Wednesday, September 15, 2010

Surgery - part one

Breast cancer is typically treated with some combination of chemotherapy, radiation and surgery. The order in which these treatments are given will depend on the type of cancer you have. For my big tumour, my medical oncologist decided to start with chemo. The idea was, let's shrink it before we start cutting; that way we'll have a better chance of getting all the cancer cells.

And it worked. The chemo took my 8 cm tumour down to something so small my oncologist could no longer feel it. So, then my options were radiation and surgery. My radiation oncologist told me I could choose the order, but I should do both quickly. If my surgeon wasn't going to be able to remove my breast by early February (chemo finished near the end of December), I should get going on radiation. She was pretty confident that he wouldn't be able to (I mean, come on - who can just phone a surgeon and get him to squeeze in a modified radical mastectomy in a month...and at Christmas time).  Well, (turns out I can!) my surgeon said no problem and scheduled me for the beginning of February.

I'll tell you something about my surgeon - the only time I have ever seen him not smiling was the day he told me I had cancer. He didn't smile once during the whole visit. The look on his face as he cleared the door told me everything I needed to know. The words, "You have cancer," were an unnecessary punch to the gut, punctuated by the clicking of the exam room door. But, there is a nice thing about having a doctor with a really crappy poker face - if he's smiling, he isn't worried. So when Jon and I sat in his office discussing my upcoming surgery, his smiling face was a welcome relief. "Will I have loss of range of motion?" "No, but you will probably have some numbness that won't go away." "How long is my hospital stay?" "No stay - you'll go home the same day."  "How long is my recovery?" "Very quick. We want you to start using your arm as quickly as possible to help speed recovery along." "How many lymph nodes will you take." "A bunch. But I'll try to leave as many behind as I can." Oh. OK. This is pretty straightforward stuff then.

The reality check came from my radiation oncologist. When I brought up my surgeon's sunny outlook about my mastectomy, she looked me straight in the eyes and said, "It's going to be really tough. You are going to wake up, already bald but now missing a breast." And that's what I needed to hear. While the procedure would be straightforward, the results of it would not be.

Having a mastectomy is more than just the process of removing some flesh and some lymph nodes. We have an attachment (no pun intended) to our breasts. From a very early age, they define us in society. They are part of how we define ourselves, as women, as mothers. What will it feel like to not have that breast? What will I see when I look down? And I had weeks to think about it. Weeks of trying to imagine what the new reality would be. Soon after my cancer diagnosis, if I had been told it would save my life, I would have voluntarily had both breasts removed right then. But months later, when the panic and urgency have subsided, it felt absolutely surreal that I would be voluntarily walking into the hospital to have my breast removed.

So, with Jon's help, and with support from my friends and family, I just prepared. I thought about it. I talked about it. And I focused on the reason I was doing it. While I wanted to hold onto my body the way it was, I wanted my kids to have a mom more.

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