I’ve held back telling most people a couple of important things which happen before removing the cancer from my breast. These things are the Sentinel Lymph Node Biopsy and Axillary Lymph Node, and I didn’t want to talk about its importance because I didn’t want to think about the end result should these nodes showed positive for cancer cells…
The first time Dr. C explained to me about the nodes I didn’t think much about it, as the results from my initial biopsy came back negative for carcinoma in a lymph node. I was even less worried about it when I heard the second biopsy showed up negative in another lymph node, as well. At this time, I was still under the impression I would be getting a lumpectomy, which was devastating enough at the time. It didn’t really hit home how serious the Sentinel Lymph Node Biopsy and the Axillary Lymph Nodes were, in the whole fight against cancer, until I had to say it out loud.
At my first Pre-Surgery-Admin Clinic, Dawn and I met whom we thought was a stern looking Nurse Jean. She brought us into her windowless office where she began asking formally, all the required medical questions. Do you take any medication? No. Are you taking multi-vitamins? Yes. Stop, because vitamin E thins your blood. When was the last day of your period? Don’t know for sure but I marked it in my calendar on my computer. Are you pregnant? No. Are you allergic to any medication or drugs? Sulfa.
All very clinical questions, before she asks me if I know what I am getting done in surgery and if I’m able to explain it to her. I summarized, Dr. Cil will first perform a Sentinel Lymph Node Biopsy where she removes the Sentinel lymph node at the beginning of the surgery and sends it off to Pathology, if the Sentinel comes back negative, she will just remove the lump in my breast. And if it’s positive? If it’s positive it means the cancer has spread into the Axillary lymph nodes there by meaning a good chance the cancer will spread elsewhere in my body, Dr. C will have to remove all those Axillary nodes leaving me to deal with a lifelong condition called Lympedema, where my arm swells because there are no lymph nodes filtering out toxins and fluid under my arm. And worst of all, I would have to wear a silicone drain attached from under my arm while I am recovering, to remove the blood and fluid from the surgery. As I’m recounting this to Nurse Jean, Dawn’s head jerks up from taking her notes to stare at me with her jaw opened, which prompts me to kind of think, I guess this IS as serious as it sounds. I ignore my friend’s stares, as Nurse Jean begins to show me the temporary drain which will be attached to my armpit, should the axillary is removed. As she reaches for the thin white rubber tube I slowly reach down for my handbag to grab a tissue in my bag. Nurse Jean notices my maneuver and slides me her box of tissues but I refuse the box because, if I learned anything from the day of “the surprise biopsy” it is, WCH cheaps out on their brand of facial tissues. Note to self, WCH only carry the kind of tissues which has the consistency of sandpaper.
Jean emphasizes the only way I will know if they have taken out the axillary lymph node is when I wake up and I feel the silicone ball under my armpit. As she begins her presentation on how to empty the drain and how it will hang on my clothing I could feel myself bite my bottom lip and start shaking my head. Nurse Jean pauses and nods to me as I bury my eyes in a wad of white tissues. A normal bodily function will be removed from me. Another thing, which I never thought twice about, will be removed from my body.
The nurse softens up and continues our session; should my axillary lymph nodes get removed, I must use the other arm for all blood work or needles. Jean could not highlight this enough before she begins checking out my small veins to pierce the needle into. Drinking a glass of water would plump up any vein before blood work, she tells me, if I were ever to worry about someone not listening to me for using the smallest needle (a butterfly needle) on my small veins. Both arms prove to have challenging tiny veins to Nurse Jean as she unties the rubber band from my bicep and ties it on my forearm.
“Oh, you’re doing this another way, do you need me to make a fist?” I ask just as she starts tapping the large blue vein on the side of my wrist. “OMIGODSHE’SGOINGAFTERTHEVEININMYWRIST!”
Now Dawn who was all squeamish about needles, just a few minutes earlier, decides to make light of the whole situation and says,
“Oh really? That’s really smart because it’s a much larger vein than all the other ones in our arms.” WHAT. THE. F-CK!! How is this helping ME and my wrist?
“THISISTOTALLYGOINGTOHURTISN’TIT?” I ask in panic mode, I could tell Nurse Jean is laughing inside, as she offers me a pillow to lie down on the examination table, only because she feels (and correctly so) I may pull my arm away while she is drawing blood from MY WRIST!!
“Norine! DEEP BREATHS!” Dawn shouts out, and the both of us start inhaling and exhaling LOUDLY, in the nurse’s office, as my blood is sucked into a tiny vile.
My blood, from this ordeal, was not admissible as it has been a month since we thought I would be getting a lumpectomy. As well, a procedure for a lumpectomy differs from a procedure from a mastectomy, new info will be have to be divulged to me. I revisit Nurse Jean two days prior to my partial mastectomy. I go alone after making sure I get Nurse Jean for the appointment, why should I have to recite the whole lymph node procedure over again and I was hoping to only give her a vile of blood and be on my way. Nurse Jean greets me with a smile this time, she tells me she was trying to remember who I was (as I specifically requested for her) but she said remembered the minute I stood up in the waiting room. She asked me where Dawn was, because she was so great to have around last time. Dawn was at work and couldn’t make it I tell her.
In her office, Jean reviewed my file again and asks why I didn’t have the lumpectomy. I informed her they found more cancer cells, from my MRI, and we needed to do a mastectomy and then insert tissue expanders. She sounds upbeat when she tells me, if they are starting reconstruction now, they would add the nipples in 3 months time (is it really that fast?). This was probably not going to happen early, I tell her, I think they want me to finish 6-8 months of chemo before I start the nipple process. I still have to see if I have to do radiation. She noted I have an appointment with Nuclear Medicine for the following day, before surgery, for a Sentinel injection. A dye will be injected into my nipple which will travel right to a lymph node, which is the first Sentinel lymph node and perhaps a second and third. These will be the nodes removed by Dr. C to be sent to Pathology the morning of my surgery. Don’t forget to make this appointment, Nurse Jean tells me. Geez, it was already shaping up to be a busy week before Wednesday’s surgery. Nurse Jean smiles and surprised me by asking if my apartment was all cleaned up for my Mom. Did I really tell her my Mom woes? I told her I was planning on washing floors tomorrow before her arrival and Jean takes the opportunity to remind me, on how to prevent germs by sleeping on all freshly laundered bed sheets, wear clean pyjamas and to buy a specific pre-surgery wash to use the night before and the morning before surgery.
She reviews The Drain with me. The only thing that changed is there could be two drains with a mastectomy, one for the removed breast the other for the Axillary lymph node. One drain, for sure. Which doesn’t seem so bad anymore. Are you playing “would you rather…” in your head too, as I’m telling you this? Ha.
Lastly, sitting on Nurse Jean’s examination table, she asks for my arm. I stretch it out but quickly pull it away again,
“Could we not use my the vein in my wrist this time and try to find one in the usual place?” I plead with her.
“Did I go through your wrist last time, you must have small veins!” she seemed pleased.
“I forgot to drink a glass of water before coming to see you.” I tell her.
Before I head out, Nurse Jean made sure all the consent forms are in place. Dr. B’s form was missing but she is confident he will bring it in. She is reminded how Dr. C spent a long time discussing my file with her before she met me and she also expresses I am in the hands of two very fine surgeons.