The trip to Royal Melbourne Hospital at 5.45am was uneventful. The day was overcast and traffic, light. In negligible time we were parked and headed to the Theatre admission reception on the third floor. A revisit of name, address and date of birth, just to ensure that I hadn't duped someone else into undertaking this procedure for me, and I was ushered through to finalise the details.
The nurse provided me with a hospital gown and a pair of those extremely fetching paper undies. Stretch stocking socks and paper booties. again completed the ensemble. After changing and a tearful cry and hug with Siobhan and saying that I was scared and didn't really want to do this, it was time for me to leave my wonderful rock and head through the swinging doors into the theatre complex, knowing that we wouldn't see each other again that day.
Guided to what looked like the recovery area I was put onto a gurney. This place was busier than the Flinders/Swanston streets intersection with all 12 theatres geared up and ready to each receive a patient. A quick peruse suggested much diversity of both people and procedure for the staff that morning as I was wheeled into the outer area of Theatre 1. Horrid fluroescent lights provided that buzzy blue-hued lighting that always makes me feel slightly queasy. Once stationery, two plastics registrars (not two plastic registrars) greeted me (Andrew & Laurent from memory) and asked me to stand. There, with my gown pulled down to my pubic bone, my Plastic Surgeon, Dean Trotter, together with these two other docs, proceeded to play dress-maker patterns on my torso from breast to hip, drawing dotted black lines around, alongside and under my breasts and around nipples. And then to determine what could be taken from my tummy, Dean grabbed my belly with both hands and squeezed. Ever stood near naked in front of a couple of strangers and had one of them grab your wobbly bits with both hands mentally weighing up what size cup he can turn your tummy fat into ?? Bizarre. Not a lot of dignity people, let me just say.
Following a brief but extremely reassuring visit from my wonderful Breast Surgeon Anita, whose
responsibility would be to take the breast tissue and nipples from both breasts, it was onto the next
meet and greet opportunity.
Back on the guerney, I was introduced to my anaesthetist, whose name I sadly cannot recall as I would like to declare her a national treasure. Suffice it to say, this excellent clinician ensured that not only did I enjoy an uninterrupted 9.5 hour sleep during the operation, my post operative recovery and first night was utterly trouble free for which I will be eternally grateful. When one is cut from left to right hip slightly higher than across the bikini line following the DIEP procedure which creates a new belly button and resulting tighter tumm, post operative vomiting would be a violent and extremely painful impost.
My anaesthetist inserted various bits and pieces and liquids into me to make me drowsy. She placed over me an extremely light weight blanket, one side made of extremely fine towelling paper, the other side was a very fine plastic not unlike the thickness of cling wrap. She then connected this blanket up to a plastic hose that was in turn, connected to a small portable unit now attached to my guerney at the end of the bed. Like an old fashioned portable hair dryer, my blanket inflated as warm air was pumped into the pockets. It felt like I was enveloped in a cloud - a warm and reassuring hug, which given its name Bair Hugger (though it should be Bear ), was utterly appropriate.
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| The Bair Hugger |
The last thing I recall was being wheeled into Theatre 1 and counting myriad people moving around what was a central chamber with two outer chambers linking in from separate doorways. I didn't remain conscious long enough to count beyond the 9 people I could see. But there seemed to be plenty more moving backwards and forwards in a variety colour of scrubs.
I had wanted to ask whether it would be appropriate to have some pictures taken during the operation and even a couple of short video clips of the interesting bits to upload here .....the cutting open, the nipple removal and the taking of the stomach flaps but on the other hand, I was unsure whether the key players would appreciate some kind of social media "So You Think You've Got Talent" intrusion into their work space. I decided not to ask and determined that immediate post surgical pics were sufficiently gruesome enough to give you the general gist!!!!
So I will post some photos with explanatory captions in the blog below that trace the first days post operation as well as the first 10 days or so post surgery so that you can see the body changing. I will post more stuff over subsequent months as my body heals and the swelling subsides and also to document the next stages (creation of nipples and tattooing that still must be completed).
Many things happened during my stay in hospital that I wanted to write about in actual real time as there are so many bizarre and ritualistic occurrences, that to the lay person can seem so absurd but to the health care professional are banally routine but I simply did not possess the energy to do so.
To provide you with a reference point, I have included a shot of what my breasts were like immediately pre-surgery. You will recall that the left breast had been operated on twice in May of this year, the first time to remove the tumour and the second time to clear the margins and also 12 lymph nodes under my arm which had tested positive. As the margins had to be cleared as a result of the second operation, regardless of the type of reconstruction I opted for, a third operation on my left breast was required.
Now if I was 17 years of age, posting a picture of the boobs would not be a such confronting decision (firstly because "kids these days", think nothing of sending pics of their pink bits to their 4000 closest Facebook friends, and secondly because if I was 17years of age, my boobs would be too!!!!) but in the interests of seeing what has been done with this procedure and also being able to see how quickly the body heals from major surgery is something quite compelling.
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| My breasts pre- operation. Note the underside of the left breast where two surgeries had been undertaken in May 2013 |
My operation lasted 9.5 hours. I was taken to recovery and then onto the Plastics/Trauma Unit - Ward 7 South East at RMH late on the evening Monday 11th November. For the next 24 hours, the nursing team (and every consultant, registrar, and coffee delivery man) would come into my room (a heaven-sent single private room thank you RMH) and "check my flaps" every 30 minutes. An unfortunate turn of phrase, one must concede, for the two pieces of skin grafted from my belly onto and into the place where my nipples once were situated.
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| The "lollipops" are the "Flaps" Note the newly created belly button and hip to hip suture line. |
So there I am throughout the evening, and night of November 11th, and the early hours of November 12th, still significantly delirious from the surgery and the anaesthetic with the wonderful nursing team popping in every 30 minutes and pressing the site of both grafts to test the return of the blood flow to the site which indicates that the blood supply is being maintained and telling me that my flaps look brilliant and the medical staff popping in and out randomly throughout the night also requesting of me to allow them to look at my flaps and following a bit of a press and a wait, also providing me with grave approval that my flaps did indeed look tremendous!! If I hadn't been so off my head, and extremely restricted in movement, I think I would have split my suture lines from laughing at the situation.
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| Right Breast Lollipop |
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| Left Breast Lollipop |
Sleep deprived and with a catheter and three drainage lines in situ, this routine continued for some days. Each morning, at 7.30 am or thereabouts either my Plastic Surgeon or the Senior Plastics Registrar would bring in a gaggle of junior doctors, some time as many as 8 of them in my room learning the ropes through exposure to the cases being undertaken in the Unit.
Now either I am getting so old that all doctors are looking like they were born this century, or they are sampling and experimenting on themselves and each other, all the new plastics procedures. They did not have a wrinkle to share between them if their life depended on it. All bar two were male and they all looked like they had stepped out of the pages of the latest GQ magazine!!! Very very good looking. Perhaps a selection criteria??? After all, would you trust an unfortunate looking plastic surgeon????
By day two post surgery with all tubes still in place things started to go awry. Not my flaps - they, it seems, were still fabulous - pink, soft and warm......responsive to touch indicating excellent blood flow but I would not be out of the woods for a full 48 hours post surgery. Apparently the loss of blood flow to the flaps can result in very quick deterioration and the graft can die. In case of a blood clot, you are raced back to theatre to address the clot and restore supply to the flaps. I hadn't seen them given my viewing angle and I couldn't bend to see the suture line across my tummy. However, of concern was my dropping blood pressure and oxygen levels and my extremely low urine output.
I was put on a regime of fluids including bags of saline, magnesium and phosphorite something or others- all 12 litres of them. Despite all the available orifices ( including all natural and those recently man-made by my doctors) through which this fluid could leave my body, for inexplicable reasons it did not and guess who ended up looking like Violet Beauregard after she had eaten Willy Wonker's experimental gum ball!!
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| Look Ma........no neck!!! |
I too no longer had wrinkles. Each finger and toe was its own bratwurst sausage and my skin was stretched to such a degree that bending my arms was uncomfortable. Sure, I had no crows feet and my skin was stretched very firmly across my face but I didn't look like one of those "Real Housewives of Beverly Hills". No, for me it was more a case of "Real Housewives of Bariatricville"!!!!!!
My Plastic Surgeon wasnt overly worried by the swelling as it meant that my flaps were being well supplied by well hydrated blood vessles, The fact that they may have soon needed to tether me to my bed in the event that I either rolled, or floated away like a big fat balloon did not appear to cause Dean too much concern. Mind you he seems to appear as a pretty cool customer perhaps well used to the absurdity of the situation.
He was confident that once I was up and moving around all the fluid being retained would make its way from my body. However, what with being cut from one side to another across the tummy and with the catheter and three drains in situ, this not so little black duck wasnt that all that keen to be getting out of bed anytime this century! It led to me having a bit of fluid on my lungs that coughing to dislodge proved to be a very difficult feat. So they placed this smoking mask across my face which had some chalk like substance in it that I was to breathe in and which would break up the congestion.
It did the trick and things started to improve. By Day 3 Post Surgery (Thursday) I had been assisted from bed and had taken a shower. A very long, painful and slow process when you have a a suture line, a tighter tummy and new belly button from the resulting tummy- tuck arising from the DIEP procedure. All of a sudden shower chairs, raised toilet seat frames and other such medical accessories are your fashion must haves!!!
I will write subsequently about the care I received whilst an inpatient at RMH as it deserves its own blog entry. But I can say this. You just know when you are being nursed by an outstanding nurse clinician. - their economy of movement, they exude a quiet strength and consistent confidence, their protective and preventative actions that assist your compromised movements and the grace in which they move around a disabled body and engage that patient in the process is a truly marvellous thing to behold. Bereft of the benefits of physical modesty and feeling utterly vulnerable due to such a compromised physical and emotional state, the quiet respect and competency demonstrated by your nurse towards you is the greatest salve to your jaded spirit.
So for the next few days, random registrars would appear at ridiculous hours and check out my flaps, take bloods (huge difficulty with my veins post chemo) so bloods were taken by doctors at weird times with no regard for standard "business" hours. Their engagement with you is so polemically different to that of the nursing staff. You are a set of boobs or flaps in my case, a series of wounds and drainage sites and perhaps also a set of symptoms. Trying to get them to engage with you can be a bit of a fun sport!! It appears that the relunctance to engage with the human being giving rise to the medical raison d'etre is still very much the style taught in our hospitals. I understand that with age and experience comes greater confidence and ability to relax and engage with your patient directly but seriously, the poor bunny in the headlights response to any patient generated direct question does need to be addressed in their training at some stage, the poor loves.
Two of the three drains were taken out Day 4 post surgery (the two draining fluid from my breasts) leaving the abdominal drain in place. Each day I was able to move a little easier though one still (and still does 10 days later), resembles a little old lady with curvature of the spine, so bent in half am I. I was discharged two days earlier than expected, undoubtedly directly attributable to my brilliant, fantastic flaps!!!
So I head home to the care of the Siobhan whose love, care and support have brought me through this protratced process to date. The West Highland Nursing Agency staff, whilst decoratively enhancing the home environment, are abit negligent in their duty of care unless it directly involves a bribe of a treat or cuddle!! At home, I am able to rest comfortably in a motorised recliner chair that I had brought for my mother more than 13 years ago, proving to all and sundry (particularly Siobhan) that hoarding can be a valuable personality trait!!
On Day 7 post surgery having been home for two nights, I have to head back to RMH to a wound clinic for them to check my abdo drain. I had had reason to call out Hospital In The Home (HITH) on my first night home, due to my drain tube running from my tummy and over the left arm of the recliner to a small plastic bottle on the ground(see above) and the dogs tearing around the corner to welcome someone at the front door, when they got caught up and pulled the tube out!!!!! Borrowing a wheel chair from Siobhan's mum we were able to head into the Hospital and then have a brief walk in the fresh air without me collapsing. I am able to only walk very short distances due to a combination of sore stomach becuase of the wound and lower back pai occurring because I am walking with a stoop!!!!!
I loathe the fact that my hair looks the way it does now as it could be mistaken by some as having been done intentionally. I do not have the face, nor the build for such brutally short hair!! Though had we been in Broome, one would have fitted in rather well there. Lots of gals with veeeeeeeery practical hairstyles and sensible shoes in Broome let me say!!
So now its Day 11 post surgery and here is how my body looks today. The abdo drain was removed at long last yesterday thus avoiding any further Westie entanglements or kitchen drawer catchings. Poor Siobhan is exhausted as she is single handledly responsible for all and everything around and about the house. I have a sway of follow up appoitments and can still only do few things for myself unassisted. I remain on some pretty fabulous pain killers and get tired soooooooo easily but I am more than happy with progress of the operation to date.
You judge for yourself. Hope you are enjoying good health good people
lotsa
Kelly
PS......The very sexy Compression garments one must wear 24/7.......sexy or what!!!
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