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.
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.
The 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.