46 E-mail: the last round of radiation

9/17/06

Today is Sunday. Friday (two days ago) was my last radiation treatment. You would think that I would have been happy to go and get it over with, but it was an emotional day and joy over getting through the last treatment was only part of it.

RADIATION

The morning of my final dose of radiation I ate frozen waffles and ice cream for breakfast. I had the song lyrics, “It’s my party and I’ll cry if I want to,” running through my head as I drove to the cancer center.

I brought my camera for the last treatment. It’s something I did not do when I had chemo because I did not want to make other patients in the infusion room nervous or upset. Radiation is a more private event and I wanted a memento of the last cancer treatment I’m scheduled to receive.

I figured out earlier in my treatment that other patients got confetti thrown on them after their final zap. This educated guess was confirmed earlier in the week when a woman who got treatments before I did told the receptionist on her way out that it was her last treatment and she got the confetti and everything.

I was called back to change my clothes and suddenly realized that I’d left my camera in the car. My radiation oncologist’s nurse told me it was okay to fetch the camera so that’s what I did. I came back in time to wait several minutes for someone else to finish dressing.

When it was my turn I changed into the hospital johnny, picking one of the less faded ones because it looked prettier. On the way into the radiation room one of the technicians asked if I was glad that this was my last treatment.

“No,” I told her honestly. “I’ve been dreading this treatment just as much as the others, but I’m glad I won’t have to come back for more.” That response surprised her.

My skin didn’t hurt over the last week. It healed from the painful moments of the week before and the boost didn’t cause new problems. So I should have been in better spirits because I haven’t suffered much from fatigue and the skin reaction is under control. Still, I’m sick of treatments of any kind and I’m more than ready to get back to a normal life. Last week was hard to keep myself showing up for radiation morning after morning. It’s like that final week in your old job when you’ve given two weeks’ notice. Are you really glad to show up for your last day of work at the old place of employment? If you’re like me you’d rather stay home and rest.

Back to radiation… We went through the usual routine of positioning my body on the table to line up the marks on my abdomen with the laser beams in the room. They set the table at the right elevation according to notes in my chart. The gantry with its smaller field of radiation blasted me from one side and then the other, the left side with its usual high pitch and the right side with the lower pitch that started with the boost.

I waited on the table for my treatments to finish and noticed that the radio was too low to hear the music. Typically there were commercials playing during my treatments. The week before I was finally getting to hear music, probably because my treatments were consistently late last week instead of early or on time. Friday I couldn’t hear the music, so I thought about what I’ve been through this year and all the changes I’ve endured thanks to cancer. My eyes teared up and I almost cried. But then a technician came into the room and I held back.

I got to bring my arm down from the cushioned grip over my head for the last time. I got to put my arm back into the sleeve for the last time. One of the technicians brought my camera into the room and I turned it on and showed her which button to push. She knew I wanted a picture in front of the gantry, so she started to take my picture when I asked, “What about the confetti?”

“You’re not supposed to know about that!” she said, surprised. I figured it out weeks ago, but didn’t bother to explain. So the other two technicians came into the room then. I forget that they have the sound turned on in the booth so anything said by someone in the room can be heard in front of the room in case someone needs help.

The three of them dipped their hands into a metal pail I had never noticed before and readied themselves to throw the confetti. One of the counted to three and I found myself bouncing back and forth on my toes like an excited child. On the count of three they tossed the confetti into the air and it floated silently down like snow. It got in my hair and on my face and clothes and I smiled, touched by happiness at last.

Two pictures were taken of me then, one in focus and one not. Both are next to the gantry I won't have to see anymore. On the way out I noticed the mirror and took another picture of myself.




















Then I waited to see the doctor. The radiation oncologist always meets with folks after their final treatments.

MEETING WITH THE RADIATION ONCOLOGIST

The meeting with the radiation oncologist was all sweet and not bitter. He congratulated me on getting through my treatments and asked if I had any last questions. I did.

Why did my rounds of the boost involve the gantry turning left and right like my regular treatments? I thought it was going to come straight at me where the tumor had been. And why did it have two different pitches of sound when the radiation was in use? I knew from asking the technicians questions earlier in the week that the different sounds meant different energy levels, but why was that necessary?

He shifted his hands which were holding my chart. He withdrew a small plaque and handed it to me. The plaque has a quote from John Wayne and I would see a larger version of this every day as I left the radiation lab. The plaque says, “Courage is being scared to death but saddling up anyway.” Boy, isn’t that the truth?

My doctor then said something like, “We know you put on a good face but you have to suck it up every day you come here.” Oh! I guess the people who see the patients all day long, day after day pick up on a few commonalities such as feeling less than thrilled to be there. My obstetrician must be so upbeat because she gets to spend parts of her days with pregnant patients who are looking forward to meeting their babies.

This ritual of the John Wayne plaque was a complete surprise to me. It felt good. My eyes once again teared up but I didn’t cry.

Then my doctor answered my questions. He turned to pictures in my chart to help him explain things.

The picture was an image of my breast overlaid with colored lines to show fields of energy and numbers next to the lines. The lines weren’t straight lines. They followed the contour of my body and they formed amoeba-shaped circles in the breast tissue.

He explained that the depth of my tumor site was 5 cm below the skin. The energy it would take to send radiation that deep into my body would send it too deep. He showed me a mark in the graph that invaded a significant portion of the white space below the breast. He explained that the radiation would have hurt my lung (the white space) if they had done the boost with the gantry shooting energy straight at me. That’s why the boost had the gantry going side to side just like the regular treatments.

Then he showed me a different picture of my breast with energy markings overlaid in color. I think the breast pictures (which were in black and white) were either x-rays or CT scan images.

With the second picture he explained that the lower energy travels farther. It was necessary to send lower energy at my breast (with the lower sound) because it penetrated the tissue further. The distance it needed to travel was 10 cm to reach the tumor site on one side. The distance needed was less from the other side which is why the faster energy was used there.

He also explained something I didn’t completely follow about one type of energy affecting the skin more than the other. Thought went into giving me as few treatments as possible of the energy that damages the skin more.

I appreciated the technology that allowed him to plan my radiation treatments with such careful attention to detail. I also appreciated how my doctor took the human side of treatment into consideration.

I asked if the pictures represented actual or projected treatment results. He told me they were accurate within one percent. Oh wow!

And with that, my visit was over. I’ll return for a checkup in three weeks.

I went into the dressing room, applied the lotion my friend Tara got for me, changed back into my work clothes, and left the cancer center. As usual I saw the John Wayne quote on my way out. I hugged my new plaque to me and smiled. "Courage is being scared to death but saddling up anyway." Damn straight.

Then I got into my car and cried.

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