Surgery: Six Months in the Making

I’ve already written a post about what I packed for surgery as well as the post-surgical pathology report but I’ve yet to write about the actual surgery. Being a Type-A person, the lack of chronological order irks me a but it is what it is and I suppose there is beauty in the chaos. So, on to the Surgery…

On December 31st, I received a call from University of Washington (UW) Medicine to inform me of my check-in time for surgery on Jan 2nd—5:30am. I was pleased as I assumed this meant I would be their first surgery and wanted to get in and get it over with rather than wait half a day for it to happen. It wasn’t until later that evening that I realized that the early check-in time was not conducive to taking the ferry from the Kitsap Peninsula (where we live) into Seattle the morning of the surgery. None of the ferries ran early enough to get us across the water and then make the drive to UW in time. Our other option was to drive down to Tacoma and back up into Seattle…a good 1.5-2 hour drive. On top of that, I would need to shower that morning with a special cleansing soap which would add even more time to our morning. I really wasn’t too keen on waking up at 2am and neither was my husband so I booked us an AIRBNB room just a short drive from the hospital.

We were blessed to have my husband’s parents (whom I affectionately refer to as my in-loves, rather than in-laws) fly in to help us take care of the kids during surgery and recovery so my husband, Josiah, could come and stay with me. They flew in on the 31st and the following evening, after going out for my final dinner before surgery (we got Thai food and I ordered Pho as the bone broth is highly nutritious, easy to digest, and one of my comfort foods) we said our goodbyes to them and the kiddos and took the ferry into Seattle. I will say, I think it was far easier on our kids to say goodbye at the restaurant since we took separate vehicles than it would have been at home. From the ferry, we drove to our AIRBNB, got there and settled in. Personally, I thoroughly enjoy staying at AIRBNB’s. When all was said and done, we paid the same amount for a GORGEOUS daylight basement studio apt (with heated floors) that was spotless, than we would have for a 2 star hotel with questionable reviews miles down the road.

I did my first shower/cleanse that evening before bed and then another shower/cleanse upon waking (required before surgery to kill of any nasty germs/bacteria/viruses and reduce the risk of infection). I’ll admit, I didn’t sleep super well but I’ve also had worse sleep. I kept waking up, thinking I may have missed my alarm—isn’t that always how it goes on mornings you have something important going on? Anyhow, I got out of the shower in the morning, took a good long look at what was left of my breasts (skin and nipples with implants), knowing in a few hours they would be amputated—let’s be real here, a mastectomy is an amputation. I expected to feel sorrow but I was filled with peace. I felt no apprehension nor anxiety regarding the impending surgery. I had peace and knew that this was part of my journey. I’m sure it also helped that I had over 7 months to mentally prepare for this day. As I posted in the pathology report post, I was sure I knew the outcome of the pathology report (yes, even before the surgery was performed)—I knew God was in control.

We got dressed, packed our bag, and headed to UW at 0’dark thirty. The check-in process was a wee bit muddled but easily sorted out. As we waited to be called back, I looked around at others who were awaiting surgeries that day. I wondered what their stories were. “What type of surgeries were they having? Was it to remove cancer? Was it something more benign? Were they anxious?” One woman who checked in directly prior to me was less than kind to the staff, causing me to wonder if her attitude was due to nerves or if she always treated people so rudely. Another family sat around a woman (whom I likely accurately assumed was a breast cancer warrior like myself), speaking encouragingly in a language I couldn’t quite place. When the woman was called back, one of her family members looked over at me (perhaps sensing my beanie was not a fashion statement but a necessity due to chemo), and said that her family had flown in from Spain. We wished each other well and soon I was called back by a kind nurse.

Josiah and I followed the nurse to me pre-op room where she performed all the necessary vitals and gave me the obligatory gown to change into. My plastic surgeon, Dr. Louie, was the first to stop in. He knocked then casually walked in, Starbucks in hand, cheerfully said good morning and asked if I was ready. I affirmed that I was and then asked if HE was ready. Dr. Louie chuckled and replied in the affirmative and said that he’d had a very restful night’s sleep. I thought to myself, “Good, at least one of us did and his rest was far more important!” He asked if he could make his markings on my chest before the rest of the team came in (I appreciated that small act of preserving some of my dignity), to which I happily complied. Dr. Louie concluded by wishing me well and saying he’d see me soon. Soon after he left, my nurse anesthetist came in and introduced himself. We discussed the process of the anesthesia, he asked about my nausea and since I have a history of post-op nausea (to the point of throwing up), he hooked me up with a patch behind my ear AND and oral pill prior to the surgery in addition to the IV anti-nausea meds they used. Spoiler alert: the meds worked and I didn’t experience any nausea; thank God!

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Ready for the surgery!

Soon after, Dr. Loui’s team came in and introduce themselves, followed by Dr. Calhoun’s team (oncology surgery) and finally Dr. Calhoun. We went over the procedure to make sure we were all on the same page regarding this being a bi-lateral “mastectomy completion,” meaning they would remove excess skin, the nipples, any remaining breast tissue, the implants, explant and total capsulectomy along with any remaining cancer and the goal was clear margins and a “flat closure.” My memory gets a bit hazy after that because the nurse anesthetist administered the twilight meds shortly after. I vaguely remember joking that I must be a lightweight because I felt woozy very soon after the administration and then last thing I remember prior to the surgery is being wheeled into the operating room and seeing the massive round lights (that weren’t turned on yet).

I would love to tell you that the next thing I remember is waking up after the surgery was complete but that would be a lie. The next thing I remember is becoming aware of what was being said around me. I remember them saying the IV infiltrated, not once, but TWICE and they needed to move it—twice. I tried to tell them to use my foot/leg (due to lymphedema risk in my arm) but was still too out of it actually say anything. So what on earth happened here? Well, my IV infiltrated, meaning that somehow, the medication being administered by the IV was going into my tissue rather than my vein. This is why the anesthesia started to wear off and I would imagine that the numbing meds would have at some point as well. My surgeon explained it post-op and said they were fortunate to have caught it rather quickly because sometimes once all the sheets are up around the surgical site, it’s not caught until the swelling (from the meds in the tissue) is all the way up the arm. That could have had horrible ramifications for my lymphedema and could have caused those scenarios you hear about where the patient felt the surgery but was too out of it to say anything right away. I would ASSUME that if I would have felt anything, my blood pressure and heart rate would have spiked, alerting them something was wrong. Bottom line, this was a minor complication that could have been far more complex and I am so grateful for God’s protection.

There was another small issue that arose during the surgery that I know God protected me from further complications. As I mentioned, part of the surgery involved removing my implants and the capsules that my body formed around them. These capsules are scar tissue that anyone with implants will have. This scar tissue adhered to my chest wall in places so my plastic surgeon had to cauterize the capsule to free it. In the process, this made a small tear in my pleura, the lining outside of the lungs, which allowed air in this lining. They called in the thoracic team who advised removing as much of the air as possible and gluing the tear close….so they did. Y’all…they pro-glued my chest shut! This resulted in an X-ray while I was in recovery, another at 11pm that evening, and one more before I was discharged the following day. This could have caused some very serious issues. If that tear had opened up again, they’d need to do another surgery to repair or if the air pocket grew, they’d need to drain it….ouch and ew! Thankfully, this small area was healed when I had a follow-up x-ray 4 days later.

When I finally did start to wake up after the surgery, the first thing I remember is briefly crying before passing out again. I’m not surprised at that response; I cried when I woke up from my first mastectomy, so much so that my first words to Josiah were asking him to wipe the tears out of my ears (they rolled into my ears). This time, I was slightly elevated so no tears in the ears. It did take a long time for me to fully regain consciousness (as it usually does). I would come too and open my eyes for a short time and then be out of it again. I remember the x-ray in the recovery area, but not being transferred to my room until they had to transfer me to my bed. They transferred me using the coolest hoist that was attached to the ceiling. I remember them apologizing for the “squeeze” of the hoist lifting the mesh sling, if you will, that was under me. It definitely was uncomfortable and woke me up a little bit more but the team quickly and expertly got me comfortably situated in my bed. They elevated my right hand/arm where the IV had infiltrated and applied a warm compress to help alleviate the swelling. My poor hand and fingers were so swollen. I believe my dad responded to Josiah’s picture text of my hand as a “troll hand”—he wasn’t wrong!

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IV infiltrated hand:
L- 2 hours post-op swelling R- 24 hours post-op swelling

I think I was transferred into my room around 13:00 and was so grateful to realize that despite the swollen hand and the pain, I had no nausea….Praise the Lord! I was quite hungry so my nurse showed us the menu and how to call in a meal. I could barely move my arms so I looked over the menu and my husband called in my order for a late lunch. I recall broth (highly nutritious and easy to digest), prune juice, apple sauce, and I don’t remember what else. I will point out that after any surgery, some of the meds can cause severe constipation so I order prune juice with EVERY MEAL as well as bran muffins. I’m also careful not to order foods that are binding (and thus will make constipation worse) like banana, starches, etc. Just this simple dietary adjustment the first few days after surgery can make a huge difference!

Both my surgeons came in that afternoon and I believe the next morning as well to update on the surgery, the minor issues, and to check on my recovery. My biggest obstacle this time was vertigo that didn’t subside for about 24 hours. I was a fall risk so my first time using the bathroom, my nurse had to put a belt around me and walk me to/from the toilet. I was blessed to have a nurse with a very sweet and caring disposition. Some people would feel mortified at being “walked” around but it honestly didn’t bother me; I knew it was necessary to ensure my safety. I was able to walk up and down the hall once that evening and then two to three times the next day. They wanted me up and walking as soon as I was ready to keep the circulatory system going and reduce the risk of blood clots, especially in the legs.

Speaking of the legs, when I wasn’t walking around, my legs were being “massaged” by this amazing device they’d wrap around each leg. Said device was attached to a small pump that would pump air into these wraps and it felt like a little leg massage. This was actually increasing my circulation while I was non-mobile, reducing my risk of blood clots in the leg. I personally thoroughly enjoyed this device and Josiah jokingly if the pump would fit in my duffle bag.

I don’t remember at what point in my recovery I really LOOKED down at my chest. I was a little afraid that when I did, I’d melt down or become emotional. Truth be told, I surprisingly wasn’t. I looked down inside my gown as my nurse gently applied ice packs to my bandaged, very flat chest, and thought to myself, “hey….that’s nice and flat!” Of course, I couldn’t see how flat or where the incisions were with the bandaging on but the lack of breasts didn’t bother me. Apart from the vertigo and discomfort, I was feeling as well as can be expected after a major surgery.

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Josiah stayed with me during my hospital stay and was such a blessing to me. I had very limited range of motion so he literally fed me my first two meals, brought the water cup to my lips every time I needed a drink, made me smile more times than I could count, read the Bible to me, and has such a servant’s heart (which he always has but this just made it all the more evident). The hospital rolled in a HORRIBLE folding cot for him with a massive bar in the middle below the joke of a mattress. I felt HORRIBLE that he had to sleep on it but he never complained. Friends, when looking for a spouse, find someone who will care for you in this way. Forget their looks, their money, their status, and look at their HEART.

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Josiah reading the Bible to me.

I mentioned that I had 3 x-rays of my chest following the surgery. When the third x-ray showed that the lining of my pleura was still glued shut and the air pocket hadn’t grown, they finally decided I could be discharged. They had also been keeping an eye on my blood pressure (B/P), which was extra low, in part due to the meds given during surgery but also in part due to one of the meds I took before (and continued to take after) surgery, propranolol. There have been a few studies to date on combining propranolol with etodolac before and after surgeries to remove cancer that have shown these meds reduce the rate of recurrences after surgery. If you are interested, I’ll write up another post on a few other meds that seem to be promising to take before/after any cancer surgery/biopsy that have similar benefits. But back to my B/P—if memory serves me correctly, it was hovering in the 60’s/40’s . The day after surgery, it finally started coming up into a range they were comfortable with (high 90’s/high 60’s)—normal for me is about 110/72. Considering my pain was manageable, I was walking, using the bathroom well (yep they collected and measured my pee), and my vitals and images were on an upward trend, they discharged me that afternoon.

While the discharge paperwork was being processed, Josiah helped me to carefully unpin my drains (I literally had a drain coming out of both my sides to removed fluid) from my hospital gown, put my drain belt on and get those suckers tucked into the belt pockets. I can’t reiterate enough what a lifesaver these belts are. They are adjustable so you can wear them as high or low on your hips/waist as you want and the pockets can be moved around too. get on underwear (that’s true love), put on comfy/stretchy pants, a button up top, and put a beanie on my head. Once all the paperwork was in order, he got my prescriptions and we waited for my chariot —aka wheelchair—to arrive.

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One of my drains.

^^Drain Pouch Belt—MUST HAVE^^

Once my chariot…er wheelchair…arrived, I was carefully whisked off across the hospital and down to the parking garage where Josiah pulled up our car and carefully helped me transfer in, get seat belted with the seat belt pad, and head to the ferry to make our way home. I have used this seat belt pad in the past and was SUPER grateful for it this trip. Not thinking ahead very well, I suggested we take our manual transmission subaru to/from the surgery rather than the pickup, which would be more difficult to park. Well, pair a manual transmission vehicle with a new, stiff clutch, and Seattle’s steep hills, and you have a less than smooth ride. Josiah did his absolute best to make the ride a smooth as he could but I couldn’t help but laugh at my lack of foresight and said how grateful I was for the belt pad in protecting my very tender chest from the seat belt in the moments the ride wasn’t very smooth!

We got home that evening and were welcomed home with homemade signs and very cheerful little voices to greet us! The surgery I had been waiting for, for more than half a year, was finally behind me. Now the challenge of resting and following instructions of no lifting, no carrying, etc would begin…

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