On Wednesday they gave me Fentanyl. According to Wikipedia “Fentanyl is approximately 80 to 100 times more potent than morphine and roughly 15 to 20 times more potent than heroin. That explains why I thought I was on another planet and had double vision until midnight! The good news is surgery is over, I returned home yesterday and managed to get some rest last night. I’m slow, sore and very swollen but happy to forego another night on the ward. The hospital is desperately short of beds and my quick turnaround means someone else will have their surgery sooner, or an emergency patient will spend less time in a corridor. Paying it forward is a good thing when it comes to the availability of hospital beds.
Most of my memories from previous surgery proved accurate. The marker pen was purple not green this time. When I regained a semblance of rational thought I wondered why my neck, upper arms, shoulders and torso were all bright red. I had a flashback to dexamethasone, the pre and post chemo steroid that caused regular chaos, then recalled the anaesthestist telling me it was the first drug she’d inject pre-surgery. Too late to argue by then. I checked my legs – no redness. Eventually it dawned that I’d been painted with hibiscrub to protect against a whole host of nasties including MRSA. I’ll be scarlet until I can reach to give myself several thorough scrubs (and it’s safe to wash around the wound). I’d forgotten about regular post-op observations and with both arms off limits my right calf was adorned with a blood pressure cuff as well as the space boot.
Drains proved a source of amusement for the nursing staff all day. One is labelled ‘in,’ the other ‘out.’ I remember this from last time and was able to explain: one sits inside the ADM (pig intestine) pocket and one sits outside. Both are designed to offer the best possible chance for the Acellular Dermal Matrix to integrate into my body, eventually being colonised by my own cells. Human becomes part pig which in turn becomes human. Venflon placement was uneventful on entry, not so on removal due to the blood thinning injection received overnight; I’d forgotten that part too.
As ever the staff were brilliant. Miss M. was on top form – honest, consultative, down to earth. A first rate surgeon she is also amazingly humble, oozes positivity and inspires faith. The theatre nurses from Ireland and Portugal were kind, humorous, gently reassuring men. The anaesthetist was a local lady who’d read all my previous notes and expressed deep sympathy for the traumas I’d endured over the last few years. The night nurses were from Thailand and the Philippines, warm, kind and caring. The ward sister, another local, sought out whole grain bread, jam and green tea at 3am when she realised I hadn’t eaten for 21 hours. The level of care was faultless.
Faith and trust in the medical team helps clarify the thought process surrounding semi-elective surgery of this nature but going through with it remains a challenging and deeply personal decision. The procedure is invasive, it maims, scars and is inescapably linked with the reason the original surgery wasn’t elective at all. Complex psychological impacts are interwoven with the physical challenges of surgery and recovery. Opposite me was a thirty year old woman who’d just had a bilateral mastectomy. She was the super fit and healthy member of her family, the one everyone made fun of for her good eating and exercise habits, the last one anyone dreamed would develop breast cancer. Her question, the question without answer, was ‘why me?’
We shared stories and philosophies, she asked about post surgery experiences, what chemo was like and how long treatment had taken from start to finish. She was shocked by her diagnosis and reluctant to spend an entire year of her life attempting to eradicate cancer from her body, but her consultant strongly recommended chemo given her age. She felt conflicted. Her friends suggested it was too radical and debilitating, she was fit and otherwise healthy so surely diet, exercise and the operation would lead to a cure?
I remembered my thirty year old self, raw from the death of my Mother, trying to advocate for my future health (and failing miserably) at a time when much skepticism surrounded cancer genetics and inheritance. I explained if prophylactic mastectomy had been offered then I’d have leapt in without a second thought. I also explained that given a choice I’d have avoided chemo like the plague but histology meant I’d been given no choice. I shared that on reflection my reaction to the suggestion of chemo had little to do with the most effective treatment for me and everything to do with the lived experience of my Mother’s illness, a deeply traumatising period that had distorted my thinking.
It wasn’t my place to tell this young woman what treatment to sign up for or how to proceed because her cancer is as individual to her as mine was to me. Yet everyone had made fun of her healthy eating and fitness regime and she now finds herself facing cancer with friends suggestions that diet and exercise might offer a cure? I asked as politely as possible if any of her friends had experienced cancer themselves or amongst close family members because it might just be possible their thinking is clouded too? Facing a decision that might impact the rest of our lives means we owe it to ourselves to ensure, as far as possible, we’re working with facts and not obsessing with our own or other people’s perceptions. It’s by far the toughest and loneliest decision in the world… Wherever her thinking gets to, I hope it’s the right thing for her.