Radiation Therapy: The Routine

From Sunday to Thursday, I leave work around 2.45 and drive to Rambam. As my appointment is after 3.00, I can park for free in the employee’s parking lot - the guards at the gate now recognise me and don’t bother asking for the letter confirming the appointment. I no longer lose my way to the Oncology department and my card with its magnetic strip is ready at hand to pass under the scanner when I arrive.

I then round the corner and take a seat in the waiting area and wait, freezing from the excessive air-conditioning. There seems to be a regular turnover of patients waiting for treatment but some have become familiar faces: the Russian guy with the baseball cap, whose treatment now seems to precede mine; the young and always animated Asian boy, whose brightly colored head covering would indicate that he’s undergone chemo; the youngish Arab woman with a passing resemblance to Sandra Bullock; the woman whose baby doll, blond and curly hairstyle appears incongruent with her heavily-lined and overly made-up face, perhaps yet another victim of hair fallout from chemotherapy.

When my name is called, I am buzzed through one of the double doors and I make my way to the technicians’ station, where I hand over my magnetic card. I go into one of the changing rooms, remove my top and bra, take a dusty-pink robe that matches the dusty-pink doors - probably coincidentally - and then lock the door behind me. By this time, the technicians have swiped my card to display my details on the PC screen. The details include the photo that was so mysteriously taken of me when I underwent radiation planning.

The radiation room is usually dark when I emerge from the changing room, indicating that the previous patient has not yet completed treatment. When he or she appears, we sometimes exchange smiles of camaraderie. Lately, this has been Dmitri, the guy with the baseball cap, who does not acknowledge the camaraderie of a shared experience.

By the time I enter the room, the table has been adjusted to accommodate my specifics. The reclining head/arm rest is put in position and the bar where my bottom comes to rest is placed at 8. If I were shorter or taller, the bar would be adjusted accordingly. All this is done to ensure that I lie in exactly the same position at every treatment. A paper sheet is placed on the table and I climb on to it and raise my arms above my head until they’re resting more or less comfortably in the arm rests. A technician dabs my breast with a black marker, and begins to raise the table. Music plays in the background.

The machine, which I now know is called an accelerator, begins to whir. The gantry, or arm which supports the disc-shaped plate through which the radiation is beamed, cranks and groans into position on the right side of my body. I stare up at the red interlocking lines on the ceiling which are mirrored precisely across my breasts. There are a few more whirs and a few whizzes, and then the radiation spurts, during which time I remain very, very still to avoid the beam hitting vulnerable parts of my body. Inevitably, I'm conscious of an overwhelming need to scratch my nose, but I don't dare and the feeling passes. The radiation burst is anything between 20 to 26 seconds. The gantry then cranks and groans its way over to my left side, whizzes for a few seconds, then there’s another burst of radiation lasting from 19 to 22 seconds. When it’s over, I don’t move, never quite sure if it’s safe to do so, until the technician comes back into the room to lower the table and release me.

During the 13 treatments, I think I’ve been attended to by the full complement of eight or more oncological radiation technicians, who mix and match their partnerships on any one day. That is, one day, the young, blonde girl might be teamed with with older, thickset man, who is teamed the next day with the technician with wild red hair and heavy bright blue eye makeup. They are generally pleasant, more often than not ready to answer my questions, though some express surprise at my interest. Sometimes I get the feeling that they’ve been primed to indulge the nosy British woman, to just answer her questions and maybe she’ll shut up.

Each patient is assigned what is called a radiation dose rate, which accounts for the variation in seconds in each treatment. The dose rate is measured in units of 100 to comprise a minute - the dose remains constant but might be delivered at different speeds due to concurrent activity on the network. Radiation delivery seems to function pretty much in the same way that information is delivered over internet networks. The monitor above me registers the number of time units it took to deliver my dose and it usually hovers around 55 / 46.

The dabs of black marker are made by technicians whose eyesight is challenged to find the marks that were tatooed on my body during the simulation and planning sessions. The beams are directed to optimally miss my heart and as much of my lung as possible. Apparently, it’s impossible to avoid the lung completely and the beam encroaches about a centimeter into it. However, I was told that up to two and half centimeters is permitted without any threat of undue damage.

After a few treatments, radiation of my left side was interrupted by the taking of an X-Ray to check that my coordinates, defined during the simulation and planning sessions, were correct. Apparently, they were, and I’m grateful that my anxiety that the beam is not always as precise as it should be were allayed.

Basically, radiation treatment can be compared to being micro-waved whereby the nuking begins in the center and spreads outward. After 13 treatments, my breast has assumed a rosy hue. I’ve been told to expect that it will redden and swell, burn and blister like any lump of meat placed in a micro-wave oven, but so far, apart from its rosiness, I don’t see much difference between the two breasts. I apply a cooling cream both morning and evening in the hope that doing so will preclude - or at least retard - burning. As for the swelling, do I buy a bra with larger cups and stuff the non-radiated side with cotton wool? Reminds me too much of puberty!

I retrieve my card, smile at the next patient on the reverse path to the treatment room, dressed like me in the dusky pink gown. I get dressed, and, no longer mistaking the storeroom door for the exit, leave. The whole process, from the time I first swipe my card to announce my arrival to the time I reach the parking lot, takes about half an hour. The rest of the day is mine.

August 11, 2007: My Father’s Death (July 25, 07)

It’s almost a month since I last blogged and I have now had 12 radiation treatments. The first one was on July 22 and since then, the formalities, the procedure itself, and all other aspects of this treatment have become a way of life.

En route to the hospital on July 25, the day of my fourth treatment, I received a phone call from my nephew Jonathan to say that my father had been taken to hospital and that his death appeared to be imminent. As I was at the beginning stage of my treatment, Dr. Sarid agreed that I could travel to England for the funeral.

My relationship with my father was complex and the effect of his death has increased the turmoil that cancer introduced into my life. However, this blog is not the place to examine the implications of his death on my life other than to say that with the passing of my father, I am the sole survivor of the family I grew up in, the one that provided security for me as a child. This fact adds to my general sense of precariousness now that I too, like my siblings, am a victim of cancer.