Cancer Journal 5, 2019

Yesterday’s treatment regimen began with radiation therapy at 10:30 a.m., my third session. As I waited to be called in for the session, a guy came into the waiting room and sat down near me. He introduced himself as Terry (I think…that’s what I’ll call him) and told me he was being treated for throat cancer. He’s a farmer from Dumas Arkansas who, if his circle of friends is any indication of his financial state, is doing reasonably well. He said a good friend from high school, who lives in Houston, is a well-to-do lawyer who has a “extra” house in Houston and who owns a plane. The guy offered Terry a place to stay in Houston and round-trip transportation from Arkansas to Houston if Terry would agree to treatment at M.D. Anderson. Terry’s sister is a nurse at UAMS and she insisted he be treated in Little Rock by the cancer specialists there. Terry said he once owned a house in Hot Springs and spent racing season here, regularly going to the race track and betting on horses with a group of well-off friends who frequently ate at Oak Lawn restaurants and drank top shelf liquor. He stopped going to the races when he stopped drinking alcohol about three years ago. Terry felt like he was getting advice from too many sources. He went out to his hunting blind and sat and thought. He decided to stick with getting his treatment done in Hot Springs.

Terry blamed his throat cancer on a combination of things, include his smoking (he just stopped) and all the chemicals he has to use on his farm (I didn’t ask him what he produced). “Hell, I used 800 gallons of Round-Up just last year. I’m breathing in the fumes from the tractors and the mist of the chemicals. It’s no wonder I’ve got this bullshit.” Terry said cancer is epidemic in and around southeast Arkansas where farming requires enormous volumes of chemicals to generate sufficient crops to make a living. I got the impression that Terry would have rather avoid the chemicals but he couldn’t produce enough to make a living without them.

And then Terry was called in to the treatment room next to mine. He doesn’t know much about me, other than I am being treated for lung cancer and I’m a willing listener.

My treatment was, as promised, quick. From the time I was called in, right on time, until the time I was ready to leave was fifteen or sixteen minutes. And that included a minute or two for one of the techs, Dan, to add touch-up paint to a red cross on my chest. The paint, or whatever it is, has a distinct, pungent odor like a combination of oil and melted crayon (I should say the odor reminds me of melted crayon, as I imagined melted crayon would smell). I think the cross is a target for Dan and his partner to use in aiming the radiation beams.

I allow myself forty-five minutes just to get there from home. I’m tempted to rent an apartment for five days a week. No really. But, maybe.

From my radiation therapy, my wife (who had been waiting patiently in the lobby) trekked to the other side of the building for my first chemo treatment. I was called back and weighed, then taken to an examination room. A few minutes later, Dr. Chen came in, asked a few perfunctory questions, and led us back to the chemo infusion room. The room is filled with chrome-plated metal framed recliners, topped with blue plastic built-in cushions. I was told to take any open spot, which I did. A nice guy named Bob, who I presume worked there, offered me snacks and soft drinks and a blanket, etc. He asked about my cancer. I told him. He said he had lung cancer eight years go. His upper left lobe was removed. He feels fine now. He was given Alimpta, which he said was new then, and a carboplatin. I settled in to my recliner.

A while later, my assigned nurse/tech came over and attempted to insert an access needle into my newly-installed chemo port. Apparently, the needle was too short. Another tech offered advice (“a number 1) and access was granted! The process took longer than I expected, just to get the killer-chemicals dripping. First, for about 20 minutes, a drip bag of anti-nausea drugs was placed on the pole next to my recliner and dripped into me. Then, some other “pre-treatment” drugs were dripped in. Several bags of who-knows-what…she told me, but it didn’t register…were dripped in. Each time a bag emptied, the device from which the drip bags were hung on the pole beeped to alert staff to make a change.

When, finally, the chemo treatment was finished, the tech attached a Neulasta on-body-injection device on my upper left arm. Neulasta is a drug that helps boost the white blood count to reduce the risk of infection. The device attached to my arm was programmed to give me an automatic injection of the drug about 27 hours after the conclusion of my chemo treatment.

What I did not know about the device and the drug until I got home and read the literature is a little disturbing. For example:

• I should not be exposed to X-rays, MRI CT scan, etc.
• I should not drive between 26 and 29 hours after installation of the device;
• A caregiver should be present to monitor whether the device is leaking and take appropriate action;
• If there is evidence of allergic reaction, the caregiver is to contact the healthcare provide immediately and/or seek emergency treatment;
• etc.

I called about the X-rays, etc. The tech said not to worry, just tell them I have a Neulasta device. What about me driving, etc., I asked? No, you should have someone monitor you and you shouldn’t travel during the “active” time for the device.

I then contacted a friend who had offered to give me a ride for my morning treatment, (before I read about some of the more intrusive and demanding aspects of the device), to let her know that the time had changed and to inquire as to whether she could still do it. She could, but would prefer I accept another person’s offer for a ride; but she would do it if that fell through.

The schedule of my radiation treatment coincides with the beginning of the “monitoring” period for the device. So, I shouldn’t be driving or traveling and should have a caregiver present to do all these caregiver deeds…all the while hanging around a parking lot in Hot Springs, I suppose, until the danger is passed.

The more I read about the constraints, the more I decided I could not ask anyone to take it upon themselves to do what was required, even though the offer was serious and I’m sure the time and energy would have been given freely if the schedule worked…monitor leakage of the device, take appropriate action, rush me to ER, etc. etc. if things went haywire.

So, this morning I called the radiation folks to try to get an early-in-the-day appointment or to skip today’s treatment. No, no, no. We’ll talk with the techs and the doctor and get back to you. We do not want you to skip a treatment.

The call came back. Go to radiation treatment. You can drive home. We’ve never had any issues with Neulasta. And, so, I will do as the healthcare experts say.  I should be home by the time the injection begins, anyway, so my wife should be able to monitor the device and follow directions on the paperwork if anything looks amiss.