August 13, 2015 - One hand on the house

She was coming out of the exam room door as I was sitting down in the waiting room. I would place her in her early 70s, african american, wearing a matching grey flowy pant and top with a long waistline. The familiar bulge of the drain bulb situated at her hip under her long top. Her hair was in braids close to her scalp with grey and black color weaving through the rows. Wire rimmed glasses and a look of uncertainty on her face. Arms straight down at her side and shoulders curved in. Her husband held her elbow as she shuffled her step beside us to meet another elderly couple who must have joined them for the visit. "He said I couldn't even go outside. No walks, no yard work, no nothing. I said 'not even sitting outside? I can't stay inside all the time'." The lady friend said "you can't even walk outside?". The husband interjected "well, we convinced him to let us pull the patio table chair over and she can sit under the shade." The male friend asked "Dr. _____ said this?"  The husband,"No, lead plastic surgeon after we met with Dr. _____". And the mumbling continued as they gathered their stuff and headed to check out. Ron and I turned and looked at each other knowing exactly who had given these instructions as we had heard the exact thing 3 years before. We too had replied "not even to the mailbox?"

Several things struck me about this. This was her first appointment after her mastectomy surgery. She had just received a lot of information she needed to process. Her friends wanted to support her so they probably drove her and her husband to the appointment. While she looked a little overwhelmed, she looked content. And her husband was there in stride with her taking great care. It was a picture of everything you would want it to be. And it was familiar.

Ron and I got called back. Blanch, the most delightful new nurse was there. She'd been in this role for 3 months now and prior to that she did....get this....wood working. She used to build furniture and decided to go to nursing school. She was the most likable person you would ever meet. She raved about working with Lead Plastic Surgeon. I questioned her on this, and she said, no seriously he is so wonderful to work with. There need to be more delightful people in oncology. In fact, there should be a rule that un-delightful people need not apply. It really can change just about anything. They set you at ease, and they too can laugh about boob jokes.

Lead Plastic Surgeon arrived to inspect the goods. Then he ask, "have you looked at it?". He knows me too well. I told him Ron had, and then I grinned. He said "can you look at it now with me?" He's gentle and I appreciate that. We walked over to the full length mirror and studied the art before us. The difference was immediate. No longer was there the flat shelf on the right that existed before. It had rounded out. He said it would take a few more months to fully transform, but the surgery worked for what I needed it to (appearance) and for what he needed it to (functionality). He said he couldn't believe what he found inside. My body had rejected the implant and had encapsulated it not once, but twice with scar tissue. He said he removed the first capsule, but then found another one under that. Over time, it would have worsened, and then hardened, and become very painful. In that moment, I knew we had made the right decision to have the surgery. It calmed my soul. His only concern now is how thin the skin was after separating off all the scar tissue, so he placed a new mesh sling between the implant and the skin to 1) support the weight of the implant 2) provide more thickness to the skin. If all goes as planned, the skin will attach itself to the mesh making a thicker barrier. With my original surgery 3 years ago, he had also placed the mesh layer, but my body never incorporated it like it was supposed to (this was found when I got cellulitis and had to remove the implant). So we really want this one to incorporate this go round to help my skin out. And we want to prevent encapsulation of the left side. I guess all of these complications we've had are a reflection of how radiated tissue (my chest) simply doesn't function the way you would hope with normal healthy tissue. And why Lead Plastic Surgeon has been so conservative with me from the get go. Anyway, the area appears to be healing nicely at the incision, and the drain is now out. Mission accomplished so far.

Drain out! (Poor Blanche, she had to endure my counting and heavy breathing and getting everyone on the same page of removing on "six".)
Antibiotics for 5 more days.
Sports bra 24 hours a day for 1 more week, then flimsy bra for 2 months
Lifting restrictions for 3 more weeks
No driving 5 more days
I can now sleep on my unaffected left side
Ron back to work at the office today. Eeekkk!

On my way out, I told Lead Plastic Surgeon I observed the 70 year old couple leaving and the discussion I over heard. He responded with "keep one hand touching the house, I have to be so literal with you ladies. "  I greatly appreciate his conservative approach. He has a true care with best intentions at heart. And he lets me cry when I need to cry. You will be happy to know that I was all smiles yesterday. I hope the same for Ms Hattie, as I will call her. I know she has a long road ahead.

Headed out to the appointment. Excited for drain removal day.