A Day of Surgery

Having a port for cancer treatments and blood draws makes life easier for me as I live with metastatic cancer. It even can be used for contrast dyes that are given during all the scans that come with MBC life. Whereas having the port is easy-breezy, getting one removed and replaced presented a few bumps. It took two procedures to remove it. You can read that story here if you missed it. It also took two surgeries to get a new one.

The procedure had already been rescheduled once due to what best can be described as communication glitches between departments that share patients from time to time. It was finally scheduled one day before treatment so I’d be good to go. Maybe I was supposed to feel some anxiety. I thought of it as a small deal in terms of hospital events. I could let my sister feel that stress. When she dropped me off, I told her I was psyched. Bring on my port!

I have been fortunate not to have had much surgery in my life. I had a couple of breast fibroids removed in my early thirties. I pushed for surgery when I was diagnosed with metastatic breast cancer but failed to get it and I was told it wouldn’t benefit me. The cancer had already spread. Getting my original port has been one of the only surgical experiences I’ve had.

The same surgeon who put in the first port was placing the new one. He took out the old one when it had leaked. He came into my room in pre-op and went over necessary details. He told me I was I difficult to sedate when he removed it weeks earlier. I do well with local sedation or general anesthesia. With conscious sedation I move around too much. I do well with general anesthesia and wake up pretty intelligently. Good to know even though I plan to be done with surgery for a long time. My spirits were up during our pre-op discussions. I announced to everyone I was going to rock it. Off I went.

I didn’t rock it.

I woke up fairly alert in recovery and learned a new port wasn’t placed. I hadn’t seen this coming and it hit me like a ton of bricks. The thought was the vein had become too narrow and scarred. From patient notes, I read an ultrasound was successful in accessing the right internal jugular vein. Multiple attempts were made to advance the catheter portion of the port, but there appeared to be a central stenosis (narrowing). Medical speak became too technical for me after this but I understood the gist.

Another surgeon from Interventional Radiology came for a consult. I would be handed over to him since I required more specialized attention. He was an overly cheerful sort who shared bad news with a smile. It was annoying and I said something to the effect I wasn’t as happy with this news as he seemed to be. He chuckled as he told me he was unsure if a port could be placed on the left side. Stenosis needed to be ruled out. Other impacting factors involved finding an available OR and more importantly a free anesthesiologist. These were all strikes against the likelihood of my getting a port that day no matter how badly I wanted one. What would I do long term if the left side couldn’t be used? I asked my new surgeon to please try to arrange it.

Yes, I wanted a new port that day. Thoughts ran through my head about rescheduling again. Maybe the third attempt would be the charm. Rescheduling would mean more fasting, another negative COVID nasal swab, and arranging a ride for another day. I’d need to do laundry the day beforehand to check off boxes for clean sheets and clean pajamas. I would need to shower at night and in the morning with special antimicrobial soap provided to me. I would have to emotionally decompress and then start from scratch another day with no assurances it was even going to work. I would need to do food prep ahead of time so I’d have good food when I got home. These are all hidden preparations that go unseen when someone pops in for a quick procedure. It’s work for the patient, too.

My surgeon returned rather pumped that it was my lucky day. His enthusiasm was remarkable and I was equally thrilled with his news. An OR was available and an anesthesiologist found. It turned out to be the same one I had in the morning. I was happy to see her for the afternoon session. She knew me and my history. Arrangements were made for something called a central venogram and left side line/port if central stenosis could be ruled out. The easiest way for me to explain a venography is imaging of veins. What I didn’t understand until moments before I went to surgery was I’d be under for this part. If a good vein was found they’d go straight into placing the port. I’d wake up not knowing if it was successful or not.

I hate not knowing. I hate not being aware of what’s happening to me. That happens too often with cancer. I hate waking up and discovering I had on a different gown. How did THAT happen? I already was the most underdressed there. I suspect this may be standard to help protect patients from infection and keep the environment sterile. It’s a bit of a mystery. I guess what happens in surgery, stays in surgery.

I loved waking up and finding out I had a shiny new port. It was on my left side which means I have symmetrical scars. It’s not the look I want, but it’s the one I need. Maybe it’s time for a tattoo. I’m entertaining a simple cross with the word hope or perhaps simply a heartfelt expression like Bite Me. One fits my personality better than the other.

Diagram of a PowerPort. Notice the three small bumps on top that are posing a problem in feeling them.

Cheerful surgeon returned to check in on me. I was more cheerful than he was in this instance. I exclaimed a hearty “Well done!” and adopted my pandemic gesture of hands in prayer to express gratitude. I often use it in greeting as well. It works for many things. I followed up with an air high five that he was happy to return. Shortly after this, I was able to leave, having arrived at 8 AM and finally leaving around 6 PM.

Living with cancer has taught me much about priorities with health care. There is a lot on my plate. I have found I need to identify and stay true to the biggest priority whenever I have an oncology visit, treatment, test, or something else related to my health. The day of surgery, my priority was getting a new port. My priority the next day was getting treatment. As it turned out, my cancer center couldn’t use the new port because their policy was to wait a week to use new ports unless needles had been left in ready for use. Hmmph. I was disappointed but knew I could still have treatment through an IV. Treatment was the priority.

My priority the day after treatment was ice cream.

My new port has been used once, and it wasn’t easy-breezy. It flushed easily yet a blood return was hard to get. It took three stabs and lots of pushing down on it and repositioning the needle while still stuck into me. Blood finally got flowing. On my next treatment, four people tried. Once it couldn’t even be flushed. Once it returned pink blood, not red enough to count. No one can feel the three bumps needed to access it well. It was another treatment day with an IV line.

I’ll have an x-ray early next week to see what information that provides. After all the hassle to replace it, it looks like a third surgery is a good possibility. Insane.

Figuring out what is going on with the new port is one of three big health priorities for next week. I hope it is an easy fix. My port business is even more important than ice cream. I can’t wait for my port to be fixed and ice cream can move up on the list again.