"Uh-oh"

I have never been to medical school, but if it's not already part of the curriculum, they should have a seminar on phrases that you should never say when you see a patient. Some things that I would recommend a doctor keep out of his or her vocabulary might include:

• "Gross" 
• "Uh-oh"
• "Oops"
• "That wasn't supposed to happen"

On Tuesday we went in to meet with the reconstructive surgeon to begin the next phase to rebuild me after the mastectomy, and he peeled off the glue that was holding the incision together after surgery (it was supposed to just start flaking off as it healed, but only a small part of the glue had come off by the third week). Starting Friday night and through the weekend the area around the incision had been leaking some fluid, but I was told that as long as there were no obvious signs of infection--fever, chills, redness and warmth that spreads--then it was probably okay. They said to keep it covered and clean, and they would look at it when I came in for the appointment. 

When we got there, the doctor peeled off the remaining glue and the first thing he said was "uh-oh." Yep, definitely not what I wanted to hear him say. He proceeded to explain that after a mastectomy, there is a very thin flap of skin left, which means it may have more difficulty getting proper blood supply. It turns out that in the immediate area around my incision, the skin wasn't getting enough blood, and it died.

The biggest risk after any surgery is the risk of infection, and with dead skin in the area, the chance of infection increases. With the tissue expander in place (the thing that is used to stretch the skin and prepare for an implant later), that risk can derail the whole process. As the surgeon explained, if bacteria get into the skin around the tissue expander, they attach to the plastic and are virtually impossible to excise without taking the tissue expander out altogether. In order to prevent infection, we had to go back into surgery to remove the dead skin and re-stitch the wound with just the healthy skin. 

The appointment was at 10:30 a.m., and fortunately I had not eaten anything since the night before, so they sent me directly to the surgical area of the hospital and told me to check in. It was supposed to be a quick outpatient procedure, and I was hopeful that we would be out of there by early afternoon. What they didn't mention was that since I was scheduled at the last minute, there were no operating rooms open until 5:00 or so. That meant sitting in the waiting area playing Candy Crush (we did leave for a couple of hours to run some errands) and trying to distract myself from feeling very hungry. 

Finally around 4:00 we went back into a pre-op room and by 5:30 there was an open room available. This time around they were able to do the procedure under MAC, or monitored anesthesia care, instead of general anesthesia. Instead of going all the way under, I remained conscious (although sedated with something to help me relax) and breathing on my own, and they just numbed the immediate area. It may seem weird to be awake during surgery, but they want you to be conscious enough to tell them if you are feeling any pain--if that happens, they put you all the way under. The anesthesiologist Rachel was really great, and we actually had a nice conversation during the procedure, which lasted about 45 minutes. They said the sedation affects your memory, but I recall quite a bit of our conversation about my family, her favorite restaurants (she recommended Per Noi Trattoria in Sugarhouse), and the best Broadway shows (I highly recommended Rock of Ages). 

When it was all over, I had a newly stitched wound and no more dead skin. It did set me back a couple of days on my recovery and getting back to work, but overall it will hopefully just be a little bump in the road to full recovery.