Sunday, October 20, 2013

Surgery Pending, So is More Chemo...

It was exactly one week before my scheduled bilateral mastectomy.  I had been waiting for nearly an hour with more than a dozen other patients at the Winthrop P. Rockefeller Cancer Institute to see Dr. Makhoul, my oncologist, for the results of the recent breast MRI. The good doctor had recently been appointed the new director of oncology at the University of Arkansas for Medical Sciences and was busier than ever. Since being diagnosed with cancer six months earlier, I had learned the virtue of patience and it was a good thing.

Don had a conflict and couldn't accompany me to my appointment with Dr. Makhoul, but I was okay with going solo because I felt good about the pending results.  After being called to the exam room, I waited anxiously for Dr. Makhoul to enter.  A few minutes passed and the door opened, but it wasn’t Dr. Mak.  Instead, a new doctor entered the room.  He introduced himself as an oncology “fellow,” training with Dr. Makhoul. The young Syrian doctor was polite and engaging. I was impressed that he had read my medical history and was prepared to discuss the topic du jour – my breast MRI results. He informed me that the once large tumor now measured 1.6 centimeters by .6 centimeters and the second tumor, which had always been much smaller than the primary mass, appeared to be completely eradicated. I really wasn't sure how to interpret what I had just heard.  I missed Don.  The new doctor told me he was going to find Dr. Makhoul and let him answer any questions I might have.

It had been nearly a month since my last visit with Dr. Makhoul and I was actually excited to see him when he breezed into the exam room with his new protégé.  His jovial, yet soothing tone always worked wonders on those who might be wrestling with fear and uncertainty, like me. He wanted to know how I fared after my last chemo treatment and I told him that I did okay; however, I was thrilled to have the Taxol treatments behind me, because the drug was taking its toll on my weary body. He nodded his head in agreement.

Dr. Makhoul reviewed my medical file and reiterated the dimensions of the existing tumor. He said it was now a manageable size and my surgeon, Dr. Suzanne Klimberg, shouldn't have any problems excising the breast tissue.

And then he dropped a small bombshell.

“Depending on what the pathology report shows after your surgery next week, he said, "I may recommend another round of chemo."  He further explained that my triple negative diagnosis had everything to do with his recommendation.  Needless to say, I was having trouble processing what I had just heard but knew it was exactly what needed to happen.  “We won’t make a definite decision until I review the post-surgery pathology reports,” he reminded me.  Dr. Makhoul wished me good luck with my upcoming mastectomy and said he would see me on November 5 to discuss a future treatment plan...if necessary.

As I departed the cancer institute, my mind was a whirl with thoughts of surgery and the possibility of more chemotherapy.  That aside, I was prepared to do whatever my medical team suggested to rid my body of cancer, because I had literally placed my life in their healing hands

One Day Before Surgery: The Game Plan Changes

Less than a week after my appointment with Dr. Makhoul, Don and I reported to Dr. Klimberg’s office to fill out paperwork and consult with my surgeon the day before the scheduled procedure.  Upon arrival at the women’s oncology clinic, Don and I had to search for two chairs together in the overflowing waiting room.  As I scanned the crowd, I noticed that only a few patients were older than me and was stunned at how many were in their 30s and early 40s.  I was curious if the recent Angelina Jolie breast surgery phenomena had reached central Arkansas and was a reason for seeing so many young women in the clinic. Hopefully, they were there for preventative purposes, as Jolie demonstrated with her decision to have a bilateral mastectomy before she actually had cancer, and not because they had already been diagnosed with breast or gynecological cancer.

My appointment with Dr. Klimberg was scheduled for 11:00 a.m. and we expected a long wait; however, my name was called about 30 minutes later.  We were escorted to a small conference room, where an RN specializing in tissue research counseled me on the benefits of donating my breast tissue post-surgery to UAMS for scientific research.  I wholeheartedly agreed.  The fact that the type of cancer I had – triple negative – was found in only 15% of women offered a solid reason for me to participate in current and future research projects. My triple negative diagnosis was starting to weigh heavily on my mind after doing a little online research of my own.  If my tissue could help provide answers or even a vaccine, I was more than happy to help.

After I signed the release forms for the tissue donation, I was moved to an exam room, where I waited for my consultation with Dr. Klimberg.  Her nurse, Maureen, arrived first and handed me several forms to review about the surgery.  Then Dr. Tummel, a very young associate of Dr. Klimberg, entered the room and conducted a brief breast exam in advance of my surgeon’s arrival.  In typical Klimberg fashion, the dry-witted doctor made an entrance into the exam room wearing blue scrubs and accompanied by a timid, female intern.  “Let’s get this show on the road,” she directed her entourage.  One of her first duties was to explain to me all the things that could go wrong during surgery…including death…and handed me a pen to sign the consent form, which I did.  I was given additional forms to complete that would allow Dr. Klimberg and UAMS to use me in a lymphedema research project she is conducting.  Lymphedema is defined as arm swelling common in mastectomy patients.  I was familiar with the problem after observing a former colleague deal with a re-occurrence last year, which was a determining factor in me signing up for the experiment (Thank you, Renee).

After all the paperwork was in order, Dr. Klimberg pulled a permanent marker from her scrubs and began drawing possible incision lines on each breast as Dr. Tummel and the intern observed over her shoulder.  The first mark of significance was where she planned to move my nipples, followed by the “flaps” she would create for the plastic surgeon to insert the implants a few months later.  “Are you still going to do the procedure you created just for me?” I asked.  With her chin nestled between the thumb and forefinger of her right hand, she stared at my breasts and responded with a comment I wasn’t expecting.  

“I think your breasts are just too small for me to do the ‘Breast Over Pants’ as planned.”  

I started laughing and told madam surgeon that she is the first woman to ever tell me that I had small breasts.  “I meant it in a good way,” she said, trying to recover from her comment.  “Have you lost weight since I first suggested the new procedure?” she inquired. In fact, I had, but I didn't think it was a game changer.  She continued to discuss possible alternatives with Dr. Tummel for nearly 45 minutes.  Finally, they had a plan.  When I looked down at my apparently small breasts, all I could see were multiple black lines that resembled a web - and small, black dots where each nipple would be re-positioned.

Before leaving to see another patient, Dr. Klimberg told her nurse to call the surgery scheduler and make sure I was the first patient the following morning.  In a few minutes, Maureen returned and said Dr. Yuen, my plastic surgeon, already had the time slot reserved for one of his patients.  It was immediately apparent that Dr. Klimberg didn't like Maureen’s answer.  

“I’ll be right back,” she told me.  

Within a minute, Dr. Klimberg returned with a frustrated expression on her face and informed me that I would be second on the surgery schedule, which would be approximately 11:00 a.m.  “How long will the surgery take?” I asked.  “About four hours,” she told me as she hugged me before leaving the exam room.  

“I’ll see you before we put you to sleep,” she added.  “Don’t mess with my artwork,” she told me, pointing to my marked up breasts. After she left the room, I looked at my watch.  In less than 24 hours, I would be in surgery, receiving a life changing procedure.  It’s merely the next step in my treatment plan, I reminded myself, as I put on my favorite bra for the last time. 

1 comment:

  1. Hope you have a speedy recovery and I wish you a very good health and a healthy future. Keep updating us with your health.


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