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.

1 comment:

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