Sometimes You Just Need to Cry

The day before my most recent chemo treatment, which was scheduled on July 12, I met with Dr. James Yuen, Chief of Plastic Surgery at UAMS, and the surgeon assigned to handle my breast reconstruction simultaneously with the bilateral mastectomies.  I was actually excited for my first visit with him about the procedure, especially since it will be the longest phase of my breast cancer journey.  In preparation for my appointment, Dr. Yuen’s nurse forwarded several informative brochures in the mail about the latest and greatest breakthroughs in reconstructive surgery, as well as the types of implants that are now available.  The reading materials were full of overwhelmingly technical jargon, which forced me to write down lots of questions to ask the doctor.  I was prepared for the appointment.  

Dr. Yuen has been described as a masterful artist with the human body being his canvas.  When he entered the exam room, I immediately started sizing him up (only fair since he was going to be analyzing my breasts). He appeared to be in his mid to late 40s and had wisdom written all over his Asian face.  When he first started talking to me, I could immediately tell why he was a member of my wellness team and why nationally renowned breast surgeon Dr. Suzanne Klimberg appointed him as her tag-team reconstruction magician. Assisting Dr. Yuen during the appointment was a young female surgeon, whose job it would be to insert the temporary tissue expanders that stretch the breast skin in preparation for the permanent prosthesis devices. Also, making up the interview team was a male plastic surgery resident who would shadow Dr. Yuen during the surgery.

Before I was given the opportunity to ask Dr. Yuen any questions, he immediately started pelting me with inquiries, such as how many chemo treatments had I endured; whether or not I had experienced harsh side effects; and, had the mass reduced in size since treatments began in late May.  And, then he began to zero in on a topic from my chart that surprised me.  He noticed that I was an insulin dependent diabetic.  “This could change the scope and timing of the surgery,” he said without hesitation.  I could feel the anxiety filling my chest. He asked the range of my blood sugars and I shared that when I took the steroids during and immediately after the chemo treatments (to prevent nausea and vomiting), the levels were as high as 300+  (normal is 80-120) and could dramatically drop to lows in the 50s and 40s. “Hmmmmm,” he responded (seldom is that good coming from a doctor). I asked him to explain.

Dr. Yuen elaborated that normally mastectomy surgeries are scheduled about four weeks after the last chemotherapy treatment, providing time for the body to recover (somewhat) from the toxic drugs circulating through the system. Because I’m diabetic, I already have a compromised immune system and the chemo drugs further weaken my system and my ability to fight off infections.  He said implanting foreign objects, such as the temporary expanders in my breasts, would more than likely cause my body to reject the procedure and the implants.  He said 5% of his breast patients are diabetic and 90% of them who opt for reconstruction simultaneously with the mastectomy have major infections.  Some even have to have the devices removed, followed by a lengthy recovery then the procedure is attempted again after ample healing. 

Wow!  That revelation rendered me speechless, which isn’t an easy task. (Anyone who knows me will attest to that.)   During my initial appointment with Dr. Klimberg in mid-May, she never indicated that delayed reconstruction could be a possibility.  My chemo-fuzzed brain had already processed my cancer recovery timeline from diagnosis to the finished process and no where in all that did I factor in a six-month delay after the initial surgery.  In my timeline, I would have newly constructed ta-tas and be brushing my natural hair no later than March 2014. I was not only disappointed at what I had just been told; I could feel the tachycardia (rapid heart beat) taking over. Dr. Yuen warned me that I would probably endure emotional strife should the decision be made to postpone the reconstruction for six months.  “Just be prepared,” he cautioned me.

Dr. Yuen said if I felt like rolling the dice and going ahead with the simultaneous surgeries, he would support me, but he just wanted me to be aware of what could happen. Don, wearing his medical hat, immediately spoke up and told Dr.Yuen that “we” would do whatever to protect my health and there would be no risk-taking.  Suddenly, I became angry at Don for speaking on my behalf. For a moment, I felt like one-half of a ventriloquist act. Because he, too, is a surgeon, as well as my very significant other, he sometimes forgets that I have a voice in all the medical decisions pertaining to my cancer treatment.  I glared at him then told Dr. Yuen that I would process everything he had told me and let him know my decision as soon as Dr. Klimberg set the date for the mastectomy surgery.  While I love Don and know he only wants what’s best for me, I’m the one who has to ultimately make the choices that I think are right for me.  That doesn’t imply I won’t delay the procedure; it just means that I have to be comfortable and mentally prepared for the decision that is made.

Don and I said little on the ride from UAMS to my condo.  I couldn’t talk.  Tears were right on the edge of every word that might role off my tongue so I just decided not to even try to converse.  It wasn’t anger. It was the surprise of things not going according to plan.  You see, I’m the ultimate planner and somewhat of a control freak - a definite type-A personality.  When someone like me receives a cancer diagnosis, we go just a little crazy because we are no longer in charge of our bodies.  First, the cancer is in charge prior to the diagnosis, then in order to rid the body of the beast, you turn your immediate life and well-being over to a team of doctors. They are in control for the duration of the treatment. I had it in my head that I could once again be in command of my life sometime in February or March 2014.  Based on what Dr. Yuen had told me, that wasn’t going to happen.  In fact, it would probably be June or July of next year before the reconstruction process would even begin.  Pardon the pun, but it was a hard pill to swallow.

I reported to work shortly after my appointment with Dr. Yuen and traipsed to my friend Gloria’s office for a cup of coffee.  She asked about the appointment and I tried to share the details with her but just couldn’t.  I told her I would explain later.  I returned to my office, shut the door and the tears flowed.  Sometimes, you just need to cry.  Perhaps, it was two months of treatments, more than ten blog compositions and my ongoing attempts to be upbeat for friends and family that helped provoke the tears.  I was emotional for the remainder of the day.  At times, I thought I was being overly sensitive and slightly self-centered.  But, it was deeper than that and I couldn’t explain it to anyone, not even Don.

My fourth chemo treatment was scheduled the next day.  I knew I had to shake off the emotions and prepare for another tough day.  And, this too shall pass…