Tuesday, November 5, 2013

The Surgery: It Takes a Village

When I awoke on the morning of October 11, I was surprisingly calm and ready for what the day would bring.  My brother and sister-in-law, Marion and Carolyn, had driven from Northwest Arkansas the day before and spent the night with me.  Their presence provided me with much needed emotional support as I prepared for life-changing surgery.
Marla Crider, breast cancer, mastectomy, surgery, UAMS, Little Rock, Klimberg
Marla Crider, post-mastectomy surgery.

Even though the mastectomy procedure was scheduled on my older brother Mike’s birthday, he and my sister-in-law, Barbara, made the trip from Springdale to be with me, just as they had done when I had chemo treatments.  They met Don, Marion, Carolyn and me at my condo about thirty minutes before we were to all depart for UAMS.  As we sat in my great room talking and laughing, I looked around me and became a little misty-eyed. I knew my parents were observing from heaven and proud that their sons were still looking after their baby sister.

We left the condo at 9 a.m. in order to find the visitor parking deck and patient registration area at the med center’s main hospital before my assigned check-in time of 9:30 a.m.  Fortunately, living only10 minutes from the University of Arkansas for Medical Sciences campus allowed us plenty of time to find our way. Don and I departed in his vehicle and my brothers followed in theirs.  We were given directions of where to park by a nurse the previous day; however, it should have been a red flag when she used the term “loop-de-loop” in the details.

When we approached said “loop-de-loop,” we learned quickly that it was an employee only parking deck with no access.  There we were in a three-car caravan all trying to back-up and figure out what to do next.  Then, my sister-in-law saw a sign that suggested we go further up the drive.  Sure enough, there was the second “loop-de-loop.”  Really?  Who designs a double-looped entry into a parking deck?  Aren’t they confusing enough without making it worse? It was now 9:25 a.m. We made our way into the deck and searched for parking.  We lost Mike and Barbara somewhere in the parking garage and decided they were on their own.  We located two parking spaces in close proximity to each other.  Our next challenge was to find elevator B that would take us to the patient registration area.  Don, Marion, Carolyn and I wandered around the loop-de-loop, or should I say “blankety blank” parking garage and finally located the elevator by accident. Just as we stepped inside, my cell phone rang.  I recognized the number as the UAMS exchange.  I answered.  It was the pre-op nurse wanting to know where I was.  “Lost,” I said with an exasperated tone.  She tried to instruct us where to go but the elevator doors closed, which disconnected the call. It took us another five minutes but we finally found our destination. A few minutes later Mike and Barbara appeared and reported that they would never find their vehicle again.   

After filling out the obligatory paperwork, I was escorted to the pre-op area and taken to a prep room.  My assigned RN gave me a gown, circulation stockings, no-slip socks and an elasticized cap to put on in preparation for the surgery.  As I disrobed and looked at my reflection in the glass of a medical equipment cabinet, I couldn’t help but stare at my breasts one last time.  I wasn’t really sad, just relieved that phase two of my wellness plan was about to get underway. I bid “the girls” good-bye and finished dressing in my surgical attire.  The nurse returned and started taking my vital signs then gave me a small dispensing cup with a pill in it.  She explained that it was a marisol capsule – marijuana – that would help me relax and eliminate post-surgery nausea. Hmmmm. Marijuana in a red capsule.  I wondered if I would have a case of the munchies when I woke up after the surgery.

The nurse beckoned my family from the waiting area and told them they could see me before I was moved to surgery.  My brothers, their wives and Don were in the small room along with my pre-op nurse and the nurse anesthetist.  The door opened and Dr. Klimberg entered. She looked a little surprised to see so many people.  Before I could introduce her to my family, she immediately acknowledged them, introduced herself and then walked to my bedside.

“What’s your name and what are we doing to you today,” she asked with her typical dry wit.  “Very funny,” I responded.  She smiled, patted me on the arm and told my family they would take good care of me. At that very moment my vision began to blur and I couldn't stop smiling.  It was the marisol.  One by one, my family and Don kissed me on the forehead and returned to the waiting room where they would spend the next four hours. 

The pre-op team transported me to the operating room as I struggled to focus on what they were saying. The marisol pill had really affected my senses. I saw a clock on the wall.  It was 10:50 a.m.  It was the last thing I remembered.

I was desperately trying to open my eyes when I heard a voice ask if I was in pain. “I’m hurting,” I responded in a whisper. “I’m going to give you some morphine before we move you to your room,” the post-op nurse said. 

A few minutes later, five people were lifting me from the gurney to the hospital bed in my assigned room, trying with all their might not to cause me any additional discomfort because the morphine had yet to kick-in. A certified nurse’s assistant (CNA) quickly placed pillows under each forearm, which helped alleviate some of the pain.  She raised the head of the bed so that I was in an upright position.  The clock on the wall showed 5:20 p.m. What a long day for my family, I thought.  About that time, Don, Marion and Carolyn entered the room.  I didn’t see Mike and Barbara. I assumed they were searching for their car. Marion explained that after Dr. Klimberg came out of surgery to give them an update, Mike and Barbara drove back to Springdale for Mike’s birthday celebration with their kids and grandchildren. I was glad his special day wasn’t totally upstaged by my surgery. 

I could smell food in my vicinity, which made my hunger pains even more severe.  Yep, I had the munchies.  There were no symptoms of nausea, which cleared the way for me to receive a food tray. I hadn’t eaten in 24 hours. Since I couldn’t move my arms, Carolyn fed me.  Dinner was a lemon pepper chicken breast and rice and it was yummy.  Dessert was sugar-free, cherry Jell-O.  I kept telling Carolyn it was the best I had ever had.  It must have been the marisol talking. 

The next 12 hours were filled with the medical team taking vital signs, monitoring my blood sugar and dispensing medications.  There was some concern because my blood sugar registered 250 and it should have been somewhere between 80 and 120, which is normal.  Dr. Klimberg left orders to give me several units of insulin to bring it down.  The RN noted that the glucose included with my intravenous meds was probably the culprit for the high reading. 

UAMS, breast cancer, Little Rock, mastectomy, surgery, recovery
Illustration showing how drains
are inserted post-surgery.
Marion, Carolyn and Don agreed that Don would spend the night in the room with me should I need assistance.  They planned to return early the following morning to relieve him. Don didn’t get much rest because I was monitored every two hours throughout the night.  That’s when I realized that the RN was checking fluid in bottles – one on each side of me.  As the anesthesia began to clear my brain, it dawned on me that the bottles were the infamous drains that I had heard so much about.  The plastic bottles had measuring units on them to determine how much blood and serum was draining from my breast cavities.  At one point, when I tried to adjust myself in the hospital bed, I felt a pull on my side and asked Don about it.  He explained that it was the drain tubes that were inserted and stitched under each arm.  

At 4:30 a.m., the CNA came in and had been instructed to remove my catheter.  At 4:30 in the morning?  After the task was completed, I was told to ring the nurse if I had to pee and someone would assist me to the bathroom.  I was not looking forward to getting up considering I couldn’t even lift my arms. 

At 6:30 a.m., I had to make the dreaded call to the nurse and request help to get out of bed for my first post-surgery trip to the bathroom.  There had been a shift change and a male CNA arrived to help. He coached me to use my legs, rather than my upper body, to change positions.  I managed to swing my legs off the side of the bed without using my arms.  When I returned from the bathroom, Don suggested I sit in a chair for a while and rest my back.  It felt good to sit up. 

Dr. Tummel, the resident who assisted Dr. Klimberg in surgery, was making rounds and stopped by at 6:45 a.m. to check my incisions and the swelling.  He said everything looked good but he wanted Dr. Klimberg to see me, as well. In the meantime, the RN came in to check my blood sugar; it was 230. He suggested that it was time to remove my intravenous line and the pesky glucose that was escalating my blood sugar.  I was thrilled because the needle was making my hand and arm ache. The nurse injected me with two units of insulin to help decreast my sugar levels. My usual daily dose is 32 units.  I didn’t expect there to be much change.

I was still sitting in the chair at 7:10 a.m. when my door opened and Dr. Klimberg came in accompanied by Dr. Yuen, the plastic surgeon who will eventually handle my reconstruction surgery. Much to my surprise, five or six med students followed Dr. Yuen into the room.  Dr. Klimberg sat on the edge of the bed and asked if she could show Dr. Yuen the first ever, modified “Breast Over Pants” procedure she did just for me. 

“Sure,” I said, “but I thought you couldn’t do the ‘Breast Over Pants’ because my breasts were too small.”

“You aren't going to let me forget that are you," she asked.  I shook my head no. "Well, I did a variation and wanted to show Dr. Yuen since he’s never seen it before,” she responded.  Both surgeons began pressing on my numb nipples as the med students moved in for a closer look.  It was definitely a Grey’s Anatomy moment, only Dr. McDreamy wasn’t among the McYoungsters. Dr. Yuen proclaimed that Dr. Klimberg’s skin-saving procedure would allow him to adequately insert the prosthesis without having to make adjustments.  I was pleased.  Dr. Klimberg was pleased. And the med students didn’t have a clue what he was talking about.

Before Dr. Klimberg left my room, she reassured me that the surgery went very well.  She instructed me not to lift, pull or raise my arms above elbow height for the next two weeks. The drains were scheduled to be removed in ten days at her office. She told me she would notify me as soon as she received the pathology report, but it was really good news that the cancer had not infiltrated any lymph nodes, based on the preliminary results during surgery.  I tried to high five her but decided that probably wasn’t a good idea.

After Dr. Klimberg departed, one of the med students returned to my room with camera in hand.  I couldn’t imagine what he was planning to do.

“Dr. Klimberg sent me to take a photograph of your chest and her handiwork,” he explained.  I laughed as I opened my hospital gown for the photo. 

“Will my boobless, yet well preserved chest be featured in one of her medical books,” I asked the young student. “Maybe.  You never know with her,” he responded. After two clicks of the lens, the Dr. Klimberg wannabe quickly exited my room.

The RN entered my room and reported that Dr. Klimberg had signed my release orders.  I was shocked but thrilled that she was going to allow me to go home so soon; however, there was one stipulation. My blood sugar had to drop below 200 before I could leave the hospital.  The nurse gave me another 30 units of insulin to help me meet the goal.  All we had to do was wait.

By this time, Marion and Carolyn had arrived to relieve Don.  They were stunned that I was on the fast track for going home.  In anticipation of my departure, Carolyn helped me change out of my hospital gown into leggings that she had to pull up for me.  Obviously, I didn’t think about my limited arm movement when I packed.  I brought a tunic for the trip home; however, there was no way we could fasten it over the drain bottles and tubing.  I had to wear my short robe over the leggings.  I was ready to go as soon as the nurse rechecked my blood sugar.

Meanwhile, the CNA came into my room with a black apron very similar to a carpenter’s apron.  I couldn’t figure out its purpose. The CNA helped me stand up then tied the apron around me.  She placed the left drain bottle in the left front pocket of the apron and the right one in the right front pocket.  It was the perfect solution to a bulky problem.

It had been 90 minutes since I received the 30 units of insulin.  The nurse came in and checked my blood.  It was 130.  Yippee, I was going home and it was only 10:45.  There was already a wheelchair waiting for me.  Marion left to get his car and planned to pick me up in front of the loop-de-loop. Carolyn gathered my things and walked beside the wheelchair as the CNA took us to the front door.

Getting me into the car was challenging but the marisol pill given to me before my departure from the hospital made it a non-event. I felt nothing. The short drive home caused me to be slightly nauseous but the pill helped. All I wanted to do was get to my condo and deposit myself in my recliner…and eat a batch of brownies.  I had another case of the munchies.  When we arrived, I managed to maneuver myself out of the car and up the front steps.  I headed straight for my recliner. In my marisol and Percocet fog, I reflected on how many people it had taken to get me through chemotherapy, surgery, and now post-surgery recuperation. I thought to myself, it truly does take a village to cure cancer. It was the last thing I remembered for several hours.