It's been five weeks since the big surgery. The surgeon was absolutely correct when he said recovery wouldn't be a picnic. I was told it would take 3 months, and being not quite halfway to that mark, I will finally concede that I'll need every bit of that time to heal. Last week helped me finally understand this. I was feeling pretty good, so I went on an afternoon shopping trip (one store!) with my Mother. Between the extra standing and walking, and trying a couple of things on, I was wiped out by the time I got home, and very sore the next day.  I had a day to recharge, and the day after that Husband and I hosted Father's Day for about 15 members of his extended family. I stood the entire afternoon, and did my best to be a decent hostess (drink runs, food runs for the elderly in-laws, and intermittent clean up of plates etc). I was admonished a few times to 'sit down!' - but I'm stubborn, and I felt fine at the time. And I knew once I sat, it'd be harder to get up, and I didn't want to feel stiff and be limping in front of company. So I just kept going. Well, in hindsight, not giving myself a break was just plain old stupid, and I paid for it on Monday and Tuesday. (Not that I'd do it any differently...I had a great time! Here's me having a great time...I wish I knew what on earth I was saying at this moment.)

So what was so sore? Mostly my abdominals (the six-pack muscles!) which were seriously messed with as part of the surgery, and the other surgical site, my right chest and 3rd rib. At my 3 week follow up with the surgeon, I requested the operative reports. I wanted to know exactly what happened when I was asleep. I'm used to reading operative reports as a Physical Therapist and I find them very helpful when designing a treatment plan. Now I needed to read my own, intuitively knowing it was necessary for my own processing of all of this. I also viewed the surgery on youtube - but not until AFTER mine. The operative reports of course had a lot of jargon that went over my head, but despite that I was able to get a much better understanding of what happened to me, and together with the videos, I could completely appreciate how it related to the post op pain.  I'm not going to get into all that, it's too graphic and if it's something you are interested in, direct message me and I'll tell you in a one-off. But I do want to back up to the day of surgery itself. I'm going to describe it as best I can, because I've been told my website has been shared with women who will be going through the same or similar.

May 17th... it was a LONG day. About 8 hours of surgery to get this girl across the finish line to the cancer-free zone, then all night long in the PACU with intensive care before being allowed to be admitted to a regular room at 5 am the next day.

Arriving to Brigham and Women's Hospital in Boston @ 7:15am, I walked into the lobby while Husband parked the car, and I stood out of the way against a wall to do a little bit of people watching.  Lots of medical folks in scrubs, lots of patients and families, and lots of, well, sick people. I shuddered a little, because I really didn't consider myself part of that compromised group, but I knew that I'd surely be looking/moving more like it when I woke up after surgery.

We snagged the last two open seats in the surgical check-in area. So many people! Some here for day surgery, and some like me who would need to stay. By 7:30 we were called to the admitting nurse's office, where - no kidding - she had candy in a dish on her desk. What?! I hadn't been allowed to eat or drink since the night before and I was starving, so that struck me as just a little bit cruel.

Once she had all the information she needed and I'd signed a bunch of forms, I was assigned to a pre-op bay, and issued a hospital gown, socks, and a blue Patient's Belongings bag for my things. After changing into the beautiful hospital fashions, from then on there was a whirlwind of nurses and doctors in and out to prepare me for what was to come. The IV access was put in, pre-op meds started, and I had more consent forms to sign. I met the anesthesia doctors and nurse anesthetist for a full discussion of the anesthesia plan. I rejected the offer of an upper extremity nerve block, reasoning that general anesthesia would be fine and any post op pain could be managed pharmaceutically. I was concerned with any needle going near my spinal cord - ahhh no thanks.  Finally I had visits from each of my surgeons for final instructions, questions, encouragement, and to get my chest and abdomen marked up and mapped with a felt marker.

And here they are! On the right is Laura Dominici MD, who took care of me in the winter for both lumpectomies and lymph node biopsy, and did the mastectomy on this day. And on the left is Matthew Carty MD, who did the reconstruction using my (abundant) abdominal tissue. These two are like rock stars to me. Brilliant surgeons, excellent bedside manner, and just good people. It's more than important to have a good rapport with and confidence in your surgeons, and I felt like I hit the jackpot with these amazing professionals.

My surgery was on the board for 9:30, and right on schedule at 9:25 the wheels on my bed were unlocked and I was rolled out of the pre-op area and down the hall into the OR. I remember that ride, laying on my back and hooked up to an IV, unable to see much except the ceiling and walls whizzing by. But being the hard core Grey's Anatomy fan that I am, I was determined to take in as much as possible once inside the OR before they put me to sleep.  First impression: super bright and light, and it was freezing in there! In the center of the room was a narrow table that I was wheeled to, and I shifted myself off the bed onto it. I wondered 'why is this table so skinny? what if I fall off?' I shut down the random and irrational chatter in my head as I remembered my practiced relaxation imagery and breathing. Once I was positioned properly on the table by the nurses, I went to the beach. The white noise of the OR became seashore waves. The voices of the nurses became the family at the next blanket. The heat from the intense light over me became the sun. I was calm as calm can be. Quite proud of myself for that, actually. After a couple of minutes I noticed people seemed to have taken their "places" - a nurse was on my right, holding and stroking my hand. The anesthetist was behind me, at my head, repeating the Healing Statements in my ear, and then suddenly there was a mask over my nose and mouth, and the anesthetist telling me to breathe deeply. At this point, for a second or two, I felt slight panic. In my mind, it was 'this is it! no getting away now!' until I noticed I didn't like the smell of the mask. And that is the last thought I had until waking up 9 hours later in the PACU.

Coming awake after general anesthesia is like being at the opposite end of a tunnel from everyone else and they are trying to make you hear them without yelling. You hear something, but you can't quite make out what it is because it sounds so far away, and at the same time you feel so groggy and tired that it's just a little bit annoying that someone is disturbing your nap.

By then it must have been around 6:30. The first voice I remember is Husband's, telling me my surgery went very well and that my Mother and Sister were there to see me. The first sensation I remember is my mouth feeling like it was made of parchment paper.  I guess that's what having an endotracheal tube down your throat all day will do to a person. I was unable to talk, literally choking on my words, until I was allowed some ice chips, but honestly the feeling didn't completely resolve for another day or so. The next thing I noticed was that I was seriously tethered: I had intermittent compression devices on each leg, oxygen tubing in my nose, an IV in my arm, a urinary catheter, 3 post-op drain tubes (one in breast, 2 in abdomen), and a pain-pump catheter into my abdomen. Oh and my abdomen! It was rock hard from my ribcage to my belly-button. So was my new breast. (Trauma? Swelling? Don't know.) I was extremely uncomfortable in my skin, but there was no real pain yet - the anesthetic being directly delivered to my abdomen was working well, and my breast was completely numb. The worst thing at that point was the extreme thirst. I'd ask for water, and be given ice chips. I was too groggy to even think to ask why.

In the PACU and throughout my hospital stay, the protocol after my type of surgery is to have the room kept at a very warm temperature. Feeling chilled causes vasoconstriction of blood vessels. That's fine for established tissue, but for these newly transplanted abdominal vessels that have just been micro-surgically married to their counterparts in the chest, that's a gamble not to take. Any compromise to the perfusion of the transplanted tissue could start it on the road to failure.  For this reason, adequate blood flow and oxygenation are the most watched over aspect during hospital recovery time. At least once an hour during my time in the PACU, and every 4 hours for the rest of my days inpatient, my new breast was assessed with a Doppler ultrasound to hear the blood flow (it sounded just like an unborn baby's heartbeat to me). And in the PACU it was also constantly monitored with a temperature probe. Throughout that first night, I was never without at least one caregiver by my side. It's all a blur to me at this point, but I know I didn't get restful sleep. I kept hearing voices talking about the probe, and the number on it being lower that what they wanted. My caregivers were relentlessly checking it, apologizing for disturbing me (no problem! just keep that new booby alive!), and at one point I opened my eyes and saw the look on the face of the plastic surgery resident. Pure worry, almost panic, it seemed. The nurse was telling him the number on the probe was now 51 (it had been in the 70's immediately after surgery). I asked for water again, I was given ice chips. Now, think about this for a minute. My last food and drink was at 9:30 pm the night before surgery. It is now 28 hours later, and ice chips are NOT cutting it! Finally the nurse said, "We can't give you anything else, in case you have to go back to the OR. Dr. Carty will be here soon to make that determination." Well, alrighty then.

Dr. Carty, poor guy. He worked on me for 8 hours in surgery, now called in the middle of the night to come back. It was probably between 1 and 2 am when he came in. He assessed things, relocated the probe to a different place on my breast, and voila - the magic number (whatever it may be) was achieved. It was just a technology glitch! Thankful! At 5 am I was deemed stable and ready for transport to a regular room.

My surgery was on a Wednesday, and I went home four days later on Sunday. I was so doped on medication that I hardly remember those days. But somehow I had the wherewithal to type up some notes into my iPhone while I was there. I came across it a couple of weeks ago. Here's the list I wrote:

• brick boob
• pee pee parade
• thou shalt not stink
• black bean veggie burger
• head smack
• exotic zoo animal

I guess I was writing to myself in some kind of shorthand? Amazingly enough, most of it makes sense to me.  

Brick Boob: That's referring to how heavy the reconstruction felt (still feels, actually) on my chest

Pee Pee Parade: I've actually talked about this in an earlier post, about my first chemo treatment. But THIS made THAT seem like nothing. The Pee Pee Parade is when you need to get up to the bathroom, you're hooked up to a million tubes and wires (see paragraph 10!),  have an IV pole trailing you and two nurses to help get you there - one to manage the pole, tubes and wires, and one to hold you up. It is so ridiculously funny that I felt the need to name it at the time.

Thou Shalt Not Stink: No freaking idea...

Black Bean Veggie Burger: I will never ever eat this again, because I saw it return. Not pretty.

Head Smack: Two nurses were boosting me toward the head of the bed, overshot, and the top of my head made loud music with the wall behind the bed. It hurt like a mother, I saw stars, they looked horrified, and I laughed at them, the whole thing was so absurd.

Exotic Zoo Animal: That's what I felt like every morning when the group of umpteen residents and interns came to my room for rounds

Laying in a hospital bed, knowing that you can't move unless you have help, is a bit of a claustrophobic experience. No one likes it. But something that helped me re-focus was this poster, made for me by my Husband, 2 children, Mother, 6 siblings and 2 Sisters-In-Law. It lived on the wall directly across from my bed, where I could see it easily. Everyone who took care of me (and there were a lot) could see it too, and it almost always sparked conversation. I'd much rather talk about my awesome family than my pain number. In the center of the poster, the picture shows me "BC" - looking healthy and with a full head of hair. Quite different from the woman they all saw in the bed, wearing a baggy hospital gown, basically bald, who needed two people to help her walk, stooped over, to the bathroom. When I told them it was me 10 days before being diagnosed with breast cancer, less than a year ago, they got it. That poster humanized me for them in a way that I think is important, for them and for me. I became more real, the difference between diagram and 3-D.

On the last day in the hospital, I had to show the PT that I could be on my feet standing and walking for 5 minutes, and that I could safely go up and down the stairs. Ironically, the PT and I graduated from the same PT school, albeit 15 years apart. Here's Jennifer, my fellow Simmons College Alumna:

If you look closely, you'll see that I'm trying to hide my On-Q pain pump behind me with my right hand. The medication is delivered through a long skinny tube into the abdomen, and the source of the medication is inside a little black bag. In the hospital they jokingly refer to it as 'Gucci bag' - it is so NOT a Gucci, but this is one of the little tricks we play on ourselves to be able to accept something as bizarre as having tubes emanating from our bodies. I went home with it and it did its thing for another 4 days until my first follow up with Dr. Carty, when it was taken out.

The healing process is marching on, 5 weeks in. I need to wear an abdominal binder day and night for abdominal support. I can stand up mostly straight, but still bent over some. My right shoulder is weak  and tight from not being able to use it normally. I feel like a flipped turtle when it comes to getting in and out of bed, since I'm not allowed to use my abdominals (but I wouldn't even if allowed - ouch!) However... I have some pretty cool scars! I have a flat stomach again! I have about a quarter of an inch of hair on my head and my eyebrows and eyelashes are back, baby!

The most important things I have though, are health and family. I can't explain how good it feels to know the cancer is out of me. To have a Husband who continues to be the rock, going above and beyond in every way. To have a 78 year old Mother who was willing and able to baby-sit me during my first week home from the hospital, making sure I was comfortable and fed and safe. To have kids and sibs who check on me all the time.

And here's a bonus:  I got one very important gift from my Dad. He doesn't come around often, but when he does, it's always memorable. Even though he left this earth 16 years ago, he still gets a message through now and then. In the first week after the surgery, after I'd been home a few days, he walked into my dream just before I woke up. He was in full color, wearing a jacket and tie and a huge smile. In prior dreams like this, I'd go to hug him but he'd either disappear or I'd wake up. Not this time. He stayed. He was solid, I could feel him, and he hugged me back.