For another week, a survivor

There's a quick prick, and the needle is in my vein.

“She's a champ; she never moves when the needle goes in,” says Carolyne, a phlebotomist at the Midwest Cancer Center near 172nd Street and West Center Road, where I have chemotherapy three out of every four weeks. She's drawing blood out of a tricky vein on my forearm, but it's turned out to be one of the easiest to access.

I may not flinch (much) when the needle goes in, but after two years of being treated for cancer, I still turn my head away. I don't really want to see the blood coming out.

I arrived this morning about 9:15. This test of my blood counts is one of the first orders of business — along with a blood pressure check, an analysis of my urine and an exam by the nurse practitioner, since my doctor is out of the office today.

Then I head into the treatment room — a large, open, airy space outfitted with two big-screen TVs, a table where a jigsaw puzzle is continuously in progress, a counter with coffee, teas, hot chocolate and instant soups, and dozens of leather recliners. Behind each of those stand the tall silver IV poles that indicate the purpose of this place.

I take a seat in one of the recliners, open my purse and take out a bottle of Diet Pepsi — pop is not available at the drink counter. Then I open the first of the medicines I'll take, a pill called Emend that helps with nausea. Last out of my bag is a book of Sudoku puzzles.

It's all part of what has become a very familiar routine. The first time I sat in one of these chairs, I was scared to death. How could I let them drip these awful drugs into me? How could I not?

The chemo process doesn't intimidate me at all now. Aside from a couple of small needle pricks, chemo is painless. The side effects come later.

Jan, my nurse for the day, inserts a needle into the port catheter in my left chest, just a few inches below my collarbone. You can see it if you look closely, a little ring surrounded by three tinier rings, just under the skin. The scar above it, where the surgeon inserted the port, is more obvious.

Jan injects a saline-filled syringe, then another with a nausea medicine. There's a wait for the other medicines they'll administer — the office is busy today with people, like me, who have moved up appointments hoping to beat the worst of this terrible winter's latest snowstorm.

It seems like it snows every Wednesday — this is the joke between me and my mom, who has accompanied me to nearly every chemo session. It was snowing on a Wednesday when it all started.

I was having excruciating back spasms, so I went to a chiropractor the first week of January 2008. He X-rayed my back. The X-ray showed — well, I wasn't sure what it showed other than my left lung looked smaller than my right. I was pretty sure it wasn't supposed to look that way. My chiropractor strongly advised me to see a family doctor.

I made an appointment. More X-rays. There was something “abnormal,” but they weren't sure what. I went in for a CT scan the following day — the day I learned I had a large mass on my lung. The day I felt that the bottom truly dropped out of my world, even though they weren't yet using the “c” word.

I remember walking into the hospital the next day for the test that would confirm it was cancer — adenocarcinoma, as it turned out. It was snowing, making my fingers and ears as cold as the lump of dread in my chest, right next to the real lumps.

***

Heather, another nurse, brings out the IV bag with the remainder of my pre-meds, which help prevent nausea and allergic reactions. One is Benadryl, which means I almost always sleep for part of chemo.

It's 10:50 a.m., so I figure it'll be shortly after 1 p.m. when I finish. It takes about 30 minutes for the pre-meds. The first treatment drug, Taxol, takes an hour. The two others, carboplatin and Avastin, take about a half-hour each.

A man to my right strikes up a conversation with a couple across from us. My ears prick up when I hear him say he has lung cancer. He's never smoked.

“I have lung cancer too, and I never smoked,” I tell him.

Lung cancer, of course, is closely linked with cigarette smoke, but since my diagnosis, I've learned that about 20 percent of cases in women are in nonsmokers. And that lung cancer is far and away the deadliest cancer, killing more people every year than breast, prostate, colorectal and pancreatic cancers combined. Worst of all, the five-year survival rate for Stage IV nonsmall-cell lung cancer — like mine — is 2 percent.

Though I was diagnosed in January 2008, at the age of 41, it was May before it really sank in — before I let myself really believe — that my cancer was terminal. My journal entry from that day:

“It's now 12:30 a.m. and I'm losing it, just a bit. I can't go to bed, because then all there is to do is think about it, and I start crying.

“Dying is such a weird concept. It's still off in the future enough, it doesn't seem any more real than the fuzzy knowledge we all have that we'll die someday. Except it is somehow a more concrete concept when you know that THIS is what you'll probably die of.

“I think about being a ‘survivor.' The Relay for Life is coming up, and I want to walk in the survivor's lap. Are you a survivor if it's just a matter of a few years before you die? We're all dying. So is everyone who lives 'til morning a survivor?”

When I was first diagnosed, I learned of three other nonsmokers in the Omaha area who had lung cancer. I never met any of them, and yet I have wept when each died — for what they went through, for the families they left behind, for the terrible sense of foreboding their deaths give me.

But I'm not giving in. I have scores of people praying for me. And we press on with the chemo.

***

I wake up from my Benadryl fog shortly after noon. The Taxol is done running, and the carbo is dripping in. I take another pill, Zofran, for nausea.

From the very first chemo session, I would feel a little carsick on the ride home. I'd have to keep my eyes closed — I couldn't understand how people could drive themselves home from chemo. (And frankly, I find the moral support of having someone with me hugely comforting.)

A couple of months ago, I got an idea that maybe the Zofran, one of the nausea drugs I take in the days following chemo, would help the car sickness. It worked. So now I can drive myself home — a good thing since the blizzards this winter have kept Mom snowed in at her house on the last few chemo days.

In some ways, chemo is not as bad as many people think. Most associate violent bouts of vomiting with chemo, yet I have not had a problem with vomiting at all. The medicines keep the nausea under control. I do feel a little queasy — like persistent indigestion — on the one week a month I get carboplatin.

But there are many other side effects: Fatigue. Severe constipation. Muscle aches. Bloody mucus. Tingling in my fingertips, a result of slight nerve damage. Obsessing over avoiding sick people since my immune system is compromised. And the latest, blood clots, for which I am now taking blood thinners.

Of course, the most visible side effect is hair loss. During my first course of chemo two years ago, I kept most of my hair, though it did thin noticeably. By the second month this time, my hair was falling out in big gobs, so I had it shaved off. Oddly enough, the hair on my head started growing back in not too many weeks later, even while my eyebrows and eyelashes started falling out.

Chemo, and having cancer, are also hard on my pocketbook. Even with insurance, I've spent more than $11,000 in the last two years, and I'm well on my way to spending another $5,000 to $6,000 this year.

Mostly, though, I am tolerating chemo fairly well. And scans taken last month showed that all the tumors — in my lung, my liver, my abdomen — are shrinking. I am in my sixth month of chemo — the point at which we quit last time — but we'll press on for as many more months as I can tolerate it.

The incentives to stay on chemo are strong. Mostly, because it's working. And there are not a lot of other treatment options for lung cancer. I was on a couple of other drugs in between chemo sessions, but the cancer progressed to my liver in August and we returned to the chemo.

***

Jan checks on me and finds that the Avastin, the last drug of the day, is done. She waits a few seconds for the last little bit to clear the tubing, then switches the pump over to saline for a few minutes to flush things out.

Then it's time for the needle to come out. Sometimes it pinches, but today there's only a slight tug.

It's 1:15 p.m. — I have been here four hours.

She tapes a bandage over the spot. “You're free to go.”

And for another week, I am a survivor.

Contact the writer: 444-1219, susan.white@owh.com

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