Chemotherapy

So here I go, the day has come, I’m about to submit to voluntary poisoning. I can feel my skin prickle and my stomach clench as I enter the building, a plain four-story brick box that belies its status as where lives are saved or lost. On the elevator to the top floor I visualize the chemo drugs coursing through my veins in oily black, intermingling with my blood and spreading liquid dread to all my extremities, until my limbs darken and die. Once again I ponder the absurdity of deliberately ingesting toxic cocktails; knowing they will hit me hard, but not yet understanding what it will feel like or just how hammered I will be; and yet again considering that I have chosen this of my own free will. It’s hard to accept that I’m here to make myself feel dreadful – but there is grim resolve that I’m about to stop being a docile victim and start fighting back.

Now I’m shaking visibly as I walk into the treatment room, with Allison by my side; I can smell my own clammy funk despite the air-conditioned chill that has the nurses all draped in sweaters and lab coats. Scanning the room I see five or six pods of patients receiving transfusions. Each pod has four recliners, with IV stands and monitors clustered around them. Each IV has a pump to deliver the flow from a bag of liquid; most of the recliner stations have several bags hanging on the stands. The recliners are each a featureless industrial gray, and all of them have an adjacent gray chair for a family member or friend. At the end of each pod is a nurse’s station with a desk, a computer, and assorted medical hardware, scissors, clamps, clipboards and such. Several of the stations have flowers, pictures or drawings, or mugs with clever phrases, to add a personal touch to the grayness. It all smacks of functional efficiency, like an assembly line to service malfunctioning humans, all queued up for repair.

All of the servicing stations are occupied. The patients are old; at least to me, though they are more likely about my age, though not the age I see myself. Most are fully reclined, supine; many with their eyes closed, but more just staring vacantly into space. There are TV’s mounted high on the wall in each pod, tuned to Home and Garden or The Food Network or CNN, but no one seems to be watching. Closed captions scroll across the screens; the one to my left is a cooking show, and I see “sterling in the blended batter” roll across under a mixing bowl and a wooden spoon. A few patients wear headphones or ear buds, but most just seem to be staring upward as though counting the dots in the ceiling tiles, and I have a brief memory of middle school. I notice that are many Asians, and I have the fleeting thought that maybe God is punishing them for their inscrutability: ‘you’ve got cancer: I’ll bet you’ll show some emotion now!’ Others of the subjects - patients? sufferers? - are engaged in muted conversations with their companions, not wanting to share their indignities with their neighbors. One woman has a startlingly bright headscarf, swirling with purples and magentas and pinks, but the brilliant colors only heighten the contrast with her sallow complexion. And all of the faces say fatigue; fatigue and sadness and resignation, as though their vitality is draining away to make room for the venom dripping from the bags.

All of a sudden there’s a persistent beeping sound. And then another from the other side of the room. I see a nurse walk over and look at an IV pump, and begin to unhook the empty bag, the beeping is the signal that an IV is finished and needs to be changed. I will soon learn that with forty or more people under treatment the beeping signals are going off every couple of minutes, and often there are beeps going off simultaneously around the room. It’s random and unsettling, and heightens the sense of tension that blankets the somber aura of the room. In my mind I see a McDonalds, with troops of attendants in white coats scurrying around to reset machines. For a second I even sense a whiff of French fries, a thought so unsuitable that I laugh out loud.

This draws the puzzled attention of the front desk administrator. She greets me cordially, and we exchange small talk, but I’m on autopilot and none of it registers; something about traffic and rain and construction. She directs me to an open recliner, and I take my seat. Allison sits in the chair alongside.

            As I get situated I look around my little pod, maybe 15 feet by 15 feet with its office-cubicle walls and its four stations for patients. To my left is the woman with the headscarf; she looks to be about seventy, but she could just as easily be fifty or ninety. She is lying with her eyes closed, her face pasty white and slack, her chest rising and falling almost imperceptibly. But she doesn’t look peaceful, just vacant. To my right is a younger woman, maybe forty, sitting up and looking alert and unfazed, a magazine in her lap. Her companion is another woman, her sister or friend or lover, typing away on a laptop. They could be in any waiting room anywhere, as though waiting for a routine check-up. Diagonally across is a man, and I notice with a start that his blanket covers only one leg, the other side flat and empty where I want to see the second one. I look up to his face, and it is covered with splotchy blisters; there is a particularly large and angry red one above his left eye. His hair is ragged and thin, drifting downward in long unruly wisps, saying that he no longer cares to pay it mind. His arms too are riddled with sores, and there are tracks of black and blue along his forearms. Next to his recliner is a wheelchair, an exclamation point to his story.

The woman on my right looks over and gives me a half smile, and then returns to her magazine. Though we are all only a few feet apart, it is clear that this is a place of guarded privacy and equally guarded emotions. We are there together, but we are also there alone, and we all feel this. I settle into my recliner and take out my own Ipad and headphones, and Allison takes out her laptop.

My nurse comes over. She's a short. thirty-ish African-American woman with her hair in neat cornrows.

            “Hi, Mr. Abraham, I’m Frances. I’ll be your nurse today.”

“Hi Frances. I’ll be your victim.” She forces a smile, I guess she’s heard it all before.

“I understand that this is your first treatment. I will explain it to you…”

            She starts to walk me through what is going to happen. She has just the right demeanor; she is direct, but warm; matter-of-fact, but not short; professional, but compassionate. I like her instantly; she’s reassuring, but I’m literally shaking. Go ahead, I think, poison me, give me all you got – I’m ready.

            “We’ll start you with Ativan, which is a sedative, and then a steroid. They should help you a calm down a little, and give your immune system a bit of a boost. You should start to feel a little better. Please tell me your full name and birth date; we will do this every time we give you a new drug. Make sure this label on the bag is correct.”

            And so I do, and it is. (And so they do check the name and birth date every time, later that day, and the next time, and again and again over the weeks and months ahead until I consider just having it tattooed on the ample space on my bald forehead.) And then she plugs the IV into the stent that goes to the brand new chemo port high on my chest, and we are underway. But not before I get a waft of the alcohol prep that precedes each IV, the smell that will become the trigger for each clench of my gut with each new chemo bag in the weeks and months to come.

A few minutes into the steroid and sedative and I’m feeling better. There’s pleasant warmth flowing through me, I’m feeling a nice gentle buzz, and I decide the mood calls for some new age music. I push my recliner back to full tilt – hmmm, this isn’t so bad, I’m starting to calm down a little bit, the sedative is working. I plug in the headphones and Liquid Mind is pulsing through my brain, and soon I’m in a much better place, suspended between wakefulness and sleep. This is the first hour of chemotherapy; wow, this isn’t so bad, it’s not what I had expected…

“Ok, Mr. Abraham, it’s time for the first drugs. This one is called Oxaliplatin. I’m also going to give you Emend; it’s an anti-emetic, which will help keep you from becoming nauseated. You probably know that nausea has always been a big problem with chemotherapy, but these new drugs have really helped. It may make you feel pretty dried out, so try to drink some more water. What is your full name and birth date?”

“OK”, and I repeat my stats, murmuring through the gentle haze. “Do it to me one more time”, I either think or mumble, and I for a second I picture The Captain and Tenille in their sailor suits, crooning away.

She hooks up the new drugs. (Ugh, there’s that alcohol smell again.) I slip back into my drowsy reverie, the sounds of Yiruma accompanying me this time from my IPad.

            I don’t know how long it’s been, but suddenly my throat has become dry. Very, very dry. Not dry like I want a sip of water, but dry like lost-in-Death Valley-in-a-dust-storm dry. Like it’s not just my throat and my mouth dry, but it’s dry all the way to my fingertips dry. It’s like a Death Eater has come and locked lips with me and sucked every ounce of moisture out of my body dry. I’m finding it hard to breath, and swallowing is no kind of possibility.

            “Water”, I croak, and swing my chair up to a higher position and start to sit up. And that’s when the first wave connects connects, and I feel a tidal rush of druggedness as the effects of the Oxaliplatin kick in. I slump back to the chair like I’ve been hit by a two-by-four. “Unhh…  Umgh… Ogmph”, articulation fails me and my head connects drops back onto the recliner. I look over at Allison and her eyes big and white as ping-pong balls, and she scrambles to get me the bottle of water. Greedily I suck it down as it dribbles from both sides of my mouth, down my neck, soaking my shirt collar, and I find that drinking on my back is like drowning, and now I’m dry and inundated at the same time. Coughing, sputtering, gasping, I sit up again. Again I’m hit with a wave of weakness, though this time with Allison’s help I’m able to stay upright, and I spit out the water I’ve aspirated with a violent cough. In the background I can see all the eyes in the clinic looking upon me in surprise. But I’m not really concerned about the reactions; sitting up, I chug what’s left in the bottle, paying no heed to the water that leaks down the front of my shirt and soaks the front side this time. But I am beginning to breathe again.

“Are you OK?!” Allison looks like she’s seen a ghost.

            “Yeah”, I say. “More water. And I don’t feel so good…”

            The drained feeling is like nothing I’ve ever experienced, a little like the torpor of a high fever but accompanied by an other-worldly drugged sensation, like I’ve become unmoored from the floor and am floating up into the haze. Allison hands me a refilled bottle and I manage to drink it haltingly, and then I tilt the recliner again and drift back into semi-consciousness. But when I lie back this time instead of the vacant, sleeplike state I had experienced before, my mind has become active. Instead of blankness I am beginning to have visions.

I’m in a wagon, drawn by a horse, with a driver. Look its Allison driving. I’m lying in the back, it’s a small cart and I am covered with a blanket, except my head and feet stick out at either end. I’m asleep, or dead, or something between, I can’t tell. And I have no idea where we are going, but I’m helpless to move or ask. And then without any transition it’s suddenly over, and I’m in a big field, standing. All around me are colorful flowers… no, wait, they are not flowers, they are children… but they are tiny, very tiny, the size of robins or blue jays. And they are all singing. It’s the song from The Grinch, “Hurry Christmas…” And then, just as suddenly, that vision is over, and there’s new one…

And so it goes. Vision after vision, no clear link between them, no apparent reason or interpretation. Now I’m an eagle flying overhead, watching a soccer game and my daughter dribbling down the field, swerving back and forth between defenders like a droplet down a windshield. And then I’m in a car, driving across a massive suspension bridge, eight, ten, twelve, twenty lanes wide, and the road gets steeper and steeper and steeper, until I’m almost driving straight up, and then I’m off the end of the bridge into the air! That one was scary, but wait, here comes the next one…  I’m aware they are happening, and I know they are not real, and I know I’m lying in a chair in a clinic, but they just keep coming like images in a movie trailer, a surreal one with no plot or theme. They are not unpleasant or unnerving; they just are there; I’m just a helpless observer, so drained that I van only watch as the film rolls by. I know time passes, but it could be a minute or an hour or a day. The little vignettes are punctuated by beeps, one far away over there, then one nearby on my left, then a couple at the same time, here and there, but they don’t have a role in the stories. And then there’s one right next to me, and my Oxaliplatin ride is over.

“How are you doing?” Frances says, as she comes over to swap out it out and start the next IV. I look over at Allison; I see in her eyes that I look like an alien being.

“I’m OK,” I say. “I’m so weak. I can barely talk. And I’m having crazy visions.”

            “That’s not uncommon. Are they upsetting you?”

“No, not really. They’re just really weird. Like little pieces of weird dreams all spliced together.”

            “Yeah, I’ve heard that from other patients. And you are on some really powerful drugs. Well, we are ready for the next one. This one is Irinotecan, it’s very strong, too. It may make you need to use the bathroom frequently; some patients call it ‘I-run-to-the-can’. Here’s the label, what’s your full name and birth date…”

I’m glad when she walks away, talking has become such an effort. I lie back down to hear the next swell of lutes and wind chimes from my earbuds, this time it’s Enya, and I wait for a new round of visions, oh yeah, here it comes. Now I’m surrounded by owls, all the same size and color, brown and white spotted bellies and eerie white owl faces, turning their heads in unison and watching me as like I’m conducting an owl symphony. Hundreds of them in neat little rows like tuxedoed patrons in an opera hall. And then, abruptly, I’m flying off in a hot air balloon, and I look around me and there are thousands of identical balloons, all in the beach ball red-yellow-white-blue pattern. They fill the air with color, against a brilliant blue sky like the desert on a crisp winter day. It’s a glorious vista, and my heart swells and tears come to my eyes.

Suddenly my stomach starts cramping and I know immediately that lying there dreaming is suddenly not an option. It’s time to find a bathroom, in fact it’s already past time, and the consequences are going to be pretty dire. I quickly raise the recliner and swing my feet to over to the floor – and I’m greeted by a flood of blackness and loss of amy muscle control and coordination, and I promptly fall right off the other side of the chair – right into Allison’s arms as she moves up to catch me.

            “Whoa!” she says. “What are you doing?!”

“Bathroom!” I say. “Quickly!”

            She helps me rise to a wobbly crouch, and I start shuffling down the hall. But before I get two steps, I feel a pull in my chest, and the IV stand begins to topple. Frances is there in a flash, grabbing it in one hand and my arm in the other.

            “Not so fast! You’ve got to take the IV with you. You have to unplug the pumps, here, and the stand is on wheels, and the pumps keep running on the battery. So you can take it down the hall with you. Here, I’ve got it; now come on, I’ll help you.”

            And so I stagger down the hall, half my weight on Frances and the other half using the IV stand as a walker. It’s about 20 feet to the lavatory, but it feels a lot longer as the floor undulates and the walls pulse in-and-out with the blurring of my vision, and me trying to keep my sphincter tight to avoid an accident. Finally I make it to the toilet, and Frances helps me get the IV stand set before she makes a timely exit and I’m able to lower my sweatpants and almost get down to the seat before the rush starts. It’s gross and revolting as diarrhea always is, but what’s different is the smell; it’s not just the smell of excrement, but also a gagging metallic odor that is like nothing human. It reminds me of a very worst morning hangover, from a night way too much of something appalling like tequila. And so I sit on the toilet, too drained to get up, emptying my bowels with watery surges, and gagging from noxious gases that I can’t imagine could come from any living body. It’s a humbling experience; whatever else cancer will do to me, I think, first it will rob me of my dignity.

Eventually the episode is over, and I wobble back to my chair with the help of my wheeled tripod companion. I’m able to connect the cords and wires and plugs, and a few minutes later I’m lying down again, and back in the land of soft guitars and harps and visions. It’s a relief… but a short-lived one. Because before I know it, is it ten minutes later or twenty or thirty, I’m not sure, but here come the cramps again. I better get my ass back to the bathroom – now! And so I repeat the whole process; I stand a little slower and more carefully this time, and manage the IV stand and the plugs by myself, and stagger down the hallway with my stand to keep me upright, and I make it to the bathroom on my own. And I feel a weird sense of pride and accomplishment; I may be a basket case, but I can go to the bathroom by myself.

Again I manage to get back to my recliner on my own. “I remember Irinotecan”. I look up. It’s the woman on my right speaking. “I couldn’t even get out of the bathroom. I was in there for about an hour, and I was throwing up too. And when I wasn’t doing one or the other I was lying on the floor. You’re doing really well.”

            I look at her again, and try to comprehend the idea of ‘doing really well’ in the context of the churning in my gut. She looks totally normal. “Thank you,” I manage to say[ASK11] . “Do you have cancer?”

            “I did. Pancreatic, just like you. I did Folfirinox, and then I had surgery back in February. I’m cancer free now.”

            I’m stunned] , and instantly tears well in my eyes as though I’d been stung. “Wow. You look great! Who is your doctor?”

            “My surgeon is at Hopkins, Dr. Polchuck. He’s amazing. He saved my life. I’m Barbara, by the way.”

            “I’m Rick. Sick Rick, right now. Nice to meet you. Why are you here now?”

            “My doctor wants me to do chemo for awhile as follow up, in case there’s any remaining cancer. But this is a piece of cake compared to what you are doing. I know, I was only able to do seven rounds of it.”

            I try to take this all in. She’s cancer free! But only able to do seven rounds of Folfirinox. And her doctor is at Hopkins, too. Holy shit!

            We talk for a while. She had a large tumor on the head of her pancreas, with traces of cancer on her liver and in the lymph nodes. First diagnosed almost a year ago. But the chemo and surgery got it all, she’s cancer-free now. She’s an emergency room nurse, and she’s gone back to work, but only part-time. It’s incredibly uplifting for me, and stunning; it’s the first news I’ve gotten since I was diagnosed that isn’t totally fucking hopeless. I feel like crying.

Oh wait, that’s not emotion, that’s Irinotecan striking again. Oh God, I have to get to the bathroom… This time it’s a little easier, and a little harder; I know the drill, but I’m even weaker than the last time. Every time it’s a little easier and a little harder. But I’m thinking about Barbara, Badass Barbara who Beat Pancreatic Cancer, while I sit on the toilet, which turns out to be a long time this time.           

When I come back Barbara is gone. “She gave me her name and number,” says Allison. “She said you should call her if you need to talk to somebody, and I think she meant it. She even gave me a hug. I like her.”

            I do too. In fact I like her a lot. I settle back down onto my recliner and my treatment.

            So this is Irinotecan. I don’t know how long it takes, or how many trips to the bathroom, but in the end I’m even more drained and weak and grateful for my gray recliner, which I have come to see as a very underrated thing. The visions have mostly stopped, and now I’m in a state of semi-consciousness between awake and asleep. More lutes and guitars and harps play on in my head, and I’m just so, so out of it. Until the beep sounds again next to me, and I look up to see Frances.

            “OK, Leucovorin is next. It is reduced folic acid, not a chemotherapy drug itself, but it helps enhance the effects of the other drugs. I don’t know if you’ll experience any side effects from this, I haven’t had any patients mention anything from it. Here’s the label, your full name and date of birth…”

I nod, which is about all I can muster. Soon there is another clear bag of liquid hanging over my head, and I drift back into New Age land, this time to the sounds of synthesizers.

A little later there’s a hand on my arm.

“I think you should eat.” Allison.

“Huh?”

“I think you should eat. You know how important this is, we talked about it. It’s almost 2:00, you haven’t eaten since breakfast. You need to eat”.

My mind isn’t working. But if it were, eating wouldn’t even be the last thing on it. My stomach is still twisted and knotted, and the thought of chewing seems like an impossibility. Just the idea of food sends me into spasms of revulsion.

            “OK”, I mutter. “I’m starving.”

            Allison gets out the container of chicken and rice she packed this morning. It’s the good rotisserie chicken from Costco, with her jasmine rice and some broth so it will be moist and tasty. The chicken is a staple at our house, it’s fresh and tender and flavorful. Today it looks about as appetizing as coarse white sand.

            She heats it up for me in the microwave and returns to the recliner. I manage to lever myself up to a sitting position, accompanied again by a shot of lightheadedness, and get ready for lunch. She moves the tray over and puts down the plate of food. I’m sure I look like a toddler surveying his first dish of pureed brussels sprouts. Gamely I take a bite.

            Sheet rock, I think. This looks and tastes like a slab of sheet rock that has been ground into little pieces, in a sauce made of plaster, powder, and drip water from a demolition site. My stomach clenches, my throat tightens, and I begin to sweat. Its flight or fight time, and I have to make a choice. I don’t have many weapons against cancer, but eating is one of them. I clench my spoon with determination.

Yep, the second bite confirms it. Sheet rock. This is just how sheet rock would taste – dry, crumbly, pasty, with big chunks of chalky grit. I start chewing, and the taste buds send alarms: “Stop! Don’t do this! Stop!” But I soldier on, grimly, determinedly, trying to ignore the signals of nausea. This is how I have to battle, I have to maintain my weight and my strength, I have to take my medicine. Never have I enjoyed eating less, and again it reminds me of being four years old and having to choke down cold green vegetables with my nose pinched shut, the price to be excused from the table. But I keep chewing.

Eventually somehow the bowl is almost empty. I give myself permission to stop. “Take it away, please’” I hear myself say, “And take it to the trash can. Not the one over there, the one out in the hall.” Back down goes the recliner and me with it, more drained than ever, but now with a churning and clenching gut and the taste of plaster coating my tongue. Now I’m completely drained and nauseated. But I’m able to drift off again into dazed slumber.

            Before long the piercing pulse of the IV beeper brings me back. “It’s time for the last drug, Mr. Abraham”, says Frances. “This one is called Flourouracil. We call it 5-FU for short, you can probably guess why. I’m going to give you a push injection for about 20 minutes. When that is done I will set up a little pump for you to take home, and it will keep giving you a drip for about 40 hours. Your doctor explained that to you, right?”

            I nod, or at least I think I nod.

            “You might experience a chemical taste in your mouth, and you might feel more drained or fatigued. Check the name and birth date on the label…”

Yep, it is still me. More drained, I think? Any more drained and they will have to peel me off the floor like wet rug. I notice I’ve drooled out the side of my mouth and I don’t have the energy to even wipe it off. Maybe I send a telepathic message to Frances, and she reaches over with a tissue and performs clean-up operations. She seems to do this regularly, I note; it’s as though she takes on extrasensory skills as I lose the ability to communicate. I feel so helplessly grateful to her; her eyes tell me that she will be there with me.

            The 5-FU push is a short twenty minutes, but I do seem to feel even more fatigued. She comes and changes the IV connection over to the portable pump, which is about the size of a shoe, which she puts inside a bag with a strap that I can place over my shoulder. She points out that the pump has a window showing how much has been dispensed, and about how many minutes are left until it’s done. Every thirty seconds or so there is a whirring sound as the pump sends another micro-dose through the line into my bloodstream. I feel another twinge of revulsion, knowing that I will be continuing to poison myself for almost two more days.

            I look up at the clock, 3:45 pm, and I have finished my first six-hour chemotherapy session. Now I have to get home. Frances grabs one arm and Allison takes the other, and slowly we lift me upright and onto my feet. I’ve never felt as lightheaded, and I can’t seem to remember how to walk; the two women start to move, but my feet are velcroed to the floor. I reached down with my hand and touch my thigh, which reminds me that I have feeling in my leg and allows me to send a message to move it. And so I do, sliding my right foot along the floor, then the left, so that I start to shuffle forward. I am just so tired, this is so hard, please let me lie down again. I lift my head look around, and it seems like everyone is staring at me, tilting their faces forward, willing me to keep moving, taking steps. It helps, it gives me some strength. I want to show them I can do it.

            “Do you want a wheelchair?” says Frances.

            “No. NO. I can do this.”

“I will go get the car and pull it up front.” Allison.

            “OK.”

            Frances stays with me, and we limp toward the elevator. It’s only about 30 feet, and once I’m moving it seems easier to keep going than to stop. I look back into the clinic at all the eyes on me, and it is a different place than the one I had entered six hours before. No longer are these the group of pathetic souls who I had seen when I came in; now they are fighters just like me and we are together in this fight. I look into their faces and see that they are with me and that we share something that others don’t understand, even our wives and husbands and companions who are there with us, they try to but they don’t know what it feels like. And I also see determination, grim resolve that was hidden before, determination that they, that we, will do everything in our power to live, to stay alive, to be there for our families. I’m so tired, and I can’t envision how I can do this again, maybe seven more times, but now I have done it, and it’s not a mystery any more, and I have a small sense of conviction that I can do it. It’s hard, I knew it would be hard, but now that I have done it, I know I can do this. I don’t know yet if it will be enough; no one knows if it will be enough, but I will do it, I’ll be back. I turn around again and resume my shuffle to the elevator.