Tuesday, October 8, 2013

Dr. Suzanne Klimberg: The Surgeon Schedules the Surgery

The aches and pains from my final chemo treatment were causing some discomfort when I reported for my appointment a few days later with nationally known breast surgeon, Dr. Suzanne Klimberg. I nicknamed the good doctor “Picasso” because of her penchant for drawing imaginary incision lines on my breasts as a way to explain the upcoming mastectomy surgery.
marla crider, UAMS, breast cancer, mastectomy, Dr. Suzanne Klimberg
Breast surgeon, Dr. Suzanne Klimberg.

It isn't unusual for Dr. Klimberg to have several medical students shadowing her every move and hanging on her every word.  These fresh-faced wannabes are eager to learn from the best in hopes of one day using their knowledge to create new, streamlined surgical techniques or, perhaps, to develop a vaccine that could eradicate cancer all together.  There’s no better reason to be a patient at the University of Arkansas for Medical Sciences – the state’s only teaching hospital – because you see the future of medicine in every young face wearing a lab coat and can’t help but think about the possibilities.

Don, an accomplished surgeon himself, accompanied me to my appointment to ask questions about the surgery and interpret the answers.  We had only been in the exam room a few minutes when Dr. Klimberg’s nurse came in to inquire about my chemo regimen and to confirm the date of my last treatment.  She surprised me when she requested to examine my breasts.  The nurse took a black pen out of her pocket and drew a circle very near the right nipple where she felt evidence of the remaining cancer (Hmmmm.  Apparently, everyone in the Klimberg clinic is an artist and my breast seems to be their favorite canvas). She explained that she was marking the area for Dr. Klimberg to evaluate. 

A few minutes later Dr. K entered the room with a med student at her side.  The doctor introduced her protégé to Don and me as one of her brightest scholars. The fresh-faced young woman blushed at the compliment. There were now a total of five people in the small cubicle, yet no one seemed to notice (or care) that I was lying bare-breasted on the exam table. It was all in a day’s work for them. I learned quickly after my first visit to the UAMS Cancer Institute six months ago that my breasts were no longer just mine.  I had to relinquish custody of “the girls” to my medical team in an effort to rid the right one of cancer.  Dr. K moved to the right side of the exam table and the med student was on the left. The RN was in the background making notes.

Dr. Klimberg immediately zeroed in on the black circle made by the nurse.  She palpitated my right breast, then the left, and moved back to the right breast where she found what was left of the once very large mass. She instructed the med student to feel the small tumor, as well.  I was beginning to get a little nervous listening to the two of them bantering back and forth until Dr. Klimberg explained that her concern was not the small remnant of the tumor but rather the close proximity to the nipple. She was uneasy about saving it. “Do you like your nipples?” she inquired.  “Heck, yea,” I replied rather shocked at her question.  “Why wouldn’t I like them?  We’ve been close pals for 60 years,” I stated rather matter-of-factly. “Well, in case you didn’t or should I not be able to save the blood supply to the right nipple, I want to assure you that Dr. Yuen (my plastic surgeon) makes a very nice nipple.”  (It’s comforting to know that my reconstruction surgeon is known for his nipple-making.) No doubt, that was the strangest conversation I have ever had with anyone.    

I asked Dr. K if she was still planning to do the new surgical technique created just for me in an effort to salvage more tissue and skin for the breast reconstruction that had been delayed for six months due to my diabetes. “Absolutely,” she remarked. Dr. K, or should I call her Dr. Picasso, took the black pen out of her lab coat and started drawing imaginary incision lines (Here we go again, I thought. It's “show and tell” time).  The med student listened intently as Dr. Klimberg explained the procedure to her, as well as Don.   The two surgeons in the room – Dr. K and my significant other – began to throw technical terms around until I reminded them that the bare-breasted patient didn’t understand a thing they were saying.  I interrupted their physician bonding moment and inquired if Dr. K had decided on a name for the new procedure. “Breast over pants,” my surgeon said with a straight face. Interestingly, Don knew exactly why she chose it.  He enlightened me that there is a hernia repair called “vest over pants” and it all had to do with making a flap that restores blood flow to the impacted area. 

Dr. Klimberg shared with me that several of her students were vying to assist her in surgery to observe this new technique. I asked how she would determine which young surgeon-to-be would be in the operating room.  “It all comes down to which one has the best bribe,” quipped my brilliant body artist.

Dr. Klimberg’s nurse jumped in and asked if she was really supposed to put the name “breast over pants” on the surgery orders because the medical staff would question it, having never heard of such a procedure.  “Even more reason to do it,” Dr. K responded with a twinkle in her eye.  After sitting up on the exam table and covering my bareness with an unfashionable gown, the nurse informed me that I was on the surgery schedule for Friday, October 11.  “Do you know if it will be morning or afternoon?” I asked.  Dr. K jumped in and said the team usually reserves the early morning surgeries for old people and diabetics and I qualified for both.  I couldn’t help but laugh out loud at her comment as did the others in the room.  The nurse handed me several pages of instructions and told me to return for a pre-surgery consult with Dr. Klimberg on October 10, followed by a meeting with the assigned anesthesiologist. 

“It’s really going to happen,” I remarked to Don as we exited the cancer institute.  “I just hope I’m emotionally prepared when the date rolls around.” 

“I have no doubt that you will handle the surgery with the same determination that you did the chemotherapy,” he said.  From his lips to God’s ears…

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