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This is part of the full text of the medical memoir "Cancer Patient" written by Hugh Cook. The full text has been published online on a free-to-read-online basis. This autobiographical non-fiction account deals with the author's initial health problems, diagnosis, and treatment with chemotherapy and radiation therapy.

The complete text of "Cancer Patient" is here on this web site but is also available for purchase from amazon.com as a proper printed paperback book. The full text may also be purchased as a download (a PDF file) from lulu.com for US $5. Go to lulu.com/hughcook

For a chapter-by-chapter breakdown of what's in the book (in its online version, in the PDF version and in the paperback version), see:-

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CANCER PATIENT is a medical memoir which deals with the author's autobiographical experiences which involve, amongst other things, chemotherapy, radiation therapy, a brain biopsy, a lumbar puncture (and then some more lumbar punctures), treatment with Ara-C, treatment with vincristine, treatment with methotrexate, treatment with radiation from a linear accelerator, and a vitrectomy (an operation to remove the jelly from an eye). This is a non-fiction account but it does contain a couple of fictional stories, clearly identified as such, and it also includes some poetry.

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Chapter Thirty-Eight

Summary

In hospital for yet another chemotherapy cycle, the author endures hospital food. The author provides details of his chemotherapy protocol (that is, his chemotherapy treatment plan). This is the author's attempt to give a step-by-step breakdown of the chemotherapy process as he experienced it. However, this just is the author's personal experience, not an account of how chemotherapy is always done, and different patients could quite possibly experience different treatment regimes. The author writes not from a position of expertise but from a position of ignorance. The author supplies a chemotherapy poem.


        Friday 15 April 2005.
        Yesterday morning I was in the shower when Auckland Hospital called to tell me to come in for my fifth cycle of chemotherapy at 11:00 rather than 10:00.
        I did so, arriving tired and scratchy, expecting that I would start receiving intravenous fluids as twelve noon as usual. But, no, the start time for IV fluid had been delayed until 18:00.
        I was able to order the lamb casserole for dinner, but what turned up instead was the cheesy bake, a disgusting mess of congealed stuff that I deemed inedible. I supplemented my evening meal with my own food: an apple, an orange, some seaweed crackers and some scroggin (a mix of nuts, raisins, pumpkin seeds and the like).
        Putting in a needle for an IV line usually goes smoothly, but on this occasion to get the lure (as they call it) in place took three different medical professionals (two nurses then one doctor, all women) and five needles.
        After that bumpy start, however, I went off to sleep solidly and magnificently, which made up for it.
        At this point I'm going to outline my protocol: the standard treatment plan for my five-day chemotherapy cycles.


* * *



        Hugh's Protocol (Chemotherapy Treatment Plan)
        (the pattern followed for chemo cycles 1 through 4)

        A. For eighteen hours, fluid loading with an innocuous combination of potassium chloride and sodium chloride, these two chemicals being supplied by one and the same bag of intravenous fluid.
        B. For the last six of those eighteen hours, sodium bicarbonate to move the pH of the urine in an alkaline direction; during this period the patient urinates into a plastic jug so the output can be measured and dipsticked to see if the pH is the desired eight or more. Stages A and B are to protect the body from the impact of the coming methotrexate.
        C. With IV sodium bicarbonate still up and running, IV methotrexate (a chemotherapy agent) runs for four hours. The methotrexate looks (to me) like a filthy bag of yellowish brown garbage. For the four hours while it's up and running, I try to sleep, or focus on something like reading a book, so I don't think about it.
        D. Following the methotrexate, a syringe of the chemotherapy agent vincristine is injected into a port in the IV line: administering this second chemotherapy agent takes close to zero time.
        E. For twenty hours, IV fluids: one a bag of fluid containing both potassium chloride and sodium chloride (as used before) and the other a bottle containing sodium bicarbonate (again, as used before).
        F. After twenty hours of IV fluids (that is, twenty-four hours after the time when the four-hour infusion of methotrexate was started) folinic acid rescue starts. The IV fluids of step E continue to run. Folinic acid injections are given into a port in an IV line every six hours to neutralize the methotrexate. When blood tests show that the methotrexate level has dropped right down, the treatment is over. On my previous chemotherapy cycles (cycles one through four), there have been, I think, eight folinic acid injections at six-hourly intervals.
        The methotrexate, which was introduced into the body to kill cancer cells, has to be neutralized otherwise it will proceed to do serious damage to the patient, including liver damage.
        In short, first they poison you then they give you the antidote, and, all going well, the cancer suffers more than you do. In my case, in practice the theory has been working out pretty well.
        A rather primitive way of doing business, really, but I'm stuck here in 2005 and can't time machine my way forward to the exquisitely engineered cancer-specific drugs of the far future.
        In addition to steps A to E, at a certain point I get medicines in tablet form, the antiemetics Zofran and Maxolon. I also take my customary daily Losec (an antacid) tablet and my two daily tablets (one milligram each) of dexamethasone (a steroid).
        During the previous chemotherapy cycle (the fourth) I also received an additional eight milligrams of dexamethasone intravenously; apparently one of its functions is to act as an antiemetic.
        Assuming nothing goes wrong, the whole cycle, having started on Thursday, will conclude some time Monday morning, and I should be home Monday afternoon.
        All going to schedule, on Wednesday I will show up at the local branch of Diagnostic Medlab, deliver a twenty-four hour urine sample which I will have collected on the Tuesday, and will have blood tests; the lab results will go to the hospital and will indicate, for example, how well my kidneys are functioning in the aftermath of chemotherapy cycle five.
        At this stage, 06:50 on Friday morning, I actually feel okay. I did sleep really well, which makes all the difference in the world; it's not always easy to sleep in hospital. My pulse, which was skittering along at 92 when I woke on Wednesday, is ticking along at 62, which seems to be a normative resting state for me.
        I have my writing notebooks and some large print library books. And breakfast, which should arrive shortly after 08:00, will be ricebubbles, something even the hospital catering system shouldn't be able to mess up.
        Outlined above, then, is the chemotherapy regime which my medical team devised for treating my individual case of non-Hodgkin's lymphoma (of the large B-cell type) of the central nervous system (brain and spinal cord).
        Additionally, I also had six injections of a chemotherapy agent called Ara-C. These injections were made into the spinal area by a procedure known as a lumbar puncture. I'm glad to say that, having had all six, I'm now scheduled to receive no more. All going well, I'll be able to live out the rest of my life (long or short) without ever again having a lumbar puncture.
        At this stage I should note yet again that this account is intended to serve as an account of one patient's subjective personal experience. It is not intended to serve as a source of medical information and should not be taken as being a source of medical information or advice.
        And what is chemotherapy like, subjectively?
        Well, for me personally, chemotherapy means lying in a hospital bed for days at a time with an IV line in one arm. Occasionally, I do unplug the high-tech drip stand from the mains power supply (a battery takes over the running of the pumps which are controlling the supply of fluid from the IV containers) and push it to the toilet to produce a urine sample.
        Or, on occasion, push it to the nearby kitchen to make a cup of tea. Or, sometimes, push it to the TV room. If I sit and watch TV, there's a place where I can plug in the drip stand, and there is also a call button for summoning nurses if necessary. During previous admission cycles, I've sometimes sat up in the small hours of the morning watching the news on America's Fox TV, or watching the BBC news.
        My own experience of chemotherapy is that it's painless but as boring as hell, an ordeal of imprisonment, me being confined (to my bed and its neighborhood) and tethered (leashed to the cumbersome drip stand by one or more IV lines.) By the end of each of the four previous chemotherapy cycles, I've been in jailbreak mode, furiously impatient to be gone.
        Well, it's now 07:25 on Friday morning. One day is done, and I have four days yet to go. Friday, Saturday, Sunday, Monday. It would be nice to have my computer along, but it's a bit expensive to risk in this insecure environment, and would be a bit difficult to use sitting in bed with a drip in one arm. And I do have books and writing materials. And the TV in the TV room if I'm in the mood.
        One guy here was sitting in bed complaining about how we don't have Internet access. "We have no access at all to the outside world," he said. Perhaps forgetting his cellphone: he most definitely did have one.
        As I think I've noted elsewhere, I've been lucky with the way chemotherapy has worked out for me. In my case, I've tolerated methotrexate well. I did have just a little nausea and vomiting during my first chemotherapy cycle, but since then I've been fine. It's worth noting (perhaps not for the first time) that individuals tend to vary in their reaction to chemotherapy, and my own personal experience is not necessarily indicative of what someone else might experience.
        Above, I've written about the structure of my chemotherapy protocol. Below is a poem which attempts to capture a little more of the flavor of my own personal chemotherapy experience.

* * *

CHEMOTHERAPY


This is not the fireworks show.
This is the fifth cycle:
The repetition of the repetitive.
Chemotherapy:
Poison then antidote.
A siege of IV fluids.

This is not the exploding sun.
This is the therapeutic crypt,
A world removed from the realms of
Surfing dandelions, croissant cafes,
Lipstick kisses and pipebomb hysterias.

This is oncology, the world of:
Relaxed, friendly,
Make yourself at home.
No alarm cries of dementia,
No rabid chimpanzees of panic,
No napalm in the marzipan.
Chemotherapy is not a Christmas stocking
Stacked with ink spray surprises
But a stack of wet bus tickets,
Moldering.

Cancer is not opera.
It is stuffed pillows,
Constipated clocks,
Blancmange without land mines.

In the domain of needles
Broccoli is reliably green
And I am a reclining spine
Gnawed at by zeroes
From now until the ricebubble morning.

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The text on this page is part of the cancer memoir "Cancer Patient" which has been posted online. All the chapters of this book are on this website and can be read for free online. However, the text is copyright - all rights reserved. For permission to use this text or any portion of it contact Hugh Cook.

Disclaimer

        This personal memoir of the writer's encounter with cancer (non-Hodgkin's lymphoma of the large B-cell type) attempts to cleave to the truth. However, the text may contain information that is wrong, outdated, incomplete or otherwise misleading.
        This memoir has been written in a time of illness by a cancer patient who, though he feels sharp enough, must admit to sometimes misinterpreting things, forgetting things, or, on occasion, quite simply not hearing things.
        This memoir is designed to communicate the writer's personal experience and is not intended as a source of medical information. Got a medical question? Ask your doctor.

Cancer Patient Copyright © 2005 Hugh Cook.

Hugh Cook

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