It was an hour past the scheduled start time for my final reconstructive surgery, and my mom and I were still in Cedar-Sinai’s pre-op waiting area. She was more anxious than I was. All I wanted to do was sleep: “Can’t they call me back so I can lie down and take a nap?”

Starting around noon that day, when I checked in on the first floor of the hospital’s south tower, a level of fatigue I had never before experienced fell upon me. Not even after my third round of chemo, when my hematocrit was so low I ended up needing a blood transfusion. Even the fatigue I sometimes get from multiple sclerosis, which I had previously thought of and described as “debilitating,” was nothing compared with this presurgery fatigue.

For the first time in my life, blinking took effort.

The fatigue was as smothering as its arrival was fast.

At 8 that morning I was fine. My mom and I walked 1 mile from our AirBnB rental to the nearest public tennis courts. We played tennis for an hour and then walked home. I remember I even had a little skip in my step.

The fatigue hit just after noon, when I finished signing the hospital’s consent forms.

My body and my mind, on edge for the past 18 months, needed time off. They needed to relax.

“We got you through chemo with enough energy to ski and hike and work, and we also did great with recovery from the double mastectomy,” they told me. “And radiation? Yup, we got through that, too, even with you pushing us on long-ass hikes your doctor rolled her eyes at when you told her about them after the fact.

“Now you’ve signed the papers for your last surgery, we get to take a break.”

Since I didn’t have the energy or the will to fight it, I gave in. I contentedly sat in the waiting area doing nothing and thinking about nothing other than sleeping.

That is not how I expected to be feeling just before going into surgery.

True, the week before, as soon as I recovered from the shock that I needed to have my final reconstructive surgery now rather than in October as planned, I began thinking of the trip to Los Angeles as a vacation.

I’d fly from Jackson to LA on Wednesday evening. My pre-op appointment was Thursday afternoon. A crazy-talented endurance athlete friend was around for a hike that morning. Since surgery wasn’t until Friday afternoon, my mom and I could play tennis that morning. That was important because I couldn’t play for eight weeks after surgery.

Unlike the removal of all of my breast tissue last June, which required three nights in the hospital post-surgery, the placement of implants is an outpatient procedure. I’d be home by 8 or 9 Friday night. On Saturday night my mom and I had tickets for a concert, the Angel City Chorale. One of my best girlfriends from college had a solo in it. Sunday, I wanted to go to the Getty Museum with my mom.

But, as I planned this “vacation,” I knew reality would eventually slap me in the face.

Until it did, however, I happily played along with the fantasy. When busy pretending this was vacation I wasn’t crying, anxious, depressed or sad.

The slap in the face never came, though.

Of the many steps laid out for me by my oncologist and surgeons at the time of my diagnosis 18.5 months ago, the attitude about this final reconstructive surgery was always “no big deal.”

“A double mastectomy is a 9 out of 10,” my surgeon told me. “When you trade out expanders for the final implants it’s a 2 out of 10.”

I agreed with the “no big deal” thinking. To me the surgery meant nothing more than the fact that I had to take it easy physically for eight weeks afterward.

It’s now been one month since the surgery, and I know, unequivocally, it was a big deal. My body, having given itself over to that contented fatigue as soon as I had turned myself over to the hospital, knew it before I did.

I’ve graduated from cancer.

Of course, every day I still fear that cancer will come back. Alongside this fear, though, are now relief, a feeling of accomplishment and confidence.

I never want to do any kind of cancer treatment again, but if I have to I know I’ve already survived it once.

Dina Mishev has written her way through breast cancer with the C-Word column. Find the full archive online at Write her at

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