R(etired)N

OK, I am a self-admitted germaphobe at the best of times.

I am not as bad as Howie Mandel, but a close second or maybe third.

I was washing airplane drop-down tabletops and armrests before it was in vogue.  (at least people no longer look at me as a crazy person while doing this)

Touching unproven surfaces was what I did with my sleeve or a paper towel.  I always washed my hands after I perused the menu at a restaurant. Keys came in handy for pressing elevator buttons and I always put wheelchair door opener plates to good use where available.

If I couldn't avoid touching a surface,  I kept my hands away from my eyes, nose and mouth because those are the portals of invasion that your hands transport to. 

I am always telling cancer patients undergoing treatment to steer clear of people who look sick - at least 6 feet away - and try and stay away from hospitals if there are other alternatives.

So now my other niece shows up on my doorstep late last night with a cold.  A virus of some sort.  Hopefully not a bacteria.

I am ready to freak out.

My brother and wife (the nurse that wanted me to fix her dress just before the wedding) popped in on their way and because the highway was closed by a fatal crash,  they brought my nephew, niece in law and their 4 1/2 year old son along as well.  It was nice to see them all - the four hour visit was just about right.

But one thing my sister-in-law neglected to mention was that her daughter was sick.

Not one mention.

I had already given her a hug and hauled her suitcase out of the car before I realized she was sniffling and coughing. 

So the #2 niece who had just arrived retired to her bedroom and I asked what her plans were for tomorrow - she wasn't sure.  She felt she needed to rest and had no plans. She was just going to "hang around" for the day.

I had thought that this was just an overnighter and normally I would love to have my nieces stay with me as long as they like, but presently, with the prospect of someone "sick" in the house,  I am panicking and am compelled to go out and buy more bottles of disinfectant to clean all surfaces #2 niece touches - and especially do a "terminal clean" (as we used to say in the hospital ) of her whole bedroom when she leaves because that's where my other sister and her husband are to be staying - tomorrow.

I am hoping I will have enough time to sweep the whole house of  viruses because my mom and dad are coming tomorrow and if they get sick -  their health is such that it would be devastating.  Getting a cold is a big deal for them.

Earlier yesterday,  if you were to ask me if I was considering going to the wedding, I might have said there was a pretty good chance.  Gauging by my reaction to one person arriving on my doorstep sick, I am thinking NOT A FREAKING CHANCE. 

If I am to be lined up with a general surgeon in coming weeks for a lymph node biopsy and more surgery - then lined up for immunotherapy at worst case scenario -  I don't want to be sick.   I can't be sick.  They won't do surgery.

Luckily my stitches are coming out first thing tomorrow morning.  That gives me the rest of the day to clean the whole house and do all the ensuing laundry - towels, sheets, bedding......

Thank goodness I still have enough ativan.

I had been feeling better and was in the midst of weaning myself off that little white pill and this little episode just set me back a smidge. 

I know I said wanted to be treated as  "normal" - but this isn't exactly what I had in mind.

I need a soak in the hot tub.

Yesterday started out ok.

Feeling very spunky, although overly medicated, I got my niece to drive me to the bank, then the local raspberry patch where I bought a flat of raspberries.

We really wanted to splurge and chow down on a whole flat, just us.

Before I could dig in, I felt this overwhelming need to vomit.

I am guessing the antibiotics are finally catching up to me.

I grab the little vomit bag I still had from my visit to the hospital in Yakima - in the days I still had a gallbladder.  I hadn't used it so I thought someday it would come in handy and stored it in my "nursing room".

Just in case. 

Thank goodness I thought ahead.

The phone rings.
It's my brother-in-law looking to speak to his niece that is staying with me.

BIL: "How are you doing"
Me: "Fine" (gasping to hold it in)
BIL: "Did Reb get there ok? How was her flight..."
Me:  *vomiting* she's....in... *vomit* ...the shower..."
BIL: "I just want you to know we are praying for you...."
Me: *vomiting*  ...can't talk now.... *vomiting*...bye...."
*click*

I can't begin to tell you how many countless phone calls I have fielded with people vomiting at the other end, and as a nurse sometimes it's a little disconcerting having to listen through the entire episode.

By hanging up so rudely, I was trying to spare my brother-in-law.  After all, it's bad enough when you are used  to hearing it....

Good news is, the construction of that little baggie with the round plastic solid opening.....everything was self contained.   No cleanup! Yay!   That's a small blessing when you are a nurse.

I had my niece  phone her dad back to apologize and see how traumatized he was. 

I am now taking gravol (dramamine for Americans) with  my antibiotics.

After all,  those raspberries won't wait!!!

This morning: Quite a few pretty yellow/green bruises with patches of purple			.  My hair full of polysporin.

Early morning and I line up my pills like a little old lady.

Antibiotics every 6 hrs, ativan prn, Tyl#3 prn, zopiclone at hs.

I am almost finished the antibiotics.  I am only using one Tyl #3, one tab approximately every 6 hours or so for minor 4/10 needle-like pain (which I am taking as a good thing!).  The half tab of ativan I am using to dull my worrisome thoughts that I don't want to have while awaiting the final pathology report.  My choice.   The zopiclone half tab helps knock me out at night so I don't have to lie in the dark thinking all sorts of horrible thoughts.

I took another photo of my face this am, as per usual.

With my work, people phone all the time post operatively, amazed at how much bruising shows up several days after surgery.   I always tell them - "it's normal" - and here I am trying to convince myself the same.

It's four days post op and I am going to keep my dressing off.

I have yellow/green bruising extending under my left eye and down my left cheek.  There is purple splotching on the flap itself -  a well placed heliotrope I am hoping isn't pre-necrotic tissue. 

To me, the suturing looks like something some little kid did.   Of course, as a lifetime picky seamstress and designer of clothing.....it would.   I have been reassured that everything will smooth out in the end and I am going to hang onto that for now.

Now for the good news.

Yesterday my niece arrived from Indianapolis.   I decided I didn't have enough fruit and treats in the fridge so I wandered the block over to the store, hoping to get my shopping done before my scheduled ativan and Tyl #3 started to take effect.   Silly of me to decide to go for a milk run seconds after ingesting my medications.

But,  regretfully, I did.

The ativan and Tylenol kicked in right at the checkout counter.   I am sure the cute, tanned, little young thing behind the till didn't want to hear the lecture on benefits of wearing sunscreen and floppy hats and she certanly didn't want to see the edge of my incision poking out from under the flap of dressing I so generously pulled back for her to view.

I happily and obliviously wandered out the door and down the road ....   leaving the poor girl gaping in horror, I am sure.

Some may judge me for self-medicating to the level of numbness.

But, for me, it means no worries about anything, and for now, I like that.

a tiny corner of the flap

The crew at the hospital were wonderful....from reception all the way to  Surgical Daycare staff - volunteers,cleaning people, nurses,  the OR staff, the anesthesiologist, the plastic surgeon.......

I have to say, I am a very lucky person to be surrounded by such dedicated and caring staff.

They also were blessed with the patience of Job for sure!!!

There was an ornery old guy across the room in Surgical Daycare prep room who was loudly complaining about the "stupid pre-op  instructions" not to smoke prior to surgery and was incessantly bugging the nurses as to "exactly how soon can I smoke".

It took me back to the days working on surgical in the 1970s when the sneaky hardcore smokers glowed in the dark in their rooms, nasal cannula in situ with oxygen going -  ciggies alite.... and you could spot the blue flames going up the nostrils (despite the "No Smoking" signs) as you passed by their doorway....usually in a four bed ward....

Nowadays, I give instructions for what would be best practice for those seeking to be healthy, but in the end, there is no controlling what people will do.  So be it.  Just don't hurt anyone else.

I have to admit I took a chill pill before arriving at Daycare so I was seeing everything filtered through Mr Ativan.

It's interesting the process one goes through now.

Showered with antibacterial soap all over the night before and the morning after.

Then, on arrival to the Surgical Daycare they give you these warmed 2% Chlorhexidine Gluconate antiseptic wipes and specific directions as to how to wipe down.  Then, all sticky I put on the gowns and the socks and the paper slippers and go sit in the easy chair with the arm board and wait.

My IV nurse had been working almost as long as me.  40 years.   She whipped in the IV like it was nothing (yes, and no gloves, old school like me with not a drop of blood lost!) and I could see the other patients around me watching enviously.

"I want her to start mine" the gal beside me mouthed at me.  I would have offered to start hers, since I used to be the "go to" person for IV starts as long as I can remember - but I was under the influence at the moment.  Not a good idea.

Apparently the IV pumps they were using were new to them - the dual pumps that you could run meds then it would go back to the original drip rate with the main bag - the type I worked with south of the border.  I was able to give one newbie on the machines advice on how to get the bubbles out and stop the alarms.  By that time I was slurring my words slightly.

I had taken a full ativan - not just half.  (Damn you, Laurie for that suggestion!!!lol) Maybe I should have just shut up.

My sweet little plastic surgeon came to visit twice preop.  He didn't look nervous but it was so endearing that he knelt by me each time and held my hand to reassure me.  Maybe he didn't realize that the ativan I had taken a couple hours earlier had erased any panic that most people would be feeling at this point.

Then - It was time.

I kissed my husband good bye and walked with the nurse through the OR doors.

I joked with the OR nurses and found out that we knew several of the same nurses.  Small world, but you come to expect that here in BC.  As a Canadian nurse, you always know someone who knows someone.  You can't get away with anything.

I knew what to do - laid down on the table and wait for the inevitable.    Then, I could hear to my left the anesthetist say "Think of somewhere nice..." and I knew I would be asleep in a minute...

"Dublin, Ireland in October....with my cousin...."

I could hear faint surprise expressed by the staff at my response....and then ....nothing.

****

Woke up - NO NAUSEA!!! That was a relief because in the past, the vomiting that ensued was horrible.  I had requested "ondansetron  please".....and the difference was amazing.

My surgeon visited a couple more times while I was in PAR....and then again in Daycare post op.
He showed me photos on his iPhone that he had taken in the OR, pre and post surgery.  He told me he had sent photos to his colleague to assist in the decision making.  I told him he had my permission to use them for anything he liked.

He told me he was a little worried that I would be going home due to  it being the weekend and he couldn't follow up  on me as he would like,  so he gave me his personal phone number and told me to call if a hematoma developed or any other concerns.

My husband went downstairs and filled the pain meds and antibiotic rx  in the hospital pharmacy while I got one more dose of ondansetron before being unhooked from the IV.  It took me all of a minute to jump into my street clothes. 

Felt really good going home.

That night I had my husband take a couple photos of my incision and had him send them to my surgeon. He replied right away:  "Looks good!"   I asked for his photos of me in the OR and he obliged.


Here they are:

Markings made by MD, I was already		unconscious

definitely still unconscious

He told me he wouldn't sleep very well worrying about me, so I thought the least I could do is alleviate his worries.   After all, such a sweet guy.....you have to encourage these young MDs!!!

HA! Just as I am writing this - guess who calls! I sent another 2 photos this am, and my cute Plastic surgeon is on the phone!  He likes the look of the incision, has me see if I can lift my brow and smile and  is happy with my reply.   He is so happy that now, instead of 2 trips to the office, I only have to go the once - to get my sutures out.

I have to make an appointment with him on Thursday or Friday.  Will let you know how that goes.

Meanwhile, my best friends are Tyl#3 and Ativan.

I want to be a little on the numb side until the pathology report comes out in about two weeks.  I will be watching my online ehealth  lab access like a hawk - and the moment the report comes through -  I will be on the phone to see my doc right away.

All's well with the world.  

For now. 

_____________
*Thank you Laurie for this new terminology! LOL!!! Don't we just love our nurse friends!! ;)

Pre-op workup done: bloodwork, ekg, cxray and interview.

Two hours going from bottom floor to second floor to third floor to first floor.

Thank goodness I had along my good friend ativan.

I texted my husband to come and pick me up and re-routed through a Mexican food drive-thru for a burrito on our way home.  I wasn't up to making lunch.

By the time I got home, the ativan had worn off and it wasn't until I realized I was posting "Please always close the doors" on every door in the house, frantically phoning every store in town for a roll-away bed for my dad for next weekend, and becoming overwhelmed with all the "stuff" I have to do - that I was way out of control.

My good friend Laurie suggested another ativan, but this time splurge on ONE WHOLE milligram.

It worked.

I didn't notice that I ate almost all the sushi my husband brought home for dinner.  He was somewhat disappointed that I only left him four pieces.  

I am much less apprehensive at the moment.

A few hours ago I had a million things I wanted to write down here - now, nothing.

I am all ready to go.
I had my first antibacterial shower.
I took off all my rings and earrings and watch.
I wrote down all my passwords for absolutely everything and put them in a safe place.
I copied down instructions as to where to find any and all insurance claims should I pass.
I  typed out all the bills that are to be paid and which account they are automatically taken out of.
I wrote out a will (good enough, they'll get the drift) - In this province everything goes to the spouse, fine by me.
I showed my husband one  more time how to get online with the bank.
I am sure he will figure it out somehow.

Hopefully he won't need all that information...

I honestly don't know how I can even function enough to write this.

I have totally lost any brains I thought I had.   Scrambled thoughts, confusion and very distracted to the point where I can't concentrate on the simplest things such as going to the fridge, getting the cream, putting it into my coffee.   Sounds simple, huh?  A million distractions pop up from point A to point B and I just can't filter things enough and I keep getting lost.

Not only am I losing my brains but I am losing all my stuff, too.

Couldn't find my cell phone....I turned the house upside down and finally left for an appointment yesterday morning without it - which panicked me to no end.

Unfortunately, because I was driving, I couldn't take an ativan to calm me down, so I had to suffer through the 3 1/2 hours sans med,  until I got home.

The entire appointment time  my brain obsessed continually  - where is that damn phone!!!

It would have been wonderful if I could have phoned it to find it via the ring tone, however  I distinctly remember turning it off  before putting it in whatever safe, obvious place I put it.

After working myself into a complete lather, and after two frantic phonecalls from our landline to my husband,  I discovered my cell phone in my binder with all my lab and pathology reports......right in the little cell phone pouch where I put it.

Sigh of relief.  What I really wanted to do was bang my head in frustration on the wall, but I needed every little neuron I had left - and assaulting myself wasn't going to do any good.

Next chore on the list, but with ativan on board:

I decided to walk the two blocks over to my hair appointment.  It was a beautiful, clear partially sunny day, just enough to warrant the sunscreen and floppy hat.

I have approximately 1/2 inch of roots and heaven knows how long it would be before I could have my hair done again so for some stupid vain reason, I made an appointment to see my hairdresser.   What I wasn't counting on was the downpour 2 hours later on the walk home. 

Lucky I wore the floppy hat, it really made a good umbrella.

But the trip to the hairdresser made me realize something else about myself.

I am getting extremely paranoid.  More than the usual.

I am worrying obsessively about being around people that are coughing or sniffling - and am even more paranoid about touching surfaces than usual...... 

I don't want to get sick before my surgery date.  You get sick, you don't get your surgery and I can't risk that.

I even have apprehensions  about going to the hospital for my pre-op workup - and not for the reason you might think.

Germs/bacteria run rampant in hospitals.

I will be staying 6 feet away from anyone that looks sick, I won't touch surfaces and I will definitely be keeping my hands away from my eyes, nose and mouth.

Hopefully I will make it to that dreaded surgery day - healthy.

We were supposed to be going camping this week :(

My husband left on his business trip this morning and here I am by myself at home.

All alone.

The problem with being by oneself when you have just been diagnosed with cancer in the past several weeks, your mind starts going places.

I have instructions and links for meditation but my mind just wasn't co-operating no matter how hard I tried, so  I took a half of an ativan.  Of course it didn't work right away so -  I start doing things.

Our tenant had asked us to watch her apartment while she was gone for the weekend.

I killed 6 wasps with my electric swatter on her stairs so our tenant won't get stung when she returned from Whistler. I watered her flowers -  even though it was raining.  I pruned the dead flowers off her baskets - even though I hate gardening and she is coming home tonight and could pretty much do that herself. 

I wandered back into the house and watched "Back to the Future" and then the first ten minutes of "Back to the Future 2" until I realized it was so stupid I just couldn't stand to watch it anymore.

Then I jumped into the hot tub.

I managed to relax for all of 10 minutes, then jumped out and cleaned the kitty litter box and the cat water dishes because I could see both from the hot tub.

Restricting myself to those two chores was an accomplishment,  seeing as how I was also contemplating power washing the pergola sheeting overhead because I could also see that from the hot tub.

My husband would kill me had I tried, because that would involve tall ladders and moving boards up on top of the pergola and manipulating the power washer and the tangle of hoses and electrical cords over the hot tub...and I had already fallen down stairs three times in the space of a year and a half....

Back in the house I sat watching HGTV until I realized I had seen all of the shows before.

I missed my husband.

My mind started going places again.

I phoned our bank and cancelled the double payments on our house mortgage, to decrease any stress for my husband,  just in case.   The Operation was in five days.  What if they accidentally disconnected the ventilator? What if I had a cardiac arrest? What if.....

Honestly, high anxiety or what?!!

Thank goodness it's almost bedtime and I can draw on my zopiclone to let me sleep, otherwise, heaven knows what else I would try to do....

Tomorrow morning I go the wine place to bottle my wine that I ordered a month before I got The News -  that wine I can't even drink anymore....at least, not in the foreseeable future.

I will probably take my ativan instead.  Now that will make the bottling interesting.

I'll let you know how it goes.
                            my husband and I on our wedding day, eight years ago. 

Really?

My sis in law thinks it would be quite ok to have me go to her son's wedding on August 3rd.

That would be 8 days post op. 

From what I am reading on the internet, it might be a little soon to be out and about.

She says they already paid for the plate - $100 per person - whether we come or not (the kids bought the package that automatically includes 120 people, and they didn't count on so many "no" responses and now they (my sis in law) will be paying for plates with no one at them already) so we "may as well come".

I felt a guilt trip coming on.

I am not sure that I will want to be there looking like Frankenstein - and face it - will I really be in the partying mood only one week after major surgery to my face?

 It could look as nice as this, although a larger area for me since my melanoma is a little deeper and they will be taking off a larger area : (and by the way, this gal was so brave to document her journey online, you have to read about it here)



 Or Like this (taken from a plastic surgeon website advert - helpful hint, I would be looking like the face in the bottom left just in case you are wondering):






I am not sure which would be better.  The first one doesn't look too bad at all, but face it, at one week, it's not just going to be a tiny little bit of scar tissue that no one is going to notice.  I don't want to ruin anyone's dinner - after all, this is a wedding and everything is supposed to be fun and pretty and light hearted.....


I know I will be stressed out awaiting the new pathology report.

I am also pretty sure I am going to be heavily medicated.

To boot, I have no dresses that can cover up the graft area on my neck. (I have no idea why I am worried about a little chunk out of my neck when it's my face that is going to look like a mess...I am not making sense....)

I will have 8 extra people staying at our house for the wedding arriving 3 days post op and I know that I will have to be arranging stuff including places to sleep and food for everyone.

I am going to be exhausted.

I messaged our regrets to my nephew and told him why.  He wrote me the sweetest note back:

 That totally blows. Really sorry to hear. One of the most scary words you can ever hear. We understand that the weeks\months after the surgery could be quite intense, so we would like to let you know that there certainly is no pressure on you having to attend if you are feeling brutal that weekend. So don't be stressing about filling a seat or what not, your recovery and comfort level is what is most important to us. But by chance you are up for it, there will always be a spot for you to come. Frankenstein it up, its totally cool. Would love to see you no matter, my White Rock mom. 

I love that boy.

 When I lived closer to the city- in White Rock, my nephew and his sister both lived with me for 3 years off and on while they went to university.  It was a pleasure to have them stay with me, although I know it wasn't easy for them cramped into a 2 bedroom apartment.....but hey - it was free room and board!  Great kids.   Quiet, fun, never partied at all....they were studious -  and I loved having them with me!

I have to admit, his little note made me cry.

We will see how it goes.

As my friends in a cancer chat room said: "One day at a Time".

I never thought I would be happy at the prospect of surgery, yet here I am.

(this was written yesterday, posted today)

This am  at 10 o'clock I was to see the plastic surgeon again.

That anxiety was building up again and I couldn't help myself.  I picked up the phone and called the gals over at the Cancer clinic.  A fleeting thought "they are going to hate me there - I call them so much" and the phone went straight through to the original gal at the desk that I talked to on Friday.

I explained what happened to the non existent surgeon's dictation and told her I was feeling like I was in limbo land.  "As an RN, you know where my head is going...."

Then good news.

The gal had actually put my file through - after I talked to her on Monday -  to the Oncologist and he had dictated a letter.....she told me she was going to make sure it was transcribed and faxed over to the plastic surgeon's office immediately so it would be there by my 10 am appointment.  "Your MD will know exactly what to do when he gets the letter...." she reassured me.

Sigh of relief.  Do those gals know how much I appreciate their efforts?  That it meant the world to me?

My RN girlfriend who offered to accompany me to the Plastic surgeon's office arrived at 8:30 on the dot. Well, maybe a couple minutes early.  She's a lot like me.

We sat and had coffee and discussed our tactics for the MD's visit. I told her to ask him how many surgeries he had done, since there was no trace of him on the internet.  We both laughed over that one, but I was serious.  I did want to know but in a way that didn't make his hands unsteady in surgery.

I had already phoned the one number I could find on the internet associated with my young doc - an office in San Francisco where he served a one year fellowship. (By the way, the young receptionist's enthusiastic review would have matched my own  - about 30 years ago!! Oh well.  It was worth a try.)

We arrived the usual 15 minutes early for my appointment. Tiptoeing up to the receiving desk,  I asked politely if the report had arrived from the Cancer clinic....and all I got was a curt "You can take a seat"....she didn't even look up.

The Plastic surgeon more than made up for the cold greeting.  I explained about being in limbo and how it was messing with my head and how I am now heavily medicated (well, to my standards anyway) and I feel this is going nowhere.   I reminded him that he was the one who told me I would have to be my own advocate.

He agreed.  We discussed (the three of us) the best way to approach the surgery and we decided that it would be the best to have him decide when he got right in there...whether he was just going to do a 5 sq cm graft where he dug out the melanoma, or whether he was going to do the flap surgery...cutting up beside my ear, in the crease of my lower lid above the cheekbone and beside my nose...and sliding over the skin. Donor skin, either way, would be my neck.

I didn't want to decide and be left with "what if" after the fact.

I just wanted the surgery done and the cancer out.

I did ask him if he was going to leave my dimple in.

"Don't worry, I will make it all pretty"

I squinted at him.."Pretty was perhaps what I was when I was in my 20s....I think I am beyond that...but hey, if you think you can do it, take a stab at it!"

I can't believe I am almost excited that on Friday the 25th, I am going to be turned into Frankenstein.

I'm going to Disneyland!

No such thing as sunscreen back then....and we were a bunch of blondies!!!

Of course I did!

ONE MINUTE past 2 pm on Monday I phoned the Cancer Clinic as I promised.

However, the effort was futile because the news wasn't good.  They hadn't received the referral letter from the Plastic surgeon, and so there was nothing the triage Oncologist could do.  I asked the gal - what would be the next step for the Oncologist had he got the referral?

"He would dictate back to the Plastic surgeon to go ahead with the surgery as per BCCA protocol as stated right on the original pathology report from June 24th 2014."

So basically, waiting for a report from the Plastic surgeon to reach the Cancer clinic was a big waste of time. It would change nothing.

Time to be my own advocate -  that's what my Plastic surgeon told me. So I called his office.

I left a message when no one picked up but forgot to give my date of birth so then phoned back and actually got a live person and had a discussion with the receptionist.  She explained that the transcriber didn't show up to the office on Friday (thus no report to the Cancer Clinic)  like she should have and so all the dictations would be done the following Thursday....a week later.  Did I want to come in and talk to the Plastic surgeon about the surgery?

I could feel my panic rising like a huge furball in my throat. 

I explained to the receptionist that I had already discussed with him the surgery in depth, photos taken for his notes and all that was needed was a date for the surgery.

Miss Receptionist further explained " Well, you will have to come in anyway to discuss this with the Surgeon.  Tell him what the Cancer Clinic told you about not needing a referral.  And, by the way - you can have the dictation if you wish (the one that I don't need anymore) because the transcriber will be here that day..."

Appointment made with the Plastic Surgeon for Thursday,  July 17 2014.

Next step -  phoning my GP.    Another  receptionist to whom I repeated the entire story again.  I also told her that basically the Cancer Clinic doesn't want to see me until after my surgery, and hey by the way, I really am not coping.....

Appointment made with my GP for Tuesday morning at 8:50 am  July 15 2014.


That same night my mother in law called to ask my opinion about when she should take her beta blocker because she had missed taking it 4 hrs ago.  To complicate matters, she had no idea about when she took her other pills - one of which was a calcium channel blocker.  I spent about 10 minutes trying to sort it out when I finally told her to call her local pharmacy.  "They are closed" she said.  I told her there should be something open so she can ask someone who can make sense of her flotilla of pills.

She then tells me that she already talked to a pharmacist earlier and he had told her to relax and take her BP and if it was ok, just skip the pill missed and carry on  - but she didn't want to go to all that bother of actually having to do something like take her blood pressure and then follow his directions - so she phoned me.

I told her I was an RN, not a pharmacist and if she wanted the best opinion on how to take her pills - someone with their Doctorate in Pharmaceutical Specialties would be the best bet.

Then she started on and on about how worried she was about an adult grandchild that was complaining of a sore arm and couldn't lift it very high and is having trouble doing her hairdressing job  - yet there she was,  in the pool splashing around having fun, not seeking medical help for *extreme* pain...which, in my thinking, if they were all hooting and hollering in  the pool, she isn't Emergency material.

 I told the MIL that the granddaughter was a big girl and could make her own decisions and explained that the xray the MIL was telling me she should insist on getting in Emergency would probably show nothing.  I told her if anything, she should arrange an appointment with her MD.

I guess MIL didn't like that answer so she kept trying to convince me that I should be saying she should have an Xray.  Finally my anxiety level got the best of me and my chest pain was telling me I needed my nitrospray fairly soon, so I told my MIL that there are worse things than a sore shoulder and if the pain/mobility issue was that bad she would be in the ED and NOT in the pool....and worst come to worse - she is young enough to find another occupation.....

It could be that I might have raised my voice just a little bit.

I passed the phone to my husband and I went to get my nitrospray.   And a 1/2 tab of zopiclone.

A couple hours later, MIL phoned back to passively aggressively tell my husband she is NEVER going to be phoning me for Medical advice ever again. 

I guess this is why I am off the phones and on sick time for the next 3 months.  

I can see that I am definitely not very therapeutic in the state I am in.

Point Robert's beach, looking back to Tsawwassen

First thing I did on Friday morning was phone the Cancer Clinic.

The Plastic Surgeon wasn't very reassuring when he let me know that he was new in town, didn't know how "the system" worked around here, and for sure I would have to be my own advocate.

I was transferred to the New Patient Intake desk.

She reassured me that I was "in the system" but my file was "on hold".

On Hold?????

When I asked why that would be, she explained - "Oh, Melanoma patients never usually come through here at all...they just have their surgery - get it cut out - and that's it. They don't usually need other treatment"

Somehow that wasn't very reassuring.

Now I am wondering why am I being referred to the Cancer Clinic when the norm is usually that we (Melanoma patients) aren't.  Was my melanoma case worse than most?

The gal on the phone was nice enough to do a little digging.

She asked me what my MD had said, and I explained to her that he wanted the tumor mapped before he did the surgery.  That the melanoma was invasive and the punch biopsy on the pathology report showed that the abnormal cells extended to the extreme edges of the sample so they are suspecting the "invasion" is deeper than what they know from the pathology report.

I was not embarrassed to play the R.N. card.  "I am also an RN that works with cancer patients and Palliative care....and you can see where my mind is going with this at the moment...."

"Oh" the kind voice continued, "well, then....what I will do is phone the Plastic surgeon to make sure he faxes his dictation over right away, I will then forward your file immediately to the Triage Oncologist and get things going for you!"

I wish I could say I was relieved to hear this.  The whole thing brought up more questions than answers - and the unfortunate thing about being a nurse is that you NEVER see the good side of cancer - never see the patients go home, get better, live on with their lives  for 20 or so years..... 

As a nurse, we only see the bad things that happen to people with cancer -    the infections, the reoccurances, the pain, the suffering, unhappiness, the dying.....

When you survive cancer, you don't come anywhere into my world - and why would you even want to?

So, nurses, by default,  have quite a skewed view of cancer to begin with.

The nice lady on the phone continued - "Now - it's Friday so I can't get much information today, but if you call back on Tuesday....even after 2 pm on Monday...I will have some information for you."

My thoughts clutched to any small thread of hope.  "Thanks! So one minute after 2 pm on Monday it is!!"

We both laughed.

When I was little, I can remember the summers went on for freaking  e-v-e-r.   Time went so slow, the time between school years seemed like a year in itself.   By some phenomenon, when you get older, time starts picking up speed -  faster and faster.  You know that comparison to a toilet paper roll - the closer to the end, the faster it goes? - It's no lie.

Right now, I am back in my childhood.

This summer is a lo-o-o-o-o-o-o-ong one already.

It can't go fast enough.

I want Winter to be HERE already.

I am in the back.  The other kids are my brother & sister and cousins.  We are sitting with my Grandma - the RN who also was a Midwife on the Prairies of Alberta in the 1920s.   Check out her stories under the lable "Grandma /Nurse Midwife" in the column on the right ---->

Thursday, July 10 2014  was my date with the plastic surgeon.

Of course I arrived 3/4 hr before I was supposed to, because that's just me.  None of this walking in last minute stuff - no - I usually get right in there and allow my anxiety to mount every second I wait.

I see a sign on the reception desk:  "Dr Brown is on vacation from June 29 to August 26, so your MD will be Dr Laliberte".

Not good.   All that research I did on Dr Brown - down the tube!!

I borrow my husband's iPhone and use my waiting time looking up this new MD on the internet and I find absolutely nothing except for a brief blurb that he was born in Saskatchewan, did his university in Manitoba and then did 2 fellowships - one in Rio de Janiero Brazil and the other in San Francisco California.  He just got his certification that allows him to practice as a plastic surgeon last summer.

No reviews, no history, no nothing for the past year since his certification.  It's almost like he's never existed!

So - after a manic but futile last minute search - Dr Laliberte calls me into his office and we get to chatting.

You know, the usual stuff:

MD: "Are you a smoker?"

ME:  "Never." (had  I said yes, he told me that he wouldn't have done surgery - the skin wouldn't tolerate it)

MD: "How much do you drink?"

ME:  "About twice a month, one glass of wine, when I remember."

MD:  "How is your health history?"

ME:  "Only medication is Nitrospray for my recent diagnosis of Coronary Micrvascular Spasms." (that will be another story - ditched the Nifedipine due to potential life shortening symptoms)

MD:  "So, I am going to  have to take 2 cm's off all the way around the nevus (all told 5cm by 5 cm patch off my left cheek) so  I will be cutting vertical the full length beside your ear, across where the crease is below your eye and down where the crease is by your nose and along the jaw. You will be missing a fair chunk (approx 5 sq cm) right on the cheekbone, so I will slide the skin over, and use a skin graft next to your ear."

ME:  "Well doc - It's not about saving face here...."

MD:  "Can I use that one?" he half-smiles.

ME:  "Sure.....and by the way -  feel free use a fish hook and raffia to sew me up....it's all about getting rid of every scrap of the cancer as far as I am concerned.  I really don't care what I look like when you are done."

MD: (Looking very serious, newbie that he is - trying to convince me that he is indeed competent....)  "I will do a very good job, you will hardly see it....almost like a little face lift procedure."

ME:  "Oh great! A lopsided face lift! LOL.  Could you maybe even it out - do the other side later if there happens to be a huge difference?"

MD: "Certainly!  But Dr Brown would follow up with that..."

Cute guy.  If I was in my 20s I might be a little star struck and or be worried about scarring....but the wonderful thing about being older (I am now 59!) - you don't really give a rip about one's looks as much.  It's quite the emancipation!

Once you get to my age - nobody looks at you.   Even my friends didn't notice that ugly nevus on my left cheek.   Natural and gradual body deterioration over the years is a benefit.  It prepares you for moments like this where half your face is about to be carved off.

  I had gotten my fill of attention in my young days and at this point I had already made that adjustment that one has to make when one gets older.  No pretending I am not 60 - because it's so obvious I am!

So what's next?

MD: " I will be referring you over to the cancer clinic....and they will do mapping as to where this has gone. Then we will make the arrangements for surgery.  I will keep you in overnight (my idea of daycare surgery went out the window with his description of the actual incision) and then go from there."

ME: "So you will send a consult to the Cancer clinic?" This is me actually telling him to do it - nicely.

MD: " I see your MD already did that." (at this point I nosed my way into his chart about me to read it for myself)  "But I will send my dictated report/request over.   Where it goes I am not sure, because I am not from around here, I don't know how the system works - but I imagine, since you are a nurse, you will be your own advocate, right?"

ME:  "you bet I will!" secretly wishing at this point there was someone else who would take up my sword and shield and do the advocating for me.

It sounded so complicated and convoluted...and my energy level presently is in the bottom of the bucket.

By the time the office appointment ended it was too late to contact the Cancer Clinic, so I made my way to the Library and put in a request for the book I found on Google Book Reviews:  "Beating Melanoma: A Five Step Survival Guide" by Steven Q Wang - John's Hopkins University Press c2011 and will await the email to pick it up.

It seemed like the best thing to do.

The waiting is killing me.



                                                                 5 years ago in Antigua
                                                                 at my cousin's wedding.

I spent 15 years in the world of Labour and Delivery.

That's 15 years out of 37 years of nursing in case you are wondering.

It was the best area of nursing and I was only sorry to discover that little tidbit 13  years into my career. 

I was also sorry that 9 years ago I had to leave it because of a nearly career-ending motor vehicle accident.

I remember quite a few years ago having a discussion with an internist about tumors and he looked at me and surreptitiously whispered - "You realize that babies are actually classified as a tumor....only they are *nice* tumors...and they only invade the body for approximately 9 months - when the body expels it."

We laughed about it at the time....but now I am thinking about how cells multiply in both the baby and the tumor that I have.....one with purpose, the other just willy-nilly.

I am just hoping that this melanoma can be as easily and completely removed.

My MD's visit is in 4 hours.

The countdown is on.
                                                                Me at age 20 months
  

Monday morning it all hit me like a ton of bricks.

I recognized I was having a slight panic attack.

That's the odd thing about being a nurse.  You see the symptoms.  You recognize them.   You know what you should be doing.....but then you don't.

I had to force myself to phone up my MD to have her slip me in first thing in the am.  One hour from my phonecall I was in her office, blubbering away.

I told her I was feeling out of control and wasn't coping.

This MD is a wonderful caring woman.  She actually was the sub-in doc while mine was on vacation.  If I wasn't so distraught, her Caribbean accent would have mesmerized me.

She sat and listened and then offered suggestions, stated she couldn't make any promises that everything was going to be fine, but assured me that everything was being done, that could, right now....and I should concentrate on that. She had already faxed the path report to the dermatologist at the Cancer Clinic and also the Plastic surgeon, but she made a point of phoning his office again while I sat there to ensure an appointment for this week.

She suggested taking  a couple weeks off work and gave me some zopiclone 7.5mg - and told me to take 1/2 at bedtime as needed.

I told her I was going to take one as soon as I got home.

By the time I  filled my RX and picked up some food at the butcher/deli so I didn't have to bother cooking.... there was a message waiting for me on my answering service.

I have an appointment to see the Plastic Surgeon this coming Thursday.  Two days from now.

Nurse habits die hard, and I have created a binder with all my bloodwork, path report, melanoma information/charts, mileage tracking (tax deductible), Proof of illness forms for work and a whole list of questions for the doc.  If nothing else, I will be very organized.

Meanwhile, I am talking with my girlfriends and getting lots of support.
Of course, the zopiclone helps.

Never in a million years did I figure on being a patient.  At least, not with this diagnosis.  It really puts everything else I have experienced as a patient in perspective.

As a Nurse for 37 years, I have been very healthy, never smoked, never did illegal drugs, ate well, kept in shape (if you don't count the last 5 years! ), didn't gain excess weight (until the last 5 years of more sedentary type nursing - but I think now it might be quite useful when I go through treatment) , always ate healthy - not much in the way of sugars, fats, fast foods or alcohol.

What got me?  The good ol' soleil.

It started out about 4 years ago as what I thought was 3 little black heads in a zig zag arrangement. As anyone would do, I picked at them to get rid of the head. They wouldn't go away so I left them alone.

After a couple more years, a little bump started forming right next to them, and since I had had a similar bump on the outside of the nostril part of my nose that I had had removed 2 times already in the last 20 years -  biopsied negative - so I didn't think much of it.

I started becoming self conscious of it in the past 1 1/2 years and so when I finally got a family MD in my community (hard to get - we need more MDs!)  I asked right away if by looking at it, did she think it was something to worry about?  She said no.  That was February 2014.

As I mentioned in my previous post, My folks had  a couple of disasters happen so they came to live with me for almost a month, so everything to do with me,  was put on the back burner.

Finally got around to having it biopsied June 16, 2014.   It took 17 days from bx to the phone call from the MD office to tell me to come in to see the MD.   I could only get in on Friday, July 4 2014 - just before the weekend.

The news was devastating.

I didn't think of how hard it would hit after the first shock.  I have only told my nursing friends, because they will just "get it" a little bit more than my other friends and family.   I am keeping family out of the loop for now - especially my mom.  She is assuming it's basal cell, just like she and dad have....and I will continue to let her think that.  I am not going to be the reason she doubles her ativan dose.

Over this past weekend, I have slipped into my usual coping mode:  Not eating very much and losing weight - 5 lbs over 3 days....which kind of worries me a bit because I want to keep some of that weight on reserve for the treatment part -  because I know how sick one gets on interferon, if that is the course they choose for me.

Having worked (oh so briefly) in the prison system where 1/2 the population has Hep C -  I have seen the results of what can happen in the course of taking Interferon.  It's not pretty.  And you usually take it over the course of a full year.

That means the rest of this year  and possibly part of the next will be a crappy one if that's the direction I am going.

Good side of it all - I am old enough not to worry about saving face. 

Retirement is just around the corner - but that's not why I came back.

For the last year I have had a little lump of skin growing in the vicinity of what I thought were a couple of little blackheads on my left cheek.

I got worried enough that I finally found an MD to go to in my community - and on examination, she said that the lump didn't look too suspicious.

So I went about my business and forgot about it because it was about then that my mother broke her arm and, she being the sole caretaker of my father who has Parkinson's, I had my brother pick them both up (5 hr drive away) and bring them to my place.  To live.

Working full time and taking care of them full time took all my energy and every hour of the day.

Finally, I lined up a removal of the bump June 16th, and my MD sent it off to pathology saying - "If you don't hear from us, you are good to go..."

My mom glibly told me over the phone, "If anything, it will probably only be basal cell like Dad and I have.  No problem, your MD will burn them off - we do it all the time - every office visit."

Well, the other day I got the call that made all the July 1st and  4th fireworks seem like one lonely little half-fizzled sparkler.

Diagnoses: "Invasive Malignant Melanoma" and as far as they can tell, it's already Stage 3 and that may be revised once I have more surgery to remove a larger area because the abnormal cells extend right to the edge of the sample.

The doctor said they would line me up fairly quickly with the plastic surgeon and also the Cancer Clinic.

It's strange after 37 years of nursing full time, to be on the other end of the medical system.

I will let you know how it goes.

All I know right now is -  it's a difficult wait.

Lucky for me I have quite a few girlfriends who are nurses.   They are all volunteering their services if I need them.   Hopefully - I won't, but it's nice that they care.