Server Down

That's what we used to say at the now defunct Napa Valley Grille where I used to work when a server would take a spill or be totally in the weeds in their section.

Server Down.

Started the day heading into San Francisco on a drizzly foggy morning, to see second opinion Plastic Surgeon, and possibly my guy if things do not work out with True North.  His office on the 4th floor was in the same building we had just been in a week or so ago, to meet Dr. Hands on the first floor.

We were greeted warmly by his staff and didn't wait long to be seen.  We met his Physician's Assistant first, and she asked questions from the typed summary I had made of the details of my case.  She was pleasant and thorough.  After she was done, she asked me to change into the goofy tissue paper thin gowns that never quite close and often rip.

Dr. Welby came in shortly after and I have to say, this guy is so charming, relaxed, personable and All American Dad handsome.  We chatted as he asked questions about my case, peppering the conversation with comments about his teenage kids and working as a server through college and part of medical school.

"I think everyone should work as a server at some time in their life, talk about multi-tasking.  I always loved that job."

You had me at hello Doc, don't tease me now with your appreciative server talk.

I was immediately comfortable with him, he was very engaging, interested and had a great easy style about him.  How could you not feel like you were cared about and in excellent hands with this guy?  By the scrapbook in his waiting room, he is obviously loved by his patients and its not surprising when you meet him.

He spent a great deal of time with us, at least an hour, and asked a fair amount of questions about what True North and The Wizard had planned for me. These are the top two plastic surgeons in the Bay area doing the DIEP procedure, and obviously each other's competition.

He talked to me about the decision to have reconstruction before or after radiation.  He quoted several studies, all of which he said pointed towards having reconstruction AFTER radiation.  The reason is that radiation can alter the appearance of newly reconstructed breasts and in one particular study out of Texas, women had to go back about 45% of the time to have the breasts "fixed" after the effects of radiation.

It was obvious that Dr. Welby was biased towards this approach.  I was surprised at this new development.  True North had said they would make Flopsy about 20% larger than Mopsy to allow for shrinkage after radiation.  If the breast is still a little large, then she would lipo it to make it symmetrical to Mopsy.  She never really discussed it as if it was a problem or a concern.  No big deal.

Dr. Welby made it seem as if you'd have a 50/50 chance of having to go back in and have another surgery to correct radiation effects.  Under his plan, I'd have The Wizard perform my left mastectomy, recover, have that side radiated, and then 3-6 months later, have my mastectomy of Mopsy and reconstruction of both breasts.  Under his plan, I'd have an implant to hold the spot where Flopsy was, and then have to wait several months for the reconstruction.

I appreciated what he was saying, but was not happy at all thinking about delaying this whole thing into next spring.  I've had my mind set that I'd wrap up this whole thing by the end of the year, and kick 2010's ass out the door with a big swig of Martinelli's Sparkling Cider, all of this behind me.

We left there realizing we'd need a lot more information to make an informed decision.  Dr. Welby said the decision was mine, he would perform the reconstruction prior to radiation if that's what I wanted, but it was obvious he does not think this is the best plan.

I have my work cut out for me.  I need to talk to The Wizard, True North, The Good Witch and my new radiation oncologist, Dr. Lotus, to ask all of them their opinion.  I may even need to talk to another radiation oncologist for a second opinion.

I need to find out from both True North and Dr. Welby how many DIEP's have you done, how many that were radiated after reconstruction needed repair, and how many that were radiated then reconstructed needed tweaking?  How satisfied were patients with the end result?  Excellent?  Good?  Satisfied?  Not?

I looked at several other plastic surgeon's websites later that night, and they seem to be fairly divided about the best course.  Some plastic surgeons do not like reconstructing a mastectomy that has been radiated.  They said that because there is no breast tissue there, the radiation tends to cause more hardening and tightness in the skin, and the skin loses elasticity.

Others recommend the DIEP first, and when the reconstructed breast is radiated, the new boob absorbs some of the radiation, and there isn't as much hardening.

Some like Dr. Welby, prefer reconstruction after radiation, because they don't like the effects of the radiation on their newly constructed work.

What's a girl to do?

This has been one of the difficult parts of this whole process.  There are no clear road maps, and often huge debate on the best course.  Some oncologists do chemo up front, others still do all the surgery first, then chemo.  There is much debate among colleagues in the treatment of breast cancer, and regional differences too.

We headed back to the Cancer Center, and Husband dropped me off then headed in to finish the rest of his work day.  I was feeling confused about the whole thing, but happy to be at chemo for my SECOND TO THE LAST TREATMENT.  Little did I know what I'd be in for.

I saw Vonda walking down the hall to greet me, where I was sitting no one else could see her.  She lifted up her shirt to flash me her GIANTS sweatshirt underneath.

"You flash everybody that comes here, or just me?"

I sure love that girl.  We always walk arm in arm down the hall to the Chemo Center.  She escorted me to my room and we sat and made each other laugh waiting for Kitty to get me my lovely poison.

"Will you change my dressing first, cause I'm all raw under there, and the line has gone in to my arm again?"

"Sure honey" Kitty said and went and got all the new dressing for that.

For the month and a half or so I've had the PICC, my skin under it is raw because they have to keep the whole area covered and sterile with Tegaderm patches.  The skin is soft and gushy and pale now, like I've been in the hot tub way too long.  With the skin being so soft, the slack in the PICC line burrows right into the skin and hurts!!  I also noticed that where the line enters my bicep, it seemed red and agitated and felt a little hard.

Kitty came in to the room, and then peeked out to ask if she had other patients.  Nope, I was the last one for the day.  The private chemo rooms have a large glass sliding door and a curtain, all of which are usually left open.  Kitty was so cute today, she slid the heavy glass door closed, threw the curtain to seal us in, and had a shit-eating grin on her face like

Woo Hoo, it's Friday, LET'S PARTY!!!

Vonda didn't have any patients either so she hung out, and before you know it, Mariah was in there with us too.  The four of us chatted while Kitty cleaned me up before starting chemo.  I sure love those ladies.  I am so overjoyed to be finishing chemo, but I will sure miss my five month Friday date with them!  Wow, I will miss them bad.

Kitty got me all cleaned up, taking the patches off, swabbing orange iodine over the whole area, and then moving the slack of the PICC line to a different place on the skin than it was before.  First thing she does before chemo is flush my PICC line with saline, by hooking it up to the valve at the end of the line, screwing in the plastic syringe and pushing in the saline.  The plastic syringe has a long plunger and she just pushes the liquid in.  That's when I feel the cool saline going through the line and a little when it goes into my arm, and then it's gone.

Kitty pushed.  The plunger did not budge.

Kitty kept pushing.  Nothing.  H-m-m, she wondered out loud, is this thing clogged?  She kept pushing, moving around me to get a little leverage to give a good shove to the plunger.  Nothing. 

"Well, let me change the valve at the end of the line, it must be clogged."  No biggie, right?  Kitty unscrewed the valve, screwed a new one on, reattached the syringe and gave a good push.

Honey nuts and oats.  Nuttin honey.

"Well, you are just our problem girl, aren't you!" Kitty said with humor and a little tension in her voice.

Oh holy crap, don't even tell me, I got two treatments to go, and my damn PICC ain't working?  What is it with me and the mechanical problems?

"Ok, so here's what we're going to do, I am going to flush out your valve with some (I forgot what she called it, but like draino for a PICC line) and that should get things flowing again.  In the meantime, I'll start an IV in your left arm to give you your pre-meds and then we'll switch back to your PICC to give you the Taxol."

Ok, I thought.  No biggie, right?

But if the Lab can hardly get a good vein to get blood of my left arm which has gone to shit, how is Kitty going to find a good enough vein to get an IV going?

I tried to relax cause Kitty works magic and talks to God when she has to do crazy MacGyver stuff to me.  Kitty is one of those fly by the seat of her pants gals, and she makes it work with whatever she's dealt.  That's how she moves through life too.  She makes it work and has faith that God will deliver help and a plan.

Kitty searched my arm.  Not a damn thing.  When a nurse with a needle starts flipping and torquing your arm to find a vein, you know you're in for some shit.  She gave a try in a spot on the arm, and when she was in, ouch, tried for the blood return.

Nuttin honey.

She continued the search then looked up at me discouraged and hesitant.  "I'm going to have to use your hand, and the only thing I see is this small vein here by your thumb.  I'm sorry honey, I'll do my best."

What happened next, I don't know if it was the wicked pain, the fact that I had not eaten all day, had my lunch with me but with all the excitement and delay had not starting eating yet, or if maybe it was all the months of trauma getting poked, stabbed, repoked, snipped, cut, all without any gin or whiskey.  Not even a silver bullet or smoked turkey leg to bite down on.

Kitty asked Mariah to get her a the smallest butterfly needle.  Butterfly needle for a skittish butterfly.

The mood started to change in the room.  I broke out in a cold drenched sweat.  I had my cute girl wig on, Miss Vonda smart ass says "You want me to flip your wig around so you can't see what's gonna happen next?"  [She was full of it today.  When I first came in she was talking about needing her eyebrows done cause they were so dark and bushy, and she says "like the hair on my ass."  Yup Vonda, I put it in.  You deserve it for all the torture!  I love you girl, you crazy funny thing.]

When I'm all done with this, the two of us could get into some serious trouble together.

We all laughed hard at her wig joke, that uncontrollable laugh that's mixed with fear.  I was drenched and feeling really strange.

"Ok here we go" Kitty said.

"Take a deep breath" Vonda said.

Mariah just looked at me scared, and I know I looked back at her scared shitless.

Kitty poked.

Oh shit, I thought, are you kidding me, oh shit.  How much more of this wicked just feels wrong hurts like hell, ouch, I can't explain it, Oh Lord help me, I can't do this shit anymore, I just can't.

I'm sorry folks, I can't do this shit anymore I thought to myself as I started to feel dizzy, and then the next thing I knew, Vonda and Mariah were fussing at me and I could tell they were talking loud all in my face but I couldn't hear anything.  It was like I was underwater and sound was muffled, and then nothing.  I could read their lips "Debbie, Debbie, come on Debbie" but no sound.

I was blacking out.  Shit.

Kitty continued to stab and move that needle around my thumb knuckle to get that itty vein, and one of the others, I can't remember who, flipped the leg rest up on the chair to get my feet up.

I still couldn't hear anything, just saw Vonda and Mariah lip synching, scurrying around, looking worried, running to get a fan, dabbing me on cheeks and forehead with a cool wet paper towel, and patting my hand hard.

I was trying not to go, but I was going.  I felt my eyes rolling back and I was trying hard to stay awake but...

Crap, I haven 't blacked out since karate class in high school when I was on my period and just had the flu, and down I went mid Hi-ya!  My Karate teacher was this hot Bruce Lee type and when I woke up I was cradled in his arms.  I was hoping he had given me CPR and asked him so, but it was not to be.

Now here I am, Server Down, 34 years later, in a damned chemo chair.  Who's gonna give me CPR?  Where the hell is Bruce Lee?

The next several minutes were a complete blur, but good ole Kitty's prayers and steady hand got the needle in and the drip dripping while Vonda and Mariah revived me.

They all looked at me so sad and so sorry and so lovingly, and I felt absolutely terrible I had worried them so.  They know better than anyone I've been through some weird odd glitches, one after the other after the other, and here in the home stretch I guess I just lost it.  I don't even know what happened.

They got me some ice water and saltine crackers and before you know it, I was rosy again, but definitely wilted, bruised, shaky and confused.

Kitty told me recently a patient fainted in chemo, the Dr. told them to call 911.  Oh man, I would have hated that and they knew it.  They weren't letting me go down.  My girls, got my back.

Order was restored, although the IV in my thumb proved to be very painful and very tempermental.  The vein was so small that if I moved even slightly, the drip would stop.  Kitty kept repositioning my hand and turning my thumb to get the needle back into the right spot, and rigged some tape on it, and the drip dripped.

What usually would take a little over an hour to drip, ended up taking well over two hours.  We never were able to switch back to the PICC.  Kitty tried to flush the draino in, but that wouldn't push in either.  My PICC was blocked and nothing could be done except take it out, and hope that this and my last chemo could be given by regular IV.  They don't like doing this because it is better for the Taxol, which is a real irritant, to travel through a line and then dump into the large vein leading into the heart.  When they give it without the PICC, the Taxol has to travel through the veins all the way.  It's just not as efficient, and can be corrosive to the smaller veins before making its way to the larger ones.

When Kitty started the Taxol, there was a terrible burning in my hand, Kitty was worried. 

"Ok, we can't have the burning, if we can't get it right into the vein and if it keeps burning we are going to have to take it out."

There was no way in hell I was going to have chemo delayed by another week.  I must have given Kitty a look that pleaded "I don't care what you have to do, make it work.  I don't care how it hurts or how long we're here, just make it freakin work."

Kitty did.  This was the first time in all these months of chemo one of them stayed in the room with me the whole time.  They never left my side.  Sometimes the drip would stop dripping or the burn would come back and Kitty would shift my hand a little or move my thumb slightly, and we were back in business.

"Well the good news is, I can take your PICC out today, and I promise, it won't hurt, really, it won't" Kitty said.

That was weird and almost hard to believe, my PICC was coming out today.  Damn, what a ride.

I forgot to mention I showed Kitty and Vonda the new rash on my hands, like poison ivy, and they said Dr. should see it.

Once we got chemo going, I needed to call the Disability Office before they closed as a follow-up regarding my check which had not arrived and from their account the day before, was not even being processed yet.  Getting through to a person at the EDD is like trying to get the President on the phone.  Just as I got connected with them, The Good Witch walked in ready to talk to me.

Oh geez, my check.  My doctor.  My check.  My doctor.

"Doc, I'm on the phone about my disability check..."

"It's ok, I know how hard it is to get them, I'll come back" and off she went.

I got the check thing all straightened out, because I had worked some shifts they were still processing that, but it should come next week, a week late.  Not so good when you're living paycheck to paycheck on half your pay.

Da Good Witch came back and while she washed her hands, my angels told her about the excitement of Server Down.  She looked at me like poor baby, and shook her head.

Yes, I am Da Queen of Da Glitches and Houston We Have A Problem.  Uh huh, that's me, as charged.

Good Witch examined my rash, asked all kinds of questions, and got that worried thinking cap look on her face.  "When did this start?  Anybody else in the house have it?  Eat anything different?  Could these be flea bites?"

Started last night, no one else has it, no did not eat anything different, and no fleas please!

"Well, your skin is extremely sensitive and I think all of this is the Taxol building up and your body is reacting and had enough of all of this.  We only have one to go, you will get there.  Ok so the PICC is coming out and next week we'll use the right arm for chemo?" she asked Kitty.

Nurses all agreed.  The Good Witch pulled up in the chair next to me so I could tell her about my meeting with Dr. Welby.  She already knew all about True North.

As we were talking, Vonda and Kitty were trying to sneak taking my PICC out, but I turned to them mid-sentence and said "I hear you guys" and we all laughed.

"Really, it's not going to hurt, just keep talking to Dr. and don't look and we're going to take it out."

Oh God help me.

Kitty was right, it didn't hurt, just felt like a damn snake crawling out of my body, across my chest and collarbone, down my arm and slithered out, back to hell.  Kitty threw the snake into medical waste.

Ok so am I a drama queen?  Really guys, really, some of this stuff just feels all wrong and you are aware of things in your body that just aren't supposed to be there.  Really.  Wicked.  That's how a lot of this is.  Wicked.

After listening to my whole deal and dilemma with Dr. Welby, I could tell the Good Witch thought he was being way to conservative and maybe a little old school.  She knows I want this stuff done and really don't want to wait if I can help it.

She suggested I phone True North and talk to her about all of this and as I had already decided, ask both Plastic Surgeons how many have you done, how many before and how many after radiation, and what were the problems with each?  She also recommended I talk to my surgeon.

She also said the Cancer Center out of Texas where some of these studies came out had "questionable numbers" and I generally felt like she thought if all the insurance stuff goes well, go ahead with True North, of course after all my fact finding.

I felt much better after talking to her.  She also mentioned if I went to five more plastic surgeons, I'd get five different recommendations so don't drive myself crazy over this.  Get as much info as you can and commit to your decision.

Next week I'll have my last chemo, please God, and then I'll see the Good Witch the week after that, and we can discuss the surgery/radiation options again.   She's my quarterback.  My Chief of Staff.

Vonda had put my lunch in the fridge and asked if I wanted it, but I wanted to wait till I got home.  I was whipped but had a huge sense of relief that my PICC was out.

I finally finished the Taxol and Kitty hardly lifted the taped down IV when the needle, barely in, just popped out on its own.  She looked at me and we both smiled.  We did it.  I am still on track and the Eagle has landed one more time despite stormy weather.

I hugged all my girls goodbye, especially Kitty.  Her daughter is scheduled for a C-section on Monday and so Kitty won't be there for my last chemo.  Probably just as well, I think I'll be crying a lot and even more so if she was there.

I love you Kitty.

I said all my goodbyes and waited for Batman who was picking me up.  When he got there, I asked him to park cause I wanted the nurses to meet him.  I paraded my six foot handsome baby around the chemo center like the proud Mama I am.

Have I mentioned how handsome both my sons are?  They got their Daddy's good sense and height, and my looks and personality.  Hee hee.  Good combo.  Would not have been as good if they got my good sense and height, and Daddy's looks and personality.  Just kidding Husband.

I went home liked a whipped puppy who spent the night out in the rain, just wanting to be home and inside and warm and crawl into bed.  I wolfed down my tuna sandwich and got in my bed.  I did it.  I did it.

Let the cranked up jacked up chemo crack decadron howling at the moon begin.

I was still wired at 2 a.m. but felt this peaceful grace and happiness come over me like somehow the worst was over (for awhile) and I was so thankful for my Angels at the Cancer Center that treat me with such love and kindness and humor and tenderness.

I NEVER EVER could have done this without these specific people.  I am serious.  I could not have done it without these lovely ladies who love me back as much as I love them.  God sent me some remarkable angels for this path.  Right on time for me.

I wrote another post a little after 2 a.m., this euphoria coming over me.  I last looked at the clock at 5 a.m.  Those next three hours flew by as I thought about my life, and these last five months, my new body on the way, just everything.

The people I love, the people who have helped carry me and lift me up on this path, and all the wonderful medical people I've met along the way, and the new ones I'm meeting now.  I have been so fortunate to get the kindest most personable care.  I have been treated with great affection.

For the hardest most challenging time of my life, some days hanging on by a thread, some days ready to give up if not for all the people who love me, I have been blessed by my family and friends, and some incredible people who have come into my life to help me get where I need to go.

It was a hell of a day that carried over into the next, and after only four hours of sleep, I woke up at 9 am completely wired again and still have not slept at all today.  Maybe I will sleep tonight.  I don't know.  I don't care.

I am over the moon that I no longer have that IV hanging out of my arm.  My arm is all banged up, scarred up and lots of inflamed tissue, but its out.  Its out.  I won't have to look every day at this visible reminder that I have cancer, I am in chemo, always having to adjust my arm to feel better, wear the little tight sleeve on my arm to protect it, and have people ask me what is that, and so on.

I look more like me now to me.  More like the old me.  The Deb without cancer.  Except for the white fuzz on my head and the sunless sunburn on my puffy pufferfish face.

I made it through another challenging day and finished it happy and grateful and peaceful and hopeful.

Tomorrow I will tell you about some things I keep forgetting to tell you about.   Changes I've made eating more whole foods and Omega 3, and the affirmations I say out loud every day.  I said a lot of them to myself last night before I finally fell asleep.

I felt so exhausted and yet wired today, talking a mile a minute, the boys know the drill when Mama is on chemo crack, but I am happy and relieved too.

I feel as if I've turned a corner.  Only tonight and tomorrow night left of Cymbalta, already feeling much better there, and ever since I got my PICC out, I swear, my neuropathy in the right foot and leg is so much better.  It might be the chemo drugs with their false high.  Probably.  I hope it stays.

Maybe I can work?  Will iron my apron for good luck.

One more to go.  Lots of phone calls to make next week.  Should be hearing back from the insurance company regarding payment of Dr. Hands.

I am still hoping for him and True North.  Still my first choice.  We'll see what happens.  I'm not even going to try and predict.

Stay tuned.

Love.  Love.  Love.