Tag Archives: midwife

“They’re heeere…”

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Foobs.

Fake boobs.

Rising out of nothingness…Suddenly. In Biblical fashion.

The surgeons very kindly took me seriously when I said the prospect of traditional dual mastectomy horrified me. They inflated temporary tissue expanders to about half capacity before I left the operating room. So when I explored my chest in the recovery room there were these little convexities–booblets–complete with my very own nipples, right where I’d expect to find them. Mightily encouraged (this is all hearsay, mind you–I’ve no memory of it), I am said to have gleefully exposed them to anyone who’d look–the spouse, my dear friend Peggy, and whatever nurses & techs were trying to keep me breathing instead of flashing the entire floor.

So I’ve discovered an inner extrovert. If it only emerges after anesthesia, I’m good.

I was apparently good that day, as the spouse was heard to say, “Gee–it looks like you’re nineteen again!” Bless him. We won’t talk about how he knew what I looked like at 19, except to say that it involved a communal swimming pool and some self-conscious skinny dipping. There are those who will remember the ’70s & how that used to be OK. Nowadays, if I’d been much younger, there’d have been arrests.

But, nobody gets to stay 19 forever, even a second time ’round. I left the hospital with the medical equivalent of saran wrap holding my chest together. This would stay on an additional two weeks, providing increased heat within really thin skin that needed to establish new circulation, and a way to peer at the nipples–which until the surgeon told me, I didn’t realize might dry up and blow away.

So now, three weeks out from the original surgery and with regular infusions of saline, foobs have emerged from the primordial booblets. Given my profession and the profound effect words have on women’s sense of self, I’ve always been careful to give body parts their correct names–at least with patients of a certain age  and comfort level. But special circumstances create the need for new vocabulary. An email friend who’s been through the same process tells me this stage is the “foob” stage. From the Latin, of course: fake boob.

Seems entirely appropriate to me, as these have certainly passed up my 19 year old booblet moment. Booblets are cute and unassuming. Foobs, well, foobs make their own way in the world. Anyone who accidentally runs into me won’t hurt me, but might come away with some serious bruises right about foob height. Which means we’re not talking “real” breasts yet.

I’ve got another one or two infusions to go before the tissue expanders reach their limit. Or I reach mine (this is not a comfortable process). A couple months after that, once things have stretched and settled to the extent they will, the expanders are exchanged for implants that feel much more like “real” breasts. And with any luck, I’ll start feeling real again, too.

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.

Sh*t.

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I hate having meltdowns. So I had two on Sunday. Sort of because my neck was killing me and Tylenol doesn’t cut it. And the chiropractor wasn’t in (lazy sod).  Retaliated by eating three ice cream bars. That helped. Then I got proactive and watched “Mastectomy and You”–the DVD my surgeon assigned. Like I get brownie points for  writing a book report. Or returning it on time. Like the stupid thing’s gonna help.

Should have been more protective of my mushy mind. Choose one source of information and stick to it, I say to my patients. Do I take my own advice? Noooo. The DVD pics bear little resemblance to the ones the plastic surgeon showed me. Not that they’re so bad, they’re just not so good, either. Hence the meltdown.

I swore I wouldn’t cry. Years ago Mom cried enough for both of us, wasting months wailing about which lifesaving procedure would, in fact, save her life. That she had months to waste should have been a clue. Her diagnosis was DCIS–now considered a high-risk precursor, but not cancer itself. Eligible for lumpectomy. In the 70s they didn’t know that and didn’t seriously offer anything other than modified or radical mastectomy. Didn’t offer reconstruction, much, either. If they did, it wasn’t until years after treatment, once survival was pretty much guaranteed. The fear was that reconstructed tissue and thick scarring might make a deep recurrence nearly impossible to see. Misogyny and concern rolled into a tight little bundle. And utterly believable as far as my mom was concerned. Lop off her breasts and replace them with something that could moot the whole point? No thanks.

Lord knows things have changed, and I’m grateful for it. Scoop out the offending bits and deal with the rest later. Unseen recurrence? Not likely. Leave the hospital with something that hurts, but pokes out instead of in? Priceless.

Mom and I were different in lots of ways. I guess every one of us is. After seeing those godawful mastectomy scars every day after my 15th year, the decision was made loooong before I was ever diagnosed. My best friend got leukemia. Possibly an infinitely worse diagnosis than mine. Ended up with stem cells, a stroke and a bald head. She rocked that look. Mom and her concave chest? Not so much. My aunt (her younger sister) didn’t even want to try it. Diagnosed two different times, she was stuck with two different reconstructions because silicone wasn’t on offer the first time. Her words to me? “Just do it.” No matter what the technique, just do it.

And her advice, I’ll take.

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.