Chemo Lessons

So, I'm super happy to report that I am still feeling quite good since Wednesday of this week, which hopefully means I have another three nice days to enjoy before Round Two begins on Tuesday morning.

But to get to the point of this lengthy blog entry, I have always said--well, have said for the last three years anyhow--that you can learn a lot sitting in the waiting room of the chemo lab. Several times while sitting and waiting to see Dr. Hilliard in the past I would write down what people would say coming in or out of the ominous chemo door, in wheel chairs or with walkers, bald or be-wigged (yes, I just made that up).

People going through chemo seem to each live in their own realities, some with a great deal of hope despite how horrible their situation appears to a casual observer, and others seem desperate and sad--you just know either they have reached the end of their life or maybe just the end of their strength.

And last Wednesday Nate and I got to go beyond the chemo door and sit in the chairs--his, metal and rather uncomfortable, mine, a big green plastic recliner. Nurse Candy sat with us and explained a million things we didn't know--like that there are thousands of different chemo regimens, built from dozens if not hundreds of different chemo medications and doses and rounds, and all with their own side effects (i.e., not all chemo drugs cause complete hair loss). I'm not sure why I would have thought that all chemo is alike, but for some reason I think I did.

Anyway, my particular chemo drugs are common for my breast cancer and age. They are referred to in chemo circles as "AC," which is short for Adriamycin and Cytoxan. The Cytoxin and it's side effects aren't so bad--well, mostly because we're done having children. If we still wanted babies of our own, we'd be in trouble with Cytoxin because it might never happen. (Not to worry, as the Rices will tell anyone who asks: we've already been "spayed and neutered.")

Nurse Candy gave me the clear Cytoxin medication in a nice little IV fluid bag, along with an anti-nausea drip, and it could have been saline for all I knew at the time. Pretty painless (going in, anyway).

The Adriamycin however, is a whole other story. Nurse Candy suits up completely to administer this (or "push" it, as they say) by hand. It's a bright red fluid. I asked if they dye it that color for the same reason people color household cleaners that are toxic and she said yes. (??!?) It's an extremely toxic "vesicant" drug. (We learned this particular class of drugs blister and corrode tissue. An example of a different vesicant I looked up later is Mustard Gas--these are interesting things to be aware of, as a drug is being pushed in your vein.)

Nurse Candy pushes Adriamycin by hand, because she has to watch and be sure it is always going into the vein and bloodstream. If something goes wrong with the IV and the Adriamycin leaks outside the vein into the surrounding tissue under my skin, a doctor must come immediately and get the Adriamycin out of the tissue by flushing it with saline. During this process, I sucked on ice and popsicles to slow the flow of blood in my mouth and prevent mouth sores from developing--evidently a problem with Adriamycin.

Adriamycin is, needless to say, a powerful drug. I'm no scientist, so I don't know how it manages to find cancer cells and destroy them, but it does. If there are any cancer cells left hiding in my body it will seek them out and destroy them--along with other fast-growing cells, which is why Adriamycin will cause "complete hair loss," nausea, etc.

Nurse Candy did lecture us about the dangers of Adriamycin, but I think perhaps if she knew what a total hypochondriac I am, she might not have been so descriptive. As it turns out, I'm not so crazy to wonder how a drug so toxic can be a good thing in my veins--it eats platelets, red blood cells, white blood cells, etc., indiscriminately and can cause heart damage.

Nurse Candy: If you have chest pain at all or an irregular heart beat, you need to call 911. Don't mess around. Does the camp have a defibrillator?

Nate: Yes. (Trying to tell her with his eyes, that this is the last thing a woman like me needs to know.)

Me: (Eyes wide.) But I have a problem with anxiety and get chest pain all the time. And I have heart palpitations too. How will I know the difference between anxiety and heart palpitations ... and a heart attack?

(long awkward pause)

Nurse Candy: I don't know.

So Adriamycin has given me a whole new disease to obsess over: heart disease. Which also runs in my family. So this is good. (Mom and Dad, please don't actually worry. I'm young and in good health. [Is that weird to say when you were just diagnosed with cancer?] It's not likely I will have heart damage.)

And this is what my chemo time looks like. It takes about an hour and a half to two hours to complete. Then for three days afterward I have to go back in and get injections in my arm to boost my white blood cell count. (I can't recall the name of the drug. Probably because it's not a freakish vesicant.)

With Round One, as you may have noticed in the blog, I became really ill. Like, old-fashioned-before-good-anti-nausea-meds-were-invented chemo ill. But they tell me that with the right anti-nause drugs now, it's possible Round Two will go smoother--as in, maybe I won't lose 5 pounds like I did with Round One.

But mostly, regarding my time in the chemo room, I have to say that it gives me perspective. One day (day 2, when I had to sit for an IV to stop my vomiting and rehydrate me), I noticed I was probably the only patient in the room younger than 60. I don't know what kinds of cancer the others had, but I can tell you that chemo is probably harder on their health than it is on mine. Another day I overheard some conversations and realized that some of the patients still had tumors inside--maybe inoperable, for all I know.

All this to say, sometimes being in the chemo room is like walking through the valley of the shadow of death. Not that I am near death myself, but that I am walking in close proximity to those who are, and it gives me perspective that helped when the misery of chemo kicked in and is helping as I anticipate Round Two.

Nobody throw my bachelors degree at me, I know I'm not properly expositing Psalm 23, but it's a poem after all, and what do we do with poetry but use it's vivid imagery out of context to make sense of feelings that are otherwise beyond description. (This I learned in life, not college.)

Like the Psalmist, I feel like I'm walking through the valley of the shadow of death.

I fear no evil--well okay, maybe a heart attack or two.

And God is with me.