Writer, mother and grandmother DIANE TREMBATH lives in Exmoor. After being given the all-clear three years ago, she has recently been diagnosed with breast cancer for the second time.
She has agreed to write a diary about her experiences for Live Better With - sharing her observations and insights, both practical and emotional. Here's part 5...
Early morning surgery meant that there was no chance of the prisoner eating a hearty breakfast – it was a cup of weak, barely milky tea at an ungodly hour and then sips of water, but only until arrival at hospital. My dear friend, carer and homeopath, J, and I set off at the crack of dawn – and it was a beautiful dawn – to ensure that we reached the hospital’s surgical admissions lounge by 7.30am, where everything seemed to be running like clockwork. Sort of...
Once we had checked in, the main waiting time was spent not in the admissions lounge but in a white cube of a room (thankfully with its own en suite bathroom). J and I talked, yet again, about the surreal nature of breast cancer treatment and I tried to remember what it had felt like the last time I had been in a similar room, nine years previously.
Spot the surgeon
There was a brief knock on the door and a tall, distinguished-looking, silver-haired man came in. It wasn’t my surgeon, Mr J, so I assumed that the new arrival must be the anaesthetist…
To give you some context here, I had originally been told that Mr J would perform the surgery (good news for me; he was my surgeon for the first bout of breast cancer and one of the most skilled and experienced in the UK). However, at my pre-op assessment appointment, I had been told that Mr J’s registrar would now carry out the surgery, under Mr J’s supervision. The nurse practitioner explained that the registrar was not a novice, however, and I should not have any worries. (According to the BMA, a registrar is ‘a junior doctor who has completed their foundation training but is still in training in a specialty area of medicine.’)
Knowing that the registrar would have had first class training, and that Mr J would be there, was encouraging and, although there had been a very brief initial flicker of disappointment, I hadn’t given the matter much further thought. And it’s vital for the next generation of surgeons not only to learn from the best but also to put what they have learned into practice.
‘Good morning,’ said the silver fox. ‘I’m Mr M, your surgeon.’
The silver fox may have been easy on the eye, but there was no way he was a junior doctor.
‘I thought it was going to be Mr J and his registrar,’ I said, somewhat confused by now.
‘No. I’m doing your surgery.’
‘Oh, OK… so where is Mr J?’
‘He’s not here today.’
And that was that. There was a brief and slightly awkward conversation and then Mr M moved swiftly on, turning my left upper body into something resembling a graffiti-covered wall. We’d already agreed that I was having a left-side mastectomy - yes, he had asked what I was there for – before Mr M mentioned the ‘level 3’ axillary node biopsy he would be carrying out.
‘Er, no,’ I said, it’s level 1.’
‘No,’ said Mr M, ‘level 3.’
‘But my patient record, signed consent form and notes all say level 1.’
‘No, I’m doing a level 3. There’s hardly any difference – about one node.’
Axillary node biopsy carries a higher risk of lymphoedema than a sentinel node biopsy, which I’d had before and which could not, therefore, be repeated. Axillary node removal levels run from 1 to 3 and the higher the level, the greater the risk. At least that’s what the explanatory literature for patients states.
To be honest, this is not really the conversation you want to be having immediately before surgery, with a surgeon whom you have never met before. It’s not good for a patient’s anxiety levels and I doubt that it’s good for the surgeon either. Who needs a distressed, anxious patient first thing on a Monday morning? So I morphed promptly into ‘smooth it over’ professional public relations mode, apologised if I had sounded snappy, and explained that it had all been rather confusing.
Mr M sat down, smiled, and immediately became more relaxed. We had a calmer conversation and he shook my hand before leaving.
‘You’ll be fine,’ he said, ’I’ve been doing this operation for 25 years.’
Definitely not a junior doctor then… but I was still curious as to the whereabouts of Mr J.
Looking back, if only someone had thought to explain, at the outset that, Mr J wasn’t able to carry out or attend the surgery but that I would be in the very capable hands of an equally experienced senior colleague, it would have made all the difference. A touch of clear communication would have taken only a minute or two and it seems such an obvious, sensible, and courteous thing to do.
Plainer sailing – accompanied by elephants and dogs
Throughout this time, L, a trainee nurse practitioner, had been in attendance and, once J and I were on our own with her, she agreed that medical terminology and language could sometimes be confusing and interpreted differently. She went to great pains to answer any outstanding questions we had; L was kind, thorough, empathetic and compassionate. What would we do without nurses and nurse practitioners?
When L eventually left the room I broke down and howled; I’d been holding it together for weeks but then the dyke burst. J just held me in her arms and let me cry it out. As I had told her (and continue to tell her) frequently, I couldn’t have coped nearly as well with the whole shebang if she had not been beside me.
Our next visitor, also L, was a junior doctor from the anaesthetics team; she was sporting a name badge in the shape of an elephant . This was very promising because the three of us were soon swapping stories about the joy of watching adult and baby pachyderms in South Africa’s Addo Elephant National Park. L then outlined the various procedures – and risks - that anaesthesia involved and we were back on solid medical ground.
Shortly afterwards, J and I had a ‘farewell, stay strong, and good luck’ hug and I walked down to the operating suite in my dark green DVT stockings, hospital gown, old silk kimono, and new slippers, accompanied by L. And there, waiting for me, was an all-female anaesthetics team, ready with a warm welcome (in every sense because, as well as personal introductions and smiles, there was an air blower heating the surgical couch…)
We talked about the conversation I’d had before my previous breast cancer surgery, with an anaesthetist who had told me about his hermaphrodite dog. (Absolutely true.) I’m not sure how often an anesthetics team is reduced to helpless laughter but those wonderful women then turned the whole thing into a ‘guess the anaesthetist’ game. And that was that. Believe me, if you are facing major surgery, there’s no better way to slip from consciousness than while laughing out loud.
Over – and out the other side
The next thing I remember was waking up in the recovery room at 11.40am, with a smiling nurse alongside me, checking my blood pressure, heart rate and temperature, and in no time at all I was wheeled to a bay in surgical admissions to be reunited with J.
The day had not started well but, once I was back on the ward, I could not have felt more safe, secure or cared for, from the nursing assistant who bought me tea (with plant milk – no problem being a vegan at this hospital) and toast with Marmite, to A, the nurse on duty, with whom J and I had the deepest conversation either of us had ever had with an NHS staff member about health, disease, and medicine.
K, my breast care nurse, arrived with a sheaf of paperwork, including instructions for protecting the wound dressing and checking the cumbersome but essential surgical drain, which was to stay in place for seven days, plus a temporary softie prosthesis (to be replaced in six to eight weeks with a permanent silicone prosthesis) and the soft protective armpit pillow, made and sponsored by local businesses. Before she left, K gave me a final reminder to make sure that I did the post-op exercises.
Then it was time for tea and biscuits and, by 4.20pm, I was sitting in a nearby patient lounge ready for J to bring the car round and take me home. Despite the absence of the dogs, who were staying with friends for a few days, my home and my own bed had never felt so precious nor so important to me. It was a very sweet homecoming indeed.
To be continued
Diane with her beloved canine companion Pumpkin
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