New Chemo

Along with my great Oncologist, there are two very important people without whom I could not do without: Nellie and Patty, the nurses in the Chemo Unit. These women are the most competent, caring and compassionate nurses I’ve encountered. They have a difficult job that on the surface seems relatively easy. To the untrained eye they might seem like overly-trained babysitters to anywhere between one to twelve chemo patients at one time. But in reality, this is a very stressful job that barely allows for bathroom or lunch breaks. Our lives and well-being are in their hands. Here is my process from the moment I enter the room.

I walk in and someone will ask what recliner I’d like. I scan the room to see if I know anyone. If I don’t recognize anyone -- and here it gets dicey, since chemo brain has allowed for very embarrassing moments, where once seated I hear from across the room, “Hey, how are you doing? How did the last chemo go?” These words come out from, what a minute before was, a total stranger.
Once seated, the nurses will ask me if I want a pillow or a blanket, I reply yes to both, having learned from past experience, that once the fluids start to flow I will get cold.
They bring both, along with all the IV bags, needles and tubes. They hook up the saline drip along with the Taxotere, steroids, and Benadryl filled bags. An additional bag of saline awaits along with a bag of Herceptin for later. All this is done in a quick and experienced manner. Once all the bags and tubes are ready, they sterilize the area over the port opening on my chest. They have to be very careful since if the area is not sterilized properly, an opportunistic infection can enter here and go directly to the heart, do not pass go, do not collect $200, since the opening leads directly to that fine muscle.

When they are ready they will ask me to take a deep breath. I do and they insert the needle in the port, which stings a bit, but is not awful. Once this is done, they run some saline in though a syringe and then pull some blood out to make sure the port is clear and not clogged. Then they set up the various drip speeds.
The Taxotere has to be administered though a machine that monitors the exact amount of drops being given. This is a strong drug which is carried into the bloodstream via another drug – can’t remember the name – that some people are violently allergic to.

Before the first treatment on this regiment, I asked my doctor what possible side effects I might experience. After listing a whole slew of interesting ones, some of which I’ve mentioned in previous postings, she blurted the last one very quickly, in a strange muffled and rapid patter, following it with a faster-still disclaimer and a nervous laugh. But I had heard the name of the last side effect: Death. Yup, that last side effect was a killer.

“I’m sorry, did you say Death?” I asked.
“Oh yes. Some, not many, can have an allergic reaction to the Taxotere. Well, not the Taxotere, but the agent (drug/chemical) that it has to be paired within the IV.” She giggled nervously. “But don’t worry. It’s rare. And we test it first. We give you a few drops first to determine if you are allergic to it. If you are, we stop immediately.” I should hope so, I think to myself.
“Don’t worry. You’ll be fine.” She added, confidently, more to herself, than to me, I think.
Should death be considered a side effect? Isn’t that rather final? I have a sneaking suspicion that side effects are reactions that are treatable and, some times, reversible. I’m pretty sure DEATH is not a side effect. I can hear the conversation now. “Your daughter is doing great, other than having suffered a bit of DEATH, she’s fine.” Then the mother hits the floor. Hard. Out cold.

But I digress. After I was hooked up, they brought over additional equipment which had never come over to my side of the room before. Oxygen and various resuscitation equipment. To some, this might have been reassuring, but I was suddenly filled with a sense of dread.

Nellie gave me the stats. “We’re going to first run the test. We’re going to give you 20 drops of the Taxotere. If you start to feel warm or begin to have trouble breathing you’ve got to tell us right away. We’ll stop everything immediately.”
“Okay.”
“Seriously, if you feel anything out of the ordinary, you’ve got to to tell us.”
“Will do.”
“Really.”
“Gotcha.”
“Okay. Here we go.” She said. And the drip began.

Next to me sat Edna, another chemo patient. She’s on the same treatment I’m on. She has the same type of breast cancer as I have and the same Oncologist. She’s one treatment ahead of me w/the Taxotere, so she went through this last time. She turned to me.
“Really. Make sure you tell them if you have any strange sensation.” She said.
“You did okay with the Taxotere. Right?” I ask, hopefully.
“Uh-huh.” Nodding in the affirmative.
I sit back and try to relax.

At this point I should mention another lovely thing chemo does: it fries your ovaries. Two years before all this started, I had a hysterectomy, because they had found pre-cancerous fibroids. The surgeon took out the cervix and uterus but left my ovaries intact, at my request. I didn’t want to slam into menopause if there was no need to. I wanted to slide into it gracefully. When I was diagnosed this January I wasn’t even in peri-menopause. Now the chemo was cooking those salvaged ovaries, giving them to me medium-well, with a side of bacon, please – Thank you. I was on the fast track, on my own personal Slip-n-Slide to menopause. And I was feeling the effects. The main one being: Ta-da! Hot flashes. All the time. Now you might think that I hate the hot flashes, but you’d be wrong. I love them. They are great, because, other than the instant bathing of myself in sweat - which is not that big deal when you have no hair - they, themselves, have a side-effect which fits into one of my many famous theories. Let me explain.

For some time now, I’ve been aware of an interesting curiosity: when we come in from extreme temperatures and our body temperature regulates, we become sleepy. For example, if we are very hot, such as in summer, and we enter an air-conditioned room, as our body’s temperature begins to regulate, we get drowsy. The moment our temperature hits normal, we fall out. The same happens in reverse. If we come in from the cold into a warm room and our body temperature goes back to normal, we get sleepy as well. I think it’s the body’s way of giving a contented sigh. It relaxes and exhales a luxurious, comfortable sigh that knocks us cold.

The hot flashes work the same way for me, especially since the vast majority of them occur during the night. I’m a light and restless sleeper. I wake up frequently during the night. A perfect example of this is that I’m writing this at 3 am. But when I awaken and get a hot flash, I push off all the covers, wait for my body to cool down, and when it does – voilá – I fall back to sleep instantly. A miracle wrapped in one sweaty little package.

Okay, so back to the chemo room.
A half hour goes by, during which Nellie and Patty watch me very carefully.

Edna asks, “How are you feeling?”
“I’m okay, so far. My ears a little warm, though. I think I’m getting one of my hot flashes.”
At that, the room goes deathly still.
“You’re getting warm?” Patty asks, alarm evident on her face.
“Yes. But I think it’s a hot flash. I can feel it starting in my stomach. From there it runs up through my scalp and to the back of my neck. This is very familiar to me.”
“You’re getting warmer?” Patty asks again, this time more urgently. She looks over to Nellie.
“You see. Your hot flash is exactly like the allergic reaction. You’d feel the same warmth.” Nellie says.
“I think it’s a hot flash.” I insist, less sure now, but hoping.
The room tenses now and you can feel it.
Patty looks to Nellie for confirmation on how to proceed.
“We’re going to put you on Oxygen and continue for two more drops. We’ll watch.” Nellie says.
“How many drops have I gotten so far?” I ask.
“Fifteen.” Fifteen? Only fifteen in a half hour? Wow.
They attach the oxygen tank through a nose tube. It feels wonderful. Cool and exhilarating. The effect of which dissipates the hot flash immediately, since it brings my temperature back to normal. Now I’m sleepy.

“How are you feeling?” Asks Nellie.
“Great.” I say, although I’m tempted to lie so I can have the oxygen longer. A sigh of relief travels through the room. Shoulders sag back into normal positions, creases disappear from their brows. Even Edna sits back, comfortably. A few minutes of terror all over in a few minutes. In my favor, thank God.

A bit longer and Nellie announces:
“Twenty. You’ve gotten the twenty drops. You’ve passed the test. Now we can proceed with the regular chemo.

How worried were they? I can tell you that a few seconds after Nellie made that announcement my oncologist came bounding into the room. “You passed the test! You passed the test!” She giddily announced with a huge smile. Then she gave me an approving nod and left the room. She must have been in her office biting her nails the whole time. Whew! Who knew...

©2006 Annelise Pichardo