Tuesday, July 30, 2013

Dr. Suzanne Klimberg: The Picasso of Breast Surgeons

Marla Crider, breast cancer, Arkansas, invasive ductal carcinoma, patient stories
Picasso's "Woman Flower."
After my recent appointment with Dr. James Yuen, Chief of Plastic Surgery at the University of Arkansas for Medical Sciences, I was disappointed to learn that simultaneous breast reconstruction was not recommended in my case because of possible diabetes­ related complications.  I had done some preliminary research and knew that it would be more difficult for Dr. Yuen to create natural looking breasts after extended healing.  He and my breast surgeon, Dr. Suzanne Klimberg, are well known nationally for their tag-team approach at providing breast cancer surviors, like I am soon to be, with anatomically sculpted breasts and a chance at normalcy after enduring chemo treatments, radiation and life altering surgery.  I trusted Dr. Yuen’s decision to delay the reconstruction for the suggested six months; however, I was concerned that waiting would impact the outcome of the procedure.

Several days after meeting with Dr. Yuen, I had a follow-up appointment with Dr. Klimberg, who counsels with her patients midway through the chemo treatments to evaluate the size of the tumor(s). I was to meet with the good doctor at 4:00 p.m. and by 4:15 I was already in a cubicle.  The exam room door opened and in walked a candy striper without the well known red and white uniform. But it wasn’t a candy-striper.  She was a young doctor with a stethoscope hanging around her neck who looked to be 15 years-old.  She sported a 10-inch waist and long blond hair that was pulled back in a ponytail and secured with a green rubber band. I was stunned when she introduced herself as Dr. Gallagher, an associate of Dr. Klimberg.  Good grief, she was a practicing breast surgeon.  And, I was an aging diva.

Dr. Gallagher asked lots of questions and inquired how I was managing the chemo treatments.  “Splendidly,” I responded.  She wanted to know if I had met with Dr. Yuen about the reconstruction surgery.  I told her that I had but he didn’t tell me what I wanted to hear.  She asked me to elaborate.  I shared the diabetes dilemma and his concern of infection if he performed the reconstruction simultaneously with the bilateral mastectomies.  Dr. Gallagher confirmed that Dr Yuen’s experience with diabetics and prosthesis rejection is a serious consideration.

Dr. Gallagher examined my breasts and was curious about how much the tumor had reduced in size.  When I told her the mass measured 5.6 centimeters prior to beginning chemo, she said it was apparent to the touch that it had decreased in size; however, she was still concerned about its close proximity to the nipple.  According to my own research and numerous conversations with my doctors, saving the nipple can be essential to reconstructing more natural looking breasts. Dr. Gallagher’s comment made me uneasy.  She completed the exam and told me Dr. Klimberg would see me shortly to discuss Dr. Yuen’s viewpoint.

A few minutes passed when the queen of breast surgeons came in accompanied by Dr. Gallagher.  She scanned my chart and asked me to tell her about my conversation with Dr. Yuen.  I told her that he wanted to delay the plastic surgery for six months after the mastectomies.  Without missing a beat she said, “Well, we just don’t like him anymore.”  For a split second her comment surprised me, but then I realized her dry wit was fully engaged. She then requested to exam me.

As I lay bare-breasted on the exam table in a very small room with young Dr. Gallagher on my left side and a very animated Dr. Klimberg on the right, she lifted and tugged on my cancer-ridden breast. I asked if she thought delaying the reconstructive surgery would cause the viability of the skin and nipple to deteriorate.  As she stared at my breast with her chin resting between her thumb and forefinger of her right hand, she quickly made the “Shhhhhh,” sound and said, “I’m thinking.” Her response made my laugh out loud.  Dr. Klimberg was in rare form and her next question proved it. 

“Do you have a pen with dark ink?” she asked her Barbie doll-like associate.  As Dr. Gallagher handed a pen to the senior surgeon, we looked at each other with curiosity and had no clue what was coming next.   Then Dr. Klimberg began drawing imaginary incision lines on my breast in black ink, explaining with each stroke how she was going to customize the surgery in order to save more skin, and especially, the nipple.

Dr. Suzanne Klimberg, UAMS
“I have wanted to try this surgery for a while and you are the perfect candidate,” Dr. Klimberg reassured me.  “The procedure doesn’t have a name yet but I’ll come up with something descriptive and appropriate before we try it on you.”  As I sat on the exam table and analyzed Dr. Klimberg’s newly created masterpiece comprised of circles and curved lines, I realized that I could be part of something medically ground-breaking.  I was thrilled and fascinated.  This, I thought to myself, is why Dr. Klimberg is one of the best breast surgeons in the country. And she’s right here in Little Rock at the UAMS Winthrop P. Rockefeller Cancer Institute.  How fortunate we Arkansans are to have her in The Natural State.

When I refocused on the conversation at hand, both doctors were still bantering about a medical name for the “Marla Crider” surgical technique.  Dr. Gallagher suggested that the new procedure should contain Dr. Klimberg’s name.  “No,” she responded, “I already have an enema named after me and that would be a little too much.”  Besides being a brilliant surgeon, this woman was also a stand-up comedian. 

Before Dr. Klimberg left the room, she said she wanted to see me again a week after my last chemo treatment, which would be in early September.  That’s when we would schedule the date for the bilateral mastectomies.  She gave me a hug and reassured me that I was going to look fabulous when the entire process was complete and suggested that a photo of my new ta-tas might be included in one of her “show and tell” presentations or even a text book. 

When I left UAMS that afternoon, I felt better than I had in months.  I could finally see the light at the end of the tunnel, thanks to Dr. Suzanne Klimberg - the Pablo Picasso of American breast surgeons.

Sunday, July 21, 2013

Chemo Treatment Four: Halfway There

My fourth treatment on July 12 marked the midway point of my chemotherapy regimen. Hopefully, it would be the last time I would have to endure the two prescribed drugs -  adriamycin and cytoxan – being infused into my veins and the ensuing havoc within my system. However, I must still engage in phase two of the treatment program, which will undoubtedly bring with it different side effects and another test of my endurance.  
Marla Crider, Arkansas, breast cancer, patient stories, UAMS, cancer treatment center, chemo
Marla Crider: Chemo treatment #4: Halfway there!
My brother, Mike, and sister-in-law, Barbara, happened to be in Little Rock on treatment day to help celebrate their granddaughter’s 21st birthday.  Being the caring and compassionate family members that they are, Mike and Barb both decided to accompany Don and me to UAMS for the afternoon of blood work, the oncologist appointment and the chemo infusion. It makes for a long day - and one that requires lots of patience.  It’s a testament to how important family and friends are to the cancer treatment process.  My brothers, sisters-in-law, and my beloved Don serve as my anchors and the ones who keep me focused and dedicated to being cancer-free. 

We arrived for the biweekly blood check at the UAMS cancer institute right on time and, as usual, had to wait for a bit before the ritual began.  I recognized a few familiar chemo patients in the waiting room. We nodded to each other, signaling that we were members of a fraternity, of sorts.  One by one, their names were called and mine soon followed. 

When I entered the infusion room, I stepped on the scales and noticed that I had lost more than a pound.  It wasn’t of concern to the medical team, since my total weight loss was still less than ten pounds, a result of the erratic, steroid-induced blood sugars that I had been experiencing. Even though the nurse’s assistant escorted me to a chair in the front of the room, I could still see that all 32 chairs were taken with patients receiving their prescribed toxin concoctions (Oh, for the day that empty chairs are the norm and not the exception). A new nurse approached my station and introduced herself.  I rattled off my name and birth date, a security measure to ensure that I was receiving the correct procedure.  As she was organizing the vials on a tray for the various blood tests, I enlightened her about my port and how it was positioned on top of a nerve.  I asked that she keep the information in mind when she inserted the needle for the blood collection.  She responded that she would, and before I had time to tense up, my experienced RN had connected the needle to the port and collected the necessary blood for testing.  It was the first time in four treatments that I didn't have to claim “port abuse.”  Nurse Pain Free was my new best friend! 

My family and I reported seven floors up for the appointment with Dr. Makhoul. When we exited the elevator, it was evident a long wait was in front of us.  Approximately an hour later, my name was called. Don and I maneuvered our way to one of Dr. Mak’s exam rooms.  Thirty minutes had passed when my wizard of an oncologist hurriedly entered the room.  He asked if I had experienced any new side effects.  “Yes,” I replied, “diarrhea.”  It took three treatments but one of the more common chemotherapy side effects had decided to make itself known during the past two weeks.  It was annoying and inconvenient but only temporary.  Other than the usual things – night sweats, insomnia and rapid heart rate – I was responding to the chemo pretty well.

Before Dr. Makhoul examined me, he checked my blood work and declared it perfect, which he said was a little unusual for someone who had undergone three chemo infusions.  He called me his “A+” patient.  When he checked the tumor, he announced that it had reduced in size to 3.3 centimeters from 3.6 two weeks earlier.  I was disappointed that there had only been a slight change. He said it wasn’t unusual for the adriamycin/cytoxan cocktail to slow its attack on the mass.  That’s why the chemo drugs are changed during the course of the therapy – to trick the cancer cells and catch them off guard. It sounded like a reasonable explanation to me.  

After I redressed, Dr. Mak alerted me that he would be attending an oncology conference when I returned for treatment five in two weeks. His nurse practitioner would be on hand to check my blood work and sign the prescription for the new chemo drugs.  I tried not to show my disappointment that I wouldn’t have the opportunity to interact and ask questions of my genius doctor.  He could read my apprehension well. Dr. Mak gave me a quick hug before he left the room.

It was mid-afternoon when the Crider entourage returned to the infusion center. The waiting room was almost empty, an indication that I would be called quickly and I was.  My sister-in-law, Barb, accompanied me to the recliner where I would receive my fourth treatment.  It was her first time to be an observer.  Yet another new nurse approached and introduced herself as my assigned RN.  I could hear Mr. Nurse Ratched bellowing orders at the patient across from me.  He made his way to my chair to say hell-o and deliver the message that a new challenge faced me in two weeks when the new drug regimen began  (Mr. Nurse Ratched, always the bearer of joy and optimism). I was confused by his statement but my RN soon explained. 

After she started the adriamycin drip, my nurse informed me that the next chemo drug would be Taxol, a powerful poison known for interfering with cancer cell growth and promoting tumor shrinkage.  I learned that the thick and sticky drug would require three hours to be injected into my system, and due to the possibility of an allergic reaction, I would receive liquid Benadryl intravenously along with the Taxol. Based on what my RN had just told me, I was quickly becoming anxious about the next phase of my treatment plan.  According to the nurse, possible drug consequences were hives, difficulty breathing, low blood pressure and/or fainting, and swelling of the face, lips, tongue, or throat.  My mind was whirling with “what ifs.”

When I was diagnosed with cancer, never once did I dread the idea of chemotherapy.  In fact, I embraced it and was ready to get started because I knew it was necessary to rid my body of cancer.  But, for the first time, I was nervous and even scared to begin the next phase of Dr. Makhoul’s prescribed treatment plan. “Oh, my” was the only response I could manage.

My concern deepened when the nurse elaborated about the side effects of Taxol, which include severe fatigue, flu-like symptoms and temporary neuropathy, i.e., tingling and numbness of the hands and feet.  Well, this just keeps getting better and better, I thought.  The RN cautioned that I would need someone with me during and after the Taxol treatment to help monitor my reactions. After hearing all the negatives about Taxol, it made me regret talking so badly about the adriamycin and cytoxan drugs throughout the first four treatments.  It reminded me of the saying, “Be careful what you wish for.”

After the last of the cytoxan had made its way into my vein, the RN removed the needle from my port and handed me the usual pill bottles containing the anti-nausea steroids that would no doubt traumatize my diabetes over the next five days. She then handed one additional bottle to me with instructions to take two pills on July 25, the night before the scheduled Taxol treatment, and two more the following morning.  She identified the new prescription as more anti-nausea steroids that would start working in advance of my introduction to Taxol.  

I left the infusion center with lots on my mind but refused to think ahead to the Taxol.  I had to deal with the present and the drugs currently circulating throughout my system.  There could and probably would be ramifications from the most recent infusion.  It was a “wait and see” situation.

The first few days after treatment four I felt pretty good but was more tired than usual.  Dr. Makhoul warned me to expect the fatigue to intensify as the drug regimen progressed, and once again, his timing was “right on.”  I felt well enough to attend an out-of-town meeting mid-week but physically paid for it upon my return. It was as if the side effects had been waiting for just the right time to slap me with a great big dose of chemotherapy reality. 

I awoke on day seven with bone pain from the Neulasta shot (white blood cell stimulant), a serious case of diarrhea and a mouthful of raw sores.  I kept telling myself that these were merely minor inconveniences and a temporary, but necessary, part of my journey to wellness.  Throughout this process, I have made a sincere effort to keep an upbeat attitude; however, when you feel like a bus just ran over you – twice – it’s best to stay in bed and rest, which I did. Dr. Makhoul has repeatedly told me to give in to the symptoms and not use precious energy to fight them.  I now understand what he meant. With chemotherapy, there is no rhyme or reason for how (or when) it affects the body.  It’s merely a situation of rolling with the punches and continuing the good fight…no matter how bad you might feel.

     

Saturday, July 13, 2013

Sometimes You Just Need to Cry

The day before my most recent chemo treatment, which was scheduled on July 12, I met with Dr. James Yuen, Chief of Plastic Surgery at UAMS, and the surgeon assigned to handle my breast reconstruction simultaneously with the bilateral mastectomies.  I was actually excited for my first visit with him about the procedure, especially since it will be the longest phase of my breast cancer journey.  In preparation for my appointment, Dr. Yuen’s nurse forwarded several informative brochures in the mail about the latest and greatest breakthroughs in reconstructive surgery, as well as the types of implants that are now available.  The reading materials were full of overwhelmingly technical jargon, which forced me to write down lots of questions to ask the doctor.  I was prepared for the appointment.  



Dr. Yuen has been described as a masterful artist with the human body being his canvas.  When he entered the exam room, I immediately started sizing him up (only fair since he was going to be analyzing my breasts). He appeared to be in his mid to late 40s and had wisdom written all over his Asian face.  When he first started talking to me, I could immediately tell why he was a member of my wellness team and why nationally renowned breast surgeon Dr. Suzanne Klimberg appointed him as her tag-team reconstruction magician. Assisting Dr. Yuen during the appointment was a young female surgeon, whose job it would be to insert the temporary tissue expanders that stretch the breast skin in preparation for the permanent prosthesis devices. Also, making up the interview team was a male plastic surgery resident who would shadow Dr. Yuen during the surgery.

Before I was given the opportunity to ask Dr. Yuen any questions, he immediately started pelting me with inquiries, such as how many chemo treatments had I endured; whether or not I had experienced harsh side effects; and, had the mass reduced in size since treatments began in late May.  And, then he began to zero in on a topic from my chart that surprised me.  He noticed that I was an insulin dependent diabetic.  “This could change the scope and timing of the surgery,” he said without hesitation.  I could feel the anxiety filling my chest. He asked the range of my blood sugars and I shared that when I took the steroids during and immediately after the chemo treatments (to prevent nausea and vomiting), the levels were as high as 300+  (normal is 80-120) and could dramatically drop to lows in the 50s and 40s. “Hmmmmm,” he responded (seldom is that good coming from a doctor). I asked him to explain.

Dr. Yuen elaborated that normally mastectomy surgeries are scheduled about four weeks after the last chemotherapy treatment, providing time for the body to recover (somewhat) from the toxic drugs circulating through the system. Because I’m diabetic, I already have a compromised immune system and the chemo drugs further weaken my system and my ability to fight off infections.  He said implanting foreign objects, such as the temporary expanders in my breasts, would more than likely cause my body to reject the procedure and the implants.  He said 5% of his breast patients are diabetic and 90% of them who opt for reconstruction simultaneously with the mastectomy have major infections.  Some even have to have the devices removed, followed by a lengthy recovery then the procedure is attempted again after ample healing. 

Wow!  That revelation rendered me speechless, which isn’t an easy task. (Anyone who knows me will attest to that.)   During my initial appointment with Dr. Klimberg in mid-May, she never indicated that delayed reconstruction could be a possibility.  My chemo-fuzzed brain had already processed my cancer recovery timeline from diagnosis to the finished process and no where in all that did I factor in a six-month delay after the initial surgery.  In my timeline, I would have newly constructed ta-tas and be brushing my natural hair no later than March 2014. I was not only disappointed at what I had just been told; I could feel the tachycardia (rapid heart beat) taking over. Dr. Yuen warned me that I would probably endure emotional strife should the decision be made to postpone the reconstruction for six months.  “Just be prepared,” he cautioned me.

Dr. Yuen said if I felt like rolling the dice and going ahead with the simultaneous surgeries, he would support me, but he just wanted me to be aware of what could happen. Don, wearing his medical hat, immediately spoke up and told Dr.Yuen that “we” would do whatever to protect my health and there would be no risk-taking.  Suddenly, I became angry at Don for speaking on my behalf. For a moment, I felt like one-half of a ventriloquist act. Because he, too, is a surgeon, as well as my very significant other, he sometimes forgets that I have a voice in all the medical decisions pertaining to my cancer treatment.  I glared at him then told Dr. Yuen that I would process everything he had told me and let him know my decision as soon as Dr. Klimberg set the date for the mastectomy surgery.  While I love Don and know he only wants what’s best for me, I’m the one who has to ultimately make the choices that I think are right for me.  That doesn’t imply I won’t delay the procedure; it just means that I have to be comfortable and mentally prepared for the decision that is made.

Don and I said little on the ride from UAMS to my condo.  I couldn’t talk.  Tears were right on the edge of every word that might role off my tongue so I just decided not to even try to converse.  It wasn’t anger. It was the surprise of things not going according to plan.  You see, I’m the ultimate planner and somewhat of a control freak - a definite type-A personality.  When someone like me receives a cancer diagnosis, we go just a little crazy because we are no longer in charge of our bodies.  First, the cancer is in charge prior to the diagnosis, then in order to rid the body of the beast, you turn your immediate life and well-being over to a team of doctors. They are in control for the duration of the treatment. I had it in my head that I could once again be in command of my life sometime in February or March 2014.  Based on what Dr. Yuen had told me, that wasn’t going to happen.  In fact, it would probably be June or July of next year before the reconstruction process would even begin.  Pardon the pun, but it was a hard pill to swallow.

I reported to work shortly after my appointment with Dr. Yuen and traipsed to my friend Gloria’s office for a cup of coffee.  She asked about the appointment and I tried to share the details with her but just couldn’t.  I told her I would explain later.  I returned to my office, shut the door and the tears flowed.  Sometimes, you just need to cry.  Perhaps, it was two months of treatments, more than ten blog compositions and my ongoing attempts to be upbeat for friends and family that helped provoke the tears.  I was emotional for the remainder of the day.  At times, I thought I was being overly sensitive and slightly self-centered.  But, it was deeper than that and I couldn’t explain it to anyone, not even Don.

My fourth chemo treatment was scheduled the next day.  I knew I had to shake off the emotions and prepare for another tough day.  And, this too shall pass…

Monday, July 1, 2013

Treatment Three: A "Phenomenal" Report

The third chemo treatment was scheduled on Friday, June 28, rather than my usual Tuesday time slot, due to my oncologist, Dr. Makhoul, being over-booked with new patients. It always saddens me to learn that there are more people coming into the UAMS cancer treatment program than are leaving it. Why must this insidious disease impact the lives of so many?  I am very hopeful that the research being conducted on behalf of cancer patients everywhere will soon prove successful.  Each day brings with it new possibilities for a cure. I am optimistic that in my lifetime I will help celebrate the day the general population will be able to receive a vaccine and spared the fear and uncertainty of chemotherapy.   And, I am especially prayerful that the children of the world will be first on the vaccine list.  


Marla Crider, breast cancer, Fayetteville, Arkansas, Little Rock, UAMS
The "Carmen Miranda" look
Each time I report for my twice-monthly blood work and chemotherapy appointments at the Winthrop P. Rockefeller (WPR) Cancer Institute, I always see a few new faces among the familiar ones.  Those of us that have a few treatments under our belts, like me, look at the expressions of the apprehensive ones as we try to figure out which particular cancer has invaded their bodies.  We stand ready to offer verbal guidance or moral support to the fresh, unknowing patients; however, we only answer questions that are asked of us.  We never intrude.  The new ones are easy to detect; they still have their natural hair and a bounce in their step.  The rest of us are usually overcome with fatigue and can be easily identified by the baldness of our heads or the stylish headgear that we assume is only temporary.

For my third treatment, my middle brother, Marion, and sister-in-law, Carolyn, accompanied me through a full afternoon of blood work, an appointment with Dr. Makhoul and the chemo infusion. They made the trip from Northwest Arkansas earlier that morning to experience my journey first hand.  My significant other, Don, was recuperating from a medical situation of his own and couldn’t manage the necessary walking that is a significant part of treatment day.

We arrived for the blood work precisely at 11 a.m. and the waiting room was full of patients.  All of us were in line, so to speak, to get our blood drawn to determine what kind of havoc the previous chemo treatment had inflicted on our bodies. After a 40 minute wait, my name was called by a nurse’s assistant. I was escorted to the scales for my biweekly weigh-in that made me feel somewhat like a prize fighter.  After all, isn’t that what I was doing?  Fighting the biggest battle of my life? I had dropped a pound but knew that was more about the erratic diabetes than the chemo. 

Next, my blood pressure, temperature and pulse were monitored and all seemed to be within range.  A few weeks earlier, when I saw my primary care physician about my roller coaster diabetes, he determined that I was also experiencing low blood pressure - 98/62 - and changed the dosage of the lisinopril medication I had been taking for years to protect my kidneys from the potential harmful effects of the diabetes.  In addition to the low blood pressure, I was also having symptoms of tachycardia or rapid heart beat, which had been going on since the second chemo treatment.  My resting heart rate was averaging 106-112 beats per minute.  It’s rather disconcerting to be sitting in your office and feel like you have just completed a 10K marathon (ok, in my case a 5K would be more like it), but that’s the way it had been for the past two weeks. I knew this was a symptom that should be discussed with Dr. Makhoul.

After my vital signs had been recorded, the tech asked me to be seated in the third chair in the front section of the infusion room.  She said Nurse Mary would be right with me.  What?  No Mr. Nurse Ratched?   Well, darn, I was ready for him, too.  I had generously dabbed the numbing cream on my chemo port before I left home to ensure my nemesis nurse wouldn’t bring me to my knees in pain, when he jabbed the needle into the ultra sensitive area under my left collarbone. 

Nurse Mary walked to my chair a few minutes later carrying all the necessary vials for the blood draw.  She began swabbing the top of my port to remove the numbing cream.  I noticed that I could feel very little as the swab moved back and forth across the skin that was usually very tender.  There are still days that I would like to get my hands on Dr. McDreamy, the port installer, and not for the reasons you might think.  The port was definitely positioned on a nerve and sometimes, when I inadvertently brush my hand across it, I have to catch my breath for a few seconds.  It’s like an electrical shock piercing through my entire body. Ahhh, the curse of Dr. McDreamy. 

As Nurse Mary verbally prepared me for the stick of the short but large gauge needle, I couldn’t feel it at first then she had to bear down to get the needle to penetrate the port.  That’s when I began sliding down the leather recliner in pain, hoping I would be just out of her reach.  Every time she pushed on the needle, a multitude of electrical shocks rippled through my body.  She kept apologizing for hurting me but that sure didn’t help the situation.  Finally, the needle made proper contact with the port and the blood began filling the vials, one right after another.  Nurse Mary explained that the needle was dull, because she never remembered having to press so hard to get a needle to connect with a port. Well, ain’t that just dandy - a dull needle on top of my usual port calamities. She left the evil needle in the port and taped the little infusion tubes to my chest for the chemo treatment that would take place a few hours later. 

I escaped the chair of terror and met Marion and Carolyn in the waiting room.  We gathered up our reading material, as well as my carry-all bag that contained details about my life since my May 1 diagnosis, and departed upstairs for my 12 noon appointment with Dr. Makhoul.  When we got off the elevator and looked in the large, open-air waiting room with the floor to ceiling glass walls, I knew it was going to be another lengthy wait.  The place was overflowing with patients and family members, all anxious to talk to their oncologists.  There were older people in wheelchairs wrapped in light blankets and young people walking on crutches, post-cancer surgery.  Trust me; the disease doesn’t discriminate by age, race or status in life. 

We found three chairs together and began our wait.  About 45 minutes later, my name was called and Carolyn decided she wanted to accompany me to my meeting with Dr. Makhoul.  She is the analytical one of the husband-wife duo. Marion is the let’s-just-do-it brother and very much like my father's side of the family.  A tech ushered us to a cubicle that had Dr. Makhoul’s name affixed to the door frame.  She left the door open indicating that Brenda, Dr. Makhoul’s efficient nurse, would be popping in soon to inquire about any side effects after treatment two.

Brenda appeared about 15 minutes later and began asking the usual questions. She was still amazed that I hadn’t experienced any harsh side effects.  I did tell her about the tachycardia and she said that Dr. Makhoul would address that with me.  She gave me a gown and told me to “suit up” for the breast exam.  I was rather excited for Dr. Makhoul to measure the tumor because I could definitely tell a difference. 

It was 1:45 p.m. when Dr. Makhoul made a hurried entrance into my cubicle.  He checked the notes Brenda had left for him in my computerized chart. That’s when he said it. “Ms. Marla, you are a phenomenal patient.  I’m impressed with how well you are tolerating the treatments.”  (You and me both, Dr. Mak.)  He noticed the mention of tachycardia in Brenda’s notes and said it’s a side effect of the treatment and that my heart rate “should” return to normal after the treatments are completed, which is anticipated to be another 2 ½ months.  I can certainly deal with that along with the night sweats, insomnia and chemo brain.  He did ask how I was sleeping and I had to admit that I wasn’t.  He told me to take two lorazepam tablets right before bedtime.  Fortunately, Dr. Mak prescribed the anti-anxiety meds prior to my first treatment, so I already had them on hand.

It was now time to check the size of the tumor.  He pulled out his handy-dandy caliper-like contraption and began to measure the mass.  He looked at me then back at the caliper.  “It’s down to 3.8 centimeters,” he told me excitedly. “This is great, just great,” my magician of a doctor told me.  “I want to reiterate that you truly are a phenomenal patient.” (I wanted to flippantly tell him that I bet he said that to all the girls, but I couldn’t. I truly did want to be as phenomenal as he kept telling me I was.)  “We’re on our way,” he said as he signed my chemo orders and sent me downstairs for treatment three.

Because my chemo team recommends eating a snack before chemo, Marion, Carolyn and I stopped by the WPR Cancer Institute cafeteria for something to tide us over until dinner time. We arrived in the infusion center and it had cleared out considerably since the late morning hours.  Only a few minutes had passed when my name was called.  Carolyn and I made our way to the assigned recliner in the infusion room.  I settled into the chair and made myself as comfortable as possible.  Carolyn was sitting in the visitor chair beside me so she could see everything that was happening.  And, then he approached…Mr. Nurse Ratched was going to be my nurse.  I had made a bet with Carolyn that he would say something about my hair and/or wig first thing and he didn’t disappoint me.  “I really like the wig,” he said.  What had gotten into him over the past two weeks?  Was it because there was someone different sitting beside me?  He was actually being empathetic.  Hmmm.  I was suspect. 
My brother, Marion Crider
 
He quickly hooked me up to the red, adriamycin as usual and allowed it to drip faster than I remembered.  I could feel the cold, red toxin as it made its way from the hanging bag to my port.  As soon as it hit my system, I could sense the nasty, metallic taste on the back of my tongue.  I quickly grabbed a piece of gum to counteract the bitterness. 

Seated in a recliner across from me was a young woman who looked to be in her 30s.  She had a bright pink scarf tied around her bald head with a large pink flower affixed to it.  She nodded at me. We had seen each other earlier in Dr. Makhoul's waiting room. I asked her how many treatments she had endured.  She said ten treatments with another eight to go.  I responded that it was my third treatment.  I didn’t have the heart to tell her that my anticipated treatment schedule would be shorter than hers.  Carolyn and I watched her pretty eyes fight back tears when she told us that surgery might not be an option in her case.  “The doctors aren’t sure it will do much good," she bravely shared with us. And then her tears flowed.  It devastated me to think that such a young, beautiful woman might not have a good prognosis after all the wear and tear of chemo on her body.  It just wasn't fair.  Her honesty subdued me to the point that I refrained from my usual banter with Mr. Nurse Ratched.  It was as if he knew exactly what was going on and was rather quiet himself.  

After the adriamycin had trickled the last drop into my veins, Mr. Nurse Ratched hooked me up to the cytoxin.  He turned it on full blast and I could feel the sneeze-like burn in my nose, which is a usual reaction. It was at this point that Carolyn switched places with my brother and he came to sit with me as the last of the toxins were being fed into my body. As we sat together, I couldn’t take my eyes off the 30-something woman across from me.  At that moment, I thought she was the bravest person I had ever met. 
 
About 20 minutes later, Mr. Nurse Ratched returned to disconnect the empty cytoxin bag, flush out my port, and remove the pesky, painful needle, which wasn’t nearly as bad coming out as it was going in a few hours earlier.  He loaded me up with the usual anti-nausea steroids and sent me on my way but not before reminding me that I was scheduled for a Neulasta shot at 3 p.m. the next day. Before I left the infusion room, I walked over to the young woman, who had told me she would be there another hour, and squeezed her hand.  It was the silent code between two fighters. 

Marion, Carolyn and I departed UAMS after a very long afternoon of waiting.  When we returned to my condo, it was easy to tell that we were all fatigued, not just me.  What troopers they had been, as well as being a very good support system on treatment day. 

I was exhausted and ready for bed at 9 p.m.  Before retiring for the night, I took the two lorazepam tablets as Dr. Makhoul suggested and slept until 4 a.m. – my longest stretch of sleep for more than a month.  When I awoke, the bright-eyed, young woman was still on my mind.  Her admission had made me step back and take another long look at my own mortality, which I hadn’t really had time to do since first hearing the “C” word thrown at me nearly two months earlier.  Yes, it’s a fact that I do have cancer.  It is also a fact that I have the best breast cancer treatment team in all of Arkansas.  And it's a fact that with every ounce of my being I will be a cancer survivor, not a statistic.  The only way I know how to combat this destructive disease is with attitude…a salty, defiant attitude.

The young woman I had encountered the day before inspired me to wrap my balding head in a festive scarf, just as she had, with a flower atop, rather than be confined to a hot, synthetic wig, especially on weekends.  I made a trip to Stein Mart, which is located dangerously close to my condo, and purchased several scarves and three obnoxiously large clip-on flowers to add pizzazz to my newly acquired head wraps. I had made up my mind that I would start wearing scarves, occasionally, in honor of her – the nameless and brave young lady that I will not forget anytime soon.