DIEP Reconstruction Aftermath: 17 Days

Yesterday was Friday, and Friday afternoon means time to see my plastic surgeon. Friday afternoons are when Dr. T sees patients in the clinic that is closer to where I live, and takes about half the time to get to than to UH.

My husband took the kids on a trip, so I was alone yesterday and today, which is fine. Nice, in a way. They left on Thursday night, which meant that if I wanted my husband to drive me to my appointment, it would have to be at UH on a different day. Otherwise, the remaining options were to stick with the Friday afternoon gig and drive myself, or get someone else to take me. The obvious 'someone else' in this case was my mom. I've written before that I've had a little bit of a hard time with my parents since my diagnosis, so I was a little very stressed about this, but it seemed safer than trying to drive myself 130 miles round trip, considering the last time I drove, it was only 12 blocks, and I spent the rest of the day sleeping.

I've also mentioned before that I have a ridiculously low tolerance for stress, so low that after all this crap, I can't even believe I'm alive. My husband once had a pet rabbit that died after literally being scared to death when it accidentally found itself in the same room as his dog, and I think I'm a lot like that weak-hearted rabbit of his. I was so stressed about going to my appointment with my mom that I was nauseous all day (which led to me not eating, which led to me feeling light-headed the whole afternoon) and short of breath. Of course, given my history of DVT, when I'm short of breath, I automatically think PULMONARY EMBOLISM, PULMONARY EMBOLISM! Fortunately, I have enough self-awareness to recognize my hypochondriac tendencies, and know that I get shortness of breath from anxiety, which I prove to myself over and over when I recover immediately after the stressor is removed. Perhaps a cruel twist in this is that one of the classic stress management techniques I've relied upon heavily throughout the years is belly breathing, which is quite painful after you've had your belly sliced open and super-glued shut.

Anyway.

Everything went fine, and I was much better on the way back than I was on the way there.

My main concern right now is my nipple. I mentioned this in my last post, and this panicked e-mail I sent to Dr. T yesterday pretty much sums it up:

So the story of my very sad nipple continues... It has this layer of gooey grossness around it that is half sloughing off, half clinging on, and I am not sure what to do with it. Should I keep it covered and moist or let it dry out or what? Put something on it? Dr. L told me not to pick at it, but it is literally falling off into my clothes and basically leaving a big mess behind. (Underneath the dead stuff, it is bleeding, so I guess that is a good thing?) It is so gross - worse than the drains. I know I have an appointment to see you tomorrow, but I want to do the right thing in the next 24 hours so this horrible thing doesn't contaminate (for lack of a better term) the rest of the tissue. Please advise.

He replied promptly:  

Keep a dry dressing over it. It'll crust over and heal. The fact that there is healthy bleeding tissue under it is great news. How do the breasts feel overall? Any other changes to your skin or swelling?

So on top of worrying about going to the appointment with my mom, I was worried about my nipple being gross, gross, gross. Even though I had prepared Dr. T for the fact that my nipple was gross, and know that as a surgeon, he sees really gross shit all. the. time (not to mention, as my surgeon, has me at my grossest), I felt really self-conscious about just HOW GROSS I was. So I took a shower in the morning and cleaned up the best that I could because seriously. Dignity, folks. (I like to think I have some.) And going to desperate lengths to save my nipple was my idea, not Dr. T's, so I have to admit that the school girl in me was fearing there might be a little bit of I told you so! ahead of me.

All the worry was for naught, though. Dr. T thought my nipple actually looked good, surprisingly good. He kept reassuring me, It's good! Very good! I told him the past week had made me think I should have just let him cut it off like he wanted to, and he said, No! No! It's going to be worth it! in a voice that was the reverse of I told you so! and more like You told me so! I told him I knew I wasn't supposed to be messing around with it, but that I just had to try to clean it up before my appointment - it was THAT GROSS. He thanked me and said I had done a nice job. LOL.

(And wow, I can't believe I just wrote, like, four paragraphs about my nipple. Oh breast cancer, what are you doing to me?!)

Everything else was good. Dr. T almost seemed in awe of his own work as he inspected everything and said, 'Wow, that looks good. Wow, that looks so good!' He did say that part of my transplanted tissue seemed a bit harder than the rest and wanted to see if there was any fluid building up. After trying to locate a Doppler in the clinic, he eventually walked me down the hall to the ultrasound room, assuring me the whole time, 'Everything is good, everything looks great. I just want to make sure there's not fluid build up.' I asked him what it would mean if there were, and he said, 'It'll be okay. Don't worry. Don't worry!'

It was quite a hilarious scene, the ultrasound. The ultrasound tech had no idea what a flap transplant was or what she was supposed to be looking for, and Dr. T had never done an ultrasound before. But eventually he/she/they determined everything was good, and the tech switched to a view that showed blood flow, and instructed Dr. T to move the probe around. I had mostly been closing my eyes because I cannot stand to look at myself, and closing my eyes is apparently some sort of anxiety-ridden escape mechanism. 'Can you see that?' Dr. T asked me. Then, noticing I was trying hard to NOT pay attention, he instructed, 'Look up! Look at the monitor!' Red lines streaked across the monitor. 'That's blood flow,' he said proudly. 'That's the blood feeding the transplant. It's good! It's great!' He was like a kid in a candy store. He was giddy; everything he said had an underlying tone of OMG I cannot believe I did it!

Then he walked me back to the original room, asking me if I had any questions for him. I asked him about the limited range of motion in my arm, and what I should do about it. He told me he intended to contact Dr. L about a good physical therapist in town, and that I should start physical therapy... sometime. After we got back to the room, I figured he would split and that would be that. But I sat down, then he sat down, and talked to me about a few things, including a fundraiser he asked me to attend - BRA Day - promising that 100% of the 'awareness' money would go toward actual research. (But seriously, BRA Day? I tried not to gag while he was telling me about it.)

Eventually, as things were wrapping up, I took a deep breath and said, 'Can you do me a favor?' Of course, he said, Sure. I told him that I wanted him to meet my mom. I knew he was running late, and I knew it was the last thing a doctor running late needed, and as a patient, I knew it was the last thing I'd want a doctor running late to be running even more late over, but yet I asked him anyway. I explained apologetically, 'My mom is afraid of doctors, but I think she'll have a much easier time with all of this if she meets you.' And it's not just that my mom will have a much easier time; if my mom has an easier time, then so will I. He nodded knowingly, making a joke about how he was not a scary person, then asked what my mom's name was, and if it was okay if he went and got her. I told him it was.

So while I got dressed, Dr. T went out and got my mom, and about a minute later, he and my mom were back in the room, and Dr. T poured on the charm. Ha! I really thought he might just introduce himself and say that I was doing well, and my mom could at least have a human face to attach to my stories, but apparently before he got back to the room he told my mom that she had done a great job raising me, because I was fantastic, just fantastic, LOL! Then, back in the room, he launched into a long story about how medicine has changed, how doctors are trained to guide patients and not boss them around. He added that most of the people he went to med school with went into it because they wanted the personal interactions, the type of interaction we were having right now. Then he went on to explain how a lot of the time plastic surgeons are misunderstood, how he had once done heart surgery and organ transplants, but that doing reconstructive surgery for cancer patients and gravely disfigured accident victims was more gratifying. He even has a talk he gives - called Boobs and Butts, hahaha - that actually illustrates how plastic surgery is so much more than just that. Then he volunteered to come down and give a talk to my students, if I wanted (not necessarily the Boobs and Butts talk - anything I wanted). Oh the charm! The wining and dining! Only wait, this is after the fact. No, this guy is just cool. A-M-A-Z-I-N-G. Even after all he has put me through, I feel so lucky to have him in my life.

A funny thing happened during the appointment. Dr. T openly admitted to me that he had not really wanted to do this surgery. He wasn't sure he could do it; it made him nervous - the lack of fat, the possibility of blood clotting. He wanted to give me an implant. ('Tall, lean people look good with implants.') He did the surgery because I made him do it. He said this as he explained the surgery to his medical assistant, who seemed pretty awestruck by the idea that my breast was not actually a breast at all. Dr. T told her, only half-jokingly, 'I didn't think I could do it, but...' 'But I made him,' I finished for him. He grinned, 'Yes, she made me do it.' He said it as if a proud father bragging about having an assertive daughter. Proud of me, proud of himself. In retrospect, I knew this already, but I didn't expect Dr. T would ever admit to it openly. This whole time, I felt like I was reading into things too much, but... I wasn't. I appreciate the openness. It makes him real, human. He has always been this way, but now it is more.

Maybe next time I will ask him if he really did hurt his eye, or if he was just testing me.