Archive for April 2014

On Chemotherapy, Mustard Gas and the Garden of Gethsemane.

ChemotherapyAfter the seemingly perfunctory 20-minute wait, Dr. R tapped lightly on the door to announce his arrival to Joan and me. We, of course, invited him to join us in his own office, and he entered in his usual cheery, upbeat style, this time with his nurse Jennifer in tow.

I was glad to see the RN. She and I had communicated over the phone on several occasions since first meeting and I could tell by her smile that she was growing comfortable and supportive around me. I like to fantasize that after our meetings she tells the people around her that, “He’s going to beat this thing-he’s the one.”

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Nurses get things done.

Never underestimate a nurse’s knowledge, compassion or expertise in their chosen field. I’ve watched them write prescriptions for the doctor to sign when he re-enters the room. I once told an oncology RN that my father’s in-home nursing assistance was going to expire the coming Monday. That would leave his care in the hands of two know-nothing sons, both with jobs, and his frail, aging wife.

“That ain’t gonna happen!” she told me.

And it didn’t-assistance showed up at precisely 10 AM. If you’re ever unfortunate enough to have to hang around a hospital, make friends with the nurses.

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Jennifer assumed her position in a chair behind Dr. R as he (finally) unveiled the plan.

“There’s no hurry, mind you, but we need to think about starting chemotherapy.”

He explained the protocol in general terms and when I needed clarification, I’d ask a question then glance at Jennifer who would smile reassuringly back at me. We agreed on a start-date, April 10, and Dr. R said he’d see me again before session #3 started in May. He bade us a cheery “Adieu” and left Joan and I in the hands of his nurse.

"I don't think so-Homey don't play dat."

“I don’t think so-Homey don’t play that.”

I will receive two drugs, Rituxan and Bendamustine, on consecutive days, every 28 days for 6-8 months. Each session will take about an hour as an out-patient, with the exception of the first treatment. Side effects should be tolerable and while my hair may thin some, I probably won’t lose it all (but if it gets wispy I’ll probably hack it off-I don’t like wispy hair). Now, about that first treatment…

Rituxin is an antibody whose job is to sink its deadly hooks into a protein on the surface of cancerous “B” cells and kill ’em dead. I have about a billion too many of the vile bastards, so I’m looking forward to the internal carnage. However, the drug needs to be injected in very large doses the first time, and there is the possibility of an annoying side effect or two, namely;

• Headache
• Fever
• Chills
• Nausea
• Heartburn
• Flushing
• Weakness
• Dizziness

Despite the unsavory nature of these potential reactions, I was relieved to see that “pooping one’s pants” was not listed.

The first infusion will take 4-6 hours. Any time I encounter one of the side effects, the infusion will be halted and I will be fed a drug appropriate for relieving it. By mid-afternoon I should either be pleasantly blowed away, or in a state similar to one recovering from a frontal lobotomy.

kill-them-all-On Friday morning I meet Bendamustine for the first time. It’s job is simple; “Get in there, find those cancer cells and kill them. And don’t worry about collateral casualties-bone, muscle, skin, brain cells-eff ’em! Kill ’em all!”

To understand Bendamustine’s potential killing power, it’s interesting to consider its origins.

“The story of nitrogen mustard gas is perhaps the strangest in 20th-century science.”

mustard2
“As a chemical weapon it was brutally effective. Used on Belgian battlefields during World War I, it maimed, crippled, and killed many whose flesh was blistered away or who died from asphyxiation. It also was used much more recently in the Iran-Iraq- war, and was thought to be one of the lead “weapons of mass destruction” in the hands of Saddam Hussein.”

mustard“Nitrogen mustard’s strange turn, however, was its reincarnation a generation later in substantially lower doses as cancer chemotherapy. Physicians given the grim task of performing autopsies on soldiers who had died in 1915 from exposure to mustard made several seminal observations. The bone marrow of the dead soldiers was depleted dramatically, and their lymph nodes had shriveled away. These two effects in turn were applied to treatment of cancers affecting these specific organs, leukemia and lymphoma. Indeed, from the battlefields of WWI came the entire discipline of cancer chemotherapy. The agents live on now, both chemically and etymologically, in drugs such as bendamustine that are used to treat several cancers.”

The night before Jesus died he went to the garden of Gethsemane to have one last chat with his Father before he was tortured, then crucified.

“Going a little farther, he fell with his face to the ground and prayed, ‘My Father, if it is possible, may this cup be taken from me. Yet not as I will, but as you will.'” (Luke 22-39)

gethsemane

Jesus was saying to his Father, “Look, I know that I have to die for the world’s sins, but if we could do this without the flogging, the crown of thorns, the nails through my hands and feet and the spear in my side, I’d be open to an alternative. But it’s your call, not mine.”

Jesus was not scared of what was coming his way, but he was obviously feeling some trepidation. I’m not scared of what I’m facing either-but I’m feeling somewhat anxious. I can’t help but wonder if there isn’t a pill or two that I could swallow and thus avoid all the headaches, chills, fever, nausea, etc. Oh well; at least my pants should be clean for the ride home.