There is so much that is so wrong about chemo on so many levels. This dawned on me as I sat opposite my best friend, already far more comfortable and better prepared for what was about to happen than I could even pretend to be. I didn't need to: I was there, but I was nothing more than a welcome addition rather than anything essential to this morning's proceedings...
We arrived on time. We were not the first, and the nurse's instructions (not to mention the 'q word', as it was, at that point, fairly quiet) were not without good reason: in the three and a half hours we spent on the day unit, it progressively filled up. Soon there was not an empty chair in the house, and this was, it was very clear, just a normal day for all concerned.
There is something about this end of medicine that is (from where I was sitting, as undiagnosed but not, I would say, unaffected, observer) strangely comforting. Or at least resilience promoting. Everyone is getting on with it. And, they are there for you, if you want company along the way. There is no insistence on any camaraderie, but there is no need to feel alone either.
The warnings were read. Out loud. Again. The patient was asked to confirm her name and her date of birth as the bags containing the all-important cytotoxic ingredient were checked. And double checked. Everything had gone very smoothly, aided by the fact that cannulation was not on the agenda (and will not, with any luck feature looking ahead) thanks to the PICC line that is up and running. This is, we concluded, probably a relief to everyone concerned. Veins are not, at this point, in great quantities, and those that 'might be of interest' (as one nurse put it, as she tapped away on the nextdoor patient's forearm) are very few and far between. Charlotte's arms have been through it over the last few years.
The bag was hooked up, and the timer set. Then followed the Zometa - to keep Charlotte's bones super strong and avoid any complications the alien might leave in her wake. Lastly, it was time for line maintenance. The last hurdle. Overcome with grace: "Notice it, and let it go..." a gentle voice reminded herself as she breathed into the discomfort. Serenity personified.
Today my best friend was described to me as always having been 'very pleasant' by a nurse who has come to know her over the last 3 years. I experienced her (once again) in rather more glowing terms. She was, quite simply, the model of calm. This is simply what needs to happen, and it's good to have a plan. It is an assertive plan of action. There is little room for hesitation in the schedule, but any queries or concerns will be handled with the utmost care by the team whose care she is under, which radiates wisdom, strength and hope. No question is too silly, and no concern too insignificant for them. Patients matter. How they feel about their treatment matters. Confidence is a significant ingredient with a key role to play.
The point of the chemo is to powerfully destroy the alien and kick every last remnant of it out. The alien lacks inhibition (of any sort) and is doing Charlotte no good at all. Chemo's ability to exterminate this foul interloper depends on its ability to halt cell division (what happens relentlessly, due to her lack of inhibition). Chemo barges in on this chaos without apology, thus disabling the cells from doing what they are driven to do, obstructing the cancer, and killing the cells: as they are forcibly prevented from dividing, they must die. And this is the good part: the faster the cells are dividing (which, given Charlotte's recent presentation looks to be super swiftly) the more likely the chemo will induce cell suicide.
Today was Round 1 of 6 of the new concoction to kill the evil alien who has raised her ugly head once more. Carboplatin is the name of the new road my best friend has embarked upon which will take the form of 21 day cycles: just enough time to allow her body to recover before taking the next hit. Bring it on...