Monday, June 16, 2008


Prior to the lumpectomy, Linda's surgeon Dr. N, ran her through a bunch of imaging tests to plan the operation. She had another mammogram, a PEM (positron emission mammography) and a MRI (magnetic resonance imaging). To the best of my understanding, mammograms and MRIs are visual diagnostic tools whereas the PEM, basically a breast only PET scan, is a biological diagnostic tool. For the PEM scan, you swallow a radioactive isotope (something that emits positrons I assume) in a glucose solution. Cancer cells like to eat sugar, more so than other cells, and therefore after waiting for the glucose/isotope to make its rounds of the body, a PEM scan will "light up" those areas with a concentration of the isotope, likely cancer cells.

Linda's tests showed there was still some traces of cancer in her breast and lymph nodes after her 6 rounds of chemo. We were hoping for what they call a pCR (pathologic complete response) but instead we got a very good partial response. Even with a pCR, you still typically follow it up with a lumpectomy and radiation so the lack of a pCR didn't immediately affect the course of treatment. From the test results, the surgeon knew where and how much to cut.

The surgeon had us scheduled for surgery the morning of May 23rd at St. David's Medical Center. She never asked us if we were Catholic. Should you be Catholic if you go to a St. Something hospital? I don't think we had a choice and I never asked, however I was pleasantly surprised to find out that I didn't burst into flames when entering the hospital that day. Must of been Linda's Christian upbringing that saved us. After the requisite form filling and sign-in procedures, we made our way to the pre-op room. Linda got into her 'gown' while I found something decent to watch on the TV. Over the next hour, several doctors, nurses and orderlies made their way into the room. Each one of them looked at Linda's chart, flipped through some other paperwork, asked Linda her name and date of birth, checked something off their list, double checked her arm bracelet and continued to do whatever it was they were there to do. There must be enough 'guy goes in for a vasectomy, guy comes out without a kidney' stories to warrant all this behavior, but better safe than sorry I suppose.

As one of the orderlies went about his business, he made a remark to Linda about 'making a fashion statement'. We assumed he was talking about Linda's do-rag that she was still wearing. Linda got a bit miffed about the comment. "What the hell was that comment about? Doesn't he know I have cancer? That was kind of inappropriate". She stewed in her anger for about 15 minutes until a nurse came in and said " have your gown on might want to turn that around". Only then did we realize what the orderly was taking about. Holy shit we the point of tears. All our pent up anxiety came out and I'm sure they could hear us down the hall. It was friggin' hilarious and fantastic. Before long, they came and got Linda and wheeled her into the OR.

The 3 hour surgery had 2 stages.

1. Remove what remained of the tumor in her breast
2. Remove any cancerous lymph nodes

The first part was pretty straight forward. Cut out the tumor and enough of a clear margin to make sure you get it all. The lymph node surgery is a bit more complicated. Up until fairly recently, lymph node removal involved what they call an 'axillary dissection'. They basically would go in and remove an entire level (maybe 2 levels) of nodes (there are 3 levels in all) in the hopes they got any cancerous nodes. A 'sentinel node biopsy' is a new technique where they inject a blue dye at the tumor site and see which lymph node the tumor drains to. The first one it hits is called the 'sentinel node'. This is likely the first node you'd find cancer in if it has spread (which we knew it had but were unsure of its state after chemo). They take that node and, during the operation, slice it in half and run a 'touch test' on it. I'm not quite sure what the touch test involves but it determines if there is cancer in the node. If cancer is found, then they go the next one in the chain. If it is found to be cancerous also, then they continue on and take out a chain of them. If no cancer is found in the sentinel node, then they are done and do not take out any more. Why don't you just take them all out and make sure all the cancer is gone? Lymph nodes are an essential part of the body's defense system. All parts of the body drain to lymph nodes (some under your arm, in your throat, in your abdomen etc). If you mess with those areas too much, you risk getting a chronic condition called lymphedema. If you've ever seen someone with a full length compression sleeve on their arm, there is a good chance they have lymphedema.

The only other time I had been in a waiting room was when my son had his Celiac disease biopsy, and Linda was there with me. Now I was alone with only my thoughts. During those 3 hours I must of walked a good 20 miles up and down the halls. At one point I sat down to watch CNN which was on the TV in the waiting room. I was terrorized by some 2 year-old who was making his way around the waiting room. His grandmother would call him back every 5 minutes or so for a refill of juice and Oreos. He fell somewhere between cute and objectionable. It was only after he tried to grab my vending machine dispensed honey glazed donut for the fifth time did I realize he was waiting for his mother to come out of surgery...and grandma was waiting for her daughter. All of a sudden he didn't seem quite as aggravating. I offered him some of my donut but he was no longer interested. Little bastard.

2 hours elapsed and I hadn't heard anything. The dude (by dude, I mean a 20-something guy who was way cooler than me) at the front desk approached me, "Are you John? Dr. N would like to talk to you on the phone". What the hell? A doctor calling me? Is this good or bad? It was in between. Dr. N informed me that the lumpectomy had gone fine and she was confident she was able to get clear margins however the sentinel lymph node tested positive for cancer metastasis as did the second one. Fuck me. I had "paid it forward" with the donut offering and this is the thanks I get. This sucked ass. Dr N. went in and removed 17 more nodes, the pathology of which we wouldn't know for a week. It would be another hour before Linda was out of surgery so I took a walk outside in the 100F Texas heat.

I walked around the block which was under construction, near some shitty student housing and right next to the busiest freeway in the US. Not quite the relaxing walk I needed. As I walked down the frontage road to I-35 I passed an Ethiopian restaurant. It looked like it had gone belly up. No kidding? Nothing says home cooking like bowl of porridge with flies on it. Needless to say I ended up in the hospital cafeteria. I sat there for half an hour eating my sandwich and people watching. I watched a guy come through the checkout line. He had nasty burn scars on every piece of skin I could see. He chatted up the checkout girl like he knew her and had obviously been in this cafeteria many times before. For all the shitty luck we'd had over the past 5 months, I guess "sucking ass" is a relative term.

As I stepped off the elevator into the waiting room, the dude at the front desk informed me my wife was in recovery and I could go see her at any time. I actually said 'Sweet' to him in a pathetic attempt to be as cool as he was. I think I missed it by a decade or more.

After she woke up, we laughed some more about the backward gown. I loaded my semi-drugged-up Honey into the car and brought her home.

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