Sunday, January 3, 2016

On the way to chemotherapy

Like any other human process, chemotherapy consists of a series of steps. New patients have to get the hang of these steps, and once you do that you have a measure of security and assurance. But as a new patient you're both participant and observer, and it turns out that the particular steps that you find yourself taking also tell you a lot about the world you're now a part of. So I'll try to trace these steps here, and to say something about what those steps reflect, about cancer and cancer treatment.

When we arrive for chemotherapy, the first step is to check in. Actually that leaves out a step: the trip upstairs on the elevator. I was startled the first time we arrived because all the elevators have a seat in one corner -- a welcome sign that the people who planned the physical space were thinking about the condition of the people who'd be using it, but also a troubling sign of how frail some of those users might be or might become.

But the elevator isn't quite the first step either. The first step, if you arrive as early in the morning as we try to, is a brief wait on the first floor till the treatment floors open at about 7 AM. We wait in the Laurance S. Rockefeller Pavilion, a quite pleasant space with seating for 15 or 20 people and a small water pool on one side into which people, including me, toss coins for luck. It's not a surprise to find a Rockefeller's name on the wall; I imagine that Memorial Sloan-Kettering (MSK) does vigorous fund-raising, and there are donor names elsewhere in the building as well. The building we go to is in the East 50s in midtown Manhattan; this is expensive real estate, and every element of the massive treatment program running in this building is expensive as well. So many people get cancer; so much money is spent on the fight against it.

In any case, after the pause downstairs and the trip up in the elevator, we reach the fourth floor, where my chemotherapy takes place. This floor is focused on gastrointestinal cancer, so I imagine there are others floors, perhaps in other buildings, for people with different cancers to receive their treatments.

We arrive at the registration desk. Registration is generally quick, and the people behind the desk are responsive and friendly. I'm asked to confirm my name and my date of birth, and that's it. 

It's not just good fortune that the registration process is easy. As with the elevators, it seems clear that someone has thought about how to make the patients' experience as pleasant as possible. And something more -- someone has hired staff, and trained them, to be attentive and efficient. That takes institutional commitment, as well as good individuals, and it's reassuring.

Why do they ask the patient to confirm his or her name and birthdate in particular? We learned the first day we went to MSK that this process is repeated a lot  -- when you go to have a particular procedure done, or when your medication is being started, or after a procedure is over. It's easy to see and appreciate the logic of this procedure, which helps insure that each patient gets only the treatment he or she is supposed to have. (Long ago, in a university health clinic, a staff person called out "Stephen Ellmann" and a person sitting near me stood up. It turned out we shared not only the name but even the extra "n" in Ellmann. So I know this isn't a hypothetical problem.) But there's probably also another, worrying purpose: to measure the mental status of the patients, who may be fragile enough to be disoriented by some of the processes they go through.

And then, having checked in, we go and sit down in the waiting area. More on the waiting area in a future post.

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