Happy Birthday, Dave!

Today is my husband Dave’s 33rd birthday. While this cancer crap has been hard on everyone who loves me, he is in the unenviable position of being the only person, other than myself, of course, who has to live with this 24 hours a day. The kids are too young to be very aware of what’s actually happening, and as much as I know it’s on my parents’ minds pretty much constantly, my mom can go home and focus on other things from time to time and my dad is 1500 miles away.

Obviously, I am the only one who has to deal with the physical pain of healing from surgery, experiencing the poison of chemotherapy and actually having had the cancer inside me, but as my husband, Dave has had to deal with the reality of knowing his wife and best friend is sick and hurting and there’s really not a whole lot he can do about it.

We have been together for almost eleven years and every marriage has its ups and downs. Unfortunately, we were in a bit of a rough patch for a few months recently and then – dun dun dun (the music again) CANCER. There have been times in the last 5.5 weeks since my diagnosis when I just really wasn’t sure how we were going to make it through this cancer journey together.

Today Dave stepped up and came through for me in the most amazing way and I was reminded of why we’ve been together for as long as we have. We may still have challenges ahead of us in our relationship, but I think today was as much a birthday gift for himself as it was a huge gift to me.

We had another appointment with my plastic surgeon today – Dr. Jacobsen of the fancy schmancy Biltmore office. Over the past week, I’d been getting increasingly anxious over the fluid build up in my healing chest and especially over the pain and numbness of my left arm yesterday. I wasn’t sure if I was healing well enough to start the process of filling the implant expanders and I was just generally apprehensive about the whole appointment.

Our appointment was set for noon. We finally got called back into a room at 1:30 and we didn’t see the doctor until after 2pm. This was our fourth visit to his office and we’ve never waited less than an hour to get in with the doctor. In fact, despite the office having two waiting areas, there are usually so many people there that some have to stand for a while.

Dr. Jacobsen finally entered the room and asked how we were doing. I told him that I definitely had some fluid build up that had me concerned and tried to describe what I’d experienced with my arm yesterday. He was moving about the room, pulling over a tray of instruments, adjusting the booby spotlight and generally not seeming to pay much attention to anything I was saying. He had me open the drape top to examine me, pushed a little on the fluid build up and said it was really very little and nothing to worry about.

As I was still trying to describe the arm concerns, he rubbed an alcohol pad across the top of my chest and I winced. He told me I couldn’t feel anything and I let him know that the top of my chest is still quite tender and bruised-feeling and it did actually hurt for him to press on it like that. In order to do the fluid injection for the implant expansion, a small tool has to be pressed to the skin to find the opening in the implant. He was continuing to rub the alcohol and press the tool into me while I was trying to ask a question, so I stopped and asked what he was doing.

He joked that it was a Geiger counter and he was checking me for radiation and in the next half second I realized he was coming at me with a three inch needle.

I yelled at him to stop and he assured me that it wasn’t going to hurt (though I was obviously feeling more than he seemed to think I could). I told him that I wasn’t concerned about pain, but he couldn’t just be coming with me at a needle without telling me what we were doing. Of course, he’d explained the process last week when the drains were removed and I knew exactly what was supposed to happen today, but what kind of doctor walks into a room and starts a procedure without ever asking a patient if they have any questions or concerns about the procedure??? This whole interaction had taken place in less than three minutes after we’d been waiting for over 2 hours.

I told him that I felt like he was talking down to me and he was just worried about whether or not my boobs were going to be pretty (and he reminded me that he’s very good at what he does so of course they will be) while I had actual concerns about healing and getting well and didn’t really give a damn in that moment what my boobs were going to LOOK like. I was still concerned about not having feeling in my arm for a day and the fact that I couldn’t even make myself lunch and had to call my mom and sister to come make me a sandwich.

He said he never used the word pretty (which he hasn’t; he says I’m healing beautifully and that my new breasts will be absolutely beautiful) and then asked if they made me a good sandwich.

He said he wasn’t talking down to me and again told me that I wouldn’t feel any pain in the procedure. At this point I was pretty pissed off, so I just leaned back for him to redo the alcohol and expansion-finding tool part. I have never had a fear of needles and have always kind of enjoyed watching blood draws and things once the needle is actually in. As long as I don’t watch the insertion, I can generally watch the rest, so once I felt the needle prick, I looked to see how the rest of the process went.

As he was slowly pushing saline into the first implant, he said he’d be able to drain the fluid on the other side from the same insertion that he’d be filling the implant with. Now, the implant opening is at the top of the chest and of course, all the fluid build up was pooled in the bottom of the area (thanks, gravity). When I asked if he’d really be able to get all of that fluid out without fishing around in me with a needle, he assured me that he didn’t fish. He said if I wanted a doctor that bad, I’d have to go find one down on Van Buren. But then he admitted he might have to make another needle insertion to drain the fluid that I had.

While he was filling the implants, he turned to Dave and said over his shoulder, “See? This doesn’t hurt her. She can’t feel it, there was nothing to be afraid of.”

Of course, it wasn’t any more painful than a blood draw, but I could definitely feel several ounces of fluid entering a foreign body in my chest and I realized that my entire lower body had tensed up when I was angry. I tried to concentrate on deep breathing and relaxing and by the time the first side was done, I was mostly relaxed again and even tried to make a joke about how tensed up my muscles had been.

He began the expansion on the second side, which was a bit more painful, so I mostly just watched Dave’s face watching the procedure to see how things were going. He was watching intently, but didn’t seem concerned so I continued to just try to stay calm and breathe deeply rather than think about how weird this whole thing really is. I now have little plastic bags of fluid under my skin and muscle to (eventually) look like I have boobies again. Bizarre.

Dr. Jacobsen explained to Dave (not to me) that in order to drain the fluid from the cavity, he would simply slide the needle out of the implant but keep it under the skin to draw the fluid out. This also happened to include pushing on my sore chest trying to force the fluid up to the needle with prodding and pressure. Fun.

He did eventually have to move the needle, and while the fluid extraction itself was not painful at all, there was a moment of very sharp pain that actually made me jump and cry out and my eyes immediately filled with tears from the stab of pain. I thought he’d just nicked me somehow when he’d taken the needle out, so I said, “Wow, that hurt!”

He replied, “What hurt? I haven’t moved anything. We’re almost done here.” and I realized the needle was still inside me.

He finished draining the fluid and showed me that he’d extracted almost as much as he’d injected and that it was the exact color he expected it to be to know things were healing correctly. By this point, tears of anger were streaming down my face so he handed me a tissue and went about putting away the tools and getting rid of the drained fluid.

I said I had a few questions and asked Dave to hand me my book where I’d written them. Dr. Jacobsen asked what I wanted to know, but I was so angry I could barely speak. I managed to say through clenched teeth that I was working on it and simply looked at Dave.

The doctor finally came back around to the side of my chair and asked again if I had a question for him. I was so mad that I could not even look up at him. I knew if I opened my mouth, all that was going to come out was, “Why are you such an ass?”

Luckily, Dave jumped in and explained that I am an information seeker and that if he would simply talk to me about what we were doing and answer my questions, I’d be a lot more relaxed with everything. Dr. Jacobsen asked what information he needed to give me and said he'd answered all the questions in my book - as if it was silly of me to have a book of concerns about healing when I have to manage at least three doctors for several months.

Dave asked what had happened that made me jump and cry out and Dr. Jacobsen said I was so tense that even a fly landing on me at that moment would have made me feel pain. He said he hadn't done anything that would have made me hurt. Afterwards, Dave said he'd been watching and after I jumped, Dr. Jacobsen did reposition the needle before continuing the fluid extraction as it seemed he'd created a vacuum while trying to push the fluid toward the needle above it.

Dr. Jacobsen continued to say that he could tell I was always looking for the worst case scenario and I needed to look for some positivity in my healing because I am a “healthy little girl” who just needs to try to be strong for a while and trust that he knows what he’s doing and everything is going to be fine.

This man has never taken three minutes to get to know me at all or he would know that I've approached this whole cancer experience with more positivity and strength than most people can believe...

Dave verified that the fluid build up I’d experienced was normal and asked what amount would be cause for concern or follow-up before our next appointment in two weeks. Dr. Jacobsen said that any of it would be fine and there would be no emergencies.

Wow, I am so lucky that my plastic surgeon is God!

This entire time, I was just staring at Dave, unable to speak to this ass of a doctor who seemed to think I was just a little girl who shouldn’t worry my pretty little head over such things as recovering from major surgery. And my sweet husband knew how angry I was and how anxious I was and exactly the things I needed to try to get out of the doctor to be able to relax.

When I could finally speak, I asked again about the numbness and pain in my arm. He said he had no idea what it was, but it wasn’t from anything he had done to me. It was probably something from the lymph node biopsy healing, but nothing he was concerned about and I shouldn’t worry about it either. (Yeah, right, I was absolutely ridiculous to worry about the fact that I couldn’t use my arm for an entire day. What was I thinking?)

Dave asked if he could give us any idea of how many injections I might need to get to my final breast size and Dr. Jacobsen said that of course every woman was different and I’d eventually decide what size I wanted to be because there’s no such thing as a B or C cup. How is this an answer to a question? Dave calmly asked again, “Based on Benah’s size and the fact that she’s not going to want huge breasts, how many visits do you think we will need to plan on in the next few months?”

I was so proud of him for being able to cut through the doctor’s crap and just get us an answer of how many more times I will have to endure the experience I went through today.

The doctor said he’d probably expect to give me 8-10 total injections before I was happy with the size and I might decide to stop earlier. And whenever I was happy with them, he’d want to do probably two more injections to allow for enough stretching of the skin so the implants would have a more natural motion and shape to them. He also said that while he knew I wasn’t interested in giant breasts, he probably wouldn’t be able to give me large breasts anyway because I was small and didn’t have the tissue to support them. (Sorry to those of you out there who told me to go big or go home. Sounds like I was always intended to make my money with my brain rather than my hooters...)

By this time I was able to ask a few more questions about what to expect regarding pain or muscle spasms after each expansion and he told me that I would probably be in some pain until at least December, but each week should get better than the last. And he said fluid build up was nothing to worry about, but if I didn’t like it, I should just keep wearing my compression vest as the more I wear it, the less fluid should collect in the chest cavity.

Ergh – I was so looking forward to getting out of this thing because it’s so uncomfortable, but honestly, the fluid build up was weirder. So it appears I’ll be in my pink scuba vest for a couple more weeks, at least part time. Fun.

The doctor left the room and I was still just amazed and angry about the whole interaction. Dave helped me up from the chair and helped me get dressed and knew I was still just seething at this man who treated me like I was ridiculous for having concerns about my health. Apparently they’re just boobs to him.

I know he does this procedure all day every day and honestly, the actual draining and filling of the implants was pretty uneventful (other than the one sharp stab of pain that he blamed on me...), but while it may be part of HIS routine, it’s certainly new to me.

We scheduled our next appointment for two weeks out because next week is Labor Day, but it seems this will be an almost weekly appointment for the next several months. There may be draining necessary for the next appointment or two, but that should taper off a little after I start chemo, so from there we’ll just see how I’m feeling from week to week and how I’m liking the implants as they grow.

Dave asked if I wanted to find a new doctor to finish my reconstruction. The idea certainly has its appeal, but I’m concerned about whether another surgeon would be inclined to finish what Dr. Jacobsen has started, how it would impact insurance coverage, etc. So for now, I’m trying to just tell myself that Dr. Jacobsen was recommended to me by a surgeon that I DO like very much and I DO trust. Dr. O’Neill, my breast surgeon, said that for implants, he was the best guy around. And based on his waiting room and how long it takes to get in to see him, he definitely seems to have a great reputation for doing great work.

And of course, he’s told me himself how good he is at his job...

So I’m trying to think of him as just the guy who gives me boobs, not as an actual part of my healing team. I do not intend to ask him any more questions than I absolutely need to and I will turn to Dr. O’Neill or Dr. Obenchain for most of my actual concerns about healing, despite the fact that Dr. O’Neill has told me to turn to Dr. Jacobsen for that information. He has proven that he cannot answer my questions in a satisfactory manner and I do not want to interact with him more than I need to. I trust that he is good at the surgical aspects of his job and am coming to terms with his rather limited ability to answer questions with anything more than a “Don’t worry about it,” or “Just trust me,” or “It’s fine.” Though honestly, when Dave was asking questions, he would answer them. When I asked, I was being silly and worrying too much.

Dave commented afterwards that he's either autistic-like in his social abilities or just really sexist. I'm leaning toward the latter.

I’d like to believe that all of my concerns really are nothing, but then again, my radiologists kept telling me I didn’t need to worry about that lump I’d been feeling for 18 months and we all know how that turned out. And for that matter, when I was pregnant with Fin, my midwife kept telling me I wasn’t really having contractions and there was nothing to worry about... until my water broke 5.5 weeks early and I suddenly had a baby an hour and a half later. I think I’ve done a pretty good job of listening to my body up until now and I have learned to really appreciate having doctors around me who respect the fact that I am the one living in my body and experiencing it and I might actually know what it feels like in here just a tiny bit better than they do.

So – the first draining and filling is done. I have decided that my plastic surgeon is an ass and I do not particularly like him, but he appears to be really good at the skill part of his job (based on the recommendation of a doctor who has both surgical skill AND the ability to communicate with her patients) and ultimately, I want the person who is going to give me the best medical and physical outcome when this is all said and done. I’ve suffered arrogant doctors before (though usually not for long, but we’ve already started down this road with him and I feel like it would be harder to make a switch than to just lower my expectations for his bedside manner) and I think I can make it through the next few months. With any luck, I will have completed my expansion and the final implants before the end of the year, so maybe I won’t even have to see him past the next 6 months or so.

Dave and I went out for a birthday lunch after the appointment – we were both starving by the time we got out of our “noon” appointment at 3pm – and it was so nice to feel like he had known exactly what I needed to get through that experience, how to read my needs when I was so angry and hurt that I could not speak, and how to get the information out of the doctor that I needed to hear to be able to be comfortable with what was going on. It’s been way too long since I felt like we had connected in that way and I felt like Dave really knew what was going on with me, but he came through for me today in a tough situation and I am so thankful that he was there with me. I didn’t need him to physically hold my hand because I wasn’t scared, but having him there to give me the space to be angry, and him being angry along with me, was the best support I ever could have asked for.

Happy Birthday, Dave. Thanks for spending part of your day making mine so much better. I love you.

<3
-B-