*It*Was*All*Yellow*

November 13, 2020

Friday the 13th. I have 3 appointments/meetings today. One is for my GYN at 9:20….. yes, lets just make sure all the other lady parts are doing okay. Then run to the hospital for a breast MRI at 11:30…. then back to my home town for at Parent-Teacher meeting at 1:45 for my youngest son. Shew!

I really love my GYN PA. She is amazing, super connective with lots of information. I enjoy conversating with her every time I go…… and I will never see anyone else unless my hand is forced. She was shocked to hear of my diagnosis. She also said I served as a good reminder to her to encourage her patients to be more proactive in their yearly screening mammograms, especially those of a younger age. If anything good comes out of this, I hope that is it. Everyone needs to get their mammos. It is not in anyway so uncomfortable as to not be able to complete. Buck up people… do the exam…. it is what it is…. and I guarantee it’s much better than looking at your boobs after they’ve been chopped off. (And get your PAPPY’s too!!)

On to the breast MRI. I’ve checked in with the radiology department lady so many time at this point. I am starting to enjoy her dry humor and efficiency. I’ve already met the MRI tech who is breast certified. I went down to the department the week before with my co-worker to see if I could squeeze in early (turns out the radiologist misheard the word brain for breast…. similar, but no dice). At that time she went ahead and gave me the deets about how the test would go and what I needed to do to prepare. Super nice.

The day of the MRI, the tech and I had some information-sharing that to connected us to each other. I relayed to her that we both worked at the previous hospital in our system that shut down a couple years prior. I remember her not only from working there, but I had cared for her father on several occasions. He was so sweet and so cute…. my memory is not detailed, but I do remember that. (I have such a soft spot for old people…. they are my favorite population to work with in the medical field). She vaguely remembers this and relayed to me that he had since passed and agreed to description of her dad.

While she was preparing me for the MRI, she also relayed to me that she had had breast cancer as well. She had to take an oral chemo drug for 5 years after her mastectomy…. and has been doing great ever since. This will not be the last time someone has shared their story with me over the past couple months…. it will become so much so that I feel righted in my premature freak-out about getting breast cancer.

This will be the second time I’ve laid prone on a table with my boobs hanging through holes (what if these pancakes get hung on something?) Just for info, I did have to have an IV for this particular test because they use IV contrast to show uptake within the breast. You are in the MRI tube for about half an hour with earplugs that hardly mute all the loud clicking noises….. again, it is what it is…. just do it. You will have to lay still in a superwoman pose and be asked to hold your breath several times. It’s a weird way to lay even for that short period of time, so sit up slowly when it’s over and take some extra time to let your body adjust before you stand. Results to follow.

November 19, 2020

Second visit with Dr. Vinsant. Phil finally gets to meet her. As expected, the results of my MRI are not what I wanted to hear. See link below (credit American Cancer Society) for the BI-RADS categories for MRIs.

https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/understanding-your-mammogram-report.html

So, that’s it then, nipples are gone. Again, I knew and prepared myself for this. It’s not what I want in anyway…. and I will still cling to the unlikely hope that they can be saved till the bitter end. I’ll wake up from surgery with my nips, right? Ummmm, no.

In other news, I did a saliva-sampled genetic test that revealed “no clinically signification mutation identified”. This test was performed by Myriad Genetics via their Integrated BRACAnalysis with Myriad myRisk Hereditary Cancer Testing. If there was any good news in the whole process, this was it. I have two sisters and the thought of either one having to go through this as well is the thing nightmares are made of.

(diagram courtesy of Myriad Genetics)

So, my cancer was just for funsies….. a joke my surgeon didn’t get. I’m not super sure of her humor level, so I’ll just let that go at this point.

November 24, 2020

This date is just a reminder of a canceled appointment. Before Dr. Fowler (coming soon), there was Dr. Lo. I had an appointment on this day with him that took an unreasonable amount of time to get in the first place. He is partners with the plastics physician that was originally recommended to me by a lot of my hospital friends. Dr. Lo apparently does great work and pairs my breast surgeon quite frequently. The week before this appointment, I was notified by his office that he was leaving the practice on November 30th. (Ok, awesome….. so what is the point of seeing him? Cancel.) Anyways, since he was leaving the practice, all the appointments and surgeries that were currently scheduled had to be rescheduled with alternate physicians which, as you can imagine, snowballed into a widespread problem given it was the end of the year with multiple holidays affecting those schedules. My point in even mentioning this appointment is to remind myself, and you, of the frustration that IS healthcare. That being said, I implore you (and myself) to exercise patience in any journey you find yourself in. The daily challenges that all employees face are based on any number of variables, most of which are not controllable. Since year one in nursing, I haven’t been able to count on my feet and hands the number of patients/family members who lose their minds over something ridiculous/beyond control. I knew through all of this, that patience and understanding towards my fellow healthcare workers was my number one priority. I know that it’s something that they don’t often get. When you have to use healthcare, you often hope to find people who are understanding, that make connections with you, that do good work and that LISTEN. All of these qualities are hard to find. But, you can also bet, that when healthcare workers run across a patient who is understanding, connective, has patience and appreciation, it is beyond relieving. We will do anything for those patients, even if it has nothing to do with our job. It’s unnecessary to berate or belittle anyone at any time. If you can treat someone that way, just stay at home please. I often get stuck with these types of people because my patience level is high (only at work) and my approach is always kindness until people have reached a level of unreasonableness that surpasses my kindness ability. Please don’t make me take care of you. Life is already hard. And I only have so much Essence to give…. (You’ll notice along the way how many times I had to exercise patience….. I was glad to do it, glad I learned it)

December 1, 2020

First meeting with Dr. Fowler. I had to leave work to make it here, leaving my co-workers in a bind. And once there, we waited about an hour until he finally made it to the room. (No biggie) I’ve been told that he is super OCD, therefore his surgeries take longer….. I am VERY okay with this. My impression from reading his practice website is that he is your stereotypical nerd. However, this assumption is not fair, in my mind, because without intellectuals, we would never get anywhere. Why do we, as a society, do this? I am doing my best to instill in my children that smarts are cool and THE most important thing in their life is school (not the Nintendo Switch, soccer, or blood-bathing your brother).

Dr. Fowler will be responsible for handling the reconstructive process of my surgery. New boobs. As I’ve said before, I have thought about getting implants, but I would never actually go through with it. I never wanted this to happen, but most of all, in this way. In meeting with him, the issue of nipple involvement is still rearing its dirty head.

The areolae take up a large area…….

We may not be able to save all the tissue……

That will leave us with little skin to work with…….

Expanders look like the only option…..

I will discuss the best course with Dr. Vinsant……

Overall, my sister and I are both impressed with Dr. Fowler and the knowledge and care for outcomes that he brings to the table. I was obviously upset to hear that I could not complete the removal and reconstruction in one singular surgery. I didn’t want to be put to sleep at all, let alone multiple times. My mind immediately flashes to all the horrifying things I have seen over my 15 years. Life in general has taught me to trust no one…… so I’m illogically fearful of being put to sleep. I definitely know I want my hospital friends who work with CRNAs to pick one out for me…… (you don’t want that one who sits on their phone the whole case and only checks their patient when asked…… say what?????)

Anywho, I saw examples of both the saline gel implants that he prefers, as well as the expanders. Honestly, I didn’t give much thought to either. I do remember noting (after surgery) the firmness and rigid texture of the expander, not connecting how this would affect me post-surgically. I didn’t ask too many questions about the expanders at this point because, to me, it was not quite a FIRM plan. But, I left feeling confident that my surgical team was in place and that I believed in both of their abilities to do what is best for me.

Now, back to work.

December 12, 2020

Report to the hospital for your pre-surgical COVID test any time between 8-10 AM. The nurses in the PAT area are super nice….. one of them even knows my co-worker who has talked me through all this. Who does she not know, really?? Although I am in healthcare and work at a hospital, my unit is outpatient and contact with COVID patients is a rarity and would only be accidental. Therefore, I have never had a reason to get a COVID test. This is my first one….. I feel lucky to have made it this far.

I wouldn’t say it was exactly painful, but the location of the end of the swab elicited some unintentional body movements….. my eyeballs fluttered and rolled into the back of my head and I had to hold onto the chair I was sitting in to prevent take-off. Ugh. Again, not pleasant, but survivable. Do it.

December 15, 2020

Two appointments today.

11:15, Dr. Fowler. Mark my boobs for surgery. In my head this will take 3 minutes. Phil went with me, so you can imagine all the thoughts running through his head and the overall awkwardness of the situation he was in. I’m sitting in front of 3 people, the third of who is the nurse (is she a nurse? I’m not sure….. it’s not the one who schedules all of my appointments and who I talk to on the phone. This is the one who I feel does not have much going on in the upstairs area) topless with my pancakes hanging and my high-waisters (that my sister recently talked me into) ending mid boob-sag. Dr. Fowler starts to draw the shape of my breasts with his permanent marker, outlining the surgical area which was shaped like an elongated and pointy football. The rest of the markings were anatomical in nature, but necessary similar to photo below. I was at that appointment for roughly an hour during which he would draw and redraw and draw his lines again. He gave the marker to me to take home and redraw anytime I sweated it off (turns out that was a lot). My last full shower for a while had been that morning prior to all my appointments.

(picture courtesy of the PMFA journal- ignore the yellow and red areas.)

2:30, Sentinel node injection. Check in once again at the radiology department and head down to the breast center. I met with Jillian and she took me in to the procedural area of the breast center. At this point, I have been to every room in the place. Per Jillian, the nipple gets injected with a blue dye prior to surgery with a small TB syringe at 3, 6, 9, and 12 on a clock face. This dye is carried to the lymph nodes, the first of which is the sentinel node. Pictures are then taken in the nuclear med department which effectively light up these nodes for mapping during surgery. By taking only the sentinel nodes along with the subsequent 2 or 3, as opposed to the 12-15 they used to take, you prevent post-surgical problems such as lymphedema.

The facility that I work for has had the intentions of launching a new software system for several years now that has been put off time and time again. Of course, they decided to “Go Live” with the program the Friday evening before my last two days at work. Luckily, it wasn’t working fully for our department, so I had little interaction with it….. until I started testing at the hospital. This posed a problem all through surgery. When I checked in for my sentinel node injection, I had one account under MAM (mammography) since I started in their department. After I headed over to the nuclear medicine department, they couldn’t find the order for me under that department name (this will come to haunt surgery day). The software representatives came by to help with the issue (which took about 1.5 hours), but in the end, I got my scan. (The nuclear medicine employee was overly apologetic…… I told her I would wait all day if she needed me to. This was in no way her fault, and it HAD to be done). Anyways, the scan was cool to watch on the screen and she explained everything to me. Even though the situation is unwanted, the nerd in me still enjoys seeing the inner workings of different departments (see example below).

(Image courtesy of Radiopaedia; ariticle by Dr. Daniel J Bell and Dr. Francis Deng, et al)

I had time, in those moments waiting for my scan, to respond to missed texts and messages. It was the only time since I had gotten my surgical date where I haven’t felt rushed, behind, anxious, or furiously checking things off my never-ending list. I was forced to sit, reflect and respond. My friends and family have made such a point since my diagnosis to reach out through phone calls, texts, emails and gifts to show support. And I think I was on everyone’s list that day. One of the most memorable interactions I had that day was with the daughter of the breast cancer warrior who unknowingly helped me with all my decisions. I thought about all she and her family had to go through over such a long period of time. I thought about my own kids, hoping they would never have to go through the same, while at the same time knowing my course cut the risk down to almost zero. The interaction was emotional and impossible for me to hold back tears. (I suppose this was the third time I cried, but it wasn’t for me).

She gave me some advice, directly from her mother’s mouth. I can hear her say it in my head….. imagine a little bit country, a little bit of roar, and always a big bit of infectious laughter……..

That goes right back to my mantra: IT IS WHAT IT IS.

Ugh….. surgery tomorrow. I can’t believe it’s actually here. (Love you nips…. it’s been real).