Captain Chemo

July 18, 2014

High blood pressure. Insomnia. Stomach cramps. These are not side effects of chemotherapy. These are side effects of anticipating chemotherapy. As the date of my first treatment got closer the symptoms got worse. It was only after I stepped back and thought about it that the reason became clear. I was terrified of chemotherapy. I was terrified because I had no idea what to expect. Everything I’d ever heard or read was either vague (“I had chemotherapy”) or technical (“the protocol consists of three primary…”) with no real practical descriptions. Would it hurt? How long would it take? What was involved? Would I have to do any heavy lifting or math? For some reason these were questions that I never thought to ask, at least partly because the name “chemotherapy” is so intimidating. Even shortening it to “chemo” doesn’t help, because only people with cancer get chemo, so there’s guilt by association. This is misleading. Technically taking an aspirin to get rid of a headache is chemotherapy. Why give the treatment an intimidating name? Cancer is bad enough without making the remedy sound as intimidating as the disease.

The marketing is something we can address later. For now I feel it falls to me to reveal the dirty secret of chemotherapy: it’s boring. I’’m not talking about the side effects, which can range from annoying to horrendous. I’’m talking about the actual process itself. You sit in a chair and let toxins drip into your veins for several hours. Aside from the needle sticks and remembering to unplug your IV unit so you can go to the bathroom because the power cord won’t reach that far, and remembering to plug it back in when you get back to your room even though it supposedly has a battery life of several hours, but who wants to take chances, it’’s sitting around with your feet up. Fortunately for me my first round of chemo did offer plenty to break up the monotony. Gilda Radner, who passed away from ovarian cancer, famously said, “It’’s always something.” She could just as easily have been talking about my first five days in the chemo ward.

Day 1 – Blood draw. They have to determine how to mix my chemo cocktail. I tell them shaken, not stirred, on the rocks, and with a twist. Instead a nurse sticks a needle in my arm with an open tube at the end for easy access later on. This is taped down and I’’m sent upstairs to the infusion center. In the center I’m given a small room where I can put my feet up. A nurse brings me apple juice and a granola bar. They flush my IV with cold saline, which feels strangely pleasant, almost like peppermint being injected directly into my skin. At this point I’m in full panic because I imagine things can only get worse. In fact what happens is the nurses come back with big bags of fluid which they hang from my IV stand. And that’’s it. Several hours later, bags emptied, I’m free to go. The worst thing that will happen to me today is they leave the needle in my arm for easy access tomorrow. And even that’’s not so bad until I go to take a shower and my wife has to wrap my arm in plastic.

Day 2 – The nurses tell me they’re adding an anti-nausea drug to my cocktail. I ask them to put salt around the rim. Maybe this was a mistake. After a few minutes I feel an intense burning in my arm. The nurse explains that this is happening because they’’re using the same IV from yesterday. She has to remove it and re-stick me further up. This isn’’t a problem, except that I now have trouble bending my arm, which makes it difficult to do things like unzip my pants. And since my cocktail is all liquid and includes a liter of saline, not to mention the apple juice, that’’s kind of important.

This is also the day I have surgery to get a chest port: a plastic tube that will allow direct and easy access to my jugular vein, and prevent the nurses from having to stick my arm every day so I won’’t end up looking like a heroin addict. The doctors tell me they’’re just going to use a local anesthetic, which makes me worry I’ll be vaguely conscious of people in masks stabbing my chest with scalpels. Instead the local anesthetic knocks me out completely, and I amuse the surgical staff by reciting “Comfortably Numb” lyrics when I regain consciousness. My terror leading up to the procedure becomes increasingly anti-climactic as I wait two hours in recovery listening to a man in the bed next to me demand beer and belch fifty-two times in a row.

Day 3 – Everything goes smoothly. The nurse uses my new chest port, first flushing it with saline, so I get peppermint in my chest instead of my arm. For the first time I get a sense of how future chemo treatments will go. The only thing that breaks up the monotony is a volunteer with a guitar and harmonica who comes in to sing me songs from “The Sound of Music”, “Oklahoma!” and “The Wizard of Oz”. He and I worked at the same summer camp twenty years ago. Small world.

In the evening my wife notices my legs are swollen. Maybe this is cause for alarm, but I’’m not sure what to be scared of anymore. She calls the doctor, who assures her this isn’’t unusual.

Day 4 – My right leg is horrendously swollen and my jeans don’’t fit. I wriggle into an older, larger pair, and head off to treatment. The nurses give me diuretic pills, and I entertain them by talking about elephantiasis caused by filarial worms. Then the pills kick in and I run to the bathroom every five minutes, pausing only to be yanked back because I’’ve forgotten to unplug my IV unit.

The swelling isn’’t unexpected, but the doctor schedules an ultrasound for the afternoon just to be sure it’’s just all the fluid they’’ve been giving me going straight to my hips, thighs, and calves. I’’ve now become so accustomed to getting ultrasounds I fall asleep on the table. The ultrasound technician confirms that, yes, I’’m merely filling up with fluid. No one thinks much of my suggestion that an application of leeches might help.

Day 5 – Nothing happens. I’’m not even serenaded. The blind panic that preceded chemotherapy is rapidly receding, and I start wondering what the big deal is. I’’m done for the week, and I start thinking that it would be really nice to go home and have some chemotherapy in the form of a beer.