Shenanigans, Part 3- And the action picks up...

So the evening passed, as did many other horrors. Throughout the night, the workings of the hospital continued: blood pressure checks and IV bag changes and discovering the limits of my mother's hearing aids. It will always astonish me that she is unable to hear regular conversation without the volume turned to maximum- and sometimes not then- yet a few keystrokes of messaging- SILENT keystrokes of messaging- on my iPhone at two in the morning will send her sitting bolt-upright on the sofa, with a startled 'What do you need?'

Dawn broke and the chain of events began to speed up towards the surgery, scheduled for just after lunch. I had been told that there would be a few more procedures coming, including a scan, an ultrasound and a mammogram to further confirm the location and current status of the tumour. This process started at about ten to eight, with the arrival of a spotty, universal-teen porter. You know the sort: gangly and languid and texting carelessly on his phone as he guided me to the service elevator. He was wearing a face mask, as so many people here do. I have become increasingly grateful for this over the last few months- hospitals are full of sick people, and there is no habit of covering up one's mouth when one coughs. I suspect that the masks are meant to prevent the wearer being infected, rather than consideration of others, but I do not mind.

The whipper-snapper gossiped aimlessly with a chum as we went down to the Radiation Department. It was early, and there were few people around in the corridors. The first familiar face was that of the friendly (and slightly dishy) technician who had given me the first radioactive jabs about a thousand years ago, near the beginning of this process. He was still as cheerful and slightly bewildered as before, and greeted me amiably. The other nurse, also one I had encountered before, came along shortly thereafter and dashed back and forth between me and another couple of customers before coming back and guiding me to the room where the scan would take place. I had been in this room twice before, and both occasions had resulted in strange blisters on my lips and foggy, indecipherable photos of assorted body parts- the sort through which my surgeon apparently identifies me.

The nurse talked me through what would happen next. Her English was limited, but perfectly adequate- she would be injecting a substance directly into my breast, as close to the spot of the tumour's origin as could be managed. This would hurt. Quite a lot. She then would spend five minutes rubbing this substance into the area, making sure that it would be nicely slooshed and spread about in there. (She did not say 'slooshed'. That would have been far more than just adequate- it would have been rather brilliant.) I do appreciate the candour of the people I have encountered in the hospital. It is easier and more affirming to be told the truth straight away- one can not only prepare oneself, but one also is not made to feel like a big baby when the procedure doesn't actually just sting or pinch or burn a bit- but when it bloody HURTS. 

She was right. It hurt. When the first biopsy was taken way back in May, the technician paid me the courtesy of anesthetising the area. That was the only time anyone has given me anything to reduce the discomfort of the procedures. Not even a congratulatory lollipop. The insertion of the needle into a space already bashed about by the growth of the cancer was pretty flipping wretched, in truth. The rubbing afterwards was less sharp and invasive; however it smeared the pain around, sharing and squashing it through the rest of the breast. I still wince at the thought.

Eventually, the rubbing stopped, and she stepped away for the machine to do its noisy and mysterious business. Within about twenty minutes, I was being helped down from the table, my IV trolley being rearranged around me, and my feet being slid back into my slippers. Thanking the technicians and bowing, I headed for the door.

On the other side stood Hyungji, ashen-faced, and one of the young doctors who had visited me the night before. I could not recall which procedure he'd spoken to me about- there really were so many. Something was clearly amiss. Before I could get out my usual 'Hyungji! How are you?', she was speaking:

H: Patricia, there is a problem with the surgery.
P: Uuuhhh, go ooon....
H: The hysterectomy is cancelled because there is no blood- you have a rare blood type.
P: Yes, I know I do- they told me last night that there was a problem with the blood. But they kept getting me ready for surgery, so I thought it was sorted out.
H: No, they do not have the blood.
P: Then why have they continued to get me ready for the operation?
H: Because they don't need blood for the breast surgery, they need it for the hysterectomy. The preparation is because the breast surgery was not cancelled.
P: And no one told the people operating on my breast that the hysterectomy could not go ahead?
H: I am so sorry. This is terrible.
P: So, what exactly are they telling you?
H: They want you to check out and come back and do it all Wednesday, when they can get blood.

Now, reader, I have been able to maintain pretty good humour through my dealings with the hospital and its staff, despite language barriers and culture-butting and the bizarre nature of non-socialised health care. I have managed, despite fear and uncertainty, a determination to ensure that dealing with me is as easy and good-natured a process as possible. I know that it can't be easy, taking a non-Korean speaker through this whole business. They have a tough job, and do not need me to make it tougher through bad humour or rudeness. However, I had just emerged - LITERALLY AND ACTUALLY just emerged- from a procedure so painful I made it through whistling the whole first verse of 'If I Only Had A Brain' while trying not to cry, hot on the heels of a night spent dashing back and forth to the bathroom for purposes that cannot ever be shared in polite company, in a room with a mother who leaped out of her skin with every shift or shimmer, frightened that I had fallen out of bed or garrotted myself on the IV tubes. My patience had worn thin. Dangerously.

P: Haaaaang on. They want me to check out of the hospital and return in two days?
H: Yes. And they will do both operations on Wednesday instead.
P: Because THEY did not get the blood that they needed in time for my operation?
H: (Blushing) I am so sorry...
P: No, no. You do not have to be sorry. I just want to be clear. They KNEW last night that they did not have blood, and they STILL prepared me for surgery through the night and this morning, and they want me now to go home?
H: It should not have happened.
P: Well, quite clearly! So, if I am to be sent home, will the insurance company need to authorise the procedures again? They will not want to pay for anything twice- who will pay for the night in the hospital room if I am to check out now?
H: Well, the room will have to be paid for...
P: Yes, it will. But clearly NOT by me. How much would that cost?
H: (quiet voice) About two million won.
P: Two thousand dollars. No. This is not my doing. I will not be paying that bill. And what about the test I have just had? Presumably they will not need to do that again Wednesday...
H: (Speaking quickly to the doctor, and looking stricken) They would need to do that test again.
P: Hyungji, that procedure was terrible! I am expected to go through that twice because the hospital made a mistake? What about the rest of the preparations? What about the things I had to drink last night to get ready? I would have to do that again??
H: Yes.
P: And who picks up the bill for that?
H: (silence, lips pursed, head bowed)
P: Hyungji, you asked me months ago, at the very beginning of this whole process when I was first diagnosed, WHY Westerners go home when they fall ill here. THIS is why. THIS is what they are afraid of.

She was deeply apologetic, of course. I was left with a choice. I could go ahead with the lumpectomy as planned and delay the hysterectomy until Wednesday ('And are you SURE they will have blood??' 'Yes, they will have blood.'), or I could go home and come back two days later. (And have the hospital try and give me a bill that I could not afford and would not pay, meaning that they would be unlikely to treat me at all if I returned.)

Rock, I'd like to introduce to you Hard Place. Hard Place, this is Rock.

There was really only one choice, as my mother and I discussed a few moments later: to have the breast surgery, and then do the hysterectomy two days later. At least something would be accomplished, and the charge for the room would not be wasted.

What was the learning? Well, first of all, that my doctors would really only talk to each other to confirm arrangements, not to consult on my case. Each one of them- highly trained and skilled and specialised- was treating my illness and their treatment of it as three separate events: the breast surgery, the hysterectomy and the cancer treatment. I had some evidence of this beforehand, of course, when there was some debate about whether I would be having a total or partial hysterectomy, for example. However, the fact that I would be getting prepped for one surgery when it was impossible for the other to proceed- well, I was speechless. No, not exactly speechless. I had plenty to say. But this we learn: that is the way things are done. For any one of them to question decisions made by any other of them - or even to double check some of the details- would be insulting. I do not think they were risking my health particularly; I do not deny their skill or expertise in any way. They are all exceptional. But Lord, Lord. One conversation and a modicum of different thinking would have made a big impact, and would have saved me from having to drink two gallons of vitriol again on Tuesday night.

I called Hyungji and told her that I would go ahead with the lumpectomy. She informed me that she would let the insurance company know that there would be a change in date for the hysterectomy.

H: Oh, and by the way...
P: Yes?
H: I spoke to the people at the blood bank and they said that they did have blood for you yesterday, but that there was a car accident emergency last night and they needed to use the Rhesus Negative blood for that patient.
P: Thank you, Hyungji.

Do I believe this? Does it matter?

Preparations for the lumpectomy continued now that the decision was made. The remaining tests, I was told, would include the insertion of some wires, an ultrasound, and a final mammogram. The wires sounded like something new and fun.

The same spotty teenager came and fetched me down to the women's cancer ward. It was a bit like old home week, seeing the receptionists and technicians there. I feel like we all go way back, now, and the loss of hair and addition of iv and trolley only heightened the regret of our interactions drawing to a close.

Well, not really. They've been absolutely lovely, but I really don't think that any of us expect to regret me never returning there.

The technician led me into the ultrasound room. Here, I had been subjected to the first invasive tests five months before, carrying on with the girls about the 'Snap!' of the biopsy gun. We had also talked about Italian vacations and practised our vocabulary together. This day, it was all business. They were going to help the surgeon locate the tumour remnants precisely by inserting a wire into the centre of the mass area.

P: (bleakly) Eerrrrrrrrr.... a wire, you say?
Techie: Yes. We will put needle in first and then insert wire through needle. It will hurt.
P: Terrific.

The levels of pain I've experienced over the last few months have grossly exceeded anything I had previously known. Many women cite childbirth as their most painful experience, but I do not. Annie was born by a wonderfully medicated Caesarean section, having been stuck so nicely in the breech pike position that had she decided to turn they'd have felt it in Aberdeen. I elected for the operation- wisely, I still think, as it turned out to be the most pleasant part of the whole 40 weeks- and was awake throughout. They gave me an epidural and I was doped up nicely enough that I was able to communicate cheerily with the anesthetist:

A: Make sure you tell me if you feel any pain at all, and I'll give you more anesthetic.
P: It's weird- it doesn't really feel like pain...
A: What does it feel like?
P: Well, you know when you pull the meat off a chicken bone?
A: More anesthetic!!

I was far less pleasant to Annie's dad:

P: Why are you stroking my forehead?
R: I'm trying to be comforting.
P: Do I look like I need comforting?
R: Perhaps not.
P: YOU might need comforting. Shall I stroke YOUR forehead?
R: No, that's fine.

Ok, I may have made some of that last bit up. Some. I was a little tense, though, that much is sure.

There were no epidurals offered here, though I did suggest it to the junior doctor on Tuesday night, when she was talking through the hysterectomy with me. (When I say junior, I mean that she MAY have been eight and a half.) She was pretty clear- they wanted me completely knocked out for the operation. In the meantime, I was sailing without the rigging throughout everything other than the surgery itself. (And I have not forgotten the root canal, not for one moment.)

I was brusquely arranged on the table by the ultrasound machine, and propped up on the wedge so that my left side was raised. The area around my nipple was cleaned and disinfected and deodorised, and the doo-hickey (what IS that thing called?) passed over it. Then, while one technician held the doo-hickey (See? Impossible to take this description seriously while I am calling the equipment a 'doo-hickey'!) the other deftly slid a thick needle about two inches into my breast, an inch or so directly above the nipple and at something like 45 degrees deep into the tissue. Those of you currently expressing astonishment that a needle could reach such depth in that bijou little bosom, kiss my elbow. It bloody hurt!

The needle was wide enough to accommodate a gossamer-thin wire, which the technician slid into place, guided by the image on the ultra-sound screen. She was cautious not to move the needle much, for which I was thankful. The wire itself made barely any impact at all, and once the needle was removed, I was left with just the strange sensation of something light and flimsy being suspended from my skin. This was quickly taped up, and I was bustled outside by the shorter, less chatty of the two women. After a brief sojourn in the waiting room, I was swept up by her again and taken over to a room across the corridor where the mammogram machine stood waiting patiently.

The technician's face, already business-like, now became set and grim. She had always been the less chatty of the two technicians, and it was obvious that she was far less confident in her English than her colleague. However, she'd been preparing both her explanation of what was about to happen, and some words to help with any questions I might have. In this room, two more wires were to be inserted into the tumour area- during the mammogram. I felt slightly sick. She gave me a deeply sympathetic pout, stroked my arm quickly and comfortingly, and helped me out of my pyjama top.

The procedure was similar to that of the ultrasound room. This time, however, it started with the familiar awkwardness and discomfort of the mammogram. Three different positions, three fairly forceful jostlings into place between the plates of the breast, three switches thrown and clampings, three snapping images before the clamping plates were released- twice. The technician then left the room. I was still suspended on tip-toe with my left breast uncomfortably pinned between the plates. The room was cold, my skin was clammy, I had a wire sticking out of my breast, and I had been abandoned. I doubt that it really was for long. It did not matter. I rested my head on the cold metal of the machine, and shuddered. Just all rather over-whelming.

I'd like to say that was the worst of it. However, the door opened again, and the technician returned with a young man- another Middle Schooler in a labcoat. I cannot tell you if he said a word to me. The two of them approached and manouevred a small rolling table into place next to the machine. On the table were two needles and two more gossamer wires.

I tried not to cry out, honestly I did. Having had so much said or intimated about the forbearance of Korean women, I did not want to let down the side and make a fuss. It was badbad, though, and I admit to whimpering occasionally, sucking air through my teeth in a hiss like a rattlesnake, and- bizarrely- whistling like the Scarecrow when the cries drew too close. Who knew that The Wizard of Oz would provide my pain barrier tune? The technicians once more cleaned and disinfected my breast. The first needle was pressed firmly into the tissue on the opposite side of the first wire, again deep into the flesh and at an angle. Once it was in place, the young man moved behind the protective screen and began staring at the monitor behind it. He came back out and adjusted the needle, carefully forcing it deeper before sliding one of the wires into place. Then the plates were tightened again.

P: (whistling) I'd unravel any riddle, for any individ'le, in trouble or in pain...

The machine snapped, the clamps released. Patricia moaned.

The young woman stepped out from behind the screen and came over to re-adjust me. The clamps were spun round and I was manipulated back up onto my tiptoes while she kneaded and molded the reluctant (and increasingly vulnerable-looking, now that it had a great ugly needle sticking out of it) breast into the new position and once again tightened the plates. She stroked my arm again while the young man emerged once more and picked up the other needle. The sounds she made- Lord, the universality of crooning! I have made the same sounds to Annie; my mother and grandmother have made them to me. The tenderness of understanding helplessness, and the noise that it produces- I may not have been able to comprehend more than fifteen words this woman was able to use with me, but I understood the tone of her compassion.

The clamps tightened further and the needle was once again pressed unrelentingly into my breast, deep, deep. My whistling resumed as the lad pushed it into position, changed the angle slightly, pushed it again. The woman stroked my arm, crooning the whole time. They both disappeared behind the screen again and stared at the monitor grimly before again coming out and re-adjusting the needle deeper before checking one more time, sliding in the last wire, and snapping the image. The clamps did not release this time. They were kept in place until the sympathetic technician was beside me again, helping me move away from the plates without stumbling or knocking the needles.

No new needles were inserted this time- just a final change of position, a final tip-toed posture, a final cool hand moving my head to face away from the machine, a final gentle stroke of my arm. The last image was taken after much consultation behind the screen. Then both technicians returned, and the woman continued to soothe me (... my head all full of stuffin') while the needles were removed, leaving the wires in my breast at wild angles. Then the plates were finally released, and I was helped to peel myself down while the young man cleared away the blood that now was smeared across them.

I was tidied up a bit and the wires taped behind a gauze pad out of the way before I was shown to the door with a final sympathetic bow and smile. I somehow found myself in the corridor outside the women's cancer centre once more, and while I am not entirely sure how it was that I managed to get back upstairs to the twelfth floor and to my room, I know that is where I ended up. I know this because when the bed that was to convey me into the operating room arrived twenty minutes later, I was up there waiting for it.


Coming up: In, out, shake it all about