Healing

(Note: The reason for the delay writing a new post will, I hope, become apparent as you read. We were waiting for an issue to resolve itself, which by now it has sufficiently. –  James)

Mary Rose began her medical leave from work the day before her surgery on June 17. Having worked all through her chemo and the run up to surgery, she would now have the time to recover and prepare for the last stage of her treatment, radiation. The first week or so after the procedure was an interesting period of transition. In many ways she bounced back physically rather quickly, and she was of course very relieved by the success of the surgery, but it also seemed in those days that the cumulative effect of everything she had been through up to that point began to show. An understandable weariness perhaps, or a kind of recognition of what she had experienced thus far that could only reveal itself in a pause, a relative silence. 

The immediate post-surgical period was also what you might call the days of plenty. She was kindly deluged with food, flowers and treats of every kind. It was a lovely outpouring of support and it certainly lifted her spirits with each passing day. I was also something of a beneficiary of all this; with so many complete meals being delivered to our doorstep my duties in the kitchen were almost nonexistent.

After little more than a week of recovery, Mary Rose was clearly on the rebound. Out and about on her own, driving, exercising, running errands, and plunging into an endeavor she had been looking forward to doing on her leave with an intensity akin to lust: crossing items off her epic to-do list (also known as “the pile”). It soon became apparent that she would not even need any physical therapy. She quickly got over any pain from the surgery with minimal medication, and her range of motion was fairly undiminished. She just had to be careful not to push herself or to do any heavy lifting, but that’s why God invented husbands anyway.

The complications began to emerge when she visited the plastic surgeon to check on the progress of her healing. The ideal post-surgical scenario was that by two weeks out she would be sufficiently healed to finish injecting the tissue expanders (temporary implants) that were put in place during the surgery. Then, with the expanders at their target size, radiation could begin the following week. If that timeframe held, she would have completed radiation by August 22 and we could have actually had a family vacation during the final week of the summer; a chance to celebrate, to put a period on this long, terrible sentence, and maybe even catch our breath for a moment before the tumult of back-to-school. I wanted this very badly for all of us but especially for her. I wanted this to be over, to whatever extent it could be considered over, while it was still summer. I wanted her on a beach, sand between her toes, the burden lifted, having come through the fire to a place of hope and healing. This was not to be.

The first check up after surgery revealed a large amount of scabbing over the incision on the right side, the one that would be treated with radiation. It was enough of a concern that her plastic surgeon, Dr Flaherty, felt that the wisest course of action would be to surgically remove the scab, redo the incision, and for good measure reduce the volume of the right implant to relieve a degree of pressure. This was the equivalent of turning the healing clock back to zero, thus delaying the onset of radiation (the primary concern) and throwing our vacation plans right out the window (a relatively minor but nonetheless heartbreaking concern.) Even after this corrective procedure though, it was far from smooth sailing. Much of the difficulty lay in the fact that after the mastectomy she was left with “thin flaps” (you’d think there would be a more artful or scientific term.) After removing the breast and an additional margin of tissue on the right side for safety, what was left was less than ideal for healing. There was not a lot of tissue remaining beneath the skin to work with, and it just needed more time and care to be able to stand up to radiation. 

This was a very frustrating few weeks. When would she be sufficiently healed? No one could say. When would radiation begin? Depends on the healing. Could anything be done to make her heal better or faster. No. When therefore would this whole thing be over? Not when we thought, not soon enough. After the regimen of a chemo schedule, after the technical certainty of surgery, we were now in an unfamiliar holding pattern. Waiting. Just waiting. Meanwhile the clock was ticking and the ideal window to begin radiation was closing. The frustration and worry reached a peak when, at about three weeks after surgery, we met with the radiation oncologist (an able practitioner who comes up a bit short in the bedside manner department). He expressed outright alarm at the delay caused by repairing the incision and all but flatly declared that Mary Rose would not have time to get her implants expanded any further and that she would remain the size she was. This was extremely upsetting to her, the notion that she would not be able to restore her appearance. It felt like something else being taken away, after she had already lost and endured so much. On top of all that, this doctor’s sense of urgency about starting radiation, while well founded, was so bluntly expressed that it needlessly compounded the fear of recurrence. A sense of danger that we had not felt since the original diagnosis was beginning to rear its ugly head.

It took a few days for some perspective to be restored. Dr Flaherty assured Mary Rose that there were other reconstruction options to consider down the road, even if the ideal scenario of being fully expanded before radiation could not be realized. She continued to heal, slowly but surely. A subsequent visit to the radiation oncologist was more reassuring. Another visit to Dr Flaherty. Still on track. But what was more significant than the assurances of doctors was her own quiet strength in the face of a setback. She was thrown off balance. She recovered. She was disappointed. She absorbed it. She moved on. By the first week of August she was in for a dry run of her treatments; rehearsing the routine, machines targeted and calibrated, getting familiar with a whole new set of possible side effects. She was at what you might call the outer limit of the preferred time to start radiation, but still in an acceptable range. Her first treatment was on Monday, August 11; the first of 33, every Monday to Friday for six weeks.

From the outset of Mary Rose’s treatment, all the way back in the dark days of February when chemo first began, we took comfort in the sense that we were on a path: first chemo, then surgery, then radiation. We were given a road map, and our sense of progress along the road was confirmed on a regular basis; yes, it’s working, it’s shrinking, it’s coming out, etc. July was our first real bump in the road, the first time things didn’t go as planned in the context of treatment, the first time the best case scenario of the this worst thing ever didn’t pan out. Of all the possible complications we could have encountered along the way it is certainly on the milder end of the spectrum, but it was jarring nonetheless, a reminder that cancer offers very little in the way of certainty. The question you keep circling back to is not will everything go as planned, but what will you do when it doesn’t? When the complications push back, when you lose your bearings, what will you do? Will you fall? Will you crumble? Or will you dig deep, push ahead, and find your way back to the road.