I’m now five days post-op, and – spoiler alert – I am recovering better than I expected. Last Thursday, I underwent a total salpingo-oophor-hysterectomy, which in non-medical-jibberish means that I had my ovaries, fallopian tubes, uterus, and cervix removed. I elected to undergo the surgery because my breast cancer is estrogen driven, and the ovaries are the primary producers of estrogen in the body. I elected to include the fallopian tubes and uterus in the clean-out because, simply speaking, their removal would decrease the risk of the development of future cancers in either organ. My cancer was scheduled be performed laparoscopically, and took place at my cancer center’s outpatient surgical center. If all went well, I could anticipate going home after 24 hours. The surgery was performed under general anesthesia, and my surgeon, Dr. Z, said to expect that, if all went well, I could anticipate the procedure to take about 90 minutes from start to finish.
Christian and I arrived at the surgical center on Thursday morning about as nervous as you would expect. I was ready to get things underway, and my anxious energy helped me to avoid thinking about the fact that I was hungry and hadn’t been able to drink any coffee. We were checked in, given a quick tour, and settled into the pre-op room, where I was outfitted with the latest in stylish surgical wear, complete with cheery yellow “fall risk” socks. I completed the final consent forms, paperwork, and pre-op questions, spoke with some of the doctors and nurses on my care team, and the nurse placed my IV lines – at that point, we were ready to go. I said goodbye to Christian, then the nurse led me down the hall to the operating suite. In the operating room, the nurses helped me up onto the table, I began to position my head, and that’s the last of it I remember.
As I was learning about the hysterectomy procedure, the manner in which the procedure is performed stood out to me as such a fascinating technique, both in its medical advancement and its strangeness. My procedure was, in it’s fully glory, a robotic-assisted laparoscopic total hysterectomy with salpingo-oophorectomy, performed with the DaVinci technique . This means that once I am completely under anesthesia, my body is rotated so that my head is closest to the ground and my legs are placed in stirrups in the air. In addition, instead of an open abdominal incision, similar to that used for a c-section, I had four tiny (approximately 1 inch) incisions made on my abdomen, horizontally in line with my belly button. One of the incisions is actually in my belly button. Once these incisions are made, carbon dioxide gas is used to inflate my abdominal cavity to create space for the tools to move around, and robotic arms are inserted in the small incisions. These tiny robot arms are manipulated by the surgeon, but they, rather than the surgeon himself, perform the actually physical procedure. This is great, because the laparoscopic tools are able to cauterize the tissue as they go, which results in minimal bleeding. The uterus tissue is then delivered vaginally. I was eligible for the laparoscopic procedure rather than an open procedure because there was no anticipation for the removal of large masses. My fallopian tubes, ovaries, and uterus were all removed without issue, and there was no need for any more invasive techniques to be employed. After the procedure was over, my incisions were closed with stern-strips and covered with dressings to be left on for about 36 hours. I was told to expect a small amount of bruising around the site and to feel some gas pain in my abdomen, chest, and pelvic area as my body worked to absorb some of the remaining carbon dioxide.
After the procedure, I woke up in the recovery room. I had anticipated I might feel nauseous, as is very common after anesthesia, and my procedure required anesthesia with intubation, so I was expecting a bit of cottony, scratchy throat as well. I was not prepared for the absolute panic I felt when I began to come out of the anesthesia. As I began to wake up, the only thing going through my mind was the sensation of some of the most intense abdominal pressure I have ever experienced in my life. I can only relate it to the experience of giving birth, because that was the type of pressure I felt. The only thing going through my mind was “OH MY GOD, I’M GOING TO POOP NOW, I EITHER HAVE TO GO POOP OR I’M ABOUT TO HAVE ANOTHER BABY.” I was absolutely critically focused on this pressure, and got more than a little panicky about it. I started calling out to the nurse – in my mind, I didn’t think I was very frantic, but at our nurse’s retelling, I was legitimately freaking out over this poop situation. The nurse came in and asked me if I wanted to try to go to the bathroom. I said yes (or it may have been “OMG YES, I HAVE TO GET TO THE BATHROOM NOW”) and our nurse practitioner came to help us. Somehow, I made it off the bed and onto the toilet, where I sat for what felt like an eternity (it was about two minutes) and was near tears at the fact that I felt so much abdominal pressure and couldn’t do anything about it. Eventually, the nurses helped me back into bed, and I was given some more meds, which made the whole situation a lot more comfortable. By that time, Christian had come up and was debriefed on the whole poop situation. I was sufficiently comfortable at this point to laugh with the nurses about it: the nurses’ recap of the whole story was hilarious, and I was already starting to feel a lot better.
The first few hours of recovery were about to be as expected. I was not in significant pain, but I did have a good amount of discomfort, both in the incision sites and in my torso due to the residual gas. However, the pain steadily decreased from “this feels like labor and childbirth” to “this feels like a really bad period.” My nose and mouth were so uncomfortably dry, and I could not, for the life of me, drink enough water. I ate some applesauce to help coat my mouth and stomach, and had also brought a Ricola honey throat drop, which was the MVP in easing my cotton mouth. At that point, I was able to get out of bed and walk around the floor a little bit, which surprisingly felt very good. Our wonderful friend Maria had then texted us to see how things were going and offered to bring us dinner. All I wanted at that point was matzo ball soup and a cupcake, so we squared away details, then I closed my eyes for a nap. By the time I woke up, Maria had arrived with our food, and it felt so good to sit up and talk for a bit while we ate. I did a few more laps around the floor, and my pain felt noticeable, but not overly intense or unmanageable (I made sure to stay ahead of my pain and not let things get too uncomfortable before I took more pain meds). By about 8 pm, I had been up, eating, and moving around in a surprisingly normal fashion. After I took my evening meds and did all of my vitals, I tried to go to sleep. I don’t know if it was the combination of the discomfort of the hospital bed or the adrenaline of the past few days, but I couldn’t shut my brain off and relax. I just kept thinking how relieved I was to be done with this surgery, and how glad I was that everything had gone well and that my recovery thus far had been so much easier than I imagined. I got out of bed a few times and walked around the dark, quiet halls, slowly burning off the adrenaline that had pushed me forward through everything. I felt so much relief, and honestly, so much joy to be on the other side of the surgery.
This surgery had been looming over my head for months, and for months, I had agonized over the decision to go forward with it. I agonized over almost all of the details: whether to remove only my ovaries, or to go forward with a full hysterectomy, when to do it, how I would recover, and how to find a place in my head and my identity for my self as a woman without a reproductive system. In many ways, electing to go forward with this surgery has been more upsetting to me than any other aspect of my treatment. While I knew that it was a routine procedure, and a procedure that could help improve the other aspects of my treatment, I also recognized the potential for complications that arise any time someone undergoes surgery. Also, I was electing to remove a part of myself that was so deeply intertwined with the growth and birth of my son, and, because of that, I couldn’t fully recognize these parts as something worth discarding. The night before my surgery, I stood in the shower and just broke down in tears, weeping for all of the hell we had been through, and for all of the unknowns before us. I wept out of fear, out of mourning, out of loss, and out of exhaustion: I was so weary continuing down this road I had not chosen, and yet, I had no choice but to continue on.
When I woke up the next morning, I felt nothing but relief. I was so glad to have done the procedure, so glad that it had gone well, and so relieved that it was over. I felt like I was starting fresh, opening the doors to a new chapter of my life. I felt at peace. But I was also so, so tired. We packed up, got discharged, and drove home, my pain still very manageable. Once home, I crashed, and napped until dinnertime. But at that point, I felt good enough to actually cook dinner for everyone. Each day I felt a little bit better, and made sure to rest as much as I could, but also to get up and move around every few hours. The surgical pain was fairly minimal and responsive to my pain medication; it generally felt like period cramps. However, the gas pains were fairly uncomfortable for the first two days. They were sharp and so unpleasant, but I found that taking Gas-X each morning alleviated a lot of the pressure, and knowing that this pain was normal and expected put much of my mind at ease.
As of Monday, I have not taken any pain medication. My incisions are still covered by steri-strips, but my recovery has far surpassed my expectations for both its speediness and ease. I am still trying to prioritize rest as much as possible, but I have been pleasantly surprised at how my body has healed. After nearly three years of dealing with what we eventually discovered was metastatic cancer in my bones, it has been a relief beyond words to see my body healing in such a way.