T67: First full week of radiation treatment
It’s been a little over a week since I started my radiation treatment. I have five weeks left, and like the picture above, that time seems to stretch on forever. I know it will soon pass, but it’s hard to feel that way now.
I haven’t written about my radiation treatment yet, probably because it all seems so prosaic, so routine, but maybe that’s the place I can start, by explaining my routine.
Fifteen minutes before my appointment, I walk in and register. I have a card with a bar code that I can use to self-register, or I can register with the receptionist. Thinking about that now, it’s a little disconcerting to realize that everything about me and my cancer is tied to the number on that card. From a certain perspective, I’m a series of records in a database. Nobody treats me that way, though. The receptionist, if she isn’t busy, always smiles and welcomes me, and, as always, the rest of the staff if very professional and if not always friendly, at least courteous.
Don’t take that the wrong way. I don’t expect them to be friendly. They are going to see me for five or six weeks, every day, then I’m going to disappear from their lives. They know I have cancer. When I stop coming for treatment, they are left to wonder, “Did the treatment work, or did he die?” and they probably can never know.
I worked in a nursing home for a year. When someone died, it hurt, but at least I knew, I didn’t see them one day, and then they were gone the next without me knowing what happened to them. It would have left me with a deep hole if I were to come in to work and realize that Bernice wasn’t there, and then to realize I’d never know anything about her again. She would be lost to me, like she never existed; the only thing left would be my memory of her and my concern for her well being. Being professional, but not chummy, is probably a requirement.
After registering, I fill my water bottle up.
Is that detail too prosaic for you? It’s actually one of the most important things I need to do before my treatment. My bladder has to be slightly full for the radiation to be most effective. It’s a bit maddening. I can’t see inside of myself, but I’ve been told that my bladder needs to be fairly, but not uncomfortably, full. Have you ever tried for that? It can be easy, if everything works out right, but what if they are running behind schedule, and suddenly my bladder is uncomfortably full — what do you do? Do you try to empty a bit, but not too much? Do you grin and bear it? Unlike when you’re driving down the highway trying to decide if you should stop at the next rest area, this question actually matters for my long term health.
The other thing that matters are my bowels. The more empty and quiet they are, the better. This type of radiation can have short and long term side effects on the bowels. If my bowels are full or gassy, they’ll get more radiation than if they are empty and quiet. It also makes it harder to aim the radiation properly. That means my lunch, which is 3 hours before my treatment, has become a scary thing. What do I eat to make sure I have a bowel movement right around 3pm? What do I eat to make sure I have as little gas as is possible? If I make the wrong choices, what is going to happen to me? Or maybe it doesn’t really make that much difference, maybe this is just a little thing I worry about so I have something I can do, something I can control.
I walk from the water station back to the “Gowned men’s waiting area”, thoughts about my bowel and bladder running though my head. Everything is bright and clean, there’s no hospital smell at all. As I walk, I pass a nurses station that has a one way mirror into the men’s waiting area. I wonder why they have that. Do they worry about us in there, sitting, waiting for our turn?
The waiting area has a set of lockers and chairs, a large restroom that doubles as a changing room, and a TV. On a good day, there’s no one in the waiting area so I can turn the TV off. Inevitably it’s tuned to Fox News. Why would anyone want to watch Fox News while waiting for radiation treatment? Isn’t this surreal enough without having to hear people talk about president-elect Trump’s cabinet picks?
I put my things into the locker. It’s a tight squeeze, but it’s a little like Wonderland, no matter how much stuff I bring, I can just barely manage to get it in the locker. I keep my water bottle with me, drinking regularly from it, wondering how my bowels are today.
After putting my things in the locker, I grab a pair of “pajama” pants. I hope for a large, even though they are too big for me, because the only other size is XXL. I step into the changing room, sometimes looking longingly at the toilet, wishing I could relieve myself, change my pants, and step back to the waiting area.
If it’s empty, I try to meditate. I’ve had some really enjoyable meditations there. It’s easy to mediate on the inevitability of death, my current focus, when you are facing radiation. If there are other people, we make small talk. Most of the people there are, like me, older men. As you can imagine, our conversations are about our doctors and our cancer. It’s hard to stay cheery. I often meet someone who has already had one round of treatment for prostate cancer and is back. It seems so common, it makes me scared for my future.
Then a tech comes down the hall and says, “Mr. Anderson?” and away I go, towards the treatment room. They are always courteous, asking me how I am, and other bits of small talk, but it’s a short walk, and how I am doing is a complicated topic, so it’s not a deep conversation. It is a human connection, though, and I appreciate that.
I’ve been calling the radiation itself “death rays” but my wife asked me to stop doing that. She likes to think of them as something positive, “cancer killing rays” or “life giving rays”. When walking from the waiting room to the treatment room, I try to think of them that way; I try to think that these treatments, though they are destroying cells in my body, some cancerous and some not, are going to help me live longer.
Then, through the double doors into, for lack of a better term, the machine room. It’s the room with a bunch of computer monitors, all set up to control the procedure. I tell them my name and date of birth and continue on into the treatment room. Two or three techs accompany me.
On the ceiling is a large circular light fixture, covered with blue sky and clouds. It’s designed, I’m sure, so that when I look up at the from the table, I’ll have peaceful thoughts. I don’t know about that, but it’s certainly better than staring at the acoustical tiles that line the ceiling through the rest of the room. Also hanging from the ceiling are two large computer monitors, and laser guides. The light from those guides is lined up with the three tattoos I received a week prior to the start of my treatment during a CT scan; the tattoos serve as guides, if they line me up with the lasers crossing my tattoos, I should be lined up the same way I was when I did the CT scan.
And there, drawing your attention like the massive thing it is, is the machine. It is part X-ray scanner, part radiation delivery machine. The part that I interact with is the table, it’s right in the middle of the room. The first time I walked in, I resisted lying down on it. I didn’t even really realize I was doing that until the techs asked me to lie down. Now I just walk over to it, that original concern already lost in the habit.
I lie down on the table, with my head on a firm foam pillow. The techs put a support under my knees, strap my feet around a foam support, to keep my legs still, and cover me with a blanket. I lower my pajamas and raise my shirt enough so they can see my targeting tattoos. It’s all very professional, like a massage, we all pretend that there’s no hint of nudity. They give me a piece of foam, ellipsoid in shape, to hold to keep my arms in place.
The time for chatting is through now. Using a control much like the ones used in shops with overhead cranes, they move the table, and me with it, into place. They then adjust, pulling the blankets I’m lying on this way and that, me so the lasers align just so. I’m still like a grouse, hiding next to the stump while the hunter walks by. When they get me all lined up, the techs walk out.
The next thing that happens is the machine starts to rotate around me. There’s a click, and a sign that I didn’t notice until it lit up, “X-Ray in Use” comes on, and I feel nothing.
This is the point where I usually close my eyes. I’m just along for the ride now.
After a short time, there’s another click and the sign goes out. Then it’s very still. Sometimes there’s music, sometimes there’s nothing. The techs are comparing the scan they just took to the CT, trying to line me up correctly so the radiation is targeted at the right place. Then, having made their determination, the table moves a bit and I know the treatment is about to begin.
Another click and the other sign lights up, “Beam in Use”. The machine whirs, quietly, and begins to rotate around me. If I have my eyes open, I can see two rows of little metal columns, each like an old lead typesetting character, moving, sometimes like a wave, sometimes with no discernible pattern, widening or shrinking the gap between the rows. It’s actually rather lovely, like a machine ballet. Those movements control the aim of the radiation at my body. When the gap is closed, no radiation is sent, the wider the gap, the wider the radiation beam.
After a little while, maybe 5 minutes, maybe 10, usually just as I’m falling asleep, the whirring stops, the sign turns off, the techs come back and free me from the table. I get up, we wish each other a good afternoon, sometimes with a cheery, “See you tomorrow” and I walk myself back to the waiting room.
As I write this, I realize that on that walk I’m always in a bit of a hurry.
Back in the waiting room, I step into the changing room/bathroom, relieve my bladder (remember, my bladder has been full this whole time), change into my pants, gather my things out of my locker, and head out, back to the world where I’m not a cancer patient, I’m just another guy trying to catch the light rail back to downtown.