Getting to know the surgeon: It was raining the day we went to Mount Sinai Hospital in Toronto. We went up to the 12th floor where the waiting room was busy, full of the usual Mount Sinai clients. Older women, well-dressed. My doctor is Jamie Escalon. He’s a large man with a very high hairline. He talked to me about my findings and what would happen next. He told me I would find things very different from 20 years before. The biggest changes were that this was Day Surgery, that it would take an hour to an hour and a half, and that I would have no surgical drains. He also said that anaesthetic had improved and the new variety was fast-acting, fast-acting, with little after-effect. He did one worrying thing- he referred to one area of my breast and frantically search through my notes when I mentioned there were two. I saw Krishna look concerned at this and I hope for no good reason. After my surgery I would come back for results and a treatment plan. Again, this was a familiar pattern and so in a way I hope it will follow the same successful path. Since then I’ve had some bad days, with my emotions all over the place, I’ve been tired, and worried, and sometimes terrified. People think cancer hurts, and it may very well do in later stages, but at the beginning Everything feels normal. There’s no pain, there’s no sensation, just the knowledge that something evil is inside you. It’s very strange.
I was very scared of surgery, just as I had been with my other two surgeries in 2002 and 2004. My main fears were not waking up from the anaesthetic and how I would feel when I woke up. Women’s College pre-op is a virtual session, and took place 2 days before the surgery. I spoke to four different people, all who were very informative and friendly. There was the surgical nurse who explained what would happen on the day, the pharmacist who explained what drugs I could have and how to take them, a physiotherapist who explained the exercises and limitations following surgery, and finally an anaesthesiologist who explained the actual surgery and listened to my fears. He told me he would not be the surgeon on the day but that all of his notes would be provided to that person. I can’t say I was completely reassured, but it was helpful to know that they knew my wishes and were happy to support me on the day. It felt like a lot. The number of forms with information and consent felt somewhat overwhelming and the days before the surgery it felt like everything was moving very quickly. I felt exhausted.
Lumpectomy: The day of the surgery inevitably rolled around. I had to be there at 8:30am and my surgery would be at 1:45. We took the subway with my bags- my socks, two bags- one for my clothes, one for my shoes, and my CPAP machine, which they’d asked me to bring. Apparently, they want that there in case they have trouble waking you up. Hmm.
Once on the 8th floor, I changed into Surgical clothing- a long hospital gown, a pyjama type bottom, and paper booties over my socks. I had a locker to store my belongings in. At this point Krishna was able to join me as I went down to get my pre-surgical procedures.
I was on a stretcher bed and was wheeled around, which always feels somewhat alien and official. The first procedure was an ultrasound where images helped the doctor insert wires into the areas that would be operated on. First, of course, some local anaesthetic was put into my breast. Toronto has developed a new technology called the Molly seed – a magnetic guide for the surgeon. In my case the older style, wires, was better because two magnetic Molly seeds would be a problem so close to each other. I felt a little bit disappointed by that since I was curious about the seed. Once the wires were taped down they did a mammogram to make sure they were properly in place. Luckily, they use only light pressure and everything went smoothly.
From here I was taking to the second floor to nuclear medicine for my Sentinel note images. However, there was a bit of a mix-up and they weren’t ready for me, having to order my dye from another hospital so back to the 8th floor I went. On the 8th floor I went to an area with cubicles like you find in an emergency room. They told me it’s the same area that I would be in after the surgery, so I was quite pleased to see this early on. Everyone was friendly and reassuring and although I felt anxious I certainly was not panicking, something I had really worried about.
Back to nuclear medicine. I don’t remember this from last time, and in fact I don’t think that I went through it. At the first surgery the Sentinel node biopsy was still in trial mode. In order to have it, I needed to be around for at least 6 months for our follow-up by the study. So instead two or three layers of lymph nodes were routinely removed. This time it was going to be Sentinel. I was in a really large modern room with a machine that looked like a CT scanner, lying on a very narrow bed. The technician told me that dye would be injected into the two areas and it would travel to the lymph nodes. He said, because it goes under the skin, it would sting but that sensation would fade within minutes. I didn’t feel it as a stinging, but more like a clenching or heavy pinching, definitely unpleasant but as promised short-lived. The machine moved me along under what looks like a screen without any viewing area and he left the room, which I hadn’t expected and I lay on my back for the 15 or 20 minutes he told me about. I feel quite woozy during that time, and really wanted to ask for help. Instead I breathed waiting for it to be over. When he came back in and I mentioned it he put an extra pillow under my head. He then said he was going to trace the outline of my body for the scan. I still don’t know what that was about.
Now the serious part- surgery. Several people came to talk to me including two anaesthetists who I told my preferences to. They listened without hurrying me reassuring me about my fears. What I mentioned my fear of not waking up the anaesthetist said that rarely ever happens in fact never. He told me I would be getting oxygen in the operating room and that’s when they would give me the anaesthetic. I reiterated that I didn’t want to be told when I was getting it and he nodded. The next anesthetist talk to me about the nerve block, explaining that it would go into my back near my spine and go to the nerves in the armpit and part of the breast. Did I want this done, it would reduce pain immediately after the surgery and would last from 24 to 48 hours. I said yes but I was nervous so the nurse offered me sedation. I’ve always been afraid of sedation, but said I’ll try it- seeing it as an opportunity to experience it this time around in a very protected environment. I also said I didn’t want to feel out of it so she gave me a half dose. I was hooked up to an oxygen monitor and blood pressure/ heart rate machine and noticed my blood pressure getting lower after that. That was reassuring, and I did not feel out of it but quite happy, she had given it to me saying, here is your mimosa. It’s nice to smile at such a time. They sent Krish away before the nerve block. When I got it it was again two injections with a great deal of pressure but nothing I couldn’t handle.
Finally it was time to take me to the operating room. My anxiety was rising but manageable. At this point, trusting the team was the only way forward. The team was around me, but I couldn’t see a lot. There was no music, something Krishna said he enjoyed during his surgeries, but it felt like a nice community in there, with everyone speaking softly and working together. They put my oxygen mask on, the anaesthetist repeated that he wouldn’t tell me when he was giving me the anaesthetic, but pretty soon, after a few breaths, I could sense something different. I suppose I could have felt anxious then and resisted, but chose instead to move towards it, to have it done. People talk about a blank, or “the next thing they knew” but to me it’s not really felt that way, but more like a brief and grey time, then suddenly alert. Maybe not too suddenly. I was conscious of being conscious. I felt relief and happy that I was not groggy or nauseated, but in the room with people moving around me back in the post surgical area. They asked me how I felt and I said I felt fine but noticed one area of my tongue was numb and tingling. I am was really happy to have gone through it. I think the surgeon showed up my side pretty quickly saying everything went well, see you later.
I sent a couple of messages and Krishna showed up to sit with me while I recovered. I don’t think I was there longer than an hour or so before they brought a wheelchair to go down to the lobby. So nice to be outside, we waited a few minutes before calling an Uber to go home.
Sibling chat:
— Sleepy, itchy, tongue is numb on the right. Having ginger ale, in a bit of pain
— OK. I’ll let people know you survived.
Later:
— Waiting for dinner. I’m hungry, which is a good sign seeing as they sent me home with a sick bag
–My tongue is still tingling
Cos it doesn’t pay to not worry about something
Email the next day:
— How are you feeling???? How was your night? Hoping you slept like a log.
— Ha more like a twig
Sibling chat:
In fact, the nerve block they gave me meant I had very little pain. I felt almost like a fraud. What surgery? The emotional side was harder. I lay on the couch with TV and my audiobook, being waited on with meals. My friend, Denise, sent cake – yum. But it was strangely silent. Some people chatted if I went first. No one left casseroles or flowers at my door. Bah.
