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