Mastectomy -- Colin's view (9 June 09)

After RA was prepped (changed, IV, etc.) I was able to go back and sit with her in the pre-op waiting area. Eventually it was time for her to go to nuclear medicine for the radioactive tracer injection (used to find lymph nodes for the sentinel node biopsy). I was told there was no place to wait* with her at nuclear medicine, so I did not go with her. She was gone a long time, so I waited outside in the day surgery registration waiting room. I saw her come back from nuclear medicine and went back with her to wait for the surgery.

We had good visits with the anesthesiologist and the surgeon while waiting. The surgeon had a medical student with him, and the pre-op discussions indicated he had suspected the lump was not normal due to its "feel".

RA was taken back for surgery around 1135. I went to the waiting room, pulled out my laptop, got online and worked for 2 hours while watching her progress on the status monitor. When her status changed to 'closing' I started shutting down and putting away my laptop. Overall, she was in surgery for about 2.5 hours. The surgeon came out and chatted with me while she was on her way up to recovery. He said everything went fine. He took all the skin he could, and the base tissue looked good (intact, not impacted by the lumpectomy, with no visible signs of a tumor).

I watched the status monitor to see when I could go up and join RA in recovery. Eventually I was paged, with a request to go to the day surgery registration desk. I went up, and was told RA was OK, but it would be about 30 minutes before I could go back. I just looked at the recovery nurse and said "No, not acceptable". I said she needed me there, this was NOT run-of-the-mill breast cancer, and I would be quiet and stay out of the way. She let me in.

We had arranged with the pre-op nurse for me to go back ASAP after she came back from surgery, but that deal was obviously not honored. At some point I must do a post dedicated to how the medical system is setup to handle "average" patients/spouses, not those of us who are a bit more proactive and knowledgeable. I suspect they imagined they were doing me a favor by hiding the harmless, but potentially "scary" post-anesthesia side effects like the shivers.

RA was barely awake, but was responding to questions about pain as they tried to balance IV pain medication and her recovery from general anesthesia. Her vital signs were very good. The O2 sensor was flaky, which meant the monitor kept beeping. Poor design, and from my view unacceptable if the patient really needed to be monitored (the nurse mostly ignored the monitor due to the O2 sensor). I stuck my hand through the slot in the bed railing and gently stroked her left arm. It seemed to help some. Eventually she was moved to a hospital room.


* Which I found out later was incorrect, and she did have a long wait for the injection. Oh, well. Sometimes I believe what I'm told without pushing back....by now I should know better.

Mastectomy (9 June 09)

The plan for the day: Complete mastectomy of the right breast with sentinel node biopsy.

We got up and had a relatively normal morning before heading off to Lahey North in Peabody for my surgery. I enjoyed my black coffee during the drive. With an 11:45 procedure, I was allowed to have clear liquids including black coffee up until 8:30. Got there for the same old procedure... but this time, I had a detour through nuclear medicine to get the radioactive tracer injected. This, along with a blue dye, would provide guidance to the surgeon to the lymph nodes to be removed. For a change, I had a hospital gown with the slit offset to the side. No running around with my bottom on view. It also had snaps at the shoulders. Made procedures easier. Not that I am exactly shy or modest, but I have found that acting shy and modest keeps others from being embarrassed.

I had a long wait before and after down at nuclear medicine. They had told us that Colin could not come down with me "since there was no room for him". This was true for the 10 minutes I was in getting the (VERY PAINFUL) injections of the tracer*. The tech who did my prep was "due in two weeks", so how radioactive can the stuff be? But, for the other 50 minutes before and afterward, I could have used the company. The area was under construction, and the waiting room was the hall. At least I had reading material.

When I got back up, we talked to the surgeon and the anesthesiologist about what was coming up. We re-discussed the sentinel node, the opinion offered at Dana Farber, and the fact that we disagreed with DF. We went into this fully aware that a negative reading in the nodes does not necessarily mean all is good, but that a finding in the node would definitely provide information (bad....). We discussed follow-up, and his contact at Mass General recommends radiation. We may get a second opinion on the oncology side, just to provide more interesting statistical problems for Colin and I to solve;-). (Notwithstanding, that the sample sizes for primary angiosarcoma are too small to provide any statistical confidence). The anesthesiologist was the same doctor I had for both my hand surgery in 2007 and my lumpectomy four weeks before. It was nice dealing with the same doctors, nurses, and the overall situation for this surgery. I can definitely recommend the day surgery center at Lahey North. Finally, the time was at hand, and I hopped on the gurney, they connected the IV, put in some sedative, and we were off. I remember getting into the OR, moving to the table, and then it was lights out.

I woke up with the worst case of the shivers you can imagine. I didn't particularly feel cold, but they piled warm blankets on me and gave me demerol. I felt like the weight of the blankets did more than their warmth. I got some more pain medication through the iv. They were doing all sorts of things, making notes, etc. And then Colin came in and off we went to my hospital room about 45 minutes later.

*Note to anyone who will be having this, ask for EMLA so it is less uncomfortable.