Five months from my initial diagnosis in Brighton, I had endured 6 mammograms, 3 ultrasounds, 2 CT scans, 2 biopsies and 2 general anaesthetics. I also had an MRI but that wasn’t related to my cancer. Apart from the MRI, all of the above ultimately led to the main event, a mastectomy and reconstruction.
Despite the date for surgery still being undecided, the Queen Victoria Hospital wanted to get me in for the pre-op assessment as soon as they could so that I would be ready as soon as a date was set. They asked me to attend the appointment on 26th May 2022. As I had recently had two previous pre-op assessments I mistakenly thought this one would be pretty much the same.
My husband was chasing his tail with work so, rather than ask him to take me, I asked a friend who kindly agreed. Because some Covid restrictions were still in place we assumed she wouldn’t be permitted to accompany me to the appointment so she waited in the car for me. I genuinely thought it was just some blood tests, MRSA swab and a couple of questions but had no idea I was going to hear all the details otherwise I would have asked if she could come in with me. I really regret not asking because it turned out to be very tough on my own.
First stop was the physical assessments – height, weight, double-checking information on forms, more blood tests and, on this occasion, an ECG (Electrocardiogram). Pretty straightforward and little that I hadn’t already done many times recently.
Next was my meeting with the Head Anaesthetist. Prior to my two earlier surgeries I had been visited by an anaesthetist at my hospital bed to go through a few important questions so I assumed it would be a similar conversation. I couldn’t have been more wrong! It was much more involved than that. He was a lovely man who spoke with compassion as he literally gave me a step by step account of what would happen on the day of surgery.
⁃ The surgery was estimated to take between 6 and 8 hours
⁃ I would be catheterised as it is not good to have a full bladder for such a long time. Also it would mean I wouldn’t have to worry about getting out of bed to use the toilet directly after the operation. The nurses would make sure I was able to walk a few steps before removing the catheter the day after surgery.
⁃ I have a history of severe nausea following previous general anaesthetics. However, there are various ways in which your anaesthetist can change your anaesthetic in order to reduce your chance of suffering sickness. One way is to administer Anti-sickness medication (anti-emetics) via a cannula. This has worked well for me in my recent surgeries.
⁃ I would have two drains inserted, one in my breast and one in my stomach. They would both be removed before I was discharged. A surgical drain is a small plastic tube that is sometimes used after an operation. It is put inside you during the surgery by the doctor and will stick out of your body until it is removed, usually a few days later. It connects to a small plastic bag that collects any fluid or air that has drained away from where you had the operation.
⁃ They would get me ‘up’ as soon as possible as this would speed up my recovery. He said as far as they were concerned the bed is for sleeping in only and they would encourage me to sit in the chair as much as possible post-op.
⁃ The estimated stay in hospital was two to three days. He believed that being at home promoted a quicker recovery than being in hospital.
⁃ Once the operation was completed I would be taken to the intensive recovery ward and would be observed every 15 minutes for at least the first 24 hours. They would be checking for any post-surgery complications so I could be taken back to theatre immediately if necessary. My drains would also be checked every 15 minutes to measure the output.
⁃ I would need to inject Heparin (an anticoagulant) to avoid blood clots after the operation. I would have to administer one the evening before and for a period of just over two weeks after. They would prescribe 15 syringes but said I would not need to bring any to the hospital as the nurses would do them while I was in hospital.
⁃ I would also be given a special lemon flavoured carbohydrate drink called Nutricia PreOp. It is specially formulated to help your body cope with the stress of surgery. Nutricia PreOp can make you feel more comfortable and less anxious before your operation. It can also make you feel a lot better after your surgery.
⁃ Prior to and during the operation they would administer Gabapentin. This drug helps to reduce post-operative nerve pain.
⁃ In addition to this I would have what they call pain-controlled analgesia (PCA). PCA uses an infusion pump to deliver a pre-programmed dose of an opioid medication when a demand button is pushed, in this case morphine. There is what’s called a ‘lockout interval’ which is a time period after a successfully-delivered demand dose when the pump will not administer additional opioid, even if the demand button is pushed, making it impossible to overdose on the medication.
The anaesthetist acknowledged that this was a lot of information to take in but he said it’s better to know what to expect as it can be very daunting to wake up and find yourself surrounded by lots of plastic and tubes. I appreciated him taking the time to talk me through it all. Another kind and empathetic health professional in our National Health Service.
Sometimes the strength within you is not a fiery flame for all to see, it is just a tiny spark that whispers ever so softly ‘You’ve got this. Keep going.’
Next I went in to see a specialist nurse who talked me through what to expect after my surgery. She talked to me about some of the practical things I needed to do to prepare and what my recovery would look like.
Firstly she showed me the drinks. I would take two bottles the evening before the operation and four the next morning before 7.00 am! Otherwise I would be nil by mouth from midnight the night before. She showed me how to do the injections and advised me to do them in alternate thighs as I wouldn’t be able to do them in my abdomen. I could either do them myself or ask someone to do them for me. I wanted to try myself first then I wouldn’t have to rely on anyone else to do them. My daughter is a carer and could do them if I needed her to but I thought it would take the pressure off if I could manage them independently.
The next discussion was something I had not previously been told about. The nurse showed me some support underwear that I would have to wear 23/7 for six weeks after surgery, only removing them for showering. They had to be medium control pants and go up to just below the bust. Use of post surgery compression garments is proven to be incredibly effective in aiding recovery from plastic surgery. They protect wounds from unnecessary abrasions, while providing sufficient support and preventing lymphoedema. They may also provide pain relief helping to minimise swelling, improving blood circulation, while reducing pain. She showed me some examples and a few tips on the best places to buy them, based on other patients’ experiences. She advised me to have at least two pairs.
As with my lumpectomy in January I would also have to wear a post-surgical bra and surgical stockings 23/7 but this time for six weeks, not two. Oh joy!
The nurse said that I would be able to have short, light showers as the dressings would be waterproof. I was pleased about that. It’s horrible when you can’t wash properly.
She also gave me a leaflet containing a chart of when it was ok to do everyday activities. For the first two weeks I would be able to do very little. No lifting including a kettle, anything that required standing up for more than a few minutes and any form of stretching my arms in the air or anything that would stretch my tummy. I would not be able to stand up or lie down completely straight for at least the first few days. The chart was divided up into week 1, week 2 and went up to three months. It included when you can drive, do fitness/sport, housework and so on. In some instances it suggested a timescale and also said ‘or when it feels comfortable to do so’.
Finally she advised me what to take into hospital with me and to pack for five days to be on the safe side. At one point I felt really panicky. I thought I was going to be sick and my eyes started welling up. Although everyone I had seen that day had been really kind I was totally overwhelmed.
I had one more thing to do before leaving. I had a prescription to collect from the hospital pharmacy. I picked up the six bottles of drink, a box of syringes of Heparin and a little yellow disposal bin for the used needles. The pharmacist gave me all the details for collection of the bin when I’d used the last injection. Then I walked out of the hospital with my large paper carrier bag of scary stuff!
When I got back to my friend’s car and started to tell her all about it I did actually cry. She felt bad that she hadn’t been there but it wasn’t her fault. I should have asked if she could come with me. I soon recovered and it helped to tell another person while it was all fresh in my mind so I would be less likely to forget any of the important bits. We did have a bit of a laugh when I told her about the chart and she said “you could put that on your fridge so the family can all see it” with which I replied “Sod that! They don’t need to know. I’m going to milk it for all it’s worth!”
It was all beginning to feel very real and scary….
A woman’s strength isn’t just about how much she can handle before she breaks. It’s also about how much she can handle after she’s broken.
Not long after that appointment I was finally given a date for the surgery – 14th July 2022. Although it still seemed quite a long way off, in the grand scheme of things I was okay with that and it meant that I would have a few weeks of relative normality to do the things I was worried I was going to miss out on.
“Patience is not the ability to wait, but the ability to keep a good attitude while waiting.” – Joyce Meyer (author).
Hoping for a Happy Ever After 