Month: December 2015

Jouissance: Joui-Sans

The knock of the knot –  Breast Cancer with a Lacanian Shape Angle Curve

The Real – Fear Intrigue Fortitude

Deride me not when I write sous rature! Part of my kick is the satisfaction achieved in the toying with language. Or even the loy of tanguage: tangle, wrangle, engage, joy, toy, employ. This chapter traverses the path between the lumpectomy and its clinical findings.  The chapter examines jouissance and the Lacanian Symptom in a manner that endeavours to simplify their guises. It questions how much control each of us has over our own health. Could you rot an apple with your mind? The final paragraph situates the patient face to face with the oncologists’ verdict on a day when other distracting matters took the cancer pedal off the gas!

Derrida’s first indebtedness to Heidegger lies in his use of the notion of sous rature (‘under erasure’). To write ‘Under Erasure’ is to write a word, cross it out, and then print both word and deletion. Visually the original word may be read and understood alongside its replacement. Once it has been crossed out, it is barred, its relevance is questioned. It is erased but still shows evidence of a path once taken. How does what it meant before compare with its meaning now? Meaning can be inferred in a transference from the symbolic of the writer into the personal imaginary of the reader. The reader already has a mille-feuille of layered of meanings to wrangle with.  How does writing “sous rature” add to the multitude of signifiers that vie for a priority of meaning?

Angles Curves Straights  From Something to Something Else
Breast surgery leaves a woman with cuts and scars: period. We do not know what will become of us when this journey begins. Surgeons hope for the best outcome but healing is individual. As these marks heal, some rise and wheal, some turn into thin, flat, silver slivers, others redder, wider jaggedness. Under the skin the flesh has been torn. This seismic movement may leave lumps, bumps or oddly smooths – more straights than curves, or more bulges than straights. How our bodies are left will never be static, always evolving. Our states will never be still: our mornings different to our evenings and our hormoanal tides, wild or tamed will shift the balance.

Jouissance
Jouissance is both how we feel and react to our inner drive to enjoy ourselves.  Jouissance is our individually chosen “carpe diem” how we choose to seize the day.  In their chapter metapsychology: from body to history, Bazan and Detandt (2013) propose that jouissance is in the order of “agieren” or taking action. In this sense the pleasure is felt more strongly in the action leading to the seeking of an object of desire than actually obtaining that desired object. They suggest that jouissance is related to the release of motor tension that brings relief to the drive. While pleasure implies the consumption or attainment of an object (objet petit a) jouissance is in the use of the body.

The Symptom
How we deal with life, particularly within the time of an evolving cancer journey depends on our calling, our ego and how we choose to channel the release of our libidinal drives. The Lacanian symptom is the way in which we pursue our jouissance. The symptom may take the form of a character trait, manifested as being over tidy or untidy, controlling of others or being subservient. It may compell us to seek solitude or reacquaint with friends. Seek wide outdoor spaces or stick to homely routines. It may take an artistic form. Often anxiety and the libido transformed in crisis becomes the organizing principle of the jouissance of the artist or writer. Thus our mode of jouissance is the Lacanian symptom. Our particular chosen activity and our way of enjoying it will be repeated. This is because it gives us each, (as the human subject) a consistency. Our chosen “passion” is part of who we are. The Lacanian symptom is the visible trace of the particular modality for the subject’s jouissance. It is how the subject takes action to manage the distracting, disruptive, destructive, flotsam-jetsam of the unconscious. Jouissance is about how we silence, quieten or use-up our internal individualised libidinal chitter-chatter. It is how we tame this unconscious background noise of the mind, whose volume is often ten fold when faced with an uninterpretable Real: cancer.

Jouïs-sens (to hear meaning) Jouis-sens (to enjoy meaning)
The Real is the yet unsymbolised. It often looms up alongside a life changing event: a bereavement, an illness, a trauma, a cancer diagnosis. It often brings us in touch with our mortality and the ephemerality of life. This dance around the Real is an unconscious delving into our unconscious, stirring of our fears, fuelling and symbolising our imaginings, whilst relentlessly giving no respite. There is no escape from the Real. It catches us unawares from an angle seen awry. It is a sudden recognition of something unrecognisable. This misrecognition, a méconnaissance is where the subject becomes alienated in language, adrift beyond the symbolic, beyond expressible description. The impenetrable le mur du langage “wall of language” leaves the unnamed Real of the unconscious entrapped. The unnamed essence that is the unconscious will haunt us even more persistently in sleep. Sleep, where in our dreams anything goes. Where contradictions unify and nothing is prohibited because there is no “no” in our dreams. The unconscious is independent of language, a place where no meaning has been inscribed. In psychoanalysis however, unconscious meaning may move to the dominion of the preconscious, awaiting the intermediary of language. (J)ouïs is taken from ouïr to “hear” as the analyst listens. Progressively the analysis takes form through a matter of suturing and splicing until meaning is heard, jouïs-sens (to hear the sense or meaning). The desired psychoanalytic outcome being: Jouis-sens – I enjoy, I make sense – Enjoy-meant!

In Écrits, “Psychoanalysis and its Teachings” Lacan views the symptom as inscribed in a writing process. The symptom is a pure jouissance addressed to no-one because it is the manifestation of the way a subject enjoys (jouit) their unconscious, (Seminar “L’angoisse” 1962-63). Creative outlets during times of crises are undertaken for their own sake, if others can be appreciative then all well and good, but in the first instant they are a release, a way to channel the raw libidinal energies of the bodily drives. Creative outlets are a way to deal with the un-symbolised unconscious as the Real seeks a translation. The Real clamours to be symbolised with its “compelling and potentially horrifying alien material persistence” (Žižek 1997: 55–106; Braunstein 2003; Declercq 2004). It demands an outlet as it squeezes through the register of the Imaginary.  Perhaps eventually it may succumb to a conscious translation in the more manageable symbolic realm. Although primarily the traumatic material of the Real is unsymbolised knowledge which nags submerged. It is latent, only occasionally rising (often with anxiety) as knots in our language and thought.

When Jean Hyppolite asks: “What use does the Symbolic have?” Lacan answers: “The Symbolic, the Imaginary and the Real are useful in giving its meaning to a particularly pure symbolic experience, that of analysis.” Since the symbolic dimension is the only dimension that cures, “The symbolic order is simultaneously non-being and insisting to be, that is what Freud has in mind when he talks about the death instinct as being what is most fundamental: a symbolic order in travail, in the process of coming, insisting in being realised.” Thus the “conquest of the symbolic order is essential for the human being to accede to a humanized structure of the real.” (S3 p.198).

Lacan was fond of saying “the Real is impossible,” impossible in that we cannot express it in language because the very entrance into language marks our irrevocable separation from the Real. Nevertheless in the event of acknowledging the materiality of our existence the Real overwhelms us. It forces a recognition that is perceived as traumatic as it punctures and threatens our very “reality” and drives us toward Lacan’s sense of jouissance.

Repetition and Joui-Sans
In Lacan’s later period he maintained that our methods of jouissance facilitate an achievement of libidinal-consistency by expressing-out our anxiety-evoking encounters with loss and lack. Through jouissantesque activities the holes that burrow into the pain of the Real are explored. During this (artistic, therapeutic or psychoanalytic exploration) unspeakable materials may begin to be brought to light symbolically, rather than being felt as psychogenic and enigmatic somatisations. The symptom is brought to the fore through repetition. In repetition we seek to recapture the first thrill of jouissance. Yet repetition is the curious link between the pleasure principle aka jouissance and the hidden mask of the death drive that is camouflaged behind this joy. Pleasure turns to displeasure as there is no recapturing the intensity of the very first instance of pleasure. There is no repeating the depths of ecstasy felt for the first creation, achievement or mastery. The death drive encroaches and its shadow looms larger in sync with the momentum of repetition. Pleasure turns to displeasure and eventually pain because repetition dilutes and slowly annuls the initial thrill into a consistency and evenness. There is no way to re-live the first hit of joy because everything after the first “buzz” is a reminder, a reminiscence, a substitute which never-quite has the real authenticity of the first time. If the pleasure endures, there is only so much pleasure one can take before it becomes painful pleasure.  Thus jouissance is suffering, (S7, 184).  Our jouissance mutates toward the frustration of an embittering joui-sans.  For an interesting article see  Bazan and Detandt (2013) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3818686/

Home after the lumpectomy
Home, but wounded again. Just as my body had completely recovered from the biopsy the proper surgery was done already. For weeks the biopsy aftermath had continued to zap its zings of nerve healing pain. The pain wasn’t immediate but began a week after the intervention. It was a deep abrupt “high pitched” pain arriving with no warning. Now home after the lumpectomy I was facing another state of external and internal disrepair. It was a place of limbo with no health certainties. Thrown back into a strange day-to-day without yet having a medical verdict. Hemmed in by the hourly “what if” thoughts: If the cells had spread to the lymph my prognosis would alter. The incision was below the arm pit. It was hidden, covered by a large square of gauze and a wedge of waterproof bandage. Ablutions followed post surgery care instructions. It would withstand a soft daily shower but not a baptism of emersion. I tended it cautiously. A trickle of water poured like a delicate vintage. Whilst feeling more brazen with the healthy good-side, I was more todo-terrano, enjoying the normality for functional manhandling: relishing a one-sided hot shower and the rougher texture of a dry towel.

Exercises for post surgery breast healing
I felt sad for my condemned pampered breast. Would it prove to be innocent or a traitorous accomplice harbouring the most evil malignancy? The bandage strips were strapped up tightly to give decent support all day and the maternity bra was helpful and comfortable to sleep in. It’s amazing how the body fixes itself. Every day it felt a little better. I continued to maintain the stretch exercises by using the routine sheet I’d been given to prevent stiffness. The first stages of limbering were standing poses. Reaching my arms up, stretching higher each day. The tissue tension was most noticed in the Winging It exercise. Placing hands behind the head, with elbows askew and gradually brought inwards to touch.breast exercise2Then the same but lying down: hands behind head and bringing elbows to touch, then lowering them to the floor. Ouchy, now that stretch was trickier! At first it was impossible to push my arms to the floor. The skin was taut and tight, but slowly over days it improved. breast exerciseThen a particular standing stretch I’d discovered (which wasn’t on the instruction sheet) was also incredibly hard: bringing the arm on the injured side across. Holding the right arm (of the injured side) out stretched to the right then bringing it ahead and then diagonally across the body to the left. What a tug to the back muscles that caused!

Comforting Accessories
http://www.comfybreasts.com/order.htmSleeping was difficult. My dream idea was a mattress designed with a chest slot similar to the above. I didn’t go for this but would be interested in hearing of its efficacy. After the surgery my preferred position, sleeping face down, was on-hold indefinitely. To be pain-free the injured side needed to be maintained parallel. Not so easy to keep the breast aligned on top. It helped to prop a pillow along the side of my body adjacent to the breast, to keep it from sinking to the side. The parallel arm slightly elevated. I found a site with some interesting breast pillows but following surgery I didn’t find them useful.
http://breastcancer.about.com/od/treatmentoptions/tp/comfort_pillows.htm

Power of Thought – Healing v Harming
A ten day wait lay ahead. What would the outcome be? The ideal scenario would show clear margins with no lymph involvement. But thought power was not going to change the verdict. You can’t seriously wish yourself well or think yourself sick…can you? I tried not to let my mind wander through the consequences.  But around this time there was an article that created a bit of a furore. It was about the power of positive versus negative thinking. apple powerBrow furrowed and lips pursed in thought. Can you rot an apple more quickly by throwing it a barrage of hateful thoughts. Well apparently so. Everyone would agree that you can’t wish yourself to win the lottery. You can’t really create a voodoo-like hex to wish ill on yourself or indeed others. Wishful thinking is surely as it sounds: wishful. A timely article indeed to show the power of scepticism and how a damaging mind-set supposedly causes actual bodily harm.
http://thecharismamodel.com/the-big-apple-experiment-gallery/

Bewilderment – Be Wilder I Meant!think
So the “C” diagnosis is a long fall down. Hitting the ground takes longer than you may think, with some of us hanging on before falling further. The diagnosis leaves survivors in a minefield of bewilderment. Now this is a word for a little Lacanian mischief. A word that states it is “meant” to “be” “wilder”. In this wilderness one is left to roam, to be separated, estranged, isolated, from the logical sense and meaning of “the other”. In this wilderness the patient may forget the symbolism of what is said or read. Instead being left to tune in to the body, filtering-away the white-noise of the outside. Instead listening to an imaginary dialogue of a future yet to be lived. Pre-diagnosis leaves the mind to wander and wonder. The realm of the wandering leaves us wondering where the next trip wire may be.

Echoes of you’ll be fine, they’ll figure it out are reassurances from the “big Other” – hopeful sound bites used as part of the illness language schema. So I wait, impotent and expectant, silently numbing scepticisms of any half empty glass. How will one accept and cope if faced with a sorry verdict. It is my body. If it is rotten at its core it will still be my body. Things could still swing back to the knife. Further slices required if there weren’t clear margins. If the lymph were to be affected then all sorts of possibilities open in the road ahead. Iffing and butting are impossible to surpress and they help the psyche prepare.

Word and Action
Ten days after the surgery the essential appointment arrived. My mind wasn’t actually tuned in. The admissions secretary assured us (I wasn’t alone) that my early appointment was not running late. My preoccupation was distracting. I needed to be seen to have the healing process checked. Beyond that it was all ce la vie. An automaton, I needed to leave. My eyes were darting to the time.  The door opened punctually at 10am. How efficient would this be? Entering the clinical room, the dressings were removed, the red-rawness of the scar was positively appraised and the skin-tissues were left to support themselves. In preparation, my underwear seams had been cut away to leave room for the bare skin. All was repairing nicely. We had a train to catch. My mind was not on my situation. We had to leave this appointment and leggit to the station. We couldn’t miss the train and arrive late. A week after my lumpectomy operation, my step-sister had been ingressed into a hospice. She had barely arrived there before passing away from stage 4 breast cancer. Two years earlier her symptoms had been leg and back pains and her prognosis the most grim. My appointment was at ten and her funeral, fifty miles from London was four hours later. Dressed once again we were escorted to hear my verdict. What had the surgeon found? We jostled into a tiny room with three oncologists preparing to tell the news. Hear it and run was the voice in my head. It was good news. The best news: low grade, small area of cells (<15mm) clear margins and no sign of trespass to the lymph. I didn’t want to stay to negotiate my treatment. Deep inside, I knew that they would follow the clinical protocol.  Even if I had questions the “treatment package” was set in stone. Right now I had to leave. Perhaps they’d expected a bit more of a battle from me or at least a barrage of my usual questions. My chair scraped the floor as I pushed back and arose to gather my coat. We must have cut a strange silhouette in our angular black funeral attire. We barely shook hands before pelting out into the street to pay our respects to someone who’d been dealt a harsher hand and was waiting for her final farewell.

 

Posted on by Borromean Strider 0

Op. Day – 4. Recovery Room

The knock of the knot –  Breast Cancer with Lacanian Angles

Athlete 45bpm

Drugged and Woosie in the Recovery Room, I’ve woken up. A good sign. My left arm making the blood pressure machine bleep. “You’re athletic” it came more as a statement than a question. I did warn them that I was fit. My pulse at rest dips below 45bpm. Oh hell. Had they brought me back from a close shave with the grim reaper!? Who could tell? Would the surgical team ever admit to such a thing. Had I expected to die? Pop my bucket, kick my clogs! Well there is always that outlier, that statistic! Of course it had crossed my mind. All that surgical intricacy and teamwork almost lost. Do near deaths even get recorded? My fingertips felt a little numb so it may have been a real possibility. I can wiggle my toes and fingers and what’s more I can see them move. No phantom effect here. But who cares, I’m here. I made it back, vital signs monitored and still wired up to the drip. This time with tramadul and perhaps some other opiate ingredients. It was ten to one. The second hand moved with a deliberately slow pace. The slurred tick or tock of a clock that has witnessed the imbibing of one too many sedatives. Just over the two hour surgery-time. Probably no working-hour for extra-dramatics, no window for a resuscitation, no time for a near death experience. They’d done their job and here was the result. I was awake. And they perhaps were at lunch. There was someone communicating. Someone muttering, murmuring. Was that me? Was I okay to go back to the ward? I needed the bathroom. A bed-pan. Fine how could anyone argue. Humiliation didn’t fit here. Just needed to pee. Oh what relief. Yikes the bed pan seemed a little shallow. I had drunk loads before the zero hour or nil by mouth curfew. It put my mind at rest. Didn’t need to worry about that again for a while. They took it away. Soon after I reawoke, back in “my” bay by the window, on the ward. The air was chill. Had I walked here or had they wheeled me back in? Drowsiness had won through again. Falling back into the hole of unconsciousness.

Running on pause/paws

“When can I start running again?” Ooo that question was of interest to me too. Hey who’s speaking? Who are you behind this fake curtained privacy? Do you run? I run. What surgery did they do to you? Ah a tonsillectomy. Not quite on the same page as me then. Breast surgery. Malignant cells. Yes. No I don’t know when I’ll be up to run again. We exchanged numbers when we discovered we were neighbours near-as-dammit. I lay back. Time flowed over me. The second hand was Daliesque in its inability to mark temporal change. Was I ready to leave? Soon. Soon.

http://myartmagazine.com/image/salvador-dali-painting-by-jim-warren
My Art Magazine Dali by Jim Warren

Most of the morning patients had self dismissed. A sandwich was offered. Gratefully I chewed, mouth dry, tongue like a wet roll of flannel. Egg with a vinegar mayonnaise. Perhaps I could try the cheese and ham please. The buttery bread was the most pleasant part. I texted my survival to family and friends. Delirious messages. Not so groggy now my things were neatly back in the rucksack. Of the three bras I’d brought along I chose one for support and comfort. The roushed under arm elastic low on the thick surgical dressing. The bandaged area was without sensation beyond numb even. Nurses saw that I was ready to leave. I’d been here ten hours. A bag of pain medication and dosage instructions were explained. Can’t say that I was able to take-in that information. My significant other was waiting, time resumed the pace of the outside world and we headed home.

Posted on by Borromean Strider 0

Op. Day – 3. Mammary Mia

The knock of the knot –  Breast Cancer with Lacanian Angles

Facing Magazine 2010 Again

Transported back to wait for the next step I soaked up my wholeness. More than me, I had additions. Semi-cyborg! A Seven of Nine with all her thoracic metal implants! I tucked the blankets around my knees again. Those old glossy magazines smiling, grinning knowingly at my side. A wide berth. Who would touch them? And who do I tell that their existence was rather abhorrent. The bustle of medical staff in and around the corridors. If those magazines could tell their tale. How many patients in the last five years? How much weight of patience and emotional if not physical pain was held in this corridor, contained here and seen awry by the existence of such old magazines. They’d survived the duration, not even dogeared. Or perhaps some kindly soul had just recently left these magazines as a good will gesture. But five years since they’d been published. How many millions of births and indeed deaths since then. How many graduations, retirements, parties, partings? How many therapeutic hands had grappled with a condemned cancerous breast. How many daily squirts of antibacterial gel? How many others have recoiled at the magazines from 2010?

Mama Mia – Mammary mia!

Almost immediately a new team member in yet another white coat led me into a small room with a lethal radioactive sign looming on its door. Mammogram time! This time to record the position of the wire which acts as the tumor marker. The wire localization is for the surgeon to use the wire as a guide to locate and remove the tumor. During surgery the wire will also be removed. Stripped above the waist the vertical contortion began. Thank goodness for the desensitized breast asleep with its heavy dose of local anaesthetic. Oblivious to the wire inside as I moved it around. The struggle that women of a certain cup size know only too well. A mammogram dance of breast, shoulders, chin, arms and moving the other breast away to stop its natural tendency to sit squarely adjacent to its injured twin like a sympathetic watchman. Oh yes you younger readers what joys arrive with middle age protocols. Scorned for moving my hand the radiologist bid me to stay still. Yet she was clearly relieved to see me remove the unwanted alright breast (the wrong breast not the wronged breast) from the picture-frame to come. The radiographer slipped behind her screen. She was the observer, no hands-on for her. Watch the birdie, say cheese.

scan wire
Wire Insertion – Tumor Marker

A click click accompanied by a gasp of failure, irritation towards a failed irradiation. Of course the wire was so high up under the arm, it was out of shot. A new photo-session commenced. This time at a more appropriate sideways angle. Like a David Bailey model standing square, half naked in a surgical gown posing to the commands: chin high, shoulder back, stomach tensed, jaw relaxed. A tight vice like squeeze. Who knows what was happening inside, but the local anaesthetic was so recently administered that pain was not part of the experience. Permitted to sneak a peek I saw the three images. Two of which had captured the wire insertion.

Outside in the corridor the pile of magazines lay untouched. Possibly untouched over the course of five years. Me done and dusted I waited in the wings for Michael, my guardian. It was a cool forty minute wait. I eyed the smiling magazines, they smiled in return as I nestled into the blankets. Composed and trustful, awaiting the next step and the procedure that lay ahead, back there on the surgical ward.

Speed and dope

Busy Michael returned as my loyal escort at almost ten o’clock. No longer hugging my several accumulated blankets quite so tightly I was returned to the ward and my bed by the window in the female bay. I wanted to text home, to report the success of the wire-insertion. Amazed that the procedure was over. It was a bright October morning. Sunlight poured through the window. Seconds after sitting down there was no time to contemplate because my blood pressure needed to be taken. Next the cannula team approached. As I suspected my veins had retracted under my skin. Typically not to be found in my arms, never in my arms, not by hook nor crook nor to my surprise in my hands. Before I could react, the largest most muscular team-member swooped over my shoulder (across the side I’d been protecting) and grabbed my forearm. With both hands bearing down upon the thin flesh protecting my radius and ulna he explained that if he squeezed (which he did with much skill) the veins would most certainly pop up and indeed they did. With no more ado the needle was inside the vein and the cannula was expertly fixed to the back of my hand. Someone approached with a label for my rucksack and in the next moment I’d been received by the anaesthetist. Moments later there was a short walk to the surgical room. Yes there would be time for a final trip to the toilet, how relieving, I’d drunk so much water, in preparation, the midnight before. I found myself led into the adjacent room perched and on the medical bed slipping my arms out of the gown as instructed. There was still time. Time to be introduced to members of the team. I was in the ante-room and the anaesthetic was being attached. I was introduced to students, did I mind, no, how could I? When would the blue-dye be administered? Just before surgery, not to worry.

Sentinel Lymph Node Biopsy (SLNB)

A sentinel lymph node biopsy (SLNB) is a procedure in which the sentinel lymph node is identified, removed and examined to determine whether cancer cells are present. Early yesterday morning the injection of radioactive liquid, or tracer, was administered. Once under anaesthetic the blue-dye is immediately injected into the breast and it adheres to the radioactive tracer to easily locate the sentinel lymph node. A sentinel lymph node is the first lymph node to which cancer cells are most likely to spread from the primary tumor.

sentinel node biopsy.pngThe surgical team watch as the dye collects in the first lymph nodes. This process of lymph node mapping assists swift and accurate identification of the cells. The surgeon removes about 1 to 3 of these nodes and sends them to be analysed to see if they contain cancer cells. A negative SLNB result will suggest that the cancer has not spread to the nearby lymph nodes or on to other organs. A positive SLNB result indicates the contrary, that cancer is present in the sentinel lymph nodes and may also have spread to regional lymph nodes and possibly other organs. With this information the laboratory report will help the surgical team determine the stage of the cancer and the extent of disease within the body in order to develop an appropriate treatment plan.

 

Back in the room, my underwear was riding up. Could I wriggle it downward. I fidgeted, would it make any difference at all? Would that be the first thing I fixed when I awoke? It was busy in the room ahead, one wheeled out and me wheeled in. Doped, I shifted my head back. It was exactly half past ten.

 

Posted on by Borromean Strider 0

Op. Day – 2. The Wire, Why Her?

The knock of the knot –  Breast Cancer with Lacanian Angles

Queueing behind the curtain

Soon after our arrival the first batch of patient patients were called by name. Addressed by a woman in crocs hugging a clipboard and chewing a pen. Each already signed off to their fate. Permission slips of all possible legal outcomes acknowledged in ink. I agree to… How they moved: toddling off, a macabre scene in its sombre innocence, as they were led away behind their clinical tour guide. The morning sunlight edged forward casting tubules of fairy dust, as a caretaker rhythmically mopped. Then nothing: an ellipses, ripples on still water. Time in its own dimension of now and then. An anticipation of next and another beat of the heart. Ten minutes later “our” subset were called. A mirror image where they’d gone right, we were led left. Equally obedient, six men and six women. As a member of the latter set once inside we were separated again. Our bay was female. The ladies placed their bags upon their beds. Oh cosy inmates. Each bed, made into a cubicle by a thin curtain tracked by ceiling rails. I was empty handed.

http://www.epsomandewellhistoryexplorer.org.uk/images/WestPark19Jun1991ByJRRifkin-2.jpg
“Alice:How long is forever? White Rabbit:Sometimes, just one second.” ― Lewis Carroll, Alice in Wonderland

Confidently or cluelessly or trustingly, I’d left my “just in case” rucksack in the waiting room with my dedicated personal waiter. Yes I’m very fortunate to have my significant other there awaiting – but the choices leading to what made us “us” are another rambling story of on-line intrigue, anonymity and perseverance. Did he feel the weight of the bag or the weight of the wait? The white coats granted me permission to return – to retrace those steps through heavy security doors. Several long prismatic corridors, sometimes with glaring blinking windows, other times gloomy claustrophobic burrows. Hey I’m back, I escaped the group. My nose twitched: clinical smells. The abandonned mop waited. The rucksack which included the cell phone was held aloft. A final “final kiss” and this Alice chose to start again. Or was I the rabbit? Or was there really any choice at all? Enjoy your jouissance!

Meeting Michael my Chaperone

The curtained bay was cold. A draught from the adjacent window. I watched as my legs took refuge under the blanket provided. Automaton. Self preservation. A nurse came by to take blood pressure and I asked if I was going to have the blue-dye injection or the wire insertion. Blinking I knew the protocol by heart, in theory at least. Ah yes she said, yes, Michael will be here shortly to escort you. I had time to locate the loo and then meet my anaesthetist (another tall white coat) and then Michael arrived, flying in from a previous quest. I imagined him as an invincible Icarus sweeping down valiantly as the plot twists in a medical dystopian version of Brazil.

magazines.png
Magazines Out of Time

In a jot we’d left River View and had entered the specialised breast clinic zone. Michael said to wait. He’d be back. So here I waited. Waiting again but that was fine. It was part of the conveyer-belt process: not too fast. I did what I was told. No need to think. At 8:40 I was spotted and given another blanket. As I sat I fed it between my knees. Me myself and I. I studied the corridor. There on the side table lay magazines. I never had been a fan of those glossies out-of-place in a clinical world. So much for anti-bacterial gel when some of those magazines obscenely revealed their date of issue as being five years previously. Five years. The golden aspiration of those who hope to be survivors or in remission after this bleak diagnosis. Those magazines ensconced in their own timeless gasp of horror.

Rabbit in the wire

Led to the ultrasound and wire insertion room. Upon the surgical couch they discussed how I should lay. The cancer being situated high up, situated in an almost under arm area of breast tissue. This meant that lying flat was not possible. How can they view the eleven o’clock flesh? Those of you who understand or have observed the behaviour of the larger breast will know that once prone they don’t sit pert and neat, aloft on the chest. They relax out and downwards sinking with gravity into the arm pit. They sank and took eleven o’clock along with them, daliesque. As my accused breast sank, so the clinician realised a sideways stance would be the only way. Wriggled into a “recovery” type position my face was still able to glance behind. The ultrasound screen was in view. I wasn’t going to turn into a pillar of salt…frozen in time, that would be too easy an end. This adventure required a willing participation in the suffering ahead. But at least I had a front row seat to view the performance. Let’s repeat: Enjoy your jouissance!

http://www.thebushcraftstore.co.uk/ekmps/shops/bduimportsltd/images/6-ply-rabbit-snares-various-set-ups-and-combinations-%5B2%5D-3130-p.jpg
Wire Wound

With plenty of reassurance the area was numbed. A local anaesthetic needle glinted and was applied around the areola. Fortunately I’d been quick to ask exactly where that “sharp” was going in. This was déjà vue, I was here only yesterday and I’d read the blogs. I knew the lesson and this lessened the shock. Sharp scratch and it stung like a bee. For those who need details of the level of pain: the depth reached by the needle filled anaesthetic was barely felt, before even more anaesthetic was introduced. The area was numbed, comfortably numb and then came the posturing for the wire. Compliant I was shifted leg and buttock. Next the re-posturing of the breast. The professional with her hands-on-job to move mountains. Like Muhammed if that mountain didn’t come to her she would grasp “it” with more vigor. The guilty “it” that numb part of myself that had betrayed me and led me to here. That apologetic breast which so carelessly, innocently, flaunted cleavage on the beach less than only a month ago. Placing the wire in the flesh of course required some manhandling of the floppity yet fibrous tissues. Manhandle is that an outdated term? Handled like a man, by a woman? Floppity and yet not so floppity. This is dense tissue we’re dealing with here. A lollipop figure. This is tissue with a mind of its own. Tissue that fills tensely according to the hormonal tides. The hands on approach with a push-pull pressure increased to extract the needle after the wire was in place. The experts apologised for their exertion. Almost straddling my body and heave-ho! My, my that was a struggle to retrieve. In my googling I’d already read about this possibility. The shared experience put me at ease. It was a physical effort to achieve and retract but now with the wire in place the needle was out. Pretty painless. The ends of the wire were flattened and taped across my skin. A brooch but not one of valor. I was the receptacle. I contained the treasure, I was the x that marks the spot. I was the prize ready for the next monochrome photo shoot. I didn’t pay much attention to the what, nor the why. No bravery just obedience.

Enjoy your jouissance!

 

Posted on by Borromean Strider 0

Op. Day – 1. The Curtain Call

The knock of the knot –  Breast Cancer with Lacanian Angles

No Universal Reality

We arrived on the day of surgery, October 8th at 7:30, pretty much on the dot. Dot dot dash dash, yes it seemed a bit of a dash but no elaborate preparations were made. The appointment was for a “speedy” out-patients operation so no toothbrush, only my cell phone and a choice of after-op boneless non-scaffolded underwears. Despite doubting their efficacy they were purchased precisely for their purpose and weren’t that easy to hunt down. Bravisimo was the chosen retailer for obvious reasons. Although there is still little out there informing about fit and comfort for pre-op purchasing. In September Stella McCartney, whose mother passed away from breast cancer in 1998, launched her “Louise Listening Bra” sizes S/M.

http://www.stellamccartney.com/gb/stella-mccartney/bra_cod48167088bw.html
Louise Listening Bra by Stella McCartney

 Quite a snazzy front zip fastening mastectomy compression bra, the proceeds from which will help benefit the Hello Beautiful Foundation. After much deliberation I chose a 32G maternity model the Royce Ava Bra (1154) that promised to accommodate my post lumpectomy breast. Without underwires it had a release catch (for breast feeding) but this seemed appropriate to relieve possible pain from pressure along the top of the chest and to give space for the surgical

maternity bra
Royce Ava Bra

gauze. The second design I preferred had a padded shell design. The cup was scaffolded to enable the breast to nestle in supported elevation and the side wires were set back more laterally against the ribs. Both of these bras needed customising with a scissor snip to cut away material under the arm. This was to avoid any clash and rub of stitching both animal, mine post surgery and mineral, the hemmed elasticated zigger zagger fabric in the underarm design.

Only a week ago I’d optimistically booked a batch of five yoga classes. Shockingly I managed just three on my “old-self” schedule: Wednesday and Saturday were part of my old-normality but the night before my hospitalisation the call to yoga was just irrelevant. So, essentially the guru yoga instructor is still in the dark as to the gravity of my seemingly casual absenteeism. This “mind before body” pre-op karmic choice, brings me one session closer to losing my toned arms and fitness. So instead of the chaturanga and chanting, the evening before the morning after involved a nice supper, easy chillax and a good grateful sleep. A clinging to just being. I’ve always, since birth, slept on my front so this too was a last chance to retire freely bellydown. A last sleep without pain. The last chance to be me before an unknown “x” that marks the spot. Nope, not even a pre-hospital hair appt. Neither preparation of an over night bag. All optimistic details, swamped out by just sucking in the last hours of normality, my normality…because is there ever a universal reality?

Zero Hour Arrives

The morning arrives and the taxi has little traffic to navigate. It all seems so ridiculously early. Up and active far earlier than a work day. Our timing was impeccable and we sat. Sitting in public. Sitting in the waiting room. Waiting to begin. Waiting as a pause. But isn’t sitting usually about waiting? Sitting involves anticipating, feeling the time, being “immersed in” the moment, whether it be travelling from here to there, driving or being driven, or taking in the time: sitting to relax, sitting back embraced by the hands of time, engulfed in the lap of time, gazing into the watch-face. Using the minutes to breathe, to be, to pause. Sitting as one waits: to eat, digest, or to hear the other person who sits and shares that time with you. (If you are, of course,  fortunate to have comfortable company). A companion to weigh the time with. Oh heavy hour. Be light with me.

Sitting, waiting: it’s actually unlike me not to make eye contact with others, but looking here into the eyes of those who reflected the same situation as me, looking at them seemed so inappropriate. An intimacy shared in a moment seared and pierced by the obscene audacity of gaze, of daring to look them in the eye. Risking seeing myself, my fears, my doubts, mirrored back. Stepping in, making that advance, that cut in their reality, invading the moment of the other. I didn’t look. The power of the “gaze” and the gaze-returned. The gaze of the other freezing us in time. Seeing myself perhaps as another rabbit willingly waiting to see where this road will lead. Not yet trapped in a path of no return but given hope to cross and continue. Let’s face those lights, it’s not bravery, but a combination of ignorance and trust. A faith in science. A belief in statistics. Each person waiting was mentally and emotionally preparing for a scalpel that could prove to save their life. In the headlights, the footlights, the theatrical light, waiting for the curtain to move and for their newly assigned role to begin.

 

Posted on by Borromean Strider 0

The smile without the cat: Pre-Op Grins

The knock of the knot –  A Breast Cancer Blog with Lacanian Angles Curves

Needlework and Syringes

Keeping my routines as normal as possible helped me prepare mentally and physically for the lumpectomy, which some sources call a partial mastectomy, excisional biopsy or breast-conserving surgery BCS. Clinicians regard BCS as the gold standard for early stage breast cancer treatment. Surgeons skilfully accomplish “acceptable” cosmetic outcomes by removing just enough breast tissue to achieve adequate surgical margins. My life was as busy as normal. This fake normality was fuelled by a creeping inner denial. At work I kept schtum maintaining a professional secrecy – apart from my over arching boss, work colleagues were in the dark. The only giveaway sign was my attitude, more positive, stiffly smiley, unusually chipper. I was the smile without the cat.

Three days before surgery an NHS letter arrived advising me as a woman of a certain age to come for a routine mammogram for early cancer detection. Eye roll. Despite our state of the art technology this monumental failure of “joined up working” perpetually creates these painfully ironic events. Action-reaction: I gave them a call to cancel and mentioned that for their records my breast was already being treated for cancer. The following day I received a phone call asking if I was still up for the op. That took me by surprise, I was astounded to discover that clearly there must be women who do a runner, change their minds or simply say no thanks to surgery.

At 8:30am the day before my surgery I was summoned to the hospital’s Nuclear Medicine Department to have the necessary radioactive injection. injecting the radioisotopePreparing myself for the same intravenous syringes (in the arm or hand) problematic hidden veins were not permissible. I drank a ton of water and tried to keep my veins visible by arriving briskly on foot, wearing gloves and keeping warm with lots of hand/finger agility moves. The big surprise was discovering that the needle enters around the areola. Ouch!

With my arms bent obediently behind my head, the needle injecting the radioisotope was expertly entered several times. The nurse warned me that it would hurt. Its path was numbed by doses of lidocaine, a local anaesthetic. The eye on the needle steady as if measuring across the face of a clock. The expression “sharp scratch” was replaced by a trill anecdotal comment about how patients acquaint this pain to a “bee sting” – a formulaic “sound-bite” indeed, but painwise none of this needlework caused undue discomfort.

pain embroidery
The Fabric of Pain

Imagining the pain and playing through worst case scenarios were par for the course but in-the-act going with the flow wasn’t too horrendous. It felt barbaric yes, the nurses injecting around such an intimate part in full light of day and then massaging down to ensure the radioactive liquid was absorbed. It felt bizarre and a tad torturous. But the huge bruises (on the back of my hand) from the cannulas, (needed for the breast MRi and bone scan) were more sore and a greater nuisance to every day life. Nerve healing zings of pain, a week after the three core needle biopsies from the breast, took the biscuit. These sudden unannounced debilitating zings of excruciating but momentary agony went on 24-7 for several weeks. But perhaps this is individual. Instead of pain, the greater trauma was from not knowing the details of procedures. This made me feel cumbersome and  “done to” a vulnerability shrouded by my own ignorance and heightened feelings of useless ineptitude.

As part of the lumpectomy procedure the surgical oncologist had explained that the radioisotope and blue dye injections were essential to locating the exact nodes for SNB (sentinel node biopsy). The injected nuclear fluid tracks around the lymph nodes which light up once the blue dye is absorbed. For a lumpectomy to be successful the clinical team must ensure that no tumour cells have infiltrated the lymphatic system. This is now the clinical standard of care replacing the more complex full axillary node dissection which more frequently exacerbated fluid build up and swelling in the arm called lymphodema. This condition is still a classed as a possible side effect. A set of simple thrice daily exercises are recommended to reduce the chances of accumulated fluids. http://www.lymphedivas.com/  is a phenomenal outlet for fashion compression sleeves. Their blog is informative too.

https://www.lymphedivas.com/en/shop/mariposa-pink
Mariposa Pink

The detection and treatment of breast cancer is like a biological game of hide-and-seek. Deciding if cancer is present, how widely it has spread and how to remove it are all part of the algorithm. I could not feel my cancer, it was non-palpable. What I did feel was a normal cyst. The cancer did not show up on the mammogram. I have learned that mammograms have limitations. At present they provide two-dimensional images of the three-dimensional breast. Glandular tissue and tumours are similar in density and remain occult especially in women with dense breast tissue.

cell types
Cancer Cells

My cancer barely showed on the ultrasound as an area suspicious for malignancy tucked alongside the cyst. DCIS means the cancer is still contained within the ducts. The biopsy gave confirmation that my cancer has a name, it’s called IDC and tomorrow we’ll find out if it has spread to the lymph. Above is a diagram of the types of cells, assisting to verify the stage of cancer. I would love to see what these cells are really like. Daring to ask the surgeon to keep it for me, he asked if I’d like it in a jar. In earnest I nodded. He thought I was joking.

Posted on by Borromean Strider 0