Day 1

What everyone wants to know:

·        No cancer was identified in Jen's sentinel lymph node and the tumors looked better (smaller) than the doctor expected

·        Transplant reconstruction looks good (or “great” if you are the reconstruction doc), the next 48 hours are critical to ensure it sticks and there’s no complications with clotting

·        Jen’s in a lot of pain (7 of 10), nauseous due to the narcotics and that’s with the morphine and “pain ball” in her stomach that has her abdomen completely numb – BUT she looks great!

·        Next steps on the journey:

o   Get past the next 48 hours w/o clotting or infection and get discharged from Highland Hospital on Sunday (visitors limited to 2 at a time (and welcome), no one younger than 14 because it’s flu season, but no hour limitations)

o   Receive final pathology in 10 days followed by a “conversation” between her surgeon, oncologist, and reconstructionist to determine if chemo or radiation are going to be necessary – indications continue to be that this is not likely – great news at this stage

o   Get better and begin recovery – in the near term requiring Dave to effectively empty three drains 2x-3x a day for the next 10 days or so and Jen to keep her sanity

How we got here:

Jen got even more sick over Wednesday night, if that was even possible, which as you can imagine had an extremely calming effect on her anxiety level which for fun and excitement we decided to amplify by taking my partners in crime - Will and James to her nuclear injection at 8:30 in the morning. This is the shot that provided the marking liquid so that the doctors could find Jen's sentinel lymph node during surgery. While the shot hurt a ton, it was a smaller needle and a helluva lot less painful than the hollow needle biopsy she went through in October and was a non-event otherwise. It was delayed 45 minutes leading to a little more uncertainty about when surgery could occur as there was supposed to be a 4-hour delay between the injection and surgery. Jen tried to get an answer as to whether she would be going in for surgery that day - in an attempt to avoid the shot. No luck as it turns out in Rochester the only inhibitors to major surgery are a fever or green phlegm. If you have neither you are good to go. Cough, congestion, runny nose - those are all distractions for those of us that obtain their real time degree via WebMD such as yours truly. In any event the nurse said - this is a pretty simple procedure – “just head down to same day surgery. Uh-no. Jen was like this isn't "same day" I'm going to be here for 4 days. "No kidding." So we left the hospital to drop the boys off at Jen's wonderful brother and sister-in-law’s house for the evening/weekend still not knowing whether surgery was going to happen.

Upon our return, Jen was admitted and immediately struck a chord with the admitting nurse who was a trip.

Nurse: Name?

Jen: Jennifer Weaver

Nurse: Husbands last name?

Jen: Kuder

Nurse: Hmm...are you going to take his name? Kuder-Weaver or Weaver-Kuder?

Jen:  Probably not

Nurse: You know I grew up in this neighborhood where the field where everyone used to play soccer on the weekends was on Beaver St. The cross street was Eaton - so everyone just said in response to the question what are you doing this weekend – “Eaton Beaver”. “Kuder-Weaver”, that's in the same ballpark - good decision.

Jen: I love her

It became fairly evident around that time that they were likely going to allow Jen to go into surgery. With the caveat that it appears that things have turned out excellent, I can't say that the next 45 minutes gave me any more confidence in the near term hope for our medical system. From the admitting nurses saying it was going to be a 3-4 hour procedure, to the reconstructionist saying his portion alone was going to be 5 hours alone, to our surgeon saying, I just looked at the MRI and the tumors look further away from the skin than I thought. (No kidding, I’m glad that was on your To Do’s 30 minutes before you head into the OR.) Our admitting nurse said we would not be seeing the reconstructionist before she went under anesthesia, however the surgeon suggested it was supposed to happen. “He's in the OR now (presumably conducting surgery) let me just wander in there and get him to come out now and see you.” Pretty casual around here at Highland, eh? Sure, why not? It’s not Jen in there. (Also interesting was realizing that in the middle of Jen’s 7 hour surgery, that the reconstructionist got to take his 30 minutes for lunch. Never thought about that – I guess that makes sense, we all have to eat.) Soo…doc comes out and they have the meeting of the minds in front of Jen about how this surgery is actually going to work, where they are going to make incisions, what they are both trying to accomplish, etc. Total time together, about 3 minutes and that's generous. As Jen and I were chatting this AM, it's not even clear to us that the reconstructionist had planned to take 2 flaps (basically one from each side of her stomach, significantly complicating and lengthening (doubling) the overall surgery time) before that exact moment. Now you (or I) could make the agreement that they could have met months ago, with Jen and discussed it, and it would have taken the same amount of time, with all the logistical hurdles of making that happen with two very busy and in demand physicians, thus why they do it 30 minutes before game time. I guess I was hoping that this was more than a 3 minute discussion and a little more back-and-forth. Isn't there a better way? My take was it was apparent that regardless of the facility we were going to use (Cleveland, Strong, General) they all were going to use a similar approach. Disconcerting but apparently the best blend of efficiency and effectiveness in today’s day and age. Never had an opportunity to see the Nip/Tuck operation and artistry first hand, all I can say is the magnitude of tissue they took out of her stomach was significant – think of a smile starting at each hip with about 6 inches at the center. This was my first time meeting the reconstructionist in person and he was solid – the kind of individual you would trust your loved one with, someone who it was apparent had the confidence and conviction with what he was about to do to not talk about risks and was focused on the outcome/results. Similar with her surgeon. Would recommend both without hesitation. The system/process - not so much.

 And I was off to the waiting room at about 1:15 - a one-hour change from her scheduled time of 12:15. She finally went into surgery around 2:30. My first call was from the surgeon around 4:30 to let me know the good news that the initial sentinel node pathology turned out negative but she looked good and had several hours to go. No news until 8:30 when I was paged (she was the only patient still in surgery at this point, they had started vacuuming the waiting room and locked up the front door) to let me know they were just starting to close up and it would still be awhile. Doc came out at 9:30 to let me know he had just finished and things looked great. I don’t remember much from the conversation other then him reminding me there are not many folks in the world that would even attempt this and while this type of surgery normally takes 12 hours, he does this so often, he can get it done in 6. Hey, at least he’s modest. ;) He noted there was some significant complexity beyond the normal for Jen (as he had to tie together 2 arteries and 2 veins complicated by some former surgery in her abdomen from a prior C-section and combine them to replace a single breast). I was finally able to see Jen around 10:45 but she wasn’t really conscious through the evening (or was that me) until this AM. He’s either really bad at managing expectations (which I can’t imagine) or she’s going to look fantastic as he was very happy with the result. She’s now in recovery, sleeping on-and-off, and will be here until Sunday at least – assuming everything goes well. They are checking her transplant with a Doppler device every hour to ensure blood is still flowing and will send her back into emergency surgery if there’s a clot or complication. She won’t be eating solid food until tomorrow and has to sit in a recliner to minimize the chance for fluid to collect in her lungs. (i.e., pneumonia). She’s up for visitors but Saturday is probably better given she’s drifting in and out of sleep today.

Apologies for the length (and delay) of the post – until our next update.