Reconstructive Surgery

This week has not been the most fun week of my life, but in a way it was cathartic, as it signaled the final step in my long journey to recovery. On Tuesday afternoon I received reconstructive surgery on both breasts in an attempt to make my body look normal again after my mastectomy last year. Some people may think a boob job is nothing to get upset about, and in the days leading up to the surgery, I wasn´t too worried about it, either. However, it turned out to be a bit more stressful and scary than I originally thought. For the past four months since radiation my doctor has been filling my temporary expander with saline solution in order to stretch the skin and make room for the permanent implant. Sometimes (although I seriously doubt it) the expander looks good enough that the doctor doesn´t need to replace it with an implant. After my first few fillings, however, it was clear that I was going to need another surgery to replace the expander. My left breast wasn´t even close to being in the same anatomical location as the right one. In Jon´s words, this morning, so you know I´m not exaggerating, “Your left breast was AT LEAST four inches higher than your real one.” I had this round, hard as steel lump sitting just underneath my collarbone, next to my armpit. In fact, the expander was so off that the entire mound of saline was situated above my nipple. This may be too graphic for you, but it was almost as if the nipple was folded under the breast. Super awkward and Frankenstein-like! I´m sure you can imagine what having a gruesome looking breast like that does to one´s self esteem. Luckily, through this process, I have learned to care less about what I look like, mainly because there truly was nothing I could do about it. During the winter season I was able to hide the breast discrepancy by wearing a padded bra and adding tissue on the bottom of the left one. I don´t think too many people noticed, because I stayed away from tight t-shirts and/or cleavage bearing ensembles. There was, however, one awkward moment while playing in my first soccer game at school (which I wasn´t technically supposed to be doing…. OOPS! Sorry Dr. Majlis!). I was wearing a sports bra for the first time and I had padded it so the breast placement wouldn´t be as noticeable, but after running around a bit and sweating, the padding totally shifted and began sticking out of the bra. It became very obvious that my boobs were not normal. Of course, Jon only let me know how awkward it looked till after the game. Awesome! Not to mention how naked I felt taking off my wig in front of the students for the first time and sporting my shock of dark, curly, unmanageable, post-chemo coif. So that was the beginning and end of my serious exercise attempts. In addition to my realization that I wasn´t going to be toning up my muscles any time soon, about three weeks ago I looked at the calendar and discovered I had less than three months to go until my wedding. There was no WAY I was going to ruin my beautiful strapless gown with this weird left mound sticking up out of it. So I went to the doctor and pointed to my chest and said, “You know, doc, I´m getting married in January. Is there anything we can do about this situation going on down here…?” He immediately agreed that it was time for my reconstructive surgery. So we went over my options, which turned out to really only be ONE option: a silicone implant. I had previously done research about reconstruction and had learned that although silicone implants were still the most common form of breast replacement, that there were other, newer procedures available. There are two different “flap” procedures that can be done. In these procedures the doctors take fat and tissue from your stomach, butt, or back and put it up into your breast. Although these procedures sounded good to me, (a little tummy tuck wouldn´t hurt me these days), they require a lot longer recovery time than just a simple implant. And what with the wedding coming up so soon, and my school schedule, I just couldn´t afford the time to have a complicated surgery like that. So I settled for the implant and asked for three days off from school. Maybe someday in the future, if I feel like having another surgery, I could choose one of the flap options. On the day of the surgery, I went to work as normal. The previous week had been incredibly busy. Friday night Jon and I had our “Welcome to the Jungle” belated Halloween party and Saturday night I performed a Glee number with five other faculty members in the school´s inaugural gala for the fine arts center. Both events went well, but they required a LOT of energy. So, in truth, I hadn´t had a lot of time to mentally prepare for going back to the hospital and facing the operating room again. According to Google, there is a fancy name for fear of hospitals called nosocomephobia, which I am now entirely sure that I have. This is because everything I have done in a hospital never turns out the way I had planned and often includes anxiety fueled twists and turns. For example, leading up to the surgery, I had to pass several medical exams, both as a form of post- cancer check-up, and also to ensure my body was healthy enough to undergo anesthesia. I had various blood and urine tests, an ultrasound of my stomach, lungs, liver, and ovaries, as well as an EKG for my heart. Unfortunately two of the exam results were a little scary. While having the ultrasound of my vital internal organs, the doctor declared that there was, “nothing to worry about! Everything was fine.” “Phew- what a relief!” I thought, as I hurriedly wiped off all the blue goo and headed back into work. Unfortunately, as I was driving back to school, I got a phone call from some fast-talking secretary at the clinic saying that the doctor needed me to come back in to do some more tests. I asked, for what, and she replied using some words in Spanish that I didn´t know, so I told her I wouldn´t be able to come in till the following afternoon, due to my busy rehearsal and work schedule. As I hung up the phone my entire body went cold and I immediately began shaking like a leaf. I was distressed. More tests is never a good thing… I certainly wasn´t ready to end my blissful last six months of health and head back into the land of cancer-ville, which is what I was worried was happening. And of course, I did the one thing that a panicking daughter should NEVER do; I forgot about the three-hour time difference between Santiago and Houston and called my mother at 7AM her time. It was clear that I had woken her up, and there I was, crying and telling her I needed more tests and that I was scared and didn´t know what to do. And then, my phone service cut out so I couldn´t even end the conversation properly, nor could I reach her until the end of the school day. Sorry, Mom! For the next day and a half Jon and I, and obviously my mother and father, worried and worried. We narrowed the mysterious Spanish word down to either the liver or the ovaries. We were praying that it was the ovaries, because while I was having the ultrasound the technician asked if I was pregnant. I replied no, and she remarked that the ovaries were quite enlarged. Then I told her I had breast cancer last year and was taking tamoxifen on a daily basis. Then she said, “Aaahhh, it´s probably just your body reacting to the changes in the hormones, then.” This somewhat relieved me since I knew that I hadn´t had my period since taking the tamoxifen, so I figured that maybe I had ovarian cysts and that was what the doctor wanted to take a closer look at. Being relieved at possibly having ovarian cysts might seem like a strange reaction, but when compared to cancer, well…. When we returned to the clinic the following day I brought Jon with me for moral support. We had already been through the scenario of, “what if the cancer is back?”, and he vowed that no matter what, we would get through it together. When I lay back down in the exam room the doctor came in and told me that yesterday he found three small nodules in my liver that he wanted to take a closer look at. The day before, the doctor had used a new ultrasound machine and he was finding it difficult to examine the nodes with the new technology. He proclaimed that it was probably nothing, but he just wanted to be sure. My breath quickened and I clenched my hands as he passed the cold plastic ball over my body. “Toma aire. Aguantalo. Botalo y respire normal,” he instructed over and over again, while he took pictures with the machine. After a few minutes he said that indeed, they were just normal liver nodules that many people have, and that I was fine. I did not have cancer again. He apologized for worrying me, as he knew from my medical history that being called back in for more exams probably had alerted my senses. Jon and I headed home and breathed a huge sigh of relief that the dreaded day of my cancer returning had not yet arrived. After the stress of those exams I simply tried not to think about the surgery or anything medical at all. When I carried my overnight bag into the hospital, though, and began the tedious process of checking in, I was suddenly hit with the weight of this new surgery I was having. What if my body wasn´t strong enough to handle the surgery? What if my left breast will never look like a normal body part again? How will I feel when I wake up after the anesthesia? Ugh… too many thoughts and too many worries, and suddenly I felt totally unprepared for the surgery. I worried I hadn´t asked enough questions and that maybe I should have had a different procedure done. Were they going to lift up my other breast in order to make them more even? What size were they going to make the breast? Where were they going to make the incisions? I realized that I hadn´t asked any of these questions and I began to panic again. There´s nothing more frightening than going into a surgery not knowing what is going to happen to your body. To make matters worse, when I handed my entrance orders to the nurse she read, “reconstructive surgery on the left breast with a silicone implant”, and she looked a little puzzled. “Well, aren´t you going to be having anything done on the right, to make them look more even?” “Shit!” I thought. Well, of course I want them to look even, but that´s not what I had previous discussed with the doctor, and so now I felt totally unprepared for the surgery. Dr. Schwember had already been in to draw funny blue lines and circles all over my breasts and already the anesthesiologist was there to have me sign off on the anesthesia drugs. I started completely freaking out and crying and the poor, pint-sized nurse, Blanca, kept trying to comfort me, looking genuinely shocked that this woman with the awkward haircut who had voluntarily checked herself into the hospital for a boob job, was now sobbing out of control. The anesthesiologist managed to calm me down and explained that I was experiencing a PTSD of sorts. After all that I had been through, being back in the hospital gown and preparing for surgery would obviously be very upsetting and bring back lots of unwanted feelings and memories. She promised to bring the doctor back in to explain everything to me again and got me to stop crying. Dr. Schwember returned and explained that, in addition to the implant on the left side, they were going to put a small implant on the right side as well, to help stop the natural effects of gravity on the breast over time. He acted like he had told me this all along, and that I just wasn´t remembering the details correctly. I was entirely positive that he had NEVER mentioned doing any kind of surgery on the right breast, and knew that I had written down everything exactly as he had told me on the hospital entrance forms. Eventually I agreed to have surgery on the right breast in order to balance out the implant on the left. I had to sign new forms. After all of this miscommunication, the nurses continued to prep me for surgery by asking me to remove all of my nail polish and makeup and to don the absolutely horrible blue hospital panties that resemble a much too tight diaper. As I was stripping myself down to the bare essentials, the anesthesiologist re-entered the room to declare that there was an abnormal wave on my EKG exam, and that she needed me to take another test, “just to make sure”. The operating room staff had already arrived to wheel me down into surgery, but she stopped them in their path and told them they would have to wait. The EKG machine appeared and an extremely incompetent elderly nurse attempted to get the machine to take a clear reading of my heart for approximately 20 minutes. She plugged and unplugged the machine various times, and clucked and clucked while unsticking and re-sticking the round pads to my body. She declared that she needed to use a different machine, so off she went, and again, I waited. Another nurse came in to administer the second EKG exam, and this one successfully printed a report. The operating staff took this opportunity to wheel me down to the surgical unit, since it was now approximately one hour past the time that I was supposed to start my surgery. Upon reaching the surgical unit with all of the various nurses and doctors running around in scrubs and plastic shower caps, I began to get rather nervous once again. The staff parked my hospital bed in the middle of the entrance way and left me there. Several women with giant red lips read my chart and asked if I was Mrs. Swift, Elizabeth. I said my apellido was Timms, not Swift; but yes, I was that same patient. I also informed them my doctor was waiting on some EKG results so that they wouldn´t take me into the surgery room too soon. The friendly nurse with the biggest lips decided to wheel me into the recovery room for “safe keeping” until the doctor came to find me with the results. After they parked me in a remote corner of the room where my nerves continued to get the best of me, I waited about 15 lonely minutes before anyone seemed to notice me or ask why I was there. After about 20 minutes, my anesthesiologist came sprinting into the room declaring that the wave was still appearing on my EKG and that the cardiologist had requested that I do an echocardiogram. At this point I totally almost lost it again, because now I was worried that there was something wrong with my heart. With all of the drugs that I take, heart problems wouldn´t have been out of the ordinary; I just didn´t want to deal with an ailing heart now. I wanted to be healthy and happy, successfully have my surgery, and attend my wedding with no worries. The anesthesiologist ordered two of the surgical assistants to place me in a robe and wheelchair me up to the fifth floor for the exam. She also ordered that they should hurry since they were keeping the operating room open just for me. So off we went sprinting down the labyrinth of hallways, searching for the doctor who was waiting to tell me whether my heart was strong enough for surgery or not. I was freezing. This was not entirely a surprise, being that I was barefooted, and wig-less, dressed in a flimsy hospital gown, with an even flimsier robe to protect me from prying eyes. The echocardiogram doctor was waiting to examine the heart and after finally finding a spot below my ribs where he could successfully view the heart without the expander getting in the way, we began the exam. After 20 minutes he declared my heart to be very healthy. He said the abnormal EKG results were probably caused be interference from the expander. That made sense to me, and now I was ready for them to just go ahead with the surgery already. It was supposed to be a 2-3 hour surgery with 2 hours of rest in the recovery room and it was already 6:00 PM. I knew Jon would be worried if I didn´t come back to the room before midnight. I was in a much better mood as they raced my wheelchair back down to the operating room where it seemed like 20 people were surrounding the operating table, awaiting my arrival. I clambered up onto the green cloth and hoped the drugs would take effect sooner rather than later. The anesthesiologist tied a very tight rubber tube around my right arm in an attempt to find a vein in my right hand where she could apply the anesthesia. I knew from past experience that finding a vein in my right hand was a difficult process, and indeed, the anesthesiologist was not successful. She jammed the needle into my hand over and over, wiggling it this way and that and causing tremendous pain. At one point, she removed the needle and blood began spraying out of my hand and dripping down onto the floor. “Dear God, I thought. Please stop the torture and give me the drugs in my port, already.¨ She tried, unsuccessfully, a few more times and then resorted to applying the gas mask over my mouth, and as I got dizzy I heard Dr. Buhler say they would fix it when I was under. With needle in hand, he stood over me as I thankfully passed out. When I awoke, the breathing tube was still down my throat and I began coughing and gagging, praying they would remove the uncomfortable tube. I passed out again. The two hours in the recovery room passed quickly and soon I was back upstairs with Jon completely drugged out and, thankfully, not in too much pain. I stayed in the hospital two very long days while Jon continued to work and I watched an interminable amount of TV and graded essays. I went through the now-familiar procedure of hiking up the thigh-high compression tights until they cut off blood circulation to my lower limbs, getting the painful anti-coagulant shot in my stomach at 5: 30 in the morning, and being awoken by nurses at what seemed like the most unnecessary times to give me medicine and take my vitals. The height of ridiculousness came at midnight on Wednesday when a nurse actually woke me up in order to give me a sleeping pill. “Listen lady, I´ve been asleep since 9:30. I most certainly do not need you to wake me up in order to give me a sleeping pill!!!¨ A few times I pretended to be asleep even when they were poking and prodding me, just so that they would take the hint and leave me alone. But I guess it´s their job, so I really shouldn´t be too critical. Anyway, come Thursday I was begging to be allowed to go home and relax in comfort on my couch with the doggie-doos. They obliged and, after forgetting to give me my medicine, they reluctantly let me leave the hospital. Now, two days later, here I am back at the Clinica, with surgical drain attached to my left breast while receiving my anti-body treatment. Good times! As for the breasts, they do look 100% better than they looked before, primarily because they are both now in roughly the same position on my body. They are not perfect: I would guess the left breast is about a full cup size smaller than the one on the right, but now I will at least be able to wear my wedding dress without embarrassment. I´m not sure bikini season is in order yet, but hopefully when the swelling goes down and the bandages are taken off I will learn to live with my new look. According to Jon the doctors ended up just giving me a lift on the right side instead of an implant, but I was never informed of that, so I will have to ask myself when I go to have the drains removed on Monday. I am still a little upset about the surgery, because my breasts used to be one of my few body parts that I actually liked. I know now that no matter how many surgeries I have, they will never look the same. Although they look better than they did five days ago, they just will never look the same. It seems superficial, but it still isn´t a fun reality to deal with. Of course, the prognosis could be worse, so I shouldn´t complain. It is just a fact of my new, post-cancer life. And it still is a pretty great life, despite the complications!

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