Inside, I find the current issue of Vanity Fair, Burt’s Bees lip balm, a worry bead doll, Aveeno moisturizer, and a Rain Forest chocolate bar (because this is eco-town San Francisco and there are other things to worry about besides breast cancer). Best of all—really, really best of all—there’s a slip of paper explaining the Cleaning for a Reason” program. Once a month for four months, for free, a participating maid service will send a house cleaner to our home while I’m going through chemo. This is selfish—I’m an environmental writer, after all—but right now, house cleaning is worth more than a bushel of “Save the Rain Forest” chocolate. Maybe there’s a similar “Cooking for Chemo Moms” program. I’ll have to research that. Bagels, PBJs, ramen noodles, pasta with red sauce, cereal, toast, scrambled eggs—that comprises my husband’s entire culinary repertoire.
At the bottom of the bag, there’s a note from a woman named “Andi.” She was diagnosed with breast cancer at age 25, while she was pregnant. Her son is now 25, and she remains cancer-free. To celebrate, she got 30 friends together to make the goody bags and give encouragement to women like me, who are going through chemo for the first time. Thanks Andi.
I barely have time to paw through the bag when one of the medical assistants calls me for the usual temperature, blood pressure check and dismaying weigh-in. It took two years to put it on, so why do I expect it to come off in two or three weeks? Then, husband Pete and I are shepherded into an exam room.
Within a few minutes, one of the oncology triage nurses, Janine joins us. She’s Italian, from New York, but has spent most of her life in mellow Marin County, just north of the city. She manages to straddle those two universes, brassy, intense New York, and crunchy granola Marin, with charm. Perhaps because we see the reflection of our own New York/California contradictions in Janine, Pete and I both like this nurse immediately. Janine has an RN, and an Master’s of Science in Nursing (MSN). She worked at Genentech, doing research. She spent eight years of her career nursing patients undergoing bone marrow transplants.
Over the years, I’ve done half a dozen stories about bone marrow transplants for Family Circle magazine. It was the public service commitment of an editor-in-chief, now a victim of print journalism’s implosion. During the revision of the first bone marrow feature, my editor called to make sure that I wasn’t making the lurid side effects up, bones that ache from within, eyeballs that change shape and so on. The editor couldn’t believe it is really that bad. It is.
“Chemo is bad,” I say. “But having a bone marrow transplant is much, much worse.”
“You’re right,” Janine says. “I’m not sure I would do it. People do it for their kids. They want to make sure they’ve done everything they can to survive. There are several of us at the breast care center who used to do bone marrow transplant work. We love what we do; no one can survive this work unless they love it. Chemo seems like a breeze after the bone marrow ward.”
She leaves the room for a moment to get an information sheet that she thinks I’ll need. While she’s gone, Pete and I comment that it’s great that she’s so whip smart. She is where the rubber will meet the road during my chemo. We’ll call her first if there’s a problem, she’ll decide whether to kick the problem up to the oncology fellow sitting in the “hot seat” that day (fielding all patient chemo questions) or whether it deserves Dr. Rugo’s attention.
When she returns with the last info sheet, Janine gets serious. Chemo, of course, is not a breeze. It’s just not as harrowing as the living death of a bone marrow transplant. She explains some things that we already knew: Chemo is like blanket bombing a country. Cancer cells divide quickly, so the chemo kills all quickly dividing cells. While the chemo kills cancer cells, there’s a lot of what the military would call “collateral damage”: white blood cells that fight infection, hair follicles, mouth cells and cells in the digestive tract, fingernail cells.
My particular “cocktail” will be Carboplatin, a classic, hard-hitting chemo drug, Taxotere, in the same family as Taxol, and Herceptin, to kill off those cancer cells that seem to have the Her-2 receptor.
In addition to new, targeted drugs like Herceptin, a large part of the progress in cancer treatment seems to have come in the form of better managing the chemo cocktail hangover: an arsenal of anti-nausea drugs, drugs that bolster immune systems when chemo is killing off all the white blood cells, plus various vitamin supplements, over-the-counter remedies for diarrhea, constipation, rashes, itching, insomina, and aching.
“A couple decades ago, we couldn’t give the drugs in the doses that would be most effective because the patients just wouldn’t be able to tolerate it,” Janine explains. “Now we can.”
Then she walks us through the details of each drug, and each of the drugs’ possible side effects. It’s murky, of course, because how each individual responds to chemo is completely different. Taxotere can cause weight gain, but Carboplatin can result in loss of appetite and weight. (I’m rooting for Carboplatin in that case.) Herceptin can cause diarrhea, but Carboplatin can plug up a person.
You never know until you go through it.
Janine says she’s sure I’ll do fine. I’m young (ish) and healthy except for the cancer. Still, she hammers home these message again and again:
• Don’t be tough. We’ve got drugs to spare you the nausea and the vomiting, let us know if the drugs aren’t working.
• Wash your hands. Wash your hands. Wash your hands. Bacterial infections usually result from beasties already living in our digestive system or on our skin. But viruses travel through hand-to-hand contact.
• A fever or chills that indicate an infection can be life-threatening. Chemo weakens your immune system, an infection can lead to sepsis and sepsis can be fatal. If you have a fever of more than 101 degrees Fahrenheit, call us and then go to the emergency room.
• Call if you have a nose bleed, difficulty breathing, an irregular heart beat, unusual bruising, swelling that is uncomfortable, blood in your urine, tarry stools (usually a sign of blood in your GI tract), chills, pains in the side of the back.
Then she calls in prescriptions for my medical goody bag:
I’m going to need 10 or 11 prescription medications to get through this part of the process. That’s not counting shots to beef up my immune system and the nearly one dozen over-the-counter remedies, vitamin supplements and amino acids.
It’s not like those bashes in high school and college, but let the party begin.