There are so many angles that I want to write about that it can be a little overwhelming about where to start at all.  So, let’s jump in with the easier – the more technical update.  It, of course, also has the most amount of pure detail – so may be a couple long posts!

The right place to start – well, I’m still here!  Of course we knew that this was the likely outcome – but this surgery, as with most, certainly had it’s one-liner of mortality and the signing of the Advance Directive and that should always catch one’s attention!  Actually, the Advance Directive is an amusing (if morbid) place to start.  We had assumed that we needed to have my signature witnessed at the hospital and missed the well-buried sentence of instruction that said that neither employees of the hospital nor family members could sign as witnesses.  The admissions employee who was helping us (who was already very distracted, angry at the couple who was admitted before me, and totally uncommunicative) – said that it was very normal to just go out into the waiting room and ask for a couple of witnesses to sign.

Okay, think about this – this a very legal document – the one that turns over durable power of attorney to my husband and states my position on life-continuing care should I be incapable of making decisions or communicating my wishes.  I throw myself at the corner of the waiting room with the most people – all of whom are there for surgical procedures and who knows what state they are in for themselves – I tell them that I need two witnesses to sign my Advance Directive – simply stating that this is my signature and that I am of sound mind which, really, how do they know!?  I tell them that family member and hospital employees can’t sign it and they told me that that this is what was often done – to ask you fine people if you would be willing.  They all stare at me.  I say, “Please” and someone invites me to explain it again.  And then two people are willing to sign – with addresses and everything!  It may be among the most ridiculous things I have ever had to do.

By the way, the phrasing that I formulated for the Advance Directive ended up being what I wanted with the help of my sister, Becca – who is the doctor in the family. I offer it in case it’s helpful to anyone else.  “I wish for any and all life-continuing efforts to be made unless or until there is no reasonable likelihood of the return of my cognitive functionality.”  That way I don’t need to talk about specifics like resuscitation, brain death, coma, etc.  and I was assured that Nelson would be the one to decide (in communication with my doctors) what defined “reasonable.”

So, I head up (rather abruptly) to the surgical reception area – on my own – and Nelson and Mom are told that they will be called up to see me before I’m taken in.  The first thing I’m asked is if I need a restroom and, already, things are complicated.  Because – I started my period late on Tuesday night – of course!  OF COURSE!!! I knew it was going to be close and I was worried about it, but REALLY!?  So – I’m sorry to drag you into this – but it’s definitely a factor.  You see – first off – all kinds of things happen for me during this time of the month – sometimes really bad pain, sometimes dizziness and energy issues (possibly it makes me borderline anemic), sometimes cramping and vomiting – none of these things are going to combine well with a lot of incision in and around my abdomen!  Not to mention how…erm…maneuverable I’m going to be to deal with those supplies.  The only good news here is that I’m likely to FINALLY have pain medication that can handle it!  So – the nurse says no problem –  they need to give me some mesh underwear and a pad and that’s what I’ll wear through surgery.  She also says that I’ll now just sign a document that says that I refuse a pregnancy test since I clearly won’t need one.

Mesh underwear.  This has got to be the next trend on the street and I will have been on the front cusp of stunning fashion!!  She hands me a square of mesh – alright, it’s a rectangle – but it doesn’t look like more than a single sheet.  She says that they are underwear.  I am dubious to say the least.  And she hands me a pad that could absorb the Potomac – these two things are supposed to go together.  I believe that this is quite funny.  Enough that I take the time to lay out the little rectangle of mesh to take a picture of it – had to be done.  You try “putting these on.” :

So – then – it’s a series of preparations – get into the gown and socks – see the anesthesiologist – who is fantastic.  I have to have the singer conversation with him – please use as small a tube as you can and be extra careful – and he gets that completely.  He asks who I recommend for listening and I say the first name that comes to mind – Eva Cassidy – and when he comes back in, he’s already gone to look her up and has the information for “Songbird” in his hand – I was very impressed!  I asked him about some of the things I’ve heard – that prolonged anesthesia can lead to depression and had greater risk with great amount of time.  He’s very soothing about this – first off, saying that the whole swing of emotions is possible – including all the happy ones.  Then using a driving analogy for risk.  First you look at you as the vehicle – if you have a lot of risk factors (age, health, smoking, etc) – you are rather like a moped and if you are young, strong, healthier – you’re more like a hummer.  Then you look at the level of the surgery – major surgery being brain, heart, internal organs, etc..  I may not be a hummer, but I’m at least an SUV (and my doctor would say hummer) and this surgery is a city street, not the beltway.  The length is due to the complexity and the amount of surface work, but it’s not very invasive – so he’s very reassuring.

Then, Mom and Nelson are invited in (after an hour of waiting) and then Doctor Lenert and her crew.  And here’s where it really get interesting and so surreal – the marking!

She asks if I mind if I want to have the room be private – but really, Mom and Nelson have seen everything there is to see and it’s a teaching hospital, so we’ve had the bevy of students, interns, residents and such…I just don’t care now!  Especially since we’re there to change it – if I was in for another surgery and so self-conscious about the extra weight, it would be different.  (By the way – little flash forward…I’m thinking that will be different again once I’ve recovered into this new body.  I think I’ll want my privacy back!)  But – for this…heck no…just do what you need.  So, she gets out her purple sharpie and starts going to town.  I mean…GOING to town!  We start with a few center lines and the lower incision line, but then there is a grid of sorts for reference purposes and then a little specific compass for the nipple shape – something for her to trace and shape the areola and then get the angle of the breast. They talked about where the fold of the breast should be compared to where it was and as I sat there, my breasts looked like they could just keep going down to my knees – they were so LONG!  And then she starts putting her initials everywhere (JL) and I gotta laugh!  Turns out she’s required to by the hospital!  So – after being her coloring book (she definitely was one who stayed in the lines as a kid) – the anesthesiologist was back offering to be my personal bar-tended and announced that happy hour had begun.  I said my good-byes, they wheeled  me away and I don’t remember anything else until I saw her again in the recovery room.  11 and a half hours later!  And she told me I lost 18.5 lbs that day and all went well.

That’s a good place to stop for this update and then we’ll start tackling post-surgery.