Saturday, March 5, 2016

Actually getting chemotherapy

In Creed, the latest Rocky movie, there is a scene where a patient (I won’t say who) is getting chemotherapy. When I saw it last night I realized that I couldn’t recall ever seeing chemotherapy on screen before, even though we’ve all seen many hospital moments in movies and TV. I also realized that I’d never quite described the actual process of getting chemotherapy in my earlier blog posts about the treatment process at Sloan-Kettering.

So, with the benefit of 10 infusions under my belt (actually, in my arm) so far, here goes. What I’m describing isn’t the only way cancer patients get chemotherapy; some people have a “port,” which allows for multi-day infusions (and there may be other methods I don’t know about). But my infusions last about three hours, and that’s what I’ll describe here.

When Teresa and I get to the treatment cubicle – hopefully on schedule, but we’ve noticed that later in the day there often seem to be delays of various sorts – I sit down in a large chair meant for the patient. It’s adjustable, though I still haven’t completely gotten the hang of the controls, so with some awkwardness I eventually get the leg rest to come up and the back to go down a bit – like a reclining chair in a den! Along with the reclining chair, there’s a TV and earphones in each cubicle, but we’ve never used them. Each cubicle also has a computer, which the RN’s use, and when they’re not using it I do spend some time looking at Sloan-Kettering’s screen saver, a series of photos of winter scenes, taken by members of their staff.

As I’ve mentioned in other posts, you can often hear conversations in the nearby cubicles (which are separated by curtains rather than walls). Usually everyone sounds calm. One week not long ago, however, we listened as one patient began calling out angrily for a nurse; I found that so disruptive that I called out “Stop that yelling” – startling Teresa, but also causing this man to make an effort, at least for a little while, to speak more courteously.

Meanwhile the RN – all the chemotherapy infusions are overseen by RN’s – has arrived. He or she reviews your health status, asking in particular about typical side-effects. If we’ve seen the oncologist and the nurse who works with the oncologist earlier that day (as we do every 3 weeks), then these questions have already been asked, but other weeks that wouldn’t be true, and in any case I like the basic idea that the RN’s are not just doling out the medicine but also taking responsibility for checking on my wellbeing.

Then the RN inserts the IV. (If you don’t like needles, you may want to skip this paragraph.) The needle, with a small tube attached to it, is a separate piece of equipment; once it is safely inserted, then other tubes get connected to this one, and through those tubes come the medications. The needle itself is, in my opinion, a bit long: maybe ½ to ¾ of an inch, and the RN inserts it to its full length, and then tapes it down. Once it’s in, I usually don’t feel anything from it, but sometimes the RN does some twisting the needle around first to make sure it’s settled properly in your blood vessel.

Sometimes this process doesn’t go perfectly. How easy it is to insert a needle in your vein or artery (I’m not quite sure which they’re aiming for) depends on how accessible your blood vessels are; that in turn depends on many things about your health, some of which you can’t control. One thing you can control is how hydrated you are; better hydration is important in all sorts of ways, but one of them is that more hydration leads to more accessible blood vessels. I’ve been becoming very well hydrated!

Still, in the course of my 10 infusions I’ve several times had the first “stick” not work. When this happens, the RN is always professional about it; it’s clear they want it to be right and will do a second stick if necessary. This past week, everything went fine, but the RN began the session by reminding me that the previous week I’d had to have two sticks; so I guess they keep records of exactly how the infusion process goes.

Anyway, with the needle inserted, and the tubes hooked up, the actual infusion begins. But not with the chemotherapy. Instead, they start with hydration; by the end of the process they’ll have infused about two large bags of saline solution. Once the hydration has begun they turn to the anti-side-effects drugs: in my case, two different anti-nausea medications, plus a steroid. Then they get to the actual chemotherapy – pausing to carefully record what medications they’re about to use, with another RN in the room to confirm the information. I receive gemcitabine and cisplatin, the combination viewed as the most effective treatment for my particular form of liver cancer. One of these can produce a burning feeling when it’s infused; for that they apply heat around the infusion site, and I don’t usually feel much discomfort at all.

All of this takes about three hours. (You can take your chemotherapy with you to the bathroom along the way if you need to.) It’s not very dramatic, and it’s only uncomfortable for a few moments. Some of the time I read; occasionally I’ve answered work e-mails, though in hindsight I thought that made the whole process more stressful. I eat the snacks Teresa has brought with us. And I sleep, often for an hour or more. Part of the reason I sleep is probably that we’ve gotten up so early to beat the traffic on the way into New York, but I think another part is that even though the infusion process is quite low-key, it is still intense. After all, a lot of stuff is going into your body, and of course some of it is very powerful. You, and the other people in the cubicles up and down the hall, are calmly having poison injected into you, poison you deeply hope will fight your disease.

Then when it’s all done we leave, get our parking ticket validated, and come home.


  1. I think you're writing a "handbook" about this - very detailed and objective, so much better than the ones who actually perform the activities. Your respect for the learning and the proper implementation must make the staff feel really proud. Hang in there and get all better very soon!