Surgery

 I was not given much of a choice about surgery. I don't think. There might have been a language problem. I could have been more assertive. The surgeon told me he would be doing "breast conserving surgery." I asked why not remove the entire breast. "In your case," he said, "this is the best plan." And that seemed to be that.

From my viewpoint, in Germany, Medicine decides and Insurance pays whatever's decided, which is the way it should be, of course. Breast conserving surgery requires a week's stay in hospital, and that was paid 100% by my insurance.  All of the other bills - surgeon's fees, anestheologist's, pathologist's fees, out-patient medications, examinations, tests, doctor's fees, were billed to me directly, which I paid, and I'm hoping to recoup from my insurance.

The day before surgery, my dear daughter arrived at my house in the morning, in spite of living over 100 kilometers away, in spite of her three children to ready for school,  she insisted she take me to the hospital. I was grateful. Required to check in the morning of the day before surgery, once through the paper work, we were directed to a Ward, or Station, in the enormous sprawling Frauenklinik. I was shown my bed, and my cupboard of drawers to unpack my stuff. I was relieved to see, above the bed, a place where I could plug in my iPod charger, cell phone charger, and laptop. So - this was to be my home for a week.  My daughter left, to return the next day - and I was now a cancer patient in a German hospital awaiting surgery.  

I was sent to various areas thoroughout the hospital for tests, XRay of lungs, CT scan of liver, and a photograph of my breasts (chest, no face, ID# only). And eventaully, I settled in for the night. They gave me no dinner, no water. I was not especially worried. All had been explained to me. It was what it was. It was manageable. I watched some of the second season of "Closers" on my laptop, and prayed a rosary after I turned off my lights and laptop.  Was I afraid?  Yes. But it was manageable.

Early the next morning, I was woken by a nurse giving me gauze panties and white compression stockings, and telling me to take a shower, and then put the panties and stockings on, and get back in bed.  Little did I realize that was the last completely normal, satisfying shower I would have in many months! I donned the required compression stockings and strange gauze panties and slid back into bed under the white hospital quilt. I was rolled in my bed to surgery. What a strange sensation, being rolled along flat on one's back. Interesting perspective, not wished to ever be repeated.

Once in the Operating Room, I was told to shift myself from bed to the operating table along side. At some point (no pun intended) I was given a shot. So smooth. They were so good. They gave me a shower cap and said, "Please put this on." I don't remember putting the cap on. The next thing I remembered, I was in a room with many people moving about wearing blue gowns. I had no idea where I was,  or who they were.  I had absolutely no idea who I was.   

But a young man began pushing my bed and said - "It's OK. I'm taking you back to your room. You will see, we're going back to your room." And, as we arrived on my station I began to recognize it, and I told him - "Oh, this is familiar." "Of course," he said.

Waiting for Surgery

Cancer cells are present in our bodies in increasing numbers as we grow older. But our immune systems usually zap them and there is no problem.  We count on that, we figure we will be among the greater percentage who are cancer-free.  If it doesn't work that way, we might believe our bodies have betrayed us, or we had lived incorrectly and caused our cancer. Bad mixture, betrayal and guilt. For awhile, waiting my for my surgery date, I was in that place - feeling guilty for what I might have done to cause it, yet feeling betrayed by my body for no justifiable reason.  

 

I had two weeks to prepare for hospitalization and surgery.  I cancelled my plane tickets, hotel reservations, workshops, plans to visit with friends and relatives.  I would not be leaving Germany for the States this summer.  I tried to organize my home, but didn't manage.  I appointed a medical power of attorney, and a general power of attorney. I made a Will. (As DOD civilians living overseas - we know we have to do these things.)  I watched MASH from the beginning to the end.  Eleven years of Comfort TV, watching from my good bed every night until I fell asleep. 

 

July 15, I checked into the Frauenklinik. I was beginning a journey that, strangely, did not frighten me as much as I expected it would. 

 

Discovery

True, the older we become,  the less surprised we are by life's sudden turns.  But still, seven months after a normal mamogram, I was totally unprepared for the discovery that changed my life. I'm a teacher. It was late May.  The school term was ending.  Nights were warmer and I bought a pair of lime green shorts-and-skimpy-top pajamas for the summer, to take to Cape Cod, after my week in Washington, DC: two workshops, which is part of what teachers do in the summer.

I tried the pajamas on, and posed in front of my mirror although Heaven knows why, I never expected anyone to actually see me in my new short pajamas.  The bottoms fit fine.  The top didn't, it flattened me.  And I saw in the mirror a lump in my left breast below the nipple. What in Hell was that?  I had not seen it or felt it before. The moment I touched it, I knew.  I knew. Hello - you're finally here, aren't you? I've been afraid of you all my life - and, now you're here.  

There was no sleep that night.  I did not touch the place again - it had already given me its information. The next day I called my Internal Medicine doctor for an appointment - as soon as possible, I needed to know what I already felt I knew. I'm an American working in Germany. The health care system here is different - and you're going to be seeing those many differences.   

I was told to come in to see the doctor that same morning. He sonogrammed my breast, saw the lump, and also saw a lump in the left axillary. He said, "It's amazing how clearly I can see both lumps on the sonogram."  Ominous words. He referred me to the University of Heidelberg Brust Zentrum (Breast Center) at the Frauenklinik (Women's Hospital).   The haste I was passed on to specialists, confirmed my understanding of what was happening to me.  It also calmed me.  Already I had begun to make a transition from heathy independence to trusting patient. 

Though it was a long waiting-room time to see my assigned doctor at the Brust Zentrum, once I entered his office, things happened quickly.  He was calm, but funny; soothing, but realistic.  He spoke to me in English.  He examined my breast, and the other, and the swollen lymph node. He sent me downstairs for an immediate digital mamogram.  There was no wait.  When I returned to his office , my mamogram was already on his computer screen.  I have never seen a clearer, more detailed mamogram.  I told him even I could see the lump. He looked me straight in my eyes and nodded his head slowly up and down, twice.  He didn't say a word. He didn't need to.

He laid me out on his table and did a core biopsy.  First, of course, a local anesthetic was injected. I was surprised at the large bore size of the biopsy instrument. He pressed it against my breast in two locations. It sounded like a heavy duty stapler, or a lightweight nail gun. Pop, pop!  It didn't hurt.  He told me what to expect in bruising as after effects.  I would get the results in a return appointment the following week.  Then he said, "Prepare yourself. I believe this is a malignant tumor. If it is, as I suspect, it is small and we know exactly how to take care of it. Not to worry." 

His words freed me from fantacizing worst case scenarios. Worst Case was now sitting on my doorstep, and it wasn't that terrible. Small, he said.  Still, this doctor specialist who does breast examinations for cancer in the major medical University of Germany - could be wrong.  Nevertheless, I slept very well the following nights.  Thank you, Doctors.

I didn't wait as long for my appointment the following week. When I entered the doctor's office he and his nurse were sitting casually in chairs to the side of his desk, and I was offered a place between them.   I almost laughed.  I was told with the utmost kindness, that my breast tumor was invasive ductal carcinoma, and it appeared there was lymph node involvement.  I was sent to talk to an anesthetist, and to schedule surgery and hospital admission.  (more to come)