Friday, November 13, 2015

Radiation treatment

I take one last sip of my steaming peppermint tea and turn off the engine of my trusty light blue 4Runner. I know better than to be emotionally attached to a vehicle, thank you Stephen King. But this truck has carried me through two pregnancies, brought both boys home, taken them to the emergency room, countless trips to Seattle for doctor appointments, and now my own battle with cancer. I take a deep breath and brace myself against the wind and rain. This storm is nasty, and I can't help but think of Axl singing  " a cold November Rain..." at the top of his lungs. God he turned into a wacko. Slash totally came out on top; he's a badass. Like me. I am a badass. I will get through this. Deep breath, here we go.

I open the door of my truck, get out and walk quickly across the parking lot, attempting to protect myself from the bone-chilling wind as the colorful autumn leaves dance at my feet. I am thankful the rain has stopped for now. I think of lyrics by the Cowboy Junkies, "Haven't seen the sun for seven days; November's got her nails dug in deep" and I wonder, as I approach the entrance to the Cancer Center, if the predictions for this storm will be accurate. Will we go seven days without the sun peeking through? The Dungeness River was raging when I crossed it on Old Olympic Highway.

The automatic double doors open and I walk through both sets and stop at the desk on my immediate left. Robin asks me my birth date. I smile and reply. She smiles back because she knows my last day of treatment is also my birthday, which doesn't happen very often for patients. She tells me to go on back.

I walk towards the large, light brown wooden double doors, my head is down, still chilled from the wind and on a mission; I want to be done. I no longer read sign on the right door. It is made of acrylic and somehow seems cold. Terse. It is a large white sign with black lettering that says:

Or Family
Members Beyond
This Point

They're not messing around with that sign. But I'm authorized, so I go through the door on the right, and make a quick left. On my right there is a huge set of floor-to-ceiling, double-door cabinets with simple horizontal silver handles. I open the one that says "Patient Gowns" and reach in, pull out a gown, and pick one of the changing rooms. I like the first one on the left because it is bigger and I need space around me. I know what's coming.

I grab the padlock with the key in it and close the cream colored, closet-style folding-door with two panels of horizontal slats. There is no lock inside. There used to be a hook-and-eye contraption, but somebody probably fainted and the staff couldn't get to them. Bye bye hook-and-eye lock. Patient health and safety is first here in the Radiation Oncology Department. 

I take off my bright green fleece scarf and lay it neatly on the relatively comfortable looking double wide ottoman that is against the wall, and in front of the extra large mirror that hangs on the wall. The ottoman is a funky color. Not brown, but not beige. Taupe? I don't know. But, it has gold colored thread making funky designs on it; a stem with 6 or 7 pokey things. Are those dandelion fluff...? Or are they some kind of creature from deep in the sea that is yet to be discovered? They are beautifully sharp. I appreciate the brief distraction they provide me.

I set my brown hat next to my scarf. My hat is very special to me; someone made it, but I don't know who. It even came with a purple nylon scarf that was woven into the hat at the bottom. It's a very clever design; I've received many compliments on it. I wore the purple scarf for a while, but I recently took it out and replaced is with a leopard print scarf, which just feels better for me. At the Cancer Center, they have 5 or 6 huge brown baskets that are filled with free hats. People knit and crochet hats and then donate them to the Cancer Center; the hats are for to patients. We get cold easily, it's because we have little to no hair, and the amount of heat we loose from our heads is incredible. I'm constantly cold. The volunteers are kind enough to make hats that are gender specific; it's a very cool thing. Each hat is sanitized in an autoclave and then sealed in a gallon size ziploc bag. Cancer patients have suppressed immune systems and we certainly don't want to catch a cold from a well-intended volunteer who knitted or crocheted a hat. I mean, who knows where she was sticking her fingers! Right? GERMS! I don't need to catch what you've got. But I'll take that hat, thank you very much! I really do love it!

I remove my black pea coat and hang it on the large metal hook on the wall, to the left of the large mirror. I take off my gold necklace with the butterfly on it and gently lay it on my bright green fleece scarf. My maternal grandmother gave me this necklace and butterfly when I was 17. I take off my hoop earrings that I bought from Walmart when I started My Cancer Adventure. Three pairs for $3.88. Whatever. It's all good. I started wearing them when I shaved my head back in May. These horribly cheap earrings have stood up longer than I anticipated. Not too shabby, China.

From my left wrist, I take off the silver charm bracelet that Isaac purchased for me at school last year when he was in kindergarten, during the holiday season; it was likely made in China, too. I intentionally leave the grey rubber bracelet notifying health care professionals about my chemo port. From my right wrist, I remove the two dark steel grey and pink beaded magnetic bracelets that I purchased when I was pregnant with Nathan. Someone told me that magnets can help with nausea. Ok. I'll try. As long as I don't puke, right? I was a puker. It was awful. I lay all three bracelets on my bright green fleece scarf, next to my necklace and my cheap earrings.

I take my bracelets off because once they got caught between my wrist and the cradle and it hurt. I take off my necklace because I envision my butterfly leaving a permanent mark on me neck. Unlikely. But still.

I leave my wedding band and my engagement rings on my left hand. On my right hand, I leave on the silver antique looking ring with the beautiful sapphire blue cubic zirconia, which is behind the wedding ring of my paternal grandmother. She and my grandfather were married for over 50 years. On the inside of the ring, you can still read the inscription:  . D. to R.R. The C is missing; but I know it means "Charles Doak to Ruth Romine." She always said it was the most romantic thing he did for her. The ring has been on my ring finger for 6 years; my uncle sent it to me after my grandmother died at the age of 86.

I remove my shirt and see my reflection in the huge mirror. I avoid my own gaze; but I see my body. I know what I look like. But I summon the courage to meet my own gaze and hold it. Have I really changed so much since February when I discovered my lump? Taking a deep breath, my eyes fall to the four-inch long scar on my right breast; it is as long as my left index finger. It is becoming flatter; a radiation perk. I exhale, and quickly put on my gown, opening in the back, and it swallows me, before the tears overflow. I take several more slow diaphragmatic breaths as I tie the gown at my left shoulder and then my hip. Telling myself that I'm almost done with living the nightmare that started on March 9th when I got my cancer diagnosis. I look into my own eyes in the mirror again, take another deep breath and whisper to myself "I am strong. I will do this." I take one last look at my phone: the time says 3:08. I turn around and slide open the cream colored closet style door.

I go out of the changing room, padlock in hand, line up the two eye holes, insert the lock, spin it around, and click it shut. I put the hot pink telephone chord style key chain around my left wrist. I turn right and go into the bathroom to pee before I get on the table. Always pee before you get on the table. Always.

When I'm done, I quickly cross the room and sit down in the tangerine colored chairs. There is no clock in the room, and I'm thankful. I'm sure it was discussed by the the interior designer and whoever made the decisions about this particular waiting room. No clock because it will likely cause patients to become more anxious. God knows we're all more nervous than a long-tailed cat in a room full of rocking chairs. Especially the first timers. They can tell you till they're blue in the face that it won't hurt, when the radiation beam is hitting you, but until you go through it, you don't believe them. And let's face it, patients would always rather be somewhere else. So, no. No clock for this room.

Directly across from me, there is a yellow piece of paper hanging on the wall. It is colorful and says:


I can't help but wonder who made it and why they chose the colors they did. 

To my right is a huge photograph of 3 herons on the beach, with orange and blue tones. It matches the tangerine colored chairs. There is a handled basket in the corner full of magazines. Once I looked at the astronomy magazine, but it was 10 years old. I've also looked at the Women's Day magazine, it is more current: November 2015. I look through the recipes and clever crafts, welcoming the distraction. chocolate mousse pie. I wonder if I can get Nathan and Isaac to work together and make that for Thanksgiving? Heh. That's not gonna happen. Who am I kidding?

I look up and through the slats that the four panes of horizontal, frosted glass provide. I hear the techs talking. I know the man in front of me is receiving his treatment. They aren't talking about him; I just know he's in there.

I also know the treatment is not going to hurt. I know the radiation technicians are nice. But I don't want to be here. I'm done with cancer. I'm done with treatment. I'm done with living in the hell that cancer creates for people. 

The patient before me comes out from the treatment room. He told me he turns 80 on November 22nd, "the same day they killed Kennedy" he said. His hair is jet black and he wears a wedding ring, gown, pants and shoes. He told me earlier this week that he has lung cancer. I do not know if he was a smoker; I did not ask, it is not my business.

Rob, the radiation technician comes around the corner and looks me in the eye, smiling he says, "You ready, Rachel?" 

I look at him, smile back, and say, "Ready as I'm gonna be." And we walk back together. He is a gentleman, and gives me the opportunity to go through the very tall, and double-wide glass door with a wooden frame first. It is painted with the words "Caution. Radiation area" and the radiation symbol. We walk through a second door, which is about 18 inches thick and made of lead. Both doors are shut when the machine is working.

As we walk, he says, "So today's the first day of the new position that we created on Tuesday."

We look at each other and I say, "Yes, I'm ready."

"Are you ok?" he asks me. He is a nice person; I know he genuinely cares.

"I'm tired, but I'm ok."

"It's Friday. And you're almost done..." he says. 

We turn to the right as we enter the treatment room and the machine is in the center of the room. It is huge and intimidating. I avoid looking at it and instead look at the 27-inch computer monitor hanging on the wall on the left well above the sink. On the monitor, I read my name and birth date. I verify that I am me and then walk to the treatment machine. 

On the bed is my new body cast, made specifically for me. It cradles me from my head to my low back. It is propped up at a 30-degree angle. The treatment I'm about to receive is considered a booster. I had 16 treatments of the entire right breast, and will have 5 boosters. For the original 16, I was on my back; for the boosters, I lie on my left side. Dr. Zimmerman is intensifying her treatment and targeting the scar and the tumor bed. She wants to make sure this thing doesn't grow back. She's not fucking around; but that's what happens when you get the biggest, baddest type of cancer that a pre-menopausal woman can get. So, really, I'm glad that my doc is a badass like that.

For the first 16 treatments, I would sit on the hard plastic table and bring my feet up. I would begin to untie my gown at the hip and then at the shoulder, and quickly learned that it's easier to do this before getting on the table. Sometimes, the techs help me, but I really prefer to do it myself. Especially at the beginning, I wanted them out of my space. They were lucky they didn't get elbowed (thank you Mr. and Mrs. Ventura for teaching me). But now, I don't mind the help. I'm tired, and my right side and shoulder ache.

I sit on the hard bed which is covered with a white sheet. Marj brings over a warm blanket and covers me as I lay back. Thank you Marj. I'm glad you're here. She's a woman and I find her presence comforting. But I do miss Juliet, who is on vacation. We connected instantly; she's a breast cancer survivor and her son is on the autism spectrum.

I slip my arms out of my gown, but keep my hand up, holding the gown and covering my breasts. Marj takes the gown off of my right breast. I feel exposed and emotionally raw. I continue to take deep breaths, trying to hold back the tears. Radiation is exhausting in a very different way than chemotherapy was. 

I raise my arms above my head, and they fall into the blue cast of my body. Marj pulls the sheet towards her, and as instructed, I do not help her. She is ligning up the lasers with the two small tattoos between my breasts, and the small tattoo on my right side. Gotta make sure everything lines up. These people deal in terms of millimeters, and they are doing their job, they get to help a lot of people. Cancer is big business. 

Rob picks up a controller and looks at the two 27-inch monitors that are on my left. With the controller, he raises the table so that I am elevated to about the middle of his chest. The table then pivots, and my feet are pointing towards the door. 

Rob and Marj talk business "98.2" "she's centered" "down to 73.6" "she's perfect on my side" "ok here we go..."

Rob turns to me, I am unable to move, so I look at him the best I can. He says "ok, Rachel, I'll be back in a few minutes."

"Ok I'll be here..." I say, trying to keep it light, because that's what I do. 

The machine starts to rotate to my left, I see my reflection in the glass where the radiation will come from. Above me, a 24-inch square wooden box that is attached to the ceiling becomes visible. I see a round black piece of plastic that is shining green lasers onto my chest. I also the yellow and black sign with white engraved letters that says, "CAUTION! AVOID EXPOSURE LASER RADIATION IS EMITTED FROM THIS BEAM"

I meditate. I close my eyes. I breathe.

During a few of my treatments, I would try to spell other words from "radiation" and "exposure". I got 17 words once from "radiation". Then I was done.

I hear a faint clicking coming from the machine, which is still above me, but has rotated to the left. I hear a buzzing noise, and know that the "BEAM ON" sign is lit up. I never counted how long the beam is on for.

The "BEAM ON" sign goes out and stops buzzing. It is quiet in the room. I begin to move; my feet pivoting to the left, my head going to the right as the machine rotates over me and ends up on my right. I know Rob has come in and is moving me with the controller. But he is quiet. I've joked with him that he could be a spy because of his stealth-like maneuvers.

On my sixth visit, he said, "got any itches on your nose?" as I was laying on the table and he was moving me. "Yes, actually, I do." And he said, "Yeah, it usually happens on number 5 or 6. Want me to scratch it for you?" I chuckled and said, "No, thanks, let's just finish it up!"

Rob leaves the room and silently shuts the heavy lead door. A few seconds later the "BEAM ON" sign lights up and is buzzing again, hitting the right side of my breast. And then there is silence.

The first time I was on the table, they took pictures to make sure I was in the right spot and that they could repeat the pose. Every few days, they'd take x-rays to make sure that my ribs lined up with my own ribs. The entire process is fascinating.

Rob and Marj come into the room. I put my arms in my sleeves as they lower the table and me down to a more reasonable level. The machine is rotating up into it's holding position.

Today, for the booster, I lay on my left side, in the new cradle. They got me positioned just so, with the new tattoo that is near my scar and I happen to have a freckle on my back that they used to line me up on the lasers. More pictures to make sure I'm in the right position.

Marj attached some type of contraption to the machine so that they could target the scar and tumor bed. Rob came over and drew on me with a blue permanent marker so that I would line up again with the contraption on Monday. He said to try not to rub the ink off, but that if it comes off it's no big deal.

Dr. Zimmerman came in and checked my position, making sure that I was where she wanted me. I lay on my left side, pillow between my legs, my right arm is above my head, my elbow bent at 90 degrees, resting above my head. "Perfect" she said. "Rachel are you comfortable?" she asked. "No I'm not," I said. And she said, "you don't look very comfortable, but you can tolerate it for 45 seconds, right?" "Yes. Yes I can." "Your skin looks great, by the way. Nice work!" She left the room with Rob and Marj. A second later the "BEAM ON" lights up and the buzzing starts. It stops just as quickly and Rob and Marj come in.

The table descends, the machine raises back up to it's resting position. I put my arms back in my enormous gown and sit up. I want out. I want to change and go outside and breathe fresh air.

I quickly say good bye and have a nice weekend to them. I walk with a mission through the open lead door and the open glass radiation warning door, retracing my steps back through the waiting room and towards my dressing room. The next patient is there for his treatment, I turn and courageously make eye contact with him. His lower jaw is swollen and he has no voice; he is probably in his late 50s, and was probably a smoker. My heart breaks for him a little as he nods at me.

In the dressing room I quickly get my shirt on, my earrings, necklace, bracelets on both wrists. My bright green fleece scarf, my black pea coat, and my tan crocheted hat with the leopard print scarf. I take my gown and turn to leave, hanging the lock on the eye hole as I open the door. I put the gown in the hamper in the cabinet, turn and walk through the double wooden doors and out into the  main lobby of the Cancer Center. I walk towards the sliding glass doors and say good bye to Robin, Jenn is there now too. We say "Have a good weekend" and "See you next week" to each other. The weekend is mine. I get a break from the Cancer Center.

The doors open and the wind is blowing. It feels good to be outside and walking. I step off the sidewalk and into the grey day, feeling the wind blow cold on my face, as I get closer to the 4Runner I click the unlock button on my fob and open the door when I arrive. I step up, then sit down, shutting the door against the wind. I start the engine and plug in my iPhone. I need music. I take a quick sip of my still warm peppermint tea.

I have Margot on my mind and pull up "New Dawn Coming" by the Cowboy Junkies. I unwrap and take a bite of the Ghirardelli's sea salt dark chocolate square I brought with me. Always have chocolate after treatment. Always.

I shift the truck into drive as Margot sings to me...
"Hold on honey there's a new dawn coming
and a big bird to sweep you away
Keep on dreaming soon there'll be a reason
to see it through one more day"

Yes, Margot...yes there will. 

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