The work of my surgeon is amazing. First class. He has done a superb job of rearranging the front of my body. Effectively I’ve had a huge skin transplant on the front of my torso involving a right mastectomy and then the relocation of large flaps of skin followed by intricate microsurgery where they have reattached blood vessels by cutting into my ribs to give the new skin (breasts) the blood supply.
The surgery went into well over 12 hours as the flaps failed during the surgery.
It was a lot worse than I expected, a lot, lot worse.
The technical term for the procedure I was a prophylactic mastectomy followed by bi-lateral DIEP flap reconstruction.
I checked into hospital the night before and I was in a bubble of calmness. This stayed with me as the anesthetist and surgeon came to see me. My Consultant drew all over the front of my body and kindly explained that I was having three surgeries, which would probably have three different surgeons. He took photographs and said he would see me in surgery. I asked if they would carry out pathology on the right breast and he confirmed they would.
The anesthetist then came and I explained to her that I completely understood the huge importance of her role in keeping me alive during surgery and also managing my pain relief. I was concerned that I would be sick when waking up as this had happened first time around. She was taken aback at my show of appreciation as she said most patients undervalue the anesthetist role – I certainly didn’t. A solid connection was formed.
So they put on my calf socks to prevent blood clots and also gave me an injection anti blood clotting drug. I then walked down to theatre with a nurse. I was still feeling very calm. I put this down to all the friends and family who we’re sending me positive vibes as well as the visualisation and relaxation techniques I’ve used.
I walked into the theatre and there were at least 10 people stood around. The Consultant encouraged me to come in and explained that they were discussing my procedure. Then my wonderful anesthetist explained what was going to happen. They started to attach all the stickers to my back to monitor me throughout surgery. They would be putting a large grey cannula in my right hand as well as a spare cannula in the left hand. I would also have a blood pressure monitor on the left wrist, which would leave a lot of bruising. She explained that when I woke up I would be hooked up to a morphine pump that I could self administer and she would ensure there were plenty of anti sickness drugs in there.
The cannulas were in and she gave me the anesthetic. Throughout all of this I was calm and serene unlike in the past where I’ve been fearful and cried. So I thank everyone for their positive thoughts and prayers – they really worked.
Next thing….I woke up. Groggy and I was in the ward (PCU – Progressive care unit) there was a nurse moving me around and getting me comfortable. I vaguely remember her telling me that they had had to send my husband away as I had been in surgery longer than anticipated. I then drifted in and out of consciousness for the next few hours. I slowly figured out that I had an oxygen pipe into my nose, four drains in, two out of groin and one out of each breast. I also had the blood pressure cuff permanently attached to my right arm and out of my left side there was the catheter. Behind me on my left side was the machine monitors all of my vitals. Every hour the nurse would check all my vitals and then place a Doppler machine on three points on my new breasts to monitor the blood flow into the flaps. The wounds weren’t bandaged just a steristrip across so they could get access and I could see all the bruising and scabs. The wound across my abdomen gave me pain. I was placed in a zigzag position on the bed with my knees elevated towards my chest (this is to protect the abdominal wound). I was upright with a heated blanket across my chest and abdomen (it was heated with continuously pumped hot air). On my calf not only did I have the socks on but also there were pads filled with air to provide pressure and massage the calf’s to prevent blood clots. Every day I would receive a huge syringe of antibiotic as well as the anti clotting injection.
Tuesday was a haze and I received very good one to one nursing care for most of the day. Austen visited. I don’t remember much about the visit other than I was comfortable (ish). The consultant visited and told me to take big breath every hour and to try and cough. As I had been under general anesthetic for so long I need to reeducate my lungs but also clear any fluid. I tried to do this but it was extremely painful – also the zigzag position in my bed wasn’t conducive to coughing.
A critically ill lady was also brought onto the ward; she had had a stroke as well as a tracheotomy. Hearing that poor lady clear out her tracheotomy as well as all the bleeps and sounds, the drains, the whooshing of the heated blanket, the hourly prodding and poking was all too much.
I woke at 2am in a panic, there was fluid on my lungs and I couldn’t clear it. I couldn’t get my breath. I tried to sit up and shouted to the nurses for help. Those poor nurses (a little about nurses later). I explained that I needed everything off and out – I had to breath. I thought I was going to die. I have never in my life experienced this feeling. It was utter desolation. I honesty thought this was it and I wasn’t ready to die. I couldn’t get air into my lungs, or enough air into my lungs.
At this stage I had a bright red face as the heated blanket had really heated me up. The nurses were wonderful. They very calmly explained what was happening, why I needed the oxygen pipes in my nose (because the morphine can suppress breathing). Why I was in the zigzag position, why I had the heated blanket on, why I had the pumps on my calfs, why I needed to cough. Any case they slowly took everything off me and got me some ice so I could cool down, they sat me as upright as I could get so I could attempt to cough the fluid up. I was panicky as there appeared to be blood coming out of my mouth as well as my nose but apparently this was all normal. They took the heated blanket away and gently took the pumps and socks off my legs. I calmed down and managed to cough the horrible stuff off my lungs.
Finally I felt as I could take a deep (but very painful) breath. Bless those wonderful nurses. I then made the decision not to use the morphine, as I didn’t want the oxygen mask on.
As if that wasn’t enough drama…..so I’m sat without the oxygen, morphine and blankets on and then I start to feel nausea (I have discovered that my bodies immediate reaction to pain is to vomit). As I had stopped the morphine the pain was increasing so the nurse gave me a strong anti-sickness injection. And that’s when the next stage of drama happened. My resting heart rate kept jumping to 176, when they were checking the flaps with the Doppler my blood was racing through. I tried everything to slow my heart down. I could breath now so I wasn’t panicking. The on-call Doctor came and talked through my symptoms – effectively telling me it was all normal and really to try and calm down.
My heart carried on racing. Despite this I was happy that I could now take a breath so I slowly put all the equipment back. I didn’t get any sleep.
The next day my consultant came and checked up. They agreed to do an ECG and keep me under observation until my heart settled. Therefore I would stay on the PCU ward. The also agreed to slowly start and detach me from the all the equipment. I could have one of my drains out as well as come off the morphine and oxygen. My goal with the physio for the day was to try and sit on a chair.
I had no idea how incapacitated I would be after this operation.
Every hour I had a doctor check on me and monitor my heart. It eventually calmed down.
The physio came and with the help of a nurse, we slowly negotiated how to swivel out of the bed and then to standing. I couldn’t stand fully erect (and still can’t really) because if the abdominal wound. Then from standing I had to slowly sit. Success! I could sit!
Now the nurses changed shifts regularly and this was a different nurse with a different demeanor. My goal was to sit for 20 minutes. 40 had passed and I asked the nurse if I could please get back into bed as I was starting to get waves of nausea. “I’ll be with you in a minute Lovie” – she wasn’t and so I vomited – a lot! Can you imagine the pain searing through me as my torso contracted to throw up, I felt as it I had tore open all my wounds. That prompted the “Lovie” nurse to help me back into bed with a hefty does of anti-sickness.
I then spent the rest of the day resting whilst I waited for my first drain to be removed. It was the left breast drain. The student nurse assured me that she had removed a lot and to be fair she did a good job, it was relatively painless and it was a relief to have one less pipe connected to my body.
That night I slept well as I had been moved off hourly observations to three hourly.
The following morning my goal was to walk a few steps and then I would move off the PCU ward onto the normal ward. I was able to do that and had another drain removed! On to the normal ward!
Over the next few days I had all the other pipes gradually removed. I managed to take a few more steps every day. I also managed to get some well-needed rest.
The body’s ability to heal is amazing. Over those next three days I astounded myself with what I could achieve. I could get in and out of the bed myself; I could walk up and down the corridor.
Thomas visited every day on the normal ward and completely charmed the nursing staff. The vulnerability in his little face the first time he saw me broke my heart and what made it worse is that we couldn’t have a huge all encompassing squash able hug – he tentatively put his little arms around my neck, kissed me and then we rubbed cheeks. He is a strong little soul Thomas and he has definitely been here before. He was full of questions “what was the tube sticking out of my arm” (cannula)” why couldn’t mammy stand straight” (big cut in mammy’s tummy that will get better”) he also didn’t hesitate in peeling down my gown to look at my “new boobs” “they’re a bit dirty mammy” (covered in bruises and scabs).
Saturday I was allowed home and what a joy it was to walk through my door.
Now I hope I managed to hold your attention this long, I thought it was important to capture some of those details.
What I have learnt throughout all of this: –
This was a mistake. I woke and realised with a dawning horror the magnitude of what I had done to my poor poor body. I shouldn’t have gone for such huge surgery. I should have just had the right mastectomy and maybe considered reconstruction later. I was staggered with disbelief as what I had chosen to do to my body.
As I have spent the last eighteen months caring and nurturing for my body through chemo, surgery and on-going Herceptin I have increased my sensitivity. This means that I felt everything done to me on a different intense level. I don’t know if this makes sense but in the past I would jump back into action quite quickly. That isn’t going to happen this time. I have to take time to heal. I have huge deep wounds all over the front of my body, which makes mobility difficult. I have to be gentle with myself and allow myself the time to heal.
My bodies reaction to pain is to vomit and cry. When I am weak with the pain my tolerance is zero and I tend to cry. Luckily I’m over the nausea as I’m managing my pain more effectively. Mornings are the worst as I wake in acute raw pain and it takes a good hour for the painkillers to numb it.
I have an amazing support network. From family to friends and the wider community. I am not doing this myself; I have an amazing group of souls around me. Words aren’t enough to express gratitude. I have a bedroom full of flowers, cards and toddler artwork. The prayers, positive thoughts and vibes that have been sent my way definitely help. Thank you.
This has been the hardest part. I know we quickly dismiss pain and our minds negate the effect of the words “you’ve got cancer” otherwise we wouldn’t be able to function. But this has been awful. This has been the hardest part, as I couldn’t rationalise in my mind how I could have CHOSEN to do this to my body. There is no cancer in my body; I have done this as a preventative measure. If I hadn’t removed my right breast there is a good chance the cancer would come back.
The next stage is to remove my ovaries. I want a break from surgery but that will be keyhole and at some later date in the year.
As for now, I can walk a little and the wounds are healing. I wake in the morning in acute pain but then I can manage it through the day. My abdominal wound is the worst. I have to be careful with my painkillers as one of them is giving me nightmares.
Slowly I am starting to forgive myself and heal at the same time.