About two weeks ago, Pete and I go in for my two-hour, radiation oncology prep appointment. I’m not sure if that’s the official name, but that’s what it was.
We start in an exam room. Dr. Barbara Fowble explains what the course of radiation will entail: six weeks, Monday through Friday. She explains a little bit about how radiation treats cancer. In short, the beams of radiation kick up “free radicals,” bits of cellular flotsam that can damage cells. Healthy cells can repair the damage. Cancer cells, being slightly insane and focused on frantic division rather than normal things like repair, cannot repair the damage from the beams. She covers the possible side effects: tanning and irritation of the skin, possible slight hardening of the breast tissue, fatigue, slight risk of other cancers decades down the road. She outlines the prohibitions: no soaps or lotions on the irradiated ares except the ones she’ll give me, no deodorant on the left side, no underwire bras. No antioxidant supplements.
Antioxidants fight free radicals; and radiation enlists free radicals, wayward particles that damage cells, to kill cancer. Free radicals are also thought to be part of the aging process, so there are any number of foods and supplements that claim to decrease free radicals. Obviously, it’s silly to go to the expense and trouble of radiation therapy and then take supplements to counteract it.
Dr. Fowble presents a raft of consent forms for me to sign. She asks if we have any questions.
I mention the crazy goal I’ve set of doing the Bay-to-Breakers 12K footrace in mid-May. I ask what I should do if my skin gets burned and irritated. Should I buy a tighter jog bra in that case? Dr. Fowble, who’s already made me a fan after two appointments, smiles. I can’t decide if the smile is indulgent, exasperated, or both. “In that case,” she says. “I would suggest that you don’t run.” Doctors have this annoying habit of bringing me back to reality.
Pete asks about a new proton beam radiation treatment for cancer. He’s come across the proton technology in his work as an editor for Bloomberg News. Apparently, the proton beam machine is the most expensive piece of medical equipment in the country, and that’s saying something. It’s only available at a handful of cancer centers across the country. And because it’s so expensive, it’s also controversial. More about all this in a later “Geek-Out” post.
Dr. Fowble obviously doesn’t want to get too deeply into the proton beam controversy. She does say that UCSF does not have a proton machine, except one for treating melanomas of the eye. For most breast cancer, UCSF uses the standard linear accelerator machines. More about those in a future “Geek-Out” post. Then she adds, “You know, sometimes it’s a matter of technology looking for an application.”
Then I go into a locker room, strip to the waist, put on a blue and white striped robe. They lead me into a room that looks just like a radiation oncology treatment room. Everything is the same size, and in the same arrangement, as the place where I will get the radiation. The only thing that’s missing is the actual radiation. A big, narrow table that can rise, lower and shift side-to-side sits in the center. A fresh, white sheet covers the table. A giant white gantry rotates around the gurney/table. When we get to the real deal, the linear accelerator will be mounted on this gantry. Targeting lasers shoot from various places in the room. It looks kind of like this:.
I take off the robe as a technician hands me a pillowcase to hold in front of my bustline. It’s funny what lengths we all go to in order to preserve the illusion of modesty. We all know I’m going to spend an hour or so lying topless on the table. I hitch my bottom up there, lie down, adjust my modesty pillowcase. After in-vitro fertilization treatments, childbirth, two years of breastfeeding, and nine months of cancer treatment, I don’t much care who sees my boobs, but there’s no harm in following what seems to be the radiation social norm.
A technician slides a triangular foam form under my knees. This raises my knees and makes the small of my back hit the table. It’s definitely more comfortable. Another technician asks me to put my arms above my head, to rest them in holders that look like bent half pipes. This is definitely not more comfortable. I tell the technician this must be the cancer equivalent of being thrown in the stocks. He looks at me quizzically.
“You know, the wood forms that locked up people’s head and hands,” I say. “It was a punishment in colonial times.” The technician continues to look at me quizzically. I guess American colonial history doesn’t play a large role in med tech education.
After the three technicians get me roughly in the right place, one says, “Now, from now on, we’ll move you, using the sheet. Let us do the work.”
Dr. Fowble and her resident come in. Dr. Fowble makes small marks around my left breast, explaining that this demarcates the borders of my breast. “They’d do the same thing if you needed a mastectomy,” she says. I guess this part of her job is a bit like that of a general defining a zone of military engagement.
Following her direction, the technicians start nudging me this way and that way: left, then right, up then down. They center my body along a line using one of the lasers, and make a mark on my sternum. Then they line up what seem to be two horizontal meridians across my breast, and make more marks. Another mark goes at the top of my breast.
The process melds grunt work — push and pulling my body on the table like a bit of beef — with the insanely high-tech — laser targeting and computer modeling. What we do here today will set the template for the rest of my radiation so everyone’s super careful. It takes much longer than the table is comfortable. Soon a muscle over my right scapula starts tiny, uncontrollable spasms. I start to sweat. I wonder if the technicians can see the twitching with their laser targeting, but they don’t mention anything.
“May I move my arms?” I ask.
“You can,” one says. “But if you do, we’ll have to start all over again from the beginning.”
I decide to try to cultivate Zen acceptance, something that is not one of my well-developed skills. In my head, I just keep repeating, “This too shall pass. This too shall pass. Just relax. Just relax.” I repeat this for what seems an eternity.
Finally, it’s over. “Now, we’ll just have to make some tattoos at these marks, so that we can line you up the same way every day during your treatment.”
What?!! Then I remember, hazily, some mention of this tattoo part of radiation oncology. It does make sense. But don’t they know that I am anti-tattoo? My stepdaughter Maureen, who has decorated her body in several places, can tell you all about my thoughts on getting inked. She’ll tell you that I have at times violated the wise parental course of “no comment.” Over time and many discussions with Maureen, I have decided that they’re fine for others. I’ve seen some beautiful ones. But for me? No way. The technician doesn’t stop to ask me about my thoughts on the matter.
“Just a little ink, and then a small pinch,” he says. He says this seven times. Then, hallelujah, he tells me it’s OK to move my arms. Then, he lowers the table — I hadn’t realized I was six or seven feet up in the air — and I get down.
Next, I go get a CAT scan, so that Dr. Fowble can set radiation fields that leave my heart and lungs out of the matter.
Then, I walk out of the hospital a tattooed woman. OK, they’re just little dots. If you didn’t know what to look for, you’d be excused if you mistook them for small moles. But I’ve got seven! That’s even more tattoos than my stepdaughter. Who woulda thought that cancer would make me a hipster? Kind of.