Chemo 5

This morning I wake after a lousy night. My anticipatory nausea kicks in especially early and I am gagging before I drift off. I'm awoken by gastric reflux. I lose a few hours sleep.

In the morning, Al and I are little disorganised as we are both tired. We have to pick up Nim from Cleveland and then drop Ben at school. I'm concerned about being late but it looks like I needn't have worried.

We are right on time when we arrive at the Hospital, me bearing some love cake to share, Nim with a fruitcake for the nurses, rolls and fruit salad for us. (She is happiest I think when she is sharing food).

Tracey has arrived quite early and is waiting for us. Lindar is running late as she has school drop offs. Janet is a no-show because of work commitments. Linda C is dropping by later.

Before going in I dutifully take the extra anti emetic Dr Choo has prescribed. Here's hoping it kicks in quickly.

So my support group accounted for, I am shown into my cubicle fairly quickly. As we sit down, Tracey gives me another beautifully wrapped gift of a hot pink, hot and cold eye mask. I keep telling them to stop giving me things but it hasn't seemed to work.

This time, I have a young English nurse, Lisa, who seems reasonably efficient but I have to just find out how experienced she is.

She's been practicing for 7 years and says she's put in 100s of cannulas. Still, I notice the absence of that calming banter older nurses are so much better at. To the younger ones, the job is about process, not niceties I think. There's less small talk and no attempt to make a connection.

Lisa seems to take a longer time than usual trying to find a suitable vein and when she does, the cannula after it's inserted malfunctions - and it hurts like buggery. No, it REALLY hurts.

Tracey clutches my hand and I say "I really, really love you Tracey". I feel teary thinking of my friends, not just these two, but everyone who has been cheering from me from the sidelines.

Nim is standing and holding my other hand. She's trying to take my mind off the pain.

"It's because you've helped so many people," Nim consoles.

"I'm not that special," I snivel. "I don't do that much."

Lisa is flustered and realises more veins have popped up. She asks if I want her to get someone else to try. I say no (I don't want to hurt hurt her feelings).

But the sight of a nice plump vein has her hopeful and confident. She says she's very sure she'll get this vein. She says a failure to properly place a single cannula can ruin her whole day.

And so, again I'm pricked. This time it's a success but it still hurts.

I try to make conversation through it, trying to think of what I might actually resent about all of this. Surely there is something.

Lisa is ecstatic, she connects the saline drip and leaves the room.

The next thing I know Nim has burst into solid tears and is weeping into her hands. Tracey leans over to comfort her. I'm feeling sad too.

"I just want my old friend back," Nim sputters.

"It told you not to come. I knew it would upset you, Nim," I say.

I try to keep talking so Nim isn't so upset so I say what I resent is losing my body. I worked so hard all these years and now I see my friends going running and gymming and dragon boat racing and soccer training while I have been transformed overnight into a bald, retching frump.

Another nurse realises it's an emotional scene and asks us if we'd like some privacy. For the first time, we are curtained in so that we can collect ourselves.

I also ask for some tissues for Nim.

By the time Lindar arrives, we are ready to have the Adriomyacin injected and she's missed most of the drama. She gives me a present of a Guatamalan Worrry Doll. It's really cute. Apparently you whisper your worries to the doll and put it under your pillow.

It's really nice to chat away with my friends while all the time I'm just aware of the now familiar cold feeling up my arms.

We talk about how amazing my brain memory has been, nauseating me a good 24 hours out from this session. We talk about how memories are trapped in bodies and how unhealed emotions, grief that has not been addressed and other emotional roadblocks are now being linked to dementia. We agree that seeking therapy or talking openly and honestly about your feelings to someone, anyone, is essential to moving on.

When it's time for the Taxotere, I'm feeling nauseous as predicted and worried that that damn tablet didn't work.

Through this Lindar, Tracey and I reminisce about our Sallyanne days. I tell the story of the Marketing Director who thought I needed help with my English and made me buy a Roget's Thesauraus, English Oxford Dictionary and Fowler's English Modern Usage before writing a speech for the Lord Mayor who wanted to suss out my potential to be speechwriter. I took a whole day to write a 5 minutes speech for The Great Aussie BBQ. When he saw how fabulous it was, he looked sheepish. And it was only then I realised this chap must have thought I was illiterate, just because of my then still thick Sri Lankan accent.

I'll tell you this at least. I've written literally hundreds of speeches over the years and I've never, ever, ever needed to cheat the dialogue from 'Wall Street'. Surely there are some pretty lame speechwriters out there Mr Albanese.

It's only after the Taxotere is finished that Tracey quizzes Lisa as to why she didn't put the fingernail-protecting ice gloves on. Lisa had forgotten and I was in too much of a state to pick it up.

And so, it could be that my nails will be ruined after this treatment. What to do?

Nim notices my dry lips and distributes her delicious freshly prepared fruit salad including cherries and lychees (my favourite).

I start to feel better when I'm finally eating the roll.

Soon after this, Linda C arrives. She looks lovely I think to myself. She brings an upbeat vibe to the room.

We have a cup of coffee courtesy of the hospital and eat it with a piece of my delicious love cake.

I'm feeling okay by the time the Cyclphosphamide is injected, the nurses moving quietly in and out of our cubicle to change the drugs.

And then I'm done. I can't believe I got through it.

In the foyer we are met by one of Nim's Turkish friends. She's absolutely lovely and arrives in a taxi, bearing turkish delights. She's made a special stopover. I can't believe it.

The four of us - Nim, her friend, Linda and I go up to see Dr Choo.

In the waiting room, we are so loud and chatty that the receptionist asks us to keep it down. What a spoilsport. There are only other elderly people there. They're probably half deaf anyway.

Afterwards, my meeting with Dr Choo is brief. I wheedle my way out of the blood test next week by saying that I know my counts will be low.

She checks my last blood test and in fact, it looks like the white cells had rallied strongly and the platelets were sound. That explains why I had the energy to run last week!

As Al is still working in the man pad, Linda drives me and Nim home. I'm feeling drowsy. A little worn out.

When I get home, it's funny because I don't have a key so I have to let myself in through the doggy door.

I'm praying that the extra kilos I've hoiked on won't mean I am irretrievably wedged. But as it is I'm able to drag my bum through there getting only a little mud on my pants.

I am reminded that Dexamathasone, one of my prescribed drugs, is not only used to enhance the effects of anti-emetics in chemotherapy, but is also prescribed by some vets for the treatment of ear infections in dogs.

There's probably a good reason why I chose the doggy door today. Maybe tomorrow I'll feel the need to go and bury some bones, chase my tail or scratch the back of my ears with my feet.

Dexamethazone is also abused by Bangladeshi women who want to get fat. It's 26.6 times more powerful than human cortisol, 2.6 times more powerful than prednisone. It can lead to irrational feelings of feeling good, and dependence. It's also uses to enhance athletic performance and improve weight gain. How that works I don't know. Stuff your face then go for a 10KM run? Seems counterproductive.

Anyway, I am now packed up to the gills with a load of drugs fit for any fading AFL star.

Al and Harry get home and not long after that Vlad and Evelyn drop by with a book called "Superfoods". It's sweet, really, the way people want to reach out to me. They have a quick glass of wine and leave as I'm clearly a little dopey.

It's grey and drizzing outside. I don't feel like going for a walk but content myself with finalising a painting I'm working on.

Today has been a stressful day I think. It wasn't a particularly good one. I think it was quite awful for my friends and, even though we had our usual conversation, I felt bad because I am not really handling things any better.

The place where the cannula went in is still hurting a bit. I'm retching miserably as I write this.

I apologise for the poor calibre of this post but my hurling innards have made this one particularly hard.

Oh well, things can only get better after this. After all, there is this to shout from the rooftops today: HOORAAAAYYYY! ONLY ONE MORE CHEMO SESSION TO GO.

Chemo 2

62 days after diagnosis I am home after my second chemo treatment. It's been a fairly stressful 24-hour period.

Yesterday I went for the routine blood test but I had the staff from hell - two women who couldn't find a vein and jabbed me 3 times, bruising me and finally managing barely a millilitre. I was traumatised as I felt trained monkeys would have done a better job.

As a result of this manhandling, I was anxious about the state of my veins and whether the chemo would go well. Especially the Adramycin which can cause severe tissue damage if it escapes.

Last night I slept poorly too, the insomnia exacerbated by heavy rain outside - and the fact I was expecting Harry home at midnight but the rascal changed his plans and didn't tell me!

When I wake up this morning I'm already a little exhausted. Still, Al and I leave in good time and get to the Cyril Gilbert Centre early.

Strangely, I am looking forward to the experience, NOT because of toxic chemical injections but because all three of my besties, Janet, Lindar and Tracey are ALL coming to sit with me.

I am looking forward to seeing them and it's the only thing I anticipate with pleasure.

On arrival I am led to Suite 20 and hooray! My nurse for the day is Ursula, who was the breast care nurse educator I mentioned in an earlier blog. She is the one who has battled breast cancer herself and I note, this gives her incredible empathy as she ministers to my needs.

Chatty, open and friendly, Ursula understands the need for positive chat, good information and creating confidence in the procedure.

Therefore, THIS time, the insertion of the cannula, despite the dramas of yesterday, goes without a hitch. One attempt only! Ursula places hot packs on my arms to ease my veins up. I've drunk copious amounts of water the day before to help the process along. So all is good!

Here is a picture of Ursula at work:

It hurts like buggery though and Ursula shows me how she knows the cannula is well inserted and expects no problems. She is awesome! From wo to go, she is synced into my concerns and knows exactly what to say and do to make this experience less stressful.

Ursula explains that the clear fluid that is injected first up contains steroids which are anti nauseas. This is the bugger that causes fluid retention, insomnia and increased appetite.

Ursula then tells me to let her know if I suffer any... she can't find the word. I suggest: "Dopey? Sleepy? Grumpy?" She gets it and says. "And no, not Sneezy".

"Aah" I jest, "The seven dwarfs of side effects." :))

She laughs. "Oh I can see you'll have no problems, you'll do great." I like to hear that.

Then the first of my visitors, Lindar arrives and Al decides to head off to complete the job at the Manpad. Lindar gives me a present of a large jewel that catches the light. Lovely.

Let me tell you a little about Lindar who I met at the tender age of 21. I had just started work as the Speechwriter to former Lord Mayor Sallyanne Atkinson, and Lindarrrrrrrr (as I call her, in gentle mockery of that unique extra 'r') started as the LM's Protocol Manager. Over the years, Lindar and I have shared some great laughs together while all along, I've known a woman with an incredible story to tell. Let's put it this way, she's a formidable style queen and always immaculately presented, yes. But Lindarrrr has Character with a capital C. In other words, she's had her ups and downs, her measure of life's little kicks and disappointments and has faced them with what I can only describe as equanimity and grace - perhaps too much grace!

Amongst her travails - and I hope she won't mind me sharing this - Lindar lost her beloved Dad to mesothelioma at the age of 55. I'm guessing she would have been about 38 years old then and looking back, I do feel like a pretty cruddy friend because I'm not sure I was there enough for her then. It was a terrible event that has made a deep imprint on my Lindar and so, now in the context of her profound care for me now, I am a bit pissed off at my 34 year old self for not being a little bit more on-the-ball (although, admittedly, I had a two month old baby at the time the brunt of this took place).

Just how much Lindar cares is revealed today. When Ursula begins to carefully insert the Adramycin, the "Red Devil", Lindar senses my anxiety. She grabs my hand and I realise she is CRYING! I don't know what to say so I joke about it.

"I seem to make lots of people cry these days. It's okay."

Our little moment is broken when now Tracey arrives, looking, I have to say, bloody fabulous. Held up by traffic and apologetic about being late, I'm touched that she has hurried to be by my side.

Tracey gave me a book as present last time, but she gives me ANOTHER one, beautifully wrapped and especially procured after much shopping around from the book depository. It's about how a woman dealing with breast cancer reads her way to recovery. As mutual book lovers, this is a book full of love and meaning.

Then Janet arrives after spending 25 minutes in a carpark on Moggill Road to get to me. She's taken the day off work especially and comes bearing a present that I think reflects the unexpected wonders of this day: chemo in my veins but the fears magically taken away as I've focussed instead on sharing stories and laughs with three of those of my many friends who have chosen to show me that extra care.

Janet brought me this 80s headdress, wrested from the bowels of her chest of beloved memorabilia. What do you reckon, mun? I be haulin' sum good Ufrikun mojo, ja?

But here is what else she brought. It's a letter I once wrote... to Janet and Bob's dog, Pete the Pointer, with who I shared a special bond. I loved that dog and here is a photo to prove it.

I have no clear recollection of when or why I sent this letter to Pete. I am guessing it was some time in my single years, late 20s perhaps. All I can say is re-reading it, I was laughing so hard I could barely recite it aloud:

If laughter is the best medicine, today I have it in litres. The time flies. I have good endorphins floating through my veins along with potent medicines. How different it is to what I have been expecting - nay, dreading!

As we prepare to leave, we take this photo which Janet later requests so she can show her kids, who are also worrying about my welfare. (Janet's 15 year old Georgia, even bought me a turban!)

As Janet explains, as only Janet can, in an email this evening: "I want to show them how fabulous you looked, reclining, like the Lady of Camelias, some heroine in a Victorian novella -or as it happens, a teen vampire romance, given the things sticking out of you." Here it is:

After a quick visit to see Dr Choo, Al has come to pick me up. In the car coming home, I'm quiet. I have terrible heartburn (thank you Taxotere) and I feel furry headed (thank you insomnia). It's different to the first time. I'm not chatty.

I want to go to sleep so I lie down as soon as I can, taking one of the tablets I've been prescribed for this sought of unpleasantness. Al puts on the meditation tape (a gift from Lorelei).

I doze but I don't feel comfortable so I get up to write this blog while Al has a snooze.

Ness calls me to find out how I'm going. I really appreciate her calls and tell her so. I know she's a busy working business woman these days. I don't expect much to know she is a dear and caring friend. So I tell her I love her and then: "I'm getting teary eyed so bugger off now." She laughs and we hang up.

Louisa calls so we go for a 4 km stroll. I'm pleased with myself! It's pleasant as we discuss a planned trip to Nepal next year - when I'm better.

(The steroids apparently have a kind of feel-good flow-on effect. I suppose I'm feeling it now.)

When I get home, Al's made me a margarita! I'm supposed to have taste changes but you know what? Stuff it! It tastes good.

Finally, there's a dinner of my mum's special Pittu and my favourite Chicken Curry (delivered yesterday).

What can I say. Today I have experience perhaps the greatest alchemy.

A day of potential terror has been transformed, by single acts of love and friendship, into a day of happiness.

There is nothing more I could need.

The Night Before Chemo

It's the night before my first Chemo and my mum and Aunty come over to cook me and a few friends (Greg, Lyndal, Garry, Ethel!) a special meal of 'hoppers'. This is a Sri Lankan delicacy and quite difficult to make. There is a prawn curry and a selection of sambols finished with a Sri Lankan dessert, Vatalluppum. It makes it a special night because my Dad comes along too!

Here is a picture of my guests digging in!

As you would expect, my mum (and dad) have been very worried about me since my diagnosis. I have already had the little speech about how parents want their children to outlive them.

My mum, usually too busy with endless meetings and social engagements seems to have put some of her own life on hold. She's telephoned and visited with more regularity than I can remember in a long time.

It doesn't help that, at 73, Mum has the constitution of an ox and takes no potions or pills. (Her dad popped off at 92).

Today I had to have a blood test which is a prerequisite for each chemo session. It's just a bummer that I hate needles. Strangely, I am happy to watch a heart and lung cut out but I can't bear to see a needle inserted into skin - this despite my Dad being a career Type 1 diabetic.

It's a bit depressing that I will soon be on first-name terms with the lady at the pathology lab :(

A good thing though is that my aunty Marie called today from Melbourne for a chat. I like my aunty. She emanates a certain calm and patience. So of course, I find it hilarious when she tells me my Uncle will sometimes drive her to use the 'F' word in its adjectival form. Who knew?

Yesterday my cousin, Dilhara, rang from Sri Lanka. It was really nice to hear her voice and yet again I contemplate that strange thing about cancer: of bringing people to me - and not all wielding scalpels and injections!

In the lead up tomorrow, meanwhile, I've become an armchair expert in what I've learned is an age old treatment for cancer.

My passion for science means I am keen to learn as much as I can about the protocols I have to endure.

Besides, you're talking to a person who has, up until now, thought twice about pharmaceutical intervention, the antihistamines for my seasonal allergies notwithstanding.

It's basically hugely ironic that, right now, I'm depending on drugs - the big guns - and I can only be thankful to the generations of scientists who have given me access to the idea that breast cancer is not a death sentence, that there is a very high chance of cure.

It's just unfortunate that the cure will deliver the kind of side effects that will mean I'm less Miranda Kerr and more Mahatma Gandhi at the end of it :(

As I have already mentioned, I am to have the T.A.C treatment comprising the drugs docetaxyl, doxorubicin and cyclophosphamide, comprising six cycles at three week intervals.

This is just one regime of a multitude that is part of this fascinating area of medicine, involving many different drugs, 30% of which, I learn, are derived from 'natural sources'.

For example, Taxotere or Docetaxyl is derived from the bark of the Pacific Yew Tree.

Doxorubicin, an anthracycline antibiotic, was originally derived from a bacterium isolated from a soil sample collected from an area surrounding the 13th century Castle, the Castel del Monte (in Andria, Italy). Interestingly, the prototype resulted in some 2000 analogs - other antibiotics used across the spectrum of medicine! I find that amazing.

I have no bloody idea why the Castle figures in this history but I'm fascinated by the pathways of human inquiry. However, I still do not like the the fact that the nickname for Adramycine is "the Red Death" (I can expect red pee for a day or too. Jolly times.)

Cyclophosphamide meanwhile is described as 'the old war horse' of chemo, patented in 1952. It was accidentally discovered as a derivative of the nitrogen mustard gas stockpiled in WWII.

I could fool myself I suppose, that these drugs are made from natural sources.

In fact, did you know that medicines derived from terrestrial plants and microorganisms, marine organisms and terrestrial critters are used to treat 87% of all categorised human diseases?

Cone snails (their venom to be exact), sea hares, molluscs, the Carribean sponge, the dog shark, a plethora of bacteriums, fungi, trees and other biological sources area among the thousands of species of living matter that have contributed a part of their DNA to the modern pharmacy.

But despite their origins in nature, chemo drugs are cytotoxic and some, for example Docetaxyl (or Adriamycin), are in themselves carcinogens (that is, in some doses can lead to other cancers). Oh joy.

For further proof of the incredible toxity of these drugs, I consult the 'Patient Diary' I've been given that provides specific instructions for dealing with the by-products of chemo - those secretions that are inevitable from one's nether orifices at some stage.

(I'm sorry I have to mention them but I'm hoping charming modern movies such as "Austin Powers", "The Hangover" and "Bridesmaids" has primed all of you for the concept of spew, wee and poo. This is a blog about illness, after all and sadly, tea and tulips do not figure in this narrative.)

These are, apparently, particularly toxic and must not come into contact with human skin for the first 7 days after each treatment: toilets must be fully flushed lid down; the area must be cleaned with household detergents and disposable sponges; disposable gloves are to be worn when handling bed pans and urinals (yuk!); gloves, wipes or anything else that comes into contact with the various excretions must be sealed inside two plastic bags and immediately placed in the wheelie bin; any bedding that is soiled must be washed separately from other linen in the washing machine in hot water for one full cycle.

So you see, I'm going to be positively radioactive!

Another important thing about chemotherapy is understanding its three-stages: Onset (7 days); Nadir (10-14 days) and Recovery (21-28 days). I especially like the word "Nadir". It sounds like an exotic location don't you think. "I'm sorry. Bronwyn is uncontactable right now - she is in Nadir."

What this means is that basically in every 28 days, I'll have 7 days of feeling crap, a period when my immunity will be at such a low point that even my dog will have to be sent away; and then recovery when hopefully, I'll be able to kick up my heels and whistle dixie.

That's the theory anyway.

Meanwhile, my friend Tim asks a good question: why, if I am node negative and the cancer has been cut from my breast do I need all of this, chemo, maybe radiation, ongoing drug therapy?

I find an article a 2001 Journal article that explains: "Despite apparent curative surgery in the treatment of breast cancer, 21% of node negative patients still develop lump node and distant metatastatic disease at 18 years. It is likely that this group has occult micrometastatic disease at the time of initial surgery and that they are unidentified. Recent studies have established that current routine histological assessment of regional lymph nodes underestimates breast cancer metastasis."

I guess what this really means is that cancer progresses at a microscopic level, through lymph nodes and tiny blood vessels. Locating it is as difficult as finding, say, a single quotable quote in any season of 'The Kardashians.'

I supposed that chemo is the only way to ensure these rogue little bastards can be destroyed.

So now, after my feast of hoppers, as I prepare for bed tonight and hope for a good sleep, I have to admit that, dire as the side effects are, I NEED chemo and I hope like hell it all goes well tomorrow.

For now, what can I do other than be impressed and amazed at the scientists who worked out that toxin can be therapy, that poison can be cure?

There's a certain genius behind it all.

I'm relying on that.