Tuesday, February 10, 2009

And so it begins

Back at the office this afternoon following my second round of radiation therapy, two co-workers told me that I looked so much better than I did the last time they saw me, which was a few weeks ago.

I reached for some scrap paper to reply. "I must be glowing!" I scrawled. "Just had radiation therapy."

Monday was my maiden session of baking the DNA of the evil cancer cells in my head, and today was my sophomore round of Intensity-Modulated Radiation Therapy (IMRT). Early in the day yesterday, I had my first chemotherapy session, in the chemo ward about six blocks away on the Kaiser Kampus.

So much happened on Monday, I wasn't ready to report any of it in this blog. My admittedly oblique post yesterday traveled from my imagination to the pixels on your computer screen, and maybe I should have left it inside my head.

But now I'm ready to write in the first-person about my first days of chemo and radiation therapy.

Chemo came first, bright and early Monday morning. A week ago, my oncologist took me and a friend on a tour of the chemo ward but returning there on Monday felt like I was seeing everything for the first time.

I weighed in at 136 pounds, up a bit from last week. My sister-in-law, visiting California over the weekend, told me that I need some more meat on my bones. Vanilla Isosource 1.5 isn't an animal product, but some of it is starting to stick to my skeleton.

The first surprise was being led by a nurse to a private room for my session.

The setup I observed last week looked more like a chemo beauty parlor with each station separated by curtains. If the nursing staff fills up the private rooms with patients before moving on to the beauty-parlor chairs, that is a powerful incentive for arriving early for my remaining chemo treatments.

My nurse helped me settle into a chair that looked like it had just arrived from a Barcalounger showroom, and then said she would be back to start my IV. I leaned back, popped up the footrest and opened the newspaper.

Dr. Buchschacher, the doctor overseeing my chemo, caught me struggling to read the fine print of "Get Fuzzy."

All I really want from my medical providers is competence, patience and a little humor. It's a bonus when a doctor looks like he could blend in with the medical staff on any daytime soap opera, and so far two of the doctors guiding me through this cancer odyssey fit that bill.

Dr. B explained what would be happening to me that morning, and gave me reading material on Carboplatin: the chemo drug best suited for cancer in the ovaries, lung, and head and neck. He ran down the side effects I might experience from Carboplatin, which reminded me about a question that had been nagging me.

"If I can't swallow or get food through my mouth," I wrote in a pad, "what will happen if I throw up?"

I had visions of a barf Sig-Alert breaking out in my digestive system: vomit rising through my throat only to arrive at a dead end at my mouth and creating a foul gridlock that would have nowhere to escape but through my pores.

Doc told me that it is very unusual for patients taking carboplatin to throw up, and that was enough to allay my fears.

We set up the dates for sessions two and three –March 3 and March 26– along with a visit or two along the way to see how things were progressing. Then he wished me luck and we shook hands.

Another type of medical professional I admire: someone who doesn't lunge for a Purell dispenser after shaking hands with a patient without latex protection.

The nurse came back to start the IV.

As she rolled up my sleeve, I remembered seeing her last week. When Dr. B was taking me on the tour of the ward, he pointed out my veins to a group of nurses, and promised that they would like having me as a patient. I guess I have veins that flaunt their presence, a treat for any nurse fixin' to do some needle-pokin'.

"I'll put the IV in a place that will make it easy for you to read the newspaper," she said with a smile.

She started with an IV drip of saline in one port of the IV, followed by an anti-nausea medication. Minutes later, a pharmacist came to give me a tablet of Ondansetron, also to control nausea. As I washed the Ondansetron down my G-tube, I felt confident that my 32-year-long record for not vomiting would survive my cancer crisis.

And finally, the third port in my IV was attached to the bag of Carboplatin.

By 11 a.m., the bag of carboplatin was parched dry, and the IV machine began to beep. The nurse arrived to remove the IV and said I was free to go.

I felt fine. Closest I came to feeling nauseous all morning was when I read the latest developments of the unsanitary conditions at that peanut processing plant in Blakely, Ga. (Who knows? Moseying along and nesting in my mouth when it did, cancer may have spared this peanut-butter lover from death by salmonella.)

I had lined up a friend –oh, why be coy? this friend is a saint– to drive me home if I was feeling weak from Monday's barrage of treatments.

But I had more than four hours to kill before my radiation therapy appointment. After picking up an Ondansetron prescription in the downstairs pharmacy, I walked six blocks to the eastern edge of the Kaiser Kampus and decided to hunker down in the radiation waiting room.

I checked in shortly before noon, took a seat, and then –just about three and half hours ahead of my scheduled appointment– my name was called! I didn't even have time to open my backpack to fish for the book I intended to polish off during the wait.

My treatment room for the radiation sessions this week is called Orion, and next week I'm being shuffled off to Liberty. (The other treatment rooms on the floor are Enterprise, Novalis, Trilogy, Galctica, The Ark and Ortho. Someone in the Kaiser hierarchy reads way too much science fiction.)

I weighed in for the second time of the day –the nurse fussed with the weights on the archaic scale in this exam room and called my weight at 140. I shuddered: Did I gain four pounds in a single session of chemo?

The nurse then escorted me down a walkway with photographs of nature settings along the walls that led directly to the door into Orion.

There, I was reunited with the ThermaSplint mask of my head that I insist is a gross caricature of my features, and guided into position on the metal bed. As one radiologist propped up my knees with a cushion, the other clamped the mask over my head. It felt like a vise.

And then they exited the room to begin my exposure to ionizing rays, continuing the work that the carboplatin had begun a few hours earlier.

I quickly learned that radiation therapy shares similarities with the two MRIs and CT scan I have had over the past month or so, only with a layer of sadism provided by that ThermaSplint mask.

My nose and lips were shmushed against the hard plastic. Drool leaked from the corners of my mouth and dribbled down my neck. My trach, exposed below the mask, was the only thing that seemed to be sparing me from suffocation.

The session lasted for a fortnight of misery. Peering through the slits in the mask to discover a "calming" illuminated photo of autumn leaves on Orion's ceiling, and hearing soft pop music oozing through the room's sound system only made my time on the hard metal more wrenching.

I had begun to compose a letter advising Attorney General Eric Holder of the domestic torture I endured when the machine finally stopped emitting noises and flashing light. I heard footsteps approach.

One by one, the latches of the cage were popped open, and the mask was lifted from my head. It was slathered in drool.

As I buttoned up, the radiologist wiped the mask clean. "You know," he said, "if at any point during treatment you feel uncomfortable, just raise your hand and we'll take a break."

Oh, now you tell me, I thought.

I staggered out of Orion, and found my way to the elevator, doubting whether I could take 32 more radiation sessions.

Every Monday, Tuesday, Wednesday, Thursday and Friday through March 26?! I was tempted to call Dr. B and beg to have my treatment plan flopped: Gimme 33 sessions of chemo and just three of radiation.

But once I got out of the building and felt the fresh air on my skin, my tensions eased. And I still was not feeling ill effects from the chemo.

Having taken the whole day off from work, I hopped on a bus to head down Sunset to the Arclight to catch the new 3-D animated feature, "Coraline."

The movie was relaxing. But when it was over and I walked out of the theater, I got very worried.

My vision seemed blurry and perspective was distorted. And everything was dim. Was this a side effect of chemo? A consequence of being blasted with ionized rays?

An Arclight employee helpfully set me straight. He pointed out that I was still wearing the 3-D glasses I wore during the film, and offered to take them off my face.

And that was the last time I felt any discomfort.

I don't know if this is even medically possible, but after a single morning's dose of chemo and 15 minutes of radiation (yes, that's how short it really was), I noticed some changes:

My tongue's size diminished noticeably.

I slept like a baby last night, and when I woke up this morning, my Aladdin pillowcase was dry.

My tongue was larger in the morning, but it did not approach the zeppelin-like dimensions of the past few months.

I didn't need to reach for a tissue or use my office wastebasket for a spittoon all day.

It's way too early to call a victor in my bout with cancer, but I do feel like I am going in the right direction.

The biggest surprise of all? My return visit to Orion this afternoon wasn't torture at all.

The mask fit comfortably. The radiologist asked me to doff my shirt today to keep it from getting soaked in drool and sweat but that wasn't necessary; my clothes and the mask were both dry at the end of the session. And the duration of today's radiation therapy felt more like five minutes instead of 15.

I know you had to read a lot of words today to get to here, but my next sentence is the take-home point:

Don't mean to be a Pauly-anna, but I think that maybe –just maybe– I'm gonna be fine.


  1. How long have you had that Aladdin pillow case? Would you like a new one? How about I get you a Jonas Brothers one after your treatment is over?

  2. Hmm. Plop a fez on one of those Jonas Brothers, and you'd have a fetching doppelganger for Aladdin. But could he croon "I Can Show You the World" like everyone's favorite Street Rat? The pillowcase stays.

  3. I'll buy you the steak dinner when this is over and you can swallow it. Meanwhile, keep your hands off Dr. B. -- Marvin

  4. I would have like to been there when you walked out of the theater with the 3-D Glasses attached to your face.

    And it is amazing how fast your body is reacting to treatment. This is a great sign and you WILL BE FINE.

    The power of positive thinking!!!!