Friday, January 30, 2009

How Medicine Made me a Hot Babe--the nuclear medicine portion of our program

Wow, sorry about that long post yesterday. Apparently I needed to vent all that. And now you probably need some of my Vicodin just from trying to read it. I'll see if I can be more precise. Or funnier. Or just less gory.

When we last met, I was just about to go into surgery...well, surgery day. We were up at 5:30 and while there is no point to make-up and dressing nicely, I did shower and do my hair (since I wouldn't be able to do either for another 48 hours) and I donned the pink sweat-sort-of-suit. We dutifully reported in to the surgery center at 7 a.m. So did about 173 other people. Wow. And apparently it was half-off surgery for children day because they were lined up out the door. And crying. Children cry when confronted with surgery. I cry when confronted with 7a.m. and no Starbucks. It was not a pretty, nor quiet, scene.

After they one by one took pretty much everbody else back to surgery and Chris and I were still stashed in the corner (shaking, crying and promising we'd never, ever have children), I had to remind the front desk lady that I was expected down in nuclear medicine at 7:30 (it was 7:35). She said "for what?" Ummmm...aren't you guys supposed to know that? I kid you not, I got the "I'm new at this" response. Eventually a nurse came and got me and then another nurse took us down to nuclear medicine. Which is every bit as scary as it sounds. So scary they stash it away at the bottom of the 'North tower' and you have to take a secret elevator to get there. You'll know you are there by the arctic temperatures that accost you upon entry.

Two other things happened when we entered. A lab coat wearing man, we'll call him Larry (because that was his name) entered and the receptionist said "we have a such-and-such brain serious major procedure today" (I'm paraphrasing) and he said "Really? I haven't done one of those in 20 years." Comforting huh? Please god, do not let me find out my brain is in my right breast.

Also in the waiting room was a somewhat swarthy looking man in his early 40s, unshaved and wearing a leather jacket and boots, and next to him was a woman who looked like "mom"--just not his mom. Mom like Mrs. Cunningham, or June Cleaver, or any of those moms who did not have swarthy looking sons. They took swarthy back into the treatment rooms and five minutes later a tech comes out and says to mom "Mrs. Jones? Your son-in-law would like you to be with him for the procedure." Mom smiled sweetly (and knowingly) and got up and went back. Really? Who does that? His mother in law??? And where was his wife? I'm really hoping this had nothing to do with his prostate.

Then it was my turn and oh yeah, Chris came back with me. We were greeted by "not in 20 years" Larry. Larry was quite chipper (he likes inflicting pain, it's just obvious) and he says to me, "So you understand why you're here and what we're doing?" I, who haven't had Starbucks, said "um, yeah, kinda...I just know it's painless." And he laughed at me. Full on laughed in my face. I stopped dead in my tracks. He said "Oh, come on. It's four injections. It's going to hurt. There's going to be pain." BWAHHAHAHAH!! Thanks, Larry. This was the part where they were injecting radioactive material into my breast to find the sentinel node. I don't know how I got the rest of the way down the hall into the treatment room. Once there I was happy to find that Larry the Ass was not the doctor. Larry is not even a doctor. The doctor was a young woman (of course she was young), Dr. Tabib, and far, far kinder.

I will describe what was about to happen by medical terms, courtesy of John Link, M.D. and his book "Breast Cancer Survival Manual" (which I read cover to cover yesterday):

"Doctors use the radioactive tracer as follows: They inject it in and around the cancerous area (or under the nipple) at the time of the initial cancer surgery. ...In the operating room using a portable Geiger counter known as a gamma probe, the surgical team identifies the first draining node and removes it following the removal of the primary cancer. The pathologist then analyzes the node using a technique called frozen sectioning. He freezes the node by using liquid nitrogen and then cuts the tissue into thin slices and views them under the microscope. If he sees no cancer, no further surgery is performed."

So, I had four injections around the cancerous area. And I guess, again, where mine is located is somewhat fortunate for these parts. 3 out of 4 of the injections weren't really much. But the one closest to the nipple...yeah, um... ow. Not off the charts, and certainly tolerable, but Ow. Enough to make me bite my lip. Did I mention that Larry is an ass?

Then we had two hours to kill while the radioactive material is finding its way through my breast (no, I couldn't feel anything) before I was to return for "pictures." We chose not to hang out in the arctic zone. Instead we delivered my health care directive and HIPAA release to patient services (I'm still being a lawyer) and then sat in a sunny window reading. I was reading David Sedaris's "When You Are Engulfed in Flames" and Chris was reading "Then we Came to the End." Perhaps we should have thought about our selections ahead of time.

We returned to nucler medicine and waited for "pictures." At least they gave us blankets this time. When they came to take me back this time there were other patients around--they do bone and brain scans and all sorts of "man you are really sick" stuff, and again, I'm squeamish. There was an old guy on a gurney in the hallway asleep (please god, he was just sleeping) who was just skin and bones, with his mouth open and his body contorted. Yeah, that eliminates any possible feeling bad for myself I could have mustered. (And why do they always leave someone on a gurney in the hallway??)

The "pictures" turned out to be not as simple as you would think. I was picturing a quick little x-ray and I"m gone. Not so fast. Again, I had to lay down and then this panel comes down on top of me (they ask again "are you at all claustrophobic?" so that gives you an idea how close the panel gets). And they take two "pictures" that take five minutes each. The tech points out on the screen what they are doing. So I turned my head to see the screen. As I'm waiting out the five minutes I noticed that there were actually 3 screens. The one he pointed to, a much bigger one in the middle and then one in my periphery vision that I can barely see. But the big one in the middle, while difficult to see, is scary looking. It's got a lot of red, some yellow, some pink, and a big ol' scary looking jagged-edge black spot in the middle. Wow. I've seen lots of scary pictures of my cancer but that one was the worst. Probably because of the red everywhere, and it was obviously extremely close up since they were looking for a little tiny lymph node, but that one was freaking me out a little. I kept trying to figure out where this famous lymph node was on the screen amidst all that pulsating blood. Finally I decided I just couldn't look at that screen anymore and I went back to the perfectly harmless looking black and white screen he had told me to look at. It had a nice little countdown clock on it too and that helped.

Eventually, the pictures were done and he said "good job. We found the node. I'm just going to mark it on you." Which they do. He drew on my underarm to pinpoint the node for the surgeon. Then they said I could sit up , so I did. And there in front of me was the scary, frightening, big computer screen....with a beautiful red, yellow and pink sunset and the black silhouette of a palm tree sticking up in the middle of it. The words "Polynesian Spa Music" were written across the top. But in my defense, I couldn't see that from my position under the panel!! (Louise, if you are reading this--you have to be reminded of the glass dancing booths at this point). It's possible I was nervous. But Chris got a big kick out of my story when I came back out. I blame Larry.

Seriously, squint sideways at this.... you can see cancer can't you??

Alright, back up to surgery we went. With my pictures in hand and a notebook full of medical info on me (which the nurse gave to Chris originally and made him swear under penalty of death he would return to her when we got back to the surgery center). Oh, and I had to go in a wheelchair...because of the whole "I see cancer in the sunset" thing, I'm sure.

Surgery is a giant blur to me. I remember this much: the anesthesia nurse was Steve and he was very kind and good at what he does (and was the first voice I heard when I woke up, which also let me know I was still in the surgery center and not in the hospital, which meant good news on the lymph node thing, at least in my mind). The other anesthesia nurse (apparently there to supervise Steve) was an attractive woman with a really cute, colorful surgical hat--until I noticed it was images of coffee and said "latte" "coffee" and other such words all over it, which is just cruel to me in my then state. She was concerned I might rip it off her head when the anesthesia kicked in and I lost the last two inhibitions I had left. Apparently, I did not. But I don't know because I never saw her or her hat again.

Oh, and the infamous blue dye shot straight to the nipple? Yeah, I had it, but I don't remember it. Dr. Karam assures me that I felt it because I "tried to help"--which is to say I tried to knock it away. And I was out of it. It's just crazy that they do that to some women without anesthesia. Other things to note--the blue is not indigo blue. I thought it would be like ink. It's not. It's more of a dark turquoise color. Sort of pretty. Just not, you know, for a breast. It's already faded away however. I think. There may be something there under the bandages, but I can't tell at this point.

So that was surgery day. You know the rest of surgery/ recovery day (or can scroll way, way, way down or click on the Archives for the "A Very Big Breast Day" posting to read it). Now we just wait to hear if Dr. Karam got clean margins around the tumor (i.e. no cancer cells at the edges, which means he got it all and no further surgery is necessary).

I go back to see Dr. Karam next week and at the same time will meet with a medical oncologist about the chemotherapy and treatment options. I've now heard and read enough to know that my best chance of not having a recurrence of cancer is indeed the chemo and radiation. My kind of cancer and my "test" scores indicate a high chance of recurrence (I have no idea the actual percentage--my own guess from the reading is 20-25%; I assume they'll tell me this in the next meeting). So even if Dr. Karam got all of this tumor, there is still the chance that there are some dastardly cancer cells still on the loose and ready to wreak havoc. They must be stopped.

Today I'm going to enjoy a leisurely day off. There will be sleeping, reading, and probably a phone call or twenty. Or maybe I'll start planning our Christmas/ Jimmy Buffet's birthday trip to Maui now. Since, you know, I've got tropical sunsets on my mind.... Aloha.


  1. Dear Theresa,
    It's wonderful to read your blog. I love your writing and your way of making fun. Humour is the best way to fill days and hearts ! And you are particuly good at that.
    Thanks for your help. I had a devastating day and you saved it with your ... breast ! Excellent. Wish you plenty of good wines to celebrate each step to recovery.

  2. Raphael,
    You're French...don't breasts save every day for you?
    We need to get more of your rose' wine over here--pink being the official "breast cancer awareness" color! I'm sure it's the cure I need.
    Thanks for your thoughts,

  3. yeah for the good guys ;)


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