Catia Bitching Cancer

L’operazione e’ fissata dunque per il 3 novembre, alle otto di mattina. Dovrebbe durare circa 3 ore, una per la mastectomia, due per inserire l’impianto che sara’ poi riempito di soluzione salina poco a poco (dopo che la ferita si sara’ rimarginata).

Ho anche saputo che i linfonodi sentinella sono risultati negativi, niente cancro li’!!! Il che significa che mi faranno solo una mastectomia semplice, non radicale, probabilmente.

This appointment scheduling thing is becoming comical. Yesterday I received a reminder call for an appointment that I didn’t know I had, and no reminder call for an appointment I did know about.

Today I saw another plastic surgeon for a second opinion (the appointment I knew about). I will call this second doctor McDorky. The first plastic surgeon I saw last week is also known as Cute Plastic Surgeon (despite Serena’s opinion to the contrary). McDorky doesn’t really look at me when he speaks, he mumbles rather than talk, he doesn’t allow for a lot of room to ask questions, but offers very exhaustive (and exhausting) explanations, has his own sense of humor but doesn’t laugh with you. Serena was looking at me in desperation, yawning and yearning for a Pocket Coffee (for those of you who have never had one, they are chocolates filled with espresso Y-U-M-M-Y!). One also wonders how he can be the famous plastic surgeon all the nurses have been praising and have food stains on his pants. But he has very well cared for hands, obviously, pink and soft, and well manicured. Cute Plastic Surgeon too has nicely kept hands. I wonder if that’s a plastic surgeon feature trait.

Basically, apart from a technical difference on what kind of implants the two prefer, they both suggested the same for me, except that McDorky’s attitude is much less positive. He refuses to give best case scenarios. He doesn’t exactly give worst case scenarios either, but he is very meticulous at telling you failure percentage rates, infection rates, complication rates, etc. Not exactly the most uplifting visit I’ve had so far. But, I think, it’s great that he’ll be present on Nov. 3rd: I get the cute and sparkly doctor, with the boring but experienced doctor there to supervise.

But no, turns out I don’t have that right either. The second appointment (which I didn’t know of) is with Cute Plastic Surgeon, for what I think is a pre-op visit. But instead he insists that, since he’s leaving for a month, I’d better be operated by McDorky, so that the same doctor that operates also does the follow up (filling up the implant with saline solution to start stretching the skin, check the healing, etc). He assures me he’s not dumping me. I sort of pout and tell him that I undestand I am a difficult patient. He denies. He says he can still see me, if I want to, when he comes back, especially for follow up and symmetry fixings etc., but that I am better off being operated by the one who’s going to be there for the month immediately after the surgery. I wonder if I am going to see Cute Plastic Surgeon again. Bruce don’t mind me: isn’t it better to wake up and see a cute face looking at you and touching what is left of your breast, than to stare half awake at an overweight, food stained, geek? Serena says McDorky looks like the typical grind, who in high school and college does little else but study, and is a genius at what he does. I hope so.

November 3rd, 8am is my surgery. If the right breast is ok, the operation will last about 3 hours. I should have a simple mastectomy, then an expandable implant put in.

Oh and one piece of good news: I overheard the two surgeons talk and McDorky later confirmed that the lymphnodes tested negative to cancer. I screamed in delight!!!

Someone please tell me how doctors’ offices’ schedules work. A few days ago I called USC (Kaiser contracts out on this) for my MRI appointment. The radiologist who saw my right boob ultrasound recommended I get an MRI, just in case (yeah, right!). As I said, I called them and the nice woman on the phone suggested a Nov 3rd appointment, after apparently discarding a number of other dates (‘how about…? No, that wouldn’t work…wait a minute…how about then…?’). I go ‘um…I am having a mastectomy on that date…don’t think I can be getting an MRI at the same time….’ She says ‘oh gee, we need to get you in sooner then: how about October 25th?’ What’s up with that???!!! How come Oct 25th was taken thirty seconds ago?

This goes back to my arguments with the surgeons…many of you know that I have my reservations about demanding fast resolution at the expense of others…or demanding resolution at all…but fear and a survival instinct get the best of me and when I talk to surgeons and doctors I become the ‘difficult patient’ of Seinfeld’s Elaine’s memory. I keep asking when and why not sooner, and explaining how difficult it is to wait, to live each minute with the awareness that cancer is growing in your body and the fear that at any second it could grow to the point of no return. And they invariably tell me that *biologically* it makes no difference to wait two more weeks…except that the two weeks have become two months since I discovered the lumps in my breasts. So anyway, I always leave those conversations with my surgeons both frustrated and defeated: I don’t get an earlier appointment, and I don’t know *for sure* that my cancer won’t grow to the point of no return in those days. I do trust my surgeon. I have no choice but trust her, don’t I? It’s either I trust her, and believe that she has the best information and skills available to anyone at this moment in time, or I don’t, and then I’m at square one, not knowing who to go to and having wasted two months looking for a surgeon that would take the cancer out of me.

But if I trust her to tell me the truth (and I accept that this must be an act of faith), I also have to trust that she is scheduling me as soon as she can, as soon as my case requires. But then how come all these appointments can be changed at a whim, just when you say some magic word that you don’t even know about? So what’s the magic word to mention to surgeons to get a mastectomy done sooner than after two months from discovery (one from diagnosis?).

Then today I got my MRI. Poked once again in the right arm (I never feared injections, but they are starting to get annoying), injected some dye, given ear plugs to soften the noise of the machine, stuck in a tunnel, belly down, boobs sticking out of two holes, for a little more than 15 minutes, warned that if I moved we would have to call the whole thing off and do it again in no less than 3 days…of course, I went into my zen mode, thought calming thoughts, and fell asleep. I woke up when my left arm jerked involuntarily, but it was all over. The technician took me out and told me (he was joking I swear!) I had been snoring. I had lunch in the USC hospital cafeteria (they have the *exact* same food as USC main campus cafeterias, can you believe that???), while waiting for a copy of the MRI films to bring to my surgeon.

As I look at the films, two white circles shining through in the picture of my left breast, and a series of white lines, like spiderwebs springing out of them, I tell myself I cannot possibly be alarmed, as I am not a radiologist trained at reading them.

It’s my sister Raffaella’s birthday today. She’s 36. TANTI AUGURI LELLA!!!!!!!!!!!!!!!!!

On Monday, mom and dad will be coming from Italy to stay here for a little over a month. It’s comforting and dreadful at the same time. Can it be?

Yesterday I was put under for the first time in my life. To tell the truth I was somewhat worried that I would wake up in the middle of my sentinel node biopsy. Being the direct person I am I actually asked the anesthesiologist what would they do if a patient woke up in the middle of a procedure. He calmly replied that when that happens they strike the patient with a hammer and, should the patient complain, they strike again. When the patient stops complaining, then they know s/he is asleep. Then he gave me the real reply: it had never happened to him, it happens in 1 out of 100,000 cases, and they know when it’s happening through the monitors before the patient knows. But I am jumping ahead. Before talking with the anesthesiologist I was in a crammed, unhospitable hospital room for about an hour. I was then moved to the nuclear medicine department where the Ukrainian McDreamy radiologist that performed my first biopsy injected my areola in four different locations with radioactive liquid. That the liquid was radioactive and came in a sealed, heavy container was bad enough. But then he also stuck that needle in my breast without anesthesia… O-U-C-H. Fortunately it didn’t last very long and he was so nice as to sound out each needle sting as he finished…one done, two done, three done, four done! Then I waited around another 15 minutes or so, laying on the metal bed under the machine that was later to scan me and take a picture of the route the radioactive liquid was taking. I had the prayer shawl that the women of my church had made for me: feminist purple, very soft, made in a three-stitch pattern representing the Trinity, each stitch a prayer. I spread it over me to keep myself warm in that cold room. In my hand a feng-shui amulet one of my friends gave me at the boob-party; all the other gifts in my hospital bag waiting for me in my room. I took almost all of the gifts with me, and those I couldn’t take I took the cards that accompanied them. So as I was laying under the shawl and holding the amulet I visualized my women friends laying their hands on me, then I visualized the men I love laying their hands on me (Sandro’s waving blond head hovering over all of them)…and I promptly fell asleep until the radiologist woke me up. I had to let go of the shawl and amulets and gifts when I was taken to the pre-op room and hooked up to all the machines and asked questions by nurses and doctors, but that was a short time. My surgeon also came to see me, answered some more questions, and told me that she and the young plastic surgeon decided on a Nov. 3rd mastectomy with reconstruction. Then I fell asleep, this time as a result of the sedative that was being pumped into my body.

Next thing I knew I woke up with a pounding pain in my armpit, told the nurse, who (they all seemed to have a sense of humor) told me she was going to give me soda (she meant morphin). I don’t do very well on drugs. Or should I say, I do very well. I guess it depends on the point of view. I become very chatty (yes, chattier than usual), very indiscrete (yes, more indiscrete than usual), and very nosy (yes, nosier than usual). I guess Catia to the n-th degree, if you can only imagine it. But it’s fun. I don’t know what I told the attending nurse, but I remember seeing a nurse in distress and asking if she was ok…I think they were surprised those were my first words. When they brought me into the hospital room where Serena and Bruce were waiting, one of the first things I asked Serena was whether the City of Long Beach guy that checks the pilot light in your house heating system had gone to her house and if everything was ok there. Then I fell asleep again. I drifted in and out of sleep for several hours afterwards. I remember sipping cold water and vomiting it out warm a few minutes later (no real nausea, just a little, more of a sensation that I couldn’t send anything down the stomach). I remember pulling my pants up. I remember walking to my car. I remember tossing myself into my bed. Serena and Carlo cooked for Bruce. Sandro stayed at Kristin and Mark’s for a sleepover. I woke up at 1:30 am and called my sisters, drank a cup of water, went back to sleep. I woke up several times and went back to sleep, until 8 am, when I finally got up and got dressed.

The bandage looks like nothing really, I can see a 2-in. scar underneath. It doesn’t hurt a bit, so I’ll have yet another bottle of unused vicodin in my medicine cabinet. My surgeon saw Bruce and Serena after the surgery to let them know how it went. She said she has taken out 5 nodes and they all look clear, but we’ll have to wait for the pathologist’s assessment…in about a week.

On Thursday I had my first appointment with a plastic surgeon. First impressions certainly count, and though Serena disagrees, I thought the surgeon was cute. That’s one point in his favor. He’s young too, with 40 implant reconstructions in his portfolio. That to me is minus one point. At this time, however, I still have the second opinion appointment to go to, so I don’t have to make a decision right away. The surgeon thought that an implant would be the best option for me and he agreed that I could have a breast augmentation done on the other side to create more symmetry between the two boobs. If you ask Serena I was all giggly and proud when he told me I didn’t have enough fat on my stomach for a TRAM flap reconstruction!!! He actually said these exact words: you have such a pretty stomach, I don’t want to ruin that. I am still gloating, can you tell? I asked him so many questions in such a machine-gun sort of way, that Serena told me I was relentless. He was patiently answering all questions, humoring me with some gentle sarcasm. I liked that. Anyway he and my surgeon talked yesterday and scheduled a mastectomy with immediate reconstruction for November 3rd. In the meantime, I will talk to the other plastic surgeon on Oct 26 for a second opinion, then go from there. My surgeon, whom I have come to trust immensely, has told me that although this plastic surgeon I’ve seen first is younger and with less experience, his work is also excellent and she trusts him. So I’ll wait and see, then go with what she suggests. I figure that an implant job is much easier to fix anyway, if I don’t like the results.

As I came home from my appointment I met outside my house with a couple of friends who had just arrived for the goodbye-boob party I had arranged. I thought that, since my left boob has given me many gifts and pleasures (she breastfed my son, she gave me and my not-numerous-but-certainly-important lovers a good time, and she has been an important part of me for over 41 years), she deserves to be let go with a collective thankful celebration. So I invited my friends (female sex only) to a potluck party. What an attendance. I didn’t count, but there must have been over 20 women in my house and what a hoot!!!!! Food to die for, flowers, gifts and laughter that made my heart burst with joy and thankfulness. I am sure my boob was happy too. There were tears as well, which made me grateful that I have friends who can make me laugh but who also cry and worry for me. It may seem trite but I do indeed feel so lucky. We prayed together, thanking God for the gifts my left boob brought me, for the gifts of friendship and laughter. But we also prayed for those who, because of where they live, can’t be cured of diseases that are easily curable in the north of the world, for the injustice of all this and for the strength to work for justice. Then we charged the spring of the jumping mini boobs, wore the plastic boob glasses, tossed the sylicone boob against the wall, and drank another glass of wine.

Il 19 ottobre ho visto il primo chirurgo plastico. Mi ha accompagnato Serena, il che ci ha permesso di fare qualche risata. Io e Serena sicuramente non litigheremo mai per gli uomini: io ho pensato che il chirurgo fosse alquanto belloccio, lei no. Comunque il chirurgo mi ha conferermato che 1) non ho abbastanza grasso alla pancia per poter fare un trapianto di muscolo/grasso dalla pancia al seno e che quindi 2) la procedura che lui suggerisce per me e’ l’impianto. Avro’ un appuntamento per una seconda opinione con un altro chirurgo il 26 ottobre, ma nel frattempo la mia chirurga e il chirurgo plastico carino si sono messi d’accordo per una mastectomia e ricostruzione immediata il 3 novembre. Appena tornata dall’appuntamento col chirurgo sono andata a casa dove mi aspettavano un sacco di amiche per la mia ‘festa di addio alla tetta’. Ci siamo divertite un sacco. Ognuna di noi ha portato qualcosa da mangiare; poi molte mi hanno anche portato dei regali. Alcune signore della chiesa mi hanno fatto uno scialle bellissimo viola, colore femminista, fatto ai ferri con uno schema a tre punti rappresentante la trinita’. Ogni punto e’ una preghiera, mi hanno detto. Poi altre amiche mi hanno portato altre cose, come creme per il corpo, te’ calmanti, candele profumate, amuleti feng-shui, e cose spiritose come occhiali finti con tette al posto del naso, lecca lecca a forma di tetta, un paio di piccole tette a molla, una palla morbida a forma di tetta e una maglietta con scritto (in inglese) ‘per favore ignorate le mie stupende tette’. La nostra sacerdotessa ci ha guidato in una preghiera in cui tutte noi ci siamo prese per mano e in cui abbiamo ringraziato Dio della nostra amicizia, dei bei doni che ho ricevuto dalla mia tetta sinistra, e pregato per altri al mondo che hanno mali che la medicina (per mancanze nostre, a causa dell’ingiustizia umana) non cura. Abbiamo pregato per i bambini della mia amica Elisabetta che perche’ sono nati in Burma non possono ricevere operazioni salvavita che nel nord del mondo sono di routine; pregato per la mamma di una mia amica che perche’ e’ in Bangladesh non puo’ ricevere la chemio per il suo cancro al seno che qui anche e’ di routine.

Ieri poi ho fatto la biopsia del nodo sentinella. Con il mio scialle per la preghiera e in mano l’amuleto feng-shui sono andata a farmi iniettare il liquido radioattivo, poi ho dovuto lasciare scialle e amuleto a Bruce quando sono entrata in sala pre-operatoria. Non mi ricordo molto dei momenti tra le 2:30 di ieri pomeriggio fino a stamattina all’1:30. Mi ricordo le domande che mi hanno fatto prima di farmi addormentare, mi ricordo che ho parlato con l’anestesiologo e la chirurga e che dopo l’operazione mi sono svegliata con un dolore abbastanza acuto sotto l’ascella. A quel punto mi hanno dato la morfina e da li’ in poi e’ stato un divertimento. Mi sono messa a parlare ininterrottamente con l’infermiera che mi assisteva, poi mi hanno portato in camera e anche li’ continuavo un po’ a parlare a vanvera per 30 secondi e dormire per un paio di minuti. Mi hanno fatto bere un bicchiere d’acqua che ho prontamente vomitato (ma senza sentirmi male, solo cosi, come se non potesse andare giu’), mi sono vestita (ma non mi ricordo bene come), sono andata alla macchina, poi a casa e da li’ a letto, dove ho continuato a dormire mentre Bruce, Serena e Carlo mangiavano. Mi sono svegliata verso l’una per bere e chiamare le mie sorelle per dir loro che stavo bene, poi sono tornata a letto e ho dormito fino alle otto. Oggi siamo andati a mangiarci una bella colazione americana (non mangiavo dalla mezzanotte del giorno prima di ieri) e ho fatto la pipi’ verde (per il liquido colorato che mi hanno iniettato durante l’operazione). Sto benone e andremo fra poco a fare un giro in bici.

Oggi come sapete ho avuto l’appuntamento pre-operazione. Tutto e’ andato bene. Mi hanno prelevato il sangue e fatto pisciare in un vasetto, fatto l’elettrocardiogramma e i raggi x alla cassa toracica. La chirurga mi ha spiegato che venerdi mi faranno arrivare all’ospedale qualche ora prima dell’operazione, mi manderanno in radiologia e inietteranno un liquido radioattivo nell’aureola. Dopo qualche ora, mi daranno l’anestesia totale. La chirurga mi iniettera’ un liquido blu nell’aureola. Con una sonda per rilevare radioattivita’ e seguendo visivamente il percorso anche del liquido blu vedra’ dove e’ il linfonodo sentinella, lo prelevera’ e poi mi ricucira’ (penso che ce ne siano piu’ di uno di nodi sentinella, ma la procedura e’ unica). L’operazione non dovrebbe durare molto di piu’ di un’ora. Il nodulo o noduli verranno mandati al laboratorio patologico, dove determineranno se e quanto il cancro abbia invaso i linfonodi. Lo sapro’ nel giro di una settimana. Domani ho il primo appuntamento consultivo con un chirurgo plastico.

Serena and I were discussing reconstruction options. Serena will be the one who goes with me to see the plastic surgeons. I found it very therapeutic to talk about how to proceed with making a new breast-like limb after mastectomy. I have already talked about the different techniques of breast reconstruction; my preferences have been going back and forth between flap and implant reconstruction. My surgeon and Francesca tell me that flap reconstruction produces in general very realistic results. But I do mind the scarring and the limitation of movement. Serena was showing me some of her friends’ new boobs and we’ve been looking at pictures on the web (what if W is watching our searches? Some subversives + perv lesbians!!!) Granted, her friends’ were esthetic breast augmentations. But reconstruction picts on the web didn’t look half bad either (more scars, obviously fake nipple and aureola, but not bad overall). OK, I will have big round twenty-year-old boobs, but hey, who am I to complain? Because I am certainly going to have to match the two boobs, hence do something with my right breast too. I think I’ll go with implants, though I’ll say the final word after consultation with a couple of plastic surgeons.

So, after spending an afternoon talking of and looking at boob jobs I ended up not thinking about cancer, and getting a few laughs in as well. That was marvelous! I wonder sometimes if I could muster up the courage to not have a reconstruction. I admire women who choose not to. My surgeon is among them. But every time I look in the mirror and see my left breast, as droopy as a forty-one year old breastfeeder can be, it simply seem so unreal that soon it won’t be there. And while I can’t wait to have the cancer removed, I also want to savor these last days with my body intact and seemingly healthy, give or take a few aches.

Allora, domani comincia ufficialmente il viaggio chirurgico: ho un appuntamento pre-operativo con la mia chirurga e faro’ tutti gli esami che si devono fare prima di un’operazione chirurgica (esami del sangue, elettrocardiogramma, raggi x e non so che altro). Dopodomani il primo appuntamento con un chirurgo plastico per determinare se posso avere una ricostruzione immediata del seno sinistro. Il 20 faro’ la biopsia del nodo sentinella se continuero’ a pensare di avere la ricostruzione immediata. Se no, il 24 ho gia’ un appuntamento per la mastectomia.

Ho organizzato una festa per molte delle mie amiche qui giovedi 19. Sara’ una festa di addio alla tetta sinistra, per ringraziarla di essere stata buona con me (allattamento e vari sollazzi maritali!), per dirle che le voglio bene, anche se purtroppo mi devo liberare di lei, e per darle un addio come si deve. Le mie amiche porteranno da mangiare e io forniro’ da bere e una torta. Se ne andra’ in grande per lo meno.

Io e Serena oggi abbiamo discusso le varie opzioni per la ricostruzione. Pensare alla ricostruzione in un certo senso e’ una bella distrazione, che non mi fa pensare al perche’ ne avro’ bisogno. C’e’ un po’ l’illusione che la faro’ come tutte quelle altre donne che si fanno rifare le tette. Io e Serena abbiamo guardato un bel po’ di foto su internet e abbiamo discusso tutte le varie tecniche di ricostruzione. Alla fine, io penso (ma riservo la decisione finale dopo aver parlato con i chirurghi plastici) che preferirei farmi mettere un impianto. Si vedra’ che la tetta e’ rifatta, ma almeno non saro’ piena di cicatrici, e manterro’ mobilita’ e forza. Voglio continuare ad essere attiva, anzi anche aumentare la mia attivita’ sportiva. Poi le cicatrici veramente mi fanno impressione. E infine, mi sembra che l’operazione per l’impianto sia piu’ facile e meno lunga che le altre operazioni. Ma forse ho gia’ dato troppe informazioni?

…interesting exchange Toni and Alan. You guys never fail to amuse me!