Saturday, June 04, 2011

First Day of Chemo

the t-shirt I chose to wear for my afternoon walk, a gift from a friend
Oh the nerves I had this morning. I tried to eat but the only thing I could convince myself to ingest before leaving the house at 8:30 am was a homemade iced soy chai latte. Oatmeal, cereal, even toast just seemed too much.

Chemo was not my fear, of course, it was the biopsy results I was dreading/anticipating.

My friend JooYun signed up as volunteer for day one and as our two other close friends commented - she is exactly the friend they would want with them in this situation. Calm, reassuring and completely in control of her emotions - good news or bad, she is a good friend to have at your side. I realized as I approached the hospital entrance that she was walking straight toward me. A good omen.

Once I signed in at the now familiar reception desk in the oncology ward and said good morning to one of the now familiar faces, I didn't sit very long before I was called back to get my vital signs checked. One of the nurses there attended to others as I dutifully waited my turn at the scale, weighed myself and took an empty seat. The man next to me snapped a photo of all his final blood pressure, heart rate and temperature as it beeped on the machine he was still attached to. I commented that was a good idea and he grunted. Something in me has been prompting me to keep track of these numbers myself and next time, I won't leave my phone in my purse with my friend. I'll bring it with me and snap a photo for later recording. As the nurse turned her attention to me she asked my weight as she strapped the blood pressure cuff on my arm and stuck a thermometer under my tongue and told me not to lie. After consulting my chart she turned back to scold me about the marked fluctuation. I reminded her this is normal for me and that a lot of it was influenced by my fertility treatments and now that I'm back on my period my temporary reprise from bloat is gone. She eyed me suspiciously and made her notes before turning to the sick people in the room - the elderly woman helped into a chair by her two visibly worried daughters, the extremely thin woman in a coat next to me with one of those scarves with suspiciously fake-looking bangs poking out the front like the ones in the hideous "Chemo-Savvy" pamphlet I was given a few weeks ago.

My turmoil was in the emotional category shoved down out of view as I cheerily thanked the nurse and took my chart to pay my $20 copay to billing with another smile. I then collected Joo and went to Exam Room 2 to wait for the news. We waited and waited and waited.

And waited.

We took turns in the bathroom without a sink attached to the room and I showed Joo where the secret garbage can is next to the sink by the exam table and then we waited some more.

Close to 10 I was told my doctor had an emergency and was on her way. Then I was told again she is close and they were going to have me wait in the infusion room . . . I tried not to read into the fact I was being escorted toward chemotherapy.

I met Marie Anne a nurse I presume I will become more acquainted with as the summer progresses. She was sweet and efficient and honest. I also met Jeanne (sp?) as she sang her way to my side brightening everyone around her with her snappy wit, quick smile and flaming red hair. I hope I see more of her.

Marie Anne hemmed and hawed over whether to get me set up with saline before the doctor arrived and while she was asking me more intake questions my oncologist rushed in apologizing for her delay - her father is in the hospital. Of course I understand. More than this, I understand the fear of having a father in peril.

Right off she told me the biopsy was negative but before I finished my initial cheer she said she is caution about this. When the radiologist performed the biopsy he accurately extracted cells from the "bone lesion" as it is termed in my chart and when he looked at the smear before sending it off to pathology he noted abnormal cells and discussed this with my doctor. She did not expect a negative result so she suggested rather than try another biopsy (thank you very much), she would talk with the pathologist personally to better understand the report and in the mean time, we will proceed with chemotherapy and just add radiation at the end as a precaution. For now - I am back to Stage II breast cancer, as one friend put it in a text this morning "Isn't it funny when the best news ever is that you have stage II breast cancer? Hallelujah!"

Hallelujah is right. Earlier this week I was introduced to the term "storming heaven" and let me tell you the advantage to amassing an eclectic, diverse group of friends - my posse has been storming heaven in multiple ways with prayers to Mormon, Catholic, Sikh, Hindu, Buddhist, Christian, Jewish and non-denominational deities as well as pleading with the great unknown forces of the universe. Believer or non, my family and friends have focused their influence on me and whether that force turned abnormal, cancerous looking cells benign, I will never know (and to be quite honest, if those cells were malignant I would never blame it on a lack of prayers) but once again, the force of the effort has raised me up.

That fear behind me, I was ready to move forward with chemotherapy. I was given a small handful of pills explained as anti-nausea and steroids I swallowed all at once. Marie Anne lecture me about drinking lots of water to help my veins and she didn't seem to believe me when I reassured her I am a dedicated water drinker. If you don't drink lots of water, let me tell you what will convince you - kidney stones. Oh, and headaches at the smallest hint of dehydration. I carry a water bottle with me almost always. I pee every hour, sometimes more. I like water. If you really want me to drink more of it, I will but that means I need to be practically tied to a bathroom because my kidneys work double-time.

The saline-solution was cold going into the IV and I realized next time I should put my hoodie on before the IV makes it impossible. I think it was close to 11 by the time all the forms had been signed and I was ready for my first real batch of cancer killing chemicals.

The first drug in today's 2-drug cocktail is called Adriamycin and it is described aptly as "an anti-cancer chemotherapy drug." Just what I need, right? In contrast to the IV bag of saline I had been receiving for the first 30 minutes or so, the Adriamycin was given to me by Marie Anne via syringe placed into my vein and diluted with the saline solution still running into the same line. The most startling thing about Adriamycin is that it is bright Kool-Aid red. It looks menacing. The nurse warned me that it will look exactly like that coming out through my urine so I shouldn't be startled (I was still startled).


Adriamycin - my first taste of chemo

I received two fat syringes of slowly injected cherry Kool-Aid and was left to absorb it all for a bit - and to take one of my frequent pee breaks (did I not warn her I drink a lot of water and now she was injecting all kinds of fluids!). Luckily I learned right away from Jeanne that my IV cart has a name - George - and that he is polite and while he does follow me to the restroom, he averts his eyes. Oh, but yes, my urine was red right away, if you must know (and sorry if you don't want to know, but you really should realize by now I'm kind of into the details).



The parade of horribles caused by Adriamycin include: pain at the site where the med is given, nausea or vomiting, low blood counts, mouth sores, hair loss, watery eyes, discoloration in urine (check!), darkening of nail beds and fertility problems. Happily I do not need to expect all of these side effects and 12 hours after the fact, I can't say anything has concretely manifested itself other than the red urine.

Next up - cyclophosphamide aka Cytoxan, classified as an "alkylating agent" this drug is also anti-cancer - yay! An interesting historical factoid about alkylating agent, did you know mustard gas derivatives fall into this same category? A devastating attack on American ships during World War II floating in a harbor just outside Bari in southern Italy (a city my brother lived in where my sister and I visited him 11 summers ago, coincidentally) on December 2, 1943 resulted in the explosion of seventy tons of mustard gas stockpiled on one of the ships. The German raid was far more terrifying and successful than anticipated and nearly a thousand men and women died of complications over the next months. However, the incident resulted in the discovery that the gas specifically targeted bone marrow cells, a key scientific advancement in the early wild frontiers of chemotherapy discovery.

Chemotherapy drugs work (hopefully!) because they kill cells that are rapidly dividing. The normal cells will grow back and healthy but in the meantime, side effects occur (blood cells, cells in the mouth, stomach and bowel and hair follicles are similarly fast growing cells that are impacted the most). The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division - the faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink - or induce cell suicide.

Marie Anne warned me that this particular drug could cause an immediate nasal congestion or head ache. I told her everything gives me a head ache so that is the most likely outcome. Sure enough, not long after the IV was started, a sinus-like, mild head ache moved across my forehead with stuffiness to follow. The Cytoxan was briefly halted so it would go away. It stayed with me but we eventually restarted anyway since it had mostly subsided.

Aside from the technical portion and the anxiety, I have to say it was a positive experience. I had a nice big corner recliner next to the window in the infusion room. The woman in the chair closest to me offered encouraging sentiments, especially after I indicated this was my first time. I tried to be very patient when Quincy the therapy dog spent a significant amount of time with her as his owner chatted away. I had to ask not to be ignored and was granted some lap time with the small Yorkie-Poo with his own calling card. My brief time with him only intensified my growing desire to have my own dog. A hole in my life I endure in New York but which has been augmented by my diagnosis.
meeting Quincy, the therapy dog



 Later, while Joo was searching for some lunch for us, a reflexologist offered me a hand massage. I agreed to it and listened to her story. Jeanne told me I will do great bald because I have a beautiful face but when I thanked her she quickly told me she would not be saying it again and not to let it go to my head. I managed to eat half a tuna sandwich and drank my blessedly hot chai latte.

And after many hours at the hospital, close to 2 pm, I walked into the startlingly hot and bright sunshine of mid-day. I hugged Joo a couple of times and thanked her profusely and walked home wondering when I would start feeling rotten.

I made some phone calls, returned emails and texts and tried to focus on something, anything. Failing, I listened to Yo Yo Ma play Bach's unaccompanied cello suites and let the music bring me the comfort of Sundays at home, reminding me, as it always does of my cellist father.

trying to relax - I look tired but couldn't sleep
 Soon, a distraction arrived at my front door. My friend Katharine came over to keep me company, talk, sit, or leave me alone - whatever I chose. I chose chatting and then a walk - with food! We walked along my running route on the Hudson River and had an early dinner at a cafe on the pier I've wanted to try for a couple of years. It was surreal and perfect all at once. I managed to eat half a veggie burger and most of my fries and all of my blueberry lemonade. We walked back to my place and she gifted me a number of fabulous books and left me to them as she made her way home to her family confirming her offer to take care of my insurance claims. An offer even stubborn me cannot refuse.


dinner at the pier - highlight!
Around 9:30 I felt a twinge of queasiness and real or imagined I decided to break out the pills because that was what my doctor and nurse recommended. I am tired now. Overly tired. But I could not go to bed without capturing the day while it was fresh, while I am still well. I cannot say good night without thanking each of you one last time for "storming heaven" for me in whatever way works for you. As one who struggles with formal personal prayer, I am humbled by the ready gift of it from others.
beautiful city sunset out my window

1 comment:

Artax said...

So glad the news was more positive.... Continued best wishes from me for your health!

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