S is for ‘Surgery’. Part Two.

ˈsəːdʒ(ə)ri/

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

So by the end of ‘S is for Surgery Part 1’ I’d cried, waited, been prodded and ignored, cried a bit more, been soothed by angel-like nurses, then been stabbed in the nipple.  As we rejoin my journey, after all the excitement of mammogram-wire-insertion-gate and radioactive-super-boob–injection, it was something of a relief to return to the grim corridor of day surgery to do a bit more waiting.

There was a brief interlude of excitement as I was whisked off by a nurse to get gowned up.  This basically consists of being shoved in a rather grotty locker room with a single plastic chair and one of those wheely curtain things, behind which you have to undress and clad yourself in this year’s Spring-Summer NHS surgical catwalk kit. This includes the NHS gown of humiliation (guaranteed to expose at least part of your anatomy to someone who isn’t supposed to see it), the compression socks of shame (slightly chunky calves? Don’t worry they’ll squish upwards and spill out over the top) and the disposable underpants of doom (the least said about these the better).  My own bag was pushed into a locker (locker no. 999, seemed appropriate) and then …. more waiting.

Waiting for something you don’t really want to happen is painful – you’re dreading your name being called out but the longer it isn’t, the worse the dread becomes. Nice Catch 22.  My personal Catch lasted nearly two hours, until at 1pm, after being at the hospital for 6 hours, my name was finally called.  My turn.

After a quick hug with my brother, while trying to stifle the tears of fear, the nurse walked me off to theatre.  None of the TV and film glamour of being wheeled off on a bed pushed by sympathetic porters.  Nope. NHS day surgery means it’s Shank’s pony, shod only in compression socks and non-slip slipper socks, all the way to the theatre.  They even make you carry your own pillow, to which your locker key has been pinned. The anally retentive part of my brain was shrieking ‘none of this seems remotely hygienic or sterile!’

A quick stroll and my surgeon was waiting just outside the theatre.  Nice, I thought, here to offer me words of reassurance and compassion before the scariest moment of my life.  Oh no, not him.  ‘Why are you late? You’re very late.  You’ve made my entire list for the day late now’.  What the chuffing hell?  I’ve been sitting in the day surgery corridor of gloom for the past two hours.  It’s not my f**king fault if someone else didn’t do their job properly and that’s no way to speak to your terrified patient.  I had decided at this point that I really didn’t like this man but as he was about to cut a massive hole in my chest cushion now didn’t seem like the appropriate time to tell him so.

It was on to the anaesthetist’s ante-room, and finally onto a trolley.  After lots of double-checking that they’d got the right person and the right boob, there was a bit of reassuring chat from the anaesthetist, a needle in the back of my hand and then …. nothing.  I didn’t even get to do the ‘count backwards from 10’ spiel.  Don’t the NHS watch any TV?  That always happens.  Or, as I heard from a friend, someone had been asked to say the name of some celebrity they fancied and hadn’t even had time to get to the end of ‘Benedict Cumberbatch’ before they were spark out.  I didn’t get any of that.  I just went from wide awake to out cold, and then, what felt like immediately, being groggy and waking up in recovery.  As someone who’d never had a general anaesthetic before I can say it is the weirdest feeling ever.  There’s no slow losing of consciousness, no dropping off to sleep, it’s just like a jump cut from one scene in the movie to the next, with no concept of what happened in between.  Although that’s probably for the best.

For me the waking up in recovery process was pretty reluctant.  I was in pain the moment I came round and refused to open my eyes and even consider thinking about waking up properly until they’d given me a couple more doses of pain killer.  Whatever shit it is they peddle in recovery, it’s pretty good shit.  But before long, I was dragging those eyelids open, realizing that the pain was dissipating and that although I felt a bit queasy (more meds please nurse) I was not doing too badly.   And as soon as they see that, you’re whisked back off upstairs to the day surgery ward (at least this time they wheel you up on a bed) and are being offered tea and a sandwich.  Markers of being ready to leave after day surgery are having drunk something, eaten something and peed something (preferably not the bed).

As I don’t drink caffeine and didn’t think the NHS catering would stretch to Rooibos, I asked for juice but they didn’t run to that either so I was offered lemon squash.  Yes please, and I don’t really want a sandwich but yes toast would be nice thank you very much.  Turns out I’m a difficult patient, at least in my catering choices.  By now my brother had joined me and we were just chatting, posing for the obligatory post-op selfie (don’t judge) and I was starting to feel so much better.  The lemon squash was weird though.  Didn’t taste right.  Tasted vomity I said.  It can’t be, my brother said, and took a sip.  No, that’s fine.  Weird, maybe my bad boob was somehow wired to my taste buds?   But not to worry, I had a polo mint and a quick walk around the room. This proved over-enthusiastic and I was immediately overcome by a wave of nausea again so it was back to bed. Apparently general anaesthetic and I don’t really agree.  Which, as we later discovered, explains the vomity lemon squash. It turns out that I’d been rather sick in recovery while initially waking up (something I have no recollection of whatsoever).  So it wasn’t the squash that was vomity, it was my mouth.  Lovely.

And then it was all over.  I was discharged and packed off home.  With a bag full of paracetomol and ibuprofen and some confusing mixed messages about wound care. According to surgeon-who-shall-not-be-named, it was ‘just be normal, shower as you usually would and if the dressings fall off it’s fine’.  According to nurse, it was ‘be careful, don’t get the dressing or wound too wet’.  I was soon to find out who was right.  Can you guess?

So home I headed.  With a slightly deflated boob which didn’t enjoy being bounced over speed bumps by our boy-racer taxi driver and which I was too scared to even look at.   After this sort of surgery, you’re dispatched with more than just physical scars to deal with.  Emotional ones need to be addressed too and I very quickly realized that recovery was going to be more than just a biological one.  What I didn’t realise as I left hospital that day was that my treatment wasn’t going to be quite as simple as the ‘1-2-3’ that the doctors had originally laid out (see U is for ‘Understanding’).

To cut a long story short, 10 days after that first surgery, I was told that although it had successfully removed the invasive tumour, they had not achieved ‘clear margins’.  This means that when they cut out the tumour, they also cut out an extra ‘margin’ of tissue around it.  The tissue is then tested and if the pathology results show no other cancer cells in this sample, then it is considered a success.  Unfortunately for me, my margins still included some of the DCIS (non-invasive, pre-cancer cells).  And unfortunately for me, that meant a second operation.  This came as a huge shock.  No-one had warned me that this was even a possibility.  I’d been reassured by my wonderful (not) surgeon that the lumpectomy would do the job, I’d be recovered in 6 weeks, ready for 3 weeks of radiotherapy and all done and dusted before Christmas.  That turned out to be far from the truth.

So, only four weeks after my very first surgical procedure, I was back at the NHS day surgery for a second one.  Known as a re-excision, or cavity shave (which sounds vaguely pornographic), the intention is to take another margin of tissue around the original site and hope that this time the pathology tests reveal it to be entirely clear of cancer cells. It was a simpler process than the first op – no wire, no nipple injection, not much waiting.  I was in at 7.30am, on the operating table by 9am, back in the ward by 12 noon and heading home by 2pm.

But that’s still not the end of the story.  There was 3 weeks of waiting to face before I would find out if the re-excision had done the job or if more drastic steps would need to be taken. And that’s not 3 weeks of fun by any means.