Tag Archives: birth

Treat your children well…

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I don’t know what I was expecting going into this Angelina Jolie-breast-preservation-mastectomy thing. Or maybe I do, if I get honest. I think I was expecting to look and feel pretty much like I did before the two, Two, TWO surgeries in one. Yeah, the Wrigley’s gum commercial dates me. I’m speaking of mastectomy followed immediately by “reconstruction.”

I’m feeling stupid because I let myself believe reconstruction meant restoration. They’re not the same. I’ve got what pass for breasts (very nicely, under clothes), but are really nothing but foobs (fake boobs, previously discussed). Kinda awful to look at without the clothes. They’re shaped by triangular-ish plastic inserts with a port for sequential infusions of saline. They could be made really, really big if I was into that sort of thing and wanted to lose the use of my right arm. More on that in another post.

And you know how they find the port to do the infusions? (Boy, what an education this has been.) With a stud-finder. Now that got my husband’s attention. He has mostly averted his eyes from the foobs, but pull out that stud-finder and he’s Johnny on the spot. It is kind of interesting. The expanders can shift, and they do, so the ports have metal in them to help with detection. Out comes the stud finder, for every infusion. First to “X” the spot, and again to check right before they stick the needle in. My doctor’s stud-finder is blue.  Hmmm.

Wall sculpture

Does she, or doesn’t she?

Weird as it is, the process works, even if the result doesn’t look quite right and the “foreign body sensation” means they’re always on my mind. Always. It’s like having something in my eye. I feel them moving against my chest wall, and I can’t keep my hands off them. I’ve had to tell my husband to poke me if he sees me holding my chest in public. The edges of the expanders wrinkle and flex just like an IV bag. Or a flattened beach ball. The ports feel exactly like the squeaker in a dog toy, only harder, and the right one hurts from the inside when I lift something and my pecs flex. You wouldn’t believe all the little things we do without thinking that require pectoral muscles. Opening a mayonnaise jar, for one.

In the mirror (and I’m always looking in the mirror), I’ve got mounds. And that’s what they’re called in surgical parlance. “Breast mounds”. Don’t know how I feel about that. I get the mental image of a bunch of men in lab coats thoughtfully considering the desirability (in one way or another) of various breast shapes and how to achieve them. I joke with the nurses that in terms of shape, my left one is Mt. Ranier and the right one, the one that gives me trouble pain-wise, is Sugarloaf. I actually like Sugarloaf better when I look down and compare the two, but they’re certainly not the breasts I’d grown to know over time. The ones the surgeon frowned at for their degree of ptosis (read sagging).

I was never taught to appreciate what I had while I had it, as I imagine many of us find, plodding through life. In the words of that gawdawful song, “you don’t know what you got ’til it’s gone.” I’ve got old photos that catch half of me sitting naked on our porch in California (because that’s what we did in California), and wonder why the hell I ever hated my little booblets. Or my not-quite-flat stomach. Or my skin that wouldn’t tan. They were fine. They were lovely. But nobody told me so because that’s not what’s done in our world.

In our world–the world of women anyhow–there’s always room for a lot of improvement. And when I was  kid, I was one of the many victims of the depression-era hangover that said children shouldn’t be encouraged. Certainly not about body-related stuff. The closest I ever got to a compliment from my mother was, “there’s nothing wrong with you–you’re not deformed.” This in response to my teenaged despair about never finding pants long enough outside the boys’ section of the store.

My dad was better, always ready with a “don’t you look nice” at odd times and when I got dressed up. Much of his life was spent around female models, and he did them the favor of always being professional, never making comparisons, and as I mentioned in another post, never “improving” on them in paint or bronze. He also didn’t make the mistake of being afraid to include me in his life or touch me once I reached puberty.

I’m glad I took photos of myself before surgery, because even at 53, even with “ptosis,” my breasts were still lovely. Not because they met media criteria, but because they were mine, they were intact, and I was used to them. And for most of my life they weren’t diseased.

These new things, these foobs, aren’t mine yet. I’m reminded every time I lift something that they aren’t breasts, they’re pectoral muscles. They clench. They spasm. They can be seen doing so under the skin. My skin is stuck to them. But only just. Skin without fat under it is thin. Transparent, really. Foobs are a constant reminder that man cannot improve on divine intent, evolution, or whatever it was that got us here.

But I’m going to have to develop some affection for these poor, benighted things, as they’re being asked to do what muscles were never meant to do–masquerade as fat. And I’m going to have to do all the exercises the physical therapist prescribed if I hope to get strong enough to stay up all night and catch babies.

The plastic surgeon tells me I’m not a “high needs” patient–the kind we health care providers all know and dread because they can’t be helped–yet I certainly feel like one. I’d kind of like to be one. I have no reason to keep going to his office,  but the support from the nurses there makes me miss having an appointment every week. What a catch-22. Something helps, yet availing myself of it feels wrong, or weak, or…well, just weak.

Foobs aren’t exactly trouble-free. I still have pain when I first wake up and the continental plates shift across my chest. Then there’s the end of the day when I just can’t stand myself any more. Fatigue hits like a ton of bricks when I’ve simply pushed a cart around the grocery store. My brain functions like Swiss cheese. Honestly, NOBODY would want me delivering their baby right now. But I feel like I should be better than this. I just know my friends would be stronger–they’d be done with it all and probably back at work again, ignoring the fatigue. Like midwives always do. Like women always do.

It scares the hell out of me, but I’m going to do the polar opposite of what my work ethic wants. I’m staying home until all this is over with. You’re all invited to join me.

It’s my party and I’ll cry if I want to…

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So I spent the last two days trying to take a friend’s advice. “Quit feeling sorry for yourself and write something interesting.” He was a little more tactful than that, but I got the message.

I did try, honest. He even gave me a good jumping-off point: my original mission statement for the Situational Midwifery blog–a soapbox about things encountered as a midwife. The things that piss me off about women’s health care. About how nothing has changed much under the sun. How women and their problems are often blamed for, well, women and their problems.

I’ve got half a lifetime’s worth of subject matter, but right now that’s not not exactly what’s rising to the top. Go ahead and look forward to future harangues, but for now they’ll be about my own stuff.

Participation is optional. Nobody is required to read a blog. I haven’t been a professional writer for more than half a lifetime now, so for all I know, it’s crap. Or it’s crap to men, or it’s crap to folks who haven’t faced something similar. I’m ashamed to say I’m one of those. I got so tired of my mother’s crying jags and worries and photos of grotesque surgeries that I was nowhere near as sympathetic as I might have been. At 15 years old. So I understand that point of view, too.

So read on, or not. Part of what I’m learning these days is to stand up for myself. My friend has given me yet another opportunity to do so, even though I’m afraid he’ll take this the wrong way. If I never hear from him again my husband (who loves this guy), will be really pissed. Then I’ve got two problems.

Hot diggity!

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Wow. I didn’t expect to be giddy with relief after the surgeon’s appointment today. Like Cinderella at the ball. Or Dorothy home in Kansas.

The three page birth plan is back in force. There will likely be no chemo. And probably no radiation. My hair won’t fall out and my skin won’t peel off. I won’t feel like I’m dying in the midst of “treatment.” Nobody batted an eye at my request for skin-sparing bilateral simple mastectomies and immediate reconstruction (the first steps of it, anyhow). The incisions are small, and the procedures will be done by folks I trust. All my externals will be left as they are–maybe even with some sensation. My friend Michelle just messaged me about the “awesome new rack” I’ll get for my troubles. LOL. I’ll be happy with just short of normal.

All the arcane testing done on my cells says they haven’t gone nearly as awry as “invasive” breast cancer implies. Chemo won’t work on “non-HER-2 expressors.” Or those with a “low Ki-67 proliferative rate.” Am I the only living woman with an urge to thank an under-acheiving cancer mutation? Mom viewed my decision to become a nurse as evidence of mediocrity. Well, hoo-yah!

We shall see. The above changes if it turns out some pesky cancer snuck into my lymph nodes. That will be determined with surgery and could require radiation. But by then I’ll have the expanders-soon-to-be-implants (yay silicone), and there’ll be no going back.

…I got to reading that last sentence, and realize there are friends and patients I know who’ve had a terrible time with aggressive cancers and all the misery chemo implies, as well as postoperative complications that require going back to the beginning and starting all over again. In the face of all that, my giddiness may well feel selfish and downright insensitive. I apologize. I’m enjoying the moment, though, and trust you don’t begrudge me that.

Not what I thought it would be…

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So I thought I’d be posting about midwife stuff.

Instead, I’m bawling into a wad of Kleenex after the second of what’s going to be a whole series of breast biopsies. Not that this is anything new. I’ve had cysts aspirated and densities sampled, and ultrasounds and mammograms–all in excess of the usual surveillance undertaken by good girls. Hey, I’m in the business. I don’t believe in the talismanic properties of medical tests, but I do them anyway.

This time seems different. Had the mammogram and got called back for more. Nothing unusual about that; it happens every time. I don’t even bring my husband these days. Then I was told I needed a fine needle aspiration. Still not alarming. But it must not be too fine a needle, as the radiologist left behind a titanium marker shaped like the stupid pink breast cancer bow. I didn’t get a vote, he just showed me the pictures and there it was: bow marks the spot.

Sitting with a cold pack on biopsy site. You can see how upset my dog, Buddy, is. There are angels among us, I tell you.

Sitting with a cold pack on biopsy site. You can see how upset my dog, Buddy, is. There are angels among us, I tell you.

Only it didn’t. Missed it by an inch. The Area Of Interest is deep, so I get invited to do a stereotactic biopsy. This one’s like being in a weird sex film–I’m face down, utterly helpless, boob dangling though a hole with people I can’t see sticking needles in it. And my husband’s in the next room (ok, I chickened out and brought him this time). There’s nobody to hold my hand. The technologist presses on my back, but I get the feeling it’s more about keeping me still than for comfort. It’s embarrassing because because I can’t breathe when I’m on my stomach. I’m snuffling and snorting, trying to keep the table dry, and they think I’m losing it–which I mostly only do in private.

So this time the marker’s in the right place. I don’t notice if it’s shaped like a bow or a bunny or what, because I’m riveted to the screen. Dunno why we bother with mammograms when there’s this kind of imaging. It clearly shows a mass. Not the “density” they’ve been whispering about, but a real mass. The radiologist calls it “very concerning.” It has spiky edges. The crablike kind that gives cancer its name.

Nobody says cancer yet (and if they keep not saying cancer I’m gonna be really embarrassed about this meltdown), but they want me back for another stereotactic hoo-haw the day after tomorrow. This time to sample smaller bright spots around the big spot. Everybody’s being very kind, very attentive, very professional. And I’d sooner stick my head in a toilet than step through their doors again. But guess what? I’ll be there Thursday morning, bright and early. Leaving the bells at home.

Empowered Blogger  

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I’m a midwife who’s been up all night for most of the last 30 years. Before that, I was editor of a small town newspaper. I left that job swearing I’d never face another 3 am deadline. Now I’m thinking what I really needed was a good night’s sleep. (And they say the definition of insanity is doing the same thing over and over, expecting a different result.)

But I miss writing, so I’ve decided to launch a blog to record some of the brain activity that occurs between naps. I’m a little worried about exposing my tender underbelly to the pointy public, but have decided to dive in and see how we all get along.

This page will be where I get on my soapbox about things I encounter as a midwife and women’s health nurse practitioner.

Some ideas:

  • HPV vaccine & parents who disapprove
  • Waterbirth. I do it, but it ain’t natural.
  • Birth plans. And staying flexible.