My surgery buddy picked me up at 5:45 am. I’d not had anything to eat or drink since 10pm the night before, as instructed. Not that I could have eaten anything due to nerves, but I was thirsty.
The first thing I had on my list of pre-op instructions was to get my radioactive tracer shot. This was so they could find my sentinel lymph nodes. I was learning more about my body parts and how they all worked than I ever really wanted to know. But it turns out that everyone’s lymph nodes are in slightly different spots. So, they shoot you full of radioactive tracer and then use a geiger counter (literally) to find exactly where yours are.
There’s a little sign in the clinic waiting room saying that if you are going to the border within three days, they will give you a letter stating you’ve had this shot. Apparently, if you do go near the border, you set off the nuclear warning alarms. A friend told me a work colleague’s husband had a radioactive dye shot and then they went to cross the border (in their car) the next day and the warning gates all dropped down – shazam – just like that. I don’t know how true that is, but it was interesting and seemed verifiable given the note on the wall.
Now, with my radioactive dye shot out of the way (took 3 seconds and before I could say I was ready, it was already all over – didn’t even feel the needle going right in my nipple), we headed down to the day surgery check in. Yes, it’s DAY SURGERY. Even mastectomies, apparently, are done as day surgery.
My lumpectomy was scheduled for 10:30 am, and was expected to take less than an hour. I was told I’d be in the hospital less than eight hours total – so from my 6:30 am start I expected to be out by 2:30 pm at the latest.
You have more forms to fill out at day surgery. (Don’t get me started. This is for sure one of the patient experience areas that needs close attention.) Then you get changed, and put your clothes in a locker that gets locked. Now you sit in the waiting room, in your surgical blue gown, waiting. Having a buddy with you is important if for no other reason than to distract you from thinking about what’s coming. Mind you, you’re there with all the other patients for day surgery – from every walk of life dealing with every body part. Some are there for obvious, visible reasons. Others, like me, have no visible evidence of their reason for being there.
When your surgery is booked, you get a bunch of papers with instructions. One is don’t eat or drink after midnight (I was having a general anaesthetic because of the lymph node removal). There are others, including the type of clothes to bring and making sure someone is there to take you home. The pre-surgery guides are pretty good, in my experience – they covered what you would experience during your operation. The post-guides we’ll cover later.
You Are Your Own Best Advocate
As part of my preparation, I made a sign on bright lime green paper that said “THIS SIDE” with an arrow pointing to the left, and in smaller letters “not that I’m paranoid or anything”. My right breast was still black and blue, and I wanted no mistakes made. Once I got wheeled in to the surgery prep clinic, I put my sign on my chest. Yes, it’s funny – and the clinicians all thought so – but it served a purpose. You are your own best advocate. We’ve all heard/read about the horror stories of the wrong body part being operated on. It’s extremely rare, but it does happen. Right up until you are put under, it doesn’t hurt to have the last words out of your mouth be “it’s my left side”. My surgeon laughed out loud and took a pic for her students at the university she teaches at (with my permission).
Because I was having a Sentinel Node Biopsy as well as a lumpectomy, I’d been informed of the risks. They gave me the radioactive tracer to find the nodes, but I’d also be getting a blue dye. The two work together to show the surgeon which nodes in the group that drains the area closest to the tumour are the first three in the chain. Hence the term ‘sentinel’. They use the geiger counter to find the group of nodes, then a blue dye is shot into the area close to the tumour. They watch the node group to see which of the nodes light up first with the blue dye – noting the first, second, and third. Those are the three they take to biopsy to see if any of the cancer cells from the tumour have made it into the lymph system.
In the pre-surgery orientation, you are told about the risks of lymph node removal, the dye and the radioactive tracer. They warn you that sometimes, in rare circumstances, the blue dye doesn’t show up in the nodes. In that case, they would take them all, I was told – as a preventive measure against the chance that cancer could have gotten there. If they took more than three, a drain would likely be used and you’d wake up with a tube coming out of your armpit, that you’d have to keep track of and empty daily, reporting the measurements to your surgeon until it got to the point where it could be removed. I really didn’t want that drain.
When you come out of surgery, they put you in Post Anaesthetic Recovery (PAR, or sometimes called PACU – post anaesthetic care unit). The first question I asked when I came to was if I had a drain. No. Whew. I glanced at the clock – 11:35 am, so right on time. Still hooked up to all kinds of monitors, but no drain. So far so good.
I was sure I was totally coherent and aware at 11:35 am. I remembered my surgeon, head OR nurse and anaesthetist coming by and chatting with them. I know we had an intelligent conversation. I just don’t recall to this day what it was. I remember the anaesthetist coming by a second time to check on me – and me saying “oh, look, it’s my new BFF”. Anyone who makes sure I am not nauseous after an anaesthetic gets on my lifetime holiday card list. After my hip operation (the only operation I’d had since my tonsils came out at age 3), I puked my guts out for three days, despite the anti-emitics. Whatever formula they used then did not agree with me. Compounded by the morphine they gave for pain. After three days I said no more and stopped all drugs. They really don’t want you to feel pain, but I said I’d rather feel it than throw up one more time. I will never be a drug addict, that’s for sure. (And, fortunately, there was no pain. I never took even an aspirin.) So, my lumpectomy anaesthetist was my hero.
LET ME OUTTA HERE
The criteria for getting out of PAR/PACU II (your vitals are stable and the anaesthetic has worn off so you move to second stage recovery) is that you have to be able to stand on your own and pee. Pee? Really??? I said to the nurse that I felt that was potentially an unfair requirement. Not having any liquid pass my lips since 10 pm the night before (and having had the last nervous pee before they wheeled me in to the OR) meant I had nothing to pee out. She looked me straight in the eye, and pointed silently to the IV in my arm, then the nearly empty saline bag hanging above it. Note to self – my powers of observation might not be up to snuff yet. I’d been confident the moment before that I could stand on my own. Now, doubt crept in. Whatever – nothing ventured, nothing gained.
I swung my legs over the side. She brought the IV pole over and had me hang on to it. I stood up. No wobblies. Ok, I can do this. I started the slow walk to the toilet, pushing my IV pole. So far so good. As I went in, she said “don’t forget, you’ll likely pee blue”. Right, the dye.
What she should have said is ‘you’ll pee Tidy Bowl blue’. It’s not just any old blue. As I finished peeing – yes, I had enough liquid in me to manage the task – I looked down. It looked as though someone had put toilet bowl cleaner in the bowl and not flushed. Bright neon blue. And, as a friend later pointed out, it might have even glowed in the dark, given the radioactive tracer I’d received earlier that morning.
At that point, I didn’t care what colour my pee was. I’d passed the two criteria – walking on my own and peeing. Freedom – I was outta there. Seven hours from start to finish.
My surgery buddy and I went to lunch.