E-Memoirs

Fanculo al cancro

I have breast cancer. Better stated, I HAD breast cancer.

I am 47 years old and healthy. Very healthy...the old idiom 'healthy as a horse' just makes me feel like I need to ramp up the workouts but can't do that right now with my drains in so let's just go with 'I am REALLY healthy'.

I hate to go to the doctor. Doctors are the worst patients in the world. There was simply nothing wrong with me or no concerns physically when I called my Gyn to inquire why I hadn’t had a well woman exam in over a year and seemed like a good idea. I wanted to get the idea of it out of the way so I could just worry about it again next year. After my tubal ligation in December 2014 I was doing great. I ordered a mammogram on myself in April of 2015 simply because I thought I fell a lump and scared myself. That exam was normal, exhale, nothing to worry about. I have no family history whatsoever of breast cancer. I had not felt a lump and I do check, even though when you drink as much coffee as I do, it is cyst city and hard to tell. Yes, I was due for my routine checkup and it was scheduled. I passed the Pap smear with flying colors (know you’re glad you know that…nothing like a good oversharing) and was not remotely concerned with the mammogram.

On June 2nd when I got the call that those pesky little calcifications on my mammogram were not benign, I questioned my health, my reserve, my future. That crap lasted about 30 seconds because I got the call in the middle of a mommy makeover. That requires some explanation: surgeons do not always have the luxury of fielding news at their convenience. That is not to say that my office, my friends and family haven’t gone to lengths in my life to protect me from something I may not want to know about when I am in surgery. In this case, we were braced for the results of the biopsy done 2 days earlier but did not know that the phone call was coming when it did.

Funny true story: on the day of the biopsy result, I was in the operating room, doing my thing, with my bestie Toni at the head of the table doing the anesthesia thing. Despite the knowledge some results were coming our way, we were having a great case, doing what I love to do most: operating. About 2 hours into the 6-hour case, my cell phone rings and Toni answers it for me, on speaker so I can participate. It’s a local phone number as evidenced by the area code but an unknown number. After the obligatory pleasantries, the man on the other end states ‘”…this is Ed from Coleman…” All I heard was ‘Komen’ as in Susan B. Komen, as in breast cancer. “The hot tub cover you ordered is in.” No one has ever been more relieved to have a new hot tub cover than me. We laughed about the irony and kept operating.

30 minutes later, reality hit. The radiologist called himself and gave me a quick pep talk, I recall he might have even said, ‘are you ready for this?’ or something like that. Remind you, I am on speaker phone with Toni holding the phone to my ear. He goes on to tell me it was indeed DCIS on the left side, high grade. Nothing invasive, very small area. Got it, thank you, have a tummy tuck to do.

The next phone call I asked Toni to make for me was to Danielle LeBlanc, a very close personal friend and fellow plastic surgeon whose practice happens to be centered on breast reconstruction. She is a PHENOMENAL surgeon…I have admired her results for years and always told her that if, God forbid I ever needed breast reconstruction, she’s my girl. She knew about the mammogram and pending results so when I got her on the phone to tell her, her reply was simply ‘dammit’. I asked her to please contact Anita Chow, the bad ass breast surgeon I selected to do my mastectomies, and find out between them if I was a candidate for bilateral nipple sparing mastectomies with straight to implant reconstruction. Love you, mean it, gotta go finish this tummy tuck…

The patient that was the recipient of that mommy makeover is aware of all the events that transpired that day while she was taking her anesthesia nap and is a friend of mine. Here’s the deal with processing unfortunate news when you’re in the middle of a surgical commitment: laser focus. It was actually a relief to have anything to think about that was not my left breast. Her case came together great, she has since recovered right on schedule and we are forever bound by the reality that my life changed at the same time hers changed. Am I overstating the power of a mommy makeover? Nope…it’s pretty great and she is rocking the fitted dress right now while I have a surgical bra and drains. But I’m getting ahead of myself…

A little education about breast cancer. It is either noninvasive or invasive which basically means noninvasive stays put and doesn’t show up anywhere else. If you have to have cancer, it is what you want. Breast cancer is either ductal or lobular which is a description of the cells it derives from. If someone has LCIS, that means lobular carcinoma in situ (noninvasive)…that is considered a pre-pre cancer and really not a big deal: that is what the radiologist that found the calcifications originally believed I had. DCIS is the same thing but ductal, a little more serious than LCIS…but still better than the nasty invasive cancers. One option to treat this tiny focus of mean cells in my left breast would have been to pluck it out (a lumpectomy) and radiate everything around it remaining and leave righty alone. The alternative to that is remove all breast tissue both sides and never have another concern that breast cancer is going to hurt me again. I have deemed this the surgical apocalypse because it is a lot for a little: but the answer I needed to live with this diagnosis because I cannot live in fear of when it will come to the right and will it recur in the left and might it be invasive. Aaarrgh!  

Toni told me only after she, myself and Jeff had our consult with Dr. Chow that she originally thought I’d lost my mind after that phone call in the operating room when I requested consideration of this surgical approach. Dr. Chow confirmed that for someone my age…young (smiling)…with this diagnosis in the location is was (close to the muscle, away from the nipple), this surgical approach is absolutely reasonable and is a surgical cure for me. No anticipation for chemotherapy or radiation. My breasts will match as closely as possible because they will be reconstructed at the same time with the same technique. Yippee! But wait a minute…double mastectomies? Damn.

After my consult with Danielle, again accompanied by my constant companions and care takers Toni and Jeff, the plan was set, the implant size selected and nothing to do but wait for surgery. 5 days before surgery I had a preoperative appointment at the hospital. Per usual, Jeff insisted on accompanying me. All the financial pleasantries taken care of…side note-if you happen to have a credit card with miles or points or anything the you benefit from while spending money, use it for your out of pocket expenses before your insurance kicks in because in some small, stupid way you get a sense of  ‘I’m earning miles through American Express toward our next flight to Italy or somewhere exotic.’…they pull me to the back to do blood work, EKG. I asked if Jeff could come with me; after all, he accompanied me to support me so extracting me from him counter intuitive, right? Her first answer was that he could wait in the waiting room but then she relented. This was one of my first moments of, ‘Really?’ I have not played the surgeon card through this experience. I did not tell her I know the system and there is no reason he cannot be with me during this. Boy, I’ve learned SO much about our medical care systems in the short time I have lived this. Things are going to change, people, but once again, I’m getting ahead of myself…

I operated, saw patients, tried to tuck everything in before my surgery because in my almost 13 years in practice, I have NEVER been away from my office as long as this stretch. The days before my surgery were busy with all of that as well as getting ready personally: mani/pedi, bikini wax, grey roots covered, a facial. Dramatic and unnecessary you say? Nope. Essential. If I’m going to be poked, prodded, cut, drained I am going to do it as the most well-groomed client the hospital has ever seen. ‘Client’, you say? Yes, try that approach next time you, regretfully, are going through something you didn’t look forward to or plan. I refused to ever be considered a ‘patient’ because that, to me, sets up a state of mind that isn’t positive. A client is someone you have negotiated services with. Not unlike contracting with a financial planner, a designer. Whatever. Call yourself a client and see how your surroundings respond…I think it’s a good thing.

We arrived at the hospital at 5am for surgery. Actually, since I hate being late, we arrived at 4:45am…always the overachievers. Around 5:15 I was taken to my room where I was asked to change into my purple paper gown and hospital issue slippers. I chose to sit in the chair next to the stretcher because that is what a client would do: remain as non-vulnerable for as long as possible. When there is so much going on you cannot control, do whatever you can to control something. Bossy? Perhaps. The process of getting a surgeon ready to have surgery is complicated.

At 6:15 I was loaded into a wheelchair for transport to radiology to have a needle placed into the tiny area of calcium. It is important during surgery to remove a margin of normal tissue surrounding the evil calcium and even the most elegant surgeon with the best dexterity could not have found the DCIS without the assistance of a small wire right in it. That process, the needle localization, was very well tolerated technically. Very little pain in the left breast but a lot of brain pain as, per protocol, I was alone in a dark waiting room, waiting for the transporter to come back and get me. Alone with my thoughts: scared. Dislike. Back to my people and support system. By this time, one of my dearest girlfriends had made the pilgrimage from Dallas to Fort Worth with custom T shirt emblazoned with my battle cry through this process: Fanculo al Cancro. The girlfriend is Christy Milkereit and the translation is ‘Fuck Cancer’ in Italian. My mother, my heritage, is Italian…hence the adoration for the language…and I think we can all agree that sporting a shirt with ‘Fanculo’ is more socially acceptable than ‘Fuck’.

My next field trip was to Nuclear Medicine to have a radiographic tracer injected into my left breast so Dr. Chow could find the sentinel lymph node to biopsy and prove that, for sure, no concern for this little cancer making a move. I asked if Jeff could come with me on this one. Yes, he was allowed to push my wheelchair and that made me smile. Good thing since the injection did not. There is a lovely program at the hospital here I believe most hospitals offer: Breast Nurse Navigator. A RN named Kim had called me before that preop appointment on Friday to introduce herself. She explained she and her partner had a list of all breast surgery patients and followed them through the process. She mentioned her partner was out and she was spread a little thin; my reply was that I happen to know the process as a surgeon myself that is actually on staff at this hospital and I have a great support system intact…please focus your attention on the other patients that may not have such great support. She agreed but showed up at the injection to hold my hand. I was told it was like a bee sting, a mosquito bite...worst case scenario, a wasp sting. Dr. Chow does her injections herself and she is a friend of mine who I admire and respect tremendously. When getting ready to do the injection she asked the nurse, ‘may I have some alcohol’ to prep the skin. My reply: “I have been asking the same question all morning…” but I clearly meant a strong cocktail instead. At least I got a giggle out of her. The injection does not feel like a bee sting at all. It feels like a hot poker right into your nipple. If I ever come across a bee or a wasp that might sting like that, I am going to shoot the little ‘fanculo’. Ouch.

Next step: operating room. I remember very little here. The nurses are my friends and know me here. They absolutely recognize that a surgeon on the other side of the game is not natural. Side note: I have had surgery many, many times before. I have been under anesthesia multiple times for unnecessary, fun, elective cosmetic surgery. I have never been coy about what procedures I’ve had done: rhinoplasties (yes, two), mastopexy, liposuction. I have had an appendectomy and a tonsillectomy. I had a tubal ligation. None of these procedures were scary, not even those that were not elective. I have never feared general anesthesia. I have also never had breast cancer facing bilateral mastectomies before. I was scared. Really scared. The anesthesiologist asked me if I wanted Versed once my IV was started. Who in the hell would say no to that, I asked. The nurse asked me if I wanted local anesthesia where she was going to start my IV. Who in the hell would say no to that, I asked. IV in, Versed in, off to surgery. I awoke about 8 hours later in recovery. I remember very little here. It was late enough that all other patients were out of the recovery room and they let my people come in. All good news: the sentinel lymph node was negative as anticipated, the flaps were healthy and Dr. LeBlanc was able to put in implants instead of expanders and save my nipples.

Let the recovery begin. I was in the hospital overnight and was paroled for good behavior the next day. It has come to my attention that I have had only sporadic good behavior since. Oops. Back to that doctors are the worst patients. I am compliant with my restrictions, whether or not those that know me best believe me. I am embracing my good fortune and the blessing that I no longer have cancer. I am frustrated with the drains and my shoulders are stiff. I cannot sleep on my side or stomach as I love to do. I have ‘breasts’ and ‘nipples’ but it is not normal and real. I am trying to make light of it, I am using humor and sarcasm to cope which works for me.

Yesterday I had a complete come apart. I asked my beloved Jeff to check things out for me…make sure that where I was hurting that there was nothing he could see of concern. Secretly in my mind I wanted him to say, ‘Damn, Boo…you’re so hot’. I stood there in front of him, topless, with drains clipped to a lariat around my neck. He inspected as I requested. He didn’t scowl, he didn’t look away in despair, he didn’t vomit. But I perceived my reality in front of him and burst into tears. ‘Don’t look at me, I’m hideous’ was my reality. I’m sorry I made you look. I’m sorry I don’t have real breasts anymore I’m sorry there are areas on my nipples that are not going to survive and they are discolored. The tears wouldn’t stop. He held me, laughing, and kissed my eyes. “Sweet girl, we’re healthy”, he said. His focus and reality is that the disease is behind us, the healing is all around us and the future is wide open. I need to come to terms with that, too.

Having breast cancer was one of the best things that ever happened to me for so many reasons. I know with certainty that I have only ever been as scared in my entire life as I was during the 3 weeks from diagnosis to surgery one time: when my mother was in the ICU, critically ill. For 5 weeks it went on…she would legitimately get better on Sunday after I arrived on Friday, such that I believed she would actually be OK and I would go back to work. That was until the end of the week when she got worse again. I lived in fear of every phone call, every message. I lost her and that will forever be the darkest time of my life. I desperately wished she was here to hold my hand and take care of me through this process but it occurred to me that she would have been so concerned for me, so sad. I could not have tolerated making her sad. Having her sitting on my shoulder as my Guardian Angel is what has helped me through this. That and the army of friends and family that have supported me, loved me, fed me, dried my tears, emptied my drains, changed my dressings.

I am a better surgeon and a better person for having lived this. I got off easy: no chemotherapy, no radiation. Yes, I have incisions and drains and implants. I will need more surgeries down the road because that is part of it. I struggle with guilt for that phases of breast cancer survival that I circumvented. Would I change my reality just to experience those things? Hell no. My heart breaks for those that I know and love that are walking that walk. I did not want to ever be a breast cancer survivor but I sure as hell would never want to be a breast cancer non-survivor. I am in a position to make changes for all patients….clients…following behind me from what I have experienced. I am lucky to know many people that support me that are in a position to really help me make a difference. I am researching how to make it happen now, I will need support and input and will keep those interested in touch.

Until then, I am laying low, waiting for my drains to come out. I laugh every day, sometimes through tears. When I say raise a glass it can be a glass of whatever you want it to be. I choose champagne, but only in moderation because I am in recovery mode right now. Saying thank you could never begin to express my gratitude to so many for so much. Let my actions tell my story and let’s make big changes: attention to early detection, support for those walking the walk without adequate support, to recovery. There are so many needs out there, so many different cancers. I want to help them all. Shooting for the stars, but doing it right now without raising my arms above my shoulders.

Love those around you, embrace the day. Smell the roses, ignore the weeds. More to come, have to go enjoy brunch with my beloveds now. Until the next time…

Here’s up to it!

#fanculoalcancro #raiseaglasstokickcancersass