Thursday, January 06, 2005

In the Infusion Room

Greg F. sent me a Year's Best American Poetry (1995) with a poem in it called "In the Infusion Room". It's a nice poem, and after I read it, it occured to me that people often ask me, 'What is it like?'

So this post is going to be full of graphic discussions of IV needles and the business of saline drips and if any of that bothers you, you so don't want to read it. But if, like me, you have a morbid interest in that kind of thing, I'll tell you what it is like in the infusion room.

I get my chemo at a branch office of The Cleveland Clinic. The Cleveland Clinic in downtown Cleveland is a twenty block long sprawling complex of buildings, and it has satellite buildings in the surrounding suburbs. I don't go to a hospital for my treatments, I go to a complex with an out patient surgical facility, labs, CAT scan, oncology unit, doctor's offices, gift shop, cafe and God knows what else. I take the elevator to the third floor, the top floor, where a rather bland, run down office-looking hallway leads to a set of glass doors and a very pleasant, rather large waiting room. I check in at the desk and sit down in the nearly empty waiting room. There's seating for fifty, but I've never seen more than six or seven people there.

The nurse calls my name and I head back to the doctor's examing room and I get asked a series of routine questions. Then another nurse comes in, often Jeanette, the first oncology nurse I ever met, and plunks down a pillow, and asks me if I have a preference in veins. It's odd how important the nurses are. I heard someone say one time that doctors keep you alive, but nurses make you well. Jeanette has been an oncology nurse for over twenty years and she has that nurse-unflappability that is so reassuring. I don't have a preference in veins. I figure the person who is going to be sticking the big-ass IV needle in me should probably decide what they think is the best vein. Nurses have different preferences. I often end up with the classic, crook of the arm vein, but I've had them in the side of my hand and in mid forearm, too. The good thing about the nurses (and the lab people) at Cleveland Clinic is that they've had a lot of practice sticking big-ass IV needles in veins and they tend to do a good job of it. I'm not squeamish about needles. I am blessed with the ability to tolerate getting stuck. Some people aren't. Some people have a port installed in their chest that remains there for the months they are getting chemo. It's about the size of a bottle cap, and since I tend to sleep on my stomach, I think it would be a royal pain.

So I get stuck, and then the oncology nurse draws two vials of blood and those are sent to the lab for CBC or Complete Blood Count. For me the important number has been the White Blood Count. Normal for an adult is 4.5 to 11.0 and the last two times my count has been 1.4. 1.5 is sort of the minimum. It take about twenty minutes to get a count, and during that time, the doctor usually shows up and asks me a series of questions. Shortness of breath? Nausea? Chest pains? And then I ask him a series of questions. What do I do when my arms hurt? Then the oncology nurse reports the count to him and the discussion ensues as to whether we're going to do chemo considering my blood count, and then we do chemo.

The Oncology Unit is in two wings, one side a regular doctor's office, and the other side a huge, more clincial looking, slightly chilly room with a nurse's station in the middle of it. There are rooms rather like examing rooms around three sides of the big room, and on the fourth side are rooms without a fourth wall. Those are my favorite rooms, because the chairs all face huge windows that look out on Cedar Avenue and the parking lot. They tend to fill up first. I get my chemo later in the day so Bob can pick me up after work, so I tend to get one of the little side rooms, the ones like an examining room. I am shown to my room, carrying book and pillow and being a little gingerly about the big-ass IV needle still stuck in me. Instead of an examining table, they have chairs in them. They look a little like lounge chairs, if lounge chairs had been designed by the people who do dentist chairs. When I walk in, I'm two weeks from my last chemo and feeling pretty good.

There's one room where there are two chairs, but everybody else is pretty isolated. A lot of people have someone sitting with them while they get their chemo, a spouse or a daughter. Lots of the people are women wearing scarves or turbans.

I get my chair and then a soft drink and sometimes a blanket. The oncology nurse hooks me up to an IV stand with a pump mounted on it. She gives me an ativan. She hangs a bag of saline and clips it into my IV line and then uses a syringe to check to see that when she draws back, she gets a return. A blood return means that when she draws saline back, a little blood comes up the transparent IV line. This shows that the IV needle is still seated right. Then she starts the pump/monitor and leaves. The pump regulates how fast I get the saline. The saline is just to flush. Flush what, I'm not quite sure. When she comes back she hangs a bag of Decadron, a steroid. It's an anti-nausea drug that lasts for about four days. You'd think that if I was mainlining serious steroids I'd notice something but it doesn't make me feel any different from the saline. She goes away and the IV pump/monitor marks the time and dosage. I read. Since I am usually reading for my book group, I tend to be reading rather intense and unhappy books. I'm thinking that I should probably start selecting lighter reading material.

After the twenty or thirty minutes of Decadron, she comes back, checks the return, and hangs vinblastine, the first chemo drug. Fortunately, it has just about as much immediate affect on me as the saline. I read some more.

The nurse comes back and asks me if I'd like lemon ice or a popsicle. She's going to give me bleomycin and adriamycin by push and both drugs are known to cause mouth sores. Sucking on ice reduces the mouth sores because it reduces the circulation in your mouth so not as much of the drug gets there. These are the first drugs I actually feel different and I have delveoped a strong aversion for popsicles as a result. Thinking about popsicles as I type this makes me queasy. Next time, I'm getting ice chips. I suck on whatever frozen thing I have chosen and the oncology nurse sits down with a syringe and feeds the adriamycin into the IV by hand. It's bright, trasparent red, and when I urinate later, my urine will be peach colored. We chat and she watches like a hawk while she does the push. Then the bleomycin. It takes about ten minutes per drug.

I find myself every so faintly queasy about this time. It gets hard to concentrate, and in fact it gets a little difficult to focus while reading. My arm is cold because the drips and drugs have all been at room temperature, and although I don't have a sensation of coldness while they are going in, I do feel as if I had been wearing a coat slung over one arm and the other arm were exposed and slightly chilled. By this point I've had the needle in for hours and since it's long, it's beginning to irritate slightly.

The good news is there's only one more drug. The bad news is that its Dacarbazine. It takes about an hour. The oncology nurse gets very intense about blood return at this point since if dacarbazine doesn't go in a vein it hurts like hell. She hangs the bag. She starts the pump. In a couple of minutes I feel as if my arm is mildly cramping. She comes back and checks on me and sometimes slows the drip. Last time she brought me a warm blanket and covered my arm and that seemed to make a delightful difference. I'm always in a quandry. I don't want her to slow the drip because that means it will take longer to finish. So I sit with a little bit of discomfort hoping to cut ten minutes off my time in the chair.

By this time I'm pretty much just feeling wrong. Not bad, just wrong. I've been sitting here for about three hours. I can't read, and I feel kind of punk. I lean my head back and check the time left on the IV. Then I make myself wait and lean back and check again. I wish Bob would show up early so I would have someone to talk to, although I really don't know if I want to talk. And then he does, and before too long, the IV pump/monitor chimes and I'm done. The nurse hangs some saline and I flush again for ten minutes. Then she pulls the IV.

I stand up and my legs are weird. I'm not dizzy, but I'm on the outskirts of it. I can't quite seem to do fine visual focus. The oncology nurse hands me a printout confirming the date and time of my next appointment. Already I know that tonight I'll be zombied. Tomorrow I'll feel good, and the day after that as well. The steroids make my cheeks pink for a few days. Then I'll have a bit of a problem with sore mouth. Not much, then seven days of mild arm and shoulder aches. Then two really good days and then back in the chair.

Some people get anticipatory nausea. They start throwing up the day before chemo. I don't throw up at all. It's not horrible. It's just...chemo.

Bob mentions food and I'm not at all sure about the idea, but since I have usually eaten next to nothing this day, we stop and I get soup. Which helps. And then home and to bed.

That is what it is like for me in the infusion room.


Blogger Madeleine Robins said...

Wow. Thanks for posting that, Maureen. It is both wonderful and terrible. I am not one of those who gets queasy about needles (I give blood regularly, which makes everyone else in the family sick to contemplate) and I have a ghoulish weakness for hospital dramas; I'm the one asking questions at the doctor's and dentists. So this sort of information is rivetting to me.

Oddly, the line that I resonated to was: "By this time I'm pretty much just feeling wrong." Some years ago I was diagnosed with a fainting disorder, for which the diagnostic procedure was a "tilt table test." They run an IV into each arm, strap you, like the Bride of Frankenstein, onto a table and then run, first one chemical and then another into your arm to see if they can make you faint (if you faint you fail the test and thus have vaso-vagal syncope, huzzah). The first substance they fed into me slows your heart rate down. And you don't feel sick. You're not in pain. You just feel wrong. Really wrong. In a way I have never experienced anytime else. Like you with the Dacarbazine.

How many chemo sessions do you have ahead of you?

January 07, 2005 12:49 AM  
Blogger Maureen McHugh said...

Mad, I've had three chemo sessions. After five more I'll be evaluated (80% of all Hodgkins cases have no sign of tumor after eight sessions.) Then I might have four more, depending on the evaluation.

The lumps in my neck have definitely gone down, but I can still feel them. Eventually I won't know if there are lumps there or just scar tissue.

Did you pass the fainting test?

January 07, 2005 9:18 AM  
Blogger Madeleine Robins said...

I flunked it. The first substance (which I recall was adenosine--I remember asking the doctor if this was one of the four building blocks of DNA) goes in for only a moment and metabolizes very quickly. If that doesn't make you faint, they run something else in the other arm that speeds up the heart rate. If you can endure that for 25 minutes you pass the test. Passing the test means you don't have vaso-vagal syncope, and they have to keep looking for some other source of the problem. Since vaso-vagal syncope simply means that, under certain circumstances, you faint, it's a pretty benign diagnosis.

I fainted 22 minutes into the second part of the test, thereby flunking and walking out with a diagnosis in my pocket and a song in my heart. And now, if I feel dizzy, I know enough to get down low...

January 07, 2005 11:49 AM  
Blogger Ted said...

The first substance (which I recall was adenosine--I remember asking the doctor if this was one of the four building blocks of DNA) goes in for only a moment and metabolizes very quickly.My sister, who's a doctor, was telling me an anecdote about one of her patients that involved adenosine. A young (thirties) woman came in with tachycardia. My sister clocked her heart rate at 240 beats a minute. Had the woman been older, this would have been an EMERGENCY, but even in a young person it's rather alarming. My sister had the staff hook her up to a heart monitor and get some adenosine, which they did without hurrying, since the woman was young and did not appear to be in distress. When the number 240 came up on the monitor, they hurried a bit more.

First my sister administered 6 mg of adenosine, and watched the monitor closely. Adenosine works quickly and is metabolized quickly, so you'll either see an effect right away or not at all. Nothing happened. So my sister administered 12 mg. The woman said, "Oh, I can feel something happening..."

And then, her heart rate dropped to 120, and everyone breathed a sigh of relief. They still had work to do to bring her heart rate back to normal, but 120 is MUCH better than 240.

January 07, 2005 3:33 PM  
Blogger Responsible Artist said...

The Infusion Room sounds dreadful and necessary. And oddly primitive. There's some metaphor in how we treat cancer by throwing things at it that are stronger than it is and trying to make it go away.

It sounds like there's some confort in knowing how many times you're likely to go through treatment, and much comfort in knowing that the odds are in your favor.

As always, the writing is pretty damn good.


January 07, 2005 4:53 PM  
Blogger Madeleine Robins said...

240 beats per minute...yikes!

My normal heartrate is about 60. If it was four times that, I think my head would explode.

January 07, 2005 9:59 PM  
Blogger Maureen McHugh said...

I get this image of people in the office working without hurry--sort of like the bomb squad being careful not to jiggle anything.

January 08, 2005 9:05 AM  
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^^ nice blog!! ^@^

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Anonymous tips malam pertama said...

i scared to death when it come to needle... :-(

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