It's a creekmore world

Week #24: ‘By any detectable means…’ the Final Battle.

The surgery leaves three drains and a big wrap.


Trish’s skin smells a little strange from the super, anti-bacterial soap they made her use. She sleeps quietly next to me.  I’m awake ahead of the alarm, waiting for 6am to come. It’s dark.  The dog rustles from sleep and licks my face with a cold nose and wagging tail.  To Monty it’s just like any other day.  But it’s not.  It’s surgery day.

How did we get here?

Tink, the queen, with perfect posture (and a tiny sneer.)  I love this photo.
Just a little over six months ago, I was pacing anxiously in the waiting room for Trish to complete the mammogram.  She had another lump in her breast.

She finally came out holding papers and folders, shuffling quickly, scanning the room looking for me, with red eyes and tears streaming down her face.  The news wasn’t good.  (Trish in Italy, left, a few weeks before the diagnosis.)

My instincts when I saw her cry  were to leap over the people and chairs, pick her up in my arms and protect her.  My wife, best friend and mother of our darling girls was going to fight for her life again.  She sobbed in my shoulder.  We spoke no words.  There was nothing to say.

The only bright spot was that we were together.  That office was filled with people alone, discovering they had cancer.  I held Trish tightly in the elevator as we walked back to our car.

Packed for the hospital
On the ride home we talked about the positives.  We had good health insurance, the best doctors, jobs that would be understanding, family and friends would help.   (We had no idea at the time how much you all would help, and we could never repay all of you for your time and love.  Thank you.)  But we had no idea what we were getting into.  No idea how much harder the second time would be.

I turn off the alarm go gather our things: a bag for Trish and me, some work and reading materials, post operative clothes.

Trish says good bye to the girls and gives them a present.
Leaving the kids

Trish stirs awake, and gets dressed.  It’s the last time her body will be in it’s original shape.  She’s allowed to take a sip of water with her morning medications, but otherwise has to do this on an empty stomach.  She seems okay, nervous, sure, but not freaking out.

We go up to say goodbye to our girls.  My parents are in the guest room, probably awake, but they don’t need to come out now.   Trish holds each one in the dark, telling them that she will be okay and not to worry.  Lily offers words of encouragement and love.  Emma seems more anxious and worried.  We reassure her as best we can and she sleepily holds on to Trish’s neck.

Good bye Emma...

We’re almost out the door, still dark at 6:30 am, but the girls appear at the top of the stairs, arms outstretched.  Trish holds them for a long time and even though we are late for the surgery already, this seems like the most important thing to do.  We stay with them until both seems okay.

The girls comedown stairs, emma crying, for more hugs.
The kids haven’t ever had a family member do surgery, and it sounds mysterious and frightening to them.  How the heck do they cut off two boobs without that being deathly painful for Mommy?  Their teachers have said it’s been a difficult week for both as they try to understand what it means to have Mom go through surgery.

We havn’t been out during rush hour at this time of day for ages, and I’m surprised by the amount of traffice.  Who the hell are all these people?  Don’t they know we are coming?

The surgical plan

Hospital check in is surprisingly easy, and we go up to the surgery room, which will be my home base for the day.  Trish reads a bad magazine to pass the time.  We don’t have much to say that hasn’t been said or discussed.

Destination reached
She’s having two surgeries today, one to remove the cancer and one to begin the reconstruction process.  Both are major.  Together she could be under the knife for 8 hours, but it’s more likely to be 6.

The mastectomy comes first, from Dr. Kathy Alley.  She will do a modified radical mastectomy on the left, cancerous, side.  The radical version, which was common since the early 1900’s until the mid-seventies, included the chest muscles and is almost no longer done.  The modified radical just takes all the breast tissue, chest muscle lining and lymph nodes that are basically under the arm pit.  On the other side, it’s a simple mastectomy which will leave the lymph nodes, but remove the breast primarily for cosmetic matching.

A typical breast cancer amid normal fatty tissue.
Dr. Alley will try to get all the breast tissue out, but leave as much intact skin and other stuff as possible.  Then she sends the lump and the lymph nodes to the pathology lab, where they will analyze and determine exactly how advanced the cancer got.  A positive report from the pathology lab, especially that the lymph nodes were mostly clear (we know they weren’t all clear) is our most important outcome.  It’s a life or death answer and the ultimate goal of this entire process is to get a good report.

The second surgery is the reconstruction.  Left with only a small flap of skin, the plastic surgeon, Dr. Kathy Huang, has to put in the temporary expanders under the chest muscles on either side, add some cadaver tissue, pull the skin over the expander and seal it up.

Dr. Huang marks the incisions
On the cancerous side, she will be moving a flap of back muscle and skin under the armpit to augment the breast tissue.  That’s needed because a) there isn’t much skin left on the cancer side after they take out the breast and b) having had radiation before, her skin won’t stretch as well.  Fresh skin from the back will help make a tight seal, and allow her to have modest boobs.

Bye Bye Boobie!

Trish gets called into the pre-op room where we wait an hour.   Nurses come in and out, introducing themselves and taking vital signs, triple checking that she hasn’t eaten and explaining that we are getting closer and closer.

Each nurse looks at the power port Trish has in her arm and says they aren’t sure this can be used during the surgery.  Trish doesn’t care how they deal during the surgery, but she is deathly afraid of needles, and really wants them to use the port, a device that sits under the skin to make needle access easy. That’s why she got it, so they didn’t have to stick her everytime she needed a needle.

They take her first vital signs.
To complilcate her phobia (and it’s serious folks, she nearly passes out from fear when they stick her)  her veins aren’t great and they can only use one arm.  Trish hyperventilates.

Eventually the anesthesiologist comes in.  She suggests that they not use the port, because they don’t have the right equipment handy to access it.  Trish and I beg them to find the equipment and use the power-port.  She concedes, but it delays surgery a while as the look for the piece they need.  Eventually they get her hooked up to the intravenous drip.

She gets wheeled off to surgery.

The surgery team, including both doctors, come in a signs some forms.  Dr. Huang spends a few minutes to discuss her back flap surgery.  She asks if we consent to letting her make an operating room decision to skip the back flap if she thinks she can safely seal the expander.   ‘Of course!’ we reply.  Dr. Huang knows that the back flap is a major concern for Trish, because of her level of activity and prior back surgery.  It would be amazing if she could do the reconstruction without that back flap.

Trish goes around the corner to the OR, bye boobies!
My final moments with her are short.  I try to reassuringly rub her feet, but there is too much equipment to get close to her.  They roll her out of the pre-op and down the hall, waving goodbye.  That’s the last I’ll see of those beautiful boobs.

That’s why they call it the waiting room.

Oh god, now I have to wait for hours.  I had thought it would be a good idea to go to the gym during this time, and it probably is.  But I can’t leave.  I need to be here in case something happens.

Next to me is a Spanish family, and they are struggling with the English instructions from the doctor.  I know how frustrating and frightening that must be.  I think back to my experience in a Soviet hospital with my girlfriend in 1989.  She had endometriosis and needed treatment.  Babushkas would come in and out, poke and prod, grumble and never smile.

I could understand some but not all of their words, and we were both frightened.  I spent a week or so there before they shipped her back to England.  I saw things I will never forget in that place, and am very appreciative of modern, fully-funded medicine.

Bored in the bathroom
Bored, I take some pictures of myself in the mirror of the little bathroom.  It’s probably been only 90 minutes but it feels like days that I’ve been waiting.  I’m afraid to even doze off in case they come in.  A short trip to the hospital gift shop, a few facebook updates, and an email or two later, and Dr. Alley comes out.  It’s been 3 hours, about 1pm, and she says a little sternly that things went very well.

I press for more information but she doens’t have much.  The pathology report, which she wants us to call her on Friday to hear, is the real determinant of success.  “Could you see it in the lymph nodes?’ I ask.  But she can’t answer that.  Lymph nodes and fat are intertwined and the same color.  She gives the whole fatty lump of breast tissue and nodes to the lab intact.  There isn’t much to see on the outside.

Dr. Alley suggests that I get some lunch and wait for the results of the next, longer surgery.  She shakes my hand firmly and dissapears.  Lunch at Suburban isn’t horrible.  They serve some carnitas, beans and tortillas that are not gross, a surprisingly good result for institutional food.  Or maybe I’m just really hungry.

Trish the Viking Vampire Pirate.  With Boobies!

My laptop is almost out of juice, and I forgot the battery charger.  Doh.  So I play with my phone for a while, downloading photo editing apps, with which I create the pirate/viking/vampire picture of Trish at left.  It’s hard to concentrate on anything and I don’t even want to listen to music in case they call my name.

The spanish family is gone.  I think I’ve been here the longest of anyone today.  I look at the magazines again, thinking maybe that there would be a new one I hadn’t noticed.  Self, Marie Claire, Smart Money WTF?  Where the hell are all the normal magazines like PC Gamer, Fine Gardening?  Or even a GQ?

A miracle

I’m dozing off.  I wonder if the doctor will find me if I’m asleep.   I dream that Tinky Winky was shot and is being treated at this hospital. He’s talking to me now and smiling with a bullet wound in his head.  ‘David’ he says.  “I have good news.’

Tinky Winky’s face morphs into that of Dr. Huang, Trish’s plastic surgeon, who is supposed to still be in surgery with Trish.  I wonder if something is wrong.  She was only operating for about 2 hours, and it was suppposed to be four.  I groggily try to gather my thoughts and and let her explain.  She says again “Good news!  I was able to close the expander without the lat flap.  She’s doing well and is in post-op recovery”

Tinky Winky was admitted while I was waiting .

She looks at me and tilts her head.  I must look shocked.  ‘That’s good right?  That’s what you wanted?”  A thousand things run through my head at the same time:  Will it work?  Was it too risky?  If it’s not risky, then how was there enough skin to do this?  Will Trish be happy if the boobs are tiny or deformed? How is this even an option when we were told it was impossible?”

All I can mumble is a yes. But I gather control of my mouth, and ask how we got such a good result.  Dr. Huang explains that she arranged for Dr. Alley to leave more skin, which isn’t the standard practice.  For a moment, I’m angry that we spent so much time agonizing over the latissimus flap, when it was as simple as asking for more skin.

But this is absolutely what we wanted, and I decide not too focus on the negative.  Dr. Huang says that we will be discharged in 24 hours if Trish doesn’t show signs of infection.  I thank her.  She is an amazing doctor.

Trish in OR recovery, green from nausea.
In the post-op room, Trish is throwing up.  I try to hold her head as she barfs into the pink plastic bowl.  A nurse watches but there isn’t much to do.  Trish says she isn’t in pain yet, but the anesthesia just hasn’t worn off.  This is gonna hurt soon.

When her color comes back, she gets rolled into a private room, and they start the dilauded and valium that will be her little friends for the next few weeks.  She shortly falls asleep and I go outside to call friends and family, all of whom are incredibly relieved.

Overnight at Hotel Suburban

When she gets up, we talk about the surgery.  She keeps asking about it because she wants to make sure she didn’t drug dream it.  Neither of us really accept it as truth.  We keep waiting to hear that there was some trick.  It’s too good to believe.  And anyway, we are tentative about expressing any joy until we get the pathology report.

Whoa!  Private room for the boobless queen.  Is this a free upgrade?
I decide to stay the night with her.  She really needs support going to the bathroom and I am a little concerned about the level of pain.  Trish is tough, and often under reports pain.  Nurses and doctors are trained to be wary about patients over doing the medications.  They want to hear key words like “Yes, I have serious pain” and “Can you bring me some more medication”.   Trish often says things like “What do you think about more pain meds?”  and in response to the question about how severe the pain is, she aways says “I’m okay”, which does not convince them to dispense pain killers.

There is a creepy pizza place on the second floor that is open late for dinner.  An old large TV is on with the baseball playoff game, which I watch while eating the not-as-gross-as-I-expected creepy pizza.  Late night staff come and go, on their breaks.  The mood is quiet.  This is a world I don’t know.

They say this soviet-looking device prevents pnumonia.
Sleep in the little reclining chair is fitful.  Nurses come in an out every 4 hours.  More than once, I help Trish pee out the IV saline solution she was injected with all day.  She needs to blow this soviet looking device (right) that prevents pneumonia?  I don’t believe it.

When I can’t sleep I watch some episodes of Breaking Bad, a great series about a man diagnosed with terminal lung cancer, who becomes a meth-amphetamine chemist and drug dealer as a way of dealing with it.  Very good series.

Discharged into my care?

We are visited by a parade of people in the morning, social workers, cancer recovery specialists, and physical therapists.  By 2pm we are driving back, and Trish is amazingly okay.  It’s hard to believe that they can release her into my care only 30 hours after brutal surgery.

Our girls are relieved and glad to see their mom, although she quickly rests on the couch and is only partly coherent from the meds.  To them it’s just been a day, but to us it feels like weeks.  I nap for several hours, and it’s almost dark when I wake up.

The meds absorb the pain pretty well. The valium is to keep her muscles relaxed, especially the pectoral muscles that now have the temporary implants underneath.   She also takes levaquin, an industrial strength antibiotic.  The biggest risk from the cosmetic surgery is that the tight skin seam seperates and infection gets inside.

It's amazing that she can stand up
On Friday, we try to figure out how to take care of her.   She’s tightly wrapped in gauze and a protective bandage, which make it difficult to sleep.  There are three drains, into which a bloody mix of fluids collect.  She hates them and grumbles a little.  They need to be emptied twice a day, a gross but painless procedure.  She eats often, which is good.

Cancer death is confirmed

Somehow we distract ourselves until 2pm, the appointed time to call Dr. Alley about the pathology report.  I gather the courage and and dial her office.  Trish, next to me on the couch inhales, but I don’t hear the exhale.  The receptionist puts me on hold.  Waiting, waiting, waiting…

“Hi, it’s Dr. Alley”   My brain scans her words and tone for a signal about the news.  She always has a stern, efficient approach and doesn’t mince words.  So there isn’t much material to work with.  Seconds tick by like years.

“It’s all good news.  The cancer responded well to the chemo therapy treatment.  The lump was down to 1.5 cm and there was no live cancer in the lymph nodes.”

I relay the news to Trish, who exhales, and sinks a little further into the couch, eyes looking up at the celing.   The news is as good as we could have hoped.  Dr. Alley elaborates that the lymph nodes were actually dead, which is not uncommon after chemotherapy.

The cancer had invaded a few of the nodes, and then the chemo killed the cancer, but took the node with it.  That means all that that the cancer wasn’t strong enough to push further down the lymph system.  The chemotherapy did the job.

Fuck you cancer, you lose.

Cancerpalooza detritus
Trish is for the first time in a long time, cancer-free.  Dr. Alley, is quick to add she is cancer-free ‘by any detectable means,’ which perfectly captures the uncertainty about  cancer.

You never really know if you have it or not, do you?  As Trish and I joke, we are all only cancer-free ‘by any detectable means.’

But it’s not time to worry about those nuances.    We are past the low point, finally.

Trish is cancer free.

Life begins… now.

8 thoughts on “Week #24: ‘By any detectable means…’ the Final Battle.

  1. Crystal Byrd

    You’re a fighter and one of the best co-workers I’ve ever worked with. God Bless Trish to you and your family. Cheers!!

  2. Veronica

    *Hugs* I’m very, very relieved that you are well and back home, Trish.

    Hugs and love to the whole family.


  3. Dave

    I literally threw my hands in the air and laughed with joy when I read your last few words.

    Thank you for chronicling this journey. I think the both of you will look back at this and appreciate all of the hard days that led to the great days ahead.

    Well done and good luck with life!!

  4. Wendee Holtcamp

    It’s time for an update! It’s been 3 months – inquiring minds want to know! :) I see Trishs FB statuses, but how are you? How are the kids? So glad the ordeal is over and the healing begins!

  5. David Post author

    Totally right! I have been working on one you’ll see soon. Thanks for the encouragement.

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