Wednesday, October 24, 2012

The Sling is the Thing

We saw Kym's plastic surgeon, Dr. Doug Forman, on Monday (one drain down, one to go!). One of his staff members commented on how they recommend their patients wear a sling, but most don't heed the advice.

I bought this $12 sling at CVS for Kym after her latest breast biopsy. Then as now, it has really helped keep Kym comfortable postoperatively. It is easy to put on and take off, is reasonably stylish ("Black is always in fashion" according to Kym), and helped remind her to keep her arm to her side even after the immediate pain subsided.   

Plus it makes a great pity bandage! People know to hold a door and to avoid giving you a tight squeeze when they say hello. Maybe it can also get you out of a speeding ticket if you really work it (though I'm not sure it will show up on one of those dastardly speed trap photos).

And can I just say how amazing my wife looks? I never grow tired of gazing upon her beauty...

Monday, October 22, 2012

Love Delivers

Like many folks these days, we have a home phone that receives many more calls than are answered as most calls are of the telemarketer / political campaigner sort. But we've been answering more calls this week... and the door... and email as friends and colleagues have been pouring out love and concern.

We have been so grateful for these thoughtful gifts and words of encouragement. They have indeed lifted our spirits and have reminded us that we are not alone in the struggle.

Perhaps the most touching gift of all was the basket full of cards we received from our son's 6th grade class. T started attending a Christian school this year as he and Kym have both recently become Christians and are building deep ties with the faith community. T's class spent a whole period working on cards that included a Bible verse of encouragement. Each one was a cherished reminder of God's love and care for Kym.

To all who have reached out with flowers and words of support and encouragement, thank you! To  those who have offered to make food, we're working on that! More later.

Sunday, October 21, 2012

Happy Birthday to Me

There's just no denying it -- today was not a birthday full of celebration. I like birthdays all right and am not particularly afraid of uttering my age (48) or of getting older. I still feel like I'm just getting started and, other than the occasional back problem stemming from high school marching band (I was a 5-foot tall bass drummer) and my recent need for reading and driving glasses after enjoying 45 years of perfect vision, I feel fortunate to enjoy excellent health.

My biggest age-related shocker came a year ago when I met Katelyn, one of the new analysts at Deloitte. Analysts are usually campus recruits -- landing their first job out of college. Some quick mental math brought me to the realization that Katelyn was born in 1989, the year I delivered my first baby in med school.

During the five years I did obstetrics, I delivered around 600 babies and most of them seemed to be named Katelyn or some variation on the theme. There were some in-vogue boys names too -- like Conner and Max maybe -- but Katelyns were popping up more often than Super-PAC ads in an election year. And their parents honestly thought that they were being so creative naming their new baby girl. I didn't have the heart to tell them that their daughter was the third Katelyn of the day.

So I'm standing in front of this very grown up, professional Katelyn -- a colleague -- trying to keep from admitting myself into an assisted living facility. And I confirm that, yes, she was born in 1989. I could feel the Alzheimer's setting in. Since then I've met at least a dozen Katelyns (Kaitlins, Katies, Caitlins -- they're all the same) running around Deloitte pretending to be adults when they've barely had enough time to be potty trained. And the real pisser of it all is that they really are adults.

So I don't mind so much that my birthday this year was overcome by recent events related to Kym's breast cancer. Kym has been doing remarkably well. She's off her pain meds and is only taking a muscle relaxant to help with the discomfort related to the expander. Still, she's moving slowly and, following yesterday's cooking marathon, has been decidedly pooped. After making an appearance at church, she spent most of the day napping. Which was fine since Kym and I had already celebrated last weekend when we attended the wedding reception for friends Harry Greenspun and Kerry McDermott -- where this picture was taken. We got a room on Marriott points and danced the night away, knowing that it would be a while before Kym was ready to cut a rug again.

Instead, I took Taylor out for breakfast and that was pretty much the extent of it. In fact, the only way I could really tell it was even my birthday was from the many nice emails and notes on Facebook I received. A number of those notes included acknowledgements that they knew far too well what I was going through because their spouse was going through the same ordeal.

It struck me that I am now a man of a certain age where friends, loved ones and colleagues are starting to get hit with those medical issues for which they seem far too young to be eligible but are actually just early adopters on an inevitable curve of far too commonplace ailments.

Let's hope for the sake of all those Katelyns out there that all those walks and races and other fundraisers for the cure have their desired effect so that no twenty-something woman need fear that they will someday have to miss celebrating a birthday because of a disease, but will be blissfully ignorant of what it means to have breast cancer.

That would be the best birthday present ever.

Saturday, October 20, 2012

Breast Cancer Couture

Kym and I made a quick stop to see the plastic surgeon the day after Kym's mastectomy.  We wanted to make sure her Jackson-Pratt drains were working properly as one of them seemed to be blocked. Everything was working fine and we got a chance to take a quick peek under the dressing to see Dr. Forman's handiwork. The site looked great. We had been concerned about the integrity of Kym's skin since her tumor has infiltrated the skin's surface forcing her surgical oncologist, Dr. Wright, to make a wider skin resection than we hoped. Thankfully, Dr. Forman had the necessary room to spare to insert an expander, which he will gradually inflate with saline to stretch Kym's skin in preparation for her permanent implant when the time is right.

With her post-operative harness and two drains on her side, I thought Kym looked like a bustier-wearing gunslinger...

Drains aren't too much fun to manage, but they are fairly simple to handle once you get the hang of it. Just as you can find a video on YouTube for learning how to do everything from French braiding hair to wrestling alligators, you can find videos for how to care for a JP drain. I put in a few of these drains during my brief stint as a clinician and was comfortable with them, but seeing how to handle them on a video can really help the uninitiated.

Kym and I are committed to chronicling our experience on this cancer journey. There are many directions I can imagine going with these posts -- from providing perspective on the caregiver experience to delving into the emotional side of it all. Our goal is to be helpful to others on the journey and to help ourselves keep perspective through our own. If you have thoughts about what you want to see here, please share.

Wednesday, October 17, 2012

Kym's Drive-By Mastectomy

In my brief career in obstetrics (in the early '90s), HMOs were coming into fashion. The big patient advocacy kerfuffle was all about "drive-by deliveries" -- where the HMOs were pushing to get new mothers out of the hospital in 24 hours.

How times have changed! Kym's 7:30am mastectomy and the first phase of reconstruction went off without a hitch. She rolled out of the OR before noon and we rolled into our driveway at 4:30pm -- exactly 11 hours after we arrived at Suburban Hospital in the pre-dawn darkness.

Our surgeons both encouraged us to go home without an overnight stay if we felt ready for it. Kym never had a Foley catheter -- they just told her to call if she couldn't void by 8pm.

But in contrast to the cost-constraint HMO mentality of the '90s, the focus was all on quality and outcomes optimization. The routine use of catheters in surgery ends up increasing the risk of infection. And spending more time at the hospital increases the risk of hospital-acquired infections too.

It turns out that quality care and cost-effective care aren't necessarily mutually exclusive.

We were thrilled to be home eating our own food and pampering Kym. We couldn't be happier with the care we received from the physicians and staff at Suburban. They focused on getting the job done and treating Kym with respect and care -- including respecting her OCD issues (more on that another day).

We are home, Kym is enjoying her meds, and we are so very grateful for the prayers and support of friends and colleagues.

No Nodes is Good Nodes

What could bring a smile to the face of a woman whose breast has just been surgically removed from her chest?

Hearing your surgeon say, "Your nodes are negative."

Kym is sore, sleepy and very happy. Definitive pathology results will come in a few more days, but we have every reason to believe that Kym's cancer has not spread beyond her right breast.

My bride will be coming home with me very shortly.

The Waiting Place

You can get so confused
that you'll start in to race
down long wiggled roads at a break-necking pace
and grind on for miles across weirdish wild space,
headed, I fear, toward a most useless place.
The Waiting Place...

...for people just waiting.
Waiting for a train to go
or a bus to come, or a plane to go
or the mail to come, or the rain to go
or the phone to ring, or the snow to snow
or waiting around for a Yes or a No
or waiting for their hair to grow.
Everyone is just waiting.
Oh, The Places You'll Go - Dr. Seuss

I sit in The Waiting Place as I type this post. Not a figurative one, an actual Waiting Place -- one of the Waitiest, Weightiest Waiting Places of them all.

I sit in the waiting area of Suburban Hospital in Bethesda, MD as Dr. Pamela Wright removes my wife Kym's right breast and Dr. Doug Forman begins the process of replacing it with something that cosmetically approximates her breast. 

At this particular Waiting Place moment, I am waiting for the news of whether Dr. Wright finds metastases in Kym's axillary lymph nodes to go with the infiltrating ductal carcinoma and two areas of ductal carcinoma in situ (DCIS) that were found by ultrasound-guided biopsy on September 11th. That little bit of information, determined by frozen section of her sentinel lymph node, will determine whether Dr. Wright will go further with her surgery and resect two of three layers of Kym's axillary lymph nodes and whether Kym will need to add a course of radiation to her planned chemotherapy.

For those of you still trying to decrypt that last paragraph, here is the sum of it:
The love of my life has breast cancer.

My few years of taking care of patients as an obstetrician/gynecologist gave me a sense of what it is like to watch someone hear the word "cancer" for the first time. Once that word enters the room, it sucks the meaning out of all other utterances, making it difficult to process anything else.

For us, the word's impact is a little less dramatic if only for its familiarity. If you have read any of my other posts on how Kym and I met, married, and "made other plans," you will know that cancer has been a central theme in our lives -- especially in Kym's as her current breast cancer completes her carcinoma trifecta that includes Hodgkin's Lymphoma (in 1983) and melanoma in situ (2004). We know the word cancer is a scary word, but it is not all-powerful, nor is it necessarily an absolute death sentence.

So we wait -- she lying on a surgical table in a dreamless, medicated slumber and I in the relative comfort of the waiting area a few hundred feet away.

We have decided that a good therapy for us will be to write about the journey. We know that the story, however it unfolds, will both help us sort out our feelings and will perhaps give others some perspective as they experience a similar walk through the shadowy corridors of uncertainty and angst. Our own journey has been made less anxious by the postings of people like John Halamka and his wife Kathy as he dutifully chronicled her journey through breast cancer over the last year.

This particular Waiting Place wait is almost over; Dr. Wright will soon come out with the news of how Cancery Kym's cancer is. Then we will enjoy another wait for the more definitive pathology report and then the recovery wait and the chemotherapy start wait and many other waits beyond. But we are not focusing on the wait; our minds and hearts are on the moments that fill the waits, those Magical, Meaningful, Matterful moments that make life worth living.