Breast Cancer: the surgery

(One part of this is not meant for the squeamish.  The indented part, one para above it and two below it might be a bit difficult to read, though honestly there isn’t any blood or anything.)

Well, been there, done that.

I have an unfortunate early history of being resistant to anaesthetics.  I realize that is almost unbelievable.  I have heard from medical doctors that they think I am not trying, as though one wants to be awake for surgery.  In any case, because of this the hospital recommended that I take some xanax before I even showed up for the operation.  And it may have been that pill which caused a puzzling recurring problem throughout the day.  What in the world does one say to the very many people who ask one, in an extremely cheery voice, “How are you today?”

Picture this:  it is 9 am and I’ve had no coffee or tea.  I go up to the admissions desk in a major cancer hospital, which is in a room with a lot of people getting cancer surgery.  This is not a happy place; there is no laughter or even really talk.  And so the admissions person asks, “And how are you today?” in that very cheery voice that indicates really that one needs to say, “Just fine, thank you.”  I simply couldn’t manage it.

So I said that I was feeling terrible, but thank you anyway.  She looked so surprised and taken aback, so something suggested to me I should say, “Actually, I am just joking.  I am really looking forward to have parts sliced away.” 

I really dislike the idea of making anything like fun of people trying their best to fulfill a function.  So perhaps it was the xanax.  But throughout the day people kept cheerily asking me how I was.  And then looking very taken aback when I said what I thought.   And then I’d try to explain.  Mind you, not one of them refrained from telling me what they thought, as when my surgeon shared the fact that she did not feel good about the operation.  She had thought a mastectomy was a much better cosmetic operation, though in the end in fact she obviously spent some time trying to get the best result with my preferences.  I thought she did a brilliant job. 

There are two difficult pre-op things they do.  One is to bracket the area to be excised with needles, as guidlines for the surgeon.  The other is to give one radioactive dye to trace the transmission from one’s breast to the lymph nodes.  The first involved using a mammogram machine cranked much more tightly than they do for mammogram and putting the needles in:

 Using a sterile technique and local anesthesia (1% buffered lidocaine), two needles (7 cm Kopans and 3 cm Hawkins ) were used to bracket the area in question in the upper outer quadrant of the right breast.  The approach was lateral to medial.  Following adjustment of the needle tips, the hookwires were deployed without difficulty.
  
The patient tolerated the procedure well and proceeded to the Operating Room in good condition.

There is one possible factual error here; I did not consider myself in good condition when it was over.  It was just awful.

What they do is push the needle in for a bit, then take a picture and then readjust, bit by bit.  The lidocaine does not cover 7 cm in; it seemed just to be topical.  I’d say the pain was close to that of childbirth.  Not everyone minds it so much, you should know. 

Apparently, putting in the dye is much worse, so they used a sedative.  In fact, it did not put me to sleep and apparently I objected all the way through, but any memory I had of it is totally gone.  It does funny things to one memory, the nurse said.  By that time, I’d had enough to remember, and I was interested in the idea of some part of one’s memory being totally just not there. 

I was thrilled to wake up from the operation itself with my mind clearly in tact, though missing a bit of memory.  I had just about no post-op pain, which now means I have a good supply of the dangerous and desirable hydroco-something or other.

The pathology report that I got yesterday had the terrific news that the margins were very good.  There’s some disagreement about how wide the margins should be, but this hospital tries for 1 cm, which is quite wide.  For now the cancer is gone and there is no need for further surgery. 

The rest of the news was bad and indeed alarming.  Though the cancer was largely dcis (ductal carcinoma in situ) and so encapsulated, scattered throughout that area were”innumerable” points of nasty bits that were microinvasive or outright invasive.  It was, in a word, multifocal.  None had spread to the lymph nodes, which was a huge good thing.  But mammograms and ultrasound were not picking them up, or at last nothing like all of them.  In fact, it took an MRI to register about 1/2 of the affected area. 

The official mammogram recommendations are now for testing every other year.  In August of 2010 I got a clear mammogram at a breast clinic which has a great deal of experience.  I don’t know where the invasion would be by 2012, but I might well be some ways toward its spreading at least into the lymph nodes. 

My partner, bless him, has stayed by my side through all of this.  That he somehow got the idea that it would be helpful for him to start telling me what to do seems now minor.  I think it was very hard for him to have so much so out of his control.

Breast cancer can leave one medicalized for the rest of one’s life, and in my case it may well do so.  The next steps probably will be radiation therapy and then hormone therapy, and frequent testing.  My version is hormone sensitive, so shutting down hormones can slow it way down.  Of course, the cancer officially counts as gone, but as many who suffer from breast cancer will tell you, the retoric about curing cancer and the reality of it are very far apart.  Of that more later.  There will be another reason to wish pink away.

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This post is about the experience of one person who, though a regular blogger here, decided to remain anonymous.  The first one is here.  The second is here.