The evening before Krista Colvin undergoes surgery to remove her breasts, her children say goodbye.
Both Annie, 8, and Wes, 10, are heading to friends’ houses for the night because Krista has to report to the hospital first thing in the morning. Annie smiles big, trying to stay strong and upbeat, but her eyes shine with tears as she lays her hand on her mother’s breast. Wes closes his eyes and snuggles into his mother’s bosom. This is the children’s way of bidding farewell to a part of her body that had nurtured and comforted them throughout their lives.
Krista, 43, was diagnosed in March with breast cancer that had spread to her lymph nodes. The surgery comes just as she begins to feel more like herself after two rounds of arduous chemotherapy. Surgeons will remove the lymph nodes and the breast that has two tumors. Because Krista carries a gene mutation that increases the chance of cancer recurring, surgeons will remove her healthy breast as well. Her body will never be the same.
“This is something that has to be done,” Krista tells herself. Sometimes tears break through her resolve, but she knows undergoing a double mastectomy is a matter of survival. So does her husband. He figures they are both getting to an age when their bodies are changing, and it’s best not to dwell on how his wife will be different.
“When I look at Krista, I look at her whole person,” Mike says. “But I wish she didn’t have cancer. I wish she didn’t have to deal with this.”
A week before her surgery, Krista drives from her Camas home to meet with Dr. Allen Gabriel, a plastic surgeon, in his Vancouver office.
As much as Krista jokes about getting “higher, tighter girls” out of cancer, she’s not sure at first about seeking reconstructive surgery.
“Do I really want to put my body through surgeries to have breasts that don’t have a function?” she wonders. But a friend helps her put it in perspective: “If it were any other body part, you wouldn’t think twice.” Insurance companies are required to cover reconstructive surgery as part of breast cancer treatment.
Gabriel proposes implanting chest expanders during the mastectomy surgery. After healing, the expanders would be injected with a little saline each week to create a pocket underneath the muscle of her chest where silicone implants would go later. Krista weighs the pros and cons. Expanders prevent scar tissue from binding to the chest wall, making later breast reconstruction easier. But the expanders could create complications during Krista’s upcoming radiation treatments.
Earlier, Krista had talked about it with her oncologist, Dr. Kathryn Kolibaba of Northwest Cancer Specialists.
“My job is to make sure the cancer care isn’t compromised by cosmetic treatment,” Kolibaba explained. “Radiation can reduce blood supply, so healing can be impaired. The body’s ability to fight off garden-variety bacteria — that’s made worse by pressure.”
The doctors agree on a plan. Krista will go ahead with the expanders, but the side that will be treated with radiation will remain deflated during the six weeks of daily treatments.
“The biggest thing is to make sure all that skin heals well,” Gabriel tells Krista.
To reduce pain, Krista consents to an off-label use of Botox. Gabriel conducted a trial that found injecting the botulinum toxin, approved by the FDA for reducing wrinkles, minimizes painful muscle spasms experienced by patients with expanders.
Those details worked out, Gabriel moves on to the question of aesthetics. The two look at a computer screen displaying a photograph of Krista’s breasts. He explains that because of the extent of her cancer, Krista is not eligible for a mastectomy that would spare her nipples. They will be removed, but reconstructed later with folds of skin and tattoos to mimic aureolas. Then there’s the issue of shape and size.
“What are your goals when we’re done?” he asks.
“I want them smaller, but I want to be balanced,” she says.
“Here’s the plan: Fuller up top. Smaller and fuller,” he says. Those final results will come months from now, after a surgery sometime next year. Meantime, she will have bumps.
“Remember,” he says, “the expanders are going to look funny.”
Krista knows having awkward bumps instead of breasts until she can complete reconstruction, perhaps next summer, will rattle her self-image. But cancer treatment has already changed her appearance. Her head, after all, is bald. At first she wore hats, but she decides to bare her head as a badge of honor for October’s National Breast Cancer Awareness Month. She even goes bald on KATU’s AM Northwest, where she does a monthly lifestyle segment.
“This is my pink ribbon,” she says.
As surgery day approaches, she focuses on logistics. She arranges to have her best friend travel from California to stay with her for a week after the operation. She organizes carpools for her children. She launders load after load of clothing. She packs her bag for the hospital.
She and Mike decide that the kids should stick to their routines as much as possible. They will stay with friends the night before surgery, but after that, Mike will be home with them while Krista recovers in the hospital. The kids will go to school. They will play in their soccer games.
Mike drives Krista to Southwest Washington Medical Center the morning of surgery. It’s hard for him to even drive by that hospital. His father was in a coma there for a week after a terrible car accident in 1979. Ten years ago, his mother was there after a brain aneurysm that killed her.
“My biggest fear is being in a waiting room by myself. I don’t want to go to the hospital and not come out with someone I love,” he says. But Krista’s surgery is taking place in the Firstenburg Tower, a recent addition to the hospital. It feels like a new place to him, and he’s able stay strong for his wife.
He stands by her bedside as nurses prepare her for surgery. He kisses her forehead, her lips.
“I’m so proud of you,” he tells her. “I’m so glad I married you and I’d do it all over again.”
Then it’s time. They kiss again. Nurses wheel Krista out of the room and down the hall.
The double doors to the operating room open with a mechanical whoosh, and Krista passes through.