. The nurse brought a vessel to catch the fluid.    

   I talked to a couple friends about these experiences. My niece Lisa, a nursing mother, said it’s not a stretch that my body would give a sympathetic response to what was happening on the movie screen. After all breast milk and lymphatic fluid are interconnected. This would be like a nursing mother doing errands away from her child and her body responds with flowing milk to another baby’s cries. I’m not sure if there’s medical proof of this or not, but it makes sense.

    My friend Signe simply said, “We women are used to gushing -- tears, menstrual cycles, breast milk. This all seems natural.”

    I like getting these feminine perspectives. As far as how I’m feeling, I’m not that uncomfortable. Or worried. I’m just hoping the weeping stops soon. I’m hoping for one more connection to “The Wolverine,” the part where his wounds seal shut for good.

Rewards

     There are rewards in letting go.

     I let go of control prior to 7:30 a.m. surgery.

     Mumbled “see you tomorrow” to my family around 8 p.m. that night.

     The nurse unhooked my oxygen tubes a couple hours later.

     A different nurse unplugged my IV early the next morning.

     I said “so long” to the Physical Therapist, the Occupational Therapist, and my discharge nurse mid-day.

     Twenty-four hours after getting home, Ron removed the catheter for the pain pump from my chest.

     At my follow-up, the plastic surgeon peeled off the tape and bandages, except for those covering my major incision line.

     I stopped the oxycodone and supplemental meds, except for antibiotics, a week after surgery.

     This brought an immediate “sayonara” to my far, far-away land dreams and nightmares.

     And a bit of a “vamoose” to my exaggerated gaiety.

     Now, two weeks out, I want to evict the drain from under my arm. It’s irritating and limits my activities. I’m sleeping on my back because sleeping on my side hurts with a tube sewn into my flesh. Each day, I document the volume and color of fluid the drain sucks from my lymph area. The color has lightened; it’s what the nurse calls “straw” and I call “light peach.” The discharge must be no more than 30 ml in a 24-hour period in order for the drain to be removed. Lately, I find myself wishful cheating. The 20 ml I jot down is really a 22. The nine I just scribbled could really be 11, depending on the angle at which I hold the jar. Still my numbers yesterday added up to 54.

     "So is 30 a magic number?” I ask, “because this thing is really annoying. I would like to get it out.”

     The nurse tells me, “you’ve had the drain longer than the average patient but some have it for a very long time.”

     I say “okay” and make a light commentary about how the vagary of that reminds me of their discharge instructions which detail numbness, pain, tingling and various sensations one may experience that “go away in time.” I’ve had all these symptoms and still do.

     She doesn’t laugh. She says, “you’re doing a great job.” The directive from Dr. Garreau is “wait” before they take the drain out. 

     I listen.

     After all, Dr. Garreau’s words dispersed a dark cloud when she called me two days after surgery with the pathology report. “All of the lymph nodes are clear,” she said. “And the cancer is pure secretory.”   

     This is the non-aggressive, highly treatable form that most often turns up in 20-something women. This is the news – the secret-- I’d been hoping for all along. 
     She said the mass was larger than they thought, but they got it all. The chemo wasn’t effective because chemo doesn’t work on secretory cancer.

    But if there were rogue cancer cells present anywhere in my body, I figure they’re likely not there anymore. And my oncologist, Dr. Vuky, agrees.

    As for not really needing the chemo and the unpleasant side effects, I’ve let go of that.

    After all, the reward is in letting go. 

"You like snakes?"

     It’s 7:30 p.m. on the day of surgery and I’m feeling good. The nausea from the anesthesiology is behind me. I’m no longer groggy. My urine, blue all day thanks to the dye injected in my lymph nodes, has softened to a lovely green.

     My left breast, the one I’ve been mad at since Spring Break, has altered. The nipple is still there – hence the nipple-sparing technique -- but I can feel the edges of a foreign object underneath. It’s the tissue expander. It feels like a miniature deflated kiddie pool and its placement is high on the chest.

     My breast is about half the size it was. In short, I am a 50-something woman on the right and an 11-year-old on the left. After healing, over time, this will change as Dr. Popowich fills the tissue expander to “the desired size.”  

   The kids and Ron just left after spending the afternoon watching my mouth flap open and me doze. (He took a picture, which I’m not posting.) It’s a bit after 8 p.m. The view from my window is of the west hills. One of the nurses had pointed it out earlier, but I couldn’t appreciate it then. It is a beautiful view.

    I’ll  just pretend I’m in a hotel. 

    Room service brought me a ginger ale and jello.  Lime. I haven’t had green jello since I was a kid. Definitely the best I’ve ever had. I’m hungry. Haven't eaten for over 24 hours. I make sure my breakfast is ordered.

     “Chopped” is on TV. My daughter turned on the set before they left. The remote control is easy. One remote to call the nurse, hit the lights, and control the TV. A dozen buttons or so, that’s all. I’d like one this simple at home.

     I missed the "Chopped" basket ingredients because my mind is elsewhere. 

     Nothing was found in the four lymph nodes taken at the time of surgery, but the official pathology report comes on Thursday. I get to wait.

   A nurse checks my vital signs. I don’t have my contacts in; I can’t read anyone’s nametag.

     “You like snakes?” she asks, pointing to the purple and black stuffed creature in my window.  

   “Well, not really, but my kids got that at the gift sh…”

    “A boa constrictor almost killed my sister,” she says. She motions with her hands how the snake was strangling the life out of her sister, who was a young adult at the time. “I’m from the Philippines,” she adds and her eyes grow wide. “One almost got me too. I was in the rice fields. I was only 11 years old when I saw that boa rear its ugly head.” She holds her hand limp and moves her fingers upwards slowly, mimicking the triangular head.  “It was getting ready to go for me. So I call for my brother. He comes to the rescue and kills it with a machete.”

     “Wow,” I say.

     “Chopped” is still on. One of the chefs has cut her finger. She frantically pulls on layers of plastic gloves.

     The nurse looks at my snake.  “I still hate snakes,” she says with a shudder and walks out the door.

     Tomorrow I go home.

     Thursday I'll get good news. 

Relinquishing Control

     This was my ordeal, exactly one week ago: 

  

     I wake, feeling a tad of congestion that started the night before. I wonder if it’s nerves. I practice deep breathing on the 15-minute drive to the hospital. We arrive at check-in early: 5:25 a.m. Third in line, I stand behind the guy in PJ bottoms and slippers, wondering what he’s having done and how old he is? He has cropped grayish-brown hair; he could be 40, 50 or 55. Is he my age? His wife seems young. Does he have cancer too? I can’t tell. At the head of the line, a couple kids mull around a woman, clearly their mom. I wonder who’s having the surgery? Is it the energized boy ducking under the belt barricade?
     Check-in amounts to initialing three boxes that match three brochures, something I’ve done dozens of times. We sit, then follow a nurse to a waiting room. Three other parties are already there. I choose a spot as far away from each of the others as possible. The first person called is old and frail. She has a hard time getting up and walking when her name is called. I breathe deep. Feel fortunate. At 6 a.m., my name is called. We go to Short Stay where a ginger-haired nurse shows me my bed. I don’t catch her name or anyone’s name. The next hour and a half flies. 
      Close the curtain. Strip. Gown ties in front. What’s your name? Birthdate? What are you having done today? Do you have an advanced directive? She takes my temperature, listens to my lungs. Reads my blood pressure. It’s high, 155/75, which frustrates me. I’m already doing a bad job. The nurse disappears and I grumble to Ron about white coat syndrome. Deep breathe. The nurse is back, preparing the IV, eyeing the plump vein on the back of my hand. I point to my wrist bump and say no IV at my hand or wrist; I advocate for the vessel they used last chemo, the one on the inside of my arm. She says she can’t see it. I hold my ground. She adds heat. It’s pale but works perfectly.
     I mention that when I came in for the livery biopsy, they ended up prepping me and getting me on the table ready for the biopsy, then they couldn’t see it clearly enough and opted against it. “Hey, maybe that will happen today,” I said. I was joking.
     “That’s not going to happen today,” the nurse said.

      Someone interrupts and informs my nurse she wrote the bed number wrong. My surgeon pops her head into my berth. “I checked your bed and thought ‘oh, no, she’s not here.’” Dr. Garreau is amiable and energetic. She asks how I’m doing.

     
     “I’m ready for you to do your thing,” I say. We chat. I mention apprehension about anesthesia. She says the anesthesia folks will be in soon. She says spinal blockers are an option; they inject the blocker on each side of my spine which helps with pain control in the chest area. I’m not so sure. She says I don’t have to have it. Before leaving, she asks, “Any questions about the surgery?”
     I pause, then motion with my hand. “So you’ll slit here…”
     She motions a lateral cut from the left side of the breast to the center. “I cut here and then hollow you out.”  That’s all the detail I need. She talks about the sentinel node removal.
     “Okay,” I say. I sign the permission slip for the surgery.
     The nurse brings me antibacterial wipes and has me wash each side of my chest for a full minute. She says they’ll repeat the procedure in surgery with orange wipes. She’s back and the anesthetist arrives.
     She introduces herself. I don’t remember her name. She describes risks of anesthesia. She asks for consent and I sign.
     The anesthesiologist arrives. I describe nausea from anesthesia in the past. Ask her about the blocker Dr. Garreau mentioned. She goes through the process and risks. Describes the 12-18 hour benefit for pain control. I opt against it. At some point, I’m offered Valium. I say yes. I’m a little tense.
     Surgical nurses arrive and introduce themselves. They’re peppy and warm. The surgical intern arrives and introduces herself. The plastic surgeon, Dr. Popowich, arrives, gets on one knee and draws on my breast with a purple marker. He leaves and others swarm in; they don’t seem to introduce themselves anymore. A woman at my feet wraps compressors around each of my legs; they’re like massaging bubble wrap. She doesn’t tell me what she’s doing; I have to ask. The wraps feel like shackles. I feel panic and start deep breathing again. At my left, a woman dots me with what appear to bits of tape. “This is an EKG,” she says. “I feel surrounded here,” I say with an awkward chuckle. “Oh, does it feel like you have no control?” she says in a jovial tone. “Yes,” I say. It seems we have rapport. But she’s done as quickly as she started. “That’s it?” I ask. “Yes,” she says. “How was it?” “Everything’s good,” she says, and darts off. Suddenly I’m being wheeled down the hall. We enter the surgery room. It’s lights and stainless steel. “Is this the surgery room?” I ask. “Yes,” I hear. 
     And the next thing I hear is: “Surgery’s over,” and I’m being wheeled into recovery. Good news follows almost as quickly.

Focusing the sky

     We went to Sisters, Ore., over the fourth. I didn’t book early enough to get a spot at one of the 'cool' resorts so we stayed at The Ponderosa Best Western, which had llamas to pet and a fragrant pine forest around its perimeter. The room was restful, furnished with rustic pine furniture and comfy beds. In the morning, the maids decluttered our space.
     It was sunny and warm, but not too hot. The nights (unlike in Portland this past week) were devoid of fireworks, which I considered a plus. We strolled the town and looked at quilts, swam, hiked and filled our lungs with the smell of pine. All in all, it was a peaceful get-away. We came back to Portland Saturday night, which gave me time to become untethered.
     There’s such a thing as too much time to ponder.
     There is such a thing as wanting to control that which we cannot control.

     On Sunday, I needed to conquer our bedroom. I wanted it clean. Not just clean, but deeply clean, a spring-clean kind of clean from the depths of the closets to the back of the drawers. I wanted a calm space like the hotel room with nothing extra, no books or mementos gathering dust, a healing space for my return from the hospital after surgery. 

   The problem was I couldn’t move. Through monosyllables, I tried to explain to Ron that I needed his help. He seemed puzzled at first but quickly dove in to help. He led with the big picture cleaning, which took him an hour, while I concentrated on organizing details. The task gave me a day’s worth of focus, made me happy and inspired one daughter to do the same with our kitchen.

     Today I feel better. Rested. More prepared somehow. 
     And right now, I’m pondering what to do with my next 10 to 12 hours. Because perhaps this is energy I shouldn't waste.

Count down and around

     It’s been interesting to see the stats on this blog. I’ve had readers from every continent except Africa. This encourages me to share information that others going through a similar journey might find helpful. Consider passing on the link if you find something worth sharing (or if you know someone in Africa). 

     I thought I could write about this journey honestly and without self-editing because it’s not like I’m baring family secrets as many nonfiction writers do.  The act of writing this blog is more about baring me.
     Still, unless one is a hermit, others are always involved. And there are places I won’t go.  For example, I won’t go into detail about my kids and how they’re handling or not handling my situation. Perhaps that’s a story for sometime down the road. Maybe it’s theirs to tell.
     I will tell you my writing energy has waned as I await the Ordeal that is eight days out. My focus is off.  I suppose this speaks to the emotional part of this journey.  That and the distractions. 

     The lengthy call from the pre-admissions nurse yesterday was one of those distractions. She covered medical history, drugs, pre-surgery instructions, including detailed shower, linen and clothing steps. She peppered me with queries. Are you feeling sick?  Have you been around anyone with a contagious disease? Have you or a family member ever had a blood clot in your leg? Will you allow a blood transfusion in the event of an emergency? Do you want a chaplain to speak with you the morning of? Are you feeling suicidal?  Have you ever reacted to anesthesia?
     No. No. No. No. No. No. Yes.
     I can tell you about the surgery specifics. How I will have a nipple-sparing mastectomy on my left breast. This, as I understand it, is a nifty and advanced procedure. After, I’ll have a cleanly deflated breast. The plastic surgeon will follow during the same surgery session and insert a tissue expander under my chest wall. I’ll have drains for a few days near the incision line. Over the coming months, the expander will be filled on an outpatient basis. When the expansion is complete, it’s replaced with a permanent implant in an hour-long procedure. If adjustments need to be made to my right side, it’s done later.
     If that felt like TMI (too much information) I can tell you that’s the abbreviated version. It happens next Tuesday. I go home on Wednesday.  I’m looking forward to getting this behind me.    

Dragon Power

     My friend George Ivan Smith promised to make me an angel bread sculpture in a few months to celebrate the end point of my Hero's Journey. But to tide me over, he made me this dragon. He delivered it warm, fresh from the oven and insisted it was made to eat. While I don't generally eat art, I ingested this beast with butter and jam. I feel the fire in my belly and I'm ready for battle because of it. (My kids helped me indulge after getting quite a chuckle when they spotted it resting on our counter.) 

      Here's a poem by Jack Prelutsky (from an accompanying book George lent me) that speaks to this moment in time, and perhaps says a little something about positive thinking.  

If you don't believe in dragons, 
It is curiously true
That the dragons you disparage
Choose to not believe in you.