An Answer to My Prayers

Finally, a happy post.

I am so, so happy right now. Like really seriously happy, not just happy in a 'happier than I have been in two months' happy (though that, too).

My consult up at University Hospital was amazing. A-M-A-Z-I-N-G.

It started off just sort of eh, whatever, with a surgical resident being the first person we saw. She asked if this was a second opinion consult and I said I actually didn't want to treat it that way; I was seriously considering having the surgery done at UH. Ultimately I think it was a good thing I made that clear because I think it may have changed how the rest of the appointment unfolded. The resident then proceeded to take a decent history and started to discuss options, when Dr. F, the surgical oncologist, came in. She was fine, but certainly no Dr. L. Interestingly, she did mention that doing a second re-excision was an option, even though I've moved past that in my mind. Before I left on vacation, I would have loved to hear that, and cling to it as a reasonable option, but I realize now it's not the best option. Choosing this would be a decision based on emotion and fear, not logic. In the end, Dr. F said she would only recommend it if it were really, really important to me to try to conserve my breast. The obvious downsides to this would be that there is absolutely no guarantee I'd have clean margins afterward, and even if I did, I would still need radiation, and my breast would end up somewhat deformed. She said unfortunately the margins that would need the most re-excision were on opposite ends, and I'd end up with a large dimple in my breast that would pull my nipple outward. However, things would remain normal in the center - 'Your cleavage would be the same.' LOL! Seriously, I don't even wear bathing suits that show cleavage, so that SO doesn't matter to me. I told her I had moved beyond that in my mind, and wanted to discuss mastectomy with reconstruction options. She asked if I had met with a plastic surgeon yet, because the plastic surgeon is really the most important person in this process, and the person who could answer my questions. I said I hadn't, so she said she would see if she could arrange to have one of their plastic surgeons come down and talk to me, which turned out to be an awesome thing. I was hoping, hoping, HOPING I'd be able to see a plastic surgeon, or that at least with this consult I would have an 'in' to get to see one faster. As it turned out, Dr. F called over to plastic surgery and said one of the surgeons, Dr. T, could come over in 15-20 minutes.

While on vacation, I did a fair amount of Google-stalking of the plastic surgeons available to me. The one Dr. L works with has impressive credentials, but I was sort of turned off by his web site, which focuses mostly on cosmetic surgeries. Going into this, I was very biased toward the UH plastic surgeons, because it seems that their focus is mostly on reconstructive surgery following cancer, amputation, and bad accidents, and less on tummy tucks and lip implants. I remembered reading about Dr. T on the web site, and was happy to get a chance to meet him without even having to make an appointment. What great luck!

After about 20 minutes, there was a knock on the door, and a young guy who was clearly not Dr. T came in. I only knew this for sure because Dr. T, based on his name, is clearly Asian, and this guy was not clearly Asian (though it turns out he is actually half Japanese). It was actually a third-year medical student doing a surgery rotation. We talked a bit, and he was an interesting guy, although his interview skills needed some work. (I should have suggested that he take an EMT class to learn how to effectively take a patient history. LOL.) He just recently finished a Ph.D. in organic chemistry, then decided to go to med school, and I feel like we ended up talking more about him than me, but that's okay. In the end, I think he regretted coming in so early, though, because it was probably another 20 minutes before Dr. T came in, and there were some awkward silences, one of which he filled by saying, 'Hopefully Dr. T will be here soon.' Oh the joys of the teaching hospital!

Finally Dr. T came in and it was pretty much love at first sight. I honestly wasn't sure what to expect because I've never met a plastic surgeon before. Also, I mentioned that he was very clearly Asian from his name, so I didn't know if he was going to be Asian Asian or Asian-American Asian. It turns out it was the latter, so I didn't have to worry about this being a brilliant-surgeon-I-can't-understand type. Dr. T was Amazing with a capital A. Capital everything, actually. Like I said before: A-M-A-Z-I-N-G.

He started off by discussing my medical history with me, though he had clearly already read up on me beforehand. (This is actually one of the really impressive things about UH; everyone I've seen there, even the med students and residents, have reviewed my history fairly thoroughly before they come in the room.) We briefly discussed my overall health, my hips and DVT, my kids, his kids, my job, and the fact that he had just moved here from Texas. However, he and his wife are actually from Virginia originally, so 'I'm not one of those Texans.' LOL. One of his colleagues in Texas was offered the position of Chief of Plastic Surgery at UH, then later offered him a position. Since his wife hates humidity, she had been hoping to leave Texas, and was thrilled. Also, like me, his wife was adopted. She's from Korea, but like me, is Asian American only in appearance, but otherwise American American (whatever that means). Dr. T, who is apparently Korean American, said he had always dated 'Americans' and his wife was the first 'Korean' he had ever dated, and his parents were excited he was finally dating a 'Korean girl.' He had to explain to them that she wasn't really Korean, but even so, they would speak Korean to her, and 'I had to keep telling them, She can't understand you!' Hahahaha!

Eventually, we got down to business and he said, 'So, if you are educated, which I know you are, because you are...' In that brief blip, I was trying to predict what he was going to say. I know you are educated because... Because I teach at a university? Because I'm Asian? LOL. Instead, he said, '... because you are a breast cancer patient.' He then went on to say that in his experience, all breast cancer patients were extremely educated about breast cancer and always knew exactly what they wanted. Then he said, 'So tell me what you want.'

It was that easy. I didn't have sit there and listen to him talk about implants and pros and cons and blah blah blah. I just said I wanted to do a mastectomy with flap reconstruction, and waited for him to tell me I wasn't big enough. He did ask why I didn't want implants, and I just shuddered, and apparently that was good enough for him. Then he gave me a good, long look for what seemed like ages (probably 2-3 seconds in reality), then said, 'You don't have a lot to work with.' (Insert le panicked sigh here.) But then, 'But I've done flap reconstruction on a woman your size... I can do it.' (glee!) I can do it. I told him I had read about the options, and knew there were various places from which the 'flap' could come, and 'I am sure I have a B-cup of fat somewhere on my body.' He said, 'If all you want is a B-cup, we can definitely do it.' (Ummmm, yes, I'm not exactly looking for augmentation in the face of a mastectomy.' LOL.) But those magic words, we can definitely do it, were amazing to hear. There was no hemming and hawing or Hmmmm, well, maybe I can do this or that, or Are you sure you don't want to consider an implant? Just a very simple and confident, I can do it. We can definitely do it. And it was confident in the right way; not an overly-confident, sleazy I can do anything you want me to for your business type of way, but an I understand this is really important to you and will figure out how to do it type of way. There is, of course, the unspoken understanding of this being the difficult route, but he didn't need to tell me that because he knew that I already know that.

So then he started the physical exam, which had the potential to be extremely humiliating, but was not at all. I felt as dignified as one can standing half-naked in a room with a male medical student (Dr. T did ask if it was okay with me if he stayed) and a male plastic surgeon pinching all of my fat, on all of my body parts that were potential sites for fat donation. He even had me stand facing my husband so my husband could verify that he wasn't being inappropriate, ha ha. He started with my abdomen, which despite my best efforts to expand over vacation, is still not very big. At one point, he sort of frowned and said, 'You really don't have a lot of fat here.' I started to get nervous, thinking he was going to change his mind, and pointed out that my thighs were fat. He said thighs were a viable option, then starting pinching my thighs. Then I added, 'Or my butt. How about my butt?' So I lay down on my stomach, and he examined my butt and said my butt would work, at which point my husband said, 'I like her butt.' So Dr. T said, 'Your husband likes your butt, so that's out.' OMG LOL. Seriously.

After much poking and prodding, Dr. T had me stand up, then he looked me in the eye and said, 'Here's the thing...' I braced myself, thinking he was going to change his mind. He continued, 'You don't have a lot of fat.' Pregnant pause. 'I can do this; I can figure it out, if you are willing to let me figure it out. I promise you I can figure out a way to make it work.' I promise you I can figure out a way to make it work. Then he looked at me, as if asking for my approval. I smiled and told him that was exactly what I wanted to hear. At this point, the fact that he understood that I was 'well educated' meant a lot, because he knew that I knew that this was not going to be easy, and maybe even that I knew it would take a 'special' surgeon to do what I wanted, and that I was okay with him having to 'figure it out.' Going into this, I wanted a surgeon who would be okay with my desire to not have implants, who could work with the fat that I have to give me a breast that is not saline or silicone, however small. I am okay with the fact that he hasn't done a lot of flap reconstruction on women my size, because quite frankly, in this day and age, most women are not my size, so there are very few surgeons who have extensive experience with it. What is more important is his surgical skills in general, and willingness to work with me.

Dr. T did mention at one point, 'You know, implants are safe.' He went on to explain some data, then said, 'If my daughter needed this, I would let her have implants.' I took note of the fact that he said let, not recommend. Then he added, 'But I completely understand why you don't want implants.' And that was that. Perhaps this was just due diligence, because he didn't push it any more. OMGILOVETHISGUY.

Also, at some point during the exam, he told me that it was extremely important for people to feel comfortable with their plastic surgeon, and that he always told people that if there was anything at all about their surgeon that made them uncomfortable, that they should move on immediately and without question. After saying this, he looked somewhat expectantly at both me and my husband, as if asking if we were comfortable and okay with everything. I didn't quite know what to say, but then my husband gave a little chuckle and declared, 'I'm having fun!' And... it was fun. Sort of. Obviously it was not fun in that 'vacation on the beach' sort of fun, but it was 'fun' in that it was not at all traumatic, and what could have potentially been the most humiliating and degrading experience of my entire life, at a point when I'm already feeling like I'm at rock bottom, was the complete opposite. I never felt embarrassed or degraded; it was all the right combination of light-heartedness and seriousness. We laughed and joked, but never to the extent that we lost sight of the fact that this is some weighty stuff. While I'm trying to wrap my mind around one of the most traumatic experiences of my life, I'm also joking about how all the beer I drank on vacation went to my thighs instead of my gut. Reality + sense of humor = totally my style.

Other random tidbits from our visit, because I cannot organize them into any coherent fashion:

• Dr. T agreed to do a surgery where he takes all of the fat from my abdomen to try to recreate a breast for me. He was not certain this would be 'enough,' but offered, 'If it isn't enough, and you can't live with it, I can do a liposuction and a fat transplant from your thighs.' This would be approximately three months post-mastectomy. Although my thighs have more fat, and he could use a thigh to make a 'flap' during the original surgery, this would involve taking a muscle (the gracilis), and then I would have one fat thigh and one skinny one (and be missing a muscle, which is not trivial).
• At one point, when Dr. T was squeezing my love handles, he declared, 'This is what it is like to be a plastic surgeon in Asia!' I didn't quite get what he meant, but then he went on say that in Asia, I'd be 'normal,' and not a I need a special plastic surgeon to do my reconstruction type. 
• He mentioned that this is a complex surgery, and will take 6-8 hours, although he has done it in as little as 5. I assured him I did not want him to rush. I think this is one of those things where I'm supposed to act aghast and be like HOLY SHIT! EIGHT HOURS! but he already knew that I knew this, so it wasn't an issue. Then he said that because it was a complex surgery, he would need an additional surgeon, and that he would request that his colleague, who was the Chief of Plastic Surgery, perform the surgery with him. Then, as if I needed convincing that this was okay, he added, 'If I were having surgery, I'd want the Chief of Plastic Surgery at UH operating on me. He's really good.' Pause. Then he added, 'And I'm pretty good, too.' And the latter was so perfect, so full of the right combination of moxy, joking, and seriousness that it lifted my spirits and truly made me feel like this is going to be okay.
• We had a frank discussion about my nipple and nipple-conserving mastectomy. He said that technically I would be having a prophylactic mastectomy, and that I was a candidate for a 'nipple-sparing' procedure. However, sparing my nipple would make the reconstruction more difficult, and he followed this with a bunch of technical details about which I had not actually educated myself. He made it clear that he was willing to work around my nipple if doing so was important to me, but if not, he could also do nipple reconstruction later, if I wanted. In the end, I told him that the overall reconstruction was more important to me than my nipple, so if my nipple had to be sacrificed for the greater good, so be it. To which he responded, 'This is going to be easy. You are so reasonable.'
• Dr. T talked to me about the scars I will have from all of this. They will be ugly, but I'm okay with that. He mentioned that I'll have a scar from one hip to the other, but that it should be below my bikini line, and I assured him I don't care about that; I am too old for bikinis. He will also have to cut my belly button out and re-attach it, so there will be a scar all the way around it. (This stuff is not for the faint of heart.) Then he said that he was very good at minimizing scarring, and actually spent a good deal of time fixing scars that other surgeons left. 
• Dr. T said that he was going to treat this as a cosmetic surgery as much as a reconstruction. When he said this, I think I looked at him with surprise, not really understanding what he meant. Then he said, 'You have a really nice figure. At your age, and after two kids, you look great. We should preserve that.' Honestly... in retrospect, that meant a lot. He didn't say it in a creepy or inappropriate way, just very matter-of-fact. I've never thought of myself as a super vain type, but... I love how I look. Basically, I love everything about my life except for my stupid cancer and stupid hips, and I would love to preserve my good looks, if possible. I mean, in my adult life, I've never really given serious consideration to being 'good looking,' especially since I've been happily married for 15 years. If I have to be deformed and scarred and gross to keep living this awesome life, so be it, but at the same time, if I have a surgeon who wants to save my life and my figure at the same time, then praise God. 
• Dr. T then said that if I was unhappy with a result, to give him a year before I was angry with him, because this was lengthy process, and he would need a full year post-mastectomy to make everything right. This will involve follow-ups and probably revision surgery. His words: 'If you're angry with me about something, I'd ask that you not be angry until after a year. This is at least a year-long process.' 
• I asked him, after all of this, what options there would be should I end up having cancer in my right breast, and needing a reconstruction. He said, 'I have a surgery for that,' followed by some details. 'It can be done.' But then he suggested that we not get too far ahead of ourselves, that we take care of what's trying to kill you right now.
• In the end he asked if it was okay if he took some pictures of me, so that he and his colleague could make a plan. He promised me my face was not in the photo and that he would not post them on Facebook. He took the pictures with his cell phone, which was okay with me, because: 
• He gave me his e-mail, and personal cell phone number. He said: 'I'm not giving you my cell phone number because you are special; I give it to all of my cancer patients.' Then he added, with a twinkle in his eye, 'But you are special.' LOL. He said the university didn't like it if they gave out their e-mails and cell numbers, so they wouldn't print these on their business cards, but then said, with a shrug and roll of his eyes, that this was what he preferred - that I could e-mail him, call him, or text him at any time. Then he said, 'But I do surgery almost every day, so please understand it might be up to 24 hours before I respond.' SERIOUSLY?! Somebody pinch me, this has to be a dream! WTF? Seriously. I have to be dreaming.

This brought back memories of when I was shopping for ski boots, and the saleswoman told me that shopping for ski boots was similar to shopping for a wedding dress; you know when you've found the right one, and don't need to look anymore. You stop there. I think this is the same. Dr. T is The One. I am sure. I don't need to look further. I am so certain of this that I told UH to schedule my surgery ASAP, for whenever. And as much as I love Dr. L, I don't doubt this decision for a minute. As sad as I am that Dr. L will not be doing my mastectomy, because I love her so much, I'm thankful Dr. T was so amazing that there is no question left in my mind that no matter what the inconveniences, Dr. T is the one I want taking care of me.

I am so very, very, VERY grateful for this unexpected blessing.