Aunt Ginger

Hooter Hotline #8 Aunt Ginger
January 12, 2010

Hello Friends! I have so much to share, but will restrain myself and provide “just the facts” upfront. You can continue reading after items 1 & 2 if you wish to subject yourselves to my convoluted thought process and the roller coaster ride of the last several days.

1. Surgery is scheduled for 0730, Wednesday January 13th at Good Samaritan Medical Center. This means I need to arrive at 0530, but luckily the roads won’t be covered in icy slush this trip. I really did wish I could have a “Home IV Start-Kit” last time because it took them three sticks to get a proper IV going in my 1 inch diameter garden hose veins! What if I had one of my ICU pals start it tonight and I just showed up with it tomorrow…..hmmmmm…. It will take about 3 hours to remove these beauties. I’m surprised it won’t take longer because scalpel blades are very small…all that tissue…one little blade… Will she use a tiny little knife steel between cuts like a chef? Will she go through multiple scalpels? Sorry, I’m off again, aren’t I. Anyway, I will only be in one night and home on Thursday.
a. No reconstruction: Rog honestly concurs and this time I believe him.
b. No lymph nodes: The Sentinel Node Biopsy from the first lumpectomy showed no sign of cancer cells having migrated out to the lymph system. Of course it is not 100% accurate. It is always possible to miss one of those sneaky little bastards who might cause metastasis somewhere else, but it is pretty reliable. It is fascinating how they check the sentinel node; first they inject your breast with a blue dye when they take you to surgery, then the doctor massages your breast like a dough ball to get the dye into the ducts, finally she makes a little incision in your armpit looks to see which node turned blue, that lucky fellow gets removed and sent to pathology. Isn’t that brilliant!
c. I will have two Jackson Pratt drains: a JP drain is a clear tube connected to a clear bulb the size of lemon, they will located where each breast was in order to drain serous fluid out of the area. These will be in for 10 days.
d. Total recovery time: about 4 weeks.

2. It’s a Hooter Hotline Contest! Why not have some fun? Yes, I am indeed crazy, but I want you to choose names for my two drains! You know, something like “Chip and Dale!” The winner will receive some sort of alpaca product. Everyone is eligible to enter, even those related to the hooters or winners of any contest within the last thirty days may enter! Email you suggestions and I will choose a winner between popping pain pills on Friday. I want to name them because they will be my constant companions for ten days. They are also the only things I fear about this surgery. No, I’m not afraid of pain, anesthesia, heart attack, stroke or deep vein thrombosis (blood clot), but I am terrified of having two infection freeways available to roaming bacteria for 240 hours. This is where being a nurse is not helpful. So, in an effort to distract myself from my angst, I will give them personalities and engage them in activities over their brief, but glorious life spans. I will probably talk to them too. You will help shape who they become and I will send you updates (photos) of their “Bucket List” adventures.

Well, that’s it for “Just the facts, Ma’am.” And now for the usual ramblings…


I saw Dr. Wheeler last Thursday for my surgical follow-up appointment, but it also served as my pre-op appointment for Wednesday’s surgery. By the way, Dr. Wheeler’s work on the second lumpectomy was excellent again. You can hardly tell any tissue was removed from the breast. If I didn’t have “Ducts Gone Wild!” throughout my breast tissue, I would have been supremely happy with the results. Bikini-worthy, they are! Dr. Wheeler sat down and asked me how I was doing. I looked her straight in the eyes and said enthusiastically, “Great!” “Really?” she responded with surprise in her voice. “Yes, really,” I replied. “I am truly at peace with the next step because of how we got here,” I continued. After going through the last two months of decision making, I find that mastectomy is much easier to accept when you know that there’s really no choice. I believe that this clear path is God’s gift to me in answer to my prayers and yours for DORKUS here, to know what she should do. I know I am not being selfish or rash and am so grateful for the peace of mind that I have now. I am actually feeling light-hearted. So light-hearted in fact, that I was making up names of movies and Broadway shows I could star in as I drove to the appointment:
Bye, Bye, Booby
The Sentinel, (Node)
Flashless Dance
Double D-Day Invasion on Carcinoma Beach
Flats (CATS)
As Flat As it Gets
The Good, The Bad & The Ugly (no change needed)
Jennifer’s Technicolor Boob
The Ta-Ta Sisterhood

I shared a couple of these with Dr. Wheeler and she quickly added, “The Hills Are Alive!” I said, “You mean the ‘Hills Are Dead, ‘right?” “No, I mean the hills are alive with cancer,” she replied. Then, sheepishly, she added, “I have a weird sense of humor.” “Oh, I get it! That could be the title song for the ‘Sound of Cancer,’” I said to my fellow medical black-humorist.

After this little indulgence, I dove into my list of questions about the cancer and the surgery. Now that mastectomy was a reality and not just an idea, I was curious about several things:
1. “How do you make sure we get it all since it is so close to my chest wall?” My past experience filleting fish for summer work had me picturing a severe method of removal with a much bigger knife than she was planning to use. I was a really good little fish filleter in my day. I was expert at getting all the meat off the spine and ribs and never left a morsel on the skin either. It seemed like my skills would be useful for this surgery and I was having trouble envisioning a more delicate procedure that would be as effective as what I could do on the fillet line in a cannery.
It turns out that she neither wanted nor needed my fillet knife from 1981 despite being long, thin, flexible and very sharp. She told me that best practice all over the country is to remove the fascia (the lining over the muscle) with the breast tissue. Science has shown that breast cancer doesn’t grow in the pectoral muscle. While it is good news for me, it is bad news for Aunt Ginger. She was some one who would have really benefited from keeping hers. In 1978 we drove down to visit her in Yosemite where she was a National Park Ranger. She had worked for Wells Fargo many years, Baskin & Robins too, but I always admired her work as a Ranger. A single-wide trailer served as her quarters there. It backed up to a rushing river and I remember how loud it was as we tried to go to sleep. As clear as day, I can picture her funny bra hanging out on the clothesline by the trailer. My mother would have been too vain to leave it drying out in the open, but not Aunt Ginger.

2. “If the fascia is gone, will my skin adhere to the muscle?” Nope.
3. “Is there any detriment to the muscle being “fascia-less?” Nope.
4. “If radiation and Tamoxifen were supposed to “mop up” any stray DCIS (ductal cancer in situ…cancer cells within the duct wall) or IDC (infiltrative/invasive ductal cancer…cancer cells that started inside the duct and then progressed outside invading other tissue), wouldn’t they be able to “mop up” the “Widespread (in the breast) DCIS?” We don’t know for sure. My situation is very uncommon. It is suspected that the risk of recurrence might be higher in my situation. Not a lot of data on my scenario exists. I may very well have been the patient who, after finishing the 5 year Tamoxifen course, would have more cancer. I don’t want to wait and find out. I’m also very curious to see if the right breast ducts have gone as wild as my left. What has happened to me? I’m looking forward to the next pathology report!!!
5. “The reference notebook given to me by the Nurse Navigator had post-op exercises and stretches in it. When should I start doing them?” Begin after the drains come out.
6. “My last anesthesiologist, Dr. Lee, gave me such a good ride; can I request her for Wednesday?” If she is working I can. This is when it DOES help to be a nurse! I give Dr. Lee top honors because, as a veteran of seven surgeries, I now qualify as an anesthesia connoisseur! I awoke with no anesthesia gas-breath lasting 24 hours, no nausea or postural hypotension and I believe she was generous with the “happy juice.” In fact, when they rolled me into the OR from Short Stay, she was waiting for me and rushed up to the stretcher and began injecting my IV line while we were moving. My escort offered to stop the stretcher for her, but she didn’t want to waist a second and besides, she was using a “blunt needle.” I chuckled and said to her, “You seem awfully anxious to make me unconscious, did I say something to offend you when we talked earlier?” “No, no, I just want to keep you happy,” she said matter-of-factly. Well, she did. Happy I was! Honestly, who would want anyone else to watch over nap-time?

Well, this is enough for now. I must get some work done for my boss and cross a bunch of things of my to-do list for John and Rog. Thank you for letting me “brain-dump” on you. It has been so helpful to share with all of you over the last two months. You’ve kept me company with your tears, laughter, empathy, encouragement, interest in learning with me and offers of help (Well, I may have been offended by the psychiatric help offers…). You have made hard times easier. You are my friends and I pray every night for God to bless YOU. Thank you for being the net under my tightrope. I can have a little more fun walking across it knowing you are right under me.

I can’t wait to see what names my drains will have. : ^ )