Chemo No. 4: "The last of the worst"

“Um, I don’t want to alarm you,” I said to my friend Jan as we left the pharmacy yesterday, “but do you have a bag I can hold just to have handy on the ride back home? I’d hate to have anything happen to your nice car.”

She understood exactly what I meant without my spelling out the icky details.

Yesterday was my final session with the sledgehammer chemo drugs Adriamycin and Cytoxan – “the last of the worst,” as Mark put it. It was also my nastiest bout of nausea yet.

Both drugs have evocative histories – Adriamycin, belying its ugly side effects, is named after the beautiful Adriatic Sea. It was derived from microbes found in the soil outside an 13th century Italian castle, Castel del Monte.

Cytoxan is a derivative of the mustard gas used to grotesque effect in World War I. Every time I get it, I can’t help thinking of “Dulce et Decorum Est” – “Gas! Gas! Quick, boys! — an ecstasy of fumbling.” Mercifully, I don’t have the full terrors of what comes next committed to memory, but a single reading of the poem makes you think you’re insane to voluntarily have that stuff injected in your veins.

Both drugs have been major cancer-fighting agents for more than half a century. That underscores that in fact some cancer treatments haven’t changed significantly – what has changed is the calibration of the doses, and (very luckily for me) the development of much stronger and more effective anti-nausea drugs.

Despite those drugs, I spent a very uncomfortable afternoon and evening (although thankfully I never needed that bag I kept handy), but then I went to bed, slept all night and woke up with just my standard day-after mild queasiness. Somehow it felt appropriate for my final AC that I got the badge of honor of the symptoms everyone most associates with chemo.

And I am relieved that I’ve made it through the worst part of chemo.

Part Two will consist of 12 weekly sessions with Taxol, which doesn’t cause the same gastro-intestinal problems as AC. It does cause exhaustion, something I’m already feeling plenty of from the AC. By 6 pm every day, I feel as if a giant hand is pressing me down on the couch and my brain has turned into a bowl of mush.

Taxol’s biggest side effect is neuropathy – tingling, numbness and sometimes pain in the fingers and toes. Michelle, my nice chemo nurse yesterday, said that virtually all Taxol patients experience some neuropathy. “You’ll notice you’ll have trouble buttoning your clothes and you’ll start dropping things,” she said. “Your feet might feel like you’re walking on coals.”

But neuropathy is usually not permanent for people like me who get reduced doses over 12 weeks, she said. If the symptoms get too severe, my oncologist will temporarily suspend treatment until they subside. The worse the neuropathy gets, the higher the chance that it will stick around. One of the cancer center doctors is an acupuncturist and I’ve started treatments with her to try to lessen its impact. They are pretty good there about “integrative medicine” – incorporating Eastern as well as Western treatments.

When I saw my own oncologist Dr. D yesterday, I told her how anxious I’d been feeling about what Dr. Hope conveyed (BTW, Dr. Hope was compassionate in her presentation, she had a perfectly fine bedside manner; it’s just that the information she had to share was something that no amount of kindness could soften).

Dr. D said simply: “Well, you’re young and we’re doing everything we can.”

I am starting to emerge from my two weeks in Freak Out City. For one thing, I just can’t live with that heightened level of fear. For another, the things people keep telling me are slowly sinking into my mush-like brain.

As someone who has a hard time living with not-knowing, I really took to heart this beautiful quote from Rainer Maria Rilke's "Letters to a Young Poet" that Lori from C Squad posted on yesterday's comments:

Have patience with everything unresolved in your heart and try to love the questions themselves as if they were locked rooms or books written in a very foreign language. Don't search for the answers, which could not be given to you now, because you would not be able to live them. And the point is to live everything. Live the questions now. Perhaps then, someday far in the future,you will gradually, without even noticing it, live your way into the answer.

My brother-in-law Richard, who recently emerged cancer-free from his own grueling chemo treatments, had these words of wisdom about the statistics I keep harping on:

I feel about cancer stats the way Mike Ditka summed up his interest in the past -- "it's for cowards and losers." Though I abhor his neanderthal politics and sell anything antics, Coach D. was right on this point. Forget the charts and probabilities. You are doing great. You have taken some pretty heavy blows and you're still riding your bike and having positive experiences every day. I can't say why an information junkie like me never even was tempted to look up my odds, but I'm glad I didn't. I always doubt actors or writers who say they never read a word of their reviews, but some must be telling the truth. It's how you respond and your body's strength that will matter, not the general population of women who share this burden.

It is really good that you have the blog to work through your fears, but screw the statistics.

(And Mark and I used to memorize all the ballplayers batting averages as kids). But like a slot machine, each at bat, each pull of the lever is an independent event, just like each cancer.

So screw 'em indeed. I’m me, not a statistic.