Navigating cancer in a covid-19 world part 2

by Laurie-Ann Copple

"I will give you a new heart" drawn by Laurie-Ann Zachar Copple, in CapeGate Oncology's chemo room.  The nurse was Marianna, one of the kind and capable nurses in the centre.  L-A was encouraged to keep drawing in the chemo room during treatment. 

Last month we were preparing for my life-saving cancer surgery: a full mastectomy in Worcester Mediclinic.  Tony brought me in on May 12th, and from then on we weren’t allowed to be together until my hospital release.  My only human contact would be medical staff and other patients.  It’s a good thing we have a dear friend who heads the ER department at the same hospital. I had a very full backpack full of nightgown, sandals, toiletries, iPad, phone, Bible and paper.  I brought my Scottish wool cape, thinking of my last hospital visit, where I was cold in the mornings.  However, they kept the temperature comfortable.

I was given a second mask from the hospital upon admission, even though I was sent a message that I needed to bring my own supply.  So I had my white mask, which I wore on arrival until the time of my surgery.  One of the surgical nurses tucked that mask under my pillow right before surgery, so that the anaesthesia mask could go on my face (it turns out I forgot where that was, and re-found it the morning I was released).  The anesthesia man had only one hand/arm to work with to sedate me – since Dr. Arnold S was working on my left side.  So he worked on my right.  And the place where they put that infernal blood pressure machine?  (I hate that machine, it makes my arm hurt.)  They attached me above my right foot.  That was when my surgeon discovered the nasty mole that he later removed in his office surgery.   This was to be a 2 hour surgery, but must have been a few complications, because it was closer to 3 hours.  This time increase doubled the estimate for anaesthesia, and increased the ‘rent’ I was to pay for the operating theatre.  I found this out when I paid for the anaesthesia from my hospital bed. It’s funny how medical estimates are never as much as the real thing, isn’t it?  However, due to the financial miracle that was still happening at that time, we had more than enough for an increased hospital stay, meds, surgery etc.  We had hoped for $7,000.  We received $17,000!  Yay Jesus!  This meant that all aftercare, prosthetic, mastectomy supplies and continuing Herceptin treatments would be covered pretty well for the winter.  This wouldn’t include radiation treatments, but we’ll face that later when necessary.  I may also need further treatments as advised by Dr S's colleague, who filled in for him a few times).

I woke after the surgery in the recovery room.  The first face I saw was a blurry nurse, and then my friend Therden, who works in ER.  I remember him telling the nurses that I cook Hungarian paprikash really well.  LOL.  He brought a big smile to my face.  As they wheeled me back to my room, I asked for the nurses to call Tony, which they did.  I managed to remember his phone number for them to call. He was relieved.  Later, I went to go find my white mask, and found that it had been replaced with a blue hospital mask.  Ok, I thought, maybe the white one was lost (or so I thought).  I had two visitors – my own surgeon, and my friend Therden, who prayed with me behind pulled curtains.  I told him that he was like my chaplain.  He asked if I wanted anything. I told him I wanted naartjies, which is Afrikaans for little oranges.  I’ve always loved mandarins, clementines and little oranges.  He brought some later that night, while wearing his PPE from the ER (before he started his shift?).   The other visitor was my own doctor.  When I asked him if we got a good margin for the cancer, he had a worried look on his face.  He said he hoped so, but the chances with this kind of cancer weren’t high.  Still, he sent the breast and lymph nodes to the lab, so we would soon see if there was a margin.  A margin is an amount of non-cancerous flesh around the edges of the tumour.   If you can get a margin, this means that the cancer is contained within the tumour area.  He did remove the whole breast up to the chest wall, as well as nine lymph nodes, so he wasn’t taking any chances.  I was assigned a physiotherapist, who turned out to be originally from Somerset West, so we chatted about coffee and Hillsong SSW that we like to attend once a month.  Then the exercises: which were manageable. I didn’t have to walk out into the hallway – I could do these arm exercises in front of my own hospital locker.

The need for masks was the largest impact of covid-19 on my hospital stay.  The other covid-19 moment I had (after discovering that I had tested negative), was the replacement of my original roommates with one who had not yet been confirmed as negative.  I saw the looks on the nurse’s faces when they looked at her chart and then mine. They closed the curtain to her section and told me that they were going to move me to another room, where my new roommate was confirmed negative. When the nurse told me that they had tested me and found me negative, I thought she meant the tests of the cancer margins had come through and that I was ‘cancer-free.’  I write cancer-free that way because medical folk always use the term NED – ‘no evidence of disease,’ which is what came up on my PET/CT scans. But no, this was about covid-19.  I can tell you that the first thing a cancer patient thinks of about tests is nothing about the ‘other’ pervasive disease. As if I didn’t have enough to concern myself with.  So I was moved right after dinner, without a goodbye to my roommate.

After one more day, I asked for an additional night in the hospital, but it turned out that the ‘extra’ afternoon was used to remove one of my drain tubes.  I was highly medicated (due to my own pain meds stash - they never give enough pain meds!), so I watched the process of slowly pulling out the front tube, cleaning me with a solution, and re-bandaging me with very, very long bandages. Fortunately, we were given a hospital pack of four such bandages that first Dr. S’s nurse, and then Tony, could use to bandage me up. Meanwhile, I had to be confident that I could get around, with help.  I was admonished a few times by nurses by trying to get things on my own.  A few were their own error; such as getting the call button when they stashed it away inside the back of the bed, and reaching something on a hospital tray, when it was moved way out of reach.  But others, such as putting on socks and shoes, I finally had to call for help.  I wasn’t yet ready to dress myself as I prepared to check out.  Two nurses took me down to check out and if I wasn’t careful, I would have lost my walker to the hospital.  I asked for it, sharing that I had borrowed it, so one of the nurses had to retrieve it while I waited in the lobby for Tony to pick me up.

When I returned home, I missed the hospital bed, but I was more than compensated by Tony’s presence.  He could now help me, and we could enjoy life together again.  The first thing I noticed in the house, right there on the kitchen counter, was a big bouquet of pink Robyn proteas: twelve of them! How lovely!  What a home-coming!  Tony also had lunch prepared and we were able to finally share a meal together after being apart for four days.  We worked on my progress and I slept, ate and drew – a lot.  I returned to Dr. S several times,  and it looked like they might take my second drains container out soon.  The only thing is, that the daily drainage was never went under the required 50 ml needed for it to be taken out of me.  And then, while on a Facebook Messenger video call with my friend Mirjana, the second drains tubes came out.  It didn’t happen completely on one accident, but this was gradual over several incidents.  After I returned home, I didn’t have the drains tube and bottle as a routine, other than Tony emptying and measuring it each day.  Several times I let it drag slightly behind me, before it was scooped up and put in my drains bag. Then one early morning, I again forgot and the bottle lodged under my bedroom dresser, while I was nearby in the bathroom.  That hurt my side for a while. The accident that finally dislodged the drain tube occurred during the video call. It happened when I tried to adjust myself in my chair.  Big mistake. The next time I visited the bathroom, the tube fell out and when I went to put the bottle in the drains bag, I was no longer attached.  Oops!  We decided to go to Mediclinic ER to see if they could re-attach it. I was put though forms of questions where I had to explain that I was in the same hospital, but they wanted to know about my history of covid-19 before finding out what was wrong with me.  I explained that I was already tested for covid-19, and that it was negative. They wanted to know where I was tested and the date, so it could be verified.  Finally I get to the admissions desk, and this took time.   Meanwhile, the ER doctor on duty came to see me, since Tony had already called the hospital.  She ushered me into another room, since she was concerned about my vulnerability to the virus. I was given a few little plastic things to cover the tube drainage hole. She had told me all they could really do was to bandage me and send me home.  They could not re-insert the tube, which would require putting me in the surgery.  (However, Dr. S was horrified later that they didn’t call him, since he was on call for Mediclinic duty.  He could have fixed it better).  But they were concerned about getting me away from infection and for me not to be charged R900 for a bandage operation, when Tony could do it almost as well.  Dr. S joked that they were so afraid of coronavirus that they weren’t thinking properly.  Perhaps, but it’s hard to make decisions in that environment.  After the weekend, I was to go back to Cape Gate Oncology for a prosthetic appointment, consult with my favourite oncologist and a Herceptin injection.  By that time, I was already swollen with fluid, as assessed by my prosthetics lady, who is also a manual lymph drainage specialist.   So I had my first manual drainage with Dr. S and his nurse a few days after the oncology visit. The answer was not MLD or having a new drainage tube.  It was with needles.  I’m not afraid of needles, but the doctor was worried when my face went totally grey and I felt faint. So I lay down for a while. 
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This was the start to a new chapter in after-care: that of navigating my surgery after-care in an increasing covid-19 world.  The one bit of good news, no GREAT news was this:  there WAS a margin of cancer in the breast. This was rare for inflammatory breast cancer!  And then the nine lymph nodes were completely NED (cancer-free). This was extremely rare, since the cancer did touch them back in September). My surgeon was stunned and three times told me that this was a miracle.  This wasn’t the only time I had beaten the odds.  I did extremely well during the chemotherapy process.  I did extremely well during the surgery.  Now we just needed to overcome this lymphatic fluid hiccup – within being surrounded by covid-19.  But if God had helped us with healing well, surely he will complete the journey.  We would navigate being a recovering cancer patient in a covid-19 world together. 
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