Almost a week passes after my measuring session in radiation oncology. Radiation therapy happens every day, Monday through Friday, but the docs prefer that you have at least three sessions before you get to the first weekend break. My schedule didn’t quite time out correctly, so I go back in the following Monday for what they call a “dry run.”
After all the measuring and CAT scanning and tattooing of the previous week, Dr. Fowble has used all this information to create a treatment plan for “three dimensional, conformational radiation therapy.” This is now pretty standard: It involves taking imaging, and then using computers to plan the treatment, control the dose of radiation, and then deliver the dose.
During our meeting before going into the real radiation room, I ask if she might show me what she’s done.
“Of course,” she says. “No questions are stupid or unimportant. We want you to be comfortable with your treatment. I’m happy to explain as much as you want to know.” Have I said that this is the third, totally awesome cancer doctor I’ve had at UCSF?
Dr. Fowble opens my chart. The chart is getting rather thick, I notice. She unfolds a sheet that shows what they call “radiation fields.” Imagine the cone of vision that a flashlight creates on a dark night. The radiation machine can create a field like that with photons or electrons. Not only this, but the machine can do it at any angle, at any depth and in any shape. The art of radiation oncology seems to be determining what shape, orientation and number of fields will be most effective in a given case. For me, Dr. Fowble has set four radiation fields. Two will be delivered from above my body, and two from below. Superimposed over a topo map of my left breast, they’re represented by different colors and planes on the sheet in my chart.
She turns the page and shows me a cross section of my chest, one of the images created by my CAT scan the previous week.
“There’s your heart,” she says, pointing to a circle. “There are your lungs.”
“And the red and blue lines there represent a border?” I ask. “The radiation is supposed to go that far and no farther?”
“Right,” Dr. Fowble says.
The next page looks an x-y diagram from a math text. It shows how the dosage will be modulated and controlled. The idea of having your body irradiated is a little disconcerting, life and humanity being imperfect things. But it’s comforting to know that computers and smart doctors try to make it as safe as possible.
After talking a little while longer, we walk over to the actual treatment room. First, stop at the technician’s computer station. I see a treatment plan and my picture on the screen of the computer.
“Every day, you’ll stop here, and tell them your name and birthdate,” Dr. Fowble says.
The actual treatment room is a little more posh than the measuring room of the previous week. Warm-colored wood panels the walls. An artist has inset constellations in the ceiling so that patients can look at something that evokes the natural world. There’s a stereo system that’s playing opera.
We do the robe-to-pillowcase modesty dance, and I get on the treatment table, where one of the technicians proceeds to fold back the pillowcase to expose my left breast. My arms go back into the stocks, over my head.
I look to my right, and there’s a big, circular metal housing. Within this, there’s plastic square with two hair-thin lines that intersect in the middle. This is where the radiation will come out. Around this big clear eye, patients have left stickers on the steel housing. Some are a little insipid: rainbows, unicorns, teddy bears. But many are wry: a San Francisco Giants insignia, a stamp-sized square that says, “The Few, the Proud, the Hairless.”
In a weird way, looking at the stickers reminds me of the experience of watching a congregation go up for communion: the old, the young, the infirm, the vigorous, the rich, the poor, the homeless, the fashionable, the frumpy, professionals, laborers, heiresses and everything in between. I always marvel at the quirky, marvelous variety of humanity that processes up to the communion rail on a Sunday. Likewise, a whole spectrum of cancer patients have processed through this radiation treatment room: Stage 1 through Stage 4, young, old, rich, poor, those full of optimism, those barely clinging to hope, those just fighting for time. And some leave stickers, a bit of their humanity (a Tigger sticker), their humor (the few, the proud, the hairless), their backgrounds (Irish shamrocks), their interests (a yoga pose). This patient graffiti adds a little bit of informal goofiness to the imposing, whirring, computerized linear accelerator.
The doctors and technicians retreat to the computer room on the other side of the wall. “OK, we’re going to start,” the disembodied voice of the technician tells me. “You’ll hear some buzzing, and the machine will move around. Don’t worry. This shouldn’t take as long as last time. And the real treatments will only take a few minutes.”
I’ve heard that many people are overwhelmed by their first couple radiation treatments. An infusion center, for all its terror, can be a social place. You sit in the recliner while they poison you and, very often, you talk and compare notes with those in the chairs around you. When you go through radiation, it’s just you and your machine. There’s not even a technician to keep you company.
I lie there wondering if I’ll suddenly feel like crying, but I don’t. All I feel is my back starting to twitch again, just below my shoulder blade. The twitching becomes so frenzied that I wonder if I’m messing up the process, but I don’t hear anything from the intercom. I guess that I am still enough.
The machine clicks, then buzzes, then whirs. Then it rotates smoothly and almost silently around me. It clicks and buzzes again. I can see the targeting lasers mapping my body in the reflection from the machine’s eye. And my back twitches. It shivers. It twitches again, and endlessly.
In that moment, in the face of all this computerized exactitude, my twitching body feels, oh, so imperfect. And yet, when it’s free of cancer, my body is almost as well-oiled as this giant machine spinning around me like a satellite. Cells interact and divide and send oxygen and nutrients and nerve signals where they’re supposed to go. DNA and RNA do their dividing dance and regulate everything from neurotransmitters in my brain to acids in my stomach. That’s a marvel, far more complex than this impressive linear accelerator.
Perhaps it’s not really my body that’s imperfect, it’s the cancer.
I lie there thinking about how this incredibly exact machine is training itself to aim radiation at me, just so. This precise technology seeks to wreak imperfect chaos on any remaining cancer cells, even wannabe cancer cells. If the radiation can jam things up enough, those rogue cells will become so defective that they die. Which is the point: cancer dies, the patient doesn’t. Fingers crossed.
When the dry run is over, and I trade the pillowcase for my robe again, it seems to me that all this is marvelous in many, many ways.