Farewell, Dr. L

I had an appointment with Dr. L this morning, one that I had set up while on vacation. After yesterday, there was actually no purpose to the appointment, but I went anyway. I wanted to tell Dr. L of my decision in person, and I actually felt really stressed about it, as evidenced by the fact that when the MA took my vitals, my systolic blood pressure was 128, my pulse rate was 106, and I had a 99.7 degree fever. I felt sort of guilty, like I had been sneaking around behind a significant other's back and was now dumping her. I even brought her flowers. (No, I'm not kidding.)

Dr. L was her usual wonderful self, and put me at ease right away. And fortunately, she brought up the fact that I had gone to see a different surgeon up at UH without me having to. I mean, I knew she probably knew, because she is actually part of the university health system, so she is on the same patient portal as the folks at UH. When she asked me about the appointment, I told her I had found a plastic surgeon who was going to do my reconstruction. I quickly added that I was very sad, because I really wanted her to do my mastectomy. She totally understood, though, and as it turns out, I was right. The DIEP flap reconstruction I'm choosing isn't possible in my town because it is so complex and requires a team of surgeons working very closely with each other, and we do not have a major medical center where this type of thing happens. So the choice is not a hard one. She said the only flap reconstruction that the plastic surgeon she works with does is a TRAM flap reconstruction, which is much simpler, but removes your transverse abdominis muscle. She agreed that at my age, a TRAM flap reconstruction isn't the best option because of the long-term effects/risks of losing your abdominal muscle.

She did express surprise that I had enough tissue for a DIEP flap, though. I said Dr. T was going to have to use tissue from both sides, which Dr. Google told me is called a stacked DIEP flap reconstruction, and is considered even more specialized than a plain old DIEP reconstruction. Then I added that Dr. T said I might need a fat transplant later, and he could take fat from my thighs, which I was pretty psyched about. LOL. She asked if we had considered using my butt, and I said that my husband liked my butt the way it was. Then she made a funny face and admitted, 'I'd feel weird having part of my butt on my chest.' Ha! She did say that taking fat from the thighs and injecting it into a reconstructed breast gave very nice results, and that this was a good option for me. Then she joked that I'd be looking like Barbie in no time.

She inquired about the possibility of sparing my nipple or maybe just the areola, and I told her I couldn't remember the details about why this would make the reconstruction more difficult. But I think I will e-mail Dr. T for clarification now. Dr. L said that nipple reconstruction never worked out very well, but whether or not having a nipple matters 'depends on how nipple-y you want to be.' Ha ha, yes, she really did use that term. Nipple-y. Seriously, I've thought a lot about this while on vacation, and spent a creepy amount of time looking at women's breasts, and nipples, and found my eyes wandering to Dr. L's breasts as we were having the conversation. No perky nipples. I told her the thing about nipples is that I don't want to be 'nipple-y'; in fact, I'd be more inclined to want my other nipple cut off so I just don't have to worry about them at all. I was surprised when she said some women actually do this because they don't want nipple reconstruction, but 'It is weird to have one nipple out there (THO, or titty hard on, as my friend from high school used to call it) and the other one gone.' This is what I love about Dr. L. She has a very buoyant personality, but yet she doesn't sugar coat things. She is the perfect combination of positive and realistic; light-hearted and serious. It might seem trivial to be thinking about nipple weirdness in the midst of a potentially life-threatening condition, but I've noticed that even terminal cancer patients mourn losing breasts, losing their fertility, and things that seem small when you are likely going to die within a year. Perhaps this is how we maintain a sense of normalcy, a sense of ourselves.

There is something comedic about the conversations that revolve around breast reconstruction, but maybe that is a testament to the conflicting messages women get about their breasts. It is funny and yet not funny at all. In the end, Dr. L said she thought I was making a good decision, and said that if she were me, she would do exactly what I'm doing. Her endorsement meant a lot, simply because I have such a great deal of respect for her. So I reacted appropriately and burst out crying (and unfortunately I'm not kidding).

From there on out, I think it was more of a therapy session than anything. We mostly talked through some of my emotions while she hugged me and I cried. She said she was honestly surprised that some women could come to her and so easily ask her to cut their breasts off, without a second thought, and said she felt like I had 'an appropriate amount of sadness.' And even though I'm having the mastectomy done at UH, I can still call her for anything; I'm forever a part of her 'team,' and We will get you through this. She said if I need any post-mastectomy care that is not worth driving up to UH for, she is happy to provide it - like, 'when you need your drains removed.' I made a face, thinking about the reality of it all. Apparently the drains you have in you after a mastectomy are pretty much The Grossest Thing Ever. Dr. L responded to my face and said, 'Yeah, the drains are pretty gross.' Ugh.

Toward the end, I told Dr. L the hard thing about cancer was that doctors who did oncology stuff were so amazing, top-notch. She replied that was a good thing, no? I said it was going to be really hard for me from here on out to find doctors who could live up to my standards. I think she appreciated that. Then we joked about different types of doctors, swapped information about a few, and she agreed with me that in general, orthopedists are THE WORST. I said I was certain that after all this, I would never ever be able to find an orthopedist who was even close to acceptable. Then I added somewhat jokingly that I was tempted, since the mastectomy will surely bring us up to our out-of-pocket maximum for health care, to have my hip reconstructed before the end of the year. I'm not really seriously thinking about this, just because it would be way too much trauma for one year, both emotional and physical. Based on the pain from the lumpectomy, I'm guessing the pain from the mastectomy would make being on crutches pretty impossible. Dr. L said that of course I needed to take care of the cancer first, but also empathized with how difficult chronic pain is.

Eventually she brought me some information about various cancer resources - therapists, support groups, and whatnot. A few of them actually look useful. One thing that looks interesting is that the hospital offers yoga classes every other Monday night for cancer patients, which I am interested in trying to attend. I feel like my body has sort of gone to hell over the past year, especially since losing my ability to do my favorite type of exercise, which is going on walks. I really want/need to do something physical, and yoga might help with my stress as well. At the same, going into a yoga class with seasoned yoga-goers (with fresh, perky boobs in tight, nipple-revealing yoga get-ups) seems somewhat stressful right now. A friend and I had discussed going to yoga together, but now with all of this, I don't see it happening soon. But yoga with other suffering people might not be so bad. LOL. And as Dr. L pointed out, the yoga instructor is an oncology social worker with an understanding of people's needs and limitations.

In the end, I semi stopped crying, thanked Dr. L over and over, and gave her the flowers that I had dug up from my garden and put into a pot. At first I had made a bouquet from cut flowers, but it wasn't very pretty and looked like it would be messy. Plus, I wanted something that would keep living, not slowly fall to pieces and leave sad-looking flower skeletons in a vase of algae-filled water on her desk. Yes, you can read into that. There is some symbolism here. She was extremely appreciative. Then the nurse navigator came to say goodbye to me and I started crying all over again. You'd have thought I was just told that I was in Stage IV. It is amazing how much a doctor can impact you - good or bad. Of course, I am sorry that I had to know Dr. L at all, but I will forever be so grateful for the care that she provided for me, and for her absolute, genuine compassion. It has truly been a blessing.