S is for ‘Surgery’. Part One.

ˈsəːdʒ(ə)ri/

the treatment of injuries or disorders of the body by incision or manipulation, especially with instruments.

Picture the scene.  It’s about 6am on a Friday morning in early August.  The sun is shining, the sky is already a divine shade of blue and it’s going to be another glorious, sweltering day in the record-breaking heatwave that has taken London by surprise this year.  And I’m sitting on the bathroom floor, still soaking wet from the shower.  And crying.

Crying because in an hour’s time I’m going to be in hospital for my cancer surgery. Crying because it’s just hit me that I’m about to say goodbye to the way that I’ve looked since I hit puberty (give or take an extra pound or two, ahem).  Crying because one very intimate part of my anatomy is soon going to be wearing two massive scars and missing a whole hunk of meat.  I’ll never look the same way again.  Every time I look in the mirror, I’m going to see the marks that cancer has left.  I’m crying because I’m sad about that.  And angry.  Angry with myself.  If I’m honest more people have touched, poked and prodded my poor breasts in the previous 8 weeks than has probably happened in the previous 8 years.  And I’m starting to think I’ve rather short-changed them.  That my fun bags haven’t had much fun recently.  That maybe I should have been prouder of them, more content with them, less worried that they were somehow not sexy enough, shapely enough, big enough, pert enough.  Maybe I should have put them out on display a bit more because after today I’m not sure I, let alone anyone else, is going to want to bother with my bosom.

But there’s not much time for self-pity in the churning conveyor belt meat machine that is NHS day surgery, so by 7.10am I’m checked in and sitting in the rather grim and grubby waiting … corridor at the hospital.  Not even a room, just an actual corridor.  I’d been warned in advance that it was going to be a long day, that despite the 7am start I’d probably not be leaving until 8 or 9pm. And I’d naively been expecting to be assigned a bed where I could read, watch Netflix or knit while waiting to be called down to theatre.  But nope. Stained seats in an over-crowded corridor is what I, and my brother who’d gallantly volunteered to be my companion, got.

We rapidly discovered that day surgery isn’t all sitting around, thumb-twiddling though.  Oh no, there were some exciting interactions to be had.  First up, a quick meeting with my surgeon who double-checked I understood what was going to happen (boob, scalpel, hole, no cancer any more, right?), made an inappropriate joke about the age of the female anaesthetist (there is a whole other blog post coming about the inappropriateness of my surgeon) and drew an arrow in marker pen on my shoulder pointing at the offending boob.  I’m not sure whether it’s reassuring or terrifying that doctors use such crude large signals to point them in the right direction.  Probably best not to think about that too hard.

While we’re with the surgeon, let’s do a quick side-bar about the actual surgery I was about to have. The process is called variously, a lumpectomy, a wide local excision (WLE) or a therapeutic mammoplasty.  My op was snappily titled ‘round block therapeutic mammoplasty’.  This all means that the breast is cut open by removing a doughnut shape piece of skin around the areola.  The malignant tumour and some surrounding tissue is taken out through this hole and then the remaining breast tissue is rearranged to fill the gap and, hopefully, keep the breast looking well, breast like.  The wound is stitched up, leaving the scar around the areola.  I guess it’s sort of like taking a bite out of a ring doughnut then pushing the two ends back together to make a slightly smaller doughnut.  Boob doughnut.  Simples.

After the surgeon came a fleeting meeting with the anaethetist who didn’t seem to have a clue what op I was having and rather crassly asked ‘so what’s wrong with you?’, only to respond with ‘oh’ when I told her breast cancer. Still not sure if that was a test to see if I was compos mentis or if she genuinely hadn’t the foggiest who she was about to drug into oblivion.  I’d been looking forward to meeting the anaesthetist because all the pre-op paperwork I’d read said that if you were anxious about the operation, they were the person to tell as they might be able to help.  So I duly told her I was f**king terrified.  ‘We don’t do pre-meds’ she replied.  Door closed.  Patient still f**king terrified.

By now the day surgery process was starting to make me feel like an insignificant, anonymous piece of meat being casually passed from hand to hand through an impassive uncaring system and, much as I respect the hard work and life-saving skills of the NHS, right then it just felt heartless and cold.  What happened next proved me both right and wrong.

Three hours after we’d arrived, I, with my bro in tow, was sent off down to the ultrasound unit for some pre-op prep.  In order for the surgeon to find the right spot in my lump of bap flesh, they were going to insert a guide wire leading right to the tumour (see drawing above).  Afterwards I’d be walking around with the wire sticking out of me like an aerial and I was half-wondering whether I’d be able to pick up Radio 4.

Up until now I’d just about been holding my shit together, despite having a tornado of butterflies in my stomach and constantly wanting to vomit out of sheer fear. But that shit-holding-togetherness didn’t last.  I’d had ultrasounds on my breast during diagnosis and they’d been uncomfortable but brief.  But this one seemed to be dragging on and soon the radiologist was quietly muttering things to his colleague which included words such as ‘cyst’ and ‘haemotoma’ that to the half-naked woman with breast cancer on the table are utterly terrifying.  These two men stood over me, talked over me, as one pushed the ultrasound baton harder and harder into my chest, making me feel both invisible and a massive nuisance at the same time.  Eventually they gave up.  Nope, they said, we can’t see the tumour.  It happens sometimes, it’s hidden behind something.  Might be a cyst, might be a haemotoma.  Shrug.  We’re not sure.  The wire will have to be put in using a mammogram.  Just nip outside and we’ll get it set up.

So bewildered, frightened and bruised I staggered back outside into the corridor and promptly had an epic tidal wave of tears meltdown onto my unsuspecting brother. I was still heavily tear-stained when I was ushered into the mammogram room, crowded with about five female members of staff.  As soon as they saw my bleary wet face, they became the five sweetest women I’d ever met. One took charge of me, grabbed my hand and reassured me that everything would be ok, that they’d look after me and I wasn’t to worry as this happened sometimes and it didn’t mean anything bad. I was found a chair, complete with comfy pillow and a blanket to keep my shaking form warm as they set up the mammogram machine.  As they all moved around me doing mysterious things with computers and plastic slides, that one woman crouched by my side, held my hand and kept checking I was ok.  She stayed there throughout and I have never been so grateful to another human being as I was right then.  These women, in that grinding NHS mill of endless patients, carved out the time and found the compassion and humanity to offer me the comfort and reassurance I so desperately needed right then.

Once the mammogram was set up, my offending boob in place and sufficiently flattened, the radiologist returned and started the wire insertion.  The lovely woman holding my hand told me to shut my eyes and keep them shut until she said it was ok to open them again.  Chatting to me about anything she could think of to distract me from the tugging and pulling going on, she gripped my hand and I gripped back.  What felt like an age later, but was probably no more than five minutes, it was done.  The wire had been inserted and was taped to my shoulder.   I stupidly opened my eyes.  And promptly shut them again when I saw my blood-soaked boob.  My hand-holding saviour gently chided me for not listening to her instructions, wiped me clean, dressed the wound and gave me permission to open my eyes again.  God bless the women in that mammogram room.

So after that trauma, I was hardened to the next bit.  The bit I’d originally been dreading the most.  The nipple injection.  Yep, you read that right.  An injection. In your nipple.  They keep this bit quiet right up until the last moment, probably because it would send most women screaming from the room.  Jab a needle into my nip, I don’t think so matey. There is a scientific reason behind the torture as the injection is used for the Sentinel Node Biopsy during surgery. One of the biggest concerns about breast cancer, or any cancer, is that the cancer cells have moved into the lymph nodes.  If they have there’s then the possibility it will spread elsewhere in your body through the lymphatic system.  Which no-one wants.  So even if ultrasounds on the nodes in your breast and armpit show no obvious cancer involvement in those nodes (as in my case) the surgeon will still remove the sentinel lymph node (i.e., the first few nodes that a tumour might reach) to have it biopsied and checked. And in order to find that node they have to light it up.  So off you pop to the ‘nuclear medicine’ department, step over the scary black and yellow tape marking the radioactive area only patients can enter, take a seat in a massive reclining chair and a woman sticks a needle in your nip. Wham, bam, injected with radioactive liquid, thank you ma’am.

That was it, done.  Probably the best part of my day to be honest.  Painless, quick and not a mark left on me.  Later during the operation itself, the surgeon also adds a coloured dye to drain through the lymph nodes with the radioactive liquid and show up those sentinels.  The dye is blue.  It stains. So after surgery you’re not only bruised, sore and exhausted but you also have a massive Smurf boob.  And blue wee.  For days.  Then eventually green poop.  I still have small patches of blue boob now, 10 weeks after surgery.  Breast cancer, the gift that keeps on giving.

But I’ve already given you too much.  Probably enough to fuel nightmares for weeks.  So that’s where I’m going to leave you for now folks, as I’m seated back in the grim day surgery corridor, waiting.  With my radioactive, wired-for-sound boob.

There are more delights to come, so stay tuned for ‘S is for Surgery Part 2’ with its promises of natty NHS attire, reluctant recovery and vomity lemon squash.