Monday, March 26, 2007

Into chemotherapy

After surgery revealed that my colon cancer had spread throughout my abdomen, I started chemotherapy in September 2004. My expectations were formed by what I've seen in movies: chemotherapy means vomiting, hair loss, and misery.

The mechanics of chemotherapy was biweekly visits to a small clinic in Kensington, Maryland. There an intravenous line was connected to an infusion port that had been surgically implanted beneath the skin on my chest. This port led via a small tube into my aorta where the chemotherapy drugs are rapidly mixed into the blood.

The drugs used for chemotherapy vary from cancer to cancer and stage to stage. My regimen was FOLFOX-A: 5-fluorouracil (poison), oxaliplatin (mucks up DNA replication), and Avastin (stops blood vessel growth). I started each infusion session with saline and powerful antinausea medication to prepare me for the toxic drugs. Then the chemotherapy drugs were infused, one by one, over the course of a few hours. Finally I was fitted with a portable pump to continue infusing the 5-fluorouracil for the next 48 hours.

Seeing the other patients in the clinic made me realize that getting cancer at my age really was unusually bad luck. In the 2-1/2 years that I've been going to that clinic, I've seen only one other patient within ten years of my age -- a young woman also on the same treatment for colon cancer. Otherwise about half of the patients look to be in their fifties and the rest are older. It's sometimes uncomfortable feeling the extra attention that I draw as a youngster, and I'm less social with the other patients during my hours of infusion than I would be if they were my peers.

The infusion clinic is a surprisingly upbeat place. Most of the patients are in good spirits and the staff is very nice. Having dealt with many grumpy nurses in hospitals, it's a surprise to see the different personality of oncology nurses. I guess part of it might be that cancer is seen as a tragic disease and it tends to bring out extra compassion in caregivers.

The patients are probably cheerful because these are the people who are actively fighting cancer. Chemotherapy makes us feel sick in the short term, but we all hope that it's making us better and many people start to feel better as the cancer is reduced. And it seems that an optimistic attitude really does improve one's physical health.

But sometimes I see a patient with death in their eyes. They look sick, worn down by chemotherapy or the cancer itself, and in bad spirits. It makes me realize what an ultimately serious disease cancer is and what I might have to experience before long. I don't know if these patients really are at death's door or whether their just at a low point. I know that I've looked like a sick cancer patient myself at times, but then I've improved and looked like a picture of health.

I wonder what it's like for the staff to deal with such sick people every day. How many of their patients are lost to death each year? How does that affect their own lives? I know that we all die eventually, but it's exceptional to know that a person is facing death with immediacy and suffering in the meantime.

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