Nov 23, 2019
Surgery Day
So here it is. The day after surgery blog that should hold some relief with it. My feet aren’t as cold, and I am not as anxious because it is all over today.
Let me start with my day. I got up super early and showered. Packed my hospital bag and was picked up by my friend Andrea who has been there every step of the way with me. She is an amazing trooper and I know she struggles with all this too. She has lost family members to breast cancer and seen the struggles they have had when treatment wasn’t so good in the past. I can see her struggling with positiveness around this situation and is relieved when I get good news. She is optimistically cautious which is fine. I know how hard this can be firsthand. My eldest daughter, Katria on the other hand is the most positive cheerleader I know. She has no reservations to tell me all the positive things that can occur. She tells me that “I am that bitch”. She says, I will get through this and will come out stronger on the other side. She reminds me that it was caught early, and the surgery took everything that looked suspicious and yes even though they took 2 lymph nodes that she said the Dr. said slightly lit up on the scan, it was good to get them out and tested. She said even if they showed anything, they are gone, and you will get treatment. It is only uphill from here. She brightened my waiting in the surgery waiting area by showing me pictures of Layke our cute havanese and laughing about funny things. Ellery, my youngest is my quiet saviour. She is worried too and is at an age that makes her look inward rather than outward at the situation. She was amazing in the surgery waiting room too. All smiles and wanting hugs. The hugs weren’t exactly like we would normally do but we still managed some awkward hugs away from my boobs. She posted a beautiful comment on Facebook that I will forever cherish because although she doesn’t express these words to me verbally, she wrote it for the world to see. “My mom is one of the bravest, most hardworking, amazing people ever. She is strong. Heart…”. Wow, what can I say? This was beautiful and truly heartfelt. I really don’t want my children burdened with the worry or anxiety and so I hope they can be resilient and move forward. I know that Ellery has struggled leading up to this surgery this week at school. The school has been supportive, and I am so thankful.
We arrived at the hospital, registered and then onward to nuclear medicine where they would place many needles of dye into my breasts to scan for the lymph nodes. They quickly got me into the room after I put on a blue gown and they sat me down. A lovely lady explained what would happen. They let Andrea be in the room. I actually wanted Andrea in every room that they let her. The only place that didn’t was the ultrasound room where they put in the wires. I was told it all depends on the doctor’s preference. I was off to central registration where they would provide me with a chart and send me to the day surgery area. Along the way, there were many volunteers ready to point the direction of the next interaction. This hospital was under construction and so in order to organize the volume of people that need to be directed, this was likely the only way to make it work. One of my observations is that many day patients and in patients were mixed with visitors walking the halls so there wasn’t a lot of privacy. I was walking around in a blue outfit with an IV saline stat lock in the halls where visitors and others were walking. I am hopeful the new hospital building will be more patient centered in their experience for all these operational needs and programs.
We arrived in surgery and there were rows of beds around central nursing. I was given a bed and waited for a nurse to come in and ask me a few questions about my health and allergies. She said they would put in an IV and lock it for later. She attempted the IV on the left but was not successful. Another nurse came and did it without any discomfort on the right side. I was so grateful. Once this was all in place, they sent me back to the nuclear medicine to scan for pictures of the dye. The lady placed me in the machine and small plates came over my top and close to my chest. I waited for about 4 minutes. She saw something light up and so they put a mark on my skin where those were located. She then did a second film on the side and located the same lymph nodes on the side. I am guessing these are not good to light up, but nobody wanted to tell me what it meant. I am guessing that if there are irregular cells in the lymph glad, they absorb the radiation. I am going to stay hopeful that it is negative.
Following this procedure, I went to ultrasound area to wait for my Kopan wire insertion. These are fine wires placed under guided ultrasound to the lump so the surgeon knows where they are going. The ultrasound department was so cold and dim. Even Andrea was saying it was cold and she is never cold. Patients like me who have anxiety are even more cold. My feet were frozen. We waited a long time. It felt like over 30 minutes in this fridge. Following that they took me into the ultrasound room, and it was also cold. They didn’t let Andrea into this room. I cannot stress how cold I felt. The ultrasound tech went and identified the nodules and then asked me to wait. She offered me a warm blanket and then left. I waited lying on the bed for what seemed like a long time. This waiting time was probably one of the two larger poor experiences. Eventually, the radiologist and ultrasound tech came back and then started the Kopan procedure. Having already had two biopsied breasts I knew what to expect more or less. The kopan wire insertion was new. The Dr. did seem confident and said he does these 3-4 times a week. There were apparently a lot of breast lump removals. Lying there on a cold hard bed and having needles and wires poked in was a hard thing to tolerate. I tried to just take it as is and know that I had to move past this step to get to the next one. We consent and submit. It is all part of being a patient. Yes, I reminded myself that I wanted the procedure. I want to get this out of me, but I also know how being uncomfortable makes it harder.
The one other poor experience I had was when the IV nurse who couldn’t get my IV in, and then right away didn’t get another one in on a patient across from me, made a comment that it must be a Friday thing. That did not make me feel confident about her or the surgery. Because I was scheduled Friday afternoon as the last surgery of the day, shouldn’t mean I don’t get everyone’s 100% in patient care. I hope these nurses realize how these comments in a situation of true anxiety can affect the mental status of the patients there. They have no idea how patients are sitting there quietly submitting to all the procedures and feeling anxious. No matter how experienced a patient is in having procedures or surgeries, there will always be apprehension and having a nurse say she failed at a task because it was Friday is horrible. Everyone paying attention could hear her.
You need to give your Friday, your Monday best.
Once the Kopan was done, we went back to surgery area where Ellery was waiting for me. My mom had arrived. Ellery was happy to see me. My mom came in but had been sick this week so was wearing a mask. The nurse came and attached the IV drip to my IV. I was basically ready to go. I visited with Ellery, then Katria and my mom. Finally, it was just Andrea and I waiting to be taken in. It was well past my time when they took me from surgery into the OR area. Here I had to walk with my gown on, nothing but socks and booties they gave me to cover my socks and holding my IV pole. We left Andrea and I was off by myself following a young porter guy. He put me into another waiting room in the OR area. I was cold and he brought me a warm blanket. My feet were frozen as they had been the whole time. Another lady soon joined me and was talking about how she was trying to get her kids to do their own cooking while she was off. She was laughing about how it was hard to leave them on their own. We had a few laughs and then her Dr. came in to tell her about her procedure and anaesthetic and said they would be there in a few minutes to take her in. They got her ten minutes later and I waited again. I saw a nurse who is actually a friend on Facebook who works in the OR. I asked her for a warm blanket. She brought me two. One for my feet and one for my back. I talked to her a little and then she left. I waited and finally when my blankets were cold again, the anaesthetist came and sat down beside me. He was wearing the typical blue uniform and was young. He appeared to be in his mid 30s. He asked me a few questions about my checklist that I filled out and my history. He told me that he would be using the typical anaesthetic. Said there is a rare form of genetic issues but since my mom was okay with it, he didn’t seem to be worried. Just had to tell me the two rare things that could be problematic. I told him I was a bit nervous. He didn’t know how to answer my concern.
I could tell that was a struggle for him to know what to say.
Then my surgeon, Dr. Kolyn showed up very smiley and energetic. She told me they were just changing over the room. It wouldn’t be much longer. Sorry that I had to wait. She said don’t worry we will have all the time we need in there. She said everything is set up as per pathway and looks great. She leaned in to mark my left breast with CA for cancer and my right as B for benign. She smelled like coffee which made me smile inside for some reason. Through my anxiety and worry, at least the Dr. had time for a coffee and was coming to me with her Monday best.
I wished that everyone had her bedside manner, her positive attitude and way to ease people’s minds.
They both left and I waited a bit longer until a nurse came and verified my name and walked me into the OR.
This was a first experience for me, walking into an OR for the first time. I was quickly stunned by the size of the room, the many people that were standing there in blue scrubs with mostly faces covered watching me. The lights were bright. I was quickly told not to touch this one table as it was sterile to my left. I was ushered to the other side of the operating bed. I noticed a table with an iPad on it and a jacket to the far corner. I saw the big operating lights above me that you see in the movies. I saw these red and white wrap pads at my feet. I was very curious about them. As I lied down on the table two nurses were applying them to my calves but the one on the right was too small, so they had to get bigger ones. I thought they said it was for circulation. They probably lightly compressed and released throughout surgery to minimize any blood clots. What a great idea. They took my left arm and placed a blood pressure cuff around it and said it would blow up the first time fairly tight. Immediately after that they placed an oxygen mask around my nose and mouth and asked me to take big breaths. They adjusted it and then I heard the anaesthetist say that I would be going to sleep. Now I was in the Olympics and would defeat all the odds and control my mind. I immediately pictured my girls how they were dressed that day together and placed my dog Layke in the picture between them. I had practiced this image that day and had thought about it the day before. I wanted a happy memory to go with me as I went under.
The Recovery Room
As they were still rolling me into the recovery room, I was waking up. I could remember the wheels moving. An older nurse with grey hair told me where I was but I don’t remember all our conversation. I asked if they took my lymph nodes. She said the Dr. would come and talk to me. I asked I think about the surgery. I asked what time it was. Apparently, I asked the same question 3 times and the nurse seemed annoyed. She said that the anaesthetist answered my question and so did Dr. Kolyn and so did she. I said I was sorry. I didn’t remember all of them talking to me. I did remember Dr. Kolyn a bit. She said everything went fine. The nurse asked if I was in pain. I said I didn’t know. She wanted to know if I wanted pain meds through IV or could take a Percocet pill. I said I didn’t know. She did give me a sip of water and then I said my throat hurt and so she asked me if I wanted a popsicle. I said okay. They asked me what flavour. I don’t remember which one I picked but the popsicle turned out to be blue, the same colour as the radiation dye. I said to the nurse now my tongue will be the same colour as my body and pee. She made some comment on some animal having that colour and I said Sharpei’s have blue tongues. I told her I had a Sharpei. I asked her if I needed the Percocet. I wasn’t too keen on taking more medications. She literally put it in my mouth and gave me the water. The next thing I knew they were wheeling me into the surgery waiting area again where they let Katria in to see me. I am sure I was in recovery for over an hour. Then I asked for Ellery and my mom and Andrea. My dad was there too and soon everyone was at my bedside. The nurse came to see me to ask how I was feeling. I was getting clearer. Eventually he took the IV out and then had me walk ten steps. I was able to change into my cloths and then they brought a wheelchair to take me home. My dad wheeled me to Andrea’s car, and we were off home.
Reflections on patient experience
Although this is a recount of my time and day, there are many touch points that mix together to form a patient experience. Everywhere I went and all the people I was interacting with were giving me information and perspectives to either worry further or remain calm. The environmental factors were a large issue when my body turned cold from the anxiety. The waiting and not being allowed to have my support person in the room with me was another issue. Each professional didn’t do anything wrong but neither did they all make me feel secure or confident. Many didn’t smile or talk to me as Helen. They often were just there to do their part. I am grateful for all their parts but that is not the ideal experience. Mostly I remember being in the surgical area with many other people who were waiting for their turn and we were all facing each other in a long line of beds with most curtains open. I saw the expressions that were thoughtful, fearful, anxious all around me. The nurses were polite but having that one nurse talk loudly about her failure to do the IV because it was a Friday was such a miss for patient care and patient experience. Every word that comes out of their mouths is listened to with extreme mindfulness. All the interactions that we experience from the admissions clerk to the surgeon all make a difference in our confidence and health. Dr. Kolyn was outstanding in every interaction. She was the only one who gave me the positive along with the risks. She treated me like a real person and showed empathy to my situation. I am so grateful to her.