How to have a lumpectomy, Part 1

Thursday evening, the night before my surgery, a nurse called from the hospital to give me my "arrival instructions". Basically, I had to be there by 7am, I had to have no food after midnight (just like a Gremlin!), and I couldn't drink any fluids after 4am. It's the no liquids part that made me nervous. Skipping breakfast and lunch isn't such a big deal, but what if I got thirrrssstyyy? No one likes dry mouth! Our friends Matt and Sarah were over; they'd come to make us dinner and then were gonna stay overnight to help with the kids the next day. Sarah is a nurse. "Are they pretty serious about that no-liquids thing?" I asked her. "Umm, yeah," she said. Blah blah anesthesia, blah blah aspirating into your lungs, whatever. Fine.

So I decided to wake up at 4 and drink a buncha water. Guys, this is tip number one: don't do that. Cause then you will immediately start thinking about the day ahead, and your brain will rev into full awake mode, and you will not be able to go back to sleep. And then shortly thereafter, you are really gonna need to pee. And after that. And, a little while after that.

We were model patients and arrived promptly at admissions at 7am. The room was already packed with people that presumably had surgeries scheduled for that day--most of them outpatient, or day surgeries, as that was where we were supposed to check in. I amused myself by looking around and playing "guess the procedure" for each person. Hmmm, tonsillectomy! Questionable mole! Prostate!

Then they called us over and checked us in. "And what procedure are you having today?" the clerk asked. Almost like a waitress, as if I'd been given a menu to select from. "I believe I'll start with some node mapping, please...and then the lumpectomy is looking pretty good to me today."

Eventually we got called back into what must be a staging area. I was weighed, I was given a gown and robe to change into, and as some of you saw on Becky's blog, I was given these.

Not even kidding, I thought it was for my hair at first. That would've been awkward. And to think, I'd already followed the proverbial advice to wear nice undies in case you ended up in the hospital! All for naught.

They assign you to a bed at this point, and a very sweet nurse came and tucked me in with a warm blanket. But the funny thing is, I didn't really want to lie in the bed. I feel fine, I kept thinking. That's been the surreal thing about this process. I am very healthy and feel great, but.

Then the nurse walked Jason and me down to Nuclear Medicine. (I cut a fine figure in my bathrobe and running shoes, don't you worry!) "Nuclear medicine" made me envision haz mat suits and test tubes and Russian scientists...but unfortch I didn't see any of that. It is here, my friends, that the "sentinel node mapping" takes place. And in case you ever need to understand what that is (and I hope you never do!) I'll tell you a little bit about what it's like. (But if you need, like, actual medical information, get thee to Google! I majored in Psychology.)

When surgeons remove a tumor from your breast, or perform a mastectomy, they also remove and test the sentinel lymph node for cancer cells. Your sentinel node is called such because it's the first node that any cancer cells would reach if they were spreading from the original site. To put it simply, if the cancer has spread in your body, it will almost certainly be in the sentinel node. So testing the node is a good indication of the stage of cancer you are dealing with.

Sentinel node mapping is how they find the right node. Ya got lotsa nodes, dontcha know. And the sentinel is not always the nearest in proximity to the tumor. And here is where the fun begins! After checking in, I was brought into an examination room and lay down on the table. The nurse chatted me up for a bit, then the doctor came in with four different needles. The needles are very small, and each contain about .2ml of radioactive solution. The process is this: the radioactive liquid is injected, some time goes by, then they X-ray the area to see where the fluid has traveled. The sentinel node "lights up" with the fluid. I've since read that there are different techniques in finding the sentinel, but this is what was done with me.

While I chose a strategic place on the ceiling to stare at, the doctor injected each syringe into different areas of the breast. Unfortunately, they can't use any kind of local anesthetic with this procedure--it effects how the fluid moves through the tissue. That was kind of a bummer to hear.

I've been told that each person experiences this differently--a lot depends on your pain tolerance as well as the way the nerves are arrayed in your breast. For me, it was about a 4 on a scale of 1 to 10. Not what I'd choose to do on a Friday morning, but not awful either. One of the shots hurt more than others, and the fluid stings a bit going in, but it was okay. Just okay. However, for someone with problems with needles, it would be good to have a hand to hold at this point.

After the needle part was over, the nurse put a bandage over the area and told me that I had to massage it for 10 minutes. This was very important, she said. I must massage it to get the fluid moving through the tissue so that the imaging could see what it needed to see. That was slightly awkward, but whatever! Just me alone in a doctor's office, massaging my boob. Like I've done so many other times.

Eventually, they came to get me and took me to this ginormous machine. It looked a bit like an MRI machine, where you lay on the mat and it slides you under the imaging stuff. These are all the technical terms, of course. Attached to the machine is what looks like a big panel, two of them, and the technician moved one down, down down, very close to my face. "Sorry," she said, "If you had bigger breasts we wouldn't have to get it this close." Lady, if I had a nickel for every time I've heard that one. (Sorry. I don't even know what that means.)

Then I had to lay very still for about 10 minutes. Don't even think about your nose itching, cause then it will and there's nothing you can do. Nooothiinngg! Then she adjusted the machine and I laid there for 10 more minutes, with the panel on the side. You might think this is enough radioactive imaging of your boob. But it isn't! Silly girl, what do you know? Then you go sit back in the waiting room and read magazines for half an hour. Then you go back in there and do it all again. Except this time they end with taking a 3-D picture. Just like Avatar! This time the machine and the panels move and spin around you slowly and it really is better to close your eyes. Cause that's a bit disconcerting. I'm not prone to claustrophobia, but if you are--best to just keep your eyes closed, cause the panels get pretty close to you.

At this point, the doctor came into the room, and referencing some incomprehensible blobs on the imaging screen, drew on my boob with a purple Sharpie. Radioactive fluid and million dollar equipment and it ends with markers.

I'm very proud to say that the technician told me it took much less time to map my sentinel node than normal. I smiled and said, "Well, let's be honest, that fluid didn't exactly have heaps of tissue to work through." She acknowledged the truth of this, but said it was mostly because I had massaged it so well. "We get some much older women in here who just aren't comfortable doing that," she said in a confidential tone, "It's a generational thing."

Ahem. I think that's a good place to stop for now.