Pre Op 11.23.2007

I know this is after the event, but I just have to document the events leading to the actual surgery.

Dan and I got to admitting at 0920, got registered, and got called to go into the Lab for the CBC and type & screen. One poke and done. From there we were directed to Same Day Surgery. At Same Day Surgery desk, she showed us into a cubicle, Patient 3. She said she'd be right with us. It's approximately 9:50 now and we were told the Needle Localization was scheduled for 11:00. 10:15, no one comes in. 10:30, I go to the desk to ask them about my time frame. (pesky patients.... we'll be in in a few minutes....) Finally someone comes in and drops off the admission consent and the surgical consent. I notice that the surgical consent is dated and timed for Wednesday's surgery that was postponed. So when (she didn't tell me her name) came back in, she changed the date and time and initialed the change. I initialed it, too. Then she compared the consent with the surgery schedule, and the wording was different. She instructs me to get into the patient gowns, the first one open in the front, and the second one open in the back. Dan helps me with the gowns. She left again to page the Dr to verify the wording on the consent. My brother Tom arrives. It's now 11:00, and we are getting anxious about getting over to the Breast Care Center. Dr finally calls back, says the consent is fine, and the transport guy is here with the wheelchair to go the the Breast Care Center. Tom, Dan, and me in the wheelchair, (he tucked me in real good with blankets, too) got over to the next stop.

At the Breast Care Center, Charlene, who did my films at my first appointment, showed Dan and Tom to the waiting room, and me into the exam room. She explains what we're going to do. This is a stereo optic mammogram. (oh) And it's a table, with a hole in the center. Underneath is the plate squisher thing. Looks quite ominous. She helps me climb onto the table--I have to use the step thing with the handle--and get positioned "in the hole". No kidding. It is not a comfortable table, and I can imagine that people with back issues would have problems. So you're kind of down in the well with your breast in the mamm machine. Charlene maneuvers my breast tissue and moves the plates and sqooshes the breast, then goes behind the divider and takes a picture. It shows on the screen, and there's my breast, I can see the marker that had been placed in the tumor, and the tumor itself. Decent. She goes behind the divider and takes another picture from another angle, and there it is. Stereo optic images of my tumor.

Dr. Lewis Jones, Director of Radiology, a very pleasant man, comes in to do the Needle Localization and Radioactive Injection. A phone call is made because the radioactive stuff is not here from Nuclear Med. Seems it got used for another patient, and they need to mix up another dose. Dr. Jones checks his watch, because this stuff needs to be injected a couple of hours before surgery. He shrugs his shoulders, says it's no problem, by the time Dr. Sanchez is ready to search for the lymph nodes it will be time enough to have been absorbed. OK. Dr. Jones is under the table and calls out some numbers to Charlene--she confirms that that's what she's got, too, and I realize that must be some kind of measurement/marker system that correlates with the films that Dr. Sanchez is going to use in surgery. Dr. Jones tells me he's going to inject the breast with lidocaine (like we did with the biopsy), then place the marker for Dr. Sanchez. He rolls his chair under the table (is this weird or what--because, you know, I'm still squished in the machine) and he numbs the breast. So far, so good. It did burn just a bit. Then he placed the hollow needle through the breast and into the tumor. Then he and Charlene went behind the divider and took a film. They come out. There's the image. He advances the needle just a bit more, and they both go behind the divider, take the film, and come out. Perfect, he says. Then he tells me he's going to place the wire, threading the thin wire through the needle, and somehow hooks it into the tumor. When he does that, I feel a pinch, and sure enough, that's where it's been achy. It was reassuring that the breast discomfort was originating from the tumor. After the wire is placed, they go back behind the divider and shoot another film. They come out, look at the image, and says "perfect". He gets back onto the stool underneath the table, and removes the outer hollow needle, leaving the wire. He rolls out, and Charlene stoops under the table. She proceeds to inform me that she will coil the external part of the wire and secure it with Tegaderm (clear plastic) dressing. I don't really feel her do that, either. She then sticks a very small BB over the very insertion site of the wire, so that Dr. Sanchez will know precisely where to go. Charlene comes out from under the table, releases the plate (whew), lowers the table some, and assists me to roll onto my back. ok. Breathe.

Dr Jones comes back in with a vial of stuff from Nuclear Med. He's drawing the stuff up, and says he's going to inject 1 ml in each of six sites around the areola, the dark part of the nipple. (Hmmm????? My pulse quickens) ok. breathe. Hold still, now. It might burn. (Holy dogs--shouldn't I have had some of that anti-anxiety medicine for this procedure.....????) And it goes like it does in the movies--he holds the syringe up, getting just a bead at the tip of the needle, and wipes it on the sterile 4 x 4, the aims for the site. "2 o'clock" he says aloud, and inserts the needle and injects 1 ml of fluid. (Good, that part's still numb) "4 o'clock" he says again, and inserts and injects. (Didn't really feel that one, either) "6 o'clock" -- ouch, that one bit. "8 o'clock" That one burned, too. "10 o'clock" He's concentrating on getting the bead just right and wiping it off each time, and I ask why. So the geiger counter thing doesn't get confused. Oh. That one hurt just a bit. "12 o'clock" Didn't feel that one at all. "Very good," he says, looking quite pleased with himself. Maybe that's why he's the head of the department. I breathe a few times. Charlene asks me if I'm ok. Sure. She helps me to sit up, then off the table. She helps me change the gown around to close in the back "because that's the way surgery wants it" and kindly wraps me in my blankets and escorts me out into the hall. My films are up on the screen, Dr. Jones is finishing his notes. After he leaves, I talk with Charlene about how much tissue there appears to be. If the tumor is 1 cm, and Dr Sanchez takes 1 cm surrounding it, how much is left to the skin surface? She has her handy dandy ruler, and holds it up. Hard to tell, but 3 cm of tissue looks to be quite a bit of my breast.

Tom and Dan are summoned, I repose to my wheelchair, and wait for the transporter. The boys look at the x-rays and are appropriately impressed.

The transporter arrives to take us back to Same Day Surgery. It's 12:05 when we arrive back at the cubicle for Patient 3. Jim and Polly find their way in. Good to see familiar faces. What's-her-name comes in and hooks me up to the blood pressure machine. 128/99. Whoa!! I'm a bit anxious!! (you think??) She has difficulty getting the thermometer to read, so I walk her through putting the probe back into the machine to reset it. Oh, there it goes. 98.1. O2 Sat 100%. (of course--I've been deep breathing to keep my s*** together) Pulse 78. ok. Now the flurry of personnel--Jackie will circulate, she's going over the paperwork. Dr. Bob somebody is the anesthesiologist. Well, you're healthy, open your mouth, yeah, good, we're ready to go. She doesn't have an IV yet. No IV? Matt can start it. (I hope so) Matt comes in, he's the CRNA. He glances at the blood pressure machine. I tell him my pressure is normally 100's over 60's, so when my pressure drops after I'm asleep, don't panic and start pushing stuff. He smiles and says ok, good. He gets a 20 gauge in first try, right at the bend in the back of my right hand. Whew-was worried about that, too. Dr. Sanchez is there, too, and she's busy in the chart, writing something. (H&P?) While the OR crew is in there, I remind them of the torn rotator cuff and frozen shoulder on the left side, the one they'll be working on. Dr. Bob turns around and looks, and asks me where I can put my arm. We talk about positioning and support, and he says something about giving me Versed and heading out. I see the needle coming at my port, and say just a minute, I want to remember talking to my family. Someone on staff chuckled. I tell them see ya later, hugs and kisses, the medicine is injected, and I remember the cart moving.