I Left My Lobe in San Francisco: Liver Resection Story. Pre-Op

October 3rd, 2011. Picture morning in a movie: an alarm clock goes off. The screen is dark but gradually sounds fade in - the drip of the coffee pot, the padding of feet across carpet. Then, eyes blink open and shut, and open again. You see that you are in a darkened hotel room, and somebody is whispering, "Ann, it's time to get up."

5:00 a.m. It's about the time I get up to go to work, but on work days I am allowed coffee and the snooze button. I don't get coffee this morning, or even water, so in my groggy mind, I have no business being awake.

I'd been told to take a shower and use some packets of Hibiclens I'd been given to ritually purify myself before the Gods of Surgery descend upon me. I seriously hate a first-thing-in-the-morning shower-without-coffee, but I did as I was told. I don't know why I expected the Hibiclens to smell like hibiscus - it didn't.

I got out of the shower and put on Juicy Couture sweats. They were the same ones I bought for my mastectomy two years ago, so they are not quite in the best shape but this is not my first hospital rodeo, and I know nobody cares what I have on, not to mention whatever it is will taken off immediately anyway.

We wake my son up. He is surprisingly perky for that hour of the day, and off we go to the hospital.

We drive around in the black of a San Francisco night. It wasn't foggy, fortunately. We could see streetlights and lovely architecture and an emptiness that is rare in that city. I rested my head against the window for a bit. Suddenly, a booming voice cuts into my doze, "We're lost."

What? What do you mean we're lost?

My husband has made a wrong turn somewhere and can't find the hospital. And, we have to be there in five minutes. I get upset at him for never wanting to use a GPS (which we've lent to my son anyway) and then I get a text from my older son, "Where are you? We are all here."

Great. I'm going to be late for my own liver resection.

I grab my iPhone and try to use location services to get a read on where we are but my husband is frustrated, is driving aimlessly, and won't slow down. (This is a man who I have to beg to at least up it to go the speed limit). I yell at him to stop the car, we need an address, and then I see a cross street, tell my son where we are, and his girlfriend finds it on her phone and gives us directions to the hospital. I text them to let everybody know we are on the way, and we arrive within 10 minutes of our appointment time.

Not late at all in my book.

My husband drops me off to park the car and my son and I run in. The hospital staff sees me and immediately whisks me to the pre-op area, I don't even get to see the surgical waiting room where the rest of my family is. I wave as I'm hauled off, and since two people are allowed to go with me, both of my boys go.

Upon arrival in pre-op, they ask me my name and birthdate for the first of what turns out to be 4,327 times.

They give me a big yellow bag for my clothes and give me a thin, ratty hospital gown, and yellow socks that mean I'm a fall risk, and close the curtains. The boys wait outside while I get undressed and get into the bed. I complain of the cold, so they bring me those nice warm blankets, straight out of the heater, and I sit and chat with my boys.

My husband shows up eventually and since only two people are allowed to be with me, my younger son goes down to be with his aunt. They do some pre-op stuff - IVs, wrist bands, but not much. I meet my doctors and am told I'll get an epidural for pain control, and ask if I have any questions.

I never do. The only one I want to know, "Will this cure me" is one that nobody can answer.

It was at this point that I realized that perhaps the Magnesium Citrate had not yet released its grip on my bowels. Fortunately, the bathroom was right in front of me so I availed myself of it several times, while hoping this would not create a situation on the operating table. What if it did? Did they have a way to stop it? I know they'd be putting a foley catheter in, did they have something for that end too? Would the anesthesia drugs stop that sort of action? They had to know this was possible, right? Surely I'm not the only person in the world that had a 7 hour laxitive delay?

I decided it was in my best interests not to think about it.

It was now 7:00 a.m. and the area was a hub of activity. Patients being wheeled in, nurses, PAs, doctors arriving, histories being taken, people stating their name and birth dates, charts being flipped open, families coming and going. It was loud and crowded and a lot like Starbucks at 10:00 a.m. break time. One by one, people were wheeled out to their operations, doctors disappeared, nurses disappeared. It was 7:30 - my surgery time - and I was left all alone - just me and my husband and son.

The cleaning staff came in and picked up dropped linens, mopped floors, tidied everything for the next round of surgeries.

Then there was silence.

I began to wonder - have I been forgotten? Is my surgery cancelled? Is this a passive/aggressive way of punishing me for being late?

Eventually, somebody walked by and we asked them to find out what is going on. A few minutes later my nurse came in and said that they were waiting on a piece of equipment to arrive from Mt. Zion hospital and didn't want to start without it.

I had flashbacks to when my implant for reconstruction hadn't been ordered and I never did get my surgery. What part was missing? I'd met my Super Surgeon so it wasn't him. I'd met the anesthesiology team, so it wasn't them. The only thing I could think of was that it was part of the microwave ablation tool that my doctor likes to use.

What if they couldn't find it, like my old implant? What if it was broken? What if the operation was called off? Would I have to choose another date, more time off work, more hotel time, more money spent? It's unthinkable.

Somebody needs to come and take me to the OR, STAT.

At 8:15, they told us that it would be another hour. I was getting really hungry by that point, and my sister texted me and offered to drive it from Mt. Zion herself. But, their Currier was faster than expected, because it was only about ten minutes later when they said it was time to go.

Back when my older son (now 25) was 8, he had a life threatening seizure of unknown cause. He seized for 45 minutes. He stopped breathing and had to be taken by ambulance to the nearest hospital. He was on artificial ventilation for 24 hours and in the hospital for a week. That was, without a doubt, the absolute worst week of my entire life and that includes everything that has happened to me to date and trust me, my life, even aside from cancer, has not been an easy one.

Nothing compares to your child being critically ill, and there is nothing I wouldn't have done for him at that point. But, what can a mother do? You stay by their side and you comfort them as best you can, in a way you think will help them. At one point, as he was coming off the breathing tube, I said to him, "If you get better I'll get you any video game you want."

It was time to take me to the OR, and as they did, my big, burly, curly-haired, 25 year old son bent down, gave me a kiss, and said, "If you survive this, I'll give you any game you want." That made me laugh, and cry a bit, and I kissed all of my family and went through the doors to the operating room.


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I Left My Lobe in San Francisco: Liver Resection

I know many of you want all the details of my liver resection, so I am going to break the description into different sections. That way, nobody is stuck at their computer for an hour, including me, since sitting up isn't that easy yet.

Sunday, October 2nd. Magnesium Citrate. We were packed and ready to go to UCSF - after much angst, my liver wedge resection is on! I had everything important - iPhone, iPad, extra pillows for the car ride home and, of course, Paul Frank Monkey pajama pants.

Add a liberal dose of nervousness, and I had everything necessary for a successful surgery.

I had been told to do some bowel prep beginning at noon and at that point, only eat liquid meals: soup, jamba juice, "anything you can put in a blender." Then, stop all input at midnight. The bowel prep consisted of taking one 10 ounce bottle of magnesium citrate, and then waiting to explode. No enemas, thank goodness.

Clearly, timing is everything, but I'd never done this before so had no idea how to manage said time. I thought maybe I could take the laxative at home and then drive two hours to SF - by then it should have taken effect, right? But after querying everybody I know, the consensus was that it worked too quickly. It would be rather embarrassing if we'd had to stop on the Golden Gate so I could hang my butt over the railing, and I've no doubt the thought of my skinny ass dangling into the breeze might cause enough despair to spur on a suicide or two.

Best plan seemed to be an early check in at our hotel and do it all there, so that's what I arranged.

We arrived a little before 1:00 and went to our room at the Cow Hollow Motor Inn. It was nothing fancy but everybody who worked there was truly nice, plus it was clean, servicable and located next to amenenties, and was only 20 minutes from the hospital. I gave them a link because it was Fleet Week and also the Oracle World convention was in town - and this was the only hotel I called that hadn't quadrupled their rates into the $400.00 range.

As soon as we got in I downed most of the calcium citrate. It was unpleasant tasting but I wouldn't say it was disgusting; more like salty soda. While waiting for my bowels to turn into rocket fuel, I amused myself by reading the Poop Report.

Yes, folks, there really is a website for everything.

I quickly started to feel very sick. I mean, queasy as all get out. Hot, cold, hot again. Nauseated and weak. But, there was no rumbling in my bowels and no signs of lift-off. I still had a couple of ounces left in the bottle but I knew if I drank it I'd puke everywhere, so I hoped what I had in me was enough.

I suggested my husband and son go grab lunch and I was okay to stay in the room. They went across the street to a diner and I waited.

And waited.

And waited.

My older son and his girlfriend showed up and I was still resting on the bed. We chatted a while and I sent them out to find their father.

It was now 3:00, my nausea was dying down but still - nothing.

Everyone came back and my sister showed up. My plan was to play cards or rest with my family in between trips to the bathroom - but I wasn't tripping into the bathroom. I began to get very concerned that nothing at all would happen and my poor doctors would get an unexpected surprise when they cut me open. "What the hell is that?" "Looks like she didn't do her bowel prep, doctor." "Goddamn it, surgery is off."

I imagine I'd have to explain it when they saw me - me coming out from anesthesia, a bunch of masked faces looking down at me. "Doctor, I promise I drank the laxitive. No, I don't know what happened, maybe I'm just poop-resistant."

Worse, I started thinking that the process would begin at midnight and I'd get no sleep at all and I'd still be running to the bathroom when I was in pre-op.

Now it was dinnertime. I wasn't going to go out, because I was fearful I'd get stuck somewhere. I was no longer nauseated though, so I drank the remaining two ounces in the bottle, hoping that would start the brown waterworks. I asked my family to bring me some miso soup and go enjoy themselves. I surfed the net and read about laxitives (which seemed to work instantly on everybody but me) and waited.

And waited.

And waited.

My family came back from their Japanese meal, with two bowls of miso soup. I drained the tofu and seaweed out of it (solids) and sipped the broth.

And, suddenly, it happened.

A rumbling. A rolling. And, a running to the bathroom.

Ahhh...it worked, seven hours later. The trick is to mix a little magnesium citrate with red miso.

The family watched Storage Wars while I ran to the bathroom every 15 minutes. Then every 30 minutes. Then every hour.

It wasn't violent and it wasn't rocket fuel but it got me squeaky clean, so there was at least one unpleasant conversation with the doctors I got to skip.

By 11:00, I could safely sleep without thinking I'd make a mess, so we shut everything down and nodded off. 6:00 a.m. was just a few hours away.


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Updates While in the Hospital

I know you people are expecting me to post immediately out of anesthesia - and trust me, I would if I could.

I doubt I'll have the strength for a couple of days, but I hear that the nursing staff makes you get up and walk the very next day, so who knows? Maybe posting will be easy.

I think the best way for me to update you immediately is via twitter. I can use my iPhone for that so it's light and easy. If you haven't subscribed you can do so @butdocihatepink. If you don't want to subscribe - and really, I might be the most uninteresting tweeter in a world of tweeters so I don't blame you - there is a box to the right where my tweets are inlined, so you can just load this page and see how I am. Excuse any potential typos; as iPhone owners know, the device likes to change mistakes into weird words.

It doesn't mean I've thrown a clot.

....cue ominious music... If you don't hear from me in a week, I imagine the news is not very good. My family has instructions to, at some point, update this blog if I can't. When that will happen is up to them.

Dear Criminals: If you are planning on robbing me thinking the house will be empty, think again. I have a big, burly, 25 year old male house-sitter staying here with my dog and cat. It's good to have older children with scary looking friends.

Now, I have to go finish my laundry. Thank you for all the well-wishes, both emailed and posted. I do appreciate each and every thought, even if I can't respond to them all.


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Getting Close

"If you knew that hope and despair were paths to the same destination, which would you choose?" ~Robert Brault

I went to work yesterday. I realized I am taking a chance but by getting sick, I left unexpectedly and didn't want to leave too many things undone for my substitute. I was very surprised by a gift of cash along a long sheet of butcher paper signed by my coworkers. The cash amount was large and I'm pretty stunned at the outpouring of support, both financial and emotional. The money will pay for quite a few days of my family staying in a SF hotel, which had been something we were concerned about. I have posted the sign in the hallway to my bedroom so I can see positive affirmations each night as I go to bed. People have also generously offered me childcare for my youngest, among other things, all of which are so kind.

I work with great people, in a great school, and that is why I love my job.

It looks like the surgery is a go. My cold is clearing up and is not moving into my chest. I am not sneezing or coughing. The worst is that it seems to be in the larynx and my voice is shaky but that isn't dangerous. I have taken today and tomorrow off work just in case - I don't want to go in and catch something new. But as it stands I'm strong enough for surgery.

My legs - my thighs - are weak. I don't understand it. I thought it was post-flu weakness but it has not gone away. It's making some of the household things I wanted to do difficult. I began thinking the cancer was growing fast in the liver and causing it, but I got a call from the doctor today that my latest scan showed I'm holding steady - no new growth. My bloodwork is good and they will see me at 6:00 a.m on Monday.

I confess, this surgery is making me nervous. The recovery part of it makes me nervous. I've been through surgery before and not had the easiest time, and this is the mother of all surgeries. But, I will get through it.

I will be cancer-free. And, I will dance at my youngest son's wedding.

Okay, I suck as a dancer, so I probably won't.

But, I'll be there.


(I owe an apology. I was sent the book, When Cancer Hits Home, to review. It was a well-written book - by an oncologist - that gives you an excellent overview of the top cancers and standard of care treatment. But, this surgery came up much quicker than I expected, so I have not completed my review. I will. In the meantime, it's a good book. Buy it.)

No Prob...

A salesman just called me. Normally, I don't answer my home phone - ever. It's my spam phone, and one I give out to everybody I don't want to talk to since I don't answer it.

But for some reason, I accidentally did. It must be my sickness making me slightly insane.

"Hi, I'm trying to reach Ann?"

"This is she."

"Hi Ann. This is Brad from California Family Fitness. I see you used to be a member and canceled your membership, and I was just wondering why?"

"Well, you see Brad, I've been diagnosed with Stage IV Breast Cancer, and there is no Stage V. I've been pretty busy with surgeries and chemo and am not well enough to exercise."

"No prob, no prob. Ann, we'd be happy to offer you a two week trial to get you back."

Momentary stunned silence from me.

"No thanks, Brad. Next week they are removing most of my liver, and like I said, I have stage IV cancer and it's possible I won't even be alive next year. So I don't think I'm going to be joining a fitness club."

"No prob, Ann, no prob. Well, you have a good night."

I am so wishing, since Brad thinks this is not a problem, that HE could be the one to deal with it instead of me.

Cut off your breast? Lose your hair? Perpetual chemo? The omnipresent thought of your 14 year old having to watch you die?

No prob.




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I can't get sick, I'm having surgery

Thursday, as I as wrapping up my workday, I felt the beginnings of an illness. My stomach began rolling around in my belly, and I experienced a lower GI tract cramp.

Uh oh.

Attendance clerks in schools are better than the CDC in knowing whether communicable diseases are making the rounds, so I asked ours if kids had been going home sick this early in the year? Oh yes, she said, lots of colds and some stomach virus.

Stomach virus. And me, with no immune system, and out in the middle of everyone about to have a potentially lifesaving surgery. My mind flashed to all the kids I'd seen that day - ones who had borrowed pens, ones who had asked me questions, ones who had breathed on me. I thought of the teachers who are too dedicated to go home and and sick ones who had come to talk to me about substitutes.

I can't get sick. I can't miss this surgery.

As another cramp hit, I went over to tell my boss and the VP's secretary that there was a possibility that I wouldn't be there the next day. I am about as dedicated to my job as anybody can be - I truly love it. I don't think I called in sick once last year - my healthy year. But, I'm not taking chances. I want this surgery.

If my stomach so much as growls in the morning, I'm not going in.

My son and I both had an after school hair appointment, and as I watched him get his cut, the nausea began. I realized that I was going to have to cancel my portion of the haircut or something seriously unpleasant was about to appear on the shiny floor of that trendy salon. As I pulled out my husband's checkbook to pay, Cynthia either saw that I was green or didn't want to touch anything I had held, because she told me to come back and pay her at my next appointment.

I got home and went to bed. The intestinal pain got worse and worse. My stomach was roiling and the cramps were constant. I sat on the toilet off and on with no success. It felt a lot like when I'd had appendicitis; strong pain and a need to have a BM but nothing happening, at least at that end. I began throwing up which didn't relieve the pain at all.

It was clear that the Navelbine I had the day before had - after all this time - finally decided to take on the persona of its nickname - NavelBIND.

As the night wore on, I got worse and worse. I began vomiting in one of those nightmarish "sit on the toilet and vomit into the trashcan" scenarios, although sitting on the toilet was fruitless. I was great pain, and growing progressively weaker, so much so that I was having trouble walking. I was shaking, with beads of sweat all over me. I seriously considered calling 911. I really thought it was possible I wouldn't make it through the night. The only reason I didn't was that I had no fever, and that I didn't want to wreck my chances of having this surgery because of a hospitalization.

But, I knew that diarrhea that was gurgling inside needed to come out. My stomach was rolling like I was 8 months pregnant and making noises like a fussy baby, but all was blocked - to keep up the pregnancy analogy, it's like I was only 1 cm dilated and already screaming, "get it out of me!" I was afraid if the floodgates didn't open, I'd begin throwing it up from the other end - I was already past the bile portion of the regurgitation process and into the dry heaves. I wanted to take a painkiller, but wasn't sure I could keep it down, plus they also can cause constipation. Fortunately, at about 2:00 a.m. the dam broke; the Navelbine unbound. I instantly felt better. I spent some time going back and forth, from bed to toilet with diarrhea, but the pain was gone and I no longer felt like it was a potential emergency.

I slept the entire next day. I didn't even awaken until about 4:30 pm. When I emerged, I was exhausted, dirty, weak, stinky. I sat with my family for a few minutes and then went back and took another 3 hour nap. At 7:30, I got up and watched some TV with them, feeling a bit more normal. I went to bed at 11:00 and slept all night and woke up in the morning on the road to recovery.

Whew. I have an upcoming, potentially lifesaving surgery. I should be recovered before then.

Saturday, I was shaky all day and not very hungry, but I ate a little soup and some crackers and a couple of Popsicles and watched a bunch of HBO shows on my iPad. I vowed I'd go for a walk on Sunday and try to get some strength back and would be back to work on Monday to prepare for my time off.

About 9:00 pm last night, I started to feel it. A sore throat. It was faint at first, and I ate another Popsicle to try and cool it off, but I knew what was coming. And, I was right. An hour later, the throat was sorer and the back of my nasal passages were burning.

Shit. I'm getting a cold. I have an upcoming, potentially lifesaving surgery. I can't get sick!

This morning, I woke up with a full-fledged cold. Sinuses stuffed, lips chapped, nasal passages leaking constantly.

Will they even do a surgery on somebody who has a cold? Maybe a minor surgery but not a big one like this. I was told to try to get in as good a shape as I could before this operation, "Keep moving" said my SuperDoc.

And, for four straight days now, I've been sick. I've done none of the things on my to-do list and I'm behind in everything and definitely in pretty bad physical shape.

I am still struggling to walk, my legs are spaghetti legs. Two illnesses back to back with no immune system to speak of (except what Neupogen gives me) is not something that easy for a cancer patient to recover from.

I already decided not to jeopardize this surgery by going in to work tomorrow. Me, calling in with a mere cold? Unheard of. Yet, I must. This is one situation where my health has got to come first. I have to try to protect that surgery.

I meet with the anesthesiologist on Tuesday, and we'll see what he says about my cold.

Tomorrow, it's more tea, more HBO, more chicken soup and as much sleep as my body can handle. And, maybe a walk in the fresh air for strength.

Here's my worst thought: what if they don't do surgery now, but instead give me a future surgical date. What if the cancer grows so much between now and said future date (possible) that they change their mind and decide not to do it at all?

You know what that means?

I will have been killed by the common cold.


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Last Chemo - for six weeks or so

I had my second "last chemo" today. It was a bittersweet experience as I have again been chatting with people and enjoying their company, and by the time I return, many of them will be done with treatment and the group will be new again.

It's funny - even when what you are doing isn't particularly fun, when you've been doing it regularly for almost two years it becomes an integral part of your life; one that you feel you'll miss when it's gone.

Of course, I probably wouldn't say that about routine waterboarding or being forced to go to classic car shows every weekend, so it's all relative.

Who knew chemo was more fun than looking at old cars?

As I settled into my barcalounger, I loudly announced my upcoming surgery to anybody who would listen, and even those who had headphones on.

Hey, not everybody gets this surgery, you know? People should hear about it.

There was lots of interest and people said they'd pray for me.

As an aside, I am no longer the youngest woman in the chemo room. One young lady is being treated for stage III breast cancer. She is 26 years old. I wish that I was still the youngest person in that room, I must say. It's not because she's cuter than me and I'm jealous of all the cancerous old men eyeing her. It's awful that anybody gets cancer, but in truth, it's more awful that she got it than me.

As the last drip slid into my vein, I said a temporary good-bye to my fantastic nurses and my chemo acquaintances, and I walked out the door, free of that shabby yet familiar infusion room until at least a month after surgery.

Speaking of - I have a lot to do before surgery, including paperwork. My advanced directive is done but I need one more signature to make it legal. My FMLA paperwork has to be signed and I need to get the doctor to do his part. I'm going to splurge and hire a housekeeper, even though my house shouldn't be shown to strangers. Two years of cancer has rendered it pretty dirty, and I wasn't exactly Alice to begin with. It's time somebody does it, and it clearly won't be me.

I also need to rent a recliner to sleep in for my post-surgical recovery. Getting up and down out of bed is always the hardest after surgery so I'm going to get a chair with a lift. I'm no dummy anymore.

I don't know if I can wear my own clothes in the hospital or not but maybe I should buy some loose, low rise sweat pants. I have a history of flashing hospital personnel and it's not because I'm pervy. It's totally their fault - the hospital johnnys they always make you wear are way too big for me. Even the small size wraps around me twice, and for some reason they never have smalls. So, I get the large johnny that I have to wrap around myself three times and the armholes are right where your breasts are and the pants don't tie tight enough to stay on so they slide down when you sleep, get out of bed, etc.

On the other hand, this is a teaching hospital. I'll be visited by my high-powered Super Doctor, fellows, residents, interns, med students, nurses, nurses-in-training and others who will need easy access to my long incision, so maybe clothes you can swim in is good, even if you end up showing your girly parts, both missing and intact, to all who come in.

Hey, if that guy on Dancing with the Stars doesn't mind showing his burned face to the world on national TV, I shouldn't mind showing my misshapen reconstruction and short and curlies to a few medical professionals. I will draw the line if an accountant shows up.

I also need to make arrangements for my family to stay...somewhere. Ouch. A week in a San Francisco hotel and it's not a vacation.

That might hurt more than the surgery.

I also found out I can request a private room, and they are given out when available. I'm doing that tomorrow so I can prevent the assault of daytime TV that I know any roommate I have will perpetrate upon me.

I'll beg, cry and bribe to get a private room.

Do you think playing the cancer card will do any good?


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