Daily Archives: November 22, 2010

Radioactive Birthday – Caution, “R”-Rated Post

Replete with maitaki mushrooms and blue-green algae, I go to the pre-radiation appointment at Kaiser’s Cancer Treatment center, a building separate from the main hospital. A nurse tells me how the treatments will proceed. “You will have three treatments, each a week apart, each lasting 10-15 minutes. You will be alone  in a specially insulated room during the radiation. The process you will have is called ‘Brachytherapy.’ Here is a pamphlet that describes it. Basically they insert a tube into your vagina and deliver the radiation though there. Do you have any questions?” I am too busy contemplating the bombardment of my vagina to speak. The doctor comes in to meet me and to explain things in more detail. “Brachytherapy will reduce the likelihood of the cancer coming back in your vagina from 15% to 1.5%. Brachytherapy is the application of radiation into the body through a device, which can be a wire or seeds, so that the radiation is proximal to the tumor. In your case a wire is fed through the tube we insert in your vagina and this carries the radioactive charge to your tissue. We also embed little stainless steel or gold seeds into the crown of your vagina to help us gauge how far in we insert the wire. Computer software controls how much radiation is emitted through the wire and how far it penetrates.” “What exactly will the radiation accomplish?” “It will prevent the exposed cells from replicating. If any of them are cancerous, theoretically, the cancer won’t spread. Irradiated cells will not divide – neither will any healthy cells that happen to be in the radiation’s path.” “And for all we know all the cells are healthy?” “Yes, that could be the case.”

Instead of imagining a mushroom cloud ballooning out of my vagina, I can now imagine this:

Brachytherapy

I look up Brachytherapy on line. “Brachys” means “short distance” in Greek. The advantage of it is that it exposes less healthy tissue to radiation than other available methods. In my case no one knows whether there is cancerous tissue in my vagina – the cancer was in the endometrial wall and this was removed surgically. So my choice is part guess work, part faith, part risk: Do I expose healthy tissue to radiation and possible cause cancer to prevent a possibly remaining cancer from metastizing?

The procedure does not sound at all fail-safe. By the time I write this entry – a year after my treatments, there have been at least two articles in the San Jose Mercury News about deadly radiation overdoses. The first in January of 2010 features Scott Jerome-Parks. He was being treated for tongue cancer at a New York hospital. A software error caused a linear accelerator to blast his brain stem and neck with errant beams of radiation. This happened on three consecutive days. Scott became deaf, blind, unable to swallow and lost his teeth. He developed ulcers in his mouth and was finally unable to breath. His dying wish was that these accidents be studied and eradicated. Soon after this incident a breast cancer patient also suffered overdoses of radiation that burned a hole in her chest and were ultimately fatal. In August of 2010 there was an article about CT scans exposing patients to overly high doses of radiation, causing them to lose their hair, and to face long-term risks of cancer and brain damage. I have already had CT scans of my brain and abdomen, leg and lung x-rays, countless routine mammograms and oral x-rays. Enough is enough. I ask if  I can have a second opinion. What is the point of irradiating healthy tissue? “Of course you can have a second opinion, “ says the doctor. “Let me see what I can do.” He steps out the door. Moments later he returns with an older man. “This is Dr. _. He is my mentor.” The more senior doctor has some sort of speech impediment. Slowly, with great deliberation, he recounts the studies and convinces me that statistics prove that the treatment is worth the risk. My father was a statistician. He had a small black book on the shelf with large gold letters: How to Lie with Statistics. The older doc’s opinion is simply an affirmation of the first doc’s. He seems kind, conscientious, honest. I need to make up my mind. I feel the right brain yielding to the weightiness of Western protocols – of making decisions based on documented empirical study. Intuition combined with panic and remnants of childhood fears of anything nuclear, rail against the rational. The left brain wins. My treatments are scheduled for July 7, 14, 21, 2009. My birthday is July 12. I promise myself a mint chocolate chip ice cream cone when it is all over.

At the first appointment, the nurse leads me back to the dressing rooms. “Choose any of the free lockers to put your clothes in,” she says. “Can I use the bathroom first?” My nerves have gotten the best of my bladder. “Yes it’s right through here.” She leads me through a waiting room filled with the cheerful clucking of other patients.
“Oh what is she here for?!”
“What kind of cancer do you have?”
“How many treatments are you having?”
“We’ve never seen you here before.”
“ A frog???”
“Don’t mind these girls,” says the nurse. “They’re regulars.

The Waiting Room

I emerge from the dressing room donned in the shear cotton hospital gown (Shouldn’t I be wearing a body suit of lead?) and the nurse leads me into the radiation room. It is filled with computers, x-ray and radiation machines, a variety of monitors, all connected by a tangle of wires. Each piece of equipment looks like another potential for error. The radiation machine is locked to a steel u-bolt in the floor by long cables. The table where I am told to lie down is fitted with stirrups and these have knee to ankle leg wraps that the nurse velcros closed around my calves. “Is this in case I try to escape?” “This is for women who have to stay here for multiple days, so they don’t fall out when they fall asleep.” Humbled, I remember my friend’s experience with cervical cancer. She was strapped into a contraption like this for three days to shrink her tumor. She is alive and well today. My ordeal will only be 11 minutes long.

The doctor decides to experiment with stainless steel seeds instead of the usual gold ones. Using a speculum, and some kind of long-barreled device, he shoots these into the crown of my vaginal cuff (this is what it is called now that there is no cervix, no pathway to a uterus). Bang bang bang! Ow! Ow! Ow! Then he inserts the tube that will hold the radioactive wire. The nurse secures this tube with a harness and straps that fit over my shoulders and shove the base of the tube against my pelvic floor. Everything hurts. The nurses and doctor chime in, “Just relax, just relax.” But my vaginal walls feel raw and inflamed, like they are being strafed with a cheese shredder every time something goes in or out. Once everything is in place, the nurse X-rays me to make sure the wire and seeds have the right relationship. She and the doctor mumble to each other. “I’m sorry Ms. Ogus,” says the doctor, “the stainless seeds are not showing up.” “Where could they go?” I ask. “Right through the vaginal cuff? Are they floating around somewhere in my abdominal cavity?” “No, no,” reassures the doctor, giving me no explanation. “We’ll try the gold seeds this time.” The team regroups, each performs his or her duty: off come the straps, out comes the tube, in goes the speculum again. Bang bang bang! “Ow Ow Ow!” again. Out comes the speculum, in goes the tube. The nurse shoves the tube, pulls the harness tight, re-X-rays. The vaginal cuff is crowned with shimmering seeds.

The Queen

They are about to irradiate me. Doom, dread, Oppenheimer, Hiroshima, Three Mile Island, Chernobyl, sloughing flesh. Marie, Pierre and their daughter Irene Curie died prematurely so I could lie here on this table, trying to prolong my life.
“Okay, now we leave you alone in here. This is the computer that controls the radiation. Somebody will be out here the whole time. If you need anything you can call us. Don’t worry.” I try to settle in, look up to a ceiling of illuminated glass panels imprinted with treetops and blue sky.

Irradiated