Holding on to Normal

by Alana Somerville

  One morning I heard a crash.

  “Rudy, what are you doing?” I called out as I ran over to the kitchen doorway. He was playing his usual game—empty a cupboard, move on to the next, and pull everything out of that—and was chucking things on the floor. This time it was baking sheets, but anything was a target—glass lids, bowls, baking pans, even my grandmother’s huge cast-iron pan. “Put that back,” I said. He was holding a muffin tin and looking at me with a gleeful smile. He was almost a year old and was turning into the “boy” everyone said he would. I definitely wasn’t used to that. Charley had been such an easy toddler. If Rudy got the chance, he’d also take things from the kitchen and throw them down the stairs or put them under the couch in the living room, then take books or toys from the living room and put them into the now-empty kitchen cupboards.

  I scooped him up. “Stay still,” I said as he tried squirming out of my arms while I attempted to shove a pan back into its place. He managed to scramble down just as the phone rang.

  “Hey, it’s me,” Greg said. “I wanted to call to say hi and see how things are going.”

  “I’ve already tidied the floor three times,” I said, “and I know the rest of my day is going to consist of exactly the same thing over and over again.”

  “Just leave it. I’ll pick things up when I get home.”

  “I’m losing my mind.” I started bawling. Although I knew that Greg’s intentions were good, it seemed to me as though he didn’t get what I was going through or know how to sympathize with me—I couldn’t handle everything and a messy house on top of it all.

  That weekend, he helped me install baby locks on all the cupboards. Meanwhile, Charley was starting to say no to me, and she wasn’t shy about it. She was almost four years old and thought she knew everything and could do anything. She did make me laugh a lot, though. One day she decided to wear the new knee-high black boots she’d gotten, but no pants, and she danced around the living room with Buster, her stuffed rabbit toy. Another day, Mom and I could hear her talking. We peeked around the corner and she had her toy phone up to her ear.

  “She’s talking to her imaginary friend,” I said.

  “What is she saying?” Mom said.

  “Shh, I can’t hear.” We inched closer.

  Charley started talking louder. She was having an intense conversation with Dora the Explorer! Mom and I both looked at each other and had to back out of the room before we burst out laughing.

  My entire life had become scheduled to the nth degree, and chasing the kids around was the least of my day-to-day worries. My calendar was jam-packed, from taking medications at certain times, to ensuring that the kids made it to the usual playdates, school events and other things, to getting to my own appointments. Anything to do with cancer stood out, though. I drew a rectangle around the dates of any of those appointments, and there were a lot of rectangles on the calendar. The next one was a meeting with a radiation oncologist on January 17 to discuss whether I’d need radiation.

  “I’ll do it if I have to,” I said to Greg. “But I’m hoping he says I don’t need it. The less I have to undergo, the better.”

  “You’ve been through a lot already.”

  I knew radiation could burn my skin. That scared the hell out of me. Again, though, I didn’t voice my fears. I simply couldn’t.

  I also had meetings scheduled with two plastic surgeons to discuss options for breast reconstruction. I was having an entire part of my body removed, and I wanted to get more than one opinion. My mother and I both agreed that was important. The more information I had, the easier it would be to make an educated decision about which surgeon to use and what type of breast-reconstruction surgery would be the better option.

  “I’m nervous, but also excited,” I said to Mom one day when we were playing with the kids. “This will be one step closer to being healed and healthy again. I feel as though I’ve started looking at women’s breasts in a whole new way,” I confessed and picked up a ball Rudy had rolled my way. “I mean, what should mine look like? What will they look like after the fact?” I squeezed the ball. Would my new breasts feel like this? Would everyone be able to tell they weren’t real?

  “You have to make the decision, Alana.”

  I sighed. “I do know that the typical wait for a consultation with both surgeons is eight months and about a year and a half for surgery. But that’s for elective surgery.”

  “That’s a long time.” Mom sounded so surprised.

  “Turns out having cancer does have some perks,” I said wryly. “But I have no idea what to ask either of the surgeons. Should I ask to see their work? Surely they must have pictures?” Other than that, I was mystified. It was such a major decision. How would I choose? I tossed the ball back to Rudy.

  Chapter 25

  BURN, BABY, BURN—OR NOT

  Greg and I decided to bring Charley to my appointment with the radiation oncologist. She’d seen me going to treatment after treatment and was always curious. She’d ask, “What did they do to you today, Mommy?” “What does the medicine look like?” and constantly “Why does it take so long?” I didn’t always have answers for her—I was trying to be honest yet shelter her at the same time. I was relieved that she never questioned the validity of what I said. I think she just wanted answers and was all right with the ones I provided.

  Since my experience at the hair salon, buying a wig, I’d wanted Charley to be as involved in the process as possible. Even before that, I had thought I might take her with me to my chemotherapy sessions until I realized that the minimum age for visitors is eighteen—a limit I discovered exists for the safety of patients as well as visitors, since chemotherapy drugs are so toxic. And realistically, although Charley is well behaved, the last thing anyone would want is a three-year-old having a meltdown in the middle of an infusion.

  Charley was super excited. She was always excited to tag along where I was going, and stopping at Tim Hortons on the way made it more exciting. I told her the appointment was to talk to a doctor about “medicine machines.” When we got to the office, she couldn’t wait to see what would happen. She had a hard time sitting and couldn’t stop asking questions: “Why do you have to get changed into something else?” “Why do you have to sit on that table?” “Why do Daddy and I have to sit on these chairs?” She especially wanted to know what was going to happen with the “medicine machine.”

  When Doctor 8 entered the room, he said hello to Greg and me, then turned to Charley, who immediately stopped fidgeting to focus all her attention on him. He crouched down to converse with her and asked how old she was, what her favorite color was, and what school she went to, and even talked about his own kids.

  “Hey, Charley,” he said after they had chatted for a while, “is it all right if I talk with your mom now and examine her?”

  “What are you going to look at?”

  “I’m going to check her all over to make sure she’s healthy. Is that okay with you?” He gave me a questioning look, too, and I knew he wanted to make sure I was good with Charley’s being there during my exam.

  I nodded, and Charley said, “I’m good.” She wasn’t fazed at all by anything, and I figured that was because I’d been so careful to keep her in the loop right from the beginning. I lay back and Doctor 8 started feeling under my armpits and around the incision mark from my lumpectomy. I couldn’t help but let out a little giggle, and Charley asked, “Does that tickle, Mommy?”

  “It does.” So much so that I had to hold it together to keep Doctor 8 from harm’s way—my natural reaction was to swing at someone if they went near my armpits.

  Greg and I were really impressed by Doctor 8. His gaining Charley’s trust made all the difference in the world. She had no problem sitting and listening, and we were able to direct all of our attention to what he had to say without being distracted by a bored child. I was glad Charley felt so comfortable, because I was trying to hide my own unease. Would I have to have radiation on top of chemotherapy an
d surgery? What would radiation do to me? How long would a course of radiation be? If I didn’t get it, would I have done everything possible to beat cancer?

  But before I had a chance to even ask anything, Doctor 8 said, “I don’t think radiation will be necessary. There are many reasons for that, but mainly it’s based on your decision to have a double mastectomy.” He explained that with a simple mastectomy (which I was having on the right breast), the entire breast tissue was removed, but the axillary lymph nodes remained. In a modified radical mastectomy (which I was having on the left breast), the entire breast tissue was removed, along with the axillary lymph nodes. “Because of all the tissue being removed, there will be nothing left to radiate.”

  I believed him right away. That might have seemed odd, but he’d won me over because of his talk with Charley—made me feel I could trust him. Even so, I had more questions. “What are the recurrence rates for the different procedures?”

  “Four to 8 percent for lumpectomy and radiation over thirty years, and 1 to 2 percent for mastectomy.”

  “The lower the number, the better as far as I’m concerned—I say take my foot if you have to get the recurrence rate down.” It sounded like I was joking, but I wasn’t.

  “Radiation would provide no further benefit. That is, of course, assuming that the results from the pathology are good.”

  “What exactly does that mean?”

  “Good pathology means there’s no cancer in any of the other lymph nodes taken out during your mastectomy, and that there’s no other cancer in any tissue that’s removed.”

  I sat back. My surgery was another month and a half away, and I would have to wait for pathology results after that. I realized I’d started chewing on my fingernails. Nothing would be certain until the results were in. I couldn’t help but feel that I was stuck in time while everything around me kept happening. I’d had that feeling before when I was in a situation like this. My thoughts churned in my head, but I felt unable to process them. Charley behaved, thankfully, or perhaps I couldn’t take in what was happening—Greg may have been talking with her or distracting her somehow—since my focus was all on every word coming out of Doctor 8’s mouth. He stopped talking, and I sat there, stuck, until he started talking again.

  “Because the tumor margins were clear when your surgeon performed the lumpectomy, only one of your lymph nodes was affected, and the cancer there was very small in size, it doesn’t seem likely any more tissue would be affected. Those are also reasons why I don’t think radiation will be necessary. On the off chance more cancer cells are found, we’ll revisit the radiation discussion.”

  Doctor 8’s reasoning was so logical, his manner so soothing, I felt myself relax somewhat.

  “Which reconstruction surgeon are you going to?” he asked.

  My thoughts coalesced, and I found I could speak. I told him.

  “He does amazing work. You’ve got to see pictures.”

  “I can’t wait to see.” I chuckled unexpectedly. “Who would have ever thought that one day I’d be asking to see boob photos!” The mood in the room picked up.

  “Can I come to the appointment to help you pick from the photos?” Greg asked jokingly.

  “Not a chance!” I had to smile. Men! The size of my boobs was the least of my concerns. All I cared about was going to a surgeon who knew what he or she was doing, someone who would make me look and feel normal again.

  Chapter 26

  “REAL” OR FAKE?

  In the period between my appointment with the radiation oncologist and the appointment with the plastic surgeon, life remained very much the same. If my having almost no hair on my head, only a few measly eyelashes and eyebrows, and almost no hair on the rest of my body could be considered normal. And it was the dead of winter, too. What could be better?

  I was getting tired of the no-hair thing (although I had to admit not shaving my legs was a blessing), but I was also getting used to it. I didn’t care as much what people thought about how I looked, and I found it easier to get out of the house since the nausea had eased. There were rare glimpses of the sun, and whenever it was sunny, the kids and I would bundle up and get outside. The more I saw the sun, the more I looked ahead to spring, and I knew that by the time spring arrived, the chemotherapy part of my journey would be over.

  I was looking forward to meeting my plastic surgeon, Doctor 9, to see those incredible boob photos. I asked Erin to join me for the appointment. I wanted her there for her opinion and to take notes. I also needed her along to watch Rudy. Charley was in day care that day, but I had no one else to take care of Rudy, so we bundled him up and tucked him into his car seat.

  I’d done some research and knew going in to the appointment that there were likely two choices for reconstruction surgery: fake boobs made from silicone or saline, or boobs made from a part of my own body, most likely extra tissue from my stomach. While we were waiting in the doctor’s reception area, I told Erin that I was worried about the fake boobs: that they could explode upon impact, and that my body could reject them. “With ‘real’ boobs, I’m pretty sure there won’t be any rejection issues at all, and I’ll get a tummy tuck at the same time.”

  “Bonus!” Erin said.

  Doctor 9 walked in and I could tell Erin was as surprised as I was by how young and good-looking he was. His confident manner instantly made me feel comfortable. “I want to know everything that’s going on with you,” he said. “So why don’t you tell me why you want to have reconstruction surgery?”

  I gave him my history—the cancer, the lumpectomy, and the chemotherapy. Then he began explaining the two options for surgery—transabdominal reconstruction or expanders followed by implants. Rudy decided that would be the perfect time to poop. While Erin tended to him, I continued my conversation with Doctor 9 and was impressed by his focus. He wasn’t fazed at all.

  “The first step, by the surgical oncologist, would be to remove your breasts and most of the surrounding tissue, which extends up towards your collarbone and includes the lymph nodes on your left side,” he said. “Your nipple would be removed first and tissue taken out through the hole where the nipple was. Then I’d cut two circular pieces of flesh the same size as your nipples out of your abdomen between your belly button and pubic bone. Those would fit right into the opening left by your old nipples.” He looked at me to see if I was with him and drew a quick picture to show me what he meant.

  I swallowed.

  “In order to get the piece of flesh that will become your new breast in place, a portion of your ribs would be removed, then the flesh would be attached with microscopic blood vessels to keep it alive. All of that would take about six and a half to eight hours.”

  Erin looked at me, her eyebrows raised. I knew she was thinking the same thing I was: The surgery was so complicated. It was much more invasive than I’d realized. I was kind of freaking out.

  “The recovery time would be five days in the hospital, then two to three months at home with no heavy lifting at all,” Doctor 9 continued. “The benefit of this procedure is that it’s a single operation. Once you recover from it, you’re done. There will be no rejection issues and no need to come back to get filled up.”

  “What about the breasts ever leaking or exploding on impact?”

  “No, no possibility of that. But because the breasts are formed using natural flesh, they could end up sagging just like regular breasts do over time, so they won’t be permanently perky the way implants would be.”

  I was amazed at how naive I’d been. And what was the other procedure going to be like? I knew Erin was taking notes in between watching after Rudy, but there were more things I needed to know to make a decision. I tried to gather my thoughts. “What are the risks of this particular procedure?” I could hear my voice crack a little.

  “Those microscopic blood vessels we use to attach the skin from your stomach can become pinched or twisted, and you could then lose that transplanted flesh. And hernias and scarring can form on your
abdominal area.”

  He looked at my stomach.

  “There might be enough tissue for me to do this procedure, but your breasts won’t end up being extraordinarily large, I’m afraid.”

  He probably didn’t realize, but he’d just paid me a compliment. I guess the Ab Ripper exercises were paying off. “That’s okay, I never wanted large breasts in the first place, although I figured if I was going to go through all this surgery, I might as well come out with something substantial,” I joked.

  He smiled. I was glad I could manage to be funny under the circumstances.

  “For implants, as with the other procedure, the surgical oncologist would remove your breast tissue up to your collarbone; however, I’d then remove most of the skin from the front of your breast, including your nipples. Since that’s the case, you’d have expanders placed underneath your chest wall to stretch what’s left of the remaining skin so I can place the implants where they need to go.”

  He showed me an example of an expander. They were like empty implants that had a little metal valve. “After your breasts are removed during surgery, the expanders would be filled with approximately 60 cubic centimeters—60 milliliters—of saline, and I’d stitch you up in a straight line horizontally on each breast. Starting four weeks after the surgery, you’d come in three or four times, depending on how big you want to go, each time two to three weeks apart, and I’ll put a needle through your skin into the valves to fill each expander with around 100 cubic centimeters of saline.”

  “How will I know how large to go?”

  “You live with the breasts after each fill and see how you like that size. Once you’re comfortable with them as they are, we wait approximately six weeks. Then you come in for another surgery to remove the expanders and get implants to match the size.”