The surgery journey really begins with a 90 second call on the day prior to the surgery.
"Hi this is Dr Janzen. Is this Angus?"
"Yes"
"So your bilateral mastectomy surgery is scheduled for 9:00am tomorrow. You know you'll need to be there at 7:00am?"
"Yes"
"And when are they doing the nuclear medicine?"
"It's scheduled for 1:00pm today."
"Okay. Great. See tomorrow then. Good bye"
"Wait? Will there be drains?"
"Yes absolutely. There will be four. Two on each side. Any other questions?"
"Nope. Have a great afternoon."
"I'm enjoying it so far. Likewise. Bye."
And the journey was underway.
A few minutes later I was in my way to my appointment to be made radioactive again. By injecting a small amount of radioactive dye into my breasts and then taking an image an hour later, Dr Janzen would have a good idea of where exactly to look for the sentinel lymph nodes. By only taking a couple of nodes, she hopes to prevent a lot of problems associated with complete removal of all the lymph nodes in the armpit. If, when they are biopsied, they are positive she will return and remove all the lymph nodes.
The technician had an observer student so was extremely thorough in her explanation (though I never did catch the exact radio-isotope in use.) She did manage to connect one set of dots. I wasn't sure how a picture was going to help all that much in finding something the size of a grain of rice iin my armpit. The answer is that the surgeon has a pen sized probe that acts in a similar fashion to a Geiger counter. There is enough residual radioactivity the following morning that she can locate the node by listening to the increasing beeps as she gets closer. The surgeon will also use a contrast dye that is injected during the course of surgery to outline the limits of the node to ensure that she gets it all.
Taking the image was another challenge as I had to lie perfectly still for five minutes for each of three images. Not usually a problem. But lying with my arms raised over my head triggered a strong urge to cough. We came to an agreement that she would give me a heads up that she was about to start the image. I would cough and then hold still. It all worked out and I was quickly homeward bound.
Sandra arrived at my apartment about 4:00pm and between settling her in and calls and texts from well wishers the evening passed quickly.
I stopped eating at midnight. Actually we finished supper about 9:00pm and I had nothing more to eat. I woke at 5:00am and had a big glass of clear sugary fluid (also known as apple juice) as the last fluid four hours prior to surgery. I took a shower using the special antibacterial soap. Sandra and I headed off to Jim Pattison Day Surgery Center.
Arriving at reception I was quickly and efficiently checked in. I was given a locker for my clothes and provided with the totally inadequate hospital gown, housecoat, tube socks and booties. Proceeding to the preop waiting room, we didn't sit long before being moved into the preparation area. My medical history was reviewed extensively, particularly the long list of medications that I was no longer on. The next step was to get an IV running. The nurse was unsure of whether to set it up in my arm because of the bilateral nature of surgery. Once again I realized just how unusual aspects of my treatment are.
Dr. Janzen bustled in and we chatted for a few minutes about what was going to happen. She drew pretty pictures on my chest that looked exactly like the ones that she had drawn in the handbook that I was given at my initial diagnosis. She pointed out where the dye would go in and made a marker note that all she was taking was sentinel nodes. She asked the nurse to set the IV up in my foot.
The foot IV turned into a bit of a challenge. My care nurse hadn't done it before so after setting me up on a stretcher she asked another nurse to do it. Maybe it was all the coaching she got from other nurses or me but after trying for a few minutes a third nurse took over and was also unsuccessful. They left if for the anesthesiologist. When he came to brief me on what he was going to be doing, he had a look at things. Dr. Xander asked for a bigger needle and had it in before anyone could really even blink. By now it was about 9:30am and the orderly came and wheeled me down into the operating room. We were all ready to begin.
Dr Janzen popped her head in and asked them not to put me under anesthesia until she had a chance to talk to me. The operating nurses introduced themselves and we had a good conversation about traveling. There were some jokes about getting the blood pressure cuff on my thigh. Again nothing to jeopardize blood and lymph flow in the arms. I hadn't really thought about positioning for the surgery but as my arms were spread onto rests perpendicular to the table I realized that was the natural position. When I made the obvious remark about feeling crucified I was told I wasn't the first one to make to say that.
At 10:00am Dr Janzen reappeared. She made sure that I was indeed Angus Pratt and that I was there for bilateral mastectomy with sentinel node removal. I heard the anesthesiologist say I might feel a bit of burning sensation in my foot. I did and the world got hazy.
I woke to the gentle voice of my recovery room nurse Janet taking vitals. After asking how I felt she helped me sit up a bit and I was able to look around. It was a little after 11:00am by the clock on the wall. The room was large and while there were several other patients we were well separated. Janet stayed with me the whole time, getting me used to the binder on my chest and the four sets of tubing and bulbs hanging off the binder. She offered me apple juice and told me I would be there about two hours. At 1:00pm the daycare nurse came to take me back to area that I had begun in.
Running through the handover process which involved vitals and a close examination of the surgical wounds, the two nurses realized that a severe hematoma was developing on my left side. Blood was collecting under the skin causing swelling and bruising. Dr. Janzen was called. She with the surgical resident as assistant made several attempts using 60cc syringes to reduce the hematoma. Unsuccessful she told me that they would need to go back in and find the bleed to stop it. Because I had had the apple juice they couldn't go straight back to the OR. There was also scheduling and preparation issues. A lot of ice was piled on my chest and the nurse took me back through the same preop medical history package as previously. Dr. Xander made an appearance and checked with me on the procedure again.
In a highly unusual step they allowed Sandra to come in and chat with me. I was able to let her know what was going on and asked her to let Yvette and the boys know. She had been wondering why I hadn't reappeared. I signed a new set of consent forms (wondering just how valid they would be with the residual effects of anesthesia.) We were ready to go again.
Shortly after 2:00pm I was wheeled back to the operating room. There was laughter all round as Dr Janzen came back in and asked if I was the same Angus Pratt as she had operated on earlier. I was. The procedure was much quicker and efficient.
Less than thirty minutes later I woke up in recovery with Janet hovering over me. Dr Janzen popped in a few minutes later and told me that the bleed had been obvious as soon as they opened me up. Her hand was making the little spurt spurt spurt gesture. They had cauterized it and didn't anticipate any more problems. This time I knew the drill and was a little slower to accept the apple juice when they offered it. The two hours seemed to fly by. Soon I was being wheeled back down to day care.
Training time. I was taught by an efficient young lady how to care for my wounds and the drains. I was given a couple of arrowroot cookies - first food in eighteen hours. Cookies never tasted so good. I was allowed to get up and go to the bathroom. I realized that managing all the tubbing and bulbs was going to be one of the most interesting parts of this experience. Pain was minimal with the local anesthetic still quite effective. I was given a script for pain medication.
By 6:00pm Sandra and I were back at the apartment talking about what to have for supper. Broccoli cheese soup for those who are curious. I succumbed to sleep by 9:00pm after letting family know that I was doing okay.
I have mastered the art of wearing a binder festooned with tubing and bulbs. The wounds have behaved themselves with no bleeding. And it all feels quite strange. I feel like pirate treasure with my sunken chest. My physiotherapist prescribed exercises seem to doing their job keeping lymphedema at bay. I haven't had much difficulty adjusting to sleeping my back. And after a Tylenol 3 the first night and half the second and third, pain continues to be minimal. I'm actually now at the itchy stage healing. But the binder can't come off till the drains come out. And the drains can't come out till the fluid is down to 24 mls in 24 hours. At 97 mls this morning, it may well be the seven to ten days the doctor predicted.
To not interrupt the flow of the surgery saga I neglected to mention that I had my meeting with the medical geneticist. To say that I learned a lot would be an understatement. The fundamental lesson was that there is a category between inherited (which my cancers appear not to be) and spontaneous (which my lung cancer almost certainly is) called familial. This situation occurs when you have half the BRCA gene in my case and so when a spontaneus mutation occurs in the other half of the gene you end up with cancer more easily than other folks. I have been offered and accepted a test panel that will look at about 30 genes that have been found to have an association with a variety of cancers. I will receive the results of these tests in four to six weeks. They probably won't have any direct effect on my treatment but will give me screening recommendations for myself and for my kids.
My reading this morning from Psalm 103 reminded me of the brevity of life. But more importantly it reminded me of God's love for those who love him.
Men and women don’t live very long;
like wildflowers they spring up and blossom,
But a storm snuffs them out just as quickly,
leaving nothing to show they were here.
God’s love, though, is ever and always,
eternally present to all who fear him,
Making everything right for them and their children
as they follow his Covenant ways
and remember to do whatever he said.
I rest secure in His love. Thanks for the prayers. On to the immunotherapy. Continuing to covet your prayers.