Anthropology, Respect, and I'm One Week Past Mastectomy

Bucky is staring deeply into my eyes. He sits beside my bed and Bobbi lies at my feet as i type on the laptop. 

Bucky, a seven-year-old golden retriever, a master-manipulator, wears his "I'm just a widdle boy" expression. If you know Golden Retrievers, you know that they can change their facial expressions for whatever purpose they have at the time. 99 percent of the time they choose a facial expression that will get them food. (Yesterday he wore an evil, vicious face to his younger brother, when he snarled and fake-snapped at Eiger, whom he thought had gotten into an unopened kibble bag on the floor). 

He is saying "I smell that awful' nice-smellin' Tim Hortons eggamuffin dere, lil lady, an' I was wonderin' if you were through with the wax paper wrappin' on it." I tell him that eating paper is bad for him. He replies "dat don't mean nuthin' lil lady, bulieve me, we eat poop half the time you're not lookin', in the park."

Bobbi raises her head on backup. She is confident that any snacks that get doled out to Jaida, Bucky, and Eiger, also get hand delivered to her.

I will be walking Shamus, a dog who lives three houses up the street, at one o'clock. For the past year, his parents have needed him walked daily, every other week. This works great for me these days. I get an hour of exercise so my leg muscles and core muscles don't atrophy while I convalesce.

While I walk Shay I get that same rush everyday, rain or shine, an excitement that all around me is greenery and blue water. 

The Parkway is the most amazing jewel in Ottawa's landscape. All the land beside the Ottawa River has been reserved for bike trails and walking trails. The cars have an unimpeded-by-civilization view of the river on one side, and the green trails on the other. I walk Shamus a half hour out on the green side and a half hour again by the river on the way back. 

There is no beating this city if you love nature. I have swum in the Ottawa River with the dogs three summers in a row and never gotten sick.

As a teen, I swam in the Ottawa River, in the seventies, further west, out in the countryside, as a YMCA Camp counseller (I won Best Counsellor Award there two summers in a row...BRAG, brag), where the ecoli from the Quebec cows swam across and into my intestines. I recall two-week fevers as a teen, which I now know in retrospect was Ecoli Poisoning. 

Nowadays, there is an organization called the River Keepers and lotsa good clean-up of the water system manifests itself in sewer reconstruction all over the city under the roads. The city has spent billions in cleaning up the water system here. The Water Purification building sits on an island in the Ottawa River behind which is a two acre dog park, called "Lemieux Island Off-leash Dog Park". Dave and I call it "the office."

I can't wait to get back to Bruce Pit or Lemieux, our off leash dog parks. The only thing in my way is the recuperation.

What I didn't know about mastecomy and lymphectomy is that there is a gallon of water that comes from inside you and fills the space where your boob used to be, and swells your armpit with cipherlike side-boob.

I went to the nurse on sunday, as scheduled, and she oohed and aahed about how nice was the thin, neat line the surgeon made of my incision. Yay!! You may recall how I campaigned for it, right? Please if you have read this blog and you know anyone who is approaching a mastectomy, tell them to fight for a thin, nice scar.

Here is how i did it. (What I left out of previous blogs.) You may recall I phoned the surgeon and requested no junior resident be allowed to sew me up. You also recall he returned my call and refused. Ok. Well here is what I did next.

The week before surgery you are called in to the hospital where your mastectomy will take place, for a three hour or so Pre Operation Assessment. You get a scan of whatever body parts they haven't already scanned and you meet with a Family Doctor and answer his questions and a lot of questions given by nurses too. 

At the end the nurse presents you with all the paperwork in a neat pile with a cover sheet on it. She passes you it to sign. She points at the place where you are to sign.

Don't be a dummy. Don't just sign. Don't consult with her for what you are to do next. Instead, there is a blank space on the cover sheet. You fill this in, without telling her what you are doing. I wrote "Patient requests that no junior residents be allowed on the team." Alternately, you could write "Patient requests the surgeon, Dr...X, closes the wound."

My aftercare nurse told me this was genius. Her words, this past Sunday were: "I am the first one to see the mastectomy scar. I see tons of them. Yours is the neatest, thinnest, nicest one I have seen so far." 

Isn't that great? When I told her the above, she said "well the doctors who were about to operate on you would have seen what you wrote first, and thoughts of lawsuits would have discouraged them from letting a Junior Resident close your wound." 

Indeed I recall the Senior Fellow (resident) with five years experience post residency, telling me no Juniors were even on the team. I was astonished, in the Recovery room when I asked him if there were Juniors on the team, and he said "no, no Juniors were on the team and the Big Guy (Dr. Lorimer) closed you himself."

A good friend of mine had a mastectomy last year. A bilateral. She deliberately spared me the details, beforehand, thank God, about the only yucky procedure that awaited me prior to surgery. 

In her case the language used by the Male technician, just before she entered the operating room, was seriously unfortunate. (Jesus, do these people get no training in bedside manner?) Her support was back in the waiting room. She had no friend nor daughter with her during this yucky moment. I find that shameful on the part of the people who run the Queensway Carleton, and in retrospect, am glad I had mine at the General.

Hers went like this: She said goodbye to her daughter and friend and off she was wheeled to a tech room prior to surgery. The male tech said "I need to put radioactive tracers in your breast, followed by blue dye, prior to your mastectomy, in the cancerous breast. This will be used during your operation, to take photographs of the cancer as we are removing your breasts. We need to make sure we get clean margins around the cancer." What he said next caused her to have to be held down by nurses and technicians during the procedure while she kicked and screamed: "I am going to put a needle, without freezing first, in your nipple."

Now I recall from reading Suzanne Somers' book years ago, the bit about the needle in the nipple. I fortunately forgot all that prior to my mastectomy, so that was a good thing. I recall reading that, and saying to myself, as does every woman who reads that bit, "nope, never would let anybody do that." In fact if you are reading this, male or female, right now, you are saying the same thing, right?

Well, Luanne, this is what you meant, right? That hospitals can indeed train staff to make better choices in how they do things, and how they say things to us. Here is how I received a much better way of doing things.

I wrote a blog on this already but in a nutshell: the radioactive tracers have to follow the ducts in your breast towards your lymph nodes. The cancer in ductal breast cancer will head there anyway. This is why early detection is great. If, unlike me, you do your breast checks, and feel for lumps, you prevent the cancer from heading towards the lymph glands under your armpit. 

Well these radioactive tracers pretend they are cancer heading towards your lymph nodes. The clever thing the doctors do is to allow the tracers to go from one end to the other. Think of the nipple as the beginning of the journey and the lymph gland as the end. 

Once the tracers have followed that journey, they put dye in the nipple (or in my friend's case, at the same time as the tracers) and allow the dye to follow the tracers. Once you are on the operating table, photos can be taken from inside the breast, so to speak. It is wonderful magic, these photos of things the eye cannot detect.

The lucky patient, me, for example, got the smart, humane method of doing all this. The unlucky patient, my dear friend, who will go nameless to protect her identity!, did not. The humane method I got consisted of the following:

a) a female technician who allowed

b) my support (Eliza) to be present, and

c) never said "needle in your nipple" but instead said "beside the areola"

d) who explained that the contents of the needle would be aimed under the nipple, and

e) waited till I asked, to explain that despite no surface anaesthesia being possible, there would indeed be

f) anaesthesia inside the needle, along with the tracers.

Lastly, the coloured dye would be given to me at the onset of my operation under General anaesthesia.

All the above seem miniscule to you reading this,  perhaps, these differences in how we were treated. Believe you me, when primal brain-responses are invoked (someone threatens your nipple, for instance) requiring knee-jerk primal defence mechanisms (like my friend screaming and fighting on the table) you need to have great respect for human defence mechanisms. 

You need to respect that screaming and fighting on a table are not a sign of "typical stupidity" or whatever my friend's technician thought of her behaviour. You need to teach that technician that the human comes with 108 billion ancestors on this planet whose natural willingness to fight and scream to protect at the primal level, KEPT THE HOMO SAPIEN IN EXISTENCE FOR 200,000 YEARS. As my friend, Luanne, wrote in the comment to one of my posts above, you need to respect the human body. Period. You need to respect. us. As Luanne said, "respect the body as it houses the spirit."

(Personally, I extend this respect to cats and dogs in medical situations, too. My kitty, Kitty, the grey burmese, was as cooperative a patient at the vet's as any vet ever saw. She would let you turn her inside out and upside down if you handled her with love, instead of fear. One vet wrestled her to the ground to get a needle in her arm, and the vet ended up on her back trying to do this. The next vet simply believed me, and treated Kitty with respect, and Kitty held her own leg out, allowing the needle.)

All this, just to tell you: I occasionally have phantom right nipple pain. I was under general anesthesia when the coloured dye got inserted, but I suppose the nerves are still there, though the nipple is gone. Very interesting.

So there are two things, in total, I didn't know about post-mastectomy recovery. Firstly, the massive swelling of liquid under my 26 centimeter (one foot) long scar; and secondly, that you can have phantom nipple pain.