I Used to Be An Overachiever
Lately, as a “self-employed” artist, I feel that I have napped away my former title of Overachiever. Whereas Our Oncology Lab has consistently been underachieving by being late and unhelpful. Friday, mere moments away from my surgery (okay, five days away), The Lab finally released my Oncotype DX, which is not a new phone, but a crucial score that predicts cancer recurrence by grading all of one’s genetic information into a neat crystal-ball-style package.
Now, I can at least temporarily reclaim my title of overachiever by getting the clean, low score of 11. Like in golf, the low score wins. It means I have very few markers in my DNA that would lead one to think that breast cancer may crop up its crabby head again.
Although its unhelpful and unwise to try to lay blame for illness, Drew and I have mused about why I, with little genetic help, developed this cancer. There are a lot of risk factors for breast cancer, including ones that I am guilty of, such as alcohol use, being overweight, and getting old, there are also studies that show exposure to a wide range of chemicals can increase your risk of breast cancer. What sort of chemicals might I have been exposed to that might have switched a cell toward nefarious purposes? If I were a firefighter, this cancer would be considered eligible for full compensation as a work-related illness. As I am a firefighter’s wife, even though for years I was exposed to second-hand outgassing of my husband’s clothes, skin, hair and even his “turnouts,” brought home to be washed after fires, I do not have the same protections. Now, firefighters’ partners do not come into contact with such chemicals, as uniforms and turnouts are no longer even allowed in the fire station common areas after fires – they are removed and professionally cleaned – but our firefighting career started many years before the link between the chemicals coming off the smoke of a house filled with plastic and polyesters was understood. The smell of smoke was proof of accomplishment – not the proof of carcinogenic exposure that it is today.
Still, such thoughts are unhelpful and hurtful towards the unblameable. Today, we fix it. Tomorrow, we live a life balanced as best we know how between fun and safety.
What I remember.
Pre-op “rooms” are the worst part about surgery at Good Samaritan Hospital in Portland. I remember this from my last surgery there in 2012. They are crowded and the curtains between patients are inadequate. But I suppose it’s convenient for the pre-op staff having everyone within arm’s reach. Then they gave me drugs.
What I don’t remember.
We were notified that the surgery would last eight long hours, but that the doctors would check in with Drew every two hours. Knowing now how attentive and awesome he has been as a post-surgery nurse does it bother me that he took some of that time to sneak out to the spring RV show at the Portland Expo? Maybe a little. I mean. CANCER. SURGERY. It just doesn’t fit in with how totally fantastic and helpful he has been every other moment of the ordeal. I mean. But he did bring me some awesome brochures.
I woke up in the Critical Care Center (the words “Intensive Care Unit” are so last week). People always tell you that you seem loopy after surgery but when I woke up in the CCC, I wouldn’t call myself so much loopy as sleepy. If you’re sleepy enough, you can sleep through the white noise that is actually the sound of venous flow through the teeny tiny microphone implanted in your own reconstructed breast. You can almost but not quite sleep through the nurse coming in every hour, spreading gel on tiny ultrasound wands, and listening to your own heart beat through the former abdominal arteries in your own new breast.
Mostly that night I watched the clock. As sleepy as I was, it was hard to continually go back to sleep after the hourly boob checks, while listening to your own venous flow which sounds like something between a baby ultrasound and a white noise machine turned up to eleven. It’s amazing how slow time goes by when you are waiting for morning. Drew will be coming back in the morning.
There’s not really any hospital food in the CCC. Most critical patients are too sick to think of something as prosaic as eating, but I was hungry by the next morning. I’m pretty sure the toast that my nurse brought me was from the toaster in the nurses’ station. It tasted good and buttery. If you meet a critical care nurse, shake their hand. They are a one-in-a-million kind of angel person.
I stayed in the CCC for about 24 hours. I was able to move to a regular oncology post-surgery room Thursday night, but I was not able to leave the hourly boob ultrasound checks behind. My new night nurse got frustrated by not being able to sneak in and perform her checks without waking me up. I don’t know what sort of patients she has had in the past who can sleep through someone poking them in the boob while they listen to a staticky noise machine.
My new boob looks like a hard, quilted flesh brick. My nurses explain to each other at shift change that this is how it’s supposed to look. My tummy looks rather scooped out with a scar across the top of my pubic hair from hip to hip, and a scar around my belly button. It is apparent that the flesh has been cut in a football shape, some of which was used to cover skin loss from the mastectomy and the fluff of which has been borrowed to fashion into a boob, and the ends have been stretched together to cover the missing yardage. Since the skin over the belly button is now a different stretch of skin, a hole has been made and my belly button is peeking out through the new hole.
It is all very surreal, and I prefer not to gaze too long at any of it. It will all look better in time. Apparently, quite a bit of time. I am required to lie on my back only, with my bed raised at a 35 to 45-degree angle. For now, yes, but also for the next six weeks at least. When I am able to walk, I must walk with a stooped back like an old lady with a hump until my stomach skin grows back enough to allow me to stand upright without pulling out stitches. This will get old. I know because I am writing this from the future.
Pooping as A Spectator Sport
Friday, my nurse is one of those highly experienced, no-nonsense late-career nurses with which you feel instantly comfortable. Let’s call her Ann. Her CNA today is Kevin (let’s call him that). Within minutes of meeting him, I learn that he is training for an ultramarathon run which will take him to each Legacy hospital within the Portland Metro area, he has already run an ultramarathon of his own design in which he ran 140 laps around this hospital to celebrate its 140thanniversary, he moved here from Ohio with nothing and no plans, and started at the hospital as a janitor and worked his way up to CNA. The Legacy Health organization is his family, mentor, and lifeline. You couldn’t find a more dedicated, enthusiastic worker. He goes about his job as he was trained, one step at a time, exactly as he was taught.
Opiate pain relievers have one fantastic upside – they relieve pain. The downsides are worrisome, but there is only one downside that doctors and nurses have some power over: constipation. And they tackle that one like they Really Need A Win. In the first 48 hours, I was prescribed two separate laxatives AND a suppository for good measure. Luckily, my nurses allowed me to forego the suppository IF I could prove capable of producing a poo before they started to worry.
Today it is my duty to poop. Groggy from surgery and pain medication, with a Foley catheter in place, three drains emerging from my surgical wounds and unable to use my stomach muscles or right arm, I am in no shape to have a comfortable, private poo. I feel stirrings. With the warring opiates and laxatives on board, I am worried about missing an opportunity and allowing the poo to stay and bake too long, but also worried about missing a more urgent opportunity and allowing the poo to escape when I am not ready. This requires, um, surgical precision, timing-wise. I request a chance to make an attempt. That means mobilizing Ann and Kevin, lowering the bed, helping me turn on my side and flail my legs toward the ground, then propping me up, letting the initial wooziness run its course, then helping me to walk, NOT to the bathroom (too far) but the two or three steps to a commode plopped into the middle of the room. After the mobilization of the whole team, the effort fails and I am brought back to the bed in dishonor. Don’t worry, they say, we will try again later.
A few hours later, it becomes abundantly clear what urgency really feels like, and I assemble the team for one more try. Roll over, legs over, heft my upper body up, walk one, two steps, lower the bum, and wait. The ungodly smell of pooping into a bucket makes it obvious that I have succeeded and that everyone in the room with a nose has made an enormous error career-wise. I have never felt so relieved and undignified in my entire life. Pooping into a bucket in front of two other humans who are not so hygienically challenged as yourself is an experience I wish on no one, but when you need to poop, you must play the cards you are dealt.
The flashbacks of the humiliating moment of Nurse Ann cleaning my bottom like some kind of saint while she breathes in the fumes I just produced has me occasionally wiping tears off my face for the remainder of my stay. For days afterward, every single moment that hangs with the smallest amount of pathos makes me cry. This public poop has broken my emotional reserve like nothing ever has before and I don’t know if I will ever have trouble crying at a sad movie again. The experience may have permanently moved my tear ducts closer to my eyes.
Saturday, the Occupational Therapist showed me how to use a walker to lead my nursing crew carrying IV drips and Foley bags to the bathroom and back in order to be able to poop in water. Later, she thinks I am crying because she snapped at me for bringing a washcloth I used to wipe my arm too close to my chest (arm germs too close to chest surgical site!). No, although her snappy bark was a little unprofessional, I was just trying to recover from the most recent bathroom indignity. I don’t know how much of this I have left before I spontaneously combust from embarrassment.
Planning My Escape
By Saturday I am campaigning hard to be released. I have already quit taking any narcotics and have switched to Tylenol only. I have for two days insisted on spending most of the day in a chair rather than in a bed. I am doing laps in the room and asking nurses to hold my IV while I tool around the unit with my walker. I just need to convince my doctor that I can go home without undoing all his handiwork by lifting a teakettle or pulling up my own pants. Saturday goes by without any promises, but I have hope that if my chart continues to show my active, pooping, non-opiate-taking lifestyle, I can get rid of these IV lines in my hand and slip the surly bonds of this hospital ID bracelet.
Sunday is the day. Doctor Cruise is skeptical of my choice to go fully non-opiate, worrying that the pain will raise my blood pressure, which will put an undue burden on his beautiful stitches. He gave us one last lesson (with charts and diagrams on the white board) about the (a) the lengths he went to in order to provide me with the best ab-breast, and (b) where I currently am on the risk curve that starts very high in the hours after surgery and curves down to out-of-the-woods in the weeks after (hint: I’m somewhere in the middle). He also reiterated his requirement that I must bend at the waist whenever I walk to keep the strain off my abdominal stitches – hence the walker. But in the end, he gave me his blessing and soon after the tubes started to disappear. First the Foley (good riddance), then the IV lines in my hand (what a relief). Then all that was left was to pack up our old stuff and our new stuff (my brand-new walker and tub full of wound and drain dressings) and vamoose.
We vamoose. Drew is thrilled. I am thrilled. I am also scared that the thing on my chest will never really look like a breast. It certainly doesn’t right now. I also don’t really trust my cat to not jump on my chest while I’m asleep, nor do I trust my pup not to do something reckless and stupid. (So far, with a few threats, they have obeyed).
Now, one week later, the drains have been removed from both wounds, but my chest is still swollen and lumpy. My doctors have all checked it this week and assured me that it is healing correctly, but I must take their word for it. Days are filled with ambitious intentions disintegrating into naps and backaches from walking around stooped.
Time stretches into space for the impatient.