11.11.09
The ER – Pt. 2
Let’s hope I can finish this part of the story tonight. I genuinely feel like I’m going to throw up. It’s amazing how visceral my reactions still are even after all this time.
By this point I was absolutely furious but I felt totally helpless to do anything. The news that I couldn’t be stitched back up was devastating. Couple that with the results of the culture and I was even more of a basket case than before. The culture discovered five different types of bacteria: three of which the tech never even heard of. So they put up a bag of the most badass antibiotics they had.
Unfortunately about 1/2 way through the bag I started getting EXTREMELY itchy. My throat started swelling a few minutes later and it became a bit difficult to breathe. Well Ken called the nurse and within a minute or so he had a syringe of something in the IV. He SLAMMED the plunger in and within moments I felt like I was going to pass out.
I got tunnel vision and then the tunnel started narrowing. My body felt very heavy and I felt like I was being pushed down. I told the nurse that I thought I was going to pass out. His reply was “Isn’t it a good thing you’re in the hospital then?”.
So…yeah. I was allergic to the first antibiotic. So they put up something else really badass and I was off again. This one made me a little itchy too so the nurse injected a little syringe of something else. This time much more slowly. In a matter of moments I was doing just fine and made it through the entire bag.
After a bag and a half of serious antibiotics, they also made an appointment for me with an infection specialist. Then one of the nurses packed my chest and they sent me home.
11.06.09
The Calm
After the second surgery there was actually a brief time when I thought that everything might be alright after all.
I should have known better.
I don’t know HOW I should have known better, unless past experience told me that the HiQ had no real idea what he was doing and the man was/is a menace and a disgrace to the medical profession.
I had just hoped that the worst was over.
And for a little while everything WAS okay. I actually had a period of about 12 days when everything looked like it was going to work out. Sure I was going to need one more surgery but at least I didn’t have to deal with the necrosis. I just changed the gauze over the surgical tubing drains and changed dressings like I was told.
Little did I know what was ahead of me.
11.03.09
Check Up Part 2
Dr. Elliott is EXTREMELY pleased with how well the Twins are doing. He’s thrilled with how much they’ve softened and how well the scars are fading. He’s also pleased with how my back looks.
While he was looking and “groping” (forgive me Dr. Elliott, I don’t know what else to call it when you check to see how they feel) we talked about the things I was curious about. First, I found out the reason my back has that plasticky feeling like someone set down a layer of plastic wrap across a wide section of my back.
The reason for that is that he basically disected my back, probably doing more surgical maneuvering back there than in my chest. The crackly feeling is where scar tissue has formed in kind of a sheet. It will probably take another six months or so for that to release. He gave the same prognosis for the numb areas, although those could take even longer.
We also talked about how subjective the term “recovery” is. You “recover” in the recovery room. You “recover” in the hospital. You “recover” after the surgery and that can take over a year dependent on which aspect of healing we’re talking about. For instance it took me about six months to get my endurance level back to where it was. Some people take more time. Others take less.
It’s subjective.
We also discussed nipple reconstruction. I told him it probably wouldn’t be until this time next year. He said it didn’t matter. We could do it tomorrow, next week or five years from now. Personally *I* was just relieved that he wasn’t planning to retire any time soon.
Another thing we touched on was doing a breast lift. His concern is that there wouldn’t be much point to it because as heavy as the Twins are, they would end up right back where they are in no time at all. I would have to lose at least 30 pounds before it would become feasible.
My big issue with that is around that point the Twins will start getting smaller. As I’ve written before, to watch them shrink away is like watching my original breasts rot away. I just can’t handle that right now. I just can’t. As i sit here typing I can feel the panic rising and the tears filling my eyes. I CAN’T lose them again.
Okay, okay, I know logically that I’m not losing them. They’re a part of me and I love them dearly. I’m just SO not ready for that. And for the first time in my life I’m content to weigh 218.
We also discussed the two little places on my sides that look like little handles. he called them puckers I think. (Dr. Elliott, if you read this please leave a comment and correct my verbage). He said they were normal and occurred as part of the surgery. We could do a little lipo to lessen them but to tuck the skin would require another incision. Dr. Elliott didn’t seem very keen on another couple of incisions on me and I’m really quite okay with that. He explained that when you do the tummy tuck type breast reconstruction you get the same thing at the hip bone area.
Dr. Elliott made a point of mentioning that he was SO happy we had gone with the latissimus flap reconstruction rather than the tummy tuck. We both had been extremely concerned about possible complications. The tummy tuck procedure simply carries more risk and more risk was the LAST thing I needed.
So all in all the Twins are doing great. He wants to see me again Aprilish for my one year check up. In the mean time I REALLY hope that he checks in. He seemed really interested in my blogs.
And in case I haven’t said it enough, he’s an amazing doctor. Every woman who has to go through reconstruction for ANY reason should go see Dr. Elliott at Atlanta Plastic Surgery (http://www.atlplastic.com).
11.01.09
Surgery #2
As my regular readers know I developed necrosis two weeks after the October 2nd breast augmentation and lift surgery in 2007. After several weeks of Hell I was scheduled for a second surgery on November 2. This surgery was for the purposes of removing the implants and the remaining necrotic tissue. We showed up in the afternoon at the surgical center – which we had to pay the fee for – I was prepped and before I knew it, part two of my nightmare had begun.
When I was able I looked at what had been done. It seemed, in retrospect, Frankenstinian. The line of vertical sutures looked like someone had whip stitched the skin together. I also found out that, on the left side, there had been a half inch spot left open.
I also found out that over 300 ccs of serous fluid had built up in each pocket. The implants were both intact. That explained the pressure and the bubble under my flesh. Fortunately this time the HiQ put in what passed for really crappy drains. He had inserted open-ended surgical tubing. The outer ends were covered in gauze to absorb the leaking serous fluid that my body produced. Compared to the closed-system drains I had after my reconstruction, these things were positively primitive.
I was also an A cup now down from a DD cup and before that a C cup. This wasn’t nesecarilly a bad thing. I finally had the ski slope breast shape I had been after from the beginning. By ski slope I mean the breasts that are heavy and rounded on the bottom and on the top the breast gently slopes down to be capped by a pert, rosy nipple.
I was just missing the nipple.
The HiQ assured me that after i had healed, we could do reconstruction. At this point I was already starting to have my doubts. But I’ll talk more about that later.
For those of you joining me from NaNoBloMo and reading my blog for the first time, please go read the first post for more information about what BoobCast is all about.
10.31.09
Zombie
While I was doing the wet to dry bandages before the debridment, I frequently felt like I was a zombie. No, I didn’t want to eat brains, though I DID want to severely damage the HiQ.
***WARNING! GRAPHIC CONTENT AHEAD***
No what I mean is that when I would peel off the wet to dry dressing and pull away bits of dead flesh, I couldn’t help but feel like I was, at least in part, an undead zombie. Here I was dropping bits of flesh. And that’s what zombies do…walk around, eat people and drop bits of their body.
Instead of eating people, I felt like this situation was eating me alive. And not just in the literal sense. I began losing myself to this situation. I WAS a bouncy, vibrant, spur-of-the-moment type of person before I became Zombie Maria.
It has only been in the last month or two that I’ve come back to myself. I’m not there yet. I still shamble a bit, though there are no brain cravings. And unfortunately I still haven’t gottten past the point of wishing the HiQ ill. I really couldn’t actually do anything myself. I’m not that kind of person. But you can damn betcha that I wouldn’t be feeling bad if he were to accidentally get his hands crushed.
10.29.09
Misty Watercolor Memories
The human memory is an odd creature. Or at least mine is. I have been trying to remember incidents from the first four or five weeks after the initial lift and implant insertion surgery. I’ll try to zero in on that time and then my mind will slip sideways as though the memories had a silicone shield. Everything just slides right off. Non-stick memories.
I’m guessing this happens because I tried so hard to repress and not think about what was happening WHILE it was happening. I just dealt with one second at a time, did what I had to do and cried about it afterward. I was on what amounts to auto pilot. Either that or I detached and focused on the anatomical details. Although that really started more after the second surgery.
I wonder how much of this is a coping mechanism. Avoidance used to be a major part of my modus operandi. From what I learned when I was (briefly) a psych major, avoidance isn’t considered a healthy way of coping. Though I’m not so sure I WAS avoiding. I was changing the wet to dry dressings twice daily and going to my regularly scheduled doctor appointments with the HiQ.
I have to wonder how clearly people remember incidents of severe trauma. Does our brain initiate a response that allows us to be protected from the harshness of those memories? Is it some sort of conscious mechanism in which we tell ourselves that “this gets filed back here and we’re not going to remember this any more”. Rather like sticking our fingers in our ears and yelling “LALALALALALA I CAN’T HEAR YOU LALALALALALA!!”
***WARNING – VIVID DESCRIPTION AHEAD***
And then…sometimes I get some vivid memories back. Like one of the times I was pulling off one of the wet to drys and a big chunk of flesh the size of a quarter came away with the necrotic tissue and I felt like Imhotep from “The Mummy”. Or a Zombie.
I actually spent a moment or two trying to put it back in the spot. You know…like when you’re a little kid and you break your favorite toy. You try to put it back together and it won’t go but you just can’t figure out why it won’t go back together.
Yeah, I think I was a little insane for a while.
10.28.09
The Reality of Malpractice Law Suits
In the third week after the first surgery I called two different malpractice lawyers. They both told me the same thing. In the state of Florida a plastic surgeon is only required to carry a minimum of $100,000 in malpractice insurance.
That amount would cover the investigative and legal fees and I would be left with very little. In all likelihood it would not be enough to pay for reconstructive surgery.
In the investigative part of the law suit they subpoena the records from the surgery. Once the records are subpoenaed, (or even before that) anyone can go in and change the records to indicate a more favorable position for the surgeon and the surgical team. So by the time the attorney gets them, there may be no evidence at all of malpractice.
It is also difficult to define what exactly constitutes malpractice. Who’s error was it? WAS there even an error?
Much later I spoke to a surgical nurse an another site who said that she thought, from the bruising I described, that something must have gone catastrophically wrong during surgery. But there wasn’t really a way to prove it.
So there you have it. Make sure you know what you’re getting into. Ask how much malpractice insurance your PS carries. You only get one body. Make sure it’s protected.
Packing Up
Even after the debridement the HiQ still had me packing the area with saline soaked wet-to-dry bandages. Every time I asked why this happened his reply was the standard “I don’t know”. When I asked him what was next, his standard reply was “We’ll just have to wait and see.”.
After the debridment I told him that “I don’t know” is no longer an acceptable answer. I let him know that I would accept “I don’t know but I’ll find out” and that I would expect an answer at my next appointment. When he DID finally give me an answer it amounted to “Sometimes these things just happen and we really don’t know why”.
Emotional meltdowns were a regular occurence. Ken still wasn’t allowed in with me. I wasn’t going to expose him to the horror I saw twice a day.
After the debridement there was just raw fatty tissue and flesh. Granular tissue started filling in some of the areas. granulation tissue the newly formed vascular tissue normally produced in healing of wounds of soft tissue, ultimately forming the cicatrix. A Cicatrix is a scar resulting from formation and contraction of fibrous tissue in a flesh wound So I was starting to heal.
Since the HiQ had removed all the necrotic tissue that he could, the next step was the other bad news. There was no way the implants were going to stay. They had to come out. So they scheduled me for the second surgery on November 2nd 2007. And lucky me, I got to pay for the cost to use the surgical center. Yes. You read that right.
In the next post I’ll talk about the shocking reality of law suits for malpractice.
10.24.09
Debridement
It sounds scary. I was terrified when the HIQ said that at the next appointment he was going to “remove the dead tissue”. I anticipated pain. I even had a panic attack. As if I wasn’t enough of a basket case as it was. I didn’t even get an explanation as to how it would be done.
By this time I was crying at least once a day. It had finally sunken in that things were really bad. I had lost both nipples and areolae. The tissue was completely dead. The tissue itself was blackened and rubbery. In some places it crackled when I pushed down on it. So it had to be removed.
Dead tissue is a breeding ground for infection and if it wasn’t removed, it would have caused infection that would have gone systemic and eventually killed me. So debriding, even though it sounds terrifying, is actually a good thing.
When we came back for the next appointment, the HiQ STILL didn’t explain exactly what would be going on. Thankfully his nurse did. She explained that this wouldn’t hurt because the tissue he would be removing was dead so the nerve endings were dead too. Because the nerves were dead, there wouldn’t be any sensation except for a pulling sensation.
I sat down and kept my eyes closed the entire time. I do know that he cut the tissue off with surgical scissors because I saw the instruments before the procedure. All I felt was pressure and tugging. No pain aside from the emotional grieving of having lost an intimate part of myself. I grieved for the loss the same way an amputee or breast cancer survivor would.
It still freaks me out some that he was cutting tissue off my body. It sounds like something out of a horror movie, doesn’t it? Just the concept was enough to freak me out. Yet through all of this I explained calmly and in clinical terms to Hubby what was going to happen. He was, again, not allowed in. I refused to expose him to it and I was determined that I would do my best to maintain a facade of normalcy.
I failed about half the time by this point. But I tried, by damn. I tried.
The most important thing to take away from this post is that if you have to endure debridment, it is NOT painful. It sounds scary but what’s scarier is what will happen if you do NOT have it done. So have it done and do something really nice for yourself afterward.
