The Zap Count

Dreary day. No mountain, and only one hummingbird (Robin Hood) visiting today. My son is home with a cold — one of those that creates a drippy nose and low fever but doesn’t warrant staying in bed.  So I put him to work helping me with laundry and editing a brain surgery article.  The boy doesn’t know what a brainstem cavernoma is, but he’s got a sharp eye for grammatical errors and incorrect punctuation.

The Popsicle Report:  I can’t believe it.  I had to go to the infusion center last week for my monthly port flush (an unfortunate choice of terms, but I’m not responsible for that).  First one since finishing chemo on New Year’s Eve. The flush consists of hopping in the assigned Barcalounger and going through the motions as if I were getting chemotherapy — except without the nasty drug part.  The nurse pokes the needle into the port and essentially backwashes it with saline and heparin.  The flush takes only a few minutes, and it was during those few minutes that I reminded myself to grab a Popsicle on my way out.  After all, I was legitimately in the right part of the building to snatch one.  I sat there feeling like a high schooler going back to visit elementary school.  The rooms looked familiar in a vague sort of way. (Oh yes, I recall. This window had the stained glass hummingbird on it!)

Afterward, walking across the parking lot to my car, it hit me:  I FORGOT the Popsicle!!!!
I could have, no, SHOULD have gone back  for it, but wouldn’t you know, I had to be somewhere else on time. Grrrrrr……

This week, I’m introducing The Zap Count, a countdown of the days of radiation treatment. Today‘s count:  8 down, 25 to go.

The daily visits to Radiant Care (a name that seems to describe some new type of heating system) are routine now. Drop my son at the bus stop, drive across town to the oncology center, get zapped, drive home.  I’ve got the undressing part streamlined — same room, same locker, shoes at the bottom, hat on the hook — and the technicians continue their assembly line process.  Lights out, the technicians peer at my naked chest as thought it were a map of the moon. The linac moves and buzzes, rotates around, buzzes again.  Off the table and back through the Fish room to get dressed. Films taken on Monday, see the doc on Thursday. Though I see few other patients as I come and go, the technicians tell me they treat about 30 people per day on each of the two machines.  Sixty patients a day, 5 days a week, roughly 50 weeks all works out to 15,000 people per year, give or take.  That’s roughly the population of my hometown.  In 2006, The International Journal of Radiation Oncology counted 2,246 radiation therapy centers in the U.S.  If all of them are as busy as the one I go to, well… with a calculator, you can do the math. And realize that only about half of cancer patients go through radiotherapy.

Those numbers are one of the catalysts for a series of articles in the New York Times a couple weeks ago about the dangers of radiation therapy (link: http://www.nytimes.com/2010/01/24/health/24radiation.html).  The writers describe the horrible details of several patients who were seriously injured because of errors in their treatment, and discuss the lack of regulation of the equipment and personnel involved in delivering the radiation.  One man died after gross over-radiation of his neck during treatment for tongue cancer that he believed developed as a result of his work helping people around the World Trade Center right after it came crashing down. This particular article intends to induce fear.  Whether that fear is justified isn’t quite clear though because the writers fail to follow those journalistic principles of being “fair and balanced.”  Though the articles document numerous errors (fortunately not all as dire as the ones that caused the man’s death), it doesn’t document just how many people are treated with radiation to put those errors in context.

Still, it prompted me to ask Dr. W some questions when she called me today.  She had seen the articles and assured me that Radiant Care has well-trained personnel that does regular checks on equipment, and everything is double- or triple-checked precisely to prevent errors. That’s the reason for the films taken every Monday — to ensure that the patient is in the same position for every treatment and the plan is enacted meticulously.  In my case, that means they watch very closely to ensure that the linac avoids zapping my heart. I was as relieved by Dr. W’s comments concerning the articles as I was for the real reason she called — to report the findings of the biopsy I had last week.

In a previous update, I mentioned that the docs sent me for a mammogram of the left breast and an MRI of both as follow-up to last summer‘s surgery and to lay the groundwork for radiation. For a few days, because of what appeared on the MRI, I feared I was once again in the maw of the beast. A tiny area in the right breast “lit up” (as the professionals say) on the MRI. Barely a month since I finished chemo– how could it be? And so I made a third and fourth trip to the radiology center for a mammogram, then an ultrasound, and then a biopsy of the 4 millimeter spot.  The radiologists didn’t think the spot was cancer but thought it best to check it out thoroughly “given my history” (as the professionals also say).  It turned out to be a harmless cyst, new since last summer and likely the result of fibrocystic changes related to hormone changes (despite the chemically induced menopause) and it collapsed as soon as the biopsy needle went in.

Once again, I deeply resent the fear this disease incites, but I learned much about how radiologists differentiate between harmless and harmful lesions on breast images.  Malicious things light up on MRIs.  On ultrasound images, they have tentacles (“like a starfish,” the technician said) and cast a shadow below them. And cancer doesn’t collapse when you poke it. Your average harmless cyst is nice and round, wider than it is tall, and doesn’t cast a shadow.  I know this because I asked to see the images, in the same way I asked the technician to see the images of the mammogram (which showed nothing!!!!), and I watched the ultrasound image as the doc did the biopsy.  My internist was the one who put me on to this tack last summer by saying “every patient has the right to ask” — to see the images, the records, or whatever it is you need to get answers.  And so, I asked.

And this is what I know: Women fuss about them. Men fawn over them. But except for feeding babies, breasts are highly over-rated.

So now I’m back to just my everyday level of fear (perhaps it’s time to develop a color-coded chart to echo that created by Homeland Security) and I’m determined to push through the radiation, even though it’s a daily reminder that I’m a member of a club I don’t want to be in.  I’m keeping in mind the key word a woman gave me after church last week.  Yes, another one who spotted the telltale headscarf and approached.  She had been watching for me, and flagged me over as we were walking out after the service. She was worried because she hadn’t seen me for a couple of weeks and I explained that we had been out of town and I missed one service because of a cold. Since I didn’t know her, I wondered why she was watching for me. She explained that she’d had breast cancer 7 years ago and understood what the scarf meant. The word she gave me, even forced on me when I said I have breast cancer, is had.  Not have cancer, but had cancer. And she’s right.  Those three letters trigger a vastly different way of thinking.

And  now, for some vastly different identities to go along with that new vocabulary, take a look at these photos:

Incognito

Sr. Mary Audacious

Parrothead.

I’m looking for my last shaker of salt.

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